Chapter 13
 Habits that have gotten out of control, with a
resulting negative effect on a person’s health.
 Addiction is the habitual use of a drug produced
chemical changes in the user’s body.
 Drug Addiction (four important characteristics)
Compulsive desire
2. Need to increase the dosage
3. Harmful effects to the individual
4. Harm to society
1.
2
 Often starts to bring pleasure or to avoid pain.
 Harmless or even beneficial if done in moderation
 Examples of addictive behaviors:
 Gambling
 Compulsive Exercising
 Work Addiction
 Sex and love addiction
 Compulsive buying or shopping
 Internet addiction
 Characteristics of people with addition (e.g., risk takers or
genetic disposition)
3
 Drugs are chemicals other than food that are intended
to affect the structure or function of the body
 Prescription medicines
 Over-the-counter substances
 Caffeine
 Tobacco
 Alcohol
 Illegal substances
4
 The APA’s Diagnostics and Statistical Manual of
Mental Disorders – authoritative reference
 Abuse
 APA definition
 Failure to fulfill major responsibilities
 Drug use in situations that are hazardous
 Drug related legal problems
 Drug use despite persistent social or interpersonal problems
 Physically dependent may or may not present
5
 Substance dependence
1. Developing tolerance to the substance
2. Experiencing withdrawal
3. Taking in larger amounts
4. Expressing a persistent desire to cut down
5. Spending great deal of time obtaining
6. Giving up or reducing important activities
7. Continual usage even with recognition of a
problem
 Diagnosed with at least 3 or more symptoms
during a 12-month period
6











All income and education levels
All ethnic groups
All ages
Young people are at a higher risk
Males (Twice as likely)
Troubled adolescent
Thrill-seeker
Dysfunctional families
Peer group or family that accepts
Low Socio-economical status
Dating young
7
 Experiment
 Escape
 Reliance
 Magnification of residence (i.e. the need for escape
from poverty becomes more compelling)
8
 Psychological risks








Difficulty in controlling impulses
Strong need for excitement
Feelings of rejection
Hostility
Aggression
Anxiety
Mental illness
Dual (co-occurring disorders)
9
 Social Factors
 Growing up in a family with drug abuse
 Peer group
 Poverty
10
 Intoxication
 Side effects
 Unknown drug constituents
 Risks associated with injection drug use
 Legal consequences
11

Changes in Brain chemistry
Drug factors:






Pharmacological properties
Dose-Response function
Time-action function
Drug use history
Method of use (e.g., inhalation,
injection, ingest)
12
 Opioids (narcotics)
 Natural or synthetic (laboratory-made)
 Opium, morphine, heroin, methadone, codeine,
hydrocodone, oxycodone, meperidine, and fentanly
 Effects on the body: induced euphoria
 Methods of administration
 Injection, snorting, sniffing or smoking
 Symptoms of overdose: respiratory depression, coma,
constriction of the pupils, or death.
13
 Slow down the overall activity of the CNS
 Sedative-hypnotics
 Types: barbiturates, valium, methaqualone, GHB
 Effects on the body: reduce anxiety, impair muscle
coordination, induce drowsiness
 Medical uses: Treat insomnia and anxiety disorders;
control seizures
 From use to abuse (“Club Drugs”)
 Overdosing may result in respiratory
complications
15
 Speed up the activity of the nervous or muscular
system
 Cocaine
 Methods of use (snort or injection)
 Effects (euphoria sensation for ~5 to 20 minutes)
 Use during pregnancy (consequences include:
miscarriage, premature labor, stillbirth, and low-birth-weight
baby)
16
 Amphetamines
 Effects (increase in alertness)
 Dependence (may lead to the development of a temporary
state of paranoid psychosis or delusion)
 Ritalin (used to treat attention-deficit/hyperactivity
disorder, ADHD)
 Ephedrine (a less potent form of amphetamines)
 Caffeine
18
19
 Cannabis Sativa
 THC (tetrahydrocannabinol)
 Short term effects and uses: euphoria, increases in
sensation, relaxed attitude
 Long-term effects and uses: respiratory damage such
as impaired lung function and chronic bronchial
irritation
21
 Altered state of consciousness, perceptions, feelings and
thoughts
 LSD, Mascaline, DMT, MDMA, Ketamine, PCP (angel
dust), and certain mushrooms
 Altered states of consciousness
 Flashbacks are perceptual distortions and bizarre
thoughts that occur after the drug has been entirely
eliminated from the body.
23
 Nearly all inhalants produce effects similar to those of




anesthetics, slow down the bodies functions
Volatile solvents
Nitrates
Anesthetics
Methods of use




Sniffing
Snorting
“Bagging”
“Huffing”
24
 Medication-assisted treatment
 Drug substitution
 Treatment centers
 Self-help groups and peer counseling
 Harm reduction strategies
 Codependency
http://www.youtube.com/watch?v=J46pvxFWNTY
25
Tobacco
Use of Tobacco


71 Million Americans, including 13.7 million college-aged
Americans.
2008, nearly 21% of Americans age 18 describe themselves as
current smokers.
 Nicotine Addiction
 Powerful psychoactive drug
 Reaches Brain via bloodstream in seconds
 Most physically addictive of the psychoactive drugs.
 Loss of control
 Tolerance and Withdrawal
27
Why Start in the First Place?



Children and teenagers make-up 90% of all new smokers in
this country.
Thousands of children and adolescents (12-17) start smoking
everyday.
Average age


13 for smoking
10 for spit tobacco
28
Characteristics which could increase the
potential for use.








A parent or sibling uses tobacco
Peers use tobacco
Child comes from blue-collar family
Child comes from low-income home
Single parent.
Performs poorly in school
Child drops out of school
Has positive attitudes towards tobacco
29
Reasons Why College Students Smoke
Health Hazards
 Contains hundreds of damaging chemical substances,
including acetone (nail polish remover), ammonia,
hexamine (lighter fluid), and toluene (industrial
solvent).
 Unfiltered cigarettes = 5 billion particles per cubic mm
 50,000 times more than polluted urban air
 Condensed particles in the cigarette produce the tar
(brown, sticky mass)
Chapter 8
31
Health Hazards (cont)
Carcinogens and Poisons
 43 chemicals are linked to cancer (Carcinogen)
 Benzo(a)pyrene (yellowish tar)
 Urethane (ex: solution used in making foams)
 Cocarcinogens
 Combine with other chemicals to cause cancer (e.g., formaldehyde)
 Poisonous substances
 Arsenic (e.g., insectides and weed killers)
 Hydrogen cyanide (e.g., flammable liquid used in dye)
 Carbon monoxide
 400 times greater than is considered safe in industrial workplaces
 Displaces oxygen in red blood cells
 Additives
 Nearly 600 chemicals
Chapter 8
32
33
“Light” and Low-Tar Cigarettes
Low-tar, low-nicotine, or filtered cigarettes
 No such thing as a safe cigarette
 Often smoke more

34
The effects of smoking a cigarette
35
Additional Health, Cosmetic, and
Economic Concerns








Ulcers
Impotence
Reproductive health problems
Dental diseases
Diminished physical senses
Injuries
Cosmetic concerns
Economic costs
36
Cumulative Effects
Males before 15 yrs. old are half as likely to live to 75
versus those who did not smoke
 Females with similar habits reduce life expectancy by
more than 10 years
 Female smokers spend 17% more sick days in bed
than nonsmokers
 Both men and women show a greater rate of acute
and chronic diseases

37
Other Forms of Tobacco

Spit (Smokeless) Tobacco
More than 6.6 million adults
 8% of all high school students


Cigar and Pipes
Cigar smoking has increased
by 148% from 1993-2006.
 Cigars contain more tobacco
than cigarettes.


Clover cigarettes and Bidis

Twice the tar, nicotine, and
carbon monoxide
38
39
The Effects of Smoking on the Nonsmoker

Environmental Tobacco smoke (ETS)
 Environmental Protection Agency (EPA) designated
ETS as a class A carcinogen
 Department of Health and Human Services’ National
Toxicology Program - “known human carcinogen”
 Surgeon General – 2006 – “there is no safe level of
exposure to ETS; even brief exposure can cause serious
harm”.
40
Environmental Tobacco Smoke

Mainstream smoke

Smoke exhaled by smokers
 Sidestream smoke

Smoke from the burning end of a cigarette, cigar, or pipe.
 85% of smoke in a room is second hand
 Twice the tar and nicotine
 Three times the benzo(a)pyrene
 Three times the ammonia
 Smoke from a cigar can be even more dangerous

30 times more carbon monoxide
41
ETS Effects






Develop cough, headaches, nasal discomfort, eye irritation,
breathlessness and sinus problems
Allergies will be exacerbated
Causes 3,000 deaths due to lung cancer
Contributes to about 35,000 overall deaths each year.
20% increase in the progression of atherosclerosis.
Contributes to increased asthma attacks
42
How Cigarette Smoking Damages the Lungs
Lung Cancer from Tobacco Smoking
44
Oral Cancer from Tobacco Smoking
45
Oral Cancer from Tobacco Smoking
http://www.youtube.com/w
atch?v=0hySFt8O11A
46
Cancer Survivor
47
Infants, Children, and ETS

More likely to develop







Bronchitis, pneumonia,& respiratory infections
More complications from asthma
Increased chance of SIDS (sudden infant death syndrome)
Low-birth weight
Bronchitis
Chemicals from smoking show up in breast milk
Children inhale three times more pollutants per unit of body
weight than adults.
48
Smoking and Pregnancy
Estimated 4,600 infant deaths in the U.S.
 Miscarriage, premature birth, low birth weight,
long term impairments in growth and intellectual
development
 Possible higher risks of getting cancer
 16% of pregnant women smoke

49
Cost of Tobacco Use to Society
Lost productivity from sickness, disability, and
premature death makes it close to $167 billion per
year.
 1998 Master Settlement Agreement (MSA)

43 states filed suit against tobacco companies to
recoup public health care expenditures
 Tobacco companies have to pay $206 billion over 25
years.
 Limits or bans certain types of advertising,
promotions, and lobbying.

50
How A Tobacco User Can Quit



50.2 % of all adults who have smoked have quit.
The Benefits of Quitting
Options for quitting
 Smoking cessation programs
 1-800-QUITNOW


Smoking cessation products



Department of Health and Human Services
Chantix (Varinicline)
Zyban (Bupropion)
Nicotine replacement products

Patches, gums, lozenges, nasal sprays, and inhalers
http://www.videojug.com/interview/the-benefits-of-quitting-smoking-2
51
Alcohol
The Nature of Alcohol
 Psychoactive ingredient
 Depressant
 Ethyl Alcohol – only alcohol that can be consumed
 Beer 3-6% alcohol by volume
 Malt Liquors 6-8% alcohol by volume
 Table wines 9-14% alcohol by volume
 Fermenting
 Fortified wines 20% alcohol by volume
 Sugar added
 Extra alcohol is added
 Hard liquors 35-50% alcohol by volume
 Distilling or fermented
 Proof Value
 Two times the percentage concentration
 Ingestion
 7calories per gram
 1 drink 14-17 grams or 100-120 calories
53
Absorption
 20% is rapidly absorbed from the stomach
 75% is absorbed in the upper small intestines
 Remain is absorbed along the GI track
 Absorption
 Carbonation
 Food in the stomach slows the absorption
 Eventually all the alcohol ingested will be absorbed
54
Metabolism and Excretion
 Transported throughout the body via the
bloodstream.
 Easily moves through most biological membranes
 Main site for metabolism is the Liver.
 2-20% of ingested alcohol is not metabolized.
55
Chapter 8
56
Alcohol Intake and Blood Alcohol Concentration
 Blood Alcohol Concentration(BAC)
 A measure of intoxication
 Body weight
 Percentage of body fat
 Sex
 Genetic factors
 Drinking Behavior
 Metabolism is the same if the person is
awake or asleep
57
The Immediate Effects of Alcohol on Health
 Depends on the individual.
 Low Concentrations .03% -.05%.
 Higher Concentrations 0.1% -0.2%.
 Concentration of .35% and higher.
 Alcohol hangover
 Alcohol poisoning
 Using Alcohol with other drugs
58
Drinking and Driving
 In 2004
 250,000 were injured in alcohol related automobile
crashes
 42,000 people are killed in alcohol related accidents
 Dose-response function
 Driving with a BAC of 0.14% is more
than 40 times more likely to be
involved in a crash.
 Greater than 0.14% the risk of fatal
crash is estimated to be 380 times higher.
59
60
Angels Pitcher Nick Adenhart Killed In Car Crash
April 9, 2009
Two people who were with him were also killed when, according to police, a minivan ran a red light at a
Fullerton intersection and broadsided the gray Mitsubishi they were in. The driver of the minivan, Andrew
Thomas Gallo, 22, of Riverside, was arrested on suspicion of drunken driving, hit and run and manslaughter.
61
Approximate blood concentration and body weight
© 2010 McGraw-Hill Companies. All Rights Reserved.
62
The Effects of Chronic Use
Diseases of the digestive, cardiovascular systems and some cancers
 Digestive system
 Liver function
 liver cell damage and destruction (cirrhosis)
 Pancreas inflammation
 Cardiovascular system
 moderate doses may reduce the risk of HD
 Higher doses elevates BP, may weaken heart muscle or cardiac myopathy.
 Cancer






5-6 total drinks

Hepatitis speeds the growth of this cancer

Increase risk when 2-3 drinks per day
Responsible for the most common form of liver cancer
Breast cancer
Brain Damage




Mouth, throat, larynx, and esophagus
Cognitive impairments
Memory loss, dementia, and compromised problem-solving
Wernicke-Korsakoff syndrome (brain damage)
Mortality

Alcoholics average life expectancy is about 15 years less than non-alcoholics
63
64
The Effects of Alcohol use During Pregnancy
 Effects are dose-related.
 Fetal Alcohol Syndrome (FAS)
 Full-blown FAS occurs in up to 15 out of every 10,000 live
births in the U.S.
 Under weight, flat nasal bridge, and long upper lip.
 Small and have heart defects.
 Physical and mental growth is slowed. Remain mentally
impaired. Fine motor skill problems, coordination, learning and
behavioral problems (ADS).
 Alcohol-related neurodevelopment disorder (ARND).
65
Possible Health Benefits of Alcohol
 Abstainers and light to moderate drinkers live longer
than heavy users.
 35 years old and younger, your odds of dying
increase in proportion to the amount consumed
 Moderate drinking = one drink per day for women
and two drinks per day for men.
 May lower coronary heart disease.
 Raising blood levels of HDL.
 May lower risks of diabetes, arterial blockages, Alzheimer’s
66
Alcohol Abuse and Dependence

Alcohol abuse is recurrent use that has negative

Alcohol dependence or Alcoholism more extensive
consequences.
problems, tolerance and withdrawal
 Warning signs of alcohol abuse






Drinking alone
Using deliberately and repeatedly
Feeling uncomfortable on certain occasions
Escalating consumption
Getting drunk regularly
Drinking in the morning or unusual times
67
Alcohol Abuse and Dependence
 Binge Drinking
 The National Institute on Alcohol Abuse and Alcoholism
defines:

Pattern of alcohol use that brings a person’s BAC up to
0.08 or above (typically four drinks for a male or three
for a women) within two hours.
 National Survey on Drug Use and Health defines:
 Having five drinks in row for a man or four in a
a women within two hours.
row for
 Frequent binge drinking in college were three to seven
times more likely than non-binge drinkers to engage in
unplanned or unprotected sex
 Healthy People 2010
 Reduce the rate of binge drinking to 20% among
college students
68
Alcoholism
 Patterns and Prevalence
1.
Regular daily intake of large amounts
2. Regular heavy drinking limited to weekends
3. Long periods of sobriety interspersed with binges or daily heavy
drinking
4. Heavy drinking limited to periods of stress
 Health Effects

DTs (delirium tremens)

paranoia
 Social and Psychological effects
 Causes of Alcoholism
Video: http://www.youtube.com/watch?v=gTPjlN7VR7c
70
Treatment Programs
 Not one program works for everyone.
 AA.
 12-step program
 Employee Assistance.
 Inpatient hospital rehabilitation
 Pharmacological treatments.
 Disulfiram (Antabuse)
 Inhibits the metabolic breakdown
 Naltrexone (ReVia, Depade)
 Reduces the craving for alcohol and decreases its pleasant effects.
 Injectable Naltrexone (Vivtrol) – single monthly shot
 Acamprosate (Campral)
 Acts on brain pathways related to alcohol abuse.
71
Gender and Ethnic Differences
 Men
 White American men (excessive drinking often begins in the





teens or twenties)
 “Other men” (remain controlled drinkers until later in life)
Women (alcoholism often occurs
later in life)
African Americans (alcohol abuse
usually found in African Americans)
Latinos (drinking patterns vary)
Asian Americans (low rate of alcohol abuse)
American Indians and Alaska Natives (excessive drinking varies from
tribe to tribe)
http://www.cbsnews.com/video/watch/?id=5024746n
Chapter 8
72
Video Segment:
The Effects of Drug Use on Brain Chemistry
http://www.youtube.com/watch?v=J46pvxFWNTY
http://www.aetv.com/intervention/video/?bcpid=534114
97001&bclid=129113967001&bctid=115543473001
http://www.aetv.com/intervention/video/?bcpid=534114
97001&bclid=64419253001&bctid=64670639001
73