DO NOW
(1) Make a folded sheet of paper with your preferred name on it, facing
outwards
ON A SEPARATE SHEET OF PAPER
(2) Major
(3) Where are you from?
(4) What profession are you hoping to go into?
(5) When was the last biology course you have taken?
(6) When was the last psychology course you have taken?
(7) What is a drug? (extra credit pt)
(8) What is a psychoactive drug? (extra credit pt)
(9) Name one neurotransmitter (extra credit pt)
(10) What is another name for a brain cell? (extra credit pt)
(11) Name one area of the brain (extra credit pt)
Drug and Alcohol Abuse
Week 1
Drugs and Society
Outline
• What are drugs? Who takes them? Are they
bad?
• What is substance abuse? Dependence?
• Drugs and the law
What are drugs?
• Who here has done drugs?
• What is a drug?
• What is a psychoactive drug?
What are drugs?
• Who here has done drugs?
– Probably everyone
• What is a drug?
– Any substance that modifies mind and/or body functioning
• What is a psychoactive drug?
– Drug compounds (substances) that affect the central
nervous system and/or alter consciousness and/or
perceptions
Who took the first psychoactive drug?
• Probably the oldest humans
– Alcoholic drinks are actually naturally occuring
substances (old, mushy fruits ferment and
become alcoholic)
– Coca leaves
– Religious rituals
• Think medicine man
Drug use in America
Drug
Ever Used
Alcohol
Last 30 Days
69%
4%
18%
9.20%
47%
17%
3.90%
Inhalants
5%
0.40%
0
Amphetamine
9%
2.80%
0.20%
Hallucinogens
8%
1.70%
0%
Cocaine (all)
7%
1.20%
0.10%
1.40%
0.10%
0.00%
Cigarettes (tobacco)
Marijuana/Hash
Crack
85
Daily
N/A
Drug
Ever Used
Alcohol
Last 30 Days
85
Daily
69%
4%
18%
9.20%
47%
17%
3.90%
Inhalants
5%
0.40%
0
Amphetamine
9%
2.80%
0.20%
Hallucinogens
8%
1.70%
0%
Cocaine (all)
7%
1.20%
0.10%
1.40%
0.10%
0.00%
Cigarettes (tobacco)
Marijuana/Hash
Crack
N/A
One sheet of paper per group (3-4 people)
Q1: What statistics do you find most surprising?
Q2: Note that only 19% of people have smoked tobacco
in the last month. Note that 9.5% use it daily. Compare
these statistics to alcohol use. What can you conclude
about the addictive nature of these substances?
Break Down of Drug Use
% Drug Use among 18-25 year olds (within last 30 days)
Females
Male
Asian AA
Hispanic
Caucasian
Alcohol
55
66
50
47
52
69
Cigarettes (tobacco)
37
51
26
33
31
51
Marijuana/Hash
13
20
7
15
10
19
1
3
0.7
0.5
3
3
Cocaine (all)
Break Down of Drug Use
High School Graduates
College Graduates
Alcohol
55
78
Cigarettes (tobacco)
46
30
Marijuana/Hash
17
13
2
1
Cocaine
Four principles of psychoactive drugs
• (1) Drugs, per se, are not good nor bad
• (2) Every drug has multiple effects
• (3) The size and quality of a drug’s effect
depend on dose
– The dose makes the poison, Paracelcus late 15th
century
• (4) Depends on individual’s history and
expectations
What is Drug Dependence/Addiction?
• Substance Abuse: Composed of three
processes
– Tolerance
– Physical dependence
– Psychological dependence
• Probably the biggest factor in drug taking behavior
Drug Abuse Warning Network
• DAWN
• Tracks drug-related deaths and emergency
visits at major U.S. metropolitan cities
– (can anyone see a bias here?)
• Alcohol is reported only when with other
drugs
• Drug-alcohol and drug-drug are the most
common combinations
DAWN data
•
•
•
•
•
•
ER Visits
1. Cocaine
2. Alcohol-incombination
3. Marijuana
4. Prescription Opioids
5. Benzodiazepines
Deaths
1. Prescription Opioids
(not heroin)
2. Cocaine
3. Alcohol-incombination
4. Benzodiazepines
5. Methadone
Other dangers to drug use
When Does Use Lead to Abuse?
• The amount of drug taken does not necessarily
determine abuse.
• The motive for taking the drug is the most important
factor in determining presence of abuse.
• Initial drug abuse symptoms include:
– Excessive use
– Constant preoccupation about the availability and
supply of the drug
– Refusal to admit excessive use
– Reliance on the drug
Diagonostic and Statistical Manual-IV
(DSM-IV)
• Published by the American Pyschiatric
Association
• Covers mental health disorders
• Substance-related disorders
– Intoxication disorder
– Withdrawal disorder
– Substance Use
– Substance Dependence
Criterion for Substance Use Disorder
• A maladaptive pattern of substance use
leading to clinically significant
impairment or distress, as manifested by
2 (or more) of the following, occurring
within a 12-month period:
Criteria
1. Recurrent substance use resulting in a failure to fulfill major role
obligations at work, school, or home (e.g., repeated absences or
poor work performance related to substance use; substancerelated
absences, suspensions, or expulsions from school;
neglect of children or household)
2. Recurrent substance use in situations in which it is physically
hazardous (e.g., driving an automobile or operating a machine
when impaired by substance use)
3. Continued substance use despite having persistent or recurrent
social or interpersonal problems caused or exacerbated by the
effects of the substance (e.g., arguments with spouse)
Criteria cont’d
4. Tolerance, as defined by either of the following:
a. a need for markedly increased amounts of the substance to
achieve intoxication or desired effect
b. markedly diminished effect with continued use of the
same amount of the substance
5. Withdrawal, as manifested by either of the following:
a. the characteristic withdrawal syndrome for the substance (refer
to Criteria A and B of the criteria sets for Withdrawal from the
specific substances)
b. the same (or a closely related) substance is taken to relieve or
avoid withdrawal symptoms
Criterion cont’d
6. The substance is often taken in larger amounts or over a
longer period than was intended
7. There is a persistent desire or unsuccessful efforts to cut
down or control substance use
8. A great deal of time is spent in activities necessary to obtain
the substance, use the substance, or recover from its effects
9. Important social, occupational, or recreational activities are
given up or reduced because of substance use
10. Substance use is continued despite knowledge of having a
persistent or recurrent physical or psychological problem
that is likely to have been caused or exacerbated by the
Substance
11. Craving or a strong desire or urge to use a specific
substance
Is it drug abuse if…
• The individual is not impaired in day to day life?
• If it is only a little bit of drug, but the effect on
the individual is great.
• What about “functional users?”
– i.e. functional drunk
• Where is the line draws?
The DSM-V (current edition)
• Substance use disorder in DSM-5 combines
the DSM-IV categories of substance abuse and
substance dependence into a single disorder
measured on a continuum from mild to severe
Why the change?
• In DSM-IV, the distinction between abuse and
dependence was based on the concept of
abuse as a mild or early phase and
dependence as the more severe
manifestation.
• In practice, the abuse criteria were sometimes
quite severe. The revised substance use
disorder, a single diagnosis, will better match
the symptoms that patients experience.
Substance Use Disorders
• Addiction is a type of substance use disorder
• "to devote or give (oneself) habitually or
compulsively"; from Latin addicere - bound to or
enslaved
• You can never be diagnosed with “cocaine
addition” or “marijuana addiction”
– Rather you would be diagnosed as “cocaine
dependence”
Addictions/substance dependence
• DSM-V: Persistent and maladaptive use of
psychoactive drugs.
– Chronic relpasing condition
– A very common diagnosis
– Personally devastating
– Large social costs (about $500 billion/year)
How do addictions develop
• First: initial use
• Then, interaction between
– Environmental
– Personality
– Biological
• Effects of drugs
– Genetic
• predisposition
In groups
• Read each scenario
• Then, for each scenario, determine whether
they qualify for a substance use disorder.
Substance use disorder?
• Alice started smoking when she was 16 years
old. She initially only smoked a few cigarettes
a day, socially. However, five years later, at age
21, she smokes a pack a day. She has tried
quitting multiple times, but is not able to.
Substance use disorder?
• Steve smokes crack on average twice a week.
Some weeks he does it every day. There are
some months where he doesn’t smoke at all.
Steve is doing well in his job and has a steady
relationship.
Substance use disorder?
• Jill does heroin socially, about once a month.
However, when she does heroin, she becomes
violent and has been arrested multiple times
for assault while on heroin.
Laws and Drugs
• Licit drugs: legalized drugs such as coffee,
alcohol, and tobacco.
• Illicit drugs: illegal drugs such as marijuana,
cocaine, and LSD. Over-the-counter drugs:
legalized drugs sold without a prescription.
What do you think of folks who use
drugs?
• How does the government view drug use?
• How does society view drug use?
Drug Use Attitude Shift in the U.S.
• In the 1800s, it was pretty laissez-faire
• Then…
– Toxicity issues
• Drugs became stronger, more potent
• Diseases developed
– Addiction
• Personal and public problems
– Legality
• Then it became a crime
The Harrison Act of 1914
• Marked the first legitimate effort by the
federal government to regulate and control
the production and importation of addicting
substances
The Comprehensive Drug Abuse
Prevention and Control Act (1970)
• This 1970 act divided substances with
abuse potential into categories based on
the degree of their abuse potential and
clinical usefulness.
• Schedules I, II, III, IV, and V
Schedules
• Schedule I substances have high-abuse
potential and no currently approved medicinal
uses; they cannot be prescribed.
• Schedule II substances have high-abuse
potential but are approved for medical uses
and can be prescribed.
• Schedule II–V substances reflect the likelihood
of abuse and clinical usefulness
Scheduled Drugs
•
Q3: What do you already know about some of these drugs? Pick at least 3 drugs
and provide a clinical use.
•
Q4: Are there any discrepancies in which drugs belong to which schedules?
The Comprehensive Drug Abuse
Prevention and Control Act (1970)
• Also determined criminal penalties for
possession and distribution
• Established the DEA (drug enforcement
agency)
Penalties for possesion
• Civil fine up to $10,000
• Forfeiture of car, plane, boat that was
transporting drugs.
• Loss of federal benefits (including student
loans)
• Loss of public housing
War on Drugs
• Ronald Reagan is the most famous leader in
the war on drugs
• Honest intentions: wants to reduce harm of
drugs on society
• Should we be at war on drugs?
War on Drugs
•
•
•
•
•
•
$15 billion per year
Millions of Americans in prison
Loss of individual freedom
Major inconveniences (urine tests at work!!)
Potential government corruption
Prevents 15% of all drugs prevented from reaching the
users
– If anything you are just increasing the cost of drugs slightly
• Unfair bias towards minorities in prosecution
– Black men are up to 10 times more likely to be fined or jailed for
possession than white men.
• Note: there may also be a urban versus suburban prejudice, not just a
black versus white prejudice.
Next Week
• Intro to the brain
– Neurons: basic properties
– Neurotransmitters
– Receptors
Assignment for next week