behavior 3

YourHealthTodayChapter10.pptx

10: Drugs

Your Health Today, 6th edition

©McGraw-Hill Education. All rights reserved. Authorized only for instructor use in the classroom. No reproduction or further distribution permitted without the prior written consent of McGraw-Hill Education.

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)

©McGraw-Hill Education.

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%

©McGraw-Hill Education.

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) 15-4927, Figure 1, p. 4, Rockville, MD: SAMHSA, September 2015, www.samhsa.gov/ data/sites/default/files/NSDUH-FRR1-2014/NSDUH-FRR1-2014.pdf.

©McGraw-Hill Education.

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) 15-4927, Figure 2 table, p. 5, Rockville, MD: SAMHSA, September 2015, www. samhsa.gov/data/sites/default/files/NSDUH-FRR1-2014/NSDUH-FRR1-2014.pdf.

©McGraw-Hill Education.

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

©McGraw-Hill Education.

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

©McGraw-Hill Education.

Figure 10.3 Source of pain relievers for most recent nonmedical use among past-year users aged 12 or older, 2012–2013.

Jump to long image description

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) 14-4863. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2014, www.samhsa.gov/data/sites/default/files/NSDUHresultsPDFWHTML2013/Web/ NSDUHresults2013.pdf

©McGraw-Hill Education.

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

©McGraw-Hill Education.

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

©McGraw-Hill Education.

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

©McGraw-Hill Education.

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

©McGraw-Hill Education.

Table 10.1 Routes of Administration

Route	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

©McGraw-Hill Education.

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

©McGraw-Hill Education.

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

©McGraw-Hill Education.

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

©McGraw-Hill Education.

Drugs of Abuse

Drugs of abuse are usually classified as

Stimulants

Depressants

Opioids

Hallucinogens

Inhalants

Cannabinoids

©McGraw-Hill Education.

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

©McGraw-Hill Education.

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)

©McGraw-Hill Education.

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)

©McGraw-Hill Education.

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

©McGraw-Hill Education.

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

©McGraw-Hill Education.

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

©McGraw-Hill Education.

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

©McGraw-Hill Education.

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

©McGraw-Hill Education.

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

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

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

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

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

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

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

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?

Appendix A

Long image descriptions

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

Jump back to slide containing original image