I dare someone to do it in 6 hours

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Dr. Lana Zinger, QCCCUNY

Addiction and Drug Abuse

Defining Addiction

� Defined as continued involvement with a substance or activity despite its ongoing negative consequences.

� When the individual eventually needs to consume the addictive substance or enact the behavior to feel normal.

� Classified by the American Psychiatric Association (APA) as a mental disorder

Defining Addiction

� Physiological/Psychological Dependence

• Inextricably tied together

• Addiction traditionally based on four criteria:

1. Relief of withdrawal symptoms

2. Continued use despite harm to self and others

3. Unsuccessful efforts to cease using or cut down on use, including relapse

4. Tolerance

Defining Addiction

� Signs of Addiction

• Addictions are characterized by four common symptoms

1. Compulsion (can include obsession)

2. Loss of control

3. Negative consequences

4. Denial

• Process Addictions

• Behaviors known to be addictive because they are mood altering

Addictive Behaviors

� Compulsive or Pathological Gambling

• Cravings or highs similar to those experienced by drug users

• Often seek the excitement more than the money

• Incidence higher in men, lower-income individuals, those who are divorced, African Americans, older adults, those living within 50 miles of a casino, and college students

• 38 percent have cardiovascular problems

• Suicide rate 20 times higher than that of general population

Addictive Behaviors

� Compulsive Spending

• On average, compulsive spenders are $23,000 in debt.

• Compulsive spending often leads to compulsive borrowing to help support addiction.

� Symptoms that a spender has crossed the line into addiction include

• Buying more than one of the same item

• Keeping items in the closet with the tags still attached

• Repeatedly buying much more than the person needs or can afford

• Hiding purchases from relatives and loved ones

• Experiencing feelings of excitement when shopping

Addictive Behaviors

� Exercise Addiction

• About 2 million people with anorexia nervosa and bulimia nervosa use exercise to purge instead of, or in addition to, self-induced vomiting

• Try to meet needs for nurturance, intimacy, self-esteem, and self- competency that an object or activity cannot truly meet

• Men are increasingly abusing steroids and overexercising to attain an ideal frame

• Muscle dysmorphia (bigarexia) is a pathological preoccupation with being larger and more muscular

• Symptoms include excessive weight lifting, excessive exercising, and steroid or supplement abuse

Addictive Behaviors

� Technology Addictions

• Cell phones, video games, PDAs, networking sites, and the Internet can all be addictive.

• An estimated 5 to 10 percent of Internet users will likely experience Internet addiction.

• Symptoms include general disregard for one’s health, sleep deprivation, neglecting family and friends, lack of physical activity, euphoria when online, lower grades in school, and poor job performance.

• Compensation for feelings of loneliness, marital or work problems, a poor social life, or financial problems

Addiction Affects Family and Friends

� Codependence

• Pattern of behavior

• Person becomes “addicted to the addict”

• Disregard personal needs in order to meet needs or desires of addict

� Enabling

• Knowingly or unknowingly protects addict from consequences of behavior

• Rarely conscious and generally unintentional

Drug Dynamics

� Abuse often associated with illegal drugs, but many people abuse and misuse legal drugs

• Drug misuse—use for purpose not intended

• Drug abuse—excessive use

• Misuse and abuse may lead to addiction

• Drug and alcohol abuse contributes to more than 120,000 American deaths a year

• Costs $294 billion in preventable health care expenses annually.

• Although overall use of drugs in the United States has fallen by 50 percent in the past 20 years, the past 10 years have shown an increase in the use of certain drugs by adolescents.

Drug Dynamics

� How Drugs Affect the Brain

• Mesolimbic dopamine—neurons relay messages about pleasure

• Psychoactive drugs—affects chemical neurotransmission, either enhancing it, suppressing it, or interfering with it

• Some people’s bodies naturally produce insufficient quantities of neurotransmitters, which predisposes them to addictions such as alcohol, drugs, or exercise

The Action of Cocaine at Dopamine Receptors in the Brain, an Example of Psychoactive Drug Action

Drug Dynamics

� Types of Drugs

• Prescription—more than 10,000 types sold in U.S

• Over-the-counter (OTC) drugs—no prescription needed

• Recreational—alcohol, tobacco, coffee, etc.

• Herbal preparations—products of plant origin

• Illicit (illegal)—all are psychoactive

• Commercial preparations—household cleaners, pesticides, etc.

Drug Dynamics

• Routes of Drug Administration

• Oral

• Injection

• Intravenous—into bloodstream

• Intramuscular—into muscle

• Subcutaneous—just under the skin

• Inhalation

• through the nose or mouth

• Inunction

• through the skin

• Suppositories

• through the vagina or anus

Drug Dynamics

� Drug Interactions

• Polydrug Use

• Taking several substances simultaneously

• Synergism

• Effects are multiplied

• Expressed as 2 + 2 = 10

• Example: Alcohol and barbiturates

• Antagonism

• Work at same receptor

• Inhibition—the effects of one drug are eliminated or reduced by the presence of another drug

• Example: Alcohol and antibiotics

Drug Dynamics

• Intolerance

• When drugs combine to produce extremely uncomfortable reactions

• Example: Antabuse and alcohol

• Cross-tolerance

• Tolerance for one drug creates a similar reaction to another drug

• Example: Alcohol and barbiturates

Abuse of Over-the-Counter (OTC) Drugs

• Nonprescription medicine

• High doses can cause hallucinations, bizarre sleep patterns, mood changes, and sometimes death.

• Those most vulnerable to abusing OTC drugs are teenagers, young adults, and people over the age of 65.

Abuse of Over-the-Counter (OTC) Drugs

� Sleep Aids

• Excedrin PM, Sominex, Unisom, and Tylenol PM

• Can cause problems with the sleep cycle, weaken areas of the body, or induce narcolepsy

� Cold Medicines

• Robitussin, Vicks, Coricidin, and NyQuil

• Dextromethorphan (DXM) can cause hallucinations, loss of motor control, and “out-of body” sensations

• Pseudoephedrine is being used to illegally manufacture methamphetamine

� Diet Pills

• Contain stimulants such as caffeine or Hoodia gordonii

Prescription Drug Abuse

• 15.2 million people over the age of 12 (6.2%) report abusing controlled prescription drugs in the past year.

• Prescription drug abuse is particularly common among teenagers.

• Abuse of opioids, narcotics, and pain relievers can result in life-threatening respiratory depression (reduced breathing).

• Abuse of depressants, including benzodiazepines, tranquilizers, barbiturates, and sedatives can result in seizures, respiratory depression, and decreased heart rate.

• Abuse of stimulants can cause elevated body temperature, irregular heart rate, cardiovascular system failure, and fatal seizures.

Prescription Drug Abuse

� College Students and Prescription Drug Abuse

• Increased dramatically over the past decade

• Marijuana use has risen in recent years.

• Students who abuse Adderal and Ritalin say they help them concentrate and study to increase alertness.

• Students who abuse Vicodin, OxyContin, or Percocet say they do so to relax or get high.

• College men are more likely to abuse prescription drugs than women.

Illicit Drugs

� Users of Illicit Drugs

• In 2004, an estimated 20.4 million Americans were illicit drug users.

• Among youth, marijuana use has been rising in recent years.

� Drug Use on Campus

• In 2006 51 percent of college students reported trying any drug; a third have smoked marijuana in the past year, and 20 percent have done so in the past month.

• For many students, their college environment coupled with our culture’s societal mores regarding substance use on college campuses may make substance use and abuse seem like the norm.

Reasons Why College Students Use Illicit Drugs or

Controlled Prescription Drugs

Illicit Drugs

� Why Do Some College Students Use Drugs?

• Genetics and family history

• Substance use in high school

• Positive expectations

• Mental health problems

• Sorority and fraternity membership

� Why Do Some College Students Not Use Drugs?

• Parental attitudes and behavior

• Religion and spirituality

• Student engagement

• College athletics

Annual Drug Use Prevalence, Full-time College Students vs. Respondents 1 to 4 Years Beyond High School

Common Drugs of Abuse

� Stimulants

• Cocaine

• White crystalline powder

• Derived from the leaves of the south American coca shrub

• Cocaine rapidly enters bloodstream

• Exposed fetus is likely to suffer damage

• Methods of use vary

• Freebase cocaine

• Crack

• Treatment for cocaine addiction involves mainly psychiatric counseling and 12-step programs.

Common Drugs of Abuse

� Amphetamines

• Synthetic agents that stimulate the central nervous system (CNS)

• Some are used for medicinal purposes

• Ritalin and Adderall are used for attention deficit/hyperactivity disorder (ADHD)

• High potential for abuse

College Students’ Stated Reasons for Nonmedical Use of

ADHD Drugs

Common Drugs of Abuse

� Methamphetamine

• Affects brain and CNS

• Euphoria lasts 6 to 8 hours

• Methods of use: snorted, injected, smoked, and ingested

• Increasingly common in rural America

Common Drugs of Abuse

� Caffeine

• Most popular and widely consumed drug in the United States

• Caffeine is derived from the chemical family called xanthines, which are found in plant products such as coffee, tea, and chocolate.

• Enhance mental alertness and reduce feelings of fatigue

• Side effects include wakefulness, insomnia, irregular heartbeat, dizziness, nausea, indigestion, mild delirium, and heartburn.

• Caffeine meets the requirements for addiction: tolerance, psychological dependence, and withdrawal symptoms.

Caffeine Content Comparison

Common Drugs of Abuse

� Marijuana and Other Cannabinoids

• Methods of Use and Physical Effects

• People have been using these substances for 6,000 years

• Derived from Cannabis sativa or Cannabis indica (hemp)

• Tetrahydrocannabinol (THC) is the active ingredient

• Hashish, a potent cannabis preparation, is derived from the resin of the plant.

• Long-term studies have not been conducted in the United States.

• Inhalation from smoking is harmful.

Common Drugs of Abuse

� Marijuana and Medicine

• Helps with severe nausea and vomiting during chemotherapy

• Improves appetite of those with AIDS related wasting syndrome

• Aids those with multiple sclerosis by reducing pain and spasticity

• Reduces eye pressure of glaucoma

Common Drugs of Abuse

� Effects of Chronic Marijuana Use

• Carbon monoxide in blood stream causes heart to work harder

• Contains high levels of carcinogens

• Suppression of the immune system

• Pregnant women at higher risk for stillbirth or miscarriage

Common Drugs of Abuse

� Depressants

• Opiates

• Cause drowsiness, relieve pain, and induce euphoria

• Called narcotics

• Derived from opium

• Include morphine, codeine, heroin, and black tar heroin

• Depress CNS and lower heart rate, respiration, and blood pressure

• Decrease sex drive

Common Drugs of Abuse

� Heroin Addiction

• Heroin is a white powder derived from morphine.

• Black tar heroin is a sticky, dark brown, foul smelling form of heroin that is relatively pure and inexpensive.

• Heroin withdrawal is distinct, including an intense desire for the drug, sleep disturbances, dilated pupils, and muscle tremors

• An estimated 3.7 million people have used heroin at one time in their lives

• Mainlining—intravenous injection of powdered heroin mixed in a solution and is the most common route of administration

Depressants: Opiates

� Treatment of Opiates

• Methadone

• Blocks effects of opiates withdrawal

• Potentially addictive itself

• Naltrexone

• Opiate antagonist

• Lose compulsion to use heroin

• Buprenorphine

• Blocks cravings for heroin

• Nonaddictive

Common Drugs of Abuse

� Benzodiazepines and Barbiturates

• Benzodiazepines (tranquilizers )

• The most common sedative-hypnotic drugs

• Valium, Ativan, and Xanax

• Barbiturates

• Sedative-hypnotic drugs

• Amytal and Seconal

• Less safe than benzodiazepines

• Synergistic effect when combined with alcohol, can lead to respiratory failure and death

• Can produce physical and psychological dependence in several weeks

• Cross-tolerance is a complication specific to sedatives

Common Drugs of Abuse

� Rohypnol

• A tranquilizer and “date rape” drug

• Produces a sedative effect, amnesia, muscle relaxation, and slowed psychomotor responses

• Has gained notoriety as a growing problem on college campuses as it has been added to punch and other drinks at parties in hopes of lowering women’s inhibitions and facilitating potential sexual conquests

� Gamma-hydroxybutyrate (GHB)

• CNS depressant known to have euphoric, sedative, and anabolic (bodybuilding) effects

• Another “date rape” drug

• Side effects include loss of memory, unconsciousness, amnesia, hallucinations, and death

Common Drugs of Abuse

� Hallucinogens

• Scramble messages coming to reticular formation

• Synesthesia—mixing of sensory messages

• May “hear colors” and “smell tastes”

• Lysergic acid diethylamide (LSD)

• Also called acid

• Common hallucinogen used to “unlock secrets” of the mind

• Used to “turn on” and “tune out” world

• In 1970 it was placed on controlled substances list

• Over 11 million Americans have tried acid

• Commonly sold as a “blotter” on paper

Common Drugs of Abuse

� Ecstasy methylene-dioxymethamphetamine (MDMA)

• Most common club drug

• Side effects include hallucination, paranoia, and amnesia

• Causes death in some cases, especially when combined with alcohol

• Chronic use can damage the brain

Common Drugs of Abuse

� Mescaline

• Derived from peyote cactus

• Native Americans use it for religious purposes

• Users typically swallow 10 to 12 dried peyote buttons

• Generally induces immediate vomiting

� Psilocybin

• “Magic mushrooms”

• Effects generally wear off in 4 to 6 hours

• Cultivated from spores or harvested wild

• Similar to LSD in effect

• Mushroom varieties can be easily misidentified, and mistakes can be fatal

Common Drugs of Abuse

� Phencyclidine (PCP)

• Originally used as a dissociative anesthetic

• Side effects such as amnesia led doctors to abandon use

• May cause euphoria or dysphoria

• Known to cause hallucinations, delusions, and overall delirium

� Ketamine (Special K)

• Used as an anesthetic in many hospital and veterinary clinics

• Causes hallucinations and sensory distortions

Common Drugs of Abuse

� Inhalants

• Users inhale chemicals

• Legal to purchase and not commonly recognized as drugs, though dangerous when used incorrectly

• Includes: glue, paint thinner, and rubber cement

• Amyl Nitrate and Nitrous Oxide

• Commonly known as laughing gas

• Imparts a “silly feeling”

• An overdose of fumes from inhalants can cause unconsciousness and death

Common Drugs of Abuse

� Anabolic Steroids

• Artificial forms of the male hormone testosterone that promote muscle growth and strength

• Ergogenic drugs

• Adverse effects occur

• “Performance-enhancing” steroid alternatives

• Gamma-hydroxybutyrate (GHB)

• Clenbuterol

• The 2007 Mitchell Report investigated steroid use among Major League Baseball players, 89 of whom were alleged to have used steroids

Treatment and Recovery

� An estimated 23.6 million Americans aged 12 or older needed treatment for illicit drug or alcohol use problem in 2007.

� Of these, approximately 10 percent received treatment

� Detoxification—an early abstinence period during which an addict adjusts physically and cognitively to being free from the addiction’s influence

Treatment and Recovery

� Treatment Approaches

• Outpatient Behavioral Treatment

• Cognitive behavioral therapy

• Multidimensional family therapy

• Motivational interviewing

• Motivational incentives (contingency management)

• Residential Treatment Programs

• Therapeutic communities (TCs) are highly structured programs in which addicts remain at a residence, typically for 6 to 12 months

• 12-Step Programs

• Nonjudgmental treatment programs that aim to work on personal recovery

Treatment and Recovery

• College Students’ Treatment and Recovery

• Early intervention increases the likelihood of successful treatment.

• Private therapy, group therapy, cognitive training, nutrition counseling, and health therapies all induce a better chance of recovery.

• A growing number of colleges are offering special services to students who are recovering from alcohol and other drug addictions.

• Texas Tech University received a $250,000 federal grant to create a national model of its students-in- recovery program.

Addressing Drug Misuse and Abuse in the U.S

• The financial burden of illegal drug use on the U.S. economy is around $180.9 billion per year.

� Possible Solutions to the Problem

• Scare tactics—shown not to be effective

• War on drugs—laws and policies to reduce illegal drug trade

• Multimodal approach—most effective when young people are taught to differentiate drug use, misuse, and abuse

• Harm Reduction Strategies—practical approaches to reducing negative consequences of drug use