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edhs uva

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School: University of Virginia
Department: OTHER
Course: Substance Abuse
Professor: Elizabeth pleszkoch
Term: Spring 2017
Tags:
Cost: 25
Name: EDHS 2240 weeks 1-6 notes
Description: Class + reading notes for weeks 1-6
Uploaded: 02/23/2017
33 Pages 120 Views 0 Unlocks
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∙ How can we know what is true?




∙ Manage troubling symptom of physical and mental disorders Why do some drugs require a prescription and others are illegal?




Why do people take drugs?



History of drug use & control 01/23/2017 Why do people take drugs? ∙ Enjoy the effects ∙ Cure diseases and infection ∙ Manage troubling symptom of physical and mental disorders Why do some drugs require a prescription and others are illegal? ∙ All drugs entail a measure of risk If you want to learn more check out eric goldman uconn
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If you want to learn more check out probabilify
of medical consequences ∙ Judgment of users may be impaired ∙ Risk of abuse too high Use/abuse/addiction/dependence ∙ Tend to be used interchangeably in the media ∙ Use o The legal enjoyment o your property within socially  acceptable norms o Consumption of any psychoactive substance ∙ Abuse o Any use of illegal drugs o Used both objectively and pejoratively with the intention to  vilify consumption of illicit drugs o Use that is harmful and puts the user at risk ∙ Addiction/dependence o Compulsive physiological need for and use of a habit-forming  substance characterized by tolerance and by well-defined  physiological symptoms upon withdrawal o Broadly defined as a persistent compulsive use of a substance known by the user to be physically, psychologically, or socially harmfulClinical point of view ∙ How we used to think o 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 o One thing led to another ∙ The DSM-5 defines a substance use disorder as the presence of at  least 2/11 criteria, which are clustered in four groups 1. Impaired control  Taking more or for longer than intended  Unsuccessful efforts to stop or cut down use  Spending a great deal of time obtaining, using, or  recovering from use  Craving for substance 2. Social impairment  Failure to fulfill major obligations due to use (school,  family, etc.)  Continued use despite problems caused or exacerbated  by use  Important activities given up or reduced because of  substance use (friends, sports, etc.) 3. Risky use  Recurrent use in hazardous situations (driving)  Continued use despite physical or psychological  problems that are caused or exacerbated by substance  use 4. Pharmacologic dependence  Tolerance to effects of the substance  Withdrawal symptoms when not using or using less What is a drug: classification system1. Medical utility o A substance that is used to treat or heal the body or the mind  Not all substances have medical utility  Controlled Substance Act of the United States o Medicalization: prescription of currently illegal substances for  medical purposes  Marijuana in some states  Heroin in some countries 2. Legality o Where the sale and/or possession of a substance is legal or  illegal irrespective of the user’s intent o Laws define what is a drug and determines the sort of lives  users and sellers will lead o Legality is a social construct  Vary by society  Can shift over time o Controlled Substance Act  Schedule I: no medical utility  Completely illegal with the exception of research  Tightest controls on availability  Note: marijuana is in this category ∙ DEA says it cannot change the legal status  of marijuana unless the FDA determines it  has a medical use ∙ FDA says it cannot determine marijuana has a medical use in part because of the highly  restrictive legal status of the drug  Schedule II: some medical utility High potential for abuse  Tight control on distribution  Schedule II-V: medical utility  Most have no illicit market value 3. Psychoactivity o Any substance, regardless of its legal or medical status, that  significantly and pharmacologically alters the working of the  brain is a drug  Crosses the blood-brain barrier  Acts primarily upon the central nervous system  Affects brain function  Results in alterations in perception, mood,  consciousness, cognition, and behavior o All substances that are taken recreationally are psychoactive  Taken for the effect in mind  Effects are generally experiences as pleasurable 4. Type of use o Instrumental  The use of a substance for the purpose not of achieving  an intoxication but of achieving a goal  Using caffeine or Adderall to stay awake while  studying for an exam  Drinking alcohol to relax after a hard day  Using cocaine to work a long shift  Can be either legal or illegal  No intention of getting high The effects are a means to an end o Recreational  Using a substance for the distinct purpose of getting  high or enjoying the effects  Smoking marijuana with no medical need  Snorting cocaine at a party  Taking MDMA at a rave Another classification system ∙ Celebrated o Substances that have been blessed for social consumption  and integrated into major social rituals o Use is heavily promoted within the society through various  forms of media o Few laws governing availability and use o Tax dollars are used to help those addicted and to prevent  addiction o E.g. alcohol, caffeine ∙ Tolerated o Substances that are discouraged but not prohibited, excessive use is stigmatized o Strict controls on promotion of use o Strict laws governing availability and use o Tax dollars are used to help those addicted and to prevent  addiction o E.g. tobacco ∙ Instrumental o Substances that can be legally obtained under special  conditions for clearly defined purposeso Strict controls on promotion of use o Distribution, dosage, frequency of use, and method of  ingestion is heavily regulated o E.g. prescription and over the counter medications, marijuana  in some states ∙ Prohibited o Substances with highly limited or no utilitarian value, use is  stigmatized and viewed as potentially disruptive to social  order o Promotion of use is prohibited o Possession, use, and distribution are severely punished o Tax dollars are used to eliminate availability o E.g. heroin, LSD, PCP, cocaine History of drug use ∙ Drug use can be traced through time 1. Natural era  Prehistoric humans ingested plants with psychoactive  properties  Usually for religious, ceremonial, and medicinal use  E.g. mushrooms, peyote, marijuana, coca leaves,  alcohol from fermented fruits 2. Transformative era  Began in the early 1800s  New substances created from natural plants previously  known for their psychoactive properties  Sold with colorful names, questionable claims of curing  a variety of ailments  1803: morphine  1831: codeine 1859: cocaine  1874: heroin and aspirin 3. Synthetic era  Scientists created drugs from chemical compounds not  found in nature,   Attempting to synthesize new medical and therapeutic  compounds  1903: barbital  1920s: amphetamines  1938: LSD  1950: PCP  Pharmacological revolution o Synthetic psychotherapeutic drugs used to treat  mental illness  1950s: antipsychotics and antidepressants  Recreational use became a problem ∙ Stolen from people with prescriptions ∙ Fake symptoms ∙ Paid unethical doctors ∙ Illicit labs manufacturing drugs Sociological changes and addiction ∙ Sociocultural and economic changes have given more people access to more potent drugs o Increased disposable income of young people  Recreational use of drugs in a market economy  presupposes a source of discretionary disposable  income In societies where young people have no such  income, they are less likely to use drugs  recreationally  In the US, disposable income of adolescents has  steadily increased since the 1950s  Drug use has shifted from young adulthood to late  adolescence  This is evident in a number of data sources ∙ Alcohol and drug related deaths ∙ Emergency room admissions ∙ Arrest and incarceration rates ∙ Treatment admissions o Globalization of the drug trade  The expansion of international economies has drawn  markets into a single worldwide economy that has  transformed the drug trade  Drug trade went from cottage industries within  countries to a global industry with multiple  international links to facilitate distribution Pharmacological perspectives ∙ Tolerance o A state of progressively decreasing responsiveness to a drug o Needing more of the drug to get the desired effect o Cross-tolerance  When tolerance develops for one drug, the individual  will experience tolerance for other drugs within the  same category  E.g. alcohol and benzodiazepines, heroin and oxycontin o Types of tolerance  Metabolic  The body produces more enzymes to metabolize  the drug∙ Can be genetic ∙ Some people may metabolize certain drugs  more effectively  Cellular-adaptive  Receptors adapt to the presence of the drug, turn  themselves off  Behavioral conditioning  Environmental cues routinely paired with  administration, elicit a conditioned response that  mitigates drug effects ∙ Action vs. effect o Drug action/pharmacodynamics  Specific reaction taking place at the molecular level  Interaction between a chemical introduced into the body and the body’s neurochemical system  Drugs are usually categorized according to their actions 1. Stimulants 2. Depressants 3. Vasoconstrictors 4. Antibiotics 5. Muscle relaxants 6. Diuretics  Factors influencing drug action  Dose: the amount of drug taken ∙ Miniscule dose of normally potent drug may  exert no discernible effects ∙ Massive dose of relatively safe drug may be  overwhelming and even fatal Potency: the quantity of a drug required to  produce a desired effect ∙ The smaller the quantity, the more potent  the drug ∙ Drugs vary in potency between and among  themselves  Purity: the percentage of a drug in any given  sample ∙ Purity affects potency ∙ Some illicit drugs are cut with non-additive  filters (e.g. aspirin, corn starch, laxatives)  Drug mixing: taking two or more substances at  the same time ∙ Important to consider how drugs interact ∙ Some drug combinations cancel out or  nullify the effects of other drugs (e.g.  antabuse and alcohol, suboxone and  opiates) ∙ Other drug combinations produce additive  effects that are the same as if twice as  much of either has been taken (e.g. alcohol  and barbiturates, marijuana and  benzodiazepines) o Drug effect  The direct and indirect physical and physic  consequences of taking a specific drug  Acute vs. chronic  Acute effects ∙ Short-term ∙ Occur during or immediately following a  single episode of use ∙ E.g. slurred speech, dizziness, blurred vision  Chronic effects ∙ Long-term ∙ Due to continued use of a drug ∙ E.g. cirrhosis∙ Effective dose vs. lethal dose o Effective dose (ED)  Amount of a drug needed to produce desired effect  Percent of given population in which the dose  produces the effect  ED50 = 50% of population  Can vary according to size of the person and  metabolism o Lethal dose (LD)  Amount of a drug that will kill  LD50 = 50% of population o Ratio ED to LD  Therapeutic margin  Drugs vary greatly  The larger the margin, the safer the drug (e.g.  marijuana)  The smaller the margin, the more dangerous the  drug (e.g. heroin) Judgmental heuristics ∙ Making assumptions regarding substance abuse based on incorrect  inferences and distorted reasoning o Anecdotal evidence: non-factual information based on  personal experience or observation o Stereotypical preconceptions: a belief held before analysis  based on a general belief o Anchoring: tendency to accept initial information as fact,  occurs when initial piece of information is used to make  subsequent judgments ∙ Rules of thumb used to infer frequency and meaning of other’s  behavior o Availability: what sticks in our mind is more common than  something that takes time to recallo Vividness: tendency to recall what is vivid and dramatic Measuring substance abuse ∙ There are many data sources on drug use, each with its own  strengths and limitations ∙ How can we know what is true? o Triangulation: examining a phenomenon by using two or more  independent data sources o Multiple confirmation: verifying a proposition is true through  the use of two or more data source Bias in statistics and research ∙ Errors can arise from several sources o Respondents lying  Substance use researchers rely heavily on self-report  surveys  Most respondents tell the approximate truth if they  believe it will remain anonymous  Reports from surveys are roughly accurate  Good enough to give an idea of what is going on  Provide enough information to make  generalizations and predicitons o Sampling  Sampling: the systematic selection of a subset of a  population that looks like or represents the population  as a whole  The way a sample is drawn is extremely important  Probability samples are selected to be  representative of the population (randomized)  Non-probability samples are less desirable but  validity can be increased by trying to eliminate as  many sources of bias as possible o Statistical analysis  Descriptive statistics Figures depicting the basic characteristics of a  phenomenon  Presented as totals, percentages, and rates  Errors due to ∙ Coding mistakes ∙ Skewness ∙ Outliers  Inferential statistics  Infer a cause and effect relationship between  variables  Researchers attempt to weed out, control, or hold  constant all the other factors that are related to  the ones in which we are interested  Errors due to ∙ Sampling error: chance or random errors ∙ Sampling bias: poor research design How do we measure drug use? ∙ Legal substances and prescription drugs o Sales = consumption ∙ Illegal substances o Drug testing o Hospital visits o Coroner’s records o Surveys and data collection  Arrestee Drug Abuse Monitoring Program (ADAM) History ∙ Established in 1987 ∙ Originally called Drug Use Forecasting ∙ Name changed to ADAM in 1997 ∙ Name changed to ADAM II in 2007 ∙ Program ended in 2014  Federally funded data collection program ∙ Drug tests and interviews a sample of  persons arrested in jails located in  metropolitan areas ∙ High response rate  Found that arrestees are more likely to use  psychoactive drugs ∙ Arrestees were tested for 10 drugs ∙ 60-83% tested positive ∙ Marijuana was the most commonly detected drug ∙ Cocaine detection continued to decline ∙ Opiate detection increased since 2000 ∙ Western states experienced a significant  increase in use of methamphetamines ∙ 4-10% of arrestees reported obtaining  prescription drugs without a valid  prescription  Drug Abuse Warning Network (DAWN)  History ∙ Designed and developed in 1974 ∙ Discontinued in 2011 Federally sponsored data collection ∙ Drug-related admissions to emergency room ∙ Drug-related deaths ∙ Drug-related admissions for medical or  psychiatric treatment o Reported by metropolitan hospitals,  clinics, and medical examingers o Tabulated only acute drug reactions,  did not tally chronic effects of drugs  Three drugs appeared consistently in the figures 1. Cocaine 2. Heroin 3. Alcohol  Information from DAWN supports the findings of  ADAM II ∙ Cocaine use is declining ∙ Methamphetamine and marijuana use is  increasing  Monitoring the Future Survey (MTF)  Federally sponsored data collection ∙ Conducted by the University of Michigan’s  Institute for Social Research ∙ Ongoing data collection conducted in  classrooms via self-administered  questionnaires o 8th, 10th, and 12th grade students ∙ Annual follow-up questionnaires mailed to a  sample of each graduating class for a  number of years after initial participation  Findings ∙ Annual prevalence of using any illicit drug  decreased slightly by 1.4%∙ Cigarette smoking and alcohol use are now  at the lowest levels recorded in the history  of the survey o Prevalence of e-cigarettes is now  higher than regular tobacco  National Survey on Drug Use and Health (NSDUH)  Sponsored by the Substance Abuse and Mental  Health Services Administration (SAMHSA) ∙ Ongoing questionnaire study on a  representative sample of the American  population ages 12 and older o Door to door, phone interviews ∙ Provides national estimates of the rates of  use ∙ Sample is large enough to provide reliable  estimates of drug use in each state Models of addiction ∙ Moral theory o Addiction is the result of moral weakness and a refusal to  abide by an ethical or moral code  Alcohol and drug use is freely chosen behavior that is  irresponsible and evil  Associated with sinful character defects  Gluttony  Sloth  Envy  Pride  Anger o Those inclined to the moral stance see drug use as an  intentional, criminal act  The only solution is to put these people in jail  Philosophical foundation for drug control policy and the  War on Drugs∙ Medical model and disease theory o Addiction is a chronic, relapsing disease of the brain  Characterized by altered brain structure and functioning  These brain abnormalities cause individuals with  the disease to become addicted to substances or  activities once exposure occurs  Diseases are incurable, progressive, and fatal if  left untreated  Irreversible once acquired  Abstinence arrests the disease o Classic addiction model  Addicting drug is defined by specific withdrawal  symptoms  If taken over sufficiently long period, then  discontinued  Chills, fever, diarrhea, muscle spasms, vomiting,  cramping, body aches  Recognizes cross-dependence ∙ Used to alleviate withdrawal symptoms  Not all drugs are addictive in a classic sense (e.g.  marijuana, cocaine, LSD)  The pleasure derived from taking a drug is the  driving force of compulsive, abusive use  Drugs do not need to be addictive in a classic  sense to produce dependence  Compulsive drug use is caused by the  characteristics of the user as much as the  characteristics of the drug  Society has shifted from a classic model based on  withdrawal symptoms to a reinforcement model  Drug’s potential for dependence relates to how  reinforcing it can be  Immediate sensual appeal  Capacity to generate pleasure without the  intervention of learning∙ Those things that are more reinforcing  require less work to enjoy (e.g. heroin vs.  LSD) ∙ Psychosocial integration Theories of drug abuse ∙ Biological theories o Genetic theories  Predisposition  Genes  Hormones  Neurological factors  Metabolic imbalance  Addiction as a metabolic disease ∙ Psychological theories o Reinforcement Theory  Drug use is caused by the reinforcing effects of  psychoactive drugs  Positive reinforcement  Motivation due to positive sensations (e.g.  marijuana and cocaine)  Negative reinforcement  Motivation to avoid withdrawal symptoms (e.g.  alcohol and opiates) o Inadequate Personality Theory  Masks some of life’s problems, an escape from reality  The more inadequate the personality, the greater  the likelihood of becoming involved in drug use Drug use becomes an adaptive defense  mechanism  No longer widely accepted  Replaced by learning theories o Problem-Behavior Proneness Theory  Drug use is a manifestation of other behaviors  Early sexual behavior  Juvenile delinquency  Conflict with and alienation from parents  Impulsivity  Researchers have found drug users tend to be  More rebellious and open to new experiences  Willing to take a wide variety of risks  Accepting of deviant behavior and transgressions  of norms  Hedonistic  Pleasure-seeking, non-conformist, and  unconventional ∙ Biopsychosocial Model of Addiction o Interactions between biological, psychological, and social  factors determine the cause, manifestation, and outcome of  wellness and disease o Addiction is not just a brain disease  Holistic and person-centered  Genetic and biochemical origins to addiction  Psychiatric and psychological underpinnings Public health principles contribute to addiction  The greater the availability and the lower the  price, the more widespread are the health and  social costs of addiction to those drugs  Addiction depends on individual’s own recipe of  biopsychosocial factors  Some people can have little genetic predisposition and family history of addiction, but succumb to  overwhelming psychosocial factors ∙ Sociological theories o Include broad structural, cultural, or institutional factors and  variables rather than characteristics of the person o There are four main agents of socialization  Parents  Legal drugs (e.g. alcohol, tobacco)  Peers  Illegal drugs (e.g. marijuana)  School  Media o Social Disorganization Theory  A community-level theory  Entire neighborhoods are so disorganized that  living in them increases the likelihood of engaging in deviant behavior ∙ Lack economic and social resources to  monitor, sanction behaviors of resistance ∙ Urban decay, deviant and criminal behavior  Residents fight back with social movement  organizations ∙ Mobilize the meager resources of the  community ∙ Enlist help of city hallo Social Dislocation Theory  Does not view addiction as either a medical condition  nor a moral failure  No pathological transformation of the brain, the  will, or the unconscious  Addiction is a way of adapting to increasingly  dominant and onerous aspects of the modern  world ∙ Social fragmentation ∙ Individual dislocation  It is usually easy to understand the adaptive  functions that addiction serves  Bruce Alexander, Rat Park  Johann Hari, Chasing the Scream o Social Learning Theory  Deviant, criminal, and delinquent behavior are learned  through exposure to social circles where members  define engaging in non-normative activity in positive  terms  Behavior is molded by rewards and punishment o Subcultural Theory  Use, abuse, or addiction are based on the notion that  group-based norms, values, beliefs, and behaviors  influence drug taking  Encouraged in certain social circles and discouraged in  others o Social Control/Bonding Theory  Absence of social controls that encourage conformity  lead to drug abuse  Drug use arises from the lack of ties with conforming,  mainstream sectors of society  The more attached a person is to conventional others  (e.g. parents, teachers, religion), the less likely they are  to use drugs Four critical ideas are essential to understanding rates and patterns of  use 1. Overall prevalence rateso Percentage of the population  Legal substances have much higher prevalence  Illicit substances have a hassle factor o Designated period of time  Lifetime  Year  30 days o Often exaggerated by the media 2. Loyalty/continuance rates o Percentage of population reporting regular use  Alcohol has the highest loyalty rate for legal substances  Marijuana has the highest loyalty rate for illegal  substances o Legal substances have higher continuance  Most who try an illicit substance will give it up after a  period of experimentation 3. Consumption levels o Quantity of substance used by the heaviest users within the  population o Easily confused with prevalence  Alcohol has a high prevalence rate, but not a very high  consumption level  Nicotine has a higher consumption level 4. Life cycle rates o Related to age and life cycle Illegal substance use is highly correlated with age  Legal use tends to be spread more evenly throughout  the life cycle Caffeine ∙ Most commonly consumed psychoactive drug o Unregulated in most countries, assumed to be safe o Used by 80% of the U.S. adult population ∙ Naturally occurring stimulant isolated from 60 different plant  species o Cocoa beans, kola nuts, tea leaves, coffee beans o Acts as a natural pesticide against insects feeding on the  plant ∙ Pharmacodynamics o Both water an lipid-soluble  Readily crosses the brain-blood barrier that separates  the bloodstream from the interior of the brain o Temporarily prevents or relieves drowsiness and restores  alertness  CNS stimulant  Adenosine antagonist, blocks binding  Causes the release of dopamine in the hypothalamus o Bronchial relaxation  Used to treat asthma o Increased gastric acid and urine output o Effects are felt within minutes  Peak effectiveness is around 30 minutes Takes 3-6 hours to leave the body  Nicotine decreases the half-life  Oral contraceptives and anti-depressants increase the half-life ∙ Consumption o 68 million of U.S. adults drink 3 cups of coffee per day  30 million drink 5 or more o 5% of adults consume 5-7 energy drinks every month  2% of adults consume 10 or more ∙ Addiction o 3 out of 4 regular caffeine users are addicted to the substance o Chronic use leads to habituation and tolerance o Withdrawal symptoms  Headache  Drowsiness  Fatigue  Moodiness  Impaired intellectual functioning  Difficulty concentrating Nicotine ∙ Tobacco plant is indigenous to the western hemisphere o Grown by Native Americans 1490s: Columbus was presented tobacco leaves  Smoked through a pipe for special religious and medical purposes, was not for daily use o 1812: Jamestown grew tobacco as a cash crop  1880s: regular use of small amounts, chewed or smoked o 1865: commercial production of cigarettes began in Raleigh,  hand rolled o 1881: cigarette machine invented, widespread use ∙ Pharmacodynamics o Nicotine is the primary active ingredient in tobacco  Suspended in tar particles o Absorbs rapidly in the lungs into the arterial circulation,  traveling via the carotid arteries to the CNT  Nicotine readily penetrates the blood-brain barrier  Induces a variety of CNT, cardiovascular, and metabolic  effects  Increased heart rate and blood pressure  Appetite suppression  Arousal and enhanced vigilance  Stimulates the release of neurotransmitters o Smokers regulate the level of nicotine in their system  Frequency and depth of inhalation  Amount of time smoke is held in the lungs o Feelings of pleasure and relief of nicotine withdrawal  symptoms immediately following inhalation  Rapid response reinforces and perpetuates the smoking  behavior∙ Nicotine as the gateway drug o Researchers at Columbia University dispel the gateway myth  for marijuana  Cigarette smoking found to be a more reliable predictor  of future illicit drug use  Environmental and genetic disposition that forms  nicotine addiction increases the likelihood of other drug  experimentation ∙ Nicotine and e-cigarettes o Research findings indicate that electronic cigarettes have  contributed to primary nicotine addiction and to  renormalization of nicotine use  32.5% of current electronic cigarette users are previous  non-smokers or former smokers  65% of current users are traditional smokers  14% of current users are adults ages 18-24 o Researchers found that use of e-cigarettes are encouraging  traditional smoking  Teenagers using e-cigarettes are four times as likely to  progress to smoking traditional cigarettes within a year Ethyl alcohol ∙ Classified as a drug due to psychoactive properties ∙ The second most widely used psychoactive substance in the world ∙ Amounts that constitute one standard drink o 12oz of beer o 8-9oz of malt liquor o 5oz of table wine o 1.5oz of 80 proof distilled spirits ∙ Substance Abuse and Mental Health Services Administration  (SAMHSA) o 2014 National Survey on Drug Use and Health 52.7% of Americans consume alcohol  College students (full-time)  60.1% are current drinkers  39% are binge drinkers  13.2% are heavy drinkers  9.9% drank alcohol for the first time in the past  year  4.1 drinks per day on the days on which they  drink  Average 6.4 drinks per month o Definitions  Current use: at least one drink in the past 30 days  Binge use: 5 or more drinks on the same occasion 3 or  more times during the past 30 days  Heavy use: 5 or more drinks on the same occasion 5 or  more days in the past 30 days ∙ Pharmacodynamics o Absorption  Rapidly absorbed orally  20% absorbed in stomach  80% absorbed in large intestine o Distribution  Freely passes the blood-brain barrier o Metabolism  85% metabolized in the liver 15% metabolized in the stomach o Elimination  Urine  Lungs  Sweat ∙ Women and alcohol o When consuming comparable amounts of alcohol, women  reach a peak BAC about 20% higher than men o Alcohol’s effects on women tend to be stronger and last  longer  Women’s bodies are comprised of less water than men  of similar body weight  55-65% men vs. 45-55% women  Women have lower levels of the enzyme dehydrogenase in their stomach  Breaks down alcohol  Women absorb 30% more alcohol into their  bloodstream  Fluctuations in hormone levels affect women’s ability to  process alcohol  BAC higher right before menstruation  Alcohol use may exacerbate physical symptoms  such as breast tenderness, headaches, and mood  fluctuations ∙ Pharmacological and physical effects o Reversible depression of behavior and cognition  Slows the pace of communication between  neurotransmitters  Disruptions to neurotransmitter balance triggers mood  and behavioral changes  Depression Agitation  Memory loss  Seizures  Effects on the cerebral cortex  Impairs abilities to think, plan, behave  intelligently, and act socially  Impairs the ability to solve problems, remember,  and learn  Effects on the cerebellum  Loss of balance and stumbling  Impairs cognitive functions such as memory and  emotional response o Binge drinking and long-term drinking can affect the heart  Alcoholic cardiomyopathy  Arrhythmia o Binge drinking and long-term drinking can affect the liver  Steatosis (fatty liver)  Alcoholic hepatitis  Cirrhosis o Drinking in moderation can protect the hearts of healthy  people from the risks of coronary artery disease  Protect coronary and peripheral blood vessels  Raise the levels of HDL (good cholesterol)  Reduce ischemic strokes  Preventing blood clots from forming and by  dissolving blood clos that do develop Reduce the risk of dementia among older adults ∙ Psychological effects o Chronic alcohol consumption  Severe deficits in executive functioning  Frontal lobe dysfunction  Diminished intellectual capacities o Mild to moderate consumption  Veisalgia (hangover)  Lethargy and fatigue o Disinhibition  Determined by the person, mental expectations, and  environment  Effects by BAC o Alcohol myopia  Deficits in cognition and attention cause a focus on the  present, a reduction in fear and anxiety, and impaired  problem solving skills  An inappropriate sense of master, control, and power  Intoxication may contribute to aggressive behavior by  reducing anxiety regarding consequences of behavior ∙ Powder alcohol o Powdered or crystalline alcohol is alcohol that has been  absorbed into a carbohydrate (e.g. dextrin), resulting in a dry  state rather than its usual liquid form o In March 2015, the Alcohol and Tobacco Tax Trade Bureau  (TTB) approved several powdered alcohol products, sold under the brand name Palacohol, for sale in the United States ∙ Side effects of chronic use o Dementia: disorientation and impaired judgmento Anterograde amnesia (black out) o Chronic gastritis o Peptic ulcers o Pancreatitis o Korsakoff’s Syndrome: destruction of nerve sells produces  permanent brain damage and long-term problems with  memory, learning, and cognitive skills  Confabulation: making up a memory o Liver damage: irreversible changes in the structure and  function o Cirrhosis: replacement of liver tissue by fibrous scar tissue o Esophageal varices: abnormally swollen veins within the lining of the esophagus  Esophageal varices will rupture and bleed, making  eating and drinking painful  Individuals can die wen varices rupture and bleed into  the stomach o Cancer ∙ Symptoms of withdrawal ∙ Detoxification o Detox is the most common treatment for alcohol  It is also the least effective treatment for long-term  recovery  Blocking seizures and keeping individuals alive are the  major goals  Do not allow anyone to try to detox on their own o Benzodiazepines: suppress withdrawal symptoms  E.g. Ativan, Librium, Valium o Anticonvulsant mood stabilizers: control seizure activity∙ Alcohol and risky behaviors o Risky behaviors that result from alcohol use  Driving under the influence  Smoking  Using illicit drugs  Unprotected sex  Criminal activity  Dangerous situations  Becoming the victim of a crime o What causes alcohol to be associated with risky behavior?  Disinhibition hypothesis: alcohol causes a release from  inhibitions and constraints on dangerous acts  Susceptibility hypothesis: people who are heavy  drinkers are also more likely to engage in risky  behaviors  Reciprocal hypothesis: alcohol and risky behavior fuel  each other o Alcohol and violence  Keep in mind  Most episodes of drinking do not lead to violence  Violence rarely accompanies alcohol consumption  50-60% of criminal homicides are alcohol-related  The Department of Justice estimates that 40% of  criminal offenders were under the influence of alcohol  when they committed their crimes  37% of rapes and sexual assaults  15% of robberies 27% of aggravated assaults  25% of simple assaults  Drinkers have higher rates of criminal violence and of  being a victim of violence than non-drinkers  The more individuals drinks, the greater the  likelihood they will inflict violence on others  The more individuals drink, the greater likelihood  they will be a victim of violence  Alcohol impairment injuries are most likely to take place in bars  There is a positive correlation between the sale of  alcohol in a given area and the likelihood that residents  living there will be hospitalized for assault 

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