db notes ch 1
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Exam
586,000 On an average day in 2006,the
number of U.S.adolescents,aged
twelve to seventeen,who smoked
marijuana
1,200,000 On an average day in 2006,the
number of adolescents who smoked
cigarettes
Exam
According to a national survey, about one in five
males and about one in eight females between the ages
of twelve and seventeen have been approached in the
past month by someone selling drugs. For fifteen- or
sixteen-year-old youths, the number is approximatelyone in four.
Exam
The public-health concern
about underage cigarette smoking centers on the fact
that approximately 82 percent of regular smokers in the
United States, aged thirty to thirty-nine, smoked their
first cigarette²and more than half had become regular
smokers²before they were eighteen years old.2
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Exam
The appear-
ance of Joe Camel, the Marlboro Man, and the Virginia
Slims Woman in print advertisements for cigarettes may
be increasingly distant memories, but at one time they
were dominant images that conveyed the attractiveness of
smoking to the public, particularly to young people.
They are gone now as a result of federal regulations estab-lished in 1998
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officially classified since 1970 as a drug with a high poten-
tial for abuse and no accepted medical use, in the same
category as heroin
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psychoactive drugs:Drugs that affect feelings,thoughts,perceptions,or behavior.
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The development of
anti-craving medications, particularly with respect to
cocaine abuse (see Chapter 4), is a hopeful sign that we
can finally understand the biochemical basis for drug
dependence.
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First, we will examine the
biological, psychological, and sociological effects of con-
suming certain types of drugs.
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specific substances that alter our feelings, our
thoughts, our perceptions of the world, and our behavior.These substances are referred to as psychoactive drugs
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drug: A chemical substance that,when taken into the
body,alters the structure or functioning of the body in
some way,excluding those nutrients considered to be
related to normal functioning.
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because they influence the functioning of the brain andhence our behavior and experience.
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illicit (illegal) drugs:
heroin, cocaine, and marijuana, as well as club drugssuch as Ecstasy, LSD, PCP, ketamine, and GHB.
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licit(legal) drugs,such as alcohol, nicotine, and caffeine.
In the cases of alcohol and nicotine, legal access carries a
minimum-age requirement.
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Second, we will focus on the complex interplay of
circumstances in our lives that lead to drug-taking
behavior.
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drug use
is, at least in part, a consequence of how we feel about
ourselves in relation to our parents, to our friends and
acquaintances, to events occurring around us, and to thecommunity in which we live.
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biological factors that may predispose us to drug-taking behavior.
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reasons why some
individuals engage in drug-taking behavior, whereasothers do not, will be a primary topic of discussion.
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a vicious
circle can develop in which drug-taking behavior fosters
more drug-taking behavior, in a spiraling pattern that isoften extremely difficult to break
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understanding of drug dependence
requires an examination of both biological and sociolog-
ical factors
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psychoactive drugs modifies
the functioning of the brain, both at the time during
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which the drug is present in the body and later when
the drug-taking behavior stops.
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a ³switch´ in the
brain seems to be thrown following prolonged drug use.
It starts as a voluntary behavior, but once that switch
is thrown, a pattern of drug dependence takes over.
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Second, drug dependence is a result of a complex inter-
action of the individual and his or her environment.
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The standard approach is to characterize a drug as a
chemical substance that, when taken into the body, altersthe structure or functioning of the body in some way
Note: too broad
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we need to refine our definition,
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adding the phrase excluding those nutrients considered to be related to normal functioning.
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effectively eliminate the cheese inyour next pizza from consideration as a drug,
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illicit drugs:Drugs whose manufacture,sale,or pos-
session is illegal.
licit drugs:Drugs whose manufacture,sale,or pos-
session is legal.
drug dependence: A condition in which an individual
feels a compulsive need to continue taking a drug.In
the process,the drug assumes an increasingly centralrole in the individual¶s life
Exam
First, there is probably no
perfect definition that would distinguish drugs from
nondrugs without leaving a number of cases that fallwithin some kind of gray area
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The best we can do is to
set up a definition, as we have, that handles most of the
substances we are likely to encounter
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We often make
thedistinction between drugs and nondrugs not in terms
of their physical characteristics but rather in terms of
whether the substance in question has been intended to be
used primarily as a way of inducing a bodily or psychologi-cal change.
Exam
Whether we
realize it or not, when we discuss the topic of drugs, we
are operating within a context of social and cultural
values, a group of shared feelings about what kind of
behavior (that is, what kind of drug-taking behavior) isright and what kind is wrong.
Exam
When we say ³drug misuse´ and
³drug abuse,´ for example, we are implying that some-
thing wrong is happening, that a drug is producing some
harm to the physical health or psychological well-beingof the drug user or to society in general
Exam
We cannot judge on
the basis of whether the drug is legal or illegal, since the
legality of a psychoactive drug often depends more on
historical and cultural circumstances than on its chemi-
cal properties
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The difficulty of using a criterion based on
legality is further complicated by cultural differences
around the world.
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What is the intent or motiva-
tion on the part of the drug user with respect to this kindof behavior?
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Depending on the intent of the individual,
drug-taking behavior can be classified as either instru-
mental or recreational.7
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instrumental use, we mean that a person is
taking a drug with a specific socially approved goal inmind. The user may want to stay awake longer,
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In these cases, drug-taking behavior occurs as a means
toward an end that has been defined by our society as
legitimate.
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The instru-
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mental use of drugs can also involve drugs that are illicitly
obtained, such as an amphetamine or other stimulant
drug that has been procured through illegal means to
help a person stay awake and alert after hours withoutsleep.
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recreational usemeans that a person is
taking the drug not as a means to a socially approved
goal but for the purposes of acquiring the effect of the
drug itself
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Whatever happens as a con-
sequence of the drug-taking behavior is viewed not as ameans to an end, but as an end unto itself
Note: The effect of the drug is WHY they are taking it.
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. Drinking an alcoholic beverage, for example,
is considered recreational drug-taking behavior under
most circumstances. If it is recommended by a physician
for a specified therapeutic or preventive purpose (see
Chapter 9), however, the drinking might be considered
instrumental in nature.
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Drug
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misusetypically applies to cases in which a prescriptionor nonprescription drug is used inappropriately.
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instrumental use:Referring to the motivation of a
drug user who takes the drug for a specific purpose
other than getting ³high.´
recreational use:Referring to the motivation of a drug
user who takes the drug only to get ³high´or achieve
some pleasurable effect.
drug misuse:Drug-taking behavior in which a pre-
scription or nonprescription drug is used inappro-
priately.
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drug abuse:Drug-taking behavior resulting in some
form of physical,mental,or social impairment.
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For
example, drug doses may be increased beyond the level
of the prescription in the mistaken idea that if a little is
good, more is even better.
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Drug misuse can be dangerous and potentially
lethal, particularly when alcohol is combined withdrugs that depress the nervous system.
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Drugs that have
this particular feature include antihistamines, antianxi-
ety drugs, and sleeping medications.
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elderly,
who often take a large number of separate medications.
This population is especially vulnerable to the hazards
of drug misuse.
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drug abuseis typically applied to cases
in which a licit or illicit drug is used in ways that producesome form of physical, mental, or social impairment
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primary motivation for individuals involved in drug abuse is recreational.
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Drugs
with abuse potential include not only the common street
drugs but also legally available psychoactive substances
such as caffeine and nicotine (stimulants), alcohol
andinhaled solvents (depressants), as well as a number
of prescription drugs designated for medical purposes
but used by some individuals exclusively on a recre-
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ational basis
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In these particular cases, the distinction between drugmisuse and drug abuse is particularly blurry
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When there
is no intent to make a value judgment as to the motiva-
tion or consequences of a particular type of drug-taking
behavior, that behavior will simply be referred to as
druguse.
Exam
. We need to understand the reasons why drug-taking
behavior has been so pervasive a phenomenon over the
many centuries of human history and the reasons why
drug-taking behavior remains so compelling for us inour society.
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Taking Valium with a
prescription to relieve
anxiety
Taking No Doz to stay
awake on a long trip
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Taking amphetamines
without a prescription to
stay awake the night before
a test
Taking morphine without a
prescription to relieve pain
Having an alcoholic drink
to relax before dinner
Smoking a cigarette or a
cigar for enjoyment
Smoking marijuana to
get high
Taking LSD for the
hallucinogenic effects
Exam
which our society has responded to problems associated
with drug use. How have our attitudes toward drugs
changed over time? How did people feel about drugs
and drug-taking behavior one hundred years ago, fifty
years ago, twenty years ago, or even ten years ago? These
are questions that we will now address.Note: how the stigma of drugs came to be
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We cannot judge on
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the basis of whether the drug is legal or illegal, since the
legality of a psychoactive drug often depends more on
historical and cultural circumstances than on its chemi-cal properties
Exam
The difficulty of using a criterion based on
legality is further complicated by cultural differences
around the world.
Exam
What is the intent or motiva-
tion on the part of the drug user with respect to this kindof behavior?
Exam
Depending on the intent of the individual,
drug-taking behavior can be classified as either instru-mental or recreational.7
Exam
shamanism:The philosophy and practice of healing in
which diagnosis or treatment is based on trance-like
states,either on the part of the healer (shaman) or the
patient.
shaman (SHAH-men):A healer whose diagnosis or
treatment of patients is based at least in part on
trances.These trances are frequently induced by
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hallucinogenic drugs.
Ebers Papyrus:An Egyptian document,dated
approximately 1500 B.C.,containing more than eight
hundred prescriptions for common ailments and
diseases.
years ago, the process of discovery would have been as
Exam
The accumulation of knowl-
edge about consciousness-altering substances would
mark the beginning of shamanism, a practice among
primitive societies, dating back by some estimates more
than 40,000 years, in which an individual called a
shamanacts as a healer through a combination of
trances and plant-based medicines, usually in the con-
text of a local religious rite.
Exam
Egyptian scroll known as the Ebers Papyrus, named
after a British Egyptologist who acquired it in 1872. This
mammoth document, dating from 1500 B.C., contains
more than eight hundred prescriptions for practically
every ailment imaginable, including simple wasp stings
and crocodile bites, baldness, constipation, headaches,
enlarged prostate glands, sweaty feet, arthritis, inflam-
mations of all types, heart disease, and cancer.
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improvements in the
patient¶s condition resulted from the patient¶s beliefthat
he or she would be helped, a phenomenon known as the placebo effect.
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n the early Middle Ages, Viking warriors ate the
mushroom Amanita muscaria, known as fly agaric, and
experienced a tremendous increase in energy, which
resulted in wild behavior in battle. They were called
Berserkers because of the bear skins they wore, and reck-less, violent behavior has come to be called berserk
Exam
witches operating on the periphery of medieval
society created ³witch¶s brews.´ They were said to induce
hallucinations and a sensation of flying by consuming
mixtures made of various plants such as mandrake, hen-
bane, and belladonna.
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We know now that the
sweat glands of toads contain a chemical related to
DMT, a powerful hallucinogenic drug, as well as bufote-
nine, adrug that raises blood pressure and heart rate.
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Morphine was identified as the active ingredient
in opium, a drug that had been in use for at least three
thousand years and had become the physician¶s most reli-able prescription to control the pain of disease and injury.
Exam
invention of the syringe made it possible to deliver the morphine directly and speedily into the bloodstream.
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Cocaine, having been extracted from coca leaves, was
used as a stimulant and antidepressant. Sedative powers to
calm the mind or induce sleep had been discovered in bromides and chloral hydrate.
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Anesthetic drugs had been discovered that made
surgery painless for the first time in history. A few diseases
could actually be prevented through the administration
of vaccines, such as the vaccine against smallpox that had
been introduced by Edward Jenner in 1796 and the vac-cine against rabies introduced by Louis Pasteur in 1885.
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The discovery of new pharmaceutical products marked
the modern era in the history of healing.11
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Remedies called patent medicines, sold through adver-
tisements, peddlers, or general stores, contained opium,
alcohol, and cocaine and were promoted as answers toevery common medical or nonmedical complaint.
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The respectable way wastodrink it, usually in a liquid form called laudanum
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the smoking of opium, as introduced by Chinese
immigrants imported for manual labor in the American
West, was considered degrading and immoral.
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tolerant attitude toward opium drinking, the
strong emotional opposition to opium smoking may beviewed as more anti-Chinese than anti-opium.
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The original formula for
Coca-Cola, as the name suggests, contained cocaine until
1903
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promoted cocaine as a ³magical drug.´ In an influential
paper published in 1884, Freud recommended cocaineas a safe and effective treatment for morphine addiction.
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Exam
1898,
heroin (a drug derived from morphine) was completely
legal and considered safe. Physicians were impressed
with its effectiveness in the treatment of coughs, chest
pains, and the respiratory difficulties associated with pneumonia and tuberculosis
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In 1920the Eighteenth Amendment to the U.S. Constitution took
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Violent gang
wars arose in major American cities as one group battled
another for control of the liquor trade.
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, whatever desirable health-related
effects Prohibition may have brought were perceived to
be overshadowed by the undesirable social changes that
had come along with it
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penicillin had been discovered in a particular
species of mold by Alexander Fleming in 1928, tech-
niques for extracting large amounts from the mold werenot perfected until the 1940s
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