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 AbuseWeek 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 Last 30 Days Daily

Alcohol 85 69% 4%

Cigarettes (tobacco) N/A 18% 9.20%

Marijuana/Hash 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%

Crack 1.40% 0.10% 0.00%

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?

Drug Ever Used Last 30 Days Daily

Alcohol 85 69% 4%

Cigarettes (tobacco) N/A 18% 9.20%

Marijuana/Hash 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%

Crack 1.40% 0.10% 0.00%

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

Cocaine (all) 1 3 0.7 0.5 3 3

Break Down of Drug Use

High School Graduates College Graduates

Alcohol 55 78

Cigarettes (tobacco) 46 30

Marijuana/Hash 17 13

Cocaine 2 1

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

Deaths1. Prescription Opioids(not heroin)2. Cocaine3. Alcohol-incombination4. Benzodiazepines5. 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 useleading to clinically significantimpairment or distress, as manifested by2 (or more) of the following, occurringwithin a 12-month period:

Criteria

1. Recurrent substance use resulting in a failure to fulfill major roleobligations at work, school, or home (e.g., repeated absences or

poor work performance related to substance use; substancerelatedabsences, suspensions, or expulsions from school;

neglect of children or household)

2. Recurrent substance use in situations in which it is physicallyhazardous (e.g., driving an automobile or operating a machine

when impaired by substance use)

3. Continued substance use despite having persistent or recurrentsocial 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’d6. 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 cutdown or control substance use

8. A great deal of time is spent in activities necessary to obtainthe substance, use the substance, or recover from its effects

9. Important social, occupational, or recreational activities aregiven up or reduced because of substance use

10. Substance use is continued despite knowledge of having apersistent or recurrent physical or psychological problemthat is likely to have been caused or exacerbated by the

Substance

11. Craving or a strong desire or urge to use a specificsubstance

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

• 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

The Comprehensive Drug Abuse Prevention and Control Act (1970)

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