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© 2011 McGraw-Hill Higher Education. All rights reserved.
Chapter 2Chapter 2Drug Use as a Social Drug Use as a Social
ProblemProblem
© 2011 McGraw-Hill Higher Education. All rights reserved.
Costs of Drug Use to SocietyCosts of Drug Use to Society
Deaths Emergency room visits Drugs in the workplace and lost productivity Broken homes, illnesses, shorter lives, etc. Cost of maintaining habit Cost of criminal behavior Cost of treating patients Fetal alcohol syndrome Others?
© 2011 McGraw-Hill Higher Education. All rights reserved.
Changing AttitudesChanging Attitudes
What made the government change What made the government change from the laissez-faire attitude of the from the laissez-faire attitude of the 1800s to one of control?1800s to one of control? ToxicityToxicity DependenceDependence CrimeCrime
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ToxicityToxicity
Toxic = poisonous, deadly, or dangerous
What makes a drug toxic?
Amount used
How it is used
What the user did while on the drug
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ToxicityToxicity
Physiological toxicity vs. behavioral toxicityPhysiological toxicity vs. behavioral toxicity Acute effects vs. chronic effects Acute effects vs. chronic effects
Acute behavioral toxicity (drunk driving) Chronic physiological toxicity (cirrhosis)
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Drug-Related ToxicityDrug-Related Toxicity
Examples of acute toxicityExamples of acute toxicity Behavioral: “Intoxication” that impairs the Behavioral: “Intoxication” that impairs the
actions of drug users and increases the actions of drug users and increases the danger to themselves and othersdanger to themselves and others
Physiological: Overdose that causes the Physiological: Overdose that causes the user to stop breathinguser to stop breathing
© 2011 McGraw-Hill Higher Education. All rights reserved.
Drug-Related ToxicityDrug-Related Toxicity
Examples of chronic toxicityExamples of chronic toxicity BehavioralBehavioral
Personality and lifestyle changesPersonality and lifestyle changes Effects on relationships with friends and familyEffects on relationships with friends and family
Physiological Physiological Heart diseaseHeart disease Lung cancerLung cancer CirrhosisCirrhosis Other health effectsOther health effects
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DDrug rug AAbuse buse WWarning arning NNetworketwork
A system for collecting data on drug-A system for collecting data on drug-related deaths and emergency room visits related deaths and emergency room visits at at somesome U.S. U.S. metropolitanmetropolitan hospitals hospitals
DAWN collects data on DAWN collects data on improper use of legal improper use of legal prescription and over-prescription and over-the-counter drugs as the-counter drugs as well as illicit drugswell as illicit drugs
© 2011 McGraw-Hill Higher Education. All rights reserved.
DDrug rug AAbuse buse WWarning arning NNetworketwork
Alcohol is reported only Alcohol is reported only in combination with other in combination with other drugsdrugs
Drug-alcohol and drug-Drug-alcohol and drug-drug combinations are drug combinations are very common very common
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DDrug rug AAbuse buse WWarning arning NNetworketworkToxicity DataToxicity Data
ER VisitsER Visits1.1. CocaineCocaine
2.2. Alcohol-in-Alcohol-in-combinationcombination
3.3. MarijuanaMarijuana
4.4. Prescription OpioidsPrescription Opioids
5.5. BenzodiazepinesBenzodiazepines
DeathsDeaths1.1. Prescription Opioids Prescription Opioids
(not heroin)(not heroin)
2.2. CocaineCocaine
3.3. Alcohol-in-Alcohol-in-combinationcombination
4.4. BenzodiazepinesBenzodiazepines
5.5. MethadoneMethadone
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DDrug rug AAbuse buse WWarning arning NNetworketwork
What it tells us about how dangerous a What it tells us about how dangerous a drug isdrug is Simply gives us total deaths/ER visitsSimply gives us total deaths/ER visits
What it does not tell us about how What it does not tell us about how dangerous a drug isdangerous a drug is Consider relative danger vs. total impact of Consider relative danger vs. total impact of
the drug the drug Number of users vs. number of reported Number of users vs. number of reported
problemsproblems
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Blood-Borne DiseasesBlood-Borne Diseases
Specific toxicity for users who inject drugsSpecific toxicity for users who inject drugs AIDS, HIV infection, and hepatitis B and CAIDS, HIV infection, and hepatitis B and C Sharing needles passes infectious agents Sharing needles passes infectious agents
directly into the bloodstreamdirectly into the bloodstream Some states, cities prohibitSome states, cities prohibit
needle purchase without Rxneedle purchase without Rx Syringe exchange programsSyringe exchange programs
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Substance DependenceSubstance Dependence
What do “addicts” look like?What do “addicts” look like? What drug do they take or what behavior do they What drug do they take or what behavior do they
engage in (alcohol, cigarettes, illicit drugs, food, engage in (alcohol, cigarettes, illicit drugs, food, sex, gambling, shopping, computer time)? sex, gambling, shopping, computer time)?
How much time do they spend on their habit?How much time do they spend on their habit? How much of a drug do they take?How much of a drug do they take? How do you decide on the definition of How do you decide on the definition of
dependence?dependence?
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Substance DependenceSubstance Dependence
Three basic Three basic processesprocesses ToleranceTolerance Physical Physical
dependencedependence Psychological Psychological
dependencedependence
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ToleranceTolerance
Diminished effect on the body after Diminished effect on the body after repeated use of the same drugrepeated use of the same drug
The body develops ways to compensate The body develops ways to compensate for the chemical imbalance caused by the for the chemical imbalance caused by the drugdrug
Regular drug users may build up tolerance Regular drug users may build up tolerance to the extent that their dosage would kill a to the extent that their dosage would kill a novice usernovice user
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Physical DependencePhysical Dependence
Physical dependence is defined by the Physical dependence is defined by the occurrence of a withdrawal syndromeoccurrence of a withdrawal syndrome
Tolerance typically precedes physical Tolerance typically precedes physical dependencedependence
If drug use is stopped suddenly, If drug use is stopped suddenly, withdrawal symptoms occur, ranging from withdrawal symptoms occur, ranging from mild to severemild to severe
Physical dependence means the body has Physical dependence means the body has adapted to the drug’s presenceadapted to the drug’s presence
© 2011 McGraw-Hill Higher Education. All rights reserved.
Psychological DependencePsychological Dependence
Psychological or Psychological or behavioral dependence behavioral dependence High frequency of drug useHigh frequency of drug use Craving for the drugCraving for the drug Tendency to relapse after Tendency to relapse after
stopping usestopping use Behavior is reinforced by Behavior is reinforced by
the consequencesthe consequences Over time, this becomes the Over time, this becomes the
biggest reason users report biggest reason users report they continue to usethey continue to use
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Changing Views of Changing Views of DependenceDependence
Early medical model = true addiction involves Early medical model = true addiction involves physical dependence; key is treatment of withdrawal physical dependence; key is treatment of withdrawal symptomssymptoms
Positive reinforcement model = drugs can reinforce Positive reinforcement model = drugs can reinforce behavior without physical dependencebehavior without physical dependence
Psychological dependence is increasingly viewed as Psychological dependence is increasingly viewed as the driving force behind repeated drug usethe driving force behind repeated drug use This refutes the sometimes common belief that drugs that This refutes the sometimes common belief that drugs that
aren’t as strongly physically addicting are less dangerousaren’t as strongly physically addicting are less dangerous
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Substance Abuse and Substance Abuse and Dependence: DSM-IV-TRDependence: DSM-IV-TR
APA diagnostic criteria for abuse and APA diagnostic criteria for abuse and dependence (page 36)dependence (page 36)
Complex behavioral definitionsComplex behavioral definitions Dependence can occur with or without Dependence can occur with or without
physiological dependence (i.e., withdrawal)physiological dependence (i.e., withdrawal)
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Substance Dependence: Substance Dependence: DSM-IV-TRDSM-IV-TR
A maladaptive pattern of substance use leading to clinically significant A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by three (or more) of the following, impairment or distress, as manifested by three (or more) of the following, occurring at any time in the same 12-month period:occurring at any time in the same 12-month period:1.1. ToleranceTolerance
2.2. WithdrawalWithdrawal
3.3. Substance often taken in larger amounts or over a period longer than Substance often taken in larger amounts or over a period longer than intended intended
4.4. Persistent desire or unsuccessful efforts to cut down or control substance Persistent desire or unsuccessful efforts to cut down or control substance useuse
5.5. A great deal of time is spent in obtaining the substanceA great deal of time is spent in obtaining the substance
6.6. Important social, occupational, or recreational activities are given up or Important social, occupational, or recreational activities are given up or reduced because of substance usereduced because of substance use
7.7. Substance use continues despite knowledge of having a persistent or Substance use continues despite knowledge of having a persistent or recurrent problem that is caused or exacerbated by the substancerecurrent problem that is caused or exacerbated by the substance
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Substance Abuse: Substance Abuse: DSM-IV-TRDSM-IV-TR
A maladaptive pattern of substance use leading to A maladaptive pattern of substance use leading to clinically significant impairment or distress, as clinically significant impairment or distress, as manifested by one or more of the following occurring at manifested by one or more of the following occurring at any time in the same 12-month period:any time in the same 12-month period:1.1. Recurrent substance use resulting in failure to fulfill major role Recurrent substance use resulting in failure to fulfill major role
obligations at work, school, or homeobligations at work, school, or home
2.2. Recurrent substance use in situations in which it is physically Recurrent substance use in situations in which it is physically hazardoushazardous
3.3. Recurrent substance-related legal problemsRecurrent substance-related legal problems
4.4. Continued substance use despite having persistent or Continued substance use despite having persistent or recurrent social or interpersonal problems caused or recurrent social or interpersonal problems caused or exacerbated by the effects of the substanceexacerbated by the effects of the substance
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.
Is Dependence Is Dependence Caused by the Substance?Caused by the Substance?
Some drugs are more likely Some drugs are more likely than others to lead to than others to lead to dependencedependence
Method of use, as well as Method of use, as well as other factors, influences risk other factors, influences risk of dependenceof dependence
The “war on drugs” reflects The “war on drugs” reflects the perspective that drugs are the perspective that drugs are themselves evilthemselves evil
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Is Dependence Biological? Is Dependence Biological?
Is dependence due to biochemical or Is dependence due to biochemical or physiological actions in the brain?physiological actions in the brain?
Still no way to scan the brain and know if a Still no way to scan the brain and know if a person has/had developed dependenceperson has/had developed dependence Genetic physiological or biochemical markers Genetic physiological or biochemical markers
have been sought as well, but none has have been sought as well, but none has proven reliableproven reliable
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Is There an “Addictive Is There an “Addictive Personality”? Personality”?
No way to know if the drug or the drug use No way to know if the drug or the drug use changes a person’s personalitychanges a person’s personality
Many other factors affect personalityMany other factors affect personality Sensation-seeking = a personality Sensation-seeking = a personality
characteristic statistically associated with characteristic statistically associated with early substance use and abuseearly substance use and abuse
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Is Dependence a Family Is Dependence a Family Disorder?Disorder?
Alcohol dependence Alcohol dependence often exists within a often exists within a dysfunctional familydysfunctional family
Evidence suggests that Evidence suggests that dysfunctional dysfunctional relationships play a role relationships play a role in dependence, but they in dependence, but they aren’t the only factoraren’t the only factor
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Is Substance Dependence a Is Substance Dependence a Disease? Disease?
Founders of AA characterized alcohol Founders of AA characterized alcohol dependence as a disease dependence as a disease
Others argue that dependence doesn’t Others argue that dependence doesn’t have all the characteristics of a diseasehave all the characteristics of a disease There are ways to test and treat the effects of There are ways to test and treat the effects of
alcoholism but not the disease itselfalcoholism but not the disease itself There is some disagreement over how to There is some disagreement over how to
define disease as welldefine disease as well
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Biopsychosocial PerspectiveBiopsychosocial Perspective
Dependence is related to Dependence is related to dysfunctions of:dysfunctions of: BiologyBiology PersonalityPersonality Social interactionsSocial interactions
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Drugs and CrimeDrugs and Crime
Drug use may change a Drug use may change a person’s personalityperson’s personality
People under the People under the influence may commit influence may commit crimescrimes (e.g., many cases (e.g., many cases of homicide, domestic of homicide, domestic violence, etc.)violence, etc.)
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Drugs and CrimeDrugs and Crime
Crimes may be Crimes may be carried out to obtain carried out to obtain money for drugsmoney for drugs
Drug use is a crimeDrug use is a crime
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Why We Regulate DrugsWhy We Regulate Drugs
We want to protect society from the We want to protect society from the dangers of some types of drug use = dangers of some types of drug use = legitimate social purposelegitimate social purpose
Some laws are not developed as part of a Some laws are not developed as part of a rationally devised plan and may not be rationally devised plan and may not be realistic or effective realistic or effective Current lawsCurrent laws
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Chapter 2Chapter 2
Drug Use as a Social ProblemDrug Use as a Social Problem