Lecture 10

• Drug


  Any substance other than food affecting our bodies or minds, including alcohol, tobacco, and caffeine
• Substance intoxication


  Cluster of changes in behavior, emotion, or thought caused by substances (DSM-5)
• Substance use disorders


  Maladaptive behavior patterns and reactions caused by repeated substance use
• Substance Use and Addictive Disorders

  • Individual displays a maladaptive pattern of substance use leading to significant impairment or distress

  • Presence of at least 2 of the following symptoms within a 1-year period

  • Substance is often taken in larger amounts or over a longer period than intended

  • Unsuccessful efforts or persistent desire to reduce or control substance use

  • Much time spent trying to obtain, use, or recover from the effects of substance use

  • Failure to fulfill major role obligations at work, school, or home as a result of repeated substance use
• Substance Use and Addictive Disorders

  • Individual displays a maladaptive pattern of substance use leading to significant impairment or distress

  • Presence of at least 2 of the following symptoms within a 1-year period

  • Substance is often taken in larger amounts or over a longer period than intended

  • Unsuccessful efforts or persistent desire to reduce or control substance use

  • Much time spent trying to obtain, use, or recover from the effects of substance use

  • Failure to fulfill major role obligations at work, school, or home as a result of repeated substance use
• Symptoms of substance use and addictive disorders (at least 2 within 1 year)

  • Continued use despite persistent social/interpersonal problems
  • Cessation/reduction of important activities due to substance use
  • Using substance in physically risky situations
  • Continuing use despite awareness of physical/psychological problems
  • Craving for substance
  • Tolerance effects
  • Withdrawal reactions
• How Do Racial/Ethnic Groups Differ in Substance Use Disorders?


  image:

  
• Tolerance


  Need for increasing doses of substances to produce desired effect
• Withdrawal


  Unpleasant and sometimes dangerous symptoms occurring with drug stopping or cutting back
• Depressants


  • Slow the activity of the central nervous system (CNS)

  • Reduce tension and inhibitions

  • May interfere with judgment, motor activity, and concentration

  • Most widely used depressants

  • Alcohol

  • Sedative-hypnotic drugs

  • Opioids
• Alcohol


  • 2 billion people worldwide consume alcohol (WHO)

  • More than half of U.S. residents drink alcoholic beverages

  • All alcoholic beverages contain ethyl alcohol

  • Absorbed into the blood through the stomach lining

  • Takes effect in bloodstream and CNS
• Alcohol


  • Extent of the effect of ethyl alcohol is determined by its concentration (proportion) in

  the blood; intoxication = 0.09 percent (0.9 promille; 3-4 drinks)

  • Level of impairment is closely tied to the concentration of ethyl alcohol in the blood

  • Effects of alcohol subside only after alcohol is metabolized by the liver

  • Alcohol increases the activity of the neurotransmitter GABA at key sites in the brain

  • Gender affects blood alcohol concentration
• Alcohol-Use


  • Middle schoolers: 25 percent report some use

  • High school seniors: 29 percent drink monthly; 2 percent drink daily

  • College students: 38 percent engage in monthly binge drinking
• Alcohol use disorder (alcoholism)

  • U.S. population older than 11 years: 5.4 percent

  • Teenagers: 2.3 percent

  • Men versus women: 2:1

  • Ethnic differences
• Alcohol use disorders


  • Clinical picture

  • Regular consumption and reliance affects cognition, social life, and work behaviors

  • Individual alcoholism patterns vary

  • Tolerance and withdrawal

  • Tolerance increases consumption levels

  • Variety of negative withdrawal symptoms– Delirium tremens (DTs)
• What are the personal and social impacts of alcoholism?

  • Alcoholism destroys families, social relationships, and careers

  • Plays a role in suicides, homicides, assaults, rapes, and accidents

  • Long-term excessive drinking can seriously damage physical health and cause major nutritional problems (liver cirrhosis and Korsakoff’s syndrome)

  • The 30 million children of alcoholics are likely to experience a wide range of social and psychological struggles, including risk from fetal alcohol syndrome (FAS) and miscarriage
• College Binge Drinking: An Extracurricular Crisis

  • 38 percent of students binge drink once a month; one-third binge 6 times or more monthly

  • Bingeing has lingering impacts on mood, memory, and brain/heart functioning

  • Alcohol consumption is related to academic problems and dropping out of college
• binge drinking


  4-5 drinks within an hour
• Sedative-hypnotic (anxiolytic) drugs


  • Produce feelings of relaxation and drowsiness

  • Low doses = calming or sedative effect

  • High doses = sleep inducers or hypnotics
• Barbiturates


  • Widely prescribed for the first half of the twentieth century
• Benzodiazepines


  • Safer and less likely to lead to intoxication, tolerance effects, and withdrawal reactions

  • Increase GABA activity
• Opioids


  • Include natural (opium, heroin, morphine, codeine) and synthetic (methadone) compounds

  • Known collectively as “narcotics”

  • By 1917, opium-derived drugs were deemed addictive and illegal

  • Each drug has a different strength, speed of action, and tolerance level

  • Most are smoked, inhaled, snorted, injected (skin-pop or mainline), or swallowed

  • Cause CNS depression; drugs attach to endorphin-related brain receptors
• Heroin


  • After just a few weeks, users may become caught in a pattern of abuse (and often dependence)

  • Tolerance for the drug quickly builds and withdrawal occurs when drug ingestion stops

  • Early withdrawal symptoms include anxiety and restlessness; later symptoms include twitching, aches, fever, vomiting, diarrhea, and weight loss from dehydration

  • Increased doses are required to avoid withdrawal
• Opioid use disorder


  • Affects 2 million people in the United States within a given year

  • 75 percent are addicted to pain relievers; 25 percent are addicted to heroin

  • Yearly 15000 deaths due to heroine addiction and 37000 due to pain killer addiction

  • Mortality rate is 63 times higher than in a non-addicted person when untreated
• Danger of opioid use

  • Most immediate danger is overdose

  • Ignorance of tolerance

  • Getting impure drugs

  • Infection from dirty needles and other equipment
• Stimulants


  • Stimulants increase the activity of the central nervous system (CNS)

  • Cause increases in blood pressure, heart rate, and alertness

  • Cause rapid behavior and thinking
• Most common stimulants


  • Nicotine

  • Caffeine

  • Cocaine

  • Amphetamines
• Cocaine


  • Most powerful known natural stimulant

  • Produces a euphoric rush of well-being

  • Increases the supply of dopamine at key neurons throughout the brain as well as norepinephrine and serotonin levels

  • Can be snorted, injected, or smoked

  • Tried by 40 million people (USA); currently used by 2 million people
• Stimulants


  • Effects of high doses of cocaine

  • Cocaine intoxication,

  • Cocaine-induced psychotic disorder

  • Depression-like letdown (crashing)

  • More powerful, cheaper forms have been available since 1984

  • Freebasing

  • Crack
• What are the physical dangers of cocaine?

  • Overdose—greatest risk

  • Excessive doses —depress the brain's respiratory function and stop breathing

  • Heart failure and brain seizures

  • Increased likelihood of miscarriage and of having children with abnormalities
• Stimulants-Amphetamines


  • Laboratory-manufactured stimulant drugs

  • Amphetamine, dextroamphetamine, methamphetamine

  • Most often taken in pill or capsule form

  Effects:

  • Small doses: Increase energy and alertness and reduce appetite

  • High doses: Produce a rush, intoxication, and psychosis

  • Cause an emotional letdown as they leave the body
• Stimulants- Methamphetamine (ice; crystal meth)


  • Recent surge in its popularity: Used at least once by 6 percent of all U.S. residents older than age 11; spreading across the United States

  • Equally popular among men and women and among a wide range of people

  • Designated as a club drug and often tied to raves

  Use dangers:

  • Serious negative effects on physical, mental, and social life

  • Linked to increased ER visits

  • May cause neurotoxicity
• Stimulant use disorder


  • Stimulant dominates the individual’s life

  • Leads to poor functioning in social relationships and at work

  • Tolerance and withdrawal reactions tied to increased doses

  • Annual rates among people older than age 11

  • Disorders centered on cocaine: 0.4 percent

  • Disorders centered on amphetamines: 0.6 percent
• Hallucinogens (psychedelic drugs)


  • Produce powerful changes primarily in sensory perception (trips)

  • Natural hallucinogens

  • Lysergic acid diethylamide (LSD)

  • Mescaline

  • Psilocybin (found in mushrooms)

  • MDMA (Ecstasy)
• LSD (lysergic acid diethylamide)


  • One of most powerful hallucinogens derived from ergot alkaloids (=mold)

  • Brings on a state of hallucinogen intoxication (hallucinosis)

  • Increased and altered sensory perception, psychological changes, and physical symptoms

  • Hallucinations and/or synesthesia

  • Effects wear off in about 6 hours

  • Produces these symptoms by binding to serotonin receptors

  • These neurons help control visual information and emotions, thereby causing the various effects of the drug on the user
• LSD use


  Prevalence:

  • LSD use at some point in their lives: 10 percent of U.S. population

  • Current users: around 0.2 percent, or 458,000 people

  • LSD tolerance and withdrawal are rare -> not physically addictive

  Dangers:

  • Self-injury, bad trips, flashbacks
• MDMA (3,4-methylenedioxymethamphetamine)


  • Ecstasy, Molly

  • Stimulant produces hallucinogenic effects; provides an energy boost and strong feelings of connectedness

  Dangers:

  • Immediate psychological problems (e.g., anxiety and depression), cognitive impairment, and physical symptoms (e.g., muscle tension, chills)
• Cannabis


  • Produced from varieties of hemp plants

  • Hashish: Solidified resin of the cannabis plant

  • Marijuana: Mixture of buds, crushed leaves, and flowering tops

  • Major active ingredient: tetrahydrocannabinol (THC)

  • Potency influenced by environmental conditions

  • When smoked, produces a mixture of hallucinogenic, depressant, and stimulant effects,

  known as cannabis intoxication

  • Most of the effects last 2 to 6 hours
• Cannabis + cannabis use disorder

  Cannabis use disorder is influenced by regular use:

  • Social and occupational lives of 1.6 percent of people in the United States are affected, including a large number of high school students

  • The current varieties of marijuana are 4-7 times more powerful than those found in 1970s, due to the higher THC content (>15 percent)
• Cannabis + dangers


  • Tolerance and withdrawal symptoms

  • Occasional panic reactions, automobile accidents, and decreased memory while high

  • Long-term health problems; reproduction problems