WHY A FOCUS ON ADDICTIVE BEHAVIORS?WHY A FOCUS ON ADDICTIVE BEHAVIORS?

• Study of Drug Use and Misuse Important

• A part of life in our culture - pervasive

• Affects everyone: we all have choices to make about what we do and don’t do, what we ingest and what we avoid

• Can have harmful consequences for individual, family, community, and society

• Substance use disorders are both preventable and treatable

• We are constantly being presented with information about licit and illicit substances and activities - how do we evaluate it?

OVERARCHING PRINCIPLESOVERARCHING PRINCIPLES

• Study of Drug Use and Misuse has Experiential and Scientific Basis

• Drugs are Neither Good Nor Bad: Context

• The Continuum: Drug Use, Misuse, and Dependence

• All Drugs and Potentially Addictive Behaviors Have a History and Cultural Context

• e.g., religious, spiritual usage; use for health / medical reasons

Drug Use, Misuse, and “Addiction”Drug Use, Misuse, and “Addiction”

• What is a drug?

• What is an addiction? An addict?___________

• Themes associated with “addiction”

• Conceptions and definitions vary

Dependence Potential of Psychoactive DrugsVery High: Heroin (IV)

Crack cocaineHigh: Morphine

Opium (smoked)Moderate/High: Cocaine powder

Tobacco cigarettesPCP (smoked)

Moderate: Diazedpam (Valium)AlcoholAmphetamines (oral)

Moderate/Low: CaffeineMDMA(Ecstasy”)Marijuana

Low: Ketamine

Very Low: LSD, MescalinePsilocybin

Major Stimulants Major Stimulants

Major Stimulants - CocaineMajor Stimulants - Cocaine street cocaine: coca paste and hydrochloric acid = street cocaine: coca paste and hydrochloric acid =

type of salt--powder sniffed or type of salt--powder sniffed or snortedsnorted

more addictive uses:more addictive uses:

can inject it--IV quickercan inject it--IV quicker smoking: smoking: freebase freebase - powder and ether - powder and ether crack - dissolve cocaine salt in baking soda solution, crack - dissolve cocaine salt in baking soda solution, boil off water, left with rockboil off water, left with rock

Cocaine - ETOH combo (coca-ethylene) - may alter metabolics of Cocaine - ETOH combo (coca-ethylene) - may alter metabolics of cocaine, which may be more cardiotoxic via increased half-life of cocainecocaine, which may be more cardiotoxic via increased half-life of cocaine

Major Stimulants - SpeedMajor Stimulants - SpeedAmphetamines - MethamphetaminesAmphetamines - Methamphetamines ephedrine, principal chemical in these drugs, has been ephedrine, principal chemical in these drugs, has been known for thousands of years; used as Chinese medicinal known for thousands of years; used as Chinese medicinal herbherb

ephedrine first isolated in late 1800's, and synthesized in ephedrine first isolated in late 1800's, and synthesized in 1920s when it was named “amphetamine”1920s when it was named “amphetamine”

first medically used in 1920's for treating obesity, first medically used in 1920's for treating obesity, narcolepsy, colds, and much later ADHDnarcolepsy, colds, and much later ADHD

used to enhance performance, decrease fatigue – sport & used to enhance performance, decrease fatigue – sport & military applications (e.g., go and no-go pills)military applications (e.g., go and no-go pills)

Classes/Types of Depressants

1. Anesthetics (ex. ether, nitrous oxide) 2. Barbiturates 3. Benzodiazepines (anxiolytics - ex. ? )

• 4. GGHB HB (very similar to GABA) GHB = gamma-hydroxy-butyric acid GABA = gamma-amino-butyric acid

Many labels have been used to describe them, which can be confusing:-tranquilizers -anti-anxiety pills

-sleeping pills -sedatives or hypnotics

HallucinogensHallucinogens TypesTypes1. 1. Serotonergic hallucinogensSerotonergic hallucinogens

chem similar to serotoninchem similar to serotonin

2. 2. Methylated amphetaminesMethylated amphetamineschem similar to norepinephrine...alterations in mood without much chem similar to norepinephrine...alterations in mood without much change in senseschange in senses

3. 3. Anticholinergic - (Ach)Anticholinergic - (Ach) found in plants: belladonna, mandrake, jimson weedfound in plants: belladonna, mandrake, jimson weedtrance or dream-like statestrance or dream-like states

4. 4. Dissociative anestheticsDissociative anestheticscan remain conscious in surgery; causes euphoria, numbness, can remain conscious in surgery; causes euphoria, numbness, aggressive behavior, and tactile sense disturbancesaggressive behavior, and tactile sense disturbances

MDMA

CannabisCannabis Negative effectsNegative effects

- - withdrawal symptoms that may occur after withdrawal symptoms that may occur after heavy use heavy use include:include:

1.1. nauseanausea

2.2. irritabilityirritability

3.3. sleep problems sleep problems

- apathy, decrease in motivation - apathy, decrease in motivation

- short-term memory impairment (hippocampus,- short-term memory impairment (hippocampus,

2-AG 2-AG may play role in memory loss)may play role in memory loss)

- impaired driving- impaired driving

- may trigger paranoia, usually mild forms- may trigger paranoia, usually mild forms

Cannabis - Cannabis - Negative EffectsNegative Effects -- chronic use associated with low sperm count, abnormal chronic use associated with low sperm count, abnormal sperm formation and motility, and possible male sperm formation and motility, and possible male impotence; enlarged breasts in males has also been impotence; enlarged breasts in males has also been reported. reported.

- in females, failure to ovulate has been noted- in females, failure to ovulate has been noted

- if used during pregnancy may be associated with low - if used during pregnancy may be associated with low birth weight, premature birth (but these women may also birth weight, premature birth (but these women may also be smokers, drinkers)be smokers, drinkers)

- pot as a “gateway” drug (Adolescents tend to use drugs - pot as a “gateway” drug (Adolescents tend to use drugs in this sequence: cigarettes, alcohol, pot, cocaine-heroin)in this sequence: cigarettes, alcohol, pot, cocaine-heroin)

OPIOIDSOPIOIDS

I. I. Where do they come from?Where do they come from?

poppy plantpoppy plant: from middle east and Asia: from middle east and Asia

dried sapdried sap from plant from plant isis opium; opium; cultivated annuallycultivated annually

major active ingredient in opium: major active ingredient in opium: morphinemorphine (3-10 x as strong) (3-10 x as strong)

/ synthesized in 1803/ synthesized in 1803

/ named after the Greek god of dreams Morpheus/ named after the Greek god of dreams Morpheus

/ morphine altered in late 1800s into / morphine altered in late 1800s into heroin-a “heroic” TXheroin-a “heroic” TX (10 x as (10 x as strong as morphine)strong as morphine)

// Fentanyl Fentanyl

At 40% alcohol plus 3 grams of opium per tablet, it didn't cure you, but you didn't care...

OPIOIDSOPIOIDS

II. II. Medical UsesMedical Uses

As pain reliever (morphine, demerol, codeine, lortab, As pain reliever (morphine, demerol, codeine, lortab, lorcet, percodan, percocet, vicodin)lorcet, percodan, percocet, vicodin)

with chronic pain or terminal patients with chronic pain or terminal patients

in some cough suppressantsin some cough suppressants

treatment of diarrhea, which is dehydratingtreatment of diarrhea, which is dehydrating

ALCOHOLALCOHOL

Alcohol’s PharmacologyAlcohol’s Pharmacology

It is a CNS depressantIt is a CNS depressant Peak concentrations are reached between Peak concentrations are reached between

30-90 minutes after drinking is stopped30-90 minutes after drinking is stopped Alcohol is distributed to all tissues in the Alcohol is distributed to all tissues in the

body and passes to the brain easilybody and passes to the brain easily

LD 50 is 25 drinks in 1 hour; BAC of .45 LD 50 is 25 drinks in 1 hour; BAC of .45 - .55 - .55 (BAC is expressed as a ratio of milligrams or weight of (BAC is expressed as a ratio of milligrams or weight of alcohol per 100 milliliters - about 3 ounces of blood)alcohol per 100 milliliters - about 3 ounces of blood)

most of the consumed alcohol metabolized in liver

broken down to acetaldehyde (by ADH - alcohol dehydrogenase and then to acetic acid by aldehyde dehy.)

carbon dioxide and water

excreted by lungs excreted in urine

Addiction and Withdrawal Addiction and Withdrawal IndicatorsIndicators

Is it Addictive? How do we know?Is it Addictive? How do we know?

Tolerance (cellular & metabolic) developsTolerance (cellular & metabolic) develops

Withdrawal symptoms occurWithdrawal symptoms occur BAC can still be above .00 for withdrawal sx to BAC can still be above .00 for withdrawal sx to

beginbegin

Alcohol and Women Alcohol and Women

Long-term ConsequencesLong-term Consequences

Physical:Physical: fatty liver, alcohol hepatitis, and cirrhosisfatty liver, alcohol hepatitis, and cirrhosis increased risk of CAD and various types of increased risk of CAD and various types of

cancerscancers increased susceptibility to illness; lower increased susceptibility to illness; lower

immune system functioningimmune system functioning GI problems such as pancreatitisGI problems such as pancreatitis FAS: small eyes, droopy eyelids, small head, FAS: small eyes, droopy eyelids, small head,

low intellectual functioning; associated with low intellectual functioning; associated with low SESlow SES

Long-term ConsequencesLong-term Consequences cont. cont.

Cognitive:Cognitive: impairs memory, problem-solving, learning impairs memory, problem-solving, learning

and reaction timeand reaction time neuropsychological damage can be neuropsychological damage can be

reversed with prolonged abstinencereversed with prolonged abstinence Wernicke-Korsakoff SyndromeWernicke-Korsakoff Syndrome

unable to learn new material due to failure to unable to learn new material due to failure to transfertransfer

confabulationconfabulation

College Drinking

• National Institute on Alcohol Abuse and Alcoholism:

http://www.niaaa.nih.gov/ then page down to college drinking link

• Read “Alcohol in the Vulnerable Lives of College Women”