Alcohol, Tobacco, and Drug Use and Abuse

Transcription

1 Alcohol, Tobacco, and Drg Use and Abse Chapters 9 and 10 Copyright 2015 McGraw-Hill Edcation. All rights reserved. No reprodction or distribtion withot the prior written consent of McGraw-Hill Edcation. 1

2 Who Drinks? Patterns of Alcohol Use Abot 65% of American adlts drink at least occasionally 35% of the adlt U.S. poplation are abstainers Of the two-thirds who do consme alcohol, 28% are atrisk drinkers Low-risk drinkers are men who drink no more than 14 drinks per week or women who drink no more than 7 drinks per week One drink is defined by the NIAAA as 0.5 once (or 15 grams) of alcohol Copyright 2015 McGraw-Hill Edcation. All rights reserved. No reprodction or distribtion withot the prior written consent of McGraw-Hill Edcation. 2

3 One Drink Copyright 2015 McGraw-Hill Edcation. All rights reserved. No reprodction or distribtion withot the prior written consent of McGraw-Hill Edcation. 3

4 Who Drinks? Patterns of Alcohol Use Alcohol consmption is highest between 18 and 25 for Whites and between 26 and 30 for Hispanics and African Americans People are most likely to drink as adolescents and dring early adlthood Older adlts drink significantly less than yonger adlts do Women drink less than men and start drinking later in life Copyright 2015 McGraw-Hill Edcation. All rights reserved. No reprodction or distribtion withot the prior written consent of McGraw-Hill Edcation. 4

5 Why Do Some People Have Problems with Alcohol? Psychosocial factors Family history of alcoholism Family dysfnction in general Sociocltral/environmental factors Cltral attitdes Economic factors Laws Stresses Copyright 2015 McGraw-Hill Edcation. All rights reserved. No reprodction or distribtion withot the prior written consent of McGraw-Hill Edcation. 5

6 Drinking on the College Camps Binge drinking Males: five or more drinks within two hors, at least once in the previos two-week period Females: for or more drinks within two hors for women, at least once in the previos two-week period Harvard School of Pblic Health College Alcohol Stdy fond that 44% of college stdents binge drank in the previos 30 days Same stdy fond 23% were freqent binge drinkers, meaning they had binged three or more times in the previos two weeks or more than once a week on average Copyright 2015 McGraw-Hill Edcation. All rights reserved. No reprodction or distribtion withot the prior written consent of McGraw-Hill Edcation. 6

7 Drinking on the College Camps Some health experts believe the crrent definition of binge drinking is too broad and classifies a large nmber of people as binge drinkers who may not have a problem Other terms, sch as heavy drinking or high-risk drinking, may be preferable to describe the drinking crrently labeled binge drinking Binge drinking cold be reserved for a prolonged period of intoxication (two days or more) Extreme drinking sed to describe alcohol consmption beyond binge drinking 10 to 15 drinks a day for men and 8 to 12 for women Copyright 2015 McGraw-Hill Edcation. All rights reserved. No reprodction or distribtion withot the prior written consent of McGraw-Hill Edcation. 7

8 Drinking on the College Camps Binge drinking can have serios conseqences, inclding: Sicide attempts Death Injry Assalt Sexal assalt Unsafe sex Academic problems Health problems Drnk driving Vandalism Property damage Police involvement Alcohol abse and dependence Copyright 2015 McGraw-Hill Edcation. All rights reserved. No reprodction or distribtion withot the prior written consent of McGraw-Hill Edcation. 8

9 Why Do College Stdents Binge Drink? Stdents may drink for a variety of reasons Ease social inhibitions Fit in with peers Imitate role models Redce stress Soothe negative emotions Cope with academic pressre Mistaken belief of increased sexal arosal and performance Copyright 2015 McGraw-Hill Edcation. All rights reserved. No reprodction or distribtion withot the prior written consent of McGraw-Hill Edcation. 9

10 Drinking on College Campses Pre-gaming is the excessive consmption of alcohol prior to attending an event or activity in which alcohol will be served Freshmen more likely to pre-game Spring break environment made to be condcive to excessive drinking Collapse, sexal assalts, and nprotected sex are common Copyright 2015 McGraw-Hill Edcation. All rights reserved. No reprodction or distribtion withot the prior written consent of McGraw-Hill Edcation. 10

11 Addressing the Problem Strategies for addressing the problem: Screening interviews to identify high-risk stdents Enforcing college alcohol policies Pnishing stdents who violate policies or break the law Mandating treatment for sbstance-related offenses Edcating stdents to resist peer pressre Helping stdents cope with stress and time management isses Targeting prevention messages to high-risk events Copyright 2015 McGraw-Hill Edcation. All rights reserved. No reprodction or distribtion withot the prior written consent of McGraw-Hill Edcation. 11

12 Effects of Alcohol on the Body Alcohol is qickly distribted to all the cells of the body Once it reaches the brain, alcohol alters brain chemistry and nerotransmitter fnctions Alcohol is a central nervos system depressant that impairs thinking, balance, and motor fnctions As alcohol concentrations increase, more fnctions are depressed, and greater impairment occrs Copyright 2015 McGraw-Hill Edcation. All rights reserved. No reprodction or distribtion withot the prior written consent of McGraw-Hill Edcation. 12

13 The Path of Alcohol Copyright 2015 McGraw-Hill Edcation. All rights reserved. No reprodction or distribtion withot the prior written consent of McGraw-Hill Edcation. 13

14 Alcohol Absorption Factors affecting alcohol absorption: Food in the stomach Gender Age Body fat Drg interaction Cigarette smoke Mood and physical condition Alcohol concentration Carbonation Diet soda Tolerance Copyright 2015 McGraw-Hill Edcation. All rights reserved. No reprodction or distribtion withot the prior written consent of McGraw-Hill Edcation. 14

15 Alcohol Metabolism A small amont of alcohol is metabolized in the stomach; however, 90% is metabolized by the liver Between 2% and 10% is not metabolized at all bt is excreted nchanged throgh the skin, rine, or breath The liver allows conversion of alcohol to acetaldehyde by an enzyme, alcohol dehydrogenase (ADH) Copyright 2015 McGraw-Hill Edcation. All rights reserved. No reprodction or distribtion withot the prior written consent of McGraw-Hill Edcation. 15

16 Alcohol Metabolism Blood alcohol concentration (BAC): the amont of alcohol in grams in 100 milliliters of blood, expressed as a percentage 100 mgs of alcohol in 100 milliliters of blood is eqivalent to a BAC of.10% Breath analyzers are valid based pon alcohol concentrations in the breath that correspond well to levels of alcohol in the brain The amont of body water and body fat a person has inflences the BAC levels in the body Copyright 2015 McGraw-Hill Edcation. All rights reserved. No reprodction or distribtion withot the prior written consent of McGraw-Hill Edcation. 16

17 Blood Alcohol Concentration Over Time Copyright 2015 McGraw-Hill Edcation. All rights reserved. No reprodction or distribtion withot the prior written consent of McGraw-Hill Edcation. 17

18 Gender Differences in Alcohol Absorption and Metabolism Women are generally more ssceptible to the effects of alcohol and have a higher BAC than men do based on the following: Generally smaller than men Higher body fat percentage Metabolize alcohol less efficiently As a reslt, women more vlnerable to health conseqences sch as: Liver disease Heart disease Brain damage Copyright 2015 McGraw-Hill Edcation. All rights reserved. No reprodction or distribtion withot the prior written consent of McGraw-Hill Edcation. 18

19 Copyright 2015 McGraw-Hill Edcation. All rights reserved. No reprodction or distribtion withot the prior written consent of McGraw-Hill Edcation. 19

20 Effects of Alcohol on the Body Acte alcohol intoxication is a life-threatening blood alcohol concentration which can prodce collapse of vital body fnctions A blackot is a period of time dring which a drinker is conscios bt has partial or complete amnesia for events Hangovers are a reslt of a common reaction to alcohol toxicity characterized by headache, stomach pset, thirst, and fatige Copyright 2015 McGraw-Hill Edcation. All rights reserved. No reprodction or distribtion withot the prior written consent of McGraw-Hill Edcation. 20

21 Effects of Alcohol on the Body Effects of mixing alcohol and energy drinks Up to 28 percent of college stdents reportedly mix alcohol and energy drinks, despite evidence that doing so is dangeros College stdents who mix alcohol and energy drinks are three times more likely to leave a bar drnk and for times more likely to drive drnk Other dangeros trends in alcohol consmption inclde vaporized alcohol and alcohol enemas Copyright 2015 McGraw-Hill Edcation. All rights reserved. No reprodction or distribtion withot the prior written consent of McGraw-Hill Edcation. 21

22 Medical Problems Associated with Alcohol Use Fetal alcohol syndrome (FAS): set of birth defects associated with se of alcohol dring pregnancy Heart disease and stroke Alcoholic cardiomyopathy Coronary heart disease Liver disease Fatty liver: liver swells with fat globles Alcoholic hepatitis: inflammation of the liver Cirrhosis: scarring of the liver Copyright 2015 McGraw-Hill Edcation. All rights reserved. No reprodction or distribtion withot the prior written consent of McGraw-Hill Edcation. 22

23 Medical Problems Associated with Alcohol Use Alcohol is associated with several types of cancer, particlarly cancers of the head and neck, cancers of the digestive tract, and breast cancer Heavy alcohol consmption cases anatomical changes in the brain and directly damages brain cells Recent stdies sggest that alcohol abse cases dysfnction in lng cells Long-term heavy drinkers are at risk for weight loss and malntrition Drnkorexia: excessive alcohol consmption, excessive exercising, and disordered eating Copyright 2015 McGraw-Hill Edcation. All rights reserved. No reprodction or distribtion withot the prior written consent of McGraw-Hill Edcation. 23

24 Effects of Alcohol on the Body Copyright 2015 McGraw-Hill Edcation. All rights reserved. No reprodction or distribtion withot the prior written consent of McGraw-Hill Edcation. 24

25 Social Problems Associated with Alcohol Use Redction of inhibitions, which may lead to high-risk sexal activity and a lowered likelihood of practicing safe sex Violence, inclding robbery, assalt, rape, domestic violence, and homicide Risk of injry Drnk driving Alcoholism Sicide risk Copyright 2015 McGraw-Hill Edcation. All rights reserved. No reprodction or distribtion withot the prior written consent of McGraw-Hill Edcation. 25

26 Another View: Health Benefits The Dietary Gidelines for Americans notes that moderate alcohol consmption can be beneficial Anticlotting effect on the blood Enhances body s sensitivity to inslin Stress redction Diretic effect of high water content in beer Increase in HDL In yonger adlts, alcohol appears to have fewer if any health benefits and is associated with more deaths, injries, and accidents Copyright 2015 McGraw-Hill Edcation. All rights reserved. No reprodction or distribtion withot the prior written consent of McGraw-Hill Edcation. 26

27 Alcohol Misse, Abse, and Dependence Problem drinking: pattern of alcohol se that impairs the drinker s life, casing difficlties for the drinker and for others Alcohol abse: pattern of alcohol se that leads to distress or impairment, increases the risk of health and/or social problems, and contines despite awareness of effects Alcohol dependence: disorder characterized by a strong craving for alcohol, development of tolerance for alcohol, and withdrawal symptoms Alcoholism: primary chronic disease characterized by excessive, complsive drinking Copyright 2015 McGraw-Hill Edcation. All rights reserved. No reprodction or distribtion withot the prior written consent of McGraw-Hill Edcation. 27

28 Treatment Options Brief interventions Alcohol Skills Training Program; Brief Alcohol Screening and Intervention for College Stdents (BASICS); AlcoholEd Inpatient and otpatient treatment Residential facilities Detoxification and withdrawal Medications Conseling Self-help programs Spport grops (AA, Al-Anon, Alateen, Adlt Children of Alcoholics, others) Copyright 2015 McGraw-Hill Edcation. All rights reserved. No reprodction or distribtion withot the prior written consent of McGraw-Hill Edcation. 28

29 Treatment Options The harm redction approach to treatment focses on redcing the harm associated with drinking, both to the individal and to society Controlled drinking, which emphasizes moderation rather than abstinence, is an example of harm redction Pblic policies and laws aimed at harm redction Minimm drinking age laws Drnk driving laws Ankle bracelet breathalyzers Restrictions on liqor sales and otlets Taxes on alcohol Copyright 2015 McGraw-Hill Edcation. All rights reserved. No reprodction or distribtion withot the prior written consent of McGraw-Hill Edcation. 29

30 Developing a Behavior Change Plan Following a behavior change plan can assist yo with redcing alcohol consmption Record behavior patterns Analyze yor drinking diary Establish goals Implement yor plan Evalate yor reslts Copyright 2015 McGraw-Hill Edcation. All rights reserved. No reprodction or distribtion withot the prior written consent of McGraw-Hill Edcation. 30

31 Who Smokes? Patterns of Tobacco Use 19 percent of the adlt poplation in the United States are smokers, down from 42 percent in 1965 The decline of smoking since 1965 is largely becase of pblic health campaigns abot the hazards of smoking Althogh smoking in the United States has declined, the rate of decline has slowed since 1990 Copyright 2015 McGraw-Hill Edcation. All rights reserved. No reprodction or distribtion withot the prior written consent of McGraw-Hill Edcation. 31

32 Who Smokes? Patterns of Tobacco Use Smoking is more prevalent among men than women Rates of smoking are higher among yong people than among older people Most smokers get hooked in adolescence and think they can stop at any time College stdents are more likely to smoke than the general poplation Smoking is more prevalent among the White poplation than among African Americans, Hispanics, or Asian Americans and Pacific Islanders Copyright 2015 McGraw-Hill Edcation. All rights reserved. No reprodction or distribtion withot the prior written consent of McGraw-Hill Edcation. 32

33 Sbstances in Tobacco Tar is a thick, sticky reside formed when tobacco leaves brn, containing hndreds of chemical componds and carcinogenic sbstances Carbon monoxide is an odorless gas that interferes with the ability of red blood cells to carry oxygen to vital body organs Nicotine is the primary addictive ingredient in tobacco; it is a poison and a psychoactive drg Copyright 2015 McGraw-Hill Edcation. All rights reserved. No reprodction or distribtion withot the prior written consent of McGraw-Hill Edcation. 33

34 Tobacco Prodcts Cigarettes The most poplar tobacco prodct Electronic cigarettes Hookahs Cigars Pipes Potentially greater risk than cigarettes becase of more pffs Nicotine absorbed in mcs membranes of the moth: higher risk for oral cancers Pipe smoke has more toxins than cigarette smoke Copyright 2015 McGraw-Hill Edcation. All rights reserved. No reprodction or distribtion withot the prior written consent of McGraw-Hill Edcation. 34

35 Tobacco Prodcts Smokeless tobacco Snff Chewing tobacco Sns Use of spit tobacco is believed to case abot 10 to 15 percent of oral cancers Dissolvable tobacco prodcts Small pellets, sticks, or strips that consist of finely grond and pressed tobacco Ingested orally like a breath mint Copyright 2015 McGraw-Hill Edcation. All rights reserved. No reprodction or distribtion withot the prior written consent of McGraw-Hill Edcation. 35

36 Why Do People Smoke? Nicotine is a highly addictive psychoactive drg Some health experts believe it is the most addictive of all the psychoactive drgs Increases in release of the nerotransmitter dopamine prodce feelings of pleasre and a desire to repeat the experience Behavioral dependence Many smokers have a harder time imagining their ftre life withot cigarettes than they do dealing with the physiological symptoms of withdrawal Copyright 2015 McGraw-Hill Edcation. All rights reserved. No reprodction or distribtion withot the prior written consent of McGraw-Hill Edcation. 36

37 Why Do People Smoke? Weight control Nicotine sppresses appetite and slightly increases basal metabolic rate People who start smoking often lose weight, and contining smokers gain weight less rapidly than nonsmokers Weight control is one of the major reasons yong women give for smoking Tobacco marketing and advertising Becase most smokers get hooked in adolescence, children and teenagers are prime targets of tobacco advertising Copyright 2015 McGraw-Hill Edcation. All rights reserved. No reprodction or distribtion withot the prior written consent of McGraw-Hill Edcation. 37

38 Short-Term Effects of Tobacco Use Nicotine effects can reach the brain within 7 10 seconds, prodcing stimlation and sedation Smoke qickly affects heart rate, blood pressre, and body temperatre Tar and toxins damage cilia, the hair-like strctres that prevent toxins and debris from reaching delicate lng tisse The cardiovasclar system cannot effectively deliver oxygen to mscle cells Copyright 2015 McGraw-Hill Edcation. All rights reserved. No reprodction or distribtion withot the prior written consent of McGraw-Hill Edcation. 38

39 Short-Term Effects Copyright 2015 McGraw-Hill Edcation. All rights reserved. No reprodction or distribtion withot the prior written consent of McGraw-Hill Edcation. 39

40 Long-Term Effects of Tobacco Use Cardiovasclar disease Cancer Chronic obstrctive plmonary disease Emphysema Chronic bronchitis Asthma Prematre skin wrinkling Increased risk of srgery Infertility Sexal dysfnction Periodontal disease Dodenal lcers Osteoporosis Cataracts Redced effects of some medications Compromised lng fnction Copyright 2015 McGraw-Hill Edcation. All rights reserved. No reprodction or distribtion withot the prior written consent of McGraw-Hill Edcation. 40

41 Special Health Risks for Women Lng cancer Heart disease Respiratory disease Fertility problems Menstral disorders Early menopase Women who smoke dring pregnancy are at increased risk for the following: Miscarriage Stillbirths Preterm delivery Low birth weight in infants Perinatal death High risk for SIDS Copyright 2015 McGraw-Hill Edcation. All rights reserved. No reprodction or distribtion withot the prior written consent of McGraw-Hill Edcation. 41

42 Special Health Risks for Men Greater se of other forms of tobacco (cigars, pipes, smokeless tobacco) places men at higher risk for cancers of the moth, throat, esophags, and stomach Men who smoke also are at risk for the following: Problems with sexal fnction (impotence) Fertility (motility and nmber of sperm) Copyright 2015 McGraw-Hill Edcation. All rights reserved. No reprodction or distribtion withot the prior written consent of McGraw-Hill Edcation. 42

43 Special Health Risks for Ethnic Minority Grops Mortality rates from several diseases associated with tobacco se, inclding cardiovasclar disease, cancer, and SIDS, are higher for ethnic minority grops than for Whites African American men and women are more likely to die from lng cancer, heart disease, and stroke than are members of other ethnic grops, despite lower rates of tobacco se Copyright 2015 McGraw-Hill Edcation. All rights reserved. No reprodction or distribtion withot the prior written consent of McGraw-Hill Edcation. 43

44 Benefits of Qitting Risks for many health problems are redced when smokers qit Health benefits begin immediately and are more significant over time Within a year, the risk for heart attack and coronary artery disease is redced by half Within 5 years, the risk approaches that of nonsmokers Qitting increases qality of life Copyright 2015 McGraw-Hill Edcation. All rights reserved. No reprodction or distribtion withot the prior written consent of McGraw-Hill Edcation. 44

45 Copyright 2015 McGraw-Hill Edcation. All rights reserved. No reprodction or distribtion withot the prior written consent of McGraw-Hill Edcation. 45

46 Effects of Environmental Tobacco Smoke Environmental tobacco smoke (ETS): smoke from other people s tobacco prodcts, also known as secondhand smoke or passive smoke Significant evidence indicates that inhaling ETS has serios health conseqences In 2006, the U.S. srgeon general stated that there is no safe level of ETS exposre Infants and children are especially vlnerable to the effects of ETS Copyright 2015 McGraw-Hill Edcation. All rights reserved. No reprodction or distribtion withot the prior written consent of McGraw-Hill Edcation. 46

47 Treatment Programs and Medications to Qit Smoking Treatment programs Of smokers who enter good treatment programs, 20 40% are able to qit for at least a year Medications Nicotine replacement therapy (NRT) Transdermal patch, nicotine inhaler, nicotine patch, hand gel (Nicogel) Prescription drg (Zyban, Wellbtrin, Chantix) Experimental vaccine (NicVax) Copyright 2015 McGraw-Hill Edcation. All rights reserved. No reprodction or distribtion withot the prior written consent of McGraw-Hill Edcation. 47

48 Qitting On Yor Own Develop a behavior change plan Record and analyze yor smoking patterns Establish goals Prepare to qit Implement yor plan Prevent relapse Copyright 2015 McGraw-Hill Edcation. All rights reserved. No reprodction or distribtion withot the prior written consent of McGraw-Hill Edcation. 48

49 Copyright 2015 McGraw-Hill Edcation. All rights reserved. No reprodction or distribtion withot the prior written consent of McGraw-Hill Edcation. 49

50 Confronting the Tobacco Challenge Tobacco has been part of the economy of the contry since colonial times It is a mltibillion-dollar indstry with tremendos lobbying power and a hge impact on the nation s economic health Significant inroads have been made in confronting the challenge posed by tobacco in the U.S. Copyright 2015 McGraw-Hill Edcation. All rights reserved. No reprodction or distribtion withot the prior written consent of McGraw-Hill Edcation. 50

51 Confronting the Tobacco Challenge By 2003, thosands of local laws and ordinances were in place across the contry, creating smoke-free indoor spaces Lawsits and cort settlements: The 1998 Master Settlement Agreement (MSA), in which the tobacco indstry agreed to pay $206 billion to 46 states over a 25-year period Limiting access to tobacco Raising cigarette taxes redces demand Laws restricting sales to minors Restrictions on tobacco advertising Copyright 2015 McGraw-Hill Edcation. All rights reserved. No reprodction or distribtion withot the prior written consent of McGraw-Hill Edcation. 51

52 Confronting the Tobacco Challenge The Family Smoking Prevention and Tobacco Control Act of 2009 granted athority to the FDA to reglate tobacco Larger and more explicit health warning labels reqired on tobacco prodct packaging sccessflly challenged by cigarette makers Light, low, or mild on packaging prohibited Cigarette machines only allowed in 18+ venes Single cigarette sales prohibited Free samples prohibited Prodct tie-ins prohibited Copyright 2015 McGraw-Hill Edcation. All rights reserved. No reprodction or distribtion withot the prior written consent of McGraw-Hill Edcation. 52

53 Who Uses? Patterns of Illicit Drg Use Rates of illicit drg se vary by age, gender, race and ethnicity, edcation, employment stats, and geographical region Among Americans aged 12 or older, more than 47% report having sed an illicit drg in their lifetime The most commonly sed drg is marijana There is also a sbstantial misse of psychotherapetics (prescription-type drgs) Copyright 2015 McGraw-Hill Edcation. All rights reserved. No reprodction or distribtion withot the prior written consent of McGraw-Hill Edcation. 53

54 Who Uses? Patterns of Illicit Drg Use The nmber of college stdents who abse prescription drgs increased dramatically between 1993 and 2005 Pain relievers (e.g., OxyContin, Vicodin, Percocet): se increased by 343% Stimlants (e.g., Ritalin, Adderall): se increased by 93% Tranqilizers (e.g., Xanax, Valim): se increased by 450% Sedatives (e.g., Nembtal, Seconal): se increased by 225% Copyright 2015 McGraw-Hill Edcation. All rights reserved. No reprodction or distribtion withot the prior written consent of McGraw-Hill Edcation. 54

55 What Is a Drg? Drg: sbstance other than food that affects the strctre or fnction of the body throgh its chemical action Psychoactive drgs change brain chemistry and alter consciosness, perception, mood, thoght (intoxication) Drg of abse: medical drg sed for nonmedical (recreational) prposes, or a drg that has no medical ses Sbstance: drg of abse, a medication, or a toxin; the term is sed interchangeably with drg Copyright 2015 McGraw-Hill Edcation. All rights reserved. No reprodction or distribtion withot the prior written consent of McGraw-Hill Edcation. 55

56 Types of Drgs Drgs are classified in several different ways Legal drgs inclde: Medication prescribed by physicians Over-the-conter (OTC) medications Herbal remedies Pharmacetical drgs are developed for medical prposes, whether over-the-conter or prescription Illicit drgs are nlawfl to possess, manfactre, sell, or se Copyright 2015 McGraw-Hill Edcation. All rights reserved. No reprodction or distribtion withot the prior written consent of McGraw-Hill Edcation. 56

57 Drg Misse and Abse Drg misse: se of prescription drgs for prposes other than those for which they were prescribed or in greater amonts than prescribed, or the se of nonprescription drgs or chemicals for prposes other than those intended by the manfactrer Drg abse: se of a sbstance in amonts, sitations, or a manner sch that it cases problems, or greatly increases the risk of problems, for the ser or for others Copyright 2015 McGraw-Hill Edcation. All rights reserved. No reprodction or distribtion withot the prior written consent of McGraw-Hill Edcation. 57

58 Drg Misse and Abse Sbstance se disorders is defined by the DSM-5 as a nmber of cognitive, behavioral, and physiological symptoms that persist even as the individal experiences a nmber of significant life-changing sbstance-related problems DSM-5 does not separate sbstance se disorders and dependence Copyright 2015 McGraw-Hill Edcation. All rights reserved. No reprodction or distribtion withot the prior written consent of McGraw-Hill Edcation. 58

59 Drg Misse and Abse Many will contine to view sbstance se problems in terms of drg abse, addition, dependence, withdrawal symptoms, and tolerance Addiction is the chronic relapsing brain disease characterized by complsive drg seeking and se, despite harmfl conseqences Tolerance is redced sensitivity to the effects of the drg Withdrawal symptoms are ncomfortable feelings when drg se stops Copyright 2015 McGraw-Hill Edcation. All rights reserved. No reprodction or distribtion withot the prior written consent of McGraw-Hill Edcation. 59

60 Rotes of Administration Oral most drgs are taken orally Injection Involves a hypodermic syringe to deliver drg into the bloodstream by Intravenos injection Intramsclar injection Sbctaneos injection Inhalation: smoking or hffing Application to mcos membranes Application to skin Copyright 2015 McGraw-Hill Edcation. All rights reserved. No reprodction or distribtion withot the prior written consent of McGraw-Hill Edcation. 60

61 Copyright 2015 McGraw-Hill Edcation. All rights reserved. No reprodction or distribtion withot the prior written consent of McGraw-Hill Edcation. 61

62 Factors Inflencing the Effects of Drgs Characteristics of the drg Chemical properties of the drg and its actions Characteristics of the person Age Gender Body weight and mass Physical condition Mood Experience with the drg Expectations Characteristics of the sitation Environmental experience Copyright 2015 McGraw-Hill Edcation. All rights reserved. No reprodction or distribtion withot the prior written consent of McGraw-Hill Edcation. 62

63 Effects of Drgs on the Brain Many addictive drgs act on nerons in three brain strctres: The ventral tegmental area (VTA) in the midbrain Ncles accmbens Prefrontal cortex Nerons in these strctres form a pathway referred to as the pleasre and reward circit Addictive psychoactive drgs activate and case srge in levels of dopamine and associated feelings of pleasre Copyright 2015 McGraw-Hill Edcation. All rights reserved. No reprodction or distribtion withot the prior written consent of McGraw-Hill Edcation. 63

64 Effects of Drgs on the Brain All or nearly all addictive drgs operate via the pleasre and reward circit Some also operate via additional mechanisms, i.e., the opioids Similar strctre to endorphins, which block pain when the body ndergoes stress Individals trying to recover from addiction mst overcome: Altered brain chemistry Drg-related memories Impaired implse control Copyright 2015 McGraw-Hill Edcation. All rights reserved. No reprodction or distribtion withot the prior written consent of McGraw-Hill Edcation. 64

65 Drgs of Abse Drgs of abse are sally classified as Stimlants Depressants Opioids Hallcinogens Inhalants Cannabinoids Copyright 2015 McGraw-Hill Edcation. All rights reserved. No reprodction or distribtion withot the prior written consent of McGraw-Hill Edcation. 65

66 Central Nervos System Stimlants Drgs that speed p activity in the brain and sympathetic nervos system Effects similar to the fight-or-flight reaction May stimlate movement, fidgeting, and talking, and prodce intense feelings of ephoria and create a sense of well-being Examples: Cocaine Amphetamines MDMA (Ecstasy) Bath salts Caffeine Copyright 2015 McGraw-Hill Edcation. All rights reserved. No reprodction or distribtion withot the prior written consent of McGraw-Hill Edcation. 66

67 Central Nervos System Depressants Slow down activity in the brain and sympathetic nervos system Can be deadly if missed, especially when mixed with alcohol CNS depressants carry a high risk of dependence Examples: Barbitrates and hypnotics Anti-anxiety drgs (benzodiazepines) Rohypnol GHB (gamma hydroxybtyrate) Copyright 2015 McGraw-Hill Edcation. All rights reserved. No reprodction or distribtion withot the prior written consent of McGraw-Hill Edcation. 67

68 Opioids Natral and synthetic derivatives of opim Crrently prescribed as pain relievers, anesthetics, antidiarrheal agents, and cogh sppressants Prodce feelings of pleasre and block the sensation of pain Examples: Morphine Heroin Synthetic opioids (OxyContin, Vicodin, Demerol, Diladid, Percocet, Percodan) Copyright 2015 McGraw-Hill Edcation. All rights reserved. No reprodction or distribtion withot the prior written consent of McGraw-Hill Edcation. 68

69 Opioids With low doses opioid sers experience: Ephoria Drowsiness Constriction of the ppils Slrred speech Slowed movement Impaired coordination, attention, and memory At high dosage sers can experience depressed respiration, loss of consciosness, coma, and death Opioids have a high potential for dependence Copyright 2015 McGraw-Hill Edcation. All rights reserved. No reprodction or distribtion withot the prior written consent of McGraw-Hill Edcation. 69

70 Hallcinogens Also known as psychedelics Alter perceptions and thinking in characteristic ways Intensify and distort visal and aditory perceptions and prodce hallcinations Examples: LSD (lysergic acid diethylamide) PCP (phencyclidine) Peyote Copyright 2015 McGraw-Hill Edcation. All rights reserved. No reprodction or distribtion withot the prior written consent of McGraw-Hill Edcation. 70

71 Inhalants Breathable chemical vapors that alter consciosness, prodcing a state that resembles drnkenness Active ingredients are all powerfl toxins and carcinogens The most significant negative effect for chronic sers is widespread and long-lasting brain damage Examples: Paint thinner, gasoline, gle, and spray-can propellant Copyright 2015 McGraw-Hill Edcation. All rights reserved. No reprodction or distribtion withot the prior written consent of McGraw-Hill Edcation. 71

72 Cannabinoids Marijana is the most widely sed illicit drg in the United States Derived from the hemp plant, Cannabis sativa Active ingredient is delta-9-tetrahydrocannabinol (THC) Use prodces mild ephoria, sedation, lethargy, short-term memory impairment, increase in appetite, distorted sensory perceptions, distorted sense of time, impaired coordination, and an increase in heart rate Researchers have fond that THC has a variety of effects on the brain, perhaps acconting for some impairments in problem solving and decision making Copyright 2015 McGraw-Hill Edcation. All rights reserved. No reprodction or distribtion withot the prior written consent of McGraw-Hill Edcation. 72

73 Emerging Drgs of Abse Newest set of drgs being experimented with inclde: Krokodil synthetic form of heroin N-Bomb synthetic hallcinogen more powerfl than LSD Syrp, Prple Drank, Sizzrp, and Lean prescription-strength cogh syrp mixed with soda Devils Breath hypnotic effects; can be sed to take advantage of people Copyright 2015 McGraw-Hill Edcation. All rights reserved. No reprodction or distribtion withot the prior written consent of McGraw-Hill Edcation. 73

74 Approaches to the Drg Problem Spply redction strategies: Interdiction: interception of drgs before they get into the contry Pressre on spplying contries to sppress prodction and exportation Prevent domestic prodction and selling via law enforcement Copyright 2015 McGraw-Hill Edcation. All rights reserved. No reprodction or distribtion withot the prior written consent of McGraw-Hill Edcation. 74

75 Approaches to the Drg Problem Demand redction strategies: Incarceration for drg-related crimes Half the people in U.S. prisons meet the diagnostic standards for sbstance se disorders Only 7 17% who need drg treatment receive it Prevention strategies Primary prevention: designed to reach and edcate entire poplation Secondary prevention: focs on sbgrops that are at greatest risk for se or abse Tertiary prevention: target at-risk individals rather than grops Copyright 2015 McGraw-Hill Edcation. All rights reserved. No reprodction or distribtion withot the prior written consent of McGraw-Hill Edcation. 75

76 Approaches to the Drg Problem Strategies on college campses inclde environmental management Send clear messages that drg se not acceptable Change climate of drg tolerance on camps Engage parents Provide alternative activities Involve stdents in planning and prevention Implementation of harm-redction strategies Provide containers for needle and syringe disposal Provide condoms Make naloxone (Narcan) available in case of opioid overdoes Copyright 2015 McGraw-Hill Edcation. All rights reserved. No reprodction or distribtion withot the prior written consent of McGraw-Hill Edcation. 76

77 Approaches to the Drg Problem Demand redction strategies: Drg treatment programs Narcotics Anonymos (NA) Treatment is more sccessfl when the program lasts at least three months Copyright 2015 McGraw-Hill Edcation. All rights reserved. No reprodction or distribtion withot the prior written consent of McGraw-Hill Edcation. 77

78 Approaches to the Drg Problem Harm redction strategies: Focs on helping addicts redce the harm associated with drg se Needle exchange programs Drg sbstitte programs (ex: methadone instead of heroin) Controlled availability Medicalization Decriminalization Copyright 2015 McGraw-Hill Edcation. All rights reserved. No reprodction or distribtion withot the prior written consent of McGraw-Hill Edcation. 78