hart13 ppt ch02

© 2011 McGraw-Hill Higher Education. All rights reserved.

Chapter 2Chapter 2Drug Use as a Social Drug Use as a Social

ProblemProblem


Costs of Drug Use to SocietyCosts of Drug Use to Society

Deaths Emergency room visits Drugs in the workplace and lost productivity Broken homes, illnesses, shorter lives, etc. Cost of maintaining habit Cost of criminal behavior Cost of treating patients Fetal alcohol syndrome Others?


Changing AttitudesChanging Attitudes

What made the government change What made the government change from the laissez-faire attitude of the from the laissez-faire attitude of the 1800s to one of control?1800s to one of control? ToxicityToxicity DependenceDependence CrimeCrime


ToxicityToxicity

Toxic = poisonous, deadly, or dangerous

What makes a drug toxic?

Amount used

How it is used

What the user did while on the drug


ToxicityToxicity

Physiological toxicity vs. behavioral toxicityPhysiological toxicity vs. behavioral toxicity Acute effects vs. chronic effects Acute effects vs. chronic effects

Acute behavioral toxicity (drunk driving) Chronic physiological toxicity (cirrhosis)


Drug-Related ToxicityDrug-Related Toxicity

Examples of acute toxicityExamples of acute toxicity Behavioral: “Intoxication” that impairs the Behavioral: “Intoxication” that impairs the

actions of drug users and increases the actions of drug users and increases the danger to themselves and othersdanger to themselves and others

Physiological: Overdose that causes the Physiological: Overdose that causes the user to stop breathinguser to stop breathing


Drug-Related ToxicityDrug-Related Toxicity

Examples of chronic toxicityExamples of chronic toxicity BehavioralBehavioral

Personality and lifestyle changesPersonality and lifestyle changes Effects on relationships with friends and familyEffects on relationships with friends and family

Physiological Physiological Heart diseaseHeart disease Lung cancerLung cancer CirrhosisCirrhosis Other health effectsOther health effects


DDrug rug AAbuse buse WWarning arning NNetworketwork

A system for collecting data on drug-A system for collecting data on drug-related deaths and emergency room visits related deaths and emergency room visits at at somesome U.S. U.S. metropolitanmetropolitan hospitals hospitals

DAWN collects data on DAWN collects data on improper use of legal improper use of legal prescription and over-prescription and over-the-counter drugs as the-counter drugs as well as illicit drugswell as illicit drugs



Alcohol is reported only Alcohol is reported only in combination with other in combination with other drugsdrugs

Drug-alcohol and drug-Drug-alcohol and drug-drug combinations are drug combinations are very common very common


DDrug rug AAbuse buse WWarning arning NNetworketworkToxicity DataToxicity Data

ER VisitsER Visits1.1. CocaineCocaine

2.2. Alcohol-in-Alcohol-in-combinationcombination

3.3. MarijuanaMarijuana

4.4. Prescription OpioidsPrescription Opioids

5.5. BenzodiazepinesBenzodiazepines

DeathsDeaths1.1. Prescription Opioids Prescription Opioids

(not heroin)(not heroin)

2.2. CocaineCocaine

3.3. Alcohol-in-Alcohol-in-combinationcombination

4.4. BenzodiazepinesBenzodiazepines

5.5. MethadoneMethadone



What it tells us about how dangerous a What it tells us about how dangerous a drug isdrug is Simply gives us total deaths/ER visitsSimply gives us total deaths/ER visits

What it does not tell us about how What it does not tell us about how dangerous a drug isdangerous a drug is Consider relative danger vs. total impact of Consider relative danger vs. total impact of

the drug the drug Number of users vs. number of reported Number of users vs. number of reported

problemsproblems


Blood-Borne DiseasesBlood-Borne Diseases

Specific toxicity for users who inject drugsSpecific toxicity for users who inject drugs AIDS, HIV infection, and hepatitis B and CAIDS, HIV infection, and hepatitis B and C Sharing needles passes infectious agents Sharing needles passes infectious agents

directly into the bloodstreamdirectly into the bloodstream Some states, cities prohibitSome states, cities prohibit

needle purchase without Rxneedle purchase without Rx Syringe exchange programsSyringe exchange programs


Substance DependenceSubstance Dependence

What do “addicts” look like?What do “addicts” look like? What drug do they take or what behavior do they What drug do they take or what behavior do they

engage in (alcohol, cigarettes, illicit drugs, food, engage in (alcohol, cigarettes, illicit drugs, food, sex, gambling, shopping, computer time)? sex, gambling, shopping, computer time)?

How much time do they spend on their habit?How much time do they spend on their habit? How much of a drug do they take?How much of a drug do they take? How do you decide on the definition of How do you decide on the definition of

dependence?dependence?


Substance DependenceSubstance Dependence

Three basic Three basic processesprocesses ToleranceTolerance Physical Physical

dependencedependence Psychological Psychological

dependencedependence


ToleranceTolerance

Diminished effect on the body after Diminished effect on the body after repeated use of the same drugrepeated use of the same drug

The body develops ways to compensate The body develops ways to compensate for the chemical imbalance caused by the for the chemical imbalance caused by the drugdrug

Regular drug users may build up tolerance Regular drug users may build up tolerance to the extent that their dosage would kill a to the extent that their dosage would kill a novice usernovice user


Physical DependencePhysical Dependence

Physical dependence is defined by the Physical dependence is defined by the occurrence of a withdrawal syndromeoccurrence of a withdrawal syndrome

Tolerance typically precedes physical Tolerance typically precedes physical dependencedependence

If drug use is stopped suddenly, If drug use is stopped suddenly, withdrawal symptoms occur, ranging from withdrawal symptoms occur, ranging from mild to severemild to severe

Physical dependence means the body has Physical dependence means the body has adapted to the drug’s presenceadapted to the drug’s presence


Psychological DependencePsychological Dependence

Psychological or Psychological or behavioral dependence behavioral dependence High frequency of drug useHigh frequency of drug use Craving for the drugCraving for the drug Tendency to relapse after Tendency to relapse after

stopping usestopping use Behavior is reinforced by Behavior is reinforced by

the consequencesthe consequences Over time, this becomes the Over time, this becomes the

biggest reason users report biggest reason users report they continue to usethey continue to use


Changing Views of Changing Views of DependenceDependence

Early medical model = true addiction involves Early medical model = true addiction involves physical dependence; key is treatment of withdrawal physical dependence; key is treatment of withdrawal symptomssymptoms

Positive reinforcement model = drugs can reinforce Positive reinforcement model = drugs can reinforce behavior without physical dependencebehavior without physical dependence

Psychological dependence is increasingly viewed as Psychological dependence is increasingly viewed as the driving force behind repeated drug usethe driving force behind repeated drug use This refutes the sometimes common belief that drugs that This refutes the sometimes common belief that drugs that

aren’t as strongly physically addicting are less dangerousaren’t as strongly physically addicting are less dangerous


Substance Abuse and Substance Abuse and Dependence: DSM-IV-TRDependence: DSM-IV-TR

APA diagnostic criteria for abuse and APA diagnostic criteria for abuse and dependence (page 36)dependence (page 36)

Complex behavioral definitionsComplex behavioral definitions Dependence can occur with or without Dependence can occur with or without

physiological dependence (i.e., withdrawal)physiological dependence (i.e., withdrawal)


Substance Dependence: Substance Dependence: DSM-IV-TRDSM-IV-TR

A maladaptive pattern of substance use leading to clinically significant A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by three (or more) of the following, impairment or distress, as manifested by three (or more) of the following, occurring at any time in the same 12-month period:occurring at any time in the same 12-month period:1.1. ToleranceTolerance

2.2. WithdrawalWithdrawal

3.3. Substance often taken in larger amounts or over a period longer than Substance often taken in larger amounts or over a period longer than intended intended

4.4. Persistent desire or unsuccessful efforts to cut down or control substance Persistent desire or unsuccessful efforts to cut down or control substance useuse

5.5. A great deal of time is spent in obtaining the substanceA great deal of time is spent in obtaining the substance

6.6. Important social, occupational, or recreational activities are given up or Important social, occupational, or recreational activities are given up or reduced because of substance usereduced because of substance use

7.7. Substance use continues despite knowledge of having a persistent or Substance use continues despite knowledge of having a persistent or recurrent problem that is caused or exacerbated by the substancerecurrent problem that is caused or exacerbated by the substance


Substance Abuse: Substance Abuse: DSM-IV-TRDSM-IV-TR

A maladaptive pattern of substance use leading to A maladaptive pattern of substance use leading to clinically significant impairment or distress, as clinically significant impairment or distress, as manifested by one or more of the following occurring at manifested by one or more of the following occurring at any time in the same 12-month period:any time in the same 12-month period:1.1. Recurrent substance use resulting in failure to fulfill major role Recurrent substance use resulting in failure to fulfill major role

obligations at work, school, or homeobligations at work, school, or home

2.2. Recurrent substance use in situations in which it is physically Recurrent substance use in situations in which it is physically hazardoushazardous

3.3. Recurrent substance-related legal problemsRecurrent substance-related legal problems

4.4. Continued substance use despite having persistent or Continued substance use despite having persistent or recurrent social or interpersonal problems caused or recurrent social or interpersonal problems caused or exacerbated by the effects of the substanceexacerbated by the effects of the substance


.

Is Dependence Is Dependence Caused by the Substance?Caused by the Substance?

Some drugs are more likely Some drugs are more likely than others to lead to than others to lead to dependencedependence

Method of use, as well as Method of use, as well as other factors, influences risk other factors, influences risk of dependenceof dependence

The “war on drugs” reflects The “war on drugs” reflects the perspective that drugs are the perspective that drugs are themselves evilthemselves evil


Is Dependence Biological? Is Dependence Biological?

Is dependence due to biochemical or Is dependence due to biochemical or physiological actions in the brain?physiological actions in the brain?

Still no way to scan the brain and know if a Still no way to scan the brain and know if a person has/had developed dependenceperson has/had developed dependence Genetic physiological or biochemical markers Genetic physiological or biochemical markers

have been sought as well, but none has have been sought as well, but none has proven reliableproven reliable


Is There an “Addictive Is There an “Addictive Personality”? Personality”?

No way to know if the drug or the drug use No way to know if the drug or the drug use changes a person’s personalitychanges a person’s personality

Many other factors affect personalityMany other factors affect personality Sensation-seeking = a personality Sensation-seeking = a personality

characteristic statistically associated with characteristic statistically associated with early substance use and abuseearly substance use and abuse


Is Dependence a Family Is Dependence a Family Disorder?Disorder?

Alcohol dependence Alcohol dependence often exists within a often exists within a dysfunctional familydysfunctional family

Evidence suggests that Evidence suggests that dysfunctional dysfunctional relationships play a role relationships play a role in dependence, but they in dependence, but they aren’t the only factoraren’t the only factor


Is Substance Dependence a Is Substance Dependence a Disease? Disease?

Founders of AA characterized alcohol Founders of AA characterized alcohol dependence as a disease dependence as a disease

Others argue that dependence doesn’t Others argue that dependence doesn’t have all the characteristics of a diseasehave all the characteristics of a disease There are ways to test and treat the effects of There are ways to test and treat the effects of

alcoholism but not the disease itselfalcoholism but not the disease itself There is some disagreement over how to There is some disagreement over how to

define disease as welldefine disease as well


Biopsychosocial PerspectiveBiopsychosocial Perspective

Dependence is related to Dependence is related to dysfunctions of:dysfunctions of: BiologyBiology PersonalityPersonality Social interactionsSocial interactions


Drugs and CrimeDrugs and Crime

Drug use may change a Drug use may change a person’s personalityperson’s personality

People under the People under the influence may commit influence may commit crimescrimes (e.g., many cases (e.g., many cases of homicide, domestic of homicide, domestic violence, etc.)violence, etc.)


Drugs and CrimeDrugs and Crime

Crimes may be Crimes may be carried out to obtain carried out to obtain money for drugsmoney for drugs

Drug use is a crimeDrug use is a crime


Why We Regulate DrugsWhy We Regulate Drugs

We want to protect society from the We want to protect society from the dangers of some types of drug use = dangers of some types of drug use = legitimate social purposelegitimate social purpose

Some laws are not developed as part of a Some laws are not developed as part of a rationally devised plan and may not be rationally devised plan and may not be realistic or effective realistic or effective Current lawsCurrent laws


Chapter 2Chapter 2

Drug Use as a Social ProblemDrug Use as a Social Problem

hart13 ppt ch02

Documents

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mcgrawhill higher education

drug regular drug users

drug tendency

drugs drugalcohol

drug toxic

repeated drug use

costs of drug use