Study Guide Exam 2
Chapters 6, 9, 10, 11, 14, 15
Fermentation is the production of alcohol from the interaction yeast, sugar, and water.
-naturally occurring process
B. Fermentation occurs in the natural environment.
Most fruits including grapes contain sugar.
Yeast is found in the air in high concentrations where plants grow.
If grapes or berries are crushed and come into contact with water and yeast from the air, fermentation will occur.
Beer and berry wine date back to 6400 BC.
C. Distillation involves the evaporation and condensing of alcohol vapors to produce beverages with alcohol content higher than 15 percent.
Yeast dies above 15% and the process is stopped
This is a man-made process.
This process includes heating a solution until it boils, then collecting the vapor. This is possible because water has a higher boiling point than alcohol. Therefore, the vapor is mostly alcohol.
D. Early Views on Alcohol Use
Before the American Revolution (1775-1783) most people drank more alcohol than water, clean water was scarce, alcohol killed bacteria – this is safer. -heavy alcohol use was encouraged, however
Drunkenness was viewed as misuse of a positive product.
Perceptions of alcohol changed after the American Revolution – there was a sharp rise in the amount of alcohol use and as a consequence the negative aspects of alcohol intoxication were more apparent than ever. Alcohol itself was viewed as the cause of serious problems. If you want to learn more check out What is the sum of Protons and Atomic Number?
Alcohol was the first substance to be demonized in American Culture.
E. Temperance Movement
-Social movement against the consumption of alcohol beverages (1790) This is the first time Americans formed a united social movement against alcohol use.
Heavy drinking = health problems
Alcohol use damages = morality
-basically changes self-control or the way we value things
Alcohol addiction = a disease
-initially promoted abstinence from distilled spirits only
-later promoted total abstinence
-became fashionable to “take the pledge”
F. Eventually Federal Prohibition was initiated via the 18th amendment in 1919. This amendment banned the sale of alcohol. People still drank illegally in speakeasies and private clubs. Many people obtained “prescriptions” for alcohol from Doctors. -by 1917, 64% of American’s lived in dry territory
-18th amendment banned sale of alcohol
-people still drank illegally in speakeasies and private clubs and legally through purchases of parent medicines
-enforcement was challenging and expensive We also discuss several other topics like What is the probability of rolling an even number?
Outcomes of prohibition included organized crime become more organized and more profitable However, alcohol dependence and related deaths declined. Prohibition was repealed by the 21st amendment (1933). This was due to the loss of major source of federal and state revenue from taxes. Also, many people disobeyed the drinking laws which led to a general sense of disregard for the law and general lawlessness.
-reasons for the repeal:
-alcohol taxes has been a major source of revenue
-concerns that wide spread disrespect for prohibition laws encouraged a general sense of lawlessness
-outcomes of repeal included:
-alcohol per capita sales and consumption increased
-returned to pre-prohibition levels after WW2
G. Patterns in U.S. alcohol consumption
Consumption patterns are influenced by cultural factors including perceived risk of alcohol and drinking norms.
Similar to other drugs, alcohol use peaked in the early 1980s and then declined. However, it is now on the rise again. Don't forget about the age old question of Is the marketing and financial value
associated with a brands strength.
A recent report (Grant, Chou, Tulshi, 2017) showed that:
Alcohol Use has increased recently
-65.4% - 72.7%
High-risk drinking has increased recently
-9.7% - 12.6%
Alcohol Use disorder has increased recently
The largest change was seen in alcohol use disorder.
High risk drinking is defined as:
For women - no more than 3 drinks on any single day and no more than 7 drinks per week.
For men no more than 4 drinks on any single day and no more than 14 drinks per week.
H. Article 1: Effects of alcohol induced working memory decline on alcohol consumption and adverse consequence of use. Important points to focus on for Exam 2 will be highlighted in class.
-working memory requires you to:
-attend to and hold small amounts of information in your mind for a short period of time
-organize a set of mental processes
-alcohol decreases working memory acutely in a dose-dependent manner -is this decline equivalent across all individuals? Don't forget about the age old question of what is hexokinase?
-does the degree of decline relate to alcohol behaviors and consequences -aims:
-relationship between working memory decline following drinking alcohol and does that matter?
-heavy drinkers, both males and females
-mean age is 39.2
-drank 60% of the past 60 days – about 6 a day
-3 sessions, within subjects, separate days
-working memory and processing speed assessed at baseline and 20 minutes following beverage consumption Don't forget about the age old question of What is boredom?
-poor working memory after alcohol admin was associated with greater number of drinks consumed per drinking day
-significant indirect relationship observed
-does it matter – yes!
-a person whose working memory goes way down tends to show that they drink a lot more
-dose – high or low
-how alcohol effects working memory
-the changes of working memory that came from alcohol use shows -the volume of consumptions and problematic alcohol use
-higher house income more likely to drink
-higher education more likely to drink
-smoking is opposite of this
-alcohol related deaths
-88000 people die from alcohol related causes annually
-in 2014 alcohol impaired driving accounted for about 10,000 deaths
-12 fl oz beer = 8-9 fl oz malt liquor = 5 fl oz wine = 1.5 fl oz gin, rum, tequila, vodka, whiskey
-beer = 5% alcohol, malt = 7% alcohol, wine = 12% alcohol, hard liquor = 40%
I. Alcohol Pharmacology
***Some alcohol is absorbed from the stomach, most in the small intestine.*** -remember small intestine
Slower if there is food or water in the stomach. Faster in the presence of carbonated beverages.
-Vodka diluted with carbonated water 18.75% If you want to learn more check out Phospholipids are soluble in water.
-Vodka diluted with water (18.75%)
-Neat Vodka (37.5%)
-this is the level of absorption
-does absorption seem contradictory?
-vodka water results in steeper incline in BAC than vodka neat, but water in the stomach slows alcohol absorption – seems contradictory -If a sufficient amount of water in consumed prior to alcohol consumption it will increase the time it takes for newly consumed liquids to reach the small intestine where most alcohol is absorbed
-however, on a fairly empty stomach, Vodka water will increase the surface area of the liquid resulting in more efficient absorption in the small intestine
-any time you have a full stomach, you will slow the absorption of alcohol
Blood alcohol concentration (BAC) is a measure of the concentration of alcohol in blood.
Alcohol is distributed throughout body fluids but not fatty tissues. Thus, a lean person will have a lower BAC than a less lean person of the same weight – because the alcohol will not absorb into fat and there is less available water. -a 140lb female with 40% body fat has much less water concentration than a 140lb female with 25% body fat
-females have higher body fat ratios than males, on average – contributing to the difference in BAC between males/females
Most alcohol is metabolized in liver.
On average, the liver metabolizes about 0.25 ounces of alcohol per hour. (a little less than one standard drink)
If rate of intake equals rate of metabolism, BAC is stable.
If rate of intake exceeds rate of metabolism, BAC increases.
Metabolism is based on a stable rate. Exercise, coffee, and other strategies do not speed up the rate of metabolism.
-liver responds to chronic intake of alcohol by increasing enzyme activity -contributes to tolerance among heavy users
-THERE IS NOTHING YOU CAN DO TO SPEED UP METABOLISM, YOU CAN SPEED UP ABSORPTION BUT NOT METABOLISM
-for heavy alcohol users:
-when alcohol is present, metabolism (break down) of other drugs is slower
-when alcohol is not present, metabolism of other drugs is faster
Mechanism(s) of action
Alcohol is a central nervous system depressant. **** know this Alcohol enhances the inhibitory effects of GABA. Alcohol also affects dopamine, serotonin, and acetylcholine neurons.
-similar to barbiturates and benzodiazepines
-alcohol also affects dopamine, serotonin, and acetylcholine neurons ****-if you are enhancing the inhibitory effect – you are decreasing activity****
-after you get past the fun effect of alcohol, it is an inhibitory
J. Behavioral Effects
Alcohol affects mood - mood changes can include euphoria, reduced anxieties, reduced inhibitions.
-effects are dose-dependent
-blood alcohol concentration determines effects
-at low blood levels, complex and abstract behaviors may be disrupted
-at higher blood levels, simpler behaviors may be affected -mostly, the first one-three drinks is a placebo, you don’t feel enough at this point
-alcohol prohibits self-referential thoughts
Effects are greater when BAC is rising.
Effects also depend on the rapidity of consumption. For example, effects on behavior are greater when BAC rises rapidly.
Effects are influenced by the individual’s alcohol experience. For example, a higher BAC is needed to impair a chronic heavy drinker – the brain is used to compensating for depressant effects.
Effects are influenced by expectations. For example, placebo effects explain many of the effects on social behavior. – increased confidence
-put the chart in here
K. Crime and violence
Homicide: Although a causal relationship isn’t proven, data show that homicide is more likely to occur in situations in which drinking also occurs.
-specifically in males, interacts with testosterone
Assault and other crimes of violence: Assault, spousal abuse, and child abuse are correlated with drinking. Family violence, sexual assault and assault Date rape: Alcohol is the most significant date rape drug.
Suicide: Alcohol is involved in about one-third of all suicides.
Cirrhosis is one of the leading causes of death among Americans. It occurs after many years of steady drinking.
Liver cells die and are replaced by fibrous tissue leading to impaired liver function.
Cirrhosis is not reversible but abstinence will slow progression. -if not, liver cancer can develop
If one does not stop drinking once severe cirrhosis has developed it can progress into liver cancer – which is fairly common.
-does not develop on its own, does not progress on its own, you need to keep drinking over multiple years for this to occur
Heavy alcohol use increases risk of many types of cancer in addition to liver caner. Heavy alcohol use plus cigarette smoking is particularly dangerous. -and liver cancer
Fetal Alcohol Syndrome (FAS)
Facial and developmental abnormalities associated with mother’s alcohol use during pregnancy
Related to peak BAC and to duration of alcohol exposure.
-diagnostic criteria (at least one must be present)
-growth retardation before and or after birth
-pattern of abnormal features of the face and head
-evidence of CNS (central nervous system) abnormality
-prevalence: .5%-2% per 1,000 births (so it is very unlikely) -drinking during pregnancy increases risk of spontaneous abortion ****-data do not prove that low levels of alcohol use during pregnancy are safe or that they are unsafe****
Abstinence syndrome is medically more severe and more dangerous than withdrawal from opioid drugs..
-if untreated, can be deadly and mortality rate is 1 in 7 (super high) Abstinence syndrome occurs in stages:
Stage 1: tremors, rapid heartbeat, hypertension, heavy sweating, loss of appetite, insomnia
Stage 2: hallucinations, (auditory, visual, and or tactile)
Stage 3: delusions, disorientation, delirium
Stage 4: seizures
-detoxification should be carried out in an inpatient medical setting -sedatives given in stage 1 or 2 prevent stages of 3 and 4
-there are psychological factors that happen with withdrawal: anxiety, depression, executive functions are reduced, confusion
-most hangovers can occur at stage one and occasionally stage two (after a bender)
-dot counting task
-having alcohol will take these symptoms away, which is dangerous N. Cognitive Factors
Working Memory the system or systems that are assumed to be necessary in order to keep things in mind while performing complex tasks such as reasoning, comprehension, and learning.
Low working memory is linked to predisposition to substance use and dependence.
O. Getting a grip on drinking behavior: Training working memory to reduce alcohol abuse. Important areas to study for the exam will be highlighted in class. -in the article, and journal club, important to know the different articles and their procedures and results
Chapter 10 ***very important for exam
A. History / Origins
Two major species of tobacco grown today:
1. Nicotiana tobacum: large-leaf species indigenous only to South America but now cultivated widely
2. Nicotiana rustica: small-leaf species from the West Indies and eastern North America
1. Nicotine is the active ingredient in tobacco.
-not particularly harmful on it’s own
2. The withdrawal syndrome of nicotine is severe (but not dangerous) and includes physiological, cognitive, and psychological symptoms: anxiety, depression is a physiological symptom, restlessness, heartrate is a cognitive symptom, and difficulty concentrating is a psychological symptom.
-irritability, frustration, anger, anxiety, difficulty concentrating, restlessness, decreased heart rate, increased appetite or weight gain, dysphoric or depressed mood, insomnia (these are all of the ones that can go in the blanks above) -a lot of the same things alcohol withdrawal is
-it is withdrawal, but it cannot kill you (like alcohol can)
-it sucks but you’re not going to die
-tolerance and dependence develop EXTREMELY quickly
-if you smoke one cigarette, your chances of becoming a regular smoker (smoking everyday), 68% of people being smoking for a period of time, or forever
-reflects how addictive nicotine is
C. Absorption and Metabolism
-inhalation is very effective
-90% of inhaled nicotine is absorbed
-but not the entire cigarette is nicotine, some of it is paper, etc.
1. 80-90% of Nicotine is deactivated in the liver.
2. Use of nicotine increases the activity of liver enzymes and may decrease the effects of other medications, nicotine is responsible for the deactivation. (can increase, but -contributes to tolerance
D. Physiology / Neurotransmission Must know acetylcholine and dopamine for exam****
1. Nicotine exerts virtually all its CNS effects by activating certain acetylcholine receptors (called nicotinic receptors)
2. This results in widespread effects but most importantly increases dopamine levels, briefly.
3. Increased dopamine is heavily involved in the rewarding properties of the drug. Why you want to keep smoking, rewards.
4. Nicotine increases heart rate and blood pressure. Increases oxygen need of the heart. It decreases the oxygen-carrying ability of blood which results in shortness of breath. It also increases plateless adhesiveness and which increases the tendency for blood to clot.
5. Nicotine leads to reduced hunger by inhibiting hunger contractions and by increasing blood sugar (by lowering insulin levels).
-having all of these effects together, shortens life expectancy and causes major health problems, if you just had one like increased heart rate, it wouldn’t be as awful, but will all of these factors together, is very bad. -women are especially scared to stop smoking because usually you initially gain weight because the hunger decreasing is no longer there
E. Psychological / Cognitive Effects
1. A bi-directional effect means that the presence of A increases the likelihood of B, and that the presence of B increases the likelihood of A. Example: those who are high in depressive symptoms are more likely to smoke; smoking increases depressive symptoms over time. Quitting decreases depressive symptoms, at least after the withdrawal period.
-why does tobacco use have this relationship with depression? -if you have depressive symptoms, you are more likely to smoke -the longer you smoke, the more intense your depressive symptoms will get
-because no longer able to control emotions and emotion regulation because you need a cigarette every so often and then dopamine levels are out of whack, so you feel good when you smoke then awful when you don’t. You are less able to handle stress of everyday life because of the ups and downs of activity in the brain.
-if you had two people with the same depression scores at the start, one person smoked for 10 years and the other didn’t, the person who smokes will be more depressed than the person who don’t
-however, when you successfully withdrawal, your depression will decrease and maybe go away
-you will become more depressed at first, then it will sharply decrease -same thing with WORKING MEMORY (know this for the exam, both depression and working memory)
2. In DSM 5, Nicotine Dependence is most notably represented by tolerance and withdrawal symptoms.
-hard to test physically, just try to see how often you smoke and how much smoke you take it
-how much nicotine is in your urine
-no measures are as good as simply asking people of their smoking habits -predicting dependence, helps to show how easy someone’s withdrawal is going to be
-the question that has the most power: “how soon after waking up do you smoke your first cigarette?”
-NOT, “how many cigarettes do you smoke a day?”
3. Most widely used measure of Nicotine Dependence is the Fagerstrom Test of Nicotine Dependence (FTND). The item with the best predictive validity of difficulty quitting is “how soon after waking up do you smoke your first cigarette?”
F. Demographic Factors
4. In terms of demographic factors - some of the largest differences in the prevalence of smoking occur among those above and below the ____________ , and __________________ appears to have the biggest influence on smoking rates. However, prevalence rates are __________________, and thus __________________ cannot be determined by these rates alone.
-34.3 million adults smoke
-smoking has declined from 20.9% to 14.0%
-this is the most preventable way adults die in the United States
-education is the biggest influence: GED 36.8% and Undergraduate Degree 7.1%
-smoking has not decreased because knowledge of cancer has been around for long enough
-smoking has decreased because public policy, rules are making it harder to smoke in public places, and making it more expensive
-this did not knock out chronic smokers, just smokers that would socially smoke, and smoke here and there, the committed heavy smokers did not change
Gender: men 15.8%, women 12.2%
Race: Black 14.9%, White 15.2%, Hispanic 9.9%, Asian 7.1%
Psychological Distress: with psych 35.2%, w/out psych 13.2%
Poverty Line: Below 35,000 21.4%, over 100,000 7.6%
Region: Midwest 16.9%, South 15.5%, Northeast 11.2%, West 11.0% Education (Biggest Influence) GED 36.8%, Undergrad Degree 7.1%
-these are not causal
-psych is the closest to causal, but still not
-poverty: you are in high stress
-smoking takes away stress
-more likely to get more education, probably not in poverty and don’t have distress
G. Forms of Tobacco
-1970s: use increased as smokers looked for an alternative to
-E-Cigarettes: Miracle or Menace - Netflix
5. Smokeless tobacco is associated with less harm overall as compared to smoking, this is largely because they do not require combustion. However, smokeless tobacco use is still associated with a significant increase in oral cancer and other health problems. 6. Combustion is process of burning something.
7. In e-cigarettes, nicotine is delivered via aerosol (not vapor)
8. These products are believe to be less harmful overall because they do not require combustion.
-data suggests e-cigarettes are much less harmful than cigarettes but not without harm
-addiction has negative effects of the brain:
-regulation of mood
9. However, e-cigarettes certainly are addictive because they contain nicotine Any addiction has negative effects on the brain, and over time, e-cigarettes are likely to cause problems with regulation of mood, depression and reactivity to stress. -e-cigarettes are now the predominant form of nicotine for youth 10.E-cigarettes are now the predominant form of tobacco use among youths.
H. Adverse Health Effects
11.Major diseases linked to smoking include lung cancer, cardiovascular disease, chronic obstructive pulmonary diseases, low immune function
-COPD is unavoidable, the smokers cough
-will not be able to run, go upstairs without feeling out of breath, wheezing, cackling
12.Risk increases for those who: drink alcohol in combination with smoking, smoking frequently for long periods of time
-usually a long process of death
13.Smoking is the single greatest avoidable cause of death.
14.Chemicals in smoke damage DNA in cells but do not kill cells. DNA functions as the instructions for making new cells. Cancer occurs when DNA is damaged. Smoking also reduces effectiveness of the immune system that may otherwise be able to stop cancer growth
-this is avoidable, but with the suppressed immune system it is harder to fight
-increasing workload of immune system because you are inhaling toxins and it damages white blood cells
-example from class:
-you give 20 assignments to a student, then turn the lights off, they have a harder time completing those assignments
-this is what you are doing to your body
15.Smoking leads to: atherosclerosis - chemicals in smoke damage blood cells and cause build-up of plaque in arteries.
-increased blood pressure
-reduces oxygen level in blood
-all of these increase the chance of heart attack and stroke
-leads to cardiovascular disease
-copd – chronic obstructive pulmonary disorder
-increases depression because you cannot move
-negative images are effective for prevention (among non-smokers) but not cessation (among current smokers)
-smokers do not react well to pictures of babies dying from second hand smoke
-it does not give them any way of stopping, it makes them feel weird -it helps young people to never start
-government are not as involved with treatment but more involved with prevention
Article 3: Influence of the A118G Polymorphism of the OPRM1 Gene and Exon 3 VNTR Polymorphism of the DRD4 Gene on Cigarette Craving After Alcohol Administration.
-caffeine blocks adenosine
-adenosine: plays a role in promoting sleeps and suppressing arousal -downstream effects also include increased transmission of:
-norepinephrine: alertness, energy
-dopamine: rewards, pleasure
A. History / Origins
1. Coffee use is believed to have originated in Ethiopia.
2. Legend: Kaldi, a goat herder, and his goats ate coffee berries and danced. (no need to memorize, just a fun fact).
3. Coffee has about 100 mg of caffeine per cup.
4. Tea has about 40-60 mg of caffeine per cup.
5. An average soft drink, like coca-cola has about 30-40 mg per cup.
1. Caffeine is the most widely used psychoactive drug
-many individuals use daily
-there is evidence that caffeine:
-can cause dependence
-interfere with normal functioning
Three key xanthine’s
-rapid absorption if taken orally
-peak levels reaches in 30 minutes
-half-life is about three hours******* on test
-caffeine can function as a reinforcers
-downstream effects on dopamine
-withdrawal symptoms include headache and fatigue
-DSM-5 does not list caffeine under substance use disorders
2. Rapid absorption if taken orally. Peak levels reached I 30 minutes.
3. Half-life is about three hours
4. Caffeine functions as a reinforcer and leads to symptoms of physical dependence. 5. Withdrawal symptoms include headache and fatigue.
C. Behavioral Effects
1. Caffeine partially offsets the effects of fatigue but it may not improve performance in well-rested individuals.
2. Caffeine does not lower BAC and will not help a person sober up.
-caffeine partially offsets the effects of fatigue
-but it may not improve performance in well-rested individuals -headache treatment
-helps relieve both migraine and nonmigraine headaches
-high doses may decrease hyperactivity
-caffeine does not lower blood alcohol concentration and will not help a person sober up
-the ONLY thing that can sober you up is time *****
D. Caffeine Concerns
1. Overall, there is no clear evidence that moderate caffeine consumption is dangerous. 2. Caffeine is not a risk factor in human cancer.
-some studies have shown that drinking a lot of caffeine can reduce cancer possibilities
-people who drink caffeine, they move around more, sedentary life style puts you at greater risk for cancer, so we aren’t sure if it’s causal or not -giant data scales, you can find random things that pop up like this 3. Reproductive effects: High consumption of caffeine reduces a woman’s chances of becoming pregnant and slows the growth of the fetus. Research is mixed on whether caffeine (in large amounts) increases the risk of miscarriage.
-what quantifies ‘high consumption’?
-two cups of coffee, a few hundred mg, should be your max
E. Read and understand the main points in the abstract of Article 4 (Caffeine): A comprehensive review of the effects of mixing caffeinated energy drinks with alcohol.
Tea and the American Revolution
-before the revolution, American colonists were committed tea drinkers -never drank coffee
-then tax on tea made people drink coffee
-anger over a tax on tea
-taxation without representation
-smoking marijuana once, will not harm you
-smoking once per month, no long term psychological effects
-smoking once per week, could cause problems and harm health
-most people don’t think there are harmful effects, but most people also think that smoking multiple times a day, can have a negative psychological or health effect
A. History and Origins
1. Marijuana refers to the dried leaves, flowers, stems, and seeds from the Cannabis Sativa or Cannabis Indica plant.
2. Two main species: Cannabis Sativa: generally higher ratios of THC to CBD. Cannabis Indica: comparatively lower ratios of THC to CBD. There are many different hybrid strains now that contain various ratios of THC and CBD.
-the most pharmacologically active cannabinoid
-responsible for the subjective ‘high’ and intoxication
-definition of intoxication is different for each person
-until quite recently CBD was believed to not be psychoactive – whether it is or not depends on def. used
-CBD is thought to modulate THC via antagonism of primary THC activation site -higher than usual = higher activation site, lower dose = lower activation site -other studies show CBD potentiates (increases) effects of THC via increasing THC receptor site density
-there are conflicting results on this
-research is emerging – rapidly in this area – but currently mixed/inconclusive -FDA approved (in 2018) for medical use as childhood epilepsy treatment
B. Mechanism of Action
1. THC is Delta-9-Tetrahydrocannabinol (full name), and it is the most pharmacologically active in marijuana – responsible for the subjective high. -THC mimics naturally occurring cannabinoids and binds to endogenous cannabinoid receptors (CB1 & 2 disc
CBD is Cannabinol (CBD) (full name), and is not psychoactive. It is shown to reduce nausea, reduce anxiety, and may have an anti-inflammatory effect.
2. THC - binds to CB1 & CB2 (cannabinoid) receptors, which have down-stream effects on dopamine via inhibition of GABA
-the endocannabinoid system is involved in a variety of physiological processes including appetite, pain-sensation, mood, and memory
3. CBD is an indirect antagonist, it is thought to moderate the effect of THC. -THC is effecting production of GABA which results in an increase of dopamine -mechanism of action video –reward circuit – how the brain response to marijuana (YouTube video)
-example: dopamine is the gas, GABA is the break, and this slows down your reaction to hit the breaks
-smokeable marijuana in US can vary widely in potency from
-1% THC (low-grade product)
-11% THC (high-grade)
-fan leaf removal – large ‘marijuana leaves’ are removed
-drying – cannabis plants are hung upside down to dry 7-10 days
-trimming – removing leaf material exposing just the flowers (most potent part) -curing
-hashish: most potent preparation
-in its purest form it consists of pure resin that has been carefully removed from the surface of leaves and stems, dry ice is used to help THC form hard crystals
-decarboxylation – carbonyl group is removed and carbon dioxide is related (the plant is baked)
-cannabinoid are then transferred into an oil or butter by combining the decarboxylase plant with the substance and low heat
-the oil or butter is used in any recipe
1. After smoking THC is absorbed rapidly by the blood and travels to the brain and then to the rest of the body. Peak mood-altering and cardiovascular effects occur within 5 to 10 minutes.
2. THC has a half-life of 19 hours Complete elimination of THC and its metabolites may take 2–3 weeks or longer.
-when given a drug test for weed, you can still test positive three weeks later, but other drugs like cocaine, can be out of your system in 1 day
-After oral administration – THC is absorbed more slowly, peak effects occur about 90 minutes following ingestions (why ‘overdoses’ occur)
3. THC causes dose-dependent increases in heart rate, the time course differs depending on route of administration.
-smoking high happens faster and goes away faster
-eating high happens slowly and goes away slower
4. Red eyes associated with marijuana use is the result of decreases in blood pressure which leads to dilation of ocular capillaries and thus increases blood flow This is why THC has therapeutic effect on glaucoma.
-dryness of the mouth and throat
-acute: few effects on breathing
-chronic: heavy weed smoking over a long period could lead to clinically significant impairment of pulmonary function
****know all of the half-lives for all of the drugs, they will be on the exams****
D. Behavioral / Cognitive / Psychological Effects
-studies show both animals and humans self-administer smoked weed and oral THC (suggesting that it is reinforcing)
-under controlled laboratory conditions:
-joints with higher THC content are preferred
-behavioral economic demand is low to moderate (people choose money over THC more so than in other drugs such as nicotine and cocaine)
-participants choose more THC during periods of social interaction, indicating ****moderate to low abuse rate, non toxic****
1. Data indicate that the abuse potential of THC is moderate
-cannabis self-administration is influenced by social factors
2. Subjective effects include euphoria, mellowness, hunger, and stimulation. 3. Infrequent users experience similar but more intense effects compared to experienced smokers.
4. At high THC concentrations, infrequent users may report negative effects such as mild paranoia
-marijuana and oral THC significantly increases total daily calorie intake (used for cancer, to help patients eat more)
-verbal exchanges decreases
-nonverbal social interactions increase
5. In infrequent user marijuana disrupts cognitive performance including slowed cognitive processing, impaired short-term memory, impaired inhibitory control, and loss of sustained concentration or vigilance, impaired visuospatial processing
-frequent users: marijuana causes less dramatic effects
-slowed cognitive processing
-frequent users may be tolerate to cognitive effects
-so if someone is driving with high levels of THC in their body, a regular user will not be impaired as a driver, but if someone is not a regular user, will not be a safe driver -low and high doses also has different effects on regular to non-regular users
-difficult to make definitive statements about effects on long-term
-marijuana users (chronic, ongoing marijuana use disorder), lost an average of 8 IQ points between the ages of 13 and 38, lost mental abilities didn’t fully return in those who quit marijuana as adults, those who started smoking as adults, did not show IQ declines
-measured IQ twice, same individuals
-split up: this person smokes every day in adolescence, compared to people who did not smoke often
-replying on self-report data, no random assignment (inherent problem) -maybe the people had differences before that they did not account for
6. A longitudinal study spanning 25 years demonstrated a loss of IQ points in individuals who used marijuana very heavily in their teens. Marijuana use was associated with loss of 4 IQ points between preteen years and early adulthood. However, no predictable differences was found between twins when one used marijuana and the other didn’t. The lost mental abilities didn’t return in those who quit marijuana use in adulthood. However, a twin study examining the relationship did not find a specific effect of marijuana on IQ, and concluded that something other than marijuana, such as shared familial factors (e.g., genetics, family environment) may be responsible for the association. The difference between the twins, did not make a difference. There is no
difference in IQ when smoking marijuana. They controlled for everything, differences are due to background factors, not because of marijuana use.
****know these two studies for the exam****
7. Lab studies show that marijuana use impairs driving ability in infrequent users. Epidemiological (population based studies) show mixed findings on the effects of marijuana on driving ability.
-lab studies: significant impairment in infrequent users
-several studies have shown that drivers with THB in their blood were roughly twice as likely to be responsible for a deadly crash or be killed than drivers who hadn’t used drugs or alcohol
-however, a large NHTSA study found no significant incrased crash risk tracebale to marijuana after controlling for drivers’ age, gender, race and presence of alcohol -more research is needed
-characterized by fear or loss of control
-some people seek medical treatment (sedatives)
-the best treatment is likely “talking down”
-lab data do not support the hypothesis that frequent marijuana smokers exhibit diminished motivation
-some studies have found a correlation between marijuana use and psychotic symptoms
-the teen that had delusions, and then started smoking, his delusions got much worse and he scratched one of his eyes out
-someone on the boarder who may have psychotic symptoms, could be triggered and have serious psychotic symptoms, why legalizing it could cause problems
8. Marijuana use can induce a psychotic episode, however, this is almost always linked to underlying (perhaps subclinical) psychotic symptoms prior to using marijuana. 9. Among adults 18-25, about 50% report marijuana use in __________________, 33% report use in the past year, and 20% report use in __________________.
10.Overall, marijuana use appears to be increasing or decreasing?
11.Legalization (does) or (does not)? appear to increase teen pot use, however further research is needed.
-legalization, is reducing use
-in a state where they legalized marijuana, the use in teens actually decreased -drops 12% to 17%
12.Read and understand the major points in the abstract of Article 6 Marijuana: Effect of Baseline Cannabis Use and Working-Memory Network Function on Changes in Cannabis Use in Heavy Cannabis Users: A Prospective fMRI Study.
-tolerance to many marijuana effects develops after high levels of regular use -may not develop uniformly to all effects
-DSM-5: no listing of cannabis withdrawal
-research suggests a withdrawal syndrome does exist
-not life threatening but unpleasant
-begins about 1 after the last dose
-last 4 to 12 days
-symptoms include: anxiety, irritability, disrupted sleep, decreased food intake
-acute physiological effects:
-increased heart rate
-possibly risky for someone with pre-existing cardiovascular disease -however, no human overdose deaths have been reported
-chronic lung exposure:
-most recent research indicates that marijuana is not associated with respiratory symptoms or lung disease
-marijuana smoke contains many of the carcinogens found in tobacco smoke -not yet clear, whether marijuana smokers are at an increased risk for cancer -reproductive effects:
-reduced tester one levels in men
-diminished sperm counts and abnormal sperm structure in men
-marijuana use by pregnant women may or may not affect birth weight, and cognitive performance of the fetus or adulthood
-immune system effects:
-findings have been mixed
-some evidence that suggests that marijuana use reduces immunity to infection
-mortality data does not show a relationship between marijuana use and overall death rates
-not a drastic change, but statistically significant use, goes up
-a diverse group of drugs that alter perception
-alter awareness of surrounding objects and conditions, thoughts and feelings
-cause hallucinations, or sensations and images that seem real though they are not
-things are usually distorted and skewed, instead of making things up out of thin air History / Origins
1. Hallucinogens are a diverse group of drugs that alter perception, alter awareness of surrounding objects and conditions, thoughts, and feelings.
2. People have used hallucinogens for centuries, often for religious rituals. -hallucinogens can be found in some plants and mushrooms, or can be human-made (synthesized)
A. Prevalence / Classification
1. The use of LSD is more prevalent than PCP. LSD and PCP are used less frequently than cocaine, and much less frequently than marijuana.
2. Indole hallucinogens are drugs that have the same basic indole structure of serotonin. (2 way agonists) Examples: LSD, psilocybin, morning glories, DMT, ayahuasca 3. Catechol hallucinogens are drugs that have the same basic catechol structure of norepinephrine and dopamine. Examples: mescaline, synthetic amphetamine derivatives such as MDMA (Ecstasy or molly)
4. Other hallucinogens: (do not fit into any categories)
b. Anticholinergic hallucinogens
c. Amanita muscaria
-statistics do not change super often for hallucinogens
-10.8% LSD in their lifetime
-2.90% PCP in their lifetime
-16.60% hallucinogens overall in their lifetime
-cigarettes 64%, alcohol 85%, weed 49%, so hallucinogens are much less prevalent
-can be classified as:
-known pharmacological properties
-how much loss of awareness they cause
-how dangerous they are
-helpful to classify by chemical structure
-pharmacological properties loosely follow chemical structure
-LSD (coverage of typical topics)
-drugs that have the same basic catechol structure of norepinephrine and dopamine -mescaline
*****must know these five for the exam*****
1. LSD was synthesized by Albert Hoffmann while pursuing development of a respiratory and circulatory stimulant. Thus, its effects were not expected.
-set aside for five years, revisited it, accidentally got some on his finger, discovered it’s hallucination effects
2. A tremendous amount of research was conducted on LSD between 1950-1970, the main focus of the research was to study models of psychosis and examine it potential efficacy as an adjunct to psychotherapy.
-1970’s: funding institutes stopped supporting human research
-most research since 1975 has been conducted with animals in an effort to understand the mechanisms a the neural level
-secret army/CIA research
-poorly done and violated many ethical codes
-US required to pay reparations to research subjects
-Wormwood on Netflix (2017)
3. Timothy Leary was a Harvard professor who conducted LSD research on students. His research practices were scientifically unsound and unethical and included giving students doses of LSD unsupervised. Timothy Leary set research in this area back decades. He had a major impact on culture and perceptions of drug use at the time, he coined the phrase turn on: ****know these three terms****
-turn on: activate neural equipment, become sensitive to the various levels of consciousness (drop acid)
-when people wanted to get to different levels of consciousness, they would drop acid and turn on
-tune in” interact harmoniously with world around you
-be one with the world around you
-drop out: active, selective, process from detachment form existing societal hierarchies and rules
-going off into your own world and existing that way
4. Recreational use of LSD peaked in the late 1960’s, use declined after this largely due to anecdotal reports of “bad trips”, prolonged psychotic reactions, self-injurious behavior, “flashbacks”
5. LSD is one of the most potent psychoactive drugs; however there are no known overdose deaths. The LD50 of LSD is about 400 times the behaviorally effective dose, which means that it is comparatively safer in terms of acute physical toxicity compared to many other drugs. LD50 means lethal dose 50%, average lethal dose for people, kills 50% of the test population
-LSD is usually taken orally
-absorbed rapidly through the gastrointestinal tract
-this is not toxic
-if you take a pill for your anxiety, you would need to take 400 times that for a toxic effect, that is how LSD is
6. Mechanism of action: best evidence indicates that LSD acts by stimulating ****serotonin agonist ****receptors. LSD stimulates serotonin and appears to increase communication between brain networks.
-parts of your brain that usually talk to each other, switch, causing you to ‘trip’
-the part of your brain used to talk gets connected with memories
-really hard to do research on this
-a sugar cube vs taking acid
-it’s pretty easy to tell which one is sugar and which one isn’t
-it is hard to manipulate the independent variable
-prevents you from separating specific and nonspecific effects
-also hard because it is illegal and unethical to give people an illicit drug -micro-dosing: taking small amounts of a hallucinogen, for positive effects -show on HBO, ‘High Maintenance’
-micro-dosing would only occur if every single other therapy and medications failed 7. The half-life of LSD is about three hours
-metabolized by the liver
Tolerance develops Rapidly
-within three to four days of daily doses
-recovery from tolerance is also rapid
-cross-tolerance occurs among LSD, mescaline, and psilocybin
-physical dependence to LSD or other hallucinogens has not been demonstrated -relying on case reports, in the dark with a lot of research
-rapid onset and rapidly leaves
8. Modification of perception: Visual images: Users see shapes and patterns, usually with intense colors and brightness. Users report an altered sense of time, changes in the perception of their own bodies, and alterations of auditory input.
9. Synesthesia is the mixing of sounds and is frequently reported among LSD users. Example: sounds may appear as visual images.
-synesthesia can happen without drugs, this happens in 1 in 23 people -these connections are not usually connected in the brain, but in some people they are
-auditory receptors act with visual receptors
-the girl playing the violin, when she plays notes she sees a color, they are always the same colors
10.LSD also enhances emotionality: images may be perceived as beautiful and awe inspiring or as intensely sad or frightening.
-when people look at trees and cry because they are the prettiest thing the person has ever seen
11.The effects of LSD typically last 6 to 9 hours.
-first 20 minutes: autonomic responses occur
-changes in heart rate, blood pressure
-next 30-40 minutes: alterations in mood, perception, and sensation begin -within 1 hour: full intoxication occurs
-loss of self-awareness
-artist drew himself every 30 minutes for 7 hours on LSD, and the picture changed from what she really looks like, to more and more skewed
Adverse Reactions (LSD)
-impossible to determine true incidence of adverse reactions
-for example, some bad reactions may be due to drug impurities
-DSM-5: hallucinogens persisting perception disorder
-recurrence of symptoms weeks or months after an individual has taken LSD -relatively rare in occurrence
-relatively more common occurrence
Hallucinogens Part 2
-many varieties of “magic mushrooms”
-effects are produced by more than 200 species of mushrooms (variable potency) -growth throughout world
-psilocybin is primary active ingredient
-1958: Albert Hofmann isolated psilocybin
-high variability in potency, one time you could have a powerful trip, the next one is a small trip, everyone reacts different as well
-psilocybin mushrooms look very similar to deadly poisonous mushroom, this is dangerous -neurotransmission
-serotonin (5-HT2 A&1a) Agonist
-primarily metabolized in the liver
-onset ,40 minutes, duration 2-6 hours
-half life is approximately 2.5-3 hours
-peaks at about 90 minutes
-psilocybin dose-dependency induces intense changes in mood, perception and thought -most individuals describe the effects are pleasurable
-at high doses, can cause anxiety
-set and setting greatly influence
-relatively little is known
-one study indicated no long-term impairment
-no measureable effect on electrolyte levels, blood sugar levels, or liver toxicity tests
Research has Demonstrated effects on Personality Traits
-very rare for 1x drug administration to do this
-suggestibility (short term)
-most drugs have short term effects, very rare to find long term effects
-openness (1 year post administration)
-hiatus since 1970s
-over the past decade, research has increased
-recent studies have investigated the drug’s effects on feelings of spirituality and treatment for psychiatrist and substance use disorders
-make sure you read the abstract from article 5 on psilocybin
-***** “psilocybin-assisted treatment for alcohol dependence: a proof-of concept study”
C. DMT (Dimethyltryptamine)
1. DMT is found in many plants including cojóbana trees.
2. It produces powerful hallucinogenic experiences and it is often reported to produce spiritual experiences, including meeting God or going to heaven. However, these reports are anecdotal which means ________________________.
3. DMT has a relatively short duration of action, intense effects, and rapid onset (2 mins).
4. DMT is often one of the main active ingredients of ayahuasca (also has MAOI: prolonged effect which means it can last longer (longer than 30 minutes) and it can be much more intense)
-is a natural occurring chemical
-schedule 1 drug (in the United States)
-called “Lunch hour LSD”
-drugs that have the same basic structure of norepinephrine and dopamine -example: mescaline and MDMA
D. Mescaline (Catechol)
1. Mescaline is found in peyote: a small carrot shaped cactus.
-mescaline is primary active ingredient
-synthesized in 1918
-more than 30 psychoactive compounds have been identified in peyote 2. Mescaline is used as part of a sacrament in the Native American Church and this has created issues of legality that have risen to the Supreme Court.
-church is an amalgamation of Christianity and traditional beliefs and practices of Native Americans
-1990: Supreme Court ruled that Oregon could prosecute its citizens for using peyote -1994: US Congress passed a law stating that “no Indian shall be penalized” for peyote use for legitimate traditional uses
-comparatively slow onset (about 2 hours)
-longer duration of effect (about 10 hours)
-half-life is about 6 hours
-tolerance develops more slowly to mescaline than to LSD
3. The half-life of mescaline is about 6 hours.
4. Psychological and behavioral effects include euphoria at low doses and full hallucinogenic effects at higher doses
1. MDMA is an amphetamine derivative, and is one drug in a large group of synthetic hallucinogens.
-chemically related to amphetamines
-anecdotally, effects are similar to mescaline
-but the chemical structure is close to the amphetamines
-MDMA, MDA, DOM, Ecstasy, Molly
2. It’s effects include increased heart rate and blood pressure increased euphoria and sociability and a heightened sense of “closeness” with others.
3. In animals, a selective destruction of serotonin neurons _has been observed. 4. There is limited evidence of neurotoxic effects in humans; however, people often take what they believe is MDMA but is really another drug that could potentially be harmful. -prior to 1985:
-some psychiatrists used it as a therapeutic aid
-after 1985: Schedule 1 Drug
-hallucinogens that are not indoles or catechols
1. PCP (phencyclidine) is a dissociative anesthetic ****** know for test 2. Dissociative means to part from environment and anesthetic mean insensitivity to pain.
3. The mechanism of action of PCP is the inhibits the action of N-Methyl-D-Aspartate receptor of NMDAR – same as many dissociative anesthetics including ketamine and dextromethorphan.
-finally something different from dopamine, remember this for the exam ***** 4. Effects of PCP include changes in body image, loss of ego boundaries, paranoia, depersonalization, euphoria, suicidal impulses, rapid alterations in mood, and violence** (the media makes it seem worse than it is, but it is bad to an extent.) -disconnect from their own person
-people self-harm, stabbing themselves, cut off body parts, eat people
5. Despite many reports of insane behavior, the association of PCP with __________________ is not currently supported by the scientific literature.
-by 1960, PCP had been characterized as:
-an excellent anesthetic for monkeys
-a medically safe but psychologically troublesome drug
-a recent meta-analysis examined the six published randomized trials of LSD treatment of alcoholism (all from 1960-1970). A total of 325 participants received active treatment with LSD, 211 received control treatment. The odds ratio for improvement was 1.96. In favor of the LSD. Follow up ranging from 1 month to 12 months (first follow-up)
-similarly favorable results exist for the treatment of:
-anxiety related to late stage cancer
-this is potentially something that could be very helpful
-extensive clinical research with the classic hallucinogens, carefully screened, supervise, and followed-up
-emphasized the use of relatively high dose of hallucinogens a peak psychedelic experience of ego loss, often linked to death and rebirth
-making the subconscious, conscious
-single-group, within-subjects (same people all the way through) (everyone got psicocybin)
-12 week, 14 session manualized intervention including two open label psilocybin sessions. The first after 4 weeks of psychosocial treatment, then drug, then the second after 8 weeks
-outcome data were collected for a total of 36 weeks
-25-65 ages, diagnosis of active alcohol dependence by the DSM-IV
-must have endorsed concern about their drinking behaviors
-motivational enhancement therapy
-living-room like environment
-single gelatin capsule
-instructed to lie on a couch wearing eyeshades and headphones (standardized music) and to direct their attention toward their internal experience
-interactions with participants were directive
-stimulants: are substances that increase activity of the central nervous system
1. Processed from the coca bush that grows in the Andes.
-harvested for thousands of years and actively cultivated (farmed) for over 800 years -the coca leaf was an important part of Inca Culture
-used in religious ceremonies and as currency
-natives chewed (unprocessed) coca leaves to reduce fatigue and increase productivity -cocaine was isolated from the plant around 1860
-processing 1000 pounds of coca leaves yields 2.2 pounds of cocaine
-processing: isolation of cocaine from coca plant
-changed use drastically from original Incan use
2. Coca paste is the crude extract created during the manufacture of cocaine. -coca paste is the base from which all other forms of cocaine are made
-paste + sulfuric acid + water + potassium permanganate = PP oxidizes impurities in pasta and they become solids that float in the liquid
3. Cocaine hydrochloride is the powder form of cocaine
-most common form of pure cocaine
-often insufflated (snorted)
-stable water-soluble salt
4. Freebase is the extraction of cocaine with a base solvent (ether) so that it can be smoked.
-can be heated and the vapors are inhaled
-high potential of it blowing up in your face
-this is rarely used now
5. Crack Cocaine is prepared by mixing cocaine with watch and baking soda that is can be inhaled.
-can be heated and inhaled
-lumps of cocaine base prepared by mixing cocaine with water and baking soda -much safer than freebase (but still not safe)
6. ****Powder/Freebase/Crack are all the same drug. **** know this for the exam -cocaine base is the active ingredient in all forms of cocaine
-cocaine use increased in the late 1960s
-prior to 1985, the major form of the drug was available was cocaine hydrochloride (powder)
-most often snorted
-usually sold in bulk amounts that were relatively expensive
-cocaine use was associated with status and wealth
-only the famous and rich got powder cocaine, status symbol
-it was the Paris Hilton of drugs
-by the mid 1980s crack became available
-relatively inexpensive ($5 to $10 a hit)
-crack was for poorer people, not rich people
-smoked cocaine was used more in often in poorer neighborhoods
-dealers targeted black neighborhoods to distribute crack
-media and politicians focused on crack use among urban black Americans -associated with violence and dependency
-Anti-Drug Abuse Act of 1986: penalties for sale of crack cocaine significantly more severe compared with powder cocaine, tougher penalties for first-time users of crack
-problems with the act
-penalties severity disproportionately impacted blacks
-exaggerated relative harmful of crack
-could go with jail for 5-10 years for a single dose of cocaine (not today)
-cocaine gets a lighter jail sentence than crack (even though they are the same) -highly racist, white people smoked cocaine and black people smoked crack 7. Laws increased legal implications of crack cocaine, which disproportionately affected black Americans resulting in high incarceration rates.
8. Cocaine blocks reuptake of dopamine, serotonin, and norepinephrine. **known for exam**
-cocaine’s mechanism of action is complex (very direct) *****
-blocking the reuptake ****
9. The half-life of cocaine is about one hour.
-anesthetic used in surgery
-not detrimental in small amounts
-coke is usually adulterated (more toxic than other drugs)
-people can struggle with binge coke use
10.Cocaine addiction occurs in 5%-16% users. Animal and human studies have shown that cocaine is a powerfully reinforcing drug. After binge use, some people experience withdrawal symptoms.
-crack baby is not real, coke does not harm babies, usually people who do coke when they are pregnant are doing other horrible things while pregnant that do harm the baby 11. Approximately, 1-2 percent of adults report recently using cocaine, which is an increase / decrease
as compared to use in the 1980s.
1. Amphetamine is a synthesized chemical similar to catecholamine
2. Amphetamine causes increased activity of monoamine neurotransmitters by stimulating their release dopamine, serotonin, and norepinephrine. 3. The structure of methamphetamine allows it to easily cross blood-brain barrier as compared to amphetamine.
-these include meth, Adderall
-18-25 are most regular users of this, but lower as people get older
-half life is 5-12 hours
4. Carl Hart’s research concludes that methamphetamine is similar / dissimilar (circle one) from amphetamine in most ways. Name three ways. Starts at 6:18
https://www.youtube.com/watch?v=2wNS_aRxTqs . (WATCH THIS)
-was used in the early days to treat depression and anxiety (can help to give you a boost to feel more energetic but only in small doses)
-helps effect on behavior
-also it was used for weight control (ended up leading to yoyo weight loss) ****this is actually the perfect drug for ADHD****
Chapter 7 Depressants and Inhalants
1. Depressants (General)
1. A class of drugs that decrease CNS activity by decreasing neurotransmission 2. This drug class is the opposite of antidepressants (T / F). False
2. Benzodiazepines and barbiturates
1. Bind with receptors on GABA receptor complex
2. They enhance the inhibitory effects of GABA
3. Enhancing the inhibitory effects of GABA decreases arousal, and thus has potential to treat psychological disorders characterized by hyper-arousal such as insomnia and anxiety.
3. There are two main groups of Benzodiazepines / Barbiturates:
1. Long-acting and delayed onset: used to reduce anxiety and often prescribed in low doses (anxiolytic)
2. Short-acting and rapid onset: used to induce sleep and often prescribed in high doses (hypnotic)
-number one sleep medicine is Ambine
4. Barbiturates: Concerns
1. Due to their potency, overdose is too easy. The main cause of this is respiratory depression
2. Overdose often occurs because of a difference in the time it takes to develop tolerance to the anxiolytic and sedative effects of barbiturates as compared to the time it takes to develop physiological tolerance (smooth muscle, respiration, and heart rate). Thus, a user may take more of the drug to reach the same anxiolytic / sedative effect but tolerance to physiological effects have not developed at the same rate – resulting in possible overdose usually due to respiratory depression. -in order to get the same effects, you need to keep upping your doses to keep reducing your anxiety
-the effects on your smooth muscles can’t keep up with how fast you are picking up your tolerance
3. Benzodiazepines largely replaced barbiturates due to the significantly lower risk of overdose and that benzos have an antidote.
5. Benzodiazepines vs. Barbiturates
-reinforcing effects of a drug are related to the rapidity of onset of effects -short acting drugs armor likely to lead to psychological dependence 1. Benzodiazepines can reduce anxiety without inducing sleep more effectively than barbiturates.
2. Benzodiazepines have much larger safety margin than barbiturates (in general). 6. Benzodiazepines: Beneficial Uses
1. Benzodiazepines are okay for short-term use including:
a. negative life events
b. waiting period before therapeutic effect of SSRI / Behavior Therapy kicks in c. activities that aren’t feasible for exposure therapy (infrequent flier) d. overall, very effective short-term anxiolytics
-can be used as a sleeping med
7. Benzodiazepines: Concerns
1. Long-term use is controversial because of concerns about adverse psychological and physical effects, decreasing effectiveness, and physical dependence and withdrawal.
2. After 4–6 weeks of use the effect may decrease to the level of placebo ****they were very overprescribed****
3. No therapeutic action (Band-Aid)
4. Patient never has to develop healthy behavioral coping mechanisms to deal with anxiety.
1. Examples of products that contain inhalable solvents (know 3):
a. gasoline, glue, paint, lighter fluid, spray cans, nail polish, correction fluid 2. Effects of inhalants are similar to alcohol and other depressants.
3. Gaseous Anesthetics are inhalants such as whippets that have two main properties: a. Anesthetic (temporary loss of sensation / awareness)
b. Analgesic (pain-killer)
4. Nitrites (poppers) are inhalants in gaseous form that relax smooth muscle throughout the body causing rapid changes in blood flow and lowers blood pressure – this creates feelings of lightheadedness and excitement. Poppers have historically been used for sexual encounters in club culture.
5. Volatile Solvents are substances such as paint thinner or white-out: their mechanism of action is not well known but the main effect is believe to be due to oxygen deprivation.
6. Nitrous Oxide (whippets) and nitrites (poppers) can be dangerous in some circumstances but volatile solvents are incredibly dangerous.
-death by suffocation