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Chapter 2

Drug Use as a Social Problem

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Two Categories of Problems

Problems related to taking the drug

risk of developing drug dependence

risk of overdose

Problems related to drug use as deviant behavior

arrests, fines, jailing

expenses associated with drug prevention and treatment

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Changes in U.S. Drug Laws

U.S. changed from a laissez-faire attitude (1800s) to one of tight drug restrictions

Why?

Three main concerns

Toxicity

dangerous chemicals?

Dependence

habit-forming compounds?

Crime

drug users become dangerous?

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Drug-Related Toxicity

Toxic

poisonous, deadly, or dangerous

Physiological versus Behavioral toxicity

Acute versus Chronic toxicity

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Physiological Toxicity

Acute

Prescription painkiller overdose (the user stops breathing)

Chronic

High blood pressure

Heart disease

Lung cancer

Cirrhosis

Chronic physiological toxicity (cirrhosis)

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Behavioral Toxicity

Acute

“Drunk driving”

Intoxication that dangerously impairs behavioral functioning

Chronic

Deleterious lifestyle changes

Strain on interpersonal relationships

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Drug Abuse Warning Network

A system for collecting data on drug-related emergency room visits

Data collected at some U.S. metropolitan hospitals

DAWN collects data on:

Illicit drugs

Misuse of legal prescription and OTC drugs

Does not determine whether drugs caused the ER visit

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DAWN Toxicity Data

ER Visits

Alcohol-in-combination
Cocaine
Prescription Opioids
Marijuana
Benzodiazepines
Heroin
Methamphetamine
Antidepressants
PCP
Antipsychotics

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Drug Abuse Warning Network

Does DAWN tell us how dangerous a drug is?

Data are simply number of mentions in total ER visits

What does DAWN not tell us?

Relative danger of a drug

How many problems as a proportion of total drug users?

Cause of ER visit

Drugs are mentioned in every case regardless of the cause of the accident

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Specific toxicity for users who inject drugs

Not due to the action of drug itself

Sharing needles passes infectious agents directly into bloodstream

AIDS, HIV infection, and hepatitis B and C

Syringe exchange programs

Example of harm reduction

Funded by some local governments

Lowers rate of infection

Blood-Borne Diseases

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Image source: © Creatas/PunchStock (Image Ch02_06Syringe)

What is the definition of “addiction”?

Often difficult to define

Does it matter?

What drug is ingested?

How much time is spent on drug-taking?

How much drug is ingested?

When does drug use go from “recreational” to “problematic”?

Problematic Drug Use

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Three basic processes that may occur with repeated drug use

Tolerance

Physical dependence

Psychological dependence

These processes can be defined and studied by researchers interested in understanding drug dependence

Substance Dependence

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Diminished effect of the drug after repeated use

Individual may need to use more of the drug to experience the desired effects

Tolerance

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

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Physical dependence is defined by the occurrence of a withdrawal syndrome

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

Tolerance typically precedes physical dependence

Physical dependence means the body has adapted to the presence of the drug

Physical Dependence

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Often characterized by:

High frequency of drug use

Craving for the drug

Tendency to relapse after stopping use

Behavioral psychology contextualizes psychological (or behavioral) dependence as:

Drug-taking is reinforced by consequences (the drug effects)

Research evidence:

Laboratory animals will lever-press for injections of many drugs of abuse

Psychological Dependence

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Early medical models (before 1960)

True addiction involves physical dependence

Key is treatment of withdrawal symptoms

But what about drugs with no clear withdrawal symptoms?

Positive reinforcement model (1960s)

Drugs can reinforce behavior without physical dependence

Psychological dependence–based on reinforcement–is increasingly viewed as the driving force behind repeated drug use

Changing Views of Dependence

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Diagnostic and Statistical Manual of Mental Disorders (DSM-5)

Developed by the American Psychiatric Association

Provides diagnostic criteria and definitions for multiple disorders

Focuses on complex behavioral definitions

DSM-5: Substance Use Disorders

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A problematic pattern of substance use leading to clinically significant impairment or distress, as manifested by at least two of eleven possible symptoms, occurring within a 12-month period

Diagnosis is complex

Nine of the possible symptoms are behavioral

Two of the possible symptoms are physiological

Note: physiological symptoms do not need to be present to receive the diagnosis

Severity of the disorder

Mild = 2–3 symptoms

Moderate = 4–5 symptoms

Severe = 6 or more symptoms

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DSM-5: Substance Use Disorders

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Some drugs are more likely than others to lead to dependence

Nicotine versus marijuana for example

But many other non-drug factors influence risk of dependence

Is Dependence Caused by the Substance?

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

Many studies investigating genetic, physiological, and/or biochemical markers:

Data suggest physiological consequences of drug taking

Data suggest a role genetic factors in developing dependence

But specific genetic or other biological causes of dependence have not been determined

Is Dependence Biological?

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No way to know if the drug or the drug use changes an individual’s personality

Many other factors affect personality

Sensation-seeking

A personality characteristic statistically associated with early substance use and abuse

Is there an Addictive Personality?

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Alcohol dependence often exists within the framework of a dysfunctional family

Evidence suggests that dysfunctional relationships play a role in dependence

But there are several factors contributing to dependence

Is Dependence a Family Disorder?

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Founders of AA characterized alcohol dependence as a disease

Others argue that dependence doesn’t have all the characteristics of a disease

There are no tests to reveal the underlying cause

Better to think of “disease” as an analogy for dependence?

Biopsychosocial perspective:

Dependence is related to dysfunctions of biology, personality, social interactions

Is Substance Dependence a Disease?

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Issue 1: Drug use may change a person’s personality

Little empirical evidence to support this

Indicators of criminal or antisocial behavior precede drug use

Issue 2: People under the influence may commit crimes

Little evidence that illicit drugs cause criminal behavior

Many studies link alcohol to violent crime

Does Drug Use Cause Crime?

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Issue 3: Crimes may be carried out to obtain money for drugs

Issue 4: Drug use itself is a crime

Does Drug Use Cause Crime?

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Legitimate social purpose

We want to protect society from the dangers of some types of drug use

However, some laws are not developed as part of a rationally devised plan

May not be realistic or effective

Why We Try to Regulate Drugs

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