PSY 302: Substance Abuse Chapter 3: Depressants. Depressants Drugs that depress the overall...
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Transcript of PSY 302: Substance Abuse Chapter 3: Depressants. Depressants Drugs that depress the overall...
PSY 302: Substance Abuse
Chapter 3: Depressants
Depressants
Drugs that depress the overall functioning of the Central Nervous System (CNS) to induce sedation, muscle relaxation, and drowsinessReduce tension and inhibitionsMay affect judgment, motor activity, and
concentration Typically these drugs are addicting
Depressants
Narcotics Natural opium derivatives Semisynthetic Synthetic
Sedative-Hypnotic Drugs Barbiturates
Methaqualone Benzodiazepines
Alcohol
The brain produces peptides called endorphinsThree specific endorphins have characteristics of morphine (analgesics)Large amounts of these are released when experiencing stress or painWhen they reach their receptor sites in CNS, they relieve pain
Endorphin Receptor Phenomenon Athlete’s ability to overcome painTreating pain with acupuncture
Endorphins
These receptor sites are programmed to receive endorphins Also receptive to external chemicals such as morphine
Endorphins
Direct Reinforcing EffectEndorphins have their own reinforcing effects
Indirect Reinforcing Effect Endorphin synapses may contribute to certain kinds of reinforcement by inhibiting the release of GABA indirectly
Endorphins
Ingestion of large amounts of heroin or some other opiate can lead to an endorphin deficiency
The external chemical binds to the receptor site and causing the brain to slow its natural opiate production
Leads to addiction
Endorphins
The body reacts to stress by secreting two types of chemical messengers:Hormones in the bloodNeurotransmitters in the brain
Stress & Addiction
The body reacts to stress by secreting two types of chemical messengers:Hormones in the bloodNeurotransmitters in the brain
Depressants such as heroin inhibit the release of stress hormones and stress-related neurotransmittersHowever, most who are prescribed opiates for acute pain do not become addicted
Stress & Addiction
A person having difficulties with stress who is exposed to opiates is likely to find them rewarding and become dependent on them
However, in the absence of stress, most people take opiates over long periods of time without becoming addicted Melzack (1990)
Only 2 of 38 chronic pain patients became addicted Over 10,000 burn victims treated with narcotics; none
became addicted
Stress & Addiction
When stress is relatively low:Drug addicts trying to remain off drugs can usually resist cravings from environmental cues when stress levels are low
When stress is relatively high:Can lead to a sudden relapse
Stress & Addiction
Hypersensitivity to stress may have existed before drug use, caused by the drug use, or exacerbated by the drug useChronic use of heroin may increase this hypersensitivity to stress and trigger a cycle of continued drug use when the heroin wears off
Since effects of heroin last only about 6 hours, addicts often experience withdrawal several times a day
Stress & Addiction
Opioids
Derived from opium these drugs depress CNS functioning
Include: opium, morphine, codeine, and heroin Have the effect of dulling or numbing the
senses… Pupils constrict Breathing slows User becomes lethargic
For a few hours, such things as pain and anxiety are replaced by blissful pleasure
But for bliss you pay the price…
Unfortunately, the bliss is eventually replaced by a gnawing craving for another fix
The path to addiction is insidious…When repeatedly flooded with these artificial
opiates – the brain stops producing its own natural opiates (endorphins)
So, when the drug is withdrawn, the brain lacks the normal level of these painkilling neurotransmitters
The result is the raw agony of withdrawal
Its effects…
The effects of opiates, like those of other intoxicants, depend on:The user's state of mind and on the company
the user is inWhether an opiate is used on its own or
together with other intoxicantsWhether the user is a novice or an
experienced user also has an influence on the effects of the drug
Heroin Heroin is a narcotic that is highly
addictive; It is processed from morphine, a naturally occurring substance extracted from the seedpod of the Asian poppy plant.
The most abused and most rapidly acting of the opiates.
Usually seen as a white or brown powder or as a black sticky substance. The differences in color are due to impurities left from the manufacturing process or the presence of additives.
Heroin
Pure heroin, which is a white powder with a bitter taste, is rarely sold on the streets
Sometimes cut with other substances such as sugar, powdered milk, cornstarch, or even poisons like strychnine
Methods of Use…
In the past heroin was mostly injected but in recent years it has been made in forms that can be smoked or snorted
The user feels the effect of heroin within seconds of taking it
Heroin is converted into morphine when it enters the brain, which disrupts normal brain activity and creates intense feelings of pleasure
Effects of Heroin
IntravenousOnset: 10 seconds
SubcutaneousOnset: 5-8 minutes
Short Term Reactions
Euphoria Warm flushing of the skin Dry mouth Heavy extremities Decreased mental ability Insensitivity to pain Vomiting Lowered breathing Lowered heart rate DEATH
Long Term Reactions
Addiction High degree of tolerance Brain damage Arthritis Liver disease Infection of the heart lining HIV/AIDS or hepatitis Abscesses of the skin (at injection sites) DEATH
Effects of Heroin
Agar (1973) The Rush The High The Nod Being Straight
Tolerance for Heroin
Tolerance to the high and the nod require an increase in the dosage in order to gain the same level of responseMaintenance doses of morphine or some other narcotic can prevent physical withdrawal
Heroin Withdrawal
Heroin causes severe physical and psychological symptoms 6 to 8 hours after the last dosage. Painful withdrawal gets worse as time passesSymptoms Include:
Runny nose muscle and bone pain Emotional distress and restlessness Diarrhea Vomiting Hot flashes and heavy sweating Cold flashes with goose bumps Insomnia An overwhelming need for more heroin
Medical Use
Once used to control pain, it is no longer legal to use under any circumstance
Abuse of Prescription Opioids
The main prescription opioids people abuse are Codeine Oxycodone (OxyContin®, Percodan®,
Percocet®) Hydrocodone (Vicodin®) Meperidine (Demerol®) Hydromorphone (Dilaudid®)
OxycodoneUse Patterns
The number of people abusing oxycodone has increased every year since the drug was introduced in 1995
OxycodoneFacts Oxycodone is timed-release medicine for cancer and back pain
People forge prescriptions and rob pharmacies to obtain oxycodone illegally
People abuse oxycodone by crushing the tablet and swallowing or snorting it or dissolving it in water
OxycodoneDangers
When people crush tablets before taking them, the danger of overdose is increased.
Like all opioids, oxycodone is highly addictive when it is abused
Sedative-Hypnotic Drugs: Barbiturates
Barbiturates are powerful depressants that slow down the central nervous system Classified as sedative/hypnotics
Once a very commonly used tranquilizer but because they are highly habit-forming their usage decreased They have effects similar to alcohol They depress sympathetic nervous system activity They have been used to induce sleep and reduce anxiety
In large doses, can lead to impaired memory and judgment
Barbiturates
What it feels like… Relaxation, peacefulness, sleepiness, pleasurable
intoxication, dizziness, inactivity, withdrawal, interrupted thought processes, mood swing, excitement, increased pain, hostility, depression, anxiety, confusion, changed vision, intense emotions, hangover
Barbituates give a quick “high” but the effects drop off and persist for a low level for a longer duration
Barbiturates: Tolerance
Acute tolerance develops virtually right away Chronic tolerance seems first to develop to
the depressant effects Next to the antianxiety effects Cross tolerance within benzodiazepines Some cross tolerance to barbiturates and
alcohol
Barbiturates: Tolerance
As tolerance develops, users progressively increase their daily dose to many times the original
It is extremely important to note that in spite of acquiring tolerance to the intoxicating effects of barbiturates, the user develops no tolerance to the lethal action of the drug
Therefore, high doses could produce fatal results even for tolerant abusers.
High risk for fatal overdose
Withdrawal
BarbituratesREM ReboundTremors InsomniaNauseaSeizuresHallucinations
Medical Use
Used as sedatives for treatment of insomnia and as anticonvulsants to help prevent or mitigate epileptic seizuresNot used as much anymore; high risks
involved
Sedative-Hypnotic Drugs: Benzodiazepines
Benzodiazepines (commonly referred to as benzos) are a more recent generation of tranquilizers
Some of the more common benzodiazepines are: ativan, librium, valium, and xanax
Potentially addictive Little risk of overdose
Short-Term Effects
Relaxation Drowsiness Dizziness Confusion Mood swings
Common Long-term Effects
Lethargy Irritability Nausea Loss of sexual interest Increased appetite Increased weight
Withdrawal
BenzodiazepinesAgitationDepressionPainDTsREM rebound
Medical Use
They are usually prescribed by doctors to treat anxiety and sleep problems, they can also, be used to treat panic disorders and muscle spasms, and occasionally used in the treatment of epilepsy and alcohol withdrawal (under strict medical supervision only)
Abusers
Barbituates and benzodiapines are abused by two groups of people… Individuals who overuse these drugs to
reduce daily tensions and to aid in sleep These people take excessively large doses on a
regular basisStreet drug users
Attempt to achieve a state of “relaxed euphoria” or to aid in “coming down” from a high caused by taking a stimulant
Methaqualone
Brand Name: Quaaludes/Ludes
Street Names: Ludes, Qualudes, Vitamin Q, The Love Drug, Wallbangers
Side Effects
Methaqualone can be very addictive. Habitual users often grow physically and psychologically dependent on the drug.
Withdrawal symptoms can include restlessness, irritability, antisocial behavior, and insomnia.
More severe withdrawal cases may lead to delirium, nightmares, hallucinations, epileptic-like seizures that can lead to death, and severe cravings for the drug for long periods after withdrawal.
High risk for overdose
Alcohol
Alcohol is a depressant yet we often feel lively after a couple of drinks… It gives this feeling by slowing down the brain
centers that control judgments and inhibitions
Curious Effects
MemoryBlackouts
SexMale arousal and performance issues
Blood Alcohol Level (BAL)
The amount of alcohol in your bloodSee next two slides for BAL of males and
females
Genetic Influence
Six genes have been linked to addiction These genes seem to be linked primarily
to early-onset alcoholism
See next slide
The genetic basis for early-onset alcoholism is stronger than for later-onset, especially in men
Researchers distinguish between two types of alcoholism Type I/Type A Type II/Type B
Genetic Influence
Type I/Type A characteristics include:◦ Later onset◦ Gradual onset◦ Fewer genetic relatives with alcoholism◦ Equal quantity between men and women◦ Less severe
Genetic Influence
Type II/Type B characteristic include:◦ Earlier onset (usually before 25)◦ More rapid onset◦ More genetic relatives with alcoholism◦ Men outnumber women◦ Often severe◦ Often associated with criminality
Genetic Influence
Several studies have looked at the behaviors of sons of alcoholic fathers
ProcedureControl group would be males without alcoholic fathers
ResultsSons of alcoholics show less intoxication after drinking moderate amounts of alcoholLow initial response leads to greater drinking later in lifeMore of stress reliever for sons of alcoholicsBrain abnormalities (small amygdala) in sons of alcoholics (before they became alcohol abusers)
Genetic Influence
AddictionGenes influence the likelihood of alcoholism in various ways:◦ Sensitivity of Dopamine type 4 receptor◦ Control of COMT enzyme that breaks down
dopamine
Genetic Influence
Genetic Influence
Children of alcoholics are at 2- to 4-fold higher risk for developing alcohol problems.
About 50% of brothers and 25% sisters of an alcoholic are also alcoholic.
Yet, most individuals in a family are not affected with alcoholism.
DSM Alcohol Withdrawal Criteria
A. Cessation of (or reduction in) alcohol use that has been heavy and prolonged.B. Two (or more) of the following, developing within several hours to a few days
after Criterion A. 1. Autonomic hyperactivity (e.g., diaphoresis or HR>100) 2. Increased hand tremor 3. Insomnia 4. Nausea and vomiting 5. Transient visual, tactile, or auditory hallucinations or illusions 6. Psychomotor agitation 7. Anxiety 8. Grand mal seizures
DSM Alcohol Withdrawal Criteria
C. The symptoms in Criterion B cause clinically significant distress or impairment in functioning.
D. The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder.
Dangers of Alcohol Use
Wernicke–Korsakoff SyndromeUp to 80 percent of alcoholics have a deficiency in thiamine and some of these people will go on to develop serious brain disordersThe symptoms of Wernicke’s encephalopathy include mental confusion, paralysis of the nerves that move the eyes, and difficulty with muscle coordinationFor example, patients may be too confused to find their way out of a room or may not even be able to walk
Dangers of Alcohol Use
Liver & Brain DiseaseMost people realize that heavy, long-term drinking can damage the liver, the organ chiefly responsible for breaking down alcohol into harmless byproducts and clearing it from the bodyBut people may not be aware that prolonged liver dysfunction, such as liver cirrhosis resulting from excessive alcohol consumption, can harm the brain, leading to a serious and potentially fatal brain disorder known as hepatic encephalopathy
Dangers of Alcohol Use
Fetal Alcohol Syndrome (FAS)FAS is a lifelong yet completely preventable set of physical, mental and neurobehavioral birth defects associated with alcohol consumption during pregnancy
Alcohol enters the mother’s and the fetus’ bloodstreamFAS is the leading known cause of mental retardation and birth defects
Small disproportioned head and lifelong brain abnormalities
How does a mother’s drinking affect her unborn child? Facts:
Through the blood vessels in the placenta, the mother’s blood supplies the developing baby with nourishment and oxygen
If the mother drinks alcohol, the alcohol enters her blood stream and then, through the placenta, enters the blood supply of the growing baby
So, when a pregnant woman drinks alcohol, so does her baby
Alcohol is a teratogen, a substance known to be toxic to human development
Fetal Alcohol Syndrome (FAS)
Prenatal alcohol exposure does not always result in FAS—although there is no known safe level of alcohol consumption during pregnancy
Most individuals affected by alcohol exposure before birth do not have the characteristic facial abnormalities and growth retardation identified with FAS, yet they have brain and other impairments that are just as significant
Sad facts…
In addition to mental retardation, individuals with FAS may have other neurological deficits such as poor motor skills and hand-eye coordination
They may also have a complex pattern of behavioral and learning problems, including difficulties with memory, attention and judgment.
As many as 12,000 infants are born each year with FAS
Rohypnol
Benzodiazepine drug that is not legal in US but prescribed in other countries
Dangerous when mixed with alcohol as intoxication effects may be extreme
Severely impaired judgment and motor skills Complete blackouts are possible Long recovery period Prolonged use results in physical dependence
Credits:
Some slides prepared with the help of the following websites: http://pubs.niaaa.nih.gov/publications/aa63/aa63.pdf www.towson.edu/atod/education/documents/Heroin_000.pptx http://www.midlandstech.edu/sbs/gummowa/psy212ch12.ppt.