What You’ll Learn

1. What You’ll Learn 1. Explain reasons why drug use is risky. 2. List risk factors and protective factors for drug use. 3. Discuss drug dependence, including physical and psychological dependence. 4. Outline the five stages of drug use that can progress to drug dependence.

2. What You’ll Learn 5. Discuss roles played by family members who are codependent: chief enabler, family hero, scapegoat, mascot, and lost child.

3. Key Terms • codependent • enabler • risk factor • protective factor • instant gratification • mentor • physical dependence • tolerance • withdrawal symptoms • psychological dependence

4. Why Drug Use is Risky • A risk factor is something that increases the likelihood of a negative outcome. • A protective factor is something that increases the likelihood of a positive outcome. • Drug dependence, or chemical dependence, is the continued use of a drug even though it harms the body, mind, and relationships.

5. What to Know About the Risksof Drug Use • Both legal and illegal drugs can be detrimental to health. • There are many risks involved in using drugs, such as alcohol, marijuana, narcotics, and amphetamines. • Even experimenting with a drug “just once” can cause serious consequences, even death.

6. What to Know About the Risksof Drug Use The Risks of Drug Use Description Using Drugs Can: lead to drug dependence and overdose A drug overdose can cause serious injury or death. An overdose can happen the first time or the fiftieth time a person takes a drug. Using drugs may stimulate the pleasure center of the brain, which is why people repeatedly use drugs.

7. What to Know About the Risksof Drug Use The Risks of Drug Use Description Using Drugs Can: cause accidents and lead to violence and illegal behavior Drugs slow reaction time, impair coordination, and affect judgment. Most homicides, suicides, and episodes of abuse occur when people are using drugs. Many deaths caused by motor vehicle accidents involve a person under the influence of alcohol.

8. What to Know About the Risksof Drug Use The Risks of Drug Use Description Using Drugs Can: increase the risk of HIV infection, sexually transmitted diseases (STDs), and unplanned pregnancy Drugs affect people’s ability to make responsible decisions. Teens who have been sexually active often were under the influence of drugs. This increases the likelihood of unplanned pregnancy and of contracting HIV or another STD.

9. What to Know About the Risksof Drug Use The Risks of Drug Use Description Using Drugs Can: prevent people from developing social skills and harm relationships People under the influence of drugs may say and do things that they later regret. Shy people may use drugs to relax, which prevents them from improving social skills.

10. Risk Factors • Research has identified risk factors that increase a teen’s risk of drug misuse and abuse. • Risk factors refer only to the statistical likelihood that you might use harmful drugs. • Having certain risk factors for drug use does not mean you have an excuse to use harmful drugs. You have control.

11. Thirteen Risk Factors for Drug Use 1. Lacking self-respect  Teens who lack self-respect believe they are unworthy of love and respect. They are at risk because they believe drugs will numb the negative feelings they have about themselves. They may not have enough confidence to say “no” to negative peer pressure.

12. Thirteen Risk Factors for Drug Use 2. Being unable to express emotions in healthful ways  Teens who have difficulty expressing emotions are more likely than other teens to use harmful drugs. Teens who cannot cope with stress, anger, and depression may think that drugs will help numb these feelings. They may use drugs instead of expressing feelings openly and honestly.

13. Thirteen Risk Factors for Drug Use 3. Having friends who use drugs  One of the strongest risk factors for drug use is having friends who use drugs. They may pressure you to use drugs with them or want you to support their unsafe and illegal habits. They may continue to pressure you when you say “no.”

14. Thirteen Risk Factors for Drug Use 4. Being unable to delay gratification • Delayed gratification is voluntarily postponing an immediate reward in order to complete a task before enjoying a reward. • Instant gratification is choosing an immediate reward regardless of potential harmful effects. • Drug use is a form of instant gratification.

15. Thirteen Risk Factors for Drug Use 5. Having access to drugs  The temptation to use drugs is greater when drugs are easily available. Having access to drugs includes living in a neighborhood where drugs are sold, going to a school where people sell drugs, and knowing people who sell drugs. 6. Being rejected by peers  Teens who feel rejected by peers may use drugs to try to numb feelings of loneliness or to fit in. They are friends with any teen who can supply them with drugs or will use drugs with them.

16. Thirteen Risk Factors for Drug Use 7. Having a biological family member(s) who is drug dependent • A genetic predisposition is the inheritance of genes that increase the likelihood of developing a condition, such as addiction. • Children born to parents who are addicted to drugs or alcohol are more likely to become addicted than are children born to parents without addictions.

17. Thirteen Risk Factors for Drug Use 8. Having difficult family relationships  Teens who live in families that do not have good communication and conflict-resolution skills often have difficult family relationships. These teens have an increased risk of drug use. Difficult family relationships often create a stressful atmosphere. These teens may turn to drugs to cope with stress and numb their feelings.

18. Thirteen Risk Factors for Drug Use 9. Having role models who use drugs  A role model may be someone a teen knows, such as a friend or family member or a celebrity, such as a sports star or entertainer. Teens who admire role models who use drugs may use drugs to be like their role models. 10. Using drugs early in life  The use of drugs during early childhood and adolescence is a risk factor for harmful drug use. Teens who begin drug use at an early age are more likely to become drug dependent when they are adults.

19. Thirteen Risk Factors for Drug Use 11. Doing poorly in school and/or having a learning disability  Teens who get poor grades in school are more at risk for drug use than are their peers who have better grades. Teens who have learning disabilities are at special risk. They may become frustrated and feel inadequate if they compare themselves to peers who do not have learning disabilities. They may use drugs to numb these feelings.

20. Thirteen Risk Factors for Drug Use 12. Being uninvolved in school activities and athletics  Teens who do not participate in school activities or athletics are more likely to use harmful drugs. They are more likely to be bored and to have more free time. 13. Lacking respect for authority and lawsTeens who lack respect for authority and laws are more at risk for drug use. They disregard the guidelines of parents or guardians and other responsible adults. They disregard community laws and might not care that using drugs is against the law.

21. Risk Factors for Drug Use Warning Signs Recognize these warning signs of drug use in peers: • slurred speech • red eyes and frequent use of eyedrops • glassy eyes and a blank stare • sloppy appearance • frequent use of breath fresheners •long-term runny nose and sniffing • giving up friends who do not use drugs • joining a gang • skipping school • doing poorly in school

22. Risk Factors for Drug Use Warning Signs Recognize these warning signs of drug use in peers: • missing money or objects of value •lacking energy and motivation • friends who use drugs • changing eating habits • having mood swings and hostility

24. Protective Factors • The more protective factors you practice, the less risk there is that you will abuse drugs. • Lacking protective factors does not give you an excuse to use drugs. You have control over whether or not you use harmful drugs.

25. Thirteen Protective Factors That Reduce the Risk of Drug Use 1. Having self-respect  Teens who have self-respect feel confident about themselves. They know that using drugs harms health. Teens who have self-respect make responsible decisions. They are less likely to give in to negative peer pressure than are other teens. 2. Practicing resistance skills  Teens who practice resistance skills do not give in to pressure to use drugs. They are able to say “no.” They stand up to peers who want them to use drugs.

26. Thirteen Protective Factors That Reduce the Risk of Drug Use 3. Having friends who do not misuse and abuse drugs  Teens who have friends who are drug free have less temptation than other teens to experiment with drugs. Drug-free friends do not pressure you to use drugs. 4. Being able to delay gratification  When you are able to delay gratification, you use self-control. You know that using drugs, in an attempt to “feel good now,” will have negative consequences later.

27. Thirteen Protective Factors That Reduce the Risk of Drug Use 5. Being resilient, even when living in an adverse environmentAn adverse environment is an environment that interferes with a person’s growth, development, and success. You can be resilient if you live in an adverse environment and recognize that you can control your own behavior and decisions.

28. Thirteen Protective Factors That Reduce the Risk of Drug Use 6. Having social skills  Using social skills reduces the risk of harmful drug use. Teens who lack social skills often have difficulty relating to others and might feel rejected by peers. 7. Having a set of goals and plans to reach these goals  Teens who have goals are more likely to evaluate the consequences of their actions. They recognize that using drugs now might affect their entire future.

29. Thirteen Protective Factors That Reduce the Risk of Drug Use 8. Having healthful family relationships • Teens who are close to family members are less likely than other teens are to use harmful drugs. A teen who does not have a supportive adult family member can find a mentor. • A mentor is a responsible person who guides another person.

30. Thirteen Protective Factors That Reduce the Risk of Drug Use 9. Having a positive role model  Teens often choose to copy the behavior of their role models. Having a role model who does not use drugs shows teens they can be successful and worthy of admiration without using drugs. 10. Having good stress-management skillsTeens who are able to manage stress in healthful ways do not use drugs to cope with stress. They recognize that using drugs can cause more stress.

31. Thirteen Protective Factors That Reduce the Risk of Drug Use 11. Having anger-management skills  Teens who are able to manage anger in healthful ways do not use drugs to cope with anger. They recognize that drugs may make them violent and cause them to lose control. 12. Being involved in school activities and athletics  Teens who are involved in school activities and play on athletic teams are less likely than other teens are to use harmful drugs.

32. Thirteen Protective Factors That Reduce the Risk of Drug Use 13. Having respect for authority and lawsTeens who have respect for authority and laws are less likely to use harmful drugs. They follow guidelines of parents or guardians and other responsible adults. They respect the laws of the community and know that drug use is against the law.

33. Drug Dependence • When a person is dependent on someone or something, that person has a need. • Some people might become dependent because they believe they need a drug. • Other people might need a drug because their body has a strong craving for it.

34. What to Know About Drug Dependence • Physical dependence  • Physical dependence is a condition in which a person develops tolerance to a drug, the drug becomes necessary for the person to function, or the person has withdrawal symptoms. • Tolerance is a condition in which a person becomes used to a substance. • People with a high tolerance to a drug need a greater amount of the drug to produce the same effect as people with a low tolerance.

35. What to Know About Drug Dependence • Withdrawal symptoms • Withdrawal symptoms are unpleasant reactions that occur when a person who is physically dependent on a drug no longer takes the drug. • People who are physically dependent on a drug must continue taking the drug in order to avoid withdrawal symptoms. • With many groups of drugs, withdrawal symptoms can be severe, but not necessarily life-threatening.

36. What to Know About Drug Dependence • Psychological dependence • Psychological dependence is a very strong desire to continue using a drug for emotional reasons. • People with psychological dependence may or may not be physically dependent. • Psychological dependence can become so severe that people become obsessed with the drug and may center their lives around buying and taking it.

37. What to Know About Drug Dependence Symptoms of Drug Dependence According to the Diagnostic and Statistical Manual of Mental Disorders, people are drug dependent if they have had three or more of the following symptoms in the past year: • experiencing withdrawal symptoms when stopping the use of a drug • taking large amounts of a drug or taking a drug for a long period of time •trying to quit taking a drug with no success • spending a lot of time obtaining a drug, using a drug, or recovering from the effects of drug use

38. What to Know About Drug Dependence Symptoms of Drug Dependence According to the Diagnostic and Statistical Manual of Mental Disorders, people are drug dependent if they have had three or more of the following symptoms in the past year: • giving up important activities, such as work or school, because of drug use •continuing to use a drug even though it is causing problems, such as physical illness and injury • developing tolerance to a drug

39. What to Know About Drug Dependence The Risks of Drug Use Examples Stages of Progression STAGE 1: Experimentation “I’ll just try it.” A person is tempted to experiment with a drug. He or she tries the drug. A teen is with friends. The friends are drinking beer. They are having fun. The teen does not want to feel left out. He or she decides to drink just this once to see what it is like.

40. What to Know About Drug Dependence The Risks of Drug Use Examples Stages of Progression STAGE 2: Desired effect “I like the feeling.” A person enjoys the feeling he or she gets from trying the drug. He or she continues to use the drug. The teen drinks the beer. He or she feels “cool” and relaxed. The friends comment on how great it is that he or she is drinking with them. The teen feels like he or she fits in. The next time the teen is with these friends, he or she drinks.

41. What to Know About Drug Dependence The Risks of Drug Use Examples Stages of Progression STAGE 3: Tolerance “I need more of the drug to feel good.” A person develops a tolerance to the drug and may suffer withdrawal symptoms when he or she stops using the drug. The drug may no longer have the same pleasurable effects. The teen has been drinking with friends several times. He or she needs several beers to feel any effect and is able to drink large amounts at one time. He or she is proud of winning drinking games. The teen has a headache, throws up, and has body tremors the morning after drinking.

42. What to Know About Drug Dependence The Risks of Drug Use Examples Stages of Progression STAGE 4: Denial “I don’t have a drug problem.” A person is in denial. He or she does not admit that drug use is causing problems. The person claims that he or she can stop using the drug at any time. The teen does not think the drinking is a big deal since his or her friends drink. The teen misses classes due to hangovers, gets into fights with friends, and forgets what he or she said and did. The teen gets into trouble because he or she breaks curfew or steals beer from his or her parents or guardian.

43. What to Know About Drug Dependence The Risks of Drug Use Examples Stages of Progression STAGE 5: Drug dependence “I have to have the drug.” A person has become drug dependent. The teen drinks at every social event. He or she drinks a lot of beer at one time. The teen brings his or her own alcohol to events and sneaks drinks. The teen decides to quit drinking, but cannot stick with the decision.

44. What to Know About Drug Dependence Why do you think that many people don’t believe that they could become addicted to drugs?

45. Drugs and Codependence • Codependence is a relationship in which another individual, perhaps the drug user's spouse or family member, is controlled by the drug user's addictive behavior. • A codependent is a person who wants to rescue and control a person with addictive behavior.

46. Drugs and Codependence • A family member or close friend of people who are drug dependent may be codependent. • People who are codependent usually respond to drug-dependent people by playing one of the following roles.

47. How Family Members With Codependence Respond • Chief enabler  • The enabler is a person who supports the harmful behavior of others. • The chief enabler is the family member who tries to “smooth over” the problems caused by the drug-dependent person. • The chief enabler usually is the spouse or parent of the drug-dependent person.

48. How Family Members With Codependence Respond • Scapegoat • The scapegoat is a person who is blamed as the cause of problems in the family. • The blaming takes attention away from the drug-dependent family member. • Scapegoats are labeled as not being able to do anything right and often become rebellious and use drugs. They may have little self-respect and feel resentment and anger toward family members.

49. How Family Members With Codependence Respond • Family hero • The family hero is a family member who tries to do everything right. • Family members know they can count on this person, who is often the oldest child, to be responsible for housekeeping and childcare. • The family hero may believe that if he or she were a better child, the parent or guardian who is drug dependent would stop using drugs.

50. How Family Members With Codependence Respond • Mascot • The mascot is a family member who relieves tension by acting in a funny or entertaining way. • This person makes the family laugh and feel good. • A mascot sometimes has a hard time growing out of this role and acting like an adult. The mascot often feels lonely, insecure, and inadequate.