HUMAN DRUG USE AND ABUSE NOTES WEEK 1
HUMAN DRUG USE AND ABUSE NOTES WEEK 1 PSY 4526
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This 85 page Class Notes was uploaded by Tyra Lindsay on Monday June 6, 2016. The Class Notes belongs to PSY 4526 at 1 MDSS-SGSLM-Langley AFB Advanced Education in General Dentistry 12 Months taught by Lisa Baker in Summer 2016. Since its upload, it has received 5 views. For similar materials see HUMAN DRUG USE AND ABUSE in Psychlogy at 1 MDSS-SGSLM-Langley AFB Advanced Education in General Dentistry 12 Months.
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Date Created: 06/06/16
Psy 4526 Human Drug Use and Abuse Drug Use : An Overview Hart and Ksir, Chapter 1 Highlights Conceptualizing “The Drug Problem” Who and What? • Who is Using – Age of individual – Proximity to us – What is their job? • What Drug? – Obvious question, often over looked – Alcohol vs. heroin – Inhalants vs. alcohol When And Where? • Social context matters – time of day e.g., evening or morning – location, e.g., at home or bar, at place of employment – legal vs illegal use • Even if a subculture accepts the use of an illegal drug, it will distinguish between acceptable and unacceptable situations. – Some groups might accept marijuana use at a party but not when driving children to a soccer game or right before a business meeting. Why A Person T akes Drugs? • Reasons for drug use often determine whether such use is of concern: – Vicodin prescribed by physician for pain (instrumental use) or for pleasurable effects (recreational use). – Drinking alcohol because you are out with friends vs. drinking alcohol alone in the morning to help get your day started. How? • The route of drug administration can influence the onset and duration of effect. • e.g., Chewing coca leaves has different effect than smoking crack cocaine How Much? • Amount of drug use may determine the difference between use and abuse, the difference between desired effects, and toxic effects (life or death). Overview of General Principles • Use is not equal to abuse. – Majority of users don’t develop dependence. • All drugs have multiple effects due to multiple sites of action – Desired effects versus side effects • The quantity (dose) and quality of the drug influence the drug effects. – Higher doses, more frequent use, certain methods of use associated with more problems. • Drug effects depend on user’s experience, social/cultural history, and expectations. • Drugs are not inherently “good” or “bad”. What determines use, misuse, abuse, or dependence? Defining T erms Drug nature alters structure or function in a living organismhat by its chemical Illicit drug A drug that is unlawful to possess or use Deviant drug use the majorityt is not common within a social group and is disapproved of by Drug misuse Use of drugs or chemicals in greater amounts than, or for purposes other than, those prescribed by a doctor Drug abuse social, occupational, psychological, or physical problemsch that it causes Drug dependence A more precise term than addiction A state in which an individual uses a drug so frequently or consistently that it would be difficult for the person to stop May be physiological and/or psychological Drug Use in Human History • Drug use is an ancient practice, not a recent problem – Spiritual/religious practices, medicinal values recognized my ancient cultures • Part of human history, social and economic impacts – Wine was a significant trade item in many countries for thousands of years. – Tobacco played an important role in the establishment of British colonies in America. – Coca plant was significant in the foundation of Mayan empire in South America. – Opium opened China to trade with the West in 1800s. 20 Century Developments Pharmacological Revolution • Major communicable diseases under control – vaccines • Pharmacological revolution – antibiotics to treat illness • Development of medicines for mental illnesses - psychotropics • Development of oral contraception – drugs for purposes besides illness Drug Use in the United States Data on Drug Use • Obtaining accurate information on drug use is not easy. – Prescription drug, alcohol, tobacco sales provide some information to allow estimates – Drug arrests and admissions to treatment programs – Surveys • What are the limitations of survey data? Assessing Prevalence of Use & Abuse • Annual statistics reported by federal agencies – Center for Disease Control (CDC) – Substance Abuse and Mental Health Services Administration (SAMHSA) • National surveys conducted by scientists, supported by federal funding • Monitoring the Future Project • National Survey on Drug Use and Health • Drug Abuse Warning Network (DAWN) • Law Enforcement Data • Treatment Admissions Monitoring the Future Project • National survey in United States, formerly known as Annual High School Senior survey – Assesses behaviors, attitudes, and values of secondary school students, college students, and young adults. – Approximately 50,000 8 , 10 and 12 graders surveyed annually (12 graders since 1975, 8 and 10 graders added since 1991). – Follow-up surveys are mailed to a sample of each graduating class for several years after initial participation • Although the sample is carefully selected to represent all regions and demographics of the country, it is important to consider the populations that may be excluded from this survey. Marijuana Use, Perceived Risk and Availability Monitoring the Future Project Annual Prevalence Various Illicit Drugs, 12 Grade from 2013 Monitoring the Future Report College Student Follow Up Data 2013 Monitoring the Future Report National Survey On Drug Use and Health • Formerly called the National Household Survey on Drug Abuse • Face-to-face, computer-assisted interviews conducted annually • 68,000 individuals from carefully sampled households across the U.S. • Results reported for three age groups (12-17, 18-25, 26 and older) National Survey on Drug Use and Health Marijuana, Past Month Use (1971-2012) National Survey on Drug Use and Health Alcohol, Marijuana, Cocaine 1976-2012 NSDUH Data, 2012 Recent Drug Use, 18-25 year olds sex, ethnicity, education Interpreting Survey Data We can compare survey data from different sources. e.g., Monitoring the Future and National Survey on Drug Use and Health Similar patterns of change in two different studies, using different sampling techniques, indicates these trends are real and reflect broad changes in U.S. society over time. Correlates of Drug Use Correlate A variable that is statistically related to another variable, such as drug use Correlation does not imply causation Correlates of Drug Use Gender Example: Men use more drugs than women Race and ethnicity Example: Whites are more likely to drink alcohol than African Americans Level of education Example: College graduates are less likely to smoke tobacco than high school graduates Personality variables Example: “Impulsive” individuals may use drugs at a higher rate Genetics Example: Genetics may play a role in who will develop a substance use disorder Antecedents of Drug Use What are antecedents? Factors that precede an event, such as the initiation of drug use Antecedents are not necessarily causes of drug use Examples of antecedents to drug use Aggressiveness Conduct problems Poor academic performance Attachment to a drug-using peer group Parental and community norms that support drug use Gateway Substances What is a “Gateway Substance”? One of the first drugs used by a typical drug user Alcohol and tobacco are sometimes considered gateway drugs. Gateway substances are not necessarily the cause of future drug use Gateway substances are perhaps best conceptualized as early indicators of a basic pattern of deviant behavior resulting from a variety of risk factors Motives for Drug Use Multiple factors influence the initiation of drug use Identification with a deviant subculture Rebelliousness Fads and cultural trends Reinforcing properties of drugs Desire to experience an altered state Influences on Drug Use Chapter 2 Drug Use as a Social Problem McGraw-Hill © 2013 McGraw-Hill Companies. All Rights Reserved. T wo Categories of Problems Problems related to taking the drug risk of developing drug dependence risk of overdose Problems related to drug use as deviant behavior arrests, fines, jailing expenses associated with drug prevention and treatment Changes in U.S. Drug Laws U.S. changed from a laissez-faire attitude (1800s) to one of tight drug restrictions Why? Three main concerns Toxicity dangerous chemicals? Dependence habit-forming compounds? Crime drug users become dangerous? 2-3 Drug-Related T oxicity To poisonous, deadly, or dangerous Physiological versus Behavioral toxicity Acute versus Chronic toxicity Physiological T oxicity Acute Heroin overdose (the user stops breathing) Chronic Heart disease Lung cancer Cirrhosis Chronic physiological toxicity (cirrhosis) 2-5 Behavioral T oxicity Acute “Drunk driving” Intoxication that dangerously impairs behavioral functioning Chronic Deleterious lifestyle changes Strain on interpersonal relationships 2-6 Drug Abuse Warning Network A system for collecting data on drug-related emergency room visits and deaths Data collected at some U.S. metropolitan hospitals DAWN collects data on: Illicit drugs Misuse of legal prescription and OTC drugs Does not determine whether drugs caused the death or ER visit 2-7 DAWN T oxicity Data ER Visits Deaths 1. Alcohol-in-combination 1. Prescription Opioids 2. Cocaine 2. Alcohol-in-combination 3. Prescription Opioids 3. Benzodiazepines 4. Marijuana 4. Cocaine 5. Benzodiazepines 5. Methadone 2-8 Drug Abuse Warning Network Does DAWN tell us how dangerous a drug is? Data are simply number of mentions in total ER visits/deaths What DAWN does not tell us: Relative danger of a drug How many problems as a proportion of total drug users? Cause of ER visit or death Drugs are mentioned in every case regardless of the cause of the accident 2-9 Blood-Borne Diseases Specific toxicity for users who inject drugs Not due to the action of drug itself Sharing needles passes infectious agents directly into bloodstream AIDS, HIV infection, and hepatitis B and C Syringe exchange programs Example of harm reduction Funded by some local governments Lowers rate of infection 2-10 Problematic Drug Use What is the definition of “addiction”? Often difficult to define Does it matter: What drug is ingested? How much time is spent on drug-taking? How much drug is ingested? When does drug use go from “recreational” to “problematic”? 2-11 Substance Dependence Three basic processes that may occur with repeated drug use Tolerance Physical dependence Psychological dependence These processes can be defined and studied by researchers interested in understanding drug dependence 2-12 T olerance Diminished effect of the drug after repeated use Individual may need to use more of the drug to experience the desired effects The body develops ways to compensate for the chemical imbalance caused by the drug Physical Dependence Physical dependence is defined by the occurrence of a withdrawal syndrome If drug use is stopped suddenly, withdrawal symptoms occur, ranging from mild to severe Tolerance typically precedes physical dependence Physical dependence means the body has adapted to the presence of the drug Psychological Dependence Often characterized by: High frequency of drug use Craving for the drug Tendency to relapse after stopping use Behavioral psychology contextualizes psychological (or behavioral) dependence as: Drug-taking is reinforced by consequences (the drug effects) Research evidence: Laboratory animals will lever-press for injections of many drugs of abuse 2-15 Changing Views of Dependence Early medical models (before 1960) True addiction involves physical dependence Key is treatment of withdrawal symptoms But what about drugs with no clear withdrawal symptoms? Positive reinforcement model (1960s) Drugs can reinforce behavior without physical dependence Psychological dependence – based on reinforcement – is increasingly viewed as the driving force behind repeated drug use 2-16 DSM-IV-TR: Substance Use Disorders Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) Developed by the American Psychiatric Association Provides diagnostic criteria and definitions for multiple disorders Focuses on complex behavioral definitions DSM-IV-TR substance use disorders: Substance Abuse Substance Dependence 2-17 DSM-IV-TR: Substance Abuse A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by one or more of the following occurring at any time in the same 12-month period: 1. Recurrent substance use resulting in failure to fulfill major role obligations at work, school, or home 2. Recurrent substance use in situations in which it is physically hazardous 3. Recurrent substance-related legal problems 4. Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance 2-18 DSM-IV-TR: Substance Dependence A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring at any time in the same 12-month period: 1. Tolerance 2. Withdrawal 3. Substance often taken in larger amounts or over a period longer than intended 4. Persistent desire or unsuccessful efforts to cut down or control substance use 5. A great deal of time is spent in obtaining the substance 6. Important social, occupational, or recreational activities are given up or reduced because of substance use 7. Substance use continues despite knowledge of having a persistentor recurrent problem that is caused or exacerbated by the substance Note that Tolerance and Withdrawal do not have to be present for this diagnosis 2-19 Is Dependence Caused by the Substance? Some drugs are more likely than others to lead to dependence Heroin or crack cocaine for example But method of use – or route of administration – as well as other factors influence risk of dependence 2-20 Is Dependence Biological? Is dependence due to definable biochemical or physiological actions in the brain? Many studies investigating genetic, physiological, and/or biochemical markers: Data suggest physiological consequences of drug taking But not yet useful for determining thecauses of dependence Is there an Addictive Personality? No way to know if the drug or the drug use changes an individual’s personality Many other factors affect personality Sensation-seeking A personality characteristic statistically associated with early substance use and abuse 2-22 Is Dependence a Family Disorder? Alcohol dependence often exists within the framework of a dysfunctional family Evidence suggests that dysfunctional relationships play a role in dependence But there are several factors contributing to dependence Is Dependence a Disease? Founders of AA characterized alcohol dependence as a disease Others argue that dependence doesn’t have all the characteristics of a disease There are no tests to reveal the underlying cause Better to think of “disease” as an analogy for dependence? Biopsychosocial perspective: Dependence is related to dysfunctions of biology, personality, social interactions 2-24 Does Drug Use Cause Crime? Issue 1: Drug use may change a person’s personality Little empirical evidence to support this Indicators of criminal or antisocial behavior precede drug use Issue 2: People under the influence may commit crimes Little evidence that illicit drugscause criminal behavior Many studies link alcohol to violent crime 2-25 Does Drug Use Cause Crime? Issue 3: Crimes may be carried out to obtain money for drugs Issue 4: Drug use itself is a crime Why We Try to Regulate Drugs Legitimate social purpose We want to protect society from the dangers of some types of drug use However, some laws are not developed as part of a rationally devised plan may not be realistic or effective 2-27 Chapter 4 The Nervous System McGraw-Hill © 2013 McGraw-Hill Companies. All Rights Reserved. Homeostasis Humans maintain their internal environment within certain limits Examples: body temperature, water content, glucose concentrations, etc Psychoactive drugs influence homeostasis Alcohol inhibits vasopressin release (antidiuretic hormone) Thus, after a drink more urine is produced Compared to light drinkers, heavy drinkers produce less urine after a drink During alcohol withdrawal, heavy drinkers exhibit increased vasopressin release 4-2 Components of the Nervous System Two major types of cells in the nervous system Neurons (or nerve cells) Glia (or glial cells) Neurons Major function: primary elements of the nervous system that analyze and transmit information Four defined regions: Cell body Contains the nucleus and other sustaining substances Dendrites Contains receptors which respond to chemical signals Psychoactive drugs activate or inhibit neuron based on type of receptor Axon Conducts the action potential Axon terminals Contains synaptic vesicles which store neurotransmitters 4-4 Neuron Schematic Glia Major functions: Provide firmness and structure to the brain Get nutrients into the system Eliminate waste Form myelin Communicate with other glia & neurons Glia also create the blood-brain barrier Protects the brain from toxic chemicals Psychoactive drug molecules must be able to pass the barrier 4-6 Neurotransmission Action potential a brief electrical signal transmitted along the axon Brief chain of events: 1. Resting potential is caused by uneven distribution of ions The neuron is hyperpolarized 2. Ion channels open allowing electrically charged particles to move inside the cell As a result, the neuron may become depolarized “all-or-none” action potential occurs Note: Blocking ion channels prevents the action potential and disrupts neuronal communication 3. Neurotransmitters are released 4-7 The Nervous System(s) Somatic nervous system Sensory information into the CNS Motor information back out Voluntary actions Autonomic nervous system (ANS) Sympathetic branch Parasympathetic branch Involuntary functions of the body Central nervous system (CNS) Brain Spinal cord 4-8 Somatic Nervous System Controls voluntary actions Carries sensory information into the central nervous system Carries motor (movement) information back out to the peripheral nerves Acetylcholine is the neurotransmitter at neuromuscular junctions Autonomic Nervous System Monitors and controls the body’s internal environment and involuntary functions Examples: heart rate and blood pressure Many psychoactive drugs affect the brain and the autonomic nervous system Two branches often act in opposition Sympathetic branch Example: norepinephrine is involved in increased heart rate “Fight or flight” Parasympathetic branch Example: acetylcholine is involved in decreased heart rate 4-10 Central Nervous System Consists of the brain and the spinal cord Has many functions: Integration of information Learning and memory Coordination of activity 4-11 Chemical Pathways in the Brain Dopamine Mesolimbic dopamine pathway From the ventral tegmental area to the nucleus accumbens Proposed to mediate some psychotic behavior Possible component of the “rewarding” properties of drugs Nigrostriatal dopamine pathway From the substantia nigra to the striatum Substantial cell loss leads to Parkinson’s Disease 4-12 Dopamine Pathways Chemical Pathways in the Brain Norepinephrine Multiple pathways: Arising from the locus ceruleus in the brain stem and projecting to multiple brain areas Regulates level of arousal and attentiveness Plays a role in initiation of food intake (appetite) 4-14 Chemical Pathways in the Brain Serotonin Multiple pathways: Arising from the brain stem raphe nuclei and projecting to multiple brain areas May have a role in impulsivity, aggression, depression, control of food and alcohol intake Hallucinogenic drugs influence serotonin pathways Example: LSD 4-15 Chemical Pathways in the Brain Acetylcholine Arising from nucleus basalis and projecting widely throughout the cerebral cortex Involved in Alzheimer’s disease and learning and memory Endorphins Found throughout the brain Naturally occurring opioid-like chemicals Play a role in pain relief and other functions 4-16 Chemical Pathways in the Brain GABA (Gamma-amino butyric acid) Found in most regions of the brain Inhibitory neurotransmitter Glutamate Found in most regions of the brain Excitatory neurotransmitter 4-17 Common Neurotransmitters Neurotransmitter Type of effect CNS changes Drugs of abuse dopamine inhibitory- euphoria amphetamines excitatory agitation cocaine paranoia GABA inhibitory sedation alcohol relaxation barbiturates drowsiness depression serotonin excitatory- sleep LSD inhibitory relaxation sedation acetylcholine excitatory- mild euphoria nicotine inhibitory excitation insomnia endorphins inhibitory mild euphoria opioids block pain slow respiration 4-18 Major Brain Structures Life Cycle of a Neurotransmitter 1. Neurotransmitter precursors are found circulating in the blood supply 2. Uptake: Selected precursors are taken up by cells Life Cycle of a Neurotransmitter 3. Synthesis: Precursors are synthesized into neurotransmitters through the action of enzymes Schematic representation of the action of a synthetic enzyme. 4-21 Synthesis Life Cycle of a Neurotransmitter 4. Storage: Neurotransmitters are stored in small vesicles 5. Release: When the action potential arrives, neurotransmitters are released into the synapse 6. Binding: Released neurotransmitters bind with receptors on the membrane of the postsynaptic neuron Neurotransmitters may have excitatory or inhibitory effects 4-23 Life Cycle of a Neurotransmitter 7. Metabolism: Once a signal has been sent, neurotransmitters are removed from the synapse; may return or be metabolized Schematic representation of the action of a metabolic enzyme. 4-24 Examples of Drug Actions Alter neurotransmitter availability in the synapse Through actions on: synthesis, storage, release, uptake, metabolism Example: Many antidepressants block the reuptake of dopamine, serotonin and/or norepinephrine Direct action on the receptor Drug as agonist Mimic neurotransmitters by activating the receptor Drug as antagonist Occupy neurotransmitter and prevent receptor activation 4-25 Chemical Theories of Behavior Many attempts to explain normal variations in behavior in terms of changes in brain chemistry Historical precedents Greek physician Hippocrates and the four humors Chinese philosophy—yin and yang Chemical Theories of Behavior Monoamine theory of mood Dopamine, serotonin, noreprinephrine Too little activity in monoamine systems can cause depression Too much can cause mania No single biochemical theory of mood or drug dependence has achieved sufficient experimental support 4-27 Brain Imaging T echniques: PET Positron Emission Tomography Benefit Direct measure of brain activity Limitations Injection of radioactive materials No information about brain structure 4-28 Brain Imaging T echniques: fMRI Functional Magnetic Resonance Imaging Benefits Real-time changes in brain blood flow Non-invasive Limitation No information about brain anatomy
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