1. 10: Drugs
Your Health Today, 6th edition

2. Who Uses? Patterns of Illicit Drug Use
Rates of illicit drug use vary by age, gender, race and ethnicity, education, employment status, and geographical region
Among Americans aged 12 or older, more than 47% report having used an illicit drug in their lifetime
The most commonly used drug is marijuana
There is also a substantial misuse of psychotherapeutics (prescription-type drugs)

3. Who Uses? Patterns of Illicit Drug Use (2)
The number of college students who abuse prescription drugs increased dramatically between 1993 and 2005
Pain relievers (e.g., OxyContin, Vicodin, Percocet): use increased by 343%
Stimulants (e.g., Ritalin, Adderall): use increased by 93%
Tranquilizers (e.g., Xanax, Valium): use increased by 450%
Sedatives (e.g., Nembutal, Seconal): use increased by 225%

4. Figure 10.1 Illicit drug use in the past month among persons aged 12 or older, type of drug by millions of people, 2014.
Source: Center for Behavioral Health Statistics and Quality, Behavioral Health Trends in the United States, Results from the 2014 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-50, HHS Publication No. (SMA) , Figure 1, p. 4, Rockville, MD: SAMHSA, September 2015, data/sites/default/files/NSDUH-FRR1-2014/NSDUH-FRR pdf.

5. Figure 10.2 Illicit drug use in past month, by percentage of age group, 2014.
These statistics represent people aged 12 and older who reported using drugs within the last month at the time of being surveyed.
Source: Center for Behavioral Health Statistics and Quality, Behavioral Health Trends in the United States, Results from the 2014 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-50, HHS Publication No. (SMA) , Figure 2 table, p. 5, Rockville, MD: SAMHSA, September 2015, www. samhsa.gov/data/sites/default/files/NSDUH-FRR1-2014/NSDUH-FRR pdf.

6. What Is a Drug?
Drug: substance other than food that affects the structure or function of the body through its chemical action
Psychoactive drugs change brain chemistry and alter consciousness, perception, mood, and thought (intoxication)
Drug of abuse: medical drug used for nonmedical (recreational) purposes, or a drug that has no medical uses
Substance: drug of abuse, a medication, or a toxin; the term is used interchangeably with drug

7. Types of Drugs Drugs are classified in several different ways
Legal drugs include:
Medication prescribed by physicians
Over-the-counter (OTC) medications
Herbal remedies
Pharmaceutical drugs are developed for medical purposes, whether over-the-counter or prescription
Illicit drugs are unlawful to possess, manufacture, sell, or use

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Figure 10.3 Source of pain relievers for most recent nonmedical use among past-year users aged 12 or older, 2012–2013.
Source: Substance Abuse and Mental Health Services Administration, September 2014, Results from the 2013 National Survey on Drug Use and Health: Summary of National Findings, Figure 2.16, NSDUH Series H-48, HHS Publication No. (SMA) Rockville, MD: Substance Abuse and Mental Health Services Administration, 2014, NSDUHresults2013.pdf
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9. Drug Misuse and Abuse
Drug misuse: use of prescription drugs for purposes other than those for which they were prescribed or in greater amounts than prescribed, or the use of nonprescription drugs or chemicals for purposes other than those intended by the manufacturer
Drug abuse: use of a substance in amounts, situations, or a manner such that it causes problems, or greatly increases the risk of problems, for the user or for others

10. Drug Misuse and Abuse (2)
Substance use disorders is defined by the DSM-5 as a number of cognitive, behavioral, and physiological symptoms that persist even as the individual experiences a number of significant life-changing substance-related problems
DSM-5 does not separate substance use disorders and dependence

11. Drug Misuse and Abuse (3)
Many will continue to view substance use problems in terms of drug abuse, addition, dependence, withdrawal symptoms, and tolerance
Addiction is the chronic relapsing brain disease characterized by compulsive drug seeking and use, despite harmful consequences
Tolerance is reduced sensitivity to the effects of the drug
Withdrawal symptoms are uncomfortable feelings when drug use stops

12. Routes of Administration
Oral
Most drugs are taken orally
Injection
Involves a hypodermic syringe to deliver drug into the bloodstream
Intravenous injection
Intramuscular injection
Subcutaneous injection
Inhalation: smoking or huffing
Application to mucous membranes

13. Table 10.1 Routes of Administration
Time to Reach Brain
Drug Example
Potential Adverse Effects
Inhalation: smoking and huffing
7–10 seconds
Marijuana, crack cocaine, tobacco, inhalants
Irritation of lungs; liver and kidney damage; hearing loss; vomiting
Injection
Intravenous, 15–30 seconds; intramuscular, 3–5 minutes; subcutaneous, 5–7 minutes
Heroin, cocaine, methamphetamine
Danger of overdose; collapsed veins; infection at injection site; blood infection; transmission of HIV, hepatitis C, and other pathogens
Mucus membranes: snorting
3–15 minutes
Cocaine, heroin, methamphetamine
Irritation or destruction of tissue; difficulty controlling dose
Oral ingestion: eating, drinking
20–30 minutes
Alcohol, pills
Vomiting

14. Factors Influencing the Effects of Drugs
Characteristics of the drug
Chemical properties of the drug and its actions
Characteristics of the person
Age, gender
Body weight and mass; physical condition
Mood
Experience with the drug
Expectations
Characteristics of the situation or environment
At home or surrounded by strangers

15. Effects of Drugs on the Brain
Many addictive drugs act on neurons in three brain structures:
Ventral tegmental area (VTA) in the midbrain
Nucleus accumbens
Prefrontal cortex
Neurons in these structures form a pathway referred to as the pleasure and reward circuit
Addictive psychoactive drugs activate and cause surge in levels of dopamine and associated feelings of pleasure

16. Effects of Drugs on the Brain (2)
All or nearly all addictive drugs operate via the pleasure and reward circuit
Some also operate via additional mechanisms
For example the opioids have a structure similar to that of endorphins, which block pain when the body undergoes stress
Individuals trying to recover from addiction must overcome:
Altered brain chemistry
Drug-related memories
Impaired impulse control

17. Drugs of Abuse Drugs of abuse are usually classified as Stimulants
Depressants
Opioids
Hallucinogens
Inhalants
Cannabinoids

18. Central Nervous System Stimulants
Stimulants: drugs that speed up activity in the brain and sympathetic nervous system
Effects similar to the “fight-or-flight” reaction
May stimulate movement, fidgeting, and talking, and produce intense feelings of euphoria and create a sense of well-being
Examples:
Cocaine
Amphetamines
MDMA (Ecstasy)
Bath salts

19. Central Nervous System Depressants
Depressants slow down activity in the brain and sympathetic nervous system
Can be deadly if misused, especially when mixed with alcohol
CNS depressants carry a high risk of dependence
Examples:
Barbiturates and hypnotics
Anti-anxiety drugs (benzodiazepines)
Rebound effect: when a person stops using a drug and experiences symptoms worse than those before taking the drug
Rohypnol and GHB (gamma hydroxybutyrate)

20. Opioids Opioids: natural and synthetic derivatives of opium
Currently prescribed as pain relievers, anesthetics, antidiarrheal agents, and cough suppressants
Produce feelings of pleasure and block the sensation of pain
Examples:
Morphine
Heroin
Synthetic opioids (OxyContin, Vicodin, Demerol, Dilaudid, Percocet, Percodan)

21. Opioids (2)
With low doses, opioid users experience euphoria followed by drowsiness
At high dosage, users can experience depressed respiration, loss of consciousness, coma, and death
Opioids have a high potential for dependence

22. Hallucinogens and Dissociative Drugs
Hallucinogens: alter perceptions and thinking, intensifying and distorting visual and auditory perceptions and producing hallucinations; also known as psychedelics
Alter perceptions and thinking in characteristic ways
Intensify and distort visual and auditory perceptions and produce hallucinations
Examples:
LSD (lysergic acid diethylamide)
Phencyclidine (PCP) and ketamine

23. Inhalants
Inhalants: breathable chemical vapors that alter consciousness, producing a state that resembles drunkenness
Active ingredients are all dangerously powerful toxins and carcinogens
Most significant negative effect for chronic users is widespread and long-lasting brain damage
Examples:
Paint thinner, gasoline, glue, and spray-can propellant

24. Cannabinoids
Marijuana is the most widely used illicit drug in the United States
Derived from the hemp plant, Cannabis sativa
Active ingredient is delta-9-tetrahydrocannabinol (THC)
Use produces mild euphoria, 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 found that THC has a variety of effects on the brain, perhaps accounting for some impairments in problem solving and decision making

25. Cannabinoids (2) Many people support medical uses of marijuana
Treatment for glaucoma, for the pain and nausea of cancer and chemotherapy, and for weight loss associated with AIDS
Currently 21 states and the District of Columbia have legalized marijuana in some form
Opponents argue legalization implies approval and will encourage abuse of all drugs
Like alcohol, marijuana affects the skills required to drive a car safely

26. Emerging Drugs of Abuse
Newest set of drugs being experimented with include:
Anabolic steroids—performance enhancing drugs
Synthetic cannabinoids such as K2 and Spice
“Syrup,” “Purple Drank,” “Sizzurp,” and “Lean”—all prescription-strength cough syrup containing codeine and promethazine mixed with soda
“N-Bomb,” a synthetic hallucinogen

27. Approaches to the Drug Problem
Supply reduction strategies:
Interdiction: interception of drugs before they get into the country
Pressure on supplying countries to suppress production and exportation
Prevention of domestic production and sales via law enforcement

28. Approaches to the Drug Problem (2)
Demand reduction strategies:
Incarceration for drug-related crimes
More than half the people in U.S. prisons meet the diagnostic standards for substance use disorders
Only 7–17% who need drug treatment receive it
Prevention strategies
Primary, or universal, prevention programs: designed to reach and educate entire population
Secondary, or selective strategies: focus on subgroups that are at greatest risk for use or abuse
Tertiary, or indicated, strategies: target at-risk individuals rather than groups

29. Approaches on College Campuses
Strategies on college campuses include environmental management:
Send clear messages that drug use is not acceptable
Change the climate of drug tolerance on campus
Engage parents
Identify and intervene with at-risk students
Provide alternative activities
Involve students in the planning of prevention programs

30. Approaches on College Campuses (2)
Colleges have also implemented harm-reduction strategies
Provide containers for needle and syringe disposal
Provide condoms
Make naloxone (Narcan) available in case of opioid overdose

31. Drug Treatment Programs
Treatment programs range from hospital-based inpatient programs to self-help/mutual-help groups such as Narcotics Anonymous (NA)
Treatment is a long-term process, often marked by relapses
Programs are more successful when they last at least three months
Matching services to individual needs is critical

32. Harm Reduction Strategies
These are based on the idea that completely eliminating substance use is futile and efforts should focus on reducing the associated harm
Needle exchange programs
Drug substitute programs, such as methadone for heroin addicts
Controlled availability
Medicalization
Decriminalization
Opponents argue these are simply forms of drug legalization

33. In Review
Why do people use drugs, and what are current patterns of drug use?
What are the different categories of drugs, and what are the differences between drug misuse and abuse?
How do drugs affect the body?
What are the different categories of drugs?
What are the main approaches to the drug problem?

34. Long image descriptions
Appendix A

35. Figure 10.3 Source of Pain Relievers Appendix
21.2% of users obtained pain relievers from a doctor
2.6% obtained them from more than one doctor
4.3% obtained them from a drug dealer and/or stranger
0.1% bought them on the Internet
14.5% bought them or took them from a friend or relative
53% were given them by a friend or relative
Of those friends and relatives:
83.8% obtained the pain relievers from a doctor
3.3% obtained them from more than one doctor
1.4% obtained them from a drug dealer and/or stranger
0.3% bought them on the Internet
4.9% bought them or took them from a friend or relative
5.1% were, themselves, given the pain relievers by a friend or relative
Overall a minute percentage of users obtained drugs by writing a fake prescription; by stealing the drugs from a doctor’s office, clinic, hospital, or pharmacy; or by some other means
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