chapter 11 lecture outline

11Addictions

Lecture OutlineI. Risky Behaviors

A. Overview1. The vast majority of college students do not engage in addictive

behaviors.2. However, some do and the reasons why are complex.

B. Addictive Behaviors and the Dimensions of Health1. Substance abuse and other self-destructive behaviors, such as

gambling and compulsive eating, can affect every dimension of health.a. Physical healthb. Psychological healthc. Spiritual healthd. Social healthe. Intellectual healthf. Environmental health

II. GamblingA. Introduction

1. Problem gambling has become more common among American adults than alcohol dependence.

2. Men, who are twice as likely to be frequent gamblers as women, reach their highest gambling rates in their late teens.

3. Researchers identified key indicators associated with “pathological” gambling:a. Gambling more than once a month.b. Gambling more than two hours a month.c. Wagering more than 10 percent of monthly income.d. A combination of parental gambling problems, gambling

frequency, and psychological distress.B. Gambling on Campus

1. College students who gamble do so for fun or excitement, to socialize, win money, or “just have something to do”—similar reasons why adults gamble.

2. Problem gambling refers to all individuals with gambling-related problems, including mild or occasional ones.

C. Risk Factors for Problem Gambling:

Chapter 11 –Addictions

1. Male sex2. Gambling at an early age (as young as 8)3. A big win earlier in one’s gambling career4. Consistently chasing losses5. Gambling alone6. Feeling depressed before gambling7. Feeling excited or aroused during gambling8. Behaving irrationally during gambling9. Poor grades at school10. Engaging in other addictive behaviors11. Lower socioeconomic class12. Parents with a gambling or addiction problem13. A history of delinquency or stealing money to fund

gambling14. Skipping class to go gambling

III. Drug Use on CampusA. Introduction

1. More than six in ten college students have never used marijuana or other illegal drugs.

2. Yet substance abuse remains a serious health risk for the minority of undergraduates who do use drugs.

3. Marijuana remains the most widely used illicit drug on campus.4. About 2 percent of college students report that they have

misused prescription opioids at least once in the past, while 7 percent did so in the last year.a. Characteristics of illicit drug users:

i. Most in the late teens and early 20sii. Most likely to be maleiii. Most likely to be whiteiv. Lower GPAv. More likely to be sexually activevi. Less likely to report strong religious valuesvii. More likely to not be or have never been marriedviii.Less likely to report good physical or mental healthix. More likely than nonusers to misuse prescription drugs

b. Characteristics of users of prescription drug for nonmedical reasons:i. Equally likely to be male or female.ii. More likely to be white.iii. Lower GPA.iv. Less likely to report good physical or mental health.v. More likely to report knowing a member of the faculty or

administration.B. Why Students Don’t Use Drugs:

1. Spirituality and religion.


2. Academic engagement.3. Perceived harmfulness.4. Athletics.

C. Why Students Use Drugs:1. Genetics and family history.2. Parental attitudes and behavior.3. Substance use in high school.4. Social norms.5. Positive expectations.6. Mental health problems.7. Social influences.8. Alcohol use.9. Race/ethnicity.10. Sexual identity.

IV. Understanding Drugs and Their EffectsA. Introduction

1. A drug is a chemical substance that affects the way you feel and function.

2. Drug abuse is a pattern of substance use resulting in negative consequences or impairment.

3. Drug dependence is a pattern of continuing substance use despite cognitive, behavioral, and physical symptoms.

4. Drug misuse is taking a drug for a purpose or by a person other than that for which it was intended or not taking the recommended doses.

5. Drug diversion is the transfer of a medication from the individual to whom it was prescribed to another person.

6. Risks are involved with all forms of drug use.a. Medications, caffeine, alcohol and tobacco all have

potentially life-threatening problems.B. Routes of Administration

1. Orallya. The most common way of taking a drug, by swallowing a

tablet, capsule, or liquid.b. It may not have an effect for 30 minutes or more.

2. Inhalationa. Drugs entering the body through the lungs by inhaling

smoke, gasses, aerosol sprays, or fumes from solvents or other compounds which evaporate quickly.

b. Huffing is placing inhalants in a plastic bag, putting it over the mouth and nose, and taking deep breaths.i. Huffing can have fatal consequences.

3. Intravenousa. Injection gets the drug into the bloodstream immediately.

4. Intramuscular


a. Injection gets drug into bloodstream moderately fast.5. Subcutaneous

a. Injection gets drug into bloodstream more slowly (about 10 minutes).

C. Dosage and Toxicity1. Increasing dose intensifies the effect produced by smaller doses.2. Toxicity: dosage level at which a drug becomes poisonous to the

body, causing either temporary or permanent damage.D. Individual Differences

1. Often drugs intensify the emotional state a person is in.2. Personality and psychological attitude also play a role in drug

effects.a. User’s mind-set – his or her expectations or preconceptions

about using the drug – affects the experience.E. Gender and Drugs

1. Men encounter more opportunities to use drugs2. Both genders display equal opportunity to use drugs for the first

time3. Men and women are equally likely to become addicted to

cocaine, heroin, hallucinogens, tobacco and inhalants.4. Women are more likely to become addicted to sedatives and

drugs to treat anxiety or insomnia.5. Men are more likely to abuse alcohol and marijuana6. Female cocaine users are more vulnerable to poor nutrition,

depression, and physical abuse.

V. Caffeine and Its EffectsA. Overview

1. Most widely used psychoactive (mind-affecting) drug in the world.

2. Caffeine is a stimulant.3. Drinking up to six cups a day of caffeinated or decaffeinated

coffee will not shorten your lifespan and may convey health benefits, including a lower risk of type 2 diabetes, cardiovascular and other diseases.

4. You can overdose on caffeine and develop symptoms such as restlessness, nervousness, excitement, insomnia, flushed face, increased urination, digestive complaints, and muscle twitching.

5. Withdrawal can cause headaches and other neurological symptoms.

6. High-energy Caffeinated Beveragesa. Men between 18 and 34 consume the mostb. Teens that drink them are 2 to 3 times more likely to use

alcohol, drugs, and cigarettes.7. Caffeine Intoxication


a. Based on 5 or more of the following symptoms: restless, nervousness, excitement, insomnia, flushed face, increased urination, digestive disturbances, muscle twitching, rambling though or speech, rapid or irregular heart rate, periods of inexhaustibility, and agitation.

VI. MedicationsA. Introduction

1. As many as half of all patients take the wrong medications, in the wrong doses, at the wrong times, or in the wrong ways.

2. Every year, these errors lead to an estimated 125,000 deaths and more than 8.5 billion in hospital costs.

B. Over-the-Counter Drugs1. Many widely used OTC drugs pose unsuspected hazards.2. OTC medications can be used improperly, often simply because

of a lack of education.3. Those most often misused:

a. Nasal spraysb. Laxativesc. Eye dropsd. Sleep aidse. Cough syrupf. Pain killers

C. Prescription Drugs1. The most widely used prescription drugs are pain medications,

sedative or anxiety medications, sleeping medications, and stimulant medications.

2. Nonadherencea. Many prescription medications are not taken the way they

should be; millions simply aren’t taken at all.3. Physical Side Effects

a. Serious complications include heart failure, heart attack seizures, kidney and liver failure, severe blood disorders, birth defects, blindness, memory problems, and allergic reactions.

b. Overdoses of opioid painkillers now cause more deaths than heroin and cocaine combined.

4. Psychological Side Effectsa. Can cause changed in the way people think, feel, and behave.b. Doctors may not even mention potential mental and

emotional problems.5. Drug Interactions

a. Drugs can interact in a variety of ways.b. What you eat or drink can impair or completely wipe out the

effectiveness of drugs or lead to unexpected effects on the body.


6. Generic Drugsa. The generic name is the chemical name for a drug.b. Same active ingredient and cost 20–85% less than brand

names.c. Fillers and binders that may affect the drugs absorption may

be different.d. Ask physician if generic vs. brand name matters.

7. Buying Drugs Onlinea. The dangers of unregulated distribution of medications have

alarmed government agencies and medical groups.b. American Medical Association has declared it unethical for

physicians to write prescriptions for people they haven’t met.c. Consumers have to be wary.

i. Some drugs need to be monitored.ii. Quality control is an issue.iii. Counterfeit drugs are increasingly sold on line.

VII. Prescription Drug Abuse on CampusA. Introduction

1. As many as one in five college students misuses or abuses a prescription medication every year. Only marijuana use is more widespread on campus.

B. Prescription Stimulants1. The most widely abused prescription drugs are stimulant

medications such as Ritalin.2. Most think that they help their focus, concentration, and to

study longer, but they actually have lower GPAs.C. Prescription Painkillers

1. Abuse of painkillers like OxyContin, Vicodin, is widespread on campus.

2. Like other addictions, this “habit” is a treatable brain disease.

VIII.Substance Use DisordersA. Introduction

1. Addiction is the compulsive use of a substance, loss of control, negative consequences, and denial.

B. Dependence1. Psychological dependence feeling a strong craving for a drug

because it produces pleasurable feelings or relieves stress and anxiety.

2. Physical dependence occurs when a person develops tolerance to the effects of a drug and needs larger and larger doses to achieve intoxication or another desired effect.

3. People with substance dependence disorder may use a drug to avoid or relieve withdrawal symptoms, or they may consume


larger amounts of a drug or use it over a longer period than they’d originally intended.

C. Abuse1. Psychoactive substance abuse disorder is then a person

continues to use drugs despite their awareness of persistent or repeated social, occupational, psychological, or physical problems related to drug use, or they use drugs in dangerous ways or situations.

D. Intoxication and Withdrawal1. Intoxication refers to maladaptive behavioral, psychological, and

physiologic changes that occur as a result of substance use.2. Withdrawal is the development of symptoms that cause

significant psychological and physical distress when an individual reduces or stops drug use.

E. Polyabuse1. Using several drugs.

F. Coexisting Conditions1. Many individuals with substance abuse disorders also have

another psychiatric disorder, such as depression.G. Causes of Drug Dependence and Abuse

1. The Biology of Dependencea. Addictive drugs have such a powerful impact on dopamine

and its receptors that they change the pathways within the brain’s pleasure center.

b. Dopamine, is a brain chemical associated with feelings of satisfaction and euphoria.

2. The Psychology of Vulnerabilitya. Scientists do not believe there is an addictive personality, but

certain individuals are at greater risk of drug dependence because of psychological factors, including difficulty controlling impulses, a lack of values that might constrain drug use, low self-esteem, feelings of powerlessness, and depression.

IX. Common Drugs of AbuseA. Cannabinoids

1. Marijuana and hashish are the most widely used illegal drugs.2. Some 12 million Americans use cannabis.3. How Users Feel

a. In low to moderate doses, marijuana typically creates a mild sense of euphoria, a sense of slowed time, a dreamy sort of self-absorption, and some impairment in thinking and communicating.

b. The immediate physical effects of marijuana include increased pulse rate, bloodshot eyes, dry mouth and throat,


slowed reaction times, impaired motor skills, increased appetites, and diminished short-term memory.

4. Risksa. Brain

i. Long-term marijuana use causes significant brain abnormalities, including shrinkage of key structures involved in memory, learning, and emotion that can lead to memory loss, difficulty learning new information, and psychotic symptoms.

ii. Short-term effects include problems with memory and learning; distorted perceptions; difficulty thinking and problem solving; loss of coordination; increased anxiety; and panic attacks.

b. Lungsi. Smoking cannabis may cause similar effects to smoking

tobacco.c. Heart

i. Increased risk of heart attack and sudden deathd. Pregnancy

i. Babies born to mothers who use marijuana during pregnancy are smaller and more likely to develop health problems than those born to mothers who did not use the drug.

5. Withdrawala. Compulsive, often uncontrollable craving for the drug.b. Stopping after long-term use can produce marijuana

withdrawal syndrome.i. Insomnia, restlessness, loss of appetite, and irritability.

B. Synthetic Designer Drugs1. The National Institute on Drug Abuse identifies a variety of

drugs – alcohol, LDS, MDMA, GHB, GBL, ketamine, fentanyl, Rohypnol, and nitrites – as club drugs.

2. First became popular among teen and young adults at nightclubs, bars, or night-long dances often held in warehouses.a. Ecstasy

i. Also known as MDMA, E, XTC, X, hug, beans, love drug.ii. Although it can be smoked, inhaled, or injected, it is

almost always taken as a pill.iii. How Users Feel

(a)Belongs to a family of drugs called enactogens, which literally means “touching within.”

(b)As a mood elevator, it produces a relaxed, euphoric state but does not produce hallucinations.

iv. Risks(a)Psychological difficulties (confusion, depression, sleep

problems, drug craving, severe anxiety, and paranoia)


and physical symptoms (muscle tension, involuntary teeth clenching, nausea, blurred vision, rapid eye movement, faintness, chills, sweating, and increases in heart rate and blood pressure).

b. GHB and GBLi. Gamma hydroxybutyrate - Once sold in health-food stores

for its muscle building and alleged fat burning properties, it was banned because of its effects on the brain and nervous system.

ii. Gamma butyrolactone – Acts as a stimulant and has been used as a “date rape drug.”

c. Nitritesi. They are used recreationally for a high feeling, a slowed

sense of time, a carefree sense of well-being, and intensified sexual experiences.

C. “Synthetic,” “Herbal,” and “Legal” drugs.1. New, unregulated psychoactive substances are emerging so

quickly that researchers describe their proliferation as “unprecedented in the annals of drug abuse.”

2. Despite warnings, many buyers perceive them as safe.3. Some are highly toxic industrial chemicals with potentially life-

threatening adverse effects.a. Herbal or Synthetic Marijuanab. Khat (Kat, Catha, Chat, Abyssinian Tea)c. Synthetic Stimulantsd. Herbal Ecstasye. Salvia

D. Stimulants1. Increase activity in some portion of the brain or spinal cord.2. Amphetamine

a. Trigger the release of epinephrine (adrenaline), which stimulates the central nervous system.i. How Users Feel

(a)Amphetamines produce a state of hyper-alertness and energy.

ii. Risks(a)Amphetamine intoxication may cause feelings of

grandiosity, increased heart rate, less frequent effects such as speeding up or slowing down of muscular movement, and in high doses, a rapid or irregular heartbeat.

iii. Withdrawal(a)When the immediate effects of amphetamines wear off,

users experience a crash and become shaky, irritable, anxious, and depressed.

3. Methamphetamine


a. An addictive stimulant that is less expensive and possibly more addictive than cocaine or heroin, and has become American’s leading drug problem.i. How Users Feel

(a)Methamphetamine causes the release of large amounts of dopamine, which causes a sensation of euphoria, increased self-esteem, and alertness.

ii. Risks(a)Increased heart rate, blood pressure, wakefulness and

physical activity, depressed appetite, and elevated body temperature. Other effects on the central nervous system include irritability, insomnia, confusion, tremors, convulsions, anxiety, paranoia, and aggressiveness.

(b)Meth users engage in more sex, more carelessly.


iii. The Toll on Society(a)Law enforcement officials consider meth their biggest

drug problem.iv. Withdrawal

(a)Meth addiction is difficult to treat.4. Cocaine

a. Cocaine, (also called coke, snow, lady), is a white crystalline powder extracted from the leaves of the South American coca plant.i. Various forms:

(a)Freebase(b)Crack

ii. How Users Feel(a)A powerful stimulant to the central nervous system,

cocaine targets several chemical sites in the brain, producing feelings of soaring well-being and boundless energy.

iii. Risks(a)Cocaine dependence is an easy habit to acquire.(b)The physical effects of acute cocaine intoxication

include dilated pupils, elevated or lowered blood pressure, perspiration or chills, nausea or vomiting, speeding up or slowing down of physical activity, muscular weakness, impaired breathing, chest pain, and impaired movements or muscle tone.

(c) Cocaine use can cause blood vessels in the brain to clamp shut and can trigger a stroke, bleeding in the brain, and potentially fatal brain seizures.

(d)Cocaine can damage the liver and cause lung damage in freebasers.

(e)The combination of alcohol and cocaine is particularly lethal.

iv. Withdrawal(a)When addicted individuals stop using cocaine, they

often become depressed.(b)Other symptoms of cocaine withdrawal include

fatigue, vivid and disturbing dreams, excessive or too little sleep, irritability, increased appetite, and physical slowing down or speeding up.


E. Depressants1. Depress the central nervous system, reduce activity, and induce

relaxation, drowsiness, or sleep.2. Benzodiazepines and Barbiturates

a. These depressants are the sedative-hypnotics, also known as anxiolytic or antianxiety drugs.

b. Rohypnol, also called roofies, rophie, roche, or the forget-me pill, is one of the benzodiazepines that has been of particular concern because of its abuse in date-rape.i. How Users Feel

(a)Low doses of these drugs may reduce or relieve tension, but increasing doses can cause a loosening of sexual or aggressive inhibitions.

ii. Risks(a)All sedative-hypnotic drugs can produce physical and

psychological dependence within two to four weeks.(b)Intoxication with these drugs can produce changes in

mood and behavior.(c) Taken in combination with alcohol, these drugs have a

synergistic effect that can be dangerous or even lethal.iii. Withdrawal

(a)Withdrawal from sedative-hypnotic drugs may range from relatively mild discomfort to a severe syndrome with grand mal seizures, depending on the degree of dependence.

3. Opioidsa. The opioids include opium and its derivatives (morphine,

codeine, and heroin) and synthetic drugs that have similar sleep-inducing and pain-relieving properties.

b. Synthetic opioids include meperidine (Demerol), Methadone, and Propoxyphene (Darvon).i. How Users Feel

(a)All opioids relax the user.ii. Risks

(a)Addiction is common. All regular users of opioids rapidly develop drug dependence, which can lead to lethargy, weight loss, loss of sex drive, and the continual effort to avoid withdrawal symptoms through repeated drug administration.

iii. Withdrawal(a)The intensity of opioid withdrawal depends on the

degree of addiction.F. Hallucinogens

1. Hallucinogens produce vivid and unusual changes in thought, feeling, and perception.


2. Do not produce dependence in the same way as cocaine or heroine.a. LSD and peyote are common hallucinogens.

G. Dissociative Drugs1. Initially developed as general anesthetics for surgery, these

drugs distort perceptions of sight and sound and produce feeling of dissociation or detachment from the environment or self.

2. Ketamine:a. Is an anesthetic used by veterinarians.b. It has become common in club scenes and has been used as a

date rape drug.c. It can be addictive and cause long-term memory loss.

3. PCPa. Is an illicit drug manufactured as a tablet, capsule, liquid,

spray, or crystallike white powder than can be swallowed, smoked, sniffed, or injected.

b. Its effects are utterly unpredictable.c. It may trigger violent behavior or irreversible psychosis the

first time it is used, or the twentieth time, or never.

X. InhalantsA. Inhalants or deleriants are chemicals that produce vapors with

psychoactive effects.1. The most commonly abused inhalants are solvents, aerosols,

model-airplane glue, cleaning fluids, and petroleum products like kerosene and butane.

2. At lower doses, users may feel slightly stimulated; at higher doses, they may feel less inhibited.

3. Regular use of inhalants leads to tolerance, and the effects are unpredictable.

XI. Treating Substance Dependence and Abuse1. The most difficult step is for users to admit they are addicted.2. Treatment can take place in an outpatient setting, a residential

facility, or a hospital.3. Personal treatment plans may consist of individual

psychotherapy, marital and family therapy, medication, and behavior therapy.


B. Principles of Drug Addiction Treatment1. Principles that characterize effective drug abuse treatment

include:a. Addiction is a complex but treatable disease that affects

brain function and behavior.b. No single treatment is appropriate for everyone.c. Treatment needs to be readily available.d. Effective treatment attends to multiple needs of the

individual.e. Remaining in treatment for an adequate time is critical.f. Counseling and other behavioral therapies are the most

commonly used forms of drug abuse treatment.g. Medications are an important element of treatment.h. Many drug-addicted individual also have other mental

disorders.i. Medically assisted detoxification is only the first stage of

addiction treatment and by itself does little to change the long-term drug abuse.

j. Treatment does not need to be voluntary to be effective.k. Drug use during treatment must be monitored continuously,

as lapses during treatment do occur.C. 12-Step Programs

1. As many as 200 different recovery programs are based on the spiritual 12-step program.

2. The basic precept is that members have been powerless when it comes to controlling their addictive behavior on their own.

3. To get the most out of a 12-step program:a. Try out different groups.b. Once you find a comfortable group, go back several times

before making a final decision to continue.c. Keep an open mind.d. Accept whatever feels right to you and ignore the rest.

D. Relapse prevention1. When relapses do occur, they should be viewed as neither a

mark of defeat nor evidence or moral weakness.2. The key is learning to avoid obvious cues and associations that

can set-off intense cravings.3. Therapists emphasize that every lapse does not have to lead to a

full-blown relapse.

Keywords


addiction

amphetamine

barbiturates

benzodiazepines

cannabinoids

cathinone

club drugs

cocaine

designer drugs

dopamine

drug

drug abuse

drug dependence

drug diversion

drug misuse

Ecstasy (MDMA)

gambling disorder

generic

hallucinogen

hashish

inhalants

intoxication

intramuscular

intravenous

LSD (lysergic acid diethylamide)

marijuana

opioids

over-the-counter (OTC) drugs

PCP (phencyclidine)

physical dependence

polyabuse

psychoactive

psychological dependence

salvia

stimulant

subcutaneous

toxicity

12 Step program

withdrawal


chapter 11 lecture outline

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