chapter 7 lecture recognizing and avoiding addiction and drug abuse © 2015 pearson education, inc

Chapter 7 Lecture

© 2015 Pearson Education, Inc.

Recognizing and Avoiding Addiction and Drug Abuse


LEARNING OUTCOMES

• Identify the symptoms of addiction and explain the difference between addiction and habit.

• Discuss the types of addictions, including compulsive behaviors such as gambling and shopping.

• Identify the six categories of drugs and distinguish between drug misuse and drug abuse.

• Discuss the issues of over-the-counter and prescription drug misuse and abuse, including their impact on college campuses.

• Profile illicit drug use in the United States, including who uses illicit drugs, financial impact, and prevalence on college campuses.

• Discuss the use and abuse of controlled substances, including cocaine, amphetamines, marijuana, opioids, hallucinogens, inhalants, and steroids.

• Discuss treatment and recovery options for addicts, and discuss public health approaches to preventing drug abuse and reducing the impact of addiction on our society.


What Is Addiction?

• Defined as continued involvement with a substance or activity despite its ongoing negative consequences.

• Classified by the American Psychiatric Association (APA) as a mental disorder.

• Physiological dependence results in tolerance and withdrawal.

• Psychological dependence is the dependency of the mind on a substance or behavior that can lead to psychological withdrawal symptoms, such as anxiety, irritability, or cravings.


The Process of Addiction

• Compulsion, which is characterized by obsession with, or excessive preoccupation with, the behavior and an overwhelming need to perform it

• Loss of control, or the inability to predict reliably whether any isolated occurrence of the behavior will be healthy or damaging

• Negative consequences, such as physical damage, legal trouble, financial problems, academic failure, or family dissolution, which do not occur with healthy involvement in any behavior

• Denial, the inability to perceive that the behavior is self-destructive


Cycle of Psychological Addiction


Habit versus Addiction

• Addiction involves elements of habit, a repeated behavior in which the repetition may be unconscious.

• A habit can be broken.• Addiction involves repetition of a behavior that

occurs with compulsion, and considerable discomfort occurs if the behavior is not performed.


Addiction Affects Family and Friends

• Codependence, a condition in which a person is controlled by an addict's addictive behavior– Defined by lack of ability to set boundaries– Living in a chaotic, crisis-oriented mode– Assuming responsibility for meeting others'

needs to the point of subordinating own needs or even being unaware of personal needs

• Enablers, people who knowingly or unknowingly protect addicts from the consequences of their behavior


Addictive Behaviors

• Drug chemicals are not the only source of addiction. People can become addicted to certain behaviors.

• Process addictions are behaviors known to be addictive because they are mood altering.– Gambling, compulsive buying, compulsive

exercise, and compulsive Internet or technology use are all process addictions.


Disordered Gambling

• More than 2 million Americans are considered compulsive gamblers, and 6 million more are considered to be at risk for developing gambling addiction.

• Previously called pathological gambling and now referred to as disordered gambling by the APA, it is recognized as a mental disorder.

• There is strong evidence for a biological component.


Compulsive Buying Disorder

• Shopping is often used as a way to make people feel better about themselves, but for some people it becomes compulsive buying disorder.

• Symptoms include the following:– Buying more than one of the same item– Keeping items in the closet with tags attached– Repeatedly buying more than is needed or

can be afforded– Hiding purchases from relatives and loved

ones


ABC News Video: Woman's Shopping Addiction Revealed

Discussion Questions• How can you identify if someone has a shopping

addiction?• What methods can be used to help someone

who has a shopping addiction?• Discuss possible reasons someone may

become addicted to shopping. Are there psychological abnormalities that may manifest in the need to overspend?

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Exercise Addiction

• A large portion of people with eating disorders use exercise to purge, instead of or in addition to, self-induced vomiting.

• Warning signs include working out alone, rigid exercise patterns, exercising for more than 2 hours daily, exercising when sick or injured or to avoid social events, school, or work.

• Addictive exercise results in negative consequences similar to those in other addictions.


Technology Addictions

• Cell phones, video games, PDAs, networking sites, and the Internet can all be addictive.

• An estimated 1 in 8 Internet users will likely experience Internet addiction.

• Symptoms include general disregard for one's health, sleep deprivation, neglecting family and friends, lack of physical activity, euphoria when online, lower grades in school, and poor job performance.

• Internet addicts may feel moody or uncomfortable when they are not online.


What Is a Drug?

• Drugs are substances other than food that are intended to affect the structure or function of the mind or body through chemical action.

• Prescription medications; over-the-counter (OTC) medications; legal substances such as alcohol, caffeine, and tobacco; and illegal substances such as heroin and methamphetamines are all drugs.


What Is a Drug (cont.)

• Abuse is often associated with illegal drugs, but many people abuse and misuse legal drugs.– Drug misuse—use for purpose not intended– Drug abuse—excessive use– Misuse and abuse may cause serious harm– Nine percent of Americans report being currently

addicted. By late adolescence, 42 percent have used an illicit drug, and over 21 percent of high school students have taken a prescription without doctor supervision.

– Costs $193 billion in health care costs, public costs related to crime, and lost productivity annually.


How Drugs Affect the Brain

• The brain is wired to repeat pleasurable experiences.• Life-sustaining activities activate a "pleasure circuit" of

nerve cells. One nerve cell set uses dopamine, a neurotransmitter, and sits at the top of the brain stem in the ventral tegmental area (VTA).

• This "pleasure circuit" is known as the mesolimbic dopamine system.

• All addictive drugs activate the brain's pleasure circuit, and addiction alters the way the pleasure center and other parts of the brain function.– Psychoactive drugs—affect chemical

neurotransmission, either enhancing it, suppressing it, or interfering with it.


The Action of Cocaine at Dopamine Receptors in the Brain, an Example of Psychoactive Drug Action


Types of Drugs

• Prescription: obtained only with a prescription from a licensed physician

• Over-the-counter (OTC): no prescription needed and more than 100,000 available

• Recreational: most are legal substances, such as alcohol, tobacco, coffee, etc.

• Herbal preparations: products of plant origin• Illicit (illegal): all are psychoactive• Commercial: found in commercially sold

products such as household cleaners, pesticides, etc.


Routes of Administration

• Oral Ingestion• Inhalation

– Through the nose or mouth• Injection

– Intravenous—into bloodstream– Intramuscular—into muscle– Subcutaneous—just under the skin

• Transdermal– Through the skin

• Suppositories– Through the vagina or anus


Drug Interactions

• Polydrug Use– Taking several substances simultaneously

• Synergism (Potentiation)– Effects of both drugs are multiplied beyond

the effects of each on its own. • Inhibition

– Effects of one drug are reduced or eliminated by the presence of another at the same receptor site.

• Antagonism– Drugs work at same receptor site so that one

drug blocks the action of another.


Drug Interactions (cont.)

• Intolerance– When drugs combine to produce extremely

uncomfortable reactions• Cross-tolerance

– Tolerance for one drug creates a similar reaction to another drug.


Drug Misuse and Abuse of Over-the-Counter Drugs• High doses can cause hallucinations, bizarre sleep patterns, mood

changes, and sometimes death.– Those most vulnerable to abusing OTC drugs are teenagers,

young adults, and people over the age of 65.• Sleep Aids

– Excedrin PM, Sominex, Unisom, and Tylenol PM– Can cause problems with the sleep cycle, weaken areas of the

body, or induce narcolepsy.• Cold Medicines

– Robitussin, Vicks, Coricidin, and NyQuil– Dextromethorphan (DXM) can cause hallucinations, loss of

motor control, and "out-of body" sensations.• Diet Pills

– Contain stimulants such as caffeine or Hoodia gordoni– Ephedra was banned in 2004 after more than 16,000 adverse

side effects were reported.


Prescription Drug Abuse

• About 6.1 million Americans aged 12 and older used prescription drugs for nonmedical reasons in the past month.

• It is particularly common among teens and young adults.

• The problem may be getting worse among the youngest segment of society, with nearly 15 percent of 12th graders reporting prescription drug abuse by the time they graduate.

• Risks vary from irregular heart rate to death. Injecting prescription drugs may result in exposure to HIV, hepatitis B and C and other bloodborne viruses.


College Students and Prescription Drug Abuse• Increased dramatically over the past decade• Students who abuse Vicodin, OxyContin, or

Percocet say they do so to relax or get high.• Students who abuse Adderall and Ritalin

(intended to treat attention-deficit disorder [ADHD]) say they do so for academic gain.

• Most commonly reported side effects are sleeping difficulties, irritability, and reduced appetite.


ABC News Video: GovernmentCrackdown on Painkillers

Discussion Questions• How have some medical doctors contributed to

the prescription drug epidemic?• Will greater restrictions on Vicodin and other

painkillers help reduce drug use and appeal or will people become more aggressive in searching for the drug(s)? Explain your answer.

• Given the number of Americans hooked on Vicodin, how might restrictive measures decrease use? What are appropriate measures of restriction?

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Illicit Drugs

• Illicit drug use spans all age groups, genders, ethnicities, occupations, socioeconomic groups.

• Marijuana use has risen in recent years.• Illicit Drug Use on Campus

– In 2009 just over 50 percent of college students reported trying any drug; the vast majority used marijuana.

– College offices are concerned about the link between substance abuse and poor academic performance.


30-Day Drug Use Prevalence, Full-Time College Students vs. Respondents 1–4 Years beyond High School


Illicit Drugs (cont.)

• Why Do Some College Students Use Drugs?– Positive expectations– Genetics and family

history– Substance use in high

school– Mental health

problems– Sorority and fraternity

membership

• Why Don't Some College Students Use Drugs?– Parental attitudes and

behavior– Religion and spirituality– Student engagement– College athletics– Healthy social network


Common Drugs of Abuse—Stimulants

• Stimulants: increase activity of the central nervous system.

• Cocaine– White crystalline powder– Derived from the leaves of the South American coca

shrub– Cocaine rapidly enters bloodstream.– Exposed fetus is likely to suffer damage.– Methods of use vary

• Freebase cocaine• Crack

– Treatment for cocaine addiction involves mainly psychiatric counseling and 12-step programs.


Drugs of Abuse: Uses and Effects


Drugs of Abuse: Uses and Effects (cont.)


Common Drugs of Abuse—Stimulants (cont.)• Amphetamines

– Synthetic agents that stimulate the central nervous system (CNS)

– Some are used for medicinal purposes. – Ritalin and Adderall are used for attention-deficit/hyperactivity

disorder (ADHD).– High potential for abuse

• Methamphetamine– Affects brain and CNS– Euphoria lasts 6 to 8 hours.– Methods of use: snorted, injected, smoked, and ingested– Short-term effects include increased physical activity, alertness,

rapid breathing, increased body temperature, insomnia, tremors, anxiety, confusion, and decreased appetite.


Caffeine

• Most popular and widely consumed drug in the United States– Caffeine is derived from the chemical family called

xanthines, which are found in plant products such as coffee, tea, and chocolate.

– Enhances mental alertness and reduces feelings of fatigue.

– Side effects include wakefulness, insomnia, irregular heartbeat, dizziness, nausea, indigestion, mild delirium, and heartburn.

– Caffeine meets the requirements for addiction: tolerance, psychological dependence, and withdrawal symptoms.


Caffeine Content Consumption


Marijuana and Other Cannabinoids

• Derived from either the Cannabis sativa or Cannabis indica (hemp) plant.

• Tetrahydrocannabinol (THC) is the psychoactive substance in marijuana; average concentration is 10 percent, but some forms can contain up to 27 percent.– Has many medical purposes as it controls nausea

and vomiting, improves appetite, forestalls loss of lean muscle mass associated with AIDS wasting syndrome, and reduces muscle pain and spasticity caused by multiple sclerosis.

• Frequent and/or long-term use may increase risk for testicular cancer, serious mental health problems, suppressed immune system, and impaired memory.


Narcotics and Depressants

• Opioids– Cause drowsiness, relieve pain, and induce

euphoria– Called narcotics– Derived from opium – Include morphine, codeine, heroin, and black

tar heroin– Depress CNS and lower heart rate,

respiration, and blood pressure– Decrease sex drive


Narcotics and Depressants (cont.)

• Opioids (cont.)– Physical effects of opioids

• Depress CNS and lower heart rate, respiration, and blood pressure

• Cause weakness, dizziness, nausea, euphoria• Decrease sex drive• Cause visual disturbances and lack of coordination



• Heroin Addiction – Heroin is a white powder derived from morphine.

• Black tar heroin is a sticky, dark brown, foul-smelling form of heroin that is relatively pure and inexpensive.

– Heroin withdrawal is distinct, including an intense desire for the drug, sleep disturbances, dilated pupils, and muscle tremors

– Mainlining—intravenous injection of powdered heroin mixed in a solution; the most common route of administration


Treatment for Heroin Addiction

• Methadone Maintenance– Blocks effects of opiates withdrawal– Potentially addictive itself

• Naltrexone (Trexan)– Opiate antagonist– Lose compulsion to use heroin

• Temgesic (Buprenorphine)– Blocks cravings for heroin– Nonaddictive



• Benzodiazepines and Barbiturates – Benzodiazepines (tranquilizers)

• The most common sedative-hypnotic drugs • Valium, Ativan, and Xanax

– Barbiturates • Sedative-hypnotic drugs • Amytal and Seconal• Less safe than benzodiazepines

– Synergistic effect, when combined with alcohol, can lead to respiratory failure and death.

– Can produce physical and psychological dependence in several weeks.

– Cross-tolerance is a complication specific to sedatives.



• Rohypnol – A tranquilizer and "date rape" drug– Produces a sedative effect, amnesia, muscle

relaxation, and slowed psychomotor responses.– Has gained notoriety as a growing problem on

college campuses as it has been added to punch and other drinks at parties in hopes of lowering women's inhibitions and facilitating potential sexual conquests.

• Gamma-hydroxybutyrate (GHB)– CNS depressant known to have euphoric, sedative,

and anabolic (body-building) effects– Another "date rape" drug– Side effects include loss of memory,

unconsciousness, amnesia, hallucinations, and death.


Hallucinogens

• Hallucinogens create auditory or visual changes in mood, thoughts, and feelings.– Synesthesia—mixing of sensory messages– May "hear colors" and "smell tastes"

• Lysergic Acid Diethylamide (LSD) (acid)– In 1970 it was placed on controlled substances list.– About 6 percent of Americans between age 18 and 25

have used LSD at least once in their lifetime.– Commonly sold as a "blotter" on paper, it is one of the

most powerful drugs known to science, and minute quantities produce strong effects.


Hallucinogens (cont.)

• Ecstasy (methylene-dioxymethamphetamine [MDMA]) – Most common club drug causes feelings of

extreme euphoria, openness, and warmth.– Risks include inappropriate emotional

bonding, jaw clenching, tongue and cheek chewing, short-term memory loss or confusion.

– Chronic use can damage the brain.– Combined with alcohol, Ecstasy can be fatal.



• PCP – Phencyclidine– Originally developed as a dissociative anesthetic– Effects depend on dose and include slurred speech,

impaired coordination, fever, nausea, and total loss of sensitivity to pain.

– Doses greater than 10 mg can cause convulsions and death.

• Mescaline– Derived from peyote cactus; Native Americans have

used it for religious purposes.– It is a powerful hallucinogen and CNS stimulant.– Generally induces immediate vomiting.



• Psilocybin– Similar to LSD in effect– Effects generally wear off in 4 to 6 hours.– Cultivated from spores or harvested wild.– Mushroom varieties can be easily

misidentified, and mistakes can be fatal.• Ketamine (Special K)

– Used as an anesthetic in many hospitals and veterinary clinics.

– Causes hallucinations and sensory distortions.


Inhalants

• Users inhale chemicals causing hallucinations and euphoric effects.

• Legal to purchase and not commonly recognized as drugs, though dangerous when used incorrectly

• Include glue, paint thinner, and rubber cement.• Amyl nitrate and nitrous oxide are also abused.• Users experience dizziness, disorientation,

impaired coordination and judgment; combined with alcohol, may be fatal.


Anabolic Steroids

• Artificial forms of the male hormone testosterone that promote muscle growth and strength

• Produce state of euphoria, diminished fatigue, and increase bulk and power in both sexes

• Adverse side effects include mood swings("roid rage"), acne, liver tumors, elevated cholesterol, hypertension, and kidney disease.

• In women, large doses trigger development of male attributes; in men, anabolic steroids shut down testosterone production, causing men's breasts to grow and testicles to atrophy.


Treatment and Recovery

• An estimated 21.6 million Americans needed treatment for illicit drug or alcohol abuse in 2011, but only 2.3 million received treatment.

• Detoxification is an early abstinence period when the addict physically and cognitively adjusts to being free from the addiction's influence.


Treatment Approaches

• Outpatient Behavioral Treatment– Cognitive behavioral therapy– Multidimensional family therapy– Motivational interviewing– Motivational incentives (contingency management)

• Residential Treatment Programs– Therapeutic communities (TCs) are highly structured

programs in which addicts remain at a residence, typically for 6 to 12 months.

• 12-Step Programs– Nonjudgmental treatment programs that aim to work

on personal recovery


Treatment Approaches

• Vaccines against Addictive Drugs– A promising new cocaine vaccine is in

development.– The vaccine does not eliminate the desire for

cocaine; it prevents the user from getting high by stimulating the immune system to attack the drug when it is taken.

– Clinical trials are expected soon.


Drug Treatment and Recovery for College Students• Early intervention increases the likelihood of

successful treatment.• Private therapy, group therapy, cognitive

training, nutrition counseling, and health therapies all help with recovery.

• A growing number of colleges are offering special services to students who are recovering from alcohol and other drug addictions and want to stay in school without being exposed to excessive drinking or drug use.


Addressing Drug Misuse and Abuse in the United States• Drug abuse has been part of human behavior for

thousands of years and is not likely to disappear in the near future.

• Harm Reduction Strategies– Needle-exchange programs– Changing legal sanctions and increasing

treatment services– Minimizing potential hazards with drug use

rather than the use itself

chapter 7 lecture recognizing and avoiding addiction and drug abuse © 2015 pearson education, inc

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