chapter 1 drug use and abuse

Drug Use and Abuse: General Issues

Chapter 1

Introduction

Your chapter points out that the following systems are all influenced by alcohol and other drug use. Discuss specific ways that this may be the case.

Athletic Legal Religious

Biological Medical Social/cultural

Economic Political

Educational Psychological

Pharmacology and Drugs

Pharmacology – The scientific study of drugs; concerned with all information about the effects of drugs on living systems. Considered part of biology and allied with physiology and biochemistry.

Psychopharmacology – The subarea of pharmacology that concerns the effects of drugs on behavior

Psychology – The scientific study of behavior

Although psychopharmacology is a joining of the words psychology and pharmacology, it is now recognized that understanding how drugs effect human behavior requires knowledge about social and environmental factors as well.

For example, reported drug experiences vary depending on whether the user is alone or with other people and how comfortable they are in the drug-taking setting.

Drug Terms

Drug – Broadly defined as any chemical entity or mixture of entities, not required for the maintenance of health, that alters biological function or structure when administered

Drug Abuse – Any use of drugs that causes physical, psychological, legal, or social harm to the individual user or to others affected by the drug user’s behavior. The definition of abuse centers on the

consequences of the drug user’s behavior, particularly continued use despite the occurrence of negative consequences.

There are difficulties in defining abuse because behavior that causes negative consequences in one community or culture may not cause them in another, or not to the same degree.

Drug Use – Drug consumption that does not meet the criteria for drug abuse.

Drug Effects – The action of a drug on the body. Drug effects are measured in different ways

Psychoactive – Pertaining to effects on mood, thinking, and behavior

Drug Classification

1. By origin – Examples are drugs that come from plants such as the opiates from the opium poppy with the “pure” (nonsynthetic) compounds such as morphine and codeine and semisynthetic compound, heroin. Because the classification distinguishes only the source, a given drug class may include many drugs that have different chemical actions, i. e. LSD would also fall in this category.

2. By therapeutic use, or according to similarity in how a drug is used to treat or modify something in the body – For example, amphetamines are classed as appetite-suppressants (therapeutic effects) but when taken nonmedically, it is usually for their stimulant effects. Morphine prescribed as a painkiller but taken as the street user for its euphoric effects.

3. By site of drug action, pertains to where in the body the drug is causing physical changes – For example, alcohol is called a depressant drug because of its depressant action on the central nervous system (CNS), and because of its CNS stimulant properties, cocaine is a stimulant. The Utility of this system is limited when a drug affects several different sites such as with cocaine which also has anesthetic (pain-reducing) effects or when drugs that differ widely in chemical structure or mechanism of action may affect the same body site.

4. By chemical structure – For example, the barbiturates ( such as phenobarbital, Amytal, and Seconal) are synthetic compounds derived from the chemical structure of barbituric acid

5. By mechanism of action, or how a drug produces its drug effects – A good system in principle and ongoing research in pharmacology is specifying mechanisms of actions of an increasing numbers of drugs

6. By street name – Comes from the drug “subcultures” and the street drug market and often reflect actual drug effects. For example, amphetamines are called “speed” and drugs such as barbiturates or depressants are called “downers”

What Causes The Drug Experience ?

There are three sets of pharmacological andnonpharmacological factors to help us understand thedrug experience:

1. Pharmacological factors Chemical properties and action on the body of drug used Drug dosage - quantity of drug consumed Route of drug administration - way drug enters the body

2. Characteristics of the drug user: Genetic makeup – biologically inherited differences among people that govern their reactions to the ingestion of different drugs Gender Age Drug tolerance Personality Psychological Set – An individual’s knowledge,

attitudes, expectations, and other thoughts about an object or event, such as a drug

Placebo – In pharmacology, a chemically inactive substance. Sometimes the belief that a drug will produce a certain effect is enough to experience the effect even when the person has ingested a chemically inactive substance such as a placebo.

3. Setting in which a drug is used Laws pertaining to drug use in the community

where the drugs are used Physical environment Whether other people are present

Alcohol and Drug Use in the United States

National Household Survey - A survey conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA) on individuals 12 years of age or older including households in all 50 U.S. states and the District of Columbia. Provides the best single description of frequency and quantity of drug use among a broad age range of people in U.S. society

Survey Data

Prevalence – General occurrence of an event, usually expressed in terms of percentage of some population. Another common statistic in survey studies is incidence, or the number of first-time occurrences of an event during some time period

For overall prevalence of use in the last year and the last month for different drugs, alcohol leads the use list for legal drugs while marijuana and hashish head the list for illicit drug use

Drug use differs with characteristics of people. Age, gender, race, and the user’s environment may play a role.

Individuals in the age range 18-25 have the most prevalent substance use with 3 of every 4 respondents reporting alcohol use in the past year and more than 1 of every three reporting at least one occasion of illicit drug use in the past year

Men were more than one and a half times as likely as women to report illicit drug use in the past month and more than 25% more likely to report any alcohol use

Whites showed the highest rates of alcohol use, followed by Hispanics, and then Blacks

For illicit drug use, the three ethnic /racial groups showed small differences.

Multiple Drug Use

Multiple drug use is important because of the effectsthat drug combinations have on the body. It can includetaking drugs with similar effects, or drugs with different or opposite physical effects in sequence or on the sameoccasion, i.e., “speed” to get up and “downers” to go to sleep and “speedballing”.

Polydrug Use – The same person’s regular use of more than one drug

Grain – As a measure, a unit of weight equal to 0.0648 gram

CONTEMPORARY ISSUE BOX 1.3 “Nonmedical Use of Prescribed Drugs”

Sharp increase in the past few years in the nonmedical use of prescribed drugs

Painkiller OxyContin is a major source of the abuse rates

Two factors that also contribute to the increase are:

1) “doctor shopping” for multiple prescriptions, and

2) advertisement of prescription drugs over the Internet

Abuse of prescription drugs is associated with the same kinds of physical, psychological, and social problems that come with the abuse of any other drug.

International Comparisons of Drug Use Surveys administered to over 27,000 individuals,

ages 14-54, in seven countries/cities: United Sates; Fresno County, California; Mexico City, Mexico; Ontario, Canada; the Netherlands; Sao Paulo, Brazil; and Munich, Germany

Lifetime use of alcohol or other drugs occurred at a higher rate for men than women in all countries with highest rates of alcohol use by country in the following order: Netherlands, Canada, U.S., and the lowest rates in Mexico City

Cannabis use was the second most prevalent behind alcohol for all countries but varied considerably. For example, highest prevalence was in the U.S. - 33% men and 24% women compared to 3% men and .6% women in Mexico

Lifetime use of other drugs or drug classes were highly variable but generally at a low level, with the exception of cocaine or other stimulants and anxiolytics in the U.S.

Overall lifetime drug use, excluding alcohol and cannabis, was highest (19%) in the U.S. and lowest (2%) in Mexico.

CONTEMPORARY ISSUE BOX 1.5Drugs, Criminal Activity, and Aggression

Some types of drug use are associated with criminal activity.

As drug use in a community increases, so does the occurrence of certain types of crimes, depending on the drug.

Most research on drugs and crime has been concerned with heroin and street crime such as burglary, larceny, and assault addicts commit to get money to buy more drugs.

Alcohol is associated with assaultive type crimes committed with intent to harm the victim.

Alcohol is also correlated with homicides, property offenses, sexual offenses, and check fraud.

Use of hallucinogens and marijuana is not associated with crime or may even be a negative association.

Evidence is mixed for barbiturates and tranquilizers with some studies showing no relationship and others showing the same relationship for barbiturates and crime as for alcohol and crime.

What role does the pharmacological effects of these drugs have on their relationships with crime?

Negative Consequences of Alcohol and Drug Use

“Cost of illness” studies – Look at the negative consequences of alcohol and drug use for society by quantifying in dollars what society “pays” for its members incurring specific illnesses.

In 1995, it is estimated alcohol abuse cost the U.S. $166.5 billion and drug abuse cost $109.9 billion for a total of more than $276 billion !

Costs of alcohol and drug abuse come from such sources as illness, death, medical expenses, and crime. Crime-related costs are especially significant for drug abuse (58% of the total).

DSM-IV – Published by the American Psychiatric Association (APA), the Diagnostic and Statistical Manual has a section called “substance-related” disorders that includes definitions of ”substance dependence” and “substance abuse”.

Addiction – In reference to drugs, overwhelming involvement with using a drug, getting an adequate supply of it, and having a strong tendency to resume use of it after stopping for a period.

Loss of control – Inability to stop or reduce drug use for any length of time, if that is the intention.

Two criteria for dependence are:

Tolerance – Generally, increased amounts of a drug needed to achieve intoxication, or a diminished drug effect with continued use of the same amount of a drug.

Withdrawal – A definable illness that occurs with a cessation or decrease in use of a drug.

With physiological dependence, tolerance or withdrawal must be present.

Psychological dependence – The emotional state of craving a drug either for its positive effect or to avoid negative effects associated with its abuse

Craving – A term that has been variously defined in reference to drug use; typically a strong or intense desire to use a drug

Syndrome – In medicine, a number of symptoms that occur together and characterize a specific illness or disease

Over-the-Counter Drugs – Drugs that can be obtained legally without medical prescription

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