Chapter 13

Habits that have gotten out of control, with a resulting negative effect on a person’s health.

Addiction is the habitual use of a drug produced chemical changes in the user’s body.

Drug Addiction (four important characteristics)1. Compulsive desire2. Need to increase the dosage3. Harmful effects to the individual4. Harm to society

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Often starts to bring pleasure or to avoid pain.Harmless or even beneficial if done in

moderationExamples of addictive behaviors:

GamblingCompulsive ExercisingWork AddictionSex and love addictionCompulsive buying or shoppingInternet addiction

Characteristics of people with addition (e.g., risk takers or genetic disposition)

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Drugs are chemicals other than food that are intended to affect the structure or function of the bodyPrescription medicinesOver-the-counter substances

CaffeineTobaccoAlcohol

Illegal substances

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The APA’s Diagnostics and Statistical Manual of Mental Disorders – authoritative reference

AbuseAPA definition

Failure to fulfill major responsibilitiesDrug use in situations that are hazardousDrug related legal problemsDrug use despite persistent social or interpersonal

problemsPhysically dependent may or may not present

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Substance dependence1. Developing tolerance to the substance2. Experiencing withdrawal3. Taking in larger amounts4. Expressing a persistent desire to cut down5. Spending great deal of time obtaining6. Giving up or reducing important activities7. Continual usage even with recognition of

a problemDiagnosed with at least 3 or more

symptoms during a 12-month period

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All income and education levelsAll ethnic groupsAll agesYoung people are at a higher riskMales (Twice as likely)Troubled adolescentThrill-seekerDysfunctional familiesPeer group or family that acceptsLow Socio-economical statusDating young

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ExperimentEscapeReliance Magnification of residence (i.e. the need for

escape from poverty becomes more compelling)

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Psychological risks

Difficulty in controlling impulsesStrong need for excitementFeelings of rejectionHostilityAggressionAnxietyMental illnessDual (co-occurring disorders)

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Social Factors

Growing up in a family with drug abusePeer groupPoverty

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IntoxicationSide effectsUnknown drug constituentsRisks associated with injection drug useLegal consequences

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Changes in Brain chemistry Drug factors:

Pharmacological properties Dose-Response function Time-action function Drug use history Method of use (e.g., inhalation,

injection, ingest)

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Opioids (narcotics)Natural or synthetic (laboratory-made)

Opium, morphine, heroin, methadone, codeine, hydrocodone, oxycodone, meperidine, and fentanly

Effects on the body: induced euphoriaMethods of administration

Injection, snorting, sniffing or smokingSymptoms of overdose: respiratory depression,

coma, constriction of the pupils, or death.

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Slow down the overall activity of the CNSSedative-hypnoticsTypes: barbiturates, valium, methaqualone, GHBEffects on the body: reduce anxiety, impair

muscle coordination, induce drowsinessMedical uses: Treat insomnia and anxiety

disorders; control seizuresFrom use to abuse (“Club Drugs”)Overdosing may result in respiratory

complications

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Speed up the activity of the nervous or muscular systemCocaine

Methods of use (snort or injection)Effects (euphoria sensation for ~5 to 20 minutes)Use during pregnancy (consequences include:

miscarriage, premature labor, stillbirth, and low-birth-weight baby)

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AmphetaminesEffects (increase in alertness)Dependence (may lead to the development of a

temporary state of paranoid psychosis or delusion)Ritalin (used to treat

attention-deficit/hyperactivity disorder, ADHD)Ephedrine (a less potent form of

amphetamines)Caffeine

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Cannabis SativaTHC (tetrahydrocannabinol)Short term effects and uses: euphoria,

increases in sensation, relaxed attitudeLong-term effects and uses: respiratory

damage such as impaired lung function and chronic bronchial irritation

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Altered state of consciousness, perceptions, feelings and thoughts

LSD, Mascaline, DMT, MDMA, Ketamine, PCP (angel dust), and certain mushroomsAltered states of consciousness

Flashbacks are perceptual distortions and bizarre thoughts that occur after the drug has been entirely eliminated from the body.

Nearly all inhalants produce effects similar to those of anesthetics, slow down the bodies functions

Volatile solventsNitratesAnestheticsMethods of use

SniffingSnorting“Bagging”“Huffing”

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Medication-assisted treatmentDrug substitution

Treatment centersSelf-help groups and peer counselingHarm reduction strategiesCodependency

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http://www.youtube.com/watch?v=J46pvxFWNTY

TobaccoTobacco

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Use of Tobacco

71 Million Americans, including 13.7 million college-aged Americans.

2008, nearly 21% of Americans age 18 describe themselves as current smokers.

Nicotine Addiction Powerful psychoactive drug

Reaches Brain via bloodstream in seconds Most physically addictive of the psychoactive

drugs. Loss of control Tolerance and Withdrawal

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Why Start in the First Place? Children and teenagers make-up 90% of all new

smokers in this country. Thousands of children and adolescents (12-17) start

smoking everyday. Average age

13 for smoking 10 for spit tobacco

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Characteristics which could increase the potential for use.

A parent or sibling uses tobacco Peers use tobacco Child comes from blue-collar family Child comes from low-income home Single parent. Performs poorly in school Child drops out of school Has positive attitudes towards tobacco

Reasons Why College Students Smoke

Chapter 8 31

Health HazardsContains hundreds of damaging chemical

substances, including acetone (nail polish remover), ammonia, hexamine (lighter fluid), and toluene (industrial solvent).

Unfiltered cigarettes = 5 billion particles per cubic mm

50,000 times more than polluted urban airCondensed particles in the cigarette produce

the tar (brown, sticky mass)

Chapter 8 32

Health Hazards (cont)Carcinogens and Poisons 43 chemicals are linked to cancer (Carcinogen)

Benzo(a)pyrene (yellowish tar) Urethane (ex: solution used in making foams)

Cocarcinogens Combine with other chemicals to cause cancer (e.g.,

formaldehyde) Poisonous substances

Arsenic (e.g., insectides and weed killers) Hydrogen cyanide (e.g., flammable liquid used in dye)

Carbon monoxide 400 times greater than is considered safe in industrial workplaces Displaces oxygen in red blood cells

Additives Nearly 600 chemicals

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“Light” and Low-Tar Cigarettes

Low-tar, low-nicotine, or filtered cigarettes No such thing as a safe cigarette Often smoke more

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The effects of smoking a cigarette

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Additional Health, Cosmetic, and Economic Concerns

Ulcers Impotence Reproductive health problems Dental diseases Diminished physical senses Injuries Cosmetic concerns Economic costs

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Cumulative Effects Males before 15 yrs. old are half as likely to

live to 75 versus those who did not smoke Females with similar habits reduce life

expectancy by more than 10 years Female smokers spend 17% more sick days

in bed than nonsmokers Both men and women show a greater rate of

acute and chronic diseases

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Other Forms of Tobacco Spit (Smokeless) Tobacco

More than 6.6 million adults

8% of all high school students

Cigar and Pipes Cigar smoking has

increased by 148% from 1993-2006.

Cigars contain more tobacco than cigarettes.

Clover cigarettes and Bidis Twice the tar, nicotine,

and carbon monoxide

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The Effects of Smoking on the Nonsmoker

Environmental Tobacco smoke (ETS) Environmental Protection Agency (EPA)

designated ETS as a class A carcinogen Department of Health and Human Services’

National Toxicology Program - “known human carcinogen”

Surgeon General – 2006 – “there is no safe level of exposure to ETS; even brief exposure can cause serious harm”.

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Environmental Tobacco Smoke

Mainstream smoke Smoke exhaled by smokers

Sidestream smoke Smoke from the burning end of a cigarette, cigar, or

pipe. 85% of smoke in a room is second hand Twice the tar and nicotine Three times the benzo(a)pyrene Three times the ammonia

Smoke from a cigar can be even more dangerous 30 times more carbon monoxide

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ETS Effects Develop cough, headaches, nasal discomfort, eye

irritation, breathlessness and sinus problems Allergies will be exacerbated Causes 3,000 deaths due to lung cancer Contributes to about 35,000 overall deaths each

year. 20% increase in the progression of atherosclerosis. Contributes to increased asthma attacks

How Cigarette Smoking Damages the Lungs

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http://www.youtube.com/watch?v=0hySFt8O11A

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Infants, Children, and ETS More likely to develop

Bronchitis, pneumonia,& respiratory infections More complications from asthma Increased chance of SIDS (sudden infant death

syndrome) Low-birth weight Bronchitis

Chemicals from smoking show up in breast milk Children inhale three times more pollutants per unit

of body weight than adults.

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Smoking and Pregnancy

Estimated 4,600 infant deaths in the U.S. Miscarriage, premature birth, low birth

weight, long term impairments in growth and intellectual development

Possible higher risks of getting cancer 16% of pregnant women smoke

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Cost of Tobacco Use to Society

Lost productivity from sickness, disability, and premature death makes it close to $167 billion per year.

1998 Master Settlement Agreement (MSA) 43 states filed suit against tobacco companies

to recoup public health care expenditures Tobacco companies have to pay $206 billion

over 25 years. Limits or bans certain types of advertising,

promotions, and lobbying.

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How A Tobacco User Can Quit

50.2 % of all adults who have smoked have quit. The Benefits of Quitting Options for quitting

Smoking cessation programs 1-800-QUITNOW

Department of Health and Human Services Smoking cessation products

Chantix (Varinicline) Zyban (Bupropion)

Nicotine replacement products Patches, gums, lozenges, nasal sprays, and inhalers

http://www.videojug.com/interview/the-benefits-of-quitting-smoking-2

AlcoholAlcohol

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The Nature of Alcohol Psychoactive ingredient Depressant Ethyl Alcohol – only alcohol that can be consumed

Beer 3-6% alcohol by volume Malt Liquors 6-8% alcohol by volume Table wines 9-14% alcohol by volume

Fermenting Fortified wines 20% alcohol by volume

Sugar added Extra alcohol is added

Hard liquors 35-50% alcohol by volume Distilling or fermented

Proof Value Two times the percentage concentration

Ingestion 7calories per gram 1 drink 14-17 grams or 100-120 calories

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Absorption 20% is rapidly absorbed from the stomach 75% is absorbed in the upper small intestines Remain is absorbed along the GI track Absorption

CarbonationFood in the stomach slows the absorptionEventually all the alcohol ingested will be absorbed

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Metabolism and ExcretionTransported throughout the body via the

bloodstream.Easily moves through most biological

membranesMain site for metabolism is the Liver.2-20% of ingested alcohol is not metabolized.

Chapter 8 56

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Alcohol Intake and Blood Alcohol Concentration

Blood Alcohol Concentration(BAC)A measure of intoxication Body weightPercentage of body fatSex

Genetic factorsDrinking BehaviorMetabolism is the same if the person is awake or

asleep

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The Immediate Effects of Alcohol on Health

Depends on the individual.Low Concentrations .03% -.05%.Higher Concentrations 0.1% -0.2%.

Concentration of .35% and higher.Alcohol hangoverAlcohol poisoningUsing Alcohol with other drugs

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Drinking and DrivingIn 2004

250,000 were injured in alcohol related automobile crashes

42,000 people are killed in alcohol related accidents

Dose-response functionDriving with a BAC of 0.14% is more than 40 times more likely to be involved in a crash.Greater than 0.14% the risk of fatal crash is estimated to be 380 times higher.

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Angels Pitcher Nick Adenhart Killed In Car CrashApril 9, 2009

Two people who were with him were also killed when, according to police, a minivan ran a red light at a Fullerton intersection and broadsided the gray Mitsubishi they were in. The driver of the minivan, Andrew Thomas Gallo, 22, of Riverside, was arrested on suspicion of drunken driving, hit and run and manslaughter.

© 2010 McGraw-Hill Companies. All Rights Reserved. 62

Approximate blood concentration and body weight

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The Effects of Chronic Use Diseases of the digestive, cardiovascular systems and some

cancers Digestive system

Liver function liver cell damage and destruction (cirrhosis)

Pancreas inflammation Cardiovascular system

moderate doses may reduce the risk of HD Higher doses elevates BP, may weaken heart muscle or cardiac

myopathy. Cancer

Mouth, throat, larynx, and esophagus 5-6 total drinks

Responsible for the most common form of liver cancer Hepatitis speeds the growth of this cancer

Breast cancer Increase risk when 2-3 drinks per day

Brain Damage Cognitive impairments Memory loss, dementia, and compromised problem-solving Wernicke-Korsakoff syndrome (brain damage)

Mortality Alcoholics average life expectancy is about 15 years less than non-alcoholics

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The Effects of Alcohol use During Pregnancy

Effects are dose-related.Fetal Alcohol Syndrome (FAS)

Full-blown FAS occurs in up to 15 out of every 10,000 live births in the U.S.

Under weight, flat nasal bridge, and long upper lip.Small and have heart defects.Physical and mental growth is slowed. Remain

mentally impaired. Fine motor skill problems, coordination, learning and behavioral problems (ADS).

Alcohol-related neurodevelopment disorder (ARND).

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Possible Health Benefits of Alcohol

Abstainers and light to moderate drinkers live longer than heavy users.

35 years old and younger, your odds of dying increase in proportion to the amount consumed

Moderate drinking = one drink per day for women and two drinks per day for men.May lower coronary heart disease.Raising blood levels of HDL.May lower risks of diabetes, arterial blockages,

Alzheimer’s

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Alcohol Abuse and Dependence

Alcohol abuse is recurrent use that has negative consequences.

Alcohol dependence or Alcoholism more extensive problems, tolerance and withdrawal

Warning signs of alcohol abuseDrinking aloneUsing deliberately and repeatedlyFeeling uncomfortable on certain occasionsEscalating consumptionGetting drunk regularlyDrinking in the morning or unusual times

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Alcohol Abuse and DependenceBinge Drinking

The National Institute on Alcohol Abuse and Alcoholism defines:Pattern of alcohol use that brings a person’s

BAC up to 0.08 or above (typically four drinks for a male or three for a women) within two hours.

National Survey on Drug Use and Health defines:Having five drinks in row for a man or four in a

row for a women within two hours.Frequent binge drinking in college were three to

seven times more likely than non-binge drinkers to engage in unplanned or unprotected sex

Healthy People 2010Reduce the rate of binge drinking to 20% among

college students

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AlcoholismPatterns and Prevalence

1. Regular daily intake of large amounts2. Regular heavy drinking limited to weekends3. Long periods of sobriety interspersed with binges or

daily heavy drinking4. Heavy drinking limited to periods of stress

Health Effects DTs (delirium tremens) paranoia

Social and Psychological effectsCauses of Alcoholism

Video: http://www.youtube.com/watch?v=gTPjlN7VR7c

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Treatment ProgramsNot one program works for everyone.

AA. 12-step program

Employee Assistance.Inpatient hospital rehabilitationPharmacological treatments.

Disulfiram (Antabuse)Inhibits the metabolic breakdown

Naltrexone (ReVia, Depade)Reduces the craving for alcohol and decreases its pleasant

effects. Injectable Naltrexone (Vivtrol) – single monthly shot Acamprosate (Campral)

Acts on brain pathways related to alcohol abuse.

Chapter 8 72

Gender and Ethnic Differences Men

White American men (excessive drinking often begins in the teens or twenties)

“Other men” (remain controlled drinkers until later in life) Women (alcoholism often occurs

later in life) African Americans (alcohol abuse

usually found in African Americans) Latinos (drinking patterns vary) Asian Americans (low rate of alcohol abuse) American Indians and Alaska Natives (excessive drinking

varies from tribe to tribe)

http://www.cbsnews.com/video/watch/?id=5024746n

Video Segment: The Effects of Drug Use on Brain Chemistry

http://www.youtube.com/watch?v=J46pvxFWNTY

http://www.aetv.com/intervention/video/?bcpid=53411497001&bclid=129113967001&bctid=115543473001

http://www.aetv.com/intervention/video/?bcpid=53411497001&bclid=64419253001&bctid=64670639001

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