Community Health Chapter 12 Discussion

Chapter 12

Alcohol, Tobacco, and

Other Drugs: A

Community Concern

Introduction

• Use, misuse, and abuse of mind-altering

substances predates recorded history

• Chronic alcohol and other drug abuse or

dependence is regarded as destructive behavior

in most cultures

• Affects individuals and the surrounding

community

Scope of the Current Drug Problem

• More deaths, illnesses, and disabilities can be

attributed to substance abuse than any other

preventable health condition

• Economic costs include direct costs (health

care, premature death, impaired productivity)

and indirect costs (crime and law enforcement,

courts, jails, social work)

• Those abusing are threats to themselves, their

families, and their communities

Annual Cost in Lives and Economic Cost

in $ Billions

Drug Use Among High School Seniors

Definitions

• Drug

• Psychoactive drugs

• Drug use

• Drug misuse

• Drug abuse

• Drug (chemical) dependence

• Psychological dependence

Factors that Contribute to Alcohol,

Tobacco, and Other Drug Abuse

• Risk factors – factors that increase the probability

of drug use

• Protective factors – factors that lower the

probability of drug use

• Both can be genetic or environmental

Inherited Risk Factors

• Most research related to drug dependence and

inherited risk is on alcoholism

• Research has shown genetic and biological

markers may predispose someone to increased

susceptibility to develop alcohol-related

problems

Environmental Risk Factors

• Personal factors

• Home and family life

• School and peer groups

• Sociocultural environment

Types of Drugs Abused and Resulting

Problems • Legal drugs

• Alcohol, nicotine, nonprescription (over-the-

counter) drugs, prescription drugs

• Controlled substances and illegal (illicit) drugs

• Marijuana, narcotics, cocaine and crack

cocaine, hallucinogens, stimulants, depressants,

club drugs and designer drugs, anabolic drugs,

inhalants

Legal Drugs

• Can be legally bought and sold in the

marketplace

• Includes drugs that can be closely regulated,

likely regulated, and not regulated at all

Alcohol

• Number one drug problem in the United States

• Binge drinking

• Underage drinking

• Problem drinkers

• Alcoholism

• Blood alcohol concentration (BAC)

• Fetal Alcohol Spectrum Disorders

• Fetal Alcohol Syndrome

Nicotine

• Psychoactive and addictive drug present in

tobacco products

• Environmental tobacco smoke (ETS) or

secondhand smoke

• Synar Amendment

• Tobacco use is single most preventable cause

of disease, disability, and death in the U.S.

• Community efforts: tax increases on cigarettes

Over the Counter Drugs (OTCs)

• Legal drugs other than alcohol and tobacco

that can be purchased without a physician’s

prescription

• Carefully regulated by the Food and Drug

Administration (FDA)

• Most only provide symptomatic relief, not a

cure

• Subject to misuse and abuse

Prescription Drugs

• Can be purchased only with a physician’s

prescription because they have serious side

effects for some people

• Regulated by the FDA

• Subject to misuse and abuse

• Risk of dependence and unintentional

overdose

• Development of drug-resistant strains of

pathogens

Controlled Substances and Illicit Drugs

• Those regulated by the Controlled Substances

Act of 1970

• Cannot be cultivated, manufactured, bought,

sold, or used within the confines of the law

• Schedule I – high potential for abuse; no

accepted medical uses

• Schedules II-V – have medical uses; scheduled

based on potential for risk of dependence or

abuse

• Drug Enforcement Agency (DEA) responsible

for enforcing Controlled Substances Act

Marijuana

• Products derived from hemp plant

• Most abused illicit drug in the U.S.

• Often used in conjunction with other drugs –

polydrug use

• Acute effects – reduced concentration, slowed

reaction time, impaired short term memory,

impaired judgment

• Chronic effects – damage to the respiratory

system (if smoked), amotivational syndrome

Synthetic Marijuana

• Emerging cause for concern

• Chemically produced with properties similar to

THC

• Pose serious threat to communities – potential for

abuse and other adverse health effects, long-term

effects unknown

• In 2011, five chemicals used to produce synthetic

marijuana were added to Schedule I of the CSA

• States have banned synthetic marijuana

Narcotics

• Opium and its derivatives, morphine and

heroin, come from an oriental poppy plant

• Narcotics numb the senses and reduce pain

• High potential for abuse

• Opium poppies do not grow in U.S.; drug

trafficking problems

• Heroin addiction leads to significant

community health problems

Cocaine and Crack Cocaine

• Cocaine is the psychoactive ingredient in the

leaves of the coca plant

• Powerful and addictive euphoriant/stimulant

• Purified forms – salt (white powder), dried

paste (crack)

• In 2012, annual prevalence of cocaine use

among high school seniors at lowest reported

level of 2.7%

Hallucinogens

• Produce illusions, hallucinations, changes in

perceptions

• Synesthesia – mixing of the senses

• Both naturally derived and synthetic

• LSD, mescaline, peyote, mushrooms

Stimulants

• Drugs that increase the activity of the central

nervous system

• Amphetamines

• Schedule II prescription drugs; widely abused

• Methamphetamines often made in clandestine

labs

Clandestine Laboratory Incidents

Depressants

• Slow down the central nervous system

• May lower anxiety and inhibitions

• Tolerance develops

• Strong physical dependence

• Alcohol, barbiturates, benzodiazapines

Club Drugs and Designer Drugs

• Illicit drugs, primarily synthetic, most

commonly encountered at nightclubs and raves

• MDMA (ecstasy) most popular club drug

• Rohypnol – “date rape” drug

• Designer drugs – synthesized by amateur

chemists in secret labs

• Constantly change design to stay ahead of law

enforcement

Anabolic Drugs

• Protein-building drugs

• Anabolic/androgenic steroids, testosterone,

human growth hormone

• Have some legitimate medical uses

• Sometimes abused by athletes and body

builders

• Acute and chronic side effects

Inhalants

• Collection of psychoactive breathable

chemicals

• Paint solvents, motor fuels, cleaners, glues,

aerosol sprays

• Easy availability

• Low cost

• Often drug choice of young

• Acute and chronic effects

Prevention and Control of Drug Abuse

• Requires knowledge of:

• Causes of drug-taking behavior

• Sources of illicit drugs

• Drug laws

• Treatment programs

• Community organizing skills

• Persistence, and cooperation of various

individuals and agencies

Levels of Prevention

• Primary prevention aimed at those who have

never used drugs

• Secondary prevention aimed at those who have

used, but are not chronic abusers

• Tertiary prevention aimed at drug abuse

treatment and aftercare, including relapse

prevention

Elements of Prevention

• Education

• Treatment

• Public policy

• Law enforcement

• Education and treatment goals same:

• Reduce demand for drugs

• Public policy and law enforcement goals same:

• Reduce supply and availability of drugs

Governmental Drug Prevention and

Control Agencies and Programs

• Include a multitude of federal, state, and local

agencies

• Aim to reduce either the supply or demand for

drugs

Federal Drug Control Spending

Federal Drug Control Spending

Federal Agencies and Programs

• Office of National Drug Control Policy

• Department of Justice

• Bureau of Alcohol, Tobacco, Firearms, and

Explosives (ATF)

• Department of Health and Human Services

• Substance Abuse and Mental Health Services

Administration (SAMSHA)

• National Institute on Drug Abuse

• Department of Homeland Security

State and Local Agencies and

Programs • State departments of health, education, mental

health, justice, and law enforcement all address

drug abuse prevention and control issues

• Some states have passed laws that conflict

with federal laws

• Local communities have individuals, task

forces, or agencies to prioritize problems and

decide approaches for solving them

Nongovernmental Drug Prevention and

Control Agencies and Programs

• Community-based drug education programs

• School-based drug education programs

• DARE, student assistance programs, peer

counseling programs

• Workplace-based drug education programs

• Employee assistance programs

• Voluntary health agencies

Discussion Questions

• How can risk factors for drug abuse be utilized

to aide in drug abuse prevention?

• How should federal, state, and local funds be

used to successfully deal with drug abuse

problems?