Chapter 14 Understanding Substance Abuse and Addictive Behavior A Wellness Way of Life Ninth Edition Robbins/Powers/Burgess © 2011 McGraw-Hill Higher Education

Chapter 14Understanding Substance Abuse and Addictive Behavior

A Wellness Way of LifeNinth EditionRobbins/Powers/Burgess

© 2011 McGraw-Hill Higher Education. All rights reserved.

Chapter 14 ObjectivesAfter reading this chapter, you will be able to:1. Name the three common elements found in addiction.2. Describe how addiction starts in the brain.3. Identify the most abused legal drug in the U.S.4. List five factors that affect alcohol absorption and list three

reasons why women can get drunk faster than men.5. Differentiate between low-risk alcohol use and high-risk alcohol

use.6. Define binge drinking.7. Identify the blood alcohol concentration (BAC) at which a person

is regarded as legally drunk.8. Describe the “Zero … One … Three” Rule for Lower-Risk

Drinking.9. List the harmful effects of alcohol on the body and how to help a

friend who has passed out from alcohol overindulgence.


Chapter 14 Objectives10. List five tips/strategies for drinking less or not at all.11. Identify the number one cause of preventable death and

health problems in this country.12. Identify the health hazards related to passive smoking.13. Identify the most common illegal drug used in the United

States and the drug the government lists as its top priority on the war against drugs.

14. Describe psychoactive drugs and their categories: cannabis (marijuana), stimulants, narcotics, depressants, psychedelics, and inhalants.

15. List four common kinds of nonprescription drugs that can lead to physical dependence if overused and describe how prescribed drugs can be abused.

16. Describe the danger of using dietary supplements containing ephedra (ephedrine).


Addiction

A pathological or abnormal relationship with an object or event with three common elements:– Exposure – Compulsion– Loss of control

Any behavior or substance can become an addiction, e.g., gambling, food, shopping, sex, work, etc.


Drug Dependence as a Disease The disease can be described. The course of the disease is predictable and

progressive. The disease is primary. The disease is permanent. The disease is terminal. Key questions:

– Is the drug causing any continuing disruption in my life or the lives of those close to me?

– If the answer is yes, but the person doesn’t stop the behavior, could be harmful dependence!


Addiction and the Brain Addiction is a brain disease with a genetic basis. Neurobiological changes accompany the transition

from voluntary to addictive behavior and alter the brain’s pleasure circuits.

The pleasure circuit communicated with dopamine, a neurotransmitter creating a pleasant feeling.

Drugs of abuse increase the concentration of dopamine in the brain’s reward circuit.

Because of the increase, the brain decreases dopamine receptors which results in an overall decrease in dopamine in the brain.

Therefore, pleasure decreases, resulting in a higher amount of the drug to produce the same effect.


Addictive Personality Not confirmed by research, but a genetic link for

alcoholism has been found. Family environment is the most important

component. Who is vulnerable? Those who have:

– Low esteem, sense of alienation, unable to accept comfort, need for instant gratification, rebel against authority, enjoy dangerous behavior, lie easily, are perfectionists, fear personal criticism, overly concerned with how others perceive them, tend to be submissive and dependent, and have high levels of negative emotions.


Alcohol Alcohol is technically known as ethyl alcohol or ethanol. It is a central nervous system depressant drug.

– Slows brain function – Slows reaction time– Dulls alertness– Impairs coordination – Intensifies emotions – Increases risk taking – Lowers inhibitions– Disrupts judgment and reasoning


Alcohol Absorption The amount of alcohol in the blood is measured

by blood alcohol concentration (BAC) which is a percentage. .08% is the legal limit. BAC of .4% could cause death.

Alcohol is processed by the liver at an approximate rate of 1 oz. per hour.

Speed of absorption depends on weight, gender, speed of consumption, food intake and type of beverage – 12oz. Beer, 5oz. Wine, 12oz. Wine Cooler, and 1 shot of 90 proof liquor have about same amount of alcohol.

Women get drunk faster because they have less of theenzyme that breaks down alcohol, higher levels of body fat, lower weight.

Tolerance is the body’s physical adjustment to the habitualuse of a chemical. Due to tolerance, an experienced drinker with a BAC of .08% may not feel drunk, but they are still intoxicated and at risk!


All standard size drinks provide the same amount of alcohol.

Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

Photo credit: Courtesy of Gwen Robbins/Debra Powers/Sharon Burgess


Impact of Alcohol Alcohol is by far the most devastating drug! Alcohol is a factor in 50% of deaths in motor vehicle

crashes, 33% drownings, 50% deaths caused by fire, 50% homicides, 33% of suicides, 66% of assaults, 50% domestic violence, 90% of campus rapes, 40% of academic problems.

#1 killer of teenagers: drinking and driving. Significant factor in all risk behavior especially sexual

decisions. Most dangerous consequence may be the false sense

of confidence and invulnerability that leads to disregard for health, safety, and welfare of self and others.


Long-Term Effects

Alcohol is a toxin, and its harmful effects on the body are overwhelming!– Brain damage– Nerve damage– Heart disease, high blood pressure, stroke– Cancer– Depressed immune function– Liver failure– Malnutrition


Low-Risk and High-Risk Alcohol Consumption

About 2/3 of Americans use alcohol. Low-risk use is drinking no more than one drink per day

for women and no more than two drinks per day for men. Lowest risk is no consumption.

High-risk user doesn’t follow the guidelines for low risk use and is guilty of binge drinking.

A binge is typically five drinks for a man and four drinks for a woman in about two hours that brings the BAC to .08%.

Binge drinking is dangerous for the drinker and society. Frequent bingers are 17 times more likely to miss class,

10 times more likely to vandalize property, and 8 times more likely to get hurt.

If you drink while pregnant or driving a car, you are abusing alcohol.


The Zero … One … Three Rule

The Michigan Guidelines: The Zero … One … Three Rule for Lower-Risk Drinking.– 0 = no level of drinking is recommended. Never

drink and drive or drink when pregnant.– 1 = drink only one alcoholic beverage per hour if

you do drink.– 3 = never drink more than three alcoholic

beverages per day (or more than five per week).


College and Drinking Colleges serious about lowering drinking should do the

following:– Set clear policies and consequences– Screen– Provide education programs– Restrict supply– Restrict advertisements– Provide alcohol-free living environments– Provide full-time education– Start freshman orientation before students arrive on campus– And other measures (social norming, monitoring, service learning,

etc.


Social Norming The perceptions on most campuses is that all students are

consuming vast amounts of alcohol. This is not the true picture. Students tend to overestimate the acceptability and the actual

drinking behavior of their peers. This may influence students to engage in heavy drinking

because “everyone is doing it” – even though everyone is not doing it.

Positive or social norming could with risk/harm reduction can correct false perceptions.

These techniques emphasize the true “norm” which is that not everyone is doing it. Commonly use media to advertise the correct statistics. (The median number of drinks consumed by all students is 1.5)


Alcoholism A chemical dependence to alcohol. About 1 in

13 Americans are alcoholics. It involves progressive preoccupation with

drinking, leading to physical, mental, or social dysfunction.

Genetics: history of alcoholisms in family puts you at higher risk. Family norms influence your adult behavior.

The alcoholic should completely quit using alcohol (with supervision to deal with addiction issues). Alcoholics Anonymous offers a good support system for alcohol cessation.


Coping Strategies

Get a professional assessment if you think you may be alcoholic – help is available: counseling, medical assistance, groups, AA

Listen to those around you. Your friends, co-workers, and family members can provide good insight into your behavior.

Take self-responsibility! If you drink – don’t drive or make sexual decisions. Set a limit and stick with it, don’t chug or do shots, drink non-alcoholic drinks.


Strategies for Dealing with Alcohol

Let your waistline be your incentive. Switch to juice or soft drinks. Eat first before you drink. Avoid drinking after exercise, drink water first. Don’t hold the drink in your hand. Put it down

between sips. Try cocktails without alcohol. Dilute your drinks. Make sure the alcohol is properly measured. Volunteer to be the driver and then don’t drink.


Helping a FriendIf a friend passes out from drinking or shows signs

of alcohol poisoning: Put them on their side. Do not give them anything to eat or drink. Be sure they are breathing normally – not

shallowly, but deeply. Cover them with a sheet, not a blanket, because

too much warmth can stop vital stimulation. If there is any suspicion of an alcohol overdose

call for medical help.


Other Important Risks

Alcohol should be completely avoided during pregnancy.

Alcohol use during pregnancy can cause Fetal Alcohol Syndrome – leading cause of mental retardation in the Western world.

Even a small amount can cause Fetal Alcohol Effect (FAE).


One in five women drink during pregnancy.


Photo credit: ©PhotoDisc


Tobacco Use Regular smokers lose 6 minutes of life with every

cigarette they smoke! – 2 hours lost per day! Even moderate use of any tobacco product could reduce

life expectancy by 5 to 7 years. #1 preventable cause of death – more than 400,000

deaths per year in the U.S. Factor in heart disease, cancer, emphysema, COPD, high

blood pressure, stroke, high LDL levels, etc. Quitting at any point can help your health. Smoking is becoming socially unacceptable. Sidestream

and secondhand smoke is dangerous to others. More and more states are becoming smoke free.


Why Do People Smoke? About 23% of Americans smoke – but smoking is up among

young people and college students. Most important influence: family and friends. Most start before age 18 to fit in, to appear cool, to rebel against

authority. Nicotine is physically and psychologically addictive. Most smokers want to quit. It is

possible but may take multiple tries. Best method is classes/counseling and medication together.

Many resources are available. See your instructor for local resources.

© PhotoAlto


Health Risks of Smoking Cigarette smoke has 4000 toxic chemicals. Smoking places a burden on the heart and lungs. It is a significant factor in heart disease, cancer,

stroke, COPD, and other problems. It helps to quit. Heart attack risk decreases by

50% in the first year after quitting. After 10-15 years risk is virtually the same as a non-smoker (if no damage was done).

Smokeless tobacco is also carcinogenic.


Courts ruled that tobacco companies conspired to sell a dangerous product.


Photo credit: Courtesy of Gwen Robbins/Debra Powers/Sharon Burgess


How to Quit Smoking

Identify your reasons. Set a target quit date Identify your barriers to

quitting. Make a plan for dealing

with temptations. Change to a brand you

find distasteful. Involve your friends and

family.

On the day you quit, toss out all cigarettes, tobacco, and other paraphernalia.

After quitting, change your normal routine.

When you crave, chew on carrots, pickles, sugarless gum or a toothpick.

Mark your progress.


The Clock Strategy Assign yourself specific times of the day to

light up. Gradually lengthen the intervals between

cigarettes. Cut back progressively on the number of

cigarettes per week (decreasing by on-third each week).

Breaks normal cues and habits. Said to be twice as successful as cold turkey.


When Smokers Quit



Psychoactive Drugs

Mind-affecting or mind-altering Change one’s thinking, feelings, perceptions,

behaviors Classification based on effect on Central Nervous

System– Depressants– Cannabis (Marijuana)– Stimulants – Narcotics or opiates– Psychedelics– Inhalants


Club Drugs “party drugs” Refer to a variety of drugs used at bars,

college hangouts, dance clubs or parties, i.e., raves

Attractive due to these factors:– Inexpensive– Produce increased stamina– Intoxicating

Examples include: MDMA (ecstasy), GHB, Rohypnol, and ketamine

Date rape drugs: GHB, rohypnol and ketamine are all depressants© 2011 McGraw-Hill Higher Education. All rights reserved.

Depressants

Sedatives Slow down Central Nervous System,

relax, produce sleep Alcohol Date rape drugs: GHB and Rohypnol

(“roofies”) All become dangerous when mixed with

other sedatives or narcotics.


Date Rape Drugs Are used to cause women (or men) to become overly

relaxed or pass out and may yield unknowingly in a sexual way.

To reduce the risk:– Do not leave beverages unattended.– Do not take beverages from someone you do not know and

trust.– Accept drinks only from the bartender or wait staff.– At parties, do not accept open container drinks from anyone.– Do not drink anything that has an unusual taste or appearance

(salty, foamy, residue or strange color).– Watch out for your friends.– Anyone who may have ingested these drugs should be taken

to the ER or call 911 for them.


Cannabis (Marijuana)

Most widely used illegal drug in the U.S. THC (tetrahydrocannabinol) is the primary

psychoactive ingredient.– It is fat soluble. – Stored in fatty tissues of the brain, body, and

reproductive organs.– Causes brain cell damage and lower sperm count.– Causes amotivational syndrome (low energy,

apathy, and little drive to do anything).– Smoking it increases risk for cancer.– Impair the ability to use a car, boat or machinery.


Stimulants

Speed up the CNS, resulting in alertness and excitability

Examples include:– Cocaine/crack (crystallized freebase

cocaine)– Methamphetamine– MDMA (ecstasy)– Caffeine


Narcotics or Opiates

Powerful pain killers Also known as opioids Bring pleasurable feelings and can

induce sleep and depress breathing Examples include:

– Heroin– Morphine– Opium


Psychedelics

Known mind-expanders or hallucinogens

Affect perception, awareness, and emotions

Examples include:– LSD (lysergic acid diethylamide)– mushrooms


Inhalants

Considered a step-up drug to more powerful drugs

Volatile chemicals (household products) Diverse group of breathable chemicals that

produce mind-altering vapors “Huffing” produces drug-like effects or

intoxication Examples include:

– Commercial solvents– Aerosols– Spray paint– Anesthetics


Over-the-Counter and Prescription Drugs

Over-the-counter (OTCs)– Aspirin– Cold medicines– Cough syrups– Laxatives

OTCs that can produce side effects or dependence:– Nasal sprays, laxatives, eye drops, alcohol/codeine cough

syrups, stimulants Prescription drugs

– Most are put to good use; some are abused:• Amphetamines, barbiturates, narcotics, tranquilizers

Synergistic reaction– Phenomenon that occurs when various drugs are taken in

combination, where the cumulative effect is greater than the effects of the drugs when taken separately.


Dietary Supplements with Ephedra

Ephedra, also known as Ma Huang, is an amphetamine-like drug found in some diet supplements and herbal supplements.

Side effects include:– Raised blood pressure– Irregularities in heart rate– Insomnia– Tremors, headaches and seizures– Heart attacks– Stroke – Death

Ephedra is especially dangerous for people with hypertension or other cardiovascular disease.


Rx for Action Count how many bar/clubs are within 1 mile of campus. Find out how many calories and nutrients are in a 12 oz. can of beer,

a margarita, wine cooler, or other popular drinks. List the OTCs you take in 1 week. List the prescription drugs you take in a week. Investigate where you can get help to stop smoking (or for a friend). Check to see if alcoholic drink specials (and bars) are advertised in

your campus newspaper. What percentage of students at your college are 21 or older?

Find out if alcoholic beverage companies sponsors athletic eventsor help fund buildings on your campus. What companies?

Have you been affected by someone’s alcohol/drug use? How? Find out where you can report drug problems.


What Do You Think?

How does addiction affect the brain? Are you committed to low-risk alcohol consumption? What should you do to help a friend that is passed out? If you drink, how could you drink less or not at all? If you smoke, do you want to quit? Do you know your

resources? Is using marijuana dangerous? What over-the-counter drugs do you use and are you at

risk for addiction? Do you use products with Ma huang? Do you understand

the dangers?


Questions?


Documents

Chapter 14 Understanding Substance Abuse and Addictive Behavior A Wellness Way of Life Ninth Edition Robbins/Powers/Burgess © 2011 McGraw-Hill Higher Education