1. © 2006 McGraw-Hill Higher Education. All rights reserved. Psy 526 Human Drug Use and Abuse Outline of Supplemental Readings Ksir, Hart, and Ray Chapters 1, 2, & 3

2. © 2006 McGraw-Hill Higher Education. All rights reserved. Chapter 1 Drug Use : An Overview

3. © 2006 McGraw-Hill Higher Education. All rights reserved. “Drug Use On The Rise” Who? What? When and where? How much? Why do any of these matter?

4. © 2006 McGraw-Hill Higher Education. All rights reserved. Who Is Taking The Drug?  Age  Proximity to us  What they do for a living What Drug Are They Taking?  Obvious question but often over looked  Alcohol vs. heroin  Inhalants vs. alcohol

5. © 2006 McGraw-Hill Higher Education. All rights reserved. When And Where Are Drugs Used?  The situation in which the drug is taken makes a big difference.  A 1 st grade teacher drinking on Saturday night at home vs. a 1 st grade teacher drinking during class.  Even if a subculture accepts the use of an illegal drug, it will distinguish between acceptable and unacceptable situations.  A group might accept marijuana smoking at a party but not when you are taking the kids to the soccer game or right before a multi-million dollar deal meeting.

6. © 2006 McGraw-Hill Higher Education. All rights reserved. Why A Person Takes Drugs?  Reasons for drug use often determine whether such use is of concern:  e.g., Vicodin the doctor prescribed for pain vs. Vicodin taken for pleasurable effects.  e.g., Drinking alcohol because you are out with friends vs. drinking alcohol alone in the morning to help get you out of bed.

7. © 2006 McGraw-Hill Higher Education. All rights reserved. How A Drug Is Taken?  An amount of cocaine that comes from chewing the coca leaves vs. that much cocaine snorted will lead to very different responses  How the drug is taken can also depend on how fast the user becomes addicted, how fast the response comes and how long it lasts How Much Of A Drug Is Taken?  This is often the difference between normal use and abuse; the difference between life and death

8. © 2006 McGraw-Hill Higher Education. All rights reserved. Four Principles Of Psychoactive Drugs  “Drugs” are not good or bad.  Every drug has multiple effects.  Both amount and quality of the drug influence the effect of the drug.  The effects of a drug also depend on the person.

9. © 2006 McGraw-Hill Higher Education. All rights reserved. History tells us that as long as humans have been around some have used, misused and abused some plants or substances.

10. © 2006 McGraw-Hill Higher Education. All rights reserved. Four Pharmacological Revolutions 1. Major communicable diseases under control – vaccines 2. Pharmacological revolution – antibiotics to treat illness of the body 3. Development of psychopharmacology drugs – treatment of mental illnesses 4. Development of oral contraception – drugs gave control over the body

11. © 2006 McGraw-Hill Higher Education. All rights reserved. Cultural Change in U.S.  After WWII, substance abuse was not a major concern  Soon after, concerns about alcohol came to the forefront  In the mid 1960s, LSD became a household word  Although Nixon declared a “War on Drugs”, there was still tolerance for drug use in the 1960s-70s.  In the 1980s to 1990s, less tolerance of differences including drugs  2000s, medicinal marijuana and “rave” subculture

12. © 2006 McGraw-Hill Higher Education. All rights reserved. Extent Of Drug Use  It is not possible to get accurate information on drug use.  It is not possible to get accurate information on quantity of drugs imported or sold.  Even estimates of beer or prescription drug use based on sales information may not be entirely accurate.

13. © 2006 McGraw-Hill Higher Education. All rights reserved. How We Get Information  Survey Based Questionnaires  What are the benefits?  What are some of the limitations?

14. © 2006 McGraw-Hill Higher Education. All rights reserved. Trends In Drug Use  Annual High School Senior survey  Prevalence of reported use  Attitude data and risk  Consider who is included and who is not included in this survey.

15. © 2006 McGraw-Hill Higher Education. All rights reserved. Marijuana: Trends in perceived availability, perceived risk of regular use, and prevalence of use in the past 30 days for 12 th graders

16. © 2006 McGraw-Hill Higher Education. All rights reserved. Lifetime Marijuana Use among Persons Ages 12-25, by group: 1965-2002

17. © 2006 McGraw-Hill Higher Education. All rights reserved. National Survey On Drug Use And Health  Face-to-face, computer-assisted interviews  68,000 individuals; carefully sampled households across the US  Broken down into different age groups  Results

18. © 2006 McGraw-Hill Higher Education. All rights reserved. Trends in reported drug use within the past 30 days for young adults ages 18 to 25

19. © 2006 McGraw-Hill Higher Education. All rights reserved. Correlates Of Drug Use  Age, gender, racial/ethnic grouping, education levels  SES- not a significant factor  Personality problems are poor predictors  Risk factors  Protective factors

20. © 2006 McGraw-Hill Higher Education. All rights reserved. Limitations Of Correlation Studies  Does smoking marijuana cause the user to get lower grades?  Are kids who are getting low grades more likely to smoke marijuana?

21. © 2006 McGraw-Hill Higher Education. All rights reserved. Motives For Drug Use  We all do things that we know are not right; e.g., eating too much, driving too fast, or drinking too much.  Fads and cultural trends influence what drugs are used.

22. © 2006 McGraw-Hill Higher Education. All rights reserved. Influences on drug use.

23. © 2006 McGraw-Hill Higher Education. All rights reserved. Chapter 2 Drug Use As A Social Problem

24. © 2006 McGraw-Hill Higher Education. All rights reserved. Costs Of Drug Use To Society Cost of maintaining habit Cost of treating patients Fetal alcohol syndrome Cost of criminal behavior Broken home, illness, shorter lives, etc. Drugs in the workplace Others? Emergency room visits

25. © 2006 McGraw-Hill Higher Education. All rights reserved. The Big Change  What made the government change from a laissez-faire attitude to one of control?  Toxicity  Dependence  Crime

26. © 2006 McGraw-Hill Higher Education. All rights reserved. Potency vs. Toxicity Potency: the amount of drug necessary to cause an effect. Toxicity: the capacity of a drug to do damage or cause adverse effects in the body.

27. © 2006 McGraw-Hill Higher Education. All rights reserved. Toxicity What makes a drug toxic? Amount used How it is used What the user did while on the drug

28. © 2006 McGraw-Hill Higher Education. All rights reserved. Examples of Drug-Induced Toxicity  Acute  Behavioral toxicity – “intoxication” that impairs the user’s actions and increases the danger to the individual.  Physiological – overdose that causes the user to stop breathing, the heart to stop, or causes other adverse side effects.

29. © 2006 McGraw-Hill Higher Education. All rights reserved. Examples of Drug-Induced Toxicity  Chronic  Social problems  Personality changes  Effects on friends and family  Change in lifestyle  Health problems  Heart disease  Lung cancer  Liver danger  Other health effects

30. © 2006 McGraw-Hill Higher Education. All rights reserved. Drug Abuse Warning Network  A system for reporting incidences of lethal and non-lethal drug related emergency in some U.S. metropolitan hospitals.  DAWN included improper use of prescription or over-the-counter drugs and the use of any other substance for psychic effect, dependence or suicide.  See table 2.2 on page 32 (data from 2002)  The top three mentions in ER episodes were Alcohol- in- combination, cocaine, and marijuana.  The top three mentions for fatalities were prescription narcotics, cocaine, and heroin/morphine.

31. © 2006 McGraw-Hill Higher Education. All rights reserved. Drug Abuse Warning Network  What it tells us about how dangerous a drug is?  What it does NOT tell us about how dangerous a drug is?

32. © 2006 McGraw-Hill Higher Education. All rights reserved. Blood Borne Diseases  Specific toxicity for injected drugs  AIDS, HIV and Hepatitis B and C  Why do the blood borne diseases spread so rapidly with these drug users?

33. © 2006 McGraw-Hill Higher Education. All rights reserved. Substance Dependence  What does an addict look like?  What do they take? Alcohol, cigarettes, illicit drugs, food, or computer time  How much time do they spend with their vice?  How much do they take?  What makes you decide the rules?

34. © 2006 McGraw-Hill Higher Education. All rights reserved. Substance Dependence  Three Basic Processes  Tolerance  Physical dependence  Psychological dependence

35. © 2006 McGraw-Hill Higher Education. All rights reserved. Tolerance  Tolerance is a diminished effect after repeated use of the same drug.  When tolerance develops, an increased amount of the drug is required to produce the same effects.

36. © 2006 McGraw-Hill Higher Education. All rights reserved. Physical Dependence  Physical dependence refers to the body’s requirement for the drug in order to function normally.  Tolerance may lead to physical dependence (but not always).  When the drug use is stopped promptly, withdrawal effect can happen  From mild (e.g., headaches, nausea) to severe (e.g., seizures, death).  Withdrawal symptoms differ among users and with different drugs.

37. © 2006 McGraw-Hill Higher Education. All rights reserved. Psychological Dependence  Psychological dependence is defined by the psychological/behavioral inability to stop using a drug.  Psychological dependence can be observed in person’s behavior, by the amount of time and effort the person spends seeking the drug.  It is not any less REAL than physical dependence.  Like physical dependence, psychological dependence has a physiological basis.  i.e., neurophysiological (body - mind are one)

38. © 2006 McGraw-Hill Higher Education. All rights reserved. Changing Views of Dependence  The medical model aims to treat the withdrawal symptoms, often associated with physical dependence.  The positive reinforcement model stresses that the consequences of drug use influence dependence.  Drug use is operant behavior.  Users don’t have to experience withdrawal symptoms to become addicted.

39. © 2006 McGraw-Hill Higher Education. All rights reserved. Substance Abuse and Dependence: DSM-IVTR  Substance abuse is considered maladaptive.  It is carefully separated from substance dependence  The essential feature of dependence is continued use despite significant substance- related problems known to user.

40. © 2006 McGraw-Hill Higher Education. All rights reserved. Drugs are not evil They can not do anything They can not have power Drugs are just objects that have effects on our body. Even our “War on Drugs” shows the perception that drugs are so evil that we have to wage a war on them.

41. © 2006 McGraw-Hill Higher Education. All rights reserved. Dependence is Biological  Biochemical or physiological actions in the brain  We can not scan the brain to determine if a person has developed dependence.  Researchers have searched for genetic, physiological, or biochemical markers.  To date, none have proven reliable predictors.

42. © 2006 McGraw-Hill Higher Education. All rights reserved. Personality  It is difficult to determine whether drug use changes personality.  Many other factors play a role in developing someone’s personality.

43. © 2006 McGraw-Hill Higher Education. All rights reserved. Dependence as a “Disease”  This is a popular notion.  Alcoholics Anonymous is based on this idea. Its founders and advocates believe that drug dependence should be treated as such.  Others argue that there are no tests that diagnose alcoholism.  There are ways to test and treat the effects but not the disease itself.  What are some potential problems with this label?

44. © 2006 McGraw-Hill Higher Education. All rights reserved. Drugs and Crime  Do drugs turn the person into the criminal type?  Do people under the influence of a drug commit crime?  More than half the murders in our nation in 2000 were associated with alcohol, as were two-thirds of all domestic violence.  What are the implications of these statistics?  Some forms of drug use are criminal behavior.  If someone is willing to commit one crime, they might be more willing to do other crimes.

45. © 2006 McGraw-Hill Higher Education. All rights reserved. Chapter 3 Drug Products and Their Regulation

46. © 2006 McGraw-Hill Higher Education. All rights reserved. Reformism  Race and fear used  Laws came to regulate moral behavior

47. © 2006 McGraw-Hill Higher Education. All rights reserved. Issues Leading To Legislation  Fraud in patent medicine  Hostetter’s Bitters 44% pure alcohol  Birney’s Catarrh Cure 4% cocaine  Opium  1890 federal act allowed only American citizens to import opium  Morphine  “Morphinism”  Cocaine  Mail order cocaine

48. © 2006 McGraw-Hill Higher Education. All rights reserved. Two Bureaus, Two Types Of Regulation  The Pure Food and Drug Act  Department of Agriculture  Ensures drugs were pure and honestly labeled  Harrison Act  Treasury Department  Taxing of drug for revenue

49. © 2006 McGraw-Hill Higher Education. All rights reserved. Regulation 1906 Pure Food And Drugs Act  Purity  The contents of the product must be correct and labeled correctly  1912 Sherley Amendment  Safety  Set up FDA as gatekeeper  Directions must be included  Effectiveness  1962 Kefauver-Harris Amendments

50. © 2006 McGraw-Hill Higher Education. All rights reserved. Making Of A New Drug  Preclinical research and development  Clinical research and development  Phase I  Phase II  Phase III  Permission to market

51. © 2006 McGraw-Hill Higher Education. All rights reserved. Making Of A New Drug Exceptions  Fast-track rule  Orphan Drug Law  Dietary Supplements

52. © 2006 McGraw-Hill Higher Education. All rights reserved. Controlled Substance  Early enforcement of the Harrison Act  18th Amendment  The Narcotic Division  Arresting physicians and pharmacists  Stiffer Penalties  Jones-Miller Act  Prohibited the importing of opium for heroin

53. © 2006 McGraw-Hill Higher Education. All rights reserved. Controlled Substance  Mandatory Minimum sentences  The Bureau of Narcotics  Drug Czar  Marijuana Tax Act  1956 Narcotic Drug Control Act

54. © 2006 McGraw-Hill Higher Education. All rights reserved. Drug Abuse Control Act Amendments Of 1965  Comprehensive Drug Abuse Prevention and Control Act 1970  Replaced or updated all laws  Federal vs State  Prevention and treatment  Control, not tax

55. © 2006 McGraw-Hill Higher Education. All rights reserved. Summary of Controlled Substance Schedules ScheduleCriteriaExamples I a. High potential for abuse b. No medical use c. Lack of accepted safety Heroin, Marijuana II a. High potential for abuse b. Current accepted medical use c. Abuse may lead to psychological or physical dependence MDMA, Morphine, Cocaine III a. Potential for abuse less then I and II b. Current accepted medical use c. Abuse may lead to physical dependence or high psychological dependence Anabolic steroids, most barbiturates IV a. Low Potential for abuse less then III b. Current accepted medical use c. Abuse may lead to limited physical or psychological dependence relative to III Vanax, barbital, Chloral hydrate, fenfluramine V a. Potential for abuse less then I and II b. Current accepted medical use c. Abuse may lead to physical dependence or high psychological dependence Mixture having small amounts of codeine or opium

56. © 2006 McGraw-Hill Higher Education. All rights reserved. Drug Abuse Control Act Amendments Of 1965  Possession and Selling Penalties  Omnibus Drug Act  Loss of Benefits  Drug precursors  Drug paraphernalia  Office of National Drug Control Policy

57. © 2006 McGraw-Hill Higher Education. All rights reserved. Americans in Prison

58. © 2006 McGraw-Hill Higher Education. All rights reserved. State And Local Regulations  Difference in penalties from state to state  Federal law overrides state  Federal Support for Urine Screening  Military led the way  More advanced screening  Transportation and private companies test  Schools test  Testing methods  Different test different results

59. © 2006 McGraw-Hill Higher Education. All rights reserved. Impact Of Drug Enforcement  People  Budget  International programs  Other costs  Effectiveness of Control