Module 2 - Chapters 3 and 4
Module 2 - Chapters 3 and 4 CCJ3653
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Chapter3-TheHistoryofDrugUseandDrug-Control Policy Monday, September 5, 2011:54 PM • Attitudes toward certain drugs and certain forms of drug-taking behavior have fluctuated between enthusiastic acceptance and passionate rejection • Has periods of approval and periods of disapproval • American drug-control policy also has had its own historical swings, with policies themselves not always being founded on rational decision making and empirical data ○ Based on fear, hysteria, politics, ethnic prejudice and racism ○ Instigated by attitudes toward a specific minority group associated with the drug ○ Order to arrive at the best strategies for dealing with present-day drug use and abuse DrugsinEarlyTimes Monday, September 5, 2016 2:07 PM • Entirely possible that our curiosity was inspired by observing the unusual behavior as they fed on these plants • Shamanism: the philosophy and practice of healing in which the diagnosis or treatment is based on trancelike states, on the part of either the healer (shaman) or the patient • Shaman: a healer whose diagnosis or treatment of patients is based at least in part of trances, which are induced by hallucinogenic drugs • Gradually declined ○ Passed into the hands of priesthood, which placed a greater emphasis on formal rituals and rules than on hallucinations and trances • Ebers Papyrus: an Egyptian document, dated approximately 1500 B.C., containing more than 800 prescriptions for common ailments and diseases ○ Including simple wasp sting and crocodile bites, baldness, constipation, headaches, enlarged prostate glands, sweaty feet, arthritis, inflammation of all types, heart disease and cancer ○ Most included castors oil and natural laxatives ○ Some included "berry of the poppy" (which is known to be opium) ○ Bizarre ingredients included: lizard's blood, the teeth of swine, oil of worms, the hoof of an ass, putrid meat with fly specks and crocodile dung ○ Placebo effect: any changes in a person's condition after taking a drug, based solely on that person's beliefs about the drug rather than on any physical effects of the drug ○ Some had scientific logic that was discovered later Glands of toads contain a chemical related to DMT, a powerful hallucinogenic drug, as well as bufotemine, a drug that raises blood pressure and heart rate • Viking warriors ate the mushfrooms Amanita muscaria (known as "fly agaric") and experienced increased energy. DrugsintheNineteenthCentury Monday, September 5, 20162:53 PM • Medical profession had made significant strides with respect to medical healing • Morphine was identified as the active ingredient of opium ○ Been in use for at least 3,000 years ○ Had become the physician's most reliable prescription to control the pain of disease and injury ○ Common treatment for pain during the Civil War a during which a surgeon's skill was often measured by how quickly he could saw off a wounded patient's limb "Soldier's disease" - morphine dependence ○ Morphine dependence among women made up almost half of all cases od drug dependence in the United States • The invention of the syringe • Cocaine ○ Variety of forms ○ Original formula for Coca-Cola until 1903 ○ Selling cocaine and its botanical source, coca, in more than a dozen forms, including coca-leaf cigarettes and cigars, cocaine inhalants, a coca coordinal, and an injectable cocaine solution ○ Called the "magical drug" by Sigmund Freud Reversed his opinion when his friend became dependent • Laissez-faire: the philosophy of exerting as little governmental control and regulation as possible ○ "Allow [people] to do as they please" ○ United States was the only major Western nation that allowed the unlimited distribution, sale, and promotion of psychoactive drugs during this period ○ Did not have any agencies regulations the medical field ○ It was not difficult to call oneself a doctor and distribute drugs • States' rights • Belief in the strict separation of state and federal powers ○ Left to the state DrugRegulationintheEarlyTwentiethCentury Tuesday, September 6, 2014:38 PM • Beginning to be matched by concerns about the health risks that some of these drugs could produce • Factors that fueled the movement of drug regulation 1. Abuse of patent medicines Patent medicines: a drug or combination of drugs sold through peddlers, shops or mail-order advertisements Included ingredients such as alcohol, opium, morphine, cocaine, and marijuana 2. Association of drug use with certain minority groups • Around the turn of the 20th century were not registered with the federal government or any regulatory agency, and their formulas were usually kept secret ○ Did not have to list the ingredients ○ Advertised for mail-order purchase in newspaper and magazines or available through traveling medicine shows ○ Accidental poisoning from ingredients in these medicines became widespread • Pure Food and Drug Act of 1906: Federal legislation requiring all packaged food and drugs to list the ingredients on the label of the product ○ President Theodore Roosevelt proposed a federal law that would regulate misbranded and adulterated foods ○ First drug regulatory law in American history ○ Requirement that all packaged food and drugs list the ingredients on the label of the product ○ Require manufacturers to identify specific drugs that were contained in these patent medicines DrugRegulation,1914-1938 Tuesday, September 6, 2014:49 PM • Growing prejudice against minority groups in America that were believed to be involved in drug use • Impacted upon the eventual prohibition of opium and heroin, cocaine and marijuana, as well as the temporary prohibition of alcohol • Southern newspaper began publishing "reports" of the cocaine-induced raping of white women and demonstrations of superhuman strength ○ African Americans unaffected against .32 caliber bullets ○ Propaganda campaign was successful; southerners became more afraid of African Americans and cocaine than of an increase in federal power ○ Support for the Pure Food and Drug Act • Identification of Chinese workers with the smoking opium ○ Brought with them the habit of smoking opium ○ Many Americans believed led to prostitution, gambling, and overall moral decline ○ Hostility and violence against the Chinese became commonplace The Harrison Act of 1914 • Harrison Act of 1914: Federal legislation regulating through government taxation the importing, manufacturing, selling or dispensing cocaine or opiate drugs. The law effectively changed the status of cocaine and opiates from licit to illicit substances in the United States. ○ The United States initiated a number of international conferences in an attempt to control the worldwide production and distribution of narcotics, especially opium ○ Enormous population of opium abusers within their own country, Chinese leaders were eager to participate in such conferences ○ Designed to regulate drug abuse through government taxation ○ Basis for narcotics regulation in the United States for more than half a century Importing, manufacturing, selling or dispensing cocaine or opiate drugs to register with the Treasury ○ Department, pay a special tax, and keep records of all transactions ○ Did not make opiates and cocaine illegal • The Hague in 1912 ○ The U.S. government was attempting to establish international agreements to regulate the drug trade while at the same time having no domestic policy over drug production and distribution within its own borders • Eventually, physicians stopped issuing prescription for drugs now covered under the Harrison Act ○ Failed to reduce drug-taking behavior ○ Created a new lucrative market for organized crime that continues to the present day Alcohol in America before Prohibition • Social focus of American communities during this time was the tavern • 1830 - the average per capita intake of alcohol was an immoderate five drinks a day ○ 4 times the level of consumption today ○ "Whiskey breaks" - 11 AM and 4 PM each day • Rum was the favorite in New England, North Atlantic coast • Whiskey was the favorite of the South and West The Rise of the Temperance Movement • The goal at that time was to reduce the consumption of distilled spirits (liquor) only • Temperance movement: the social movement in the United States, beginning in the nineteenth century, that advocated the renunciation of liquor consumptions • Liquor was demonized as a direct source of evil in the world. • Consumption spread like wildfire • Temperance group ○ Took credit for a drastic change that was occurring in the levels of alcohol consumption in the United States ○ Annual per capita was roughly 7 gallons to roughly 2 gallons ○ Encouraged the temperance movement to formulate its ultimate goal: the prohibition of alcohol consumption in any form The Road to National Prohibition • Anti-alcohol groups ○ Anti-Saloon League ○ National Prohibition Party ○ • World War I proved the turning point in the path toward national prohibition TheBeginningandEndingofa"NobleExperiment" Tuesday, September 6, 2015:14 PM • Prohibition: A period between 1920 and 1933 in the United States when alcohol manufacture and sale was illegal ○ Did not forbid purchase or use of alcohol ○ Only production and distribution ○ Failed to produce an alcohol-free society and spurred numerous social problems ○ Citizens had little regard for the law and continued to consume alcohol in speakeasies Speakeasies: Business establishments that sold liquor illegally during the Prohibition era ○ Public health Alcohol-related deaths, cirrhosis of the liver, mental disorders, and alcohol-related crime declined • Volstead Act of 1919: Federal legislation establishing the enforcement of the Eighteenth Amendment (Prohibition) of the U.S. Constitution ○ Mechanism for federal enforcement by creating a Prohibition Bureau under control of the Treasure Department Federal agents in the Prohibition Bureau soon developed a reputation as being inept and corrupt Agents frequently left law enforcement to embark upon their own criminal enterprises Eliot Ness □ "The Untouchables" □ Reputation for honesty and refusal to take bribed □ Able to arrest, prosecute, and eventually convict Al Capone • "Roaring Twenties" ○ Most lawless periods in American history ○ By the time that Prohibition ended, nearly 800 gangsters in the city of Chicago alone had been killed in bootleg-related battles • End of the decade ○ Beginning to put pressure on political leaders to reconsider the concept of alcohol prohibition ○ Need to restore the federal revenue dollars from taxes on alcohol, in order to help finance Depression-era programs • Twenty-first Amendment ○ Alcohol was restored as a legal commodity Marijuana and the Marijuana Tax Act of 1937 • The drug was linked to a minority group - namely, migrant Mexican workers. • Some of the Mexican workers would smoke marijuana as a drug of entertainment and relaxation • Goal was to "Keep America American" • Newspaper stories began to circulate telling of how marijuana made users become sexually excited and violently insane ○ Reefer Madness ○ Tales of murder, insanity and sexual promiscuity Federal Bureau of Narcotics (FBN) • ○ Harry J. Anslinger ○ Way to gain national attention and extend the power of FBN • Marijuana Tax of 1937: Federal legislation regulation through government taxation the manufacture and sale of marijuana. The law effectively changed the status of marijuana from a licit to an illicit substance in the United States ○ Had to pay a tax of as much as $100 per ounce for a transfer tax stamp • 1937 - Made marijuana illegal The Federal Food, Drug, and Cosmetic Act of 1938 • commercially marketed drug have been determined to be safe when used asring that directed. The law also established the U.S. Food and Drug Administration (FDA) as the enforcement agency for regulating the safety and later, through further legislation, the effectiveness of commercially marketed drugs ○ Manufacturers were required to demonstrate through research studies that their produces were safe • Drug, and Cosmetic Act to include a requirement that commercially marketed drugsd, are effective as well as safe. DrugsandSocietyfrom1945to1960 Tuesday, September 6, 2015:42 PM • Smoking was considered romantic and sexy • Little or no public awareness that alcohol to tobacco consumption could be considered drug-taking behavior • Perception of certain drugs such as heroin, marijuana, and cocaine was simple and negative ○ Bad and illegal ○ "No one you knew" had anything to do with them • A whole class of drugs and drug-taking behavior was outside the mainstream of American life ○ An atmosphere of fear and suspicious surrounded people who took such drugs • Drug abuse now became the un-American, and Congress became convinced that penalties for illicit drug use were too lenient • Minimum sentence of tow years imprisonment for first-time offenders ○ 10 years for repeat offenders Turbulence,Treatment,andtheWaronDrugs,1960-1980 Tuesday, September 6, 20165:47 PM • "Baby boomers" or "hippie" • Challenging many accepted cultural norms and the established hierarchy • Searching for new answers to old problems ○ Experimentation with drugs that their parents had been taught to fear • Marijuana, as well as new drugs such as LSD and other hallucinogens, became associated with the sons and daughters of white middle-class families • Came a disturbing increase in heroin abuse across the country ○ Increased in many inner cities, and heroin abuse was later connected to a rise in the crime rate, specifically a growing number of robberies and burglaries committed by heroin abusers to get money to buy drugs • Illicit drug use became a major political issue ○ President Richard Nixon declared a "total war on drugs" ○ Comprehensive Drug Abuse Prevention and Control Act: Federal legislation establishing five categories (schedules) of controlled substances based on their approved medical uses, potential for abuse, and potential for producing dependence. The law also shifted the jurisdiction for drug-law enforcement from the Treasury Department to the Department of Justice ○ Shifted the administration of federal drug enforcement for the Treasury Department to the Department of Justice, creating the Drug Enforcement Administration (DEA) Given the control of all drug enforcement responsibilities Conduct drug investigation, collect intelligence about general trends in drug trafficking and drug production, and coordinate efforts among federal, state and local law enforcement agencies Act as liaison with foreign law enforcement agencies Nixon administration threatened to cut off aid to Turkey if that country did not put an end to the export of opium ○ Finance a number of treatment programs for drug-dependent individuals Inpatient detoxification and therapeutic communities to newly created methadone outpatient programs Methadone □ Long-lasting opiate □ Taken orally □ Prevent heroin withdrawal symptoms for up to 24 hours □ Designed to wean heroin abusers off of heroin by allowing them to have a better chance at employment □ Ending the need to commit crimes to maintain their abuse ○ 1972 - Nixon's anti-drug program appeared to be working National network of methadone treatment center and evidence of successful eradication efforts Turkey had agreed to stop growing opium, and Mexico was cooperating with U.S. law enforcement Price of heroin was up, the purity level was down, and there was a decrease in the number of drug overdose cases RenewedEffortsatControl,1980-2000 Tuesday, September 6, 2018:09 PM • The "yuppie" era ○ Young, upwardly mobile professional • Overshadowed by a new fixation: cocaine • An aura of glamor material success ○ Because it was so expensive • "Crack" cocaine ○ Smokable and cheap ○ Succeeded in extending the problems of cocaine dependence to the inner cities of the United States • Nancy Reagan launched her "Just Say No" campaign ○ Focused mostly on white middle-class children who had not yet tried drugs • Comprehensive Crime Control Act of 1984: federal legislation increasing penalties for drug possession and trafficking under the Controlled Substances Act and expanded laws regarding asset forfeiture of major drug traffickers ○ Allowing both local and federal drug enforcement agencies to keep most of the money made from the sales of seized assets • Anti-Drug Abuse Act of 1986: federal legislation establishing mandatory minimum sentences for federal drug convictions and creating special penalties for major leaders of drug trafficking organizations • Anti-Drug Abuse Act of 1988: federal legislature creating a cabinet-level "Drug Czar" position to coordinate all federal drug-control activities • penalties for methamphetamine trafficking and setting limits on the purchase of precursor materials for methamphetamine production DomesticDrugTraffickingandNationalSecurity:2001- Present Thursday, September 8, 2015:47 PM • telephone and electronic surveillance in drug-control operations, increased moneyon laundering enforcement, and expanded operations at the U.S. border ○ Directed toward not only possible acts of terrorism but also other criminal acts such as drug trafficking • USA PATRIOT Improvement and Reauthorization Act of 2005: federal legislation modifying the USA Patriot Act of 2001, so as to satisfy certain civil liberty concerns and close certain loopholes in the previous law • Combat Methamphetamine Epidemic Act: A portion of the USA PATRIOT Improvement and Reauthorization act of 2005, setting limits on the sale of over-the-counter medications typically used as precursor materials for methamphetamine production and increasing support for law enforcement agencies involved in methamphetamine control operations TheAimsofDrug-ControlPolicy:PublicHealthandPublic Safety Thursday, September 8, 20166:02 PM • Two overlapping areas of concern: ○ Public health Requires the efforts of psychiatrists, psychologists, drug-abuse counselors, and other health professionals The decision to treat an individual with a drug problem is based on behavioral criteria The diagnosis is based solely on the adverse behavioral consequences of drug use, not on the nature of the drug itself ○ Public safety Rests upon the efforts of governmental officials and professionals in the field of criminal justice Specific categories of drugs have been established under the Controlled Substance Act of 1970, based upon accepted medical benefits and their potential for abuse Regard to the degree to which public access to a specific drug should be Drugs with the fewest medical benefits and the greatest potential for abuse should be the drugs with the most stringently restricted availability to the public, as established by law The possession and trafficking of these drugs should carry the most severe criminal penalties ○ Health professionals and criminal-justice professionals coordinate their efforts as much as possible Drug-ControlPolicyToday:FiveSchedulesofControlled Substances Thursday, September 8, 206:16 PM • Each category or schedule defines a particular chemical substance in terms of its potential for medical use and its potential for abuse • abuse (Schedule I controlled substance) should be substances whose availability to the public is most stringently restricted ○ Carry the harshest criminal penalties Chapter 4 - Fundamentals of Drug-Taking Behavior Thursday, September 8, 2016:18 PM HowDrugsEntertheBody Friday, September 9, 2018:23 PM • Four principal routes: ○ Oral administration By mouth Into the bloodstream through the gastrointestinal tract Oldest and easiest way of taking a drug Provide a degree of safety □ Many naturally growing poisons taste so vile that we normally spit them out before swallowing □ Nauseous, causing the drug to be expelled through vomiting Relatively long absorption time □ Between five and 30 minutes after ingestion □ Six - eight hours □ Induce vomiting or pump the stomach Gastrointestinal tract contains a number of natural barriers that may prevent certain drugs that we want absorbed into the bloodstream from doing so □ Degree of alkalinity or acidity in the drugs Fate of a particular drug depends upon how it reacts with that environment □ Highly alkaline drugs such as morphine, heroin or cocaine □ Insulin is destroyed by stomach acid, so it cannot be administered orally Proceed from the small intestine into the bloodstream □ Two layers of fat molecules, making it necessary for substances to be lipid-soluble, or soluble in fats, to pass through □ Muss pass through the liver for another " screening" before being released into the general circulation Enzymes in the liver that destroy a drug by metabolizing its molecular structure prior to its excretion from the body □ Further barrier separating the bloodstream from brain tissue, called the blood brain barrier, which determines a drug's psychoactive effects Deliberately elevated dose levels to allow for the fact that some proportion of the drug will not make it through the bloodstream Presence or absence of undigested food and whether the undigested food interacts with the chemical nature of the drug are examples of factors that make it difficult to make exact predictions ○ Injection Hypodermic syringe and needle Intravenous: into a vein □ Faster means of injection □ Without any intermediary tissue Arrives at the brain in less than fifteen seconds Often called mainlining Effects of an intravenous administration drugs irreversible Can cause the vein to collapse or develop a blood clot Intramuscular: into a muscle □ Large muscles (upper arm, thing or buttock) □ Absorbed into the bloodstream through the capillaries serving the muscle Slower absorption times than intravenous injections Subcutaneous (s.c. or sub-Q): underneath the skin □ Needle is inserted into the tissue just underneath the skin □ Slowest absorption time of all the injection techniques □ Desirable to have a precise control over the dosage and a steady absorption into the bloodstream □ May be easily irritated □ Only relatively small amounts of a drug can be injected under the skin compared with the quantity that can be injected into a muscle or vein ○ Inhalation Inhale it in some forms of gaseous or vaporous state Alveoli within the lungs can be imagined as a huge surface area with blood vessels lying immediately behind it Psychoactive effect of an inhaled drug is even faster than a drug delivered through intravenous injection □ Five to eight seconds Burn it and breathe in the smoke-borne particles in the air Include nicotine from cigarettes, opium, tetrahydrocannabinol (THC) from marijuana, free-base cocaine, crack cocaine, and crystallized forms of methamphetamine, paint thinners, gasoline, and cocaine, crack cocaine, and crystallized forms of methamphetamine, paint thinners, gasoline, and glues General anesthesia are administered through inhalation Long-term hazards of breathing particles in the air that contain not only the active drug but also tars and other substances produced by the burning process □ Emphysema, asthma, and lung cancer Linings leading from the treat to the lungs will be severely irritated over time ○ Absorption through the skin or membrane Sniff or snort a drug in dust or powder form into the nose Intranasal: applied to the mucous membrane of the nose Snuff tobacco or chewing tobacco, and cocaine-containing coca leaves □ Chewed without swallowing over a period of time or simply placed in the inner surface of the cheek and slowly absorbed through the membranes of the mouth Sublingual: applied under the tongue □ Used for long-term administration of nitroglycerin, estrogen, motion-sickness medication, and more recently, nicotine □ Enhances the process of skin penetration include the promising technique of administering low-frequently ultrasound, which allows large molecules such as insulin to pass through the skin □ Future techniques may involve the application of ultrasound waves to increase skin permeability permeability or the combining of medication with special compounds that help the medication slip through skin pores HowDrugsExittheBody Saturday, September 10, 20112:10 PM • The most common means is through excretion in the urine • Exhaled through breath, feces, sweat, saliva or (in the case of nursing mothers) break milk • Biotransformation: process of changing the molecular structure of a drug into forms that make it easier to be excreted from the body ○ Specific enzyme in the liver ○ Metabolite: a by-product resulting from the biotransformation process ▪ Structurally modified forms of the original drug • Excreted with urine ○ Water-soluble drugs are reabsorbed into the intestines and excreted with defecation • Some drugs can pass the liver without any biotransformation ○ Like Amanita muscaria • The larger the quantity of a drug, the faster the body tries to get rid of it ○ With the exception of alcohol • Enzymes may be increased or decreased by the presence of other drugs in the body ○ Enzyme activity decreases after the age of 40 • Chemical properties ○ Fat-soluble, the rate will be slower than if the drug is water soluble ○ Elimination half-life: the length of time it takes for a drug in the bloodstream ▪ The amount of time it takes for the drug in the bloodstream to decline to 50% of its original equilibrium level ▪ Cocaine and nicotine have the half-life of only a few hours ▪ Marijuana and prescription drugs have a much longer half-lives FactorsDeterminingtheBehavioralImpactofDrugs Monday, September 12, 20161:30 PM • If a drug is administered repeatedly, the timing of the administration plays are important role in determining the final result. Timing • Latency period: an interval of time during which the effect of a drug is not observed in the blood though the drugs has been administered ○ Concentration is increasing in the blood but is not yet high enough for a drug effect to be detected ○ Related to the absorption time of the drug • When the effect attains a maximum strength, even though the concentration in the blood continues to rise ○ May produce undesirable side effects • Time-release form ○ Keep the concentration of the drug in the blood within a "therapeutic window", high enough for the drug to be effective while low enough to avoid any toxic effects Drug Interactions • Two basic types of interactions ○ Purely additive ▪ Two drugs in combination may produce an acute effect that is greater than the effect of either drug administered separately ○ Hyperadditive ▪ The combined effect exceeding the sum of the individual drugs administered alone ▪ Synergism: the property of a drug interaction in which the combination effect of two drugs exceeds the effect of either drug administered alone □ May even double or triple the effect of the other ▪ Potentiation: the property of a synergistic drug interaction in which one drug combined with another drug produces an enhanced effect when no one of the drugs alone would have had no effects □ Combined effect of the drugs is so powerful that it can become toxic ▪ Antagonistic if the acute effect of one drug is diminished to some degree when administered with another ▪ The second exactly cancels out, or neutralize, the effect of the first Tolerance Effects • Tolerance: the capacity of a drug to produce a gradually diminished physiological or psychological effect upon repeated administrations at the same dose level ○ Over repeated administration, a drug dose needs to be increased to maintain an equivalent effect • Interaction between the actual amount of the drug taken and other factors involved in the drug-taking behavior. • The setting within which the drug-taking behavior occurs • Maximized when the drug-taking behavior occurs consistently in the same surroundings or under the same set of circumstances • Behavioral tolerance: the process of drug tolerance that is linked to drug-taking behavior occurring consistently in the same surrounding or under the same circumstance. Also known as conditioned tolerance • Pavlovian conditioning upon which behavioral tolerance is based • Siegel tested two groups of rats that were administered a series of heroin injections with increasingly higher dosages ○ Environmental cues in the room where the initial injections were given elicited some form of effect opposite to the effect of the drug ○ Conditioned tolerance - based on the principles of Pavlovian conditioning ○ Explain why a formerly drug-dependent individual is strongly advised to avoid the surroundings associated with his or her past drug-taking behavior ○ With respect to heroin but with alcohol, cocaine, nicotine, and other dependence-producing drugs as well makes it imperative that the phenomenon of behavioral tolerance be considered during the course of drug-abuse treatment and rehabilitation Cross-Tolerance • You also might have developed a tolerance for another depressant drug even though you have never taken the second one the second one • Cross-tolerance: a phenomenon in which the tolerance that results from the chronic use of one drug induces a tolerance effect with regard to a second drug that has not been used before ○ Commonly observed in the physiological and psychological effect of alcohol, barbiturates, and other depressants Individual Differences • The drug itself and specific characteristics of the person taking the drug ○ An individual's weight ▪ A heavier person will require a greater amount of drug than a lighter person to receive an equivalent drug effect ▪ Metric terms, milligrams per kilogram (mg/kg) ○ Gender ▪ Differences in body composition and sex hormones ▪ Women have a higher proportion of fat, due to a great fat-to-muscle ratio, and a lower proportion of water □ Makes them feel more intoxicated than men ▪ Reduced levels of enzymes that break down alcohol in the liver, resulting in higher alcohol levels in the blood and higher level of intoxication ▪ Increased level of estrogen and progesterone in women ○ Ethnic background ▪ About 50 percent of all people of Asia descent have lower than average levels of one of the enzymes that normally breaks down alcohol in the liver shortly before it is excreted ▪ Caucasians have a faster rate of biotransformation of antipsychotic and antianxiety medications ▪ African Americans have a slower rate of nicotine metabolism following the smoking of cigarettes relative to whites. PsychologicalFactorsinDrug-TakingBehavior Monday, September 12, 20169:14 PM • Produce of three factors: 1. The drug's pharmacological properties (the biochemical nature of the substance) 2. The individual taking the drug (set) 3. The immediate environment within drug-taking behavior is occurring (setting) • Determines the final outcome Expectation Effects • Set of expectations a person may have about what the drug will do • Placebo: Latin term translated "I will please." Any inert substance that produces a psychological or physiological reaction ○ People believed that they were effective, not from any known therapeutic property of these ingredients ○ Enthusiasm or lack of enthusiasm of the prescribing physician can play a major role ○ It is not all clear how the placebo effect is accomplished ○ We have the natural ability to increase the levels of endorphins (internally produced opiates) in the bloodstream and the brain from one moment to the next ○ Placebo research forces us to acknowledge the potential for psychological control over physiological processes in our bodies Drug Research Methodology • For a drug to be deemed truly effective, it must be shown to be better not only in comparison to a no- treatment condition • Identical-looking drug that lacks the active ingredients of the drug being evaluated • Double-blind: a procedure in a drug research in which neither the individual administering nor the individual receiving a chemical substance knowns whether the substance is the drug being evaluated or an active placebo PhysicalandPsychologicalDependence Monday, September 12, 20169:29 PM Physical Dependence • Physical dependence: a model of drug dependence based on the idea that the drug abuser continues the drug-taking behavior to avoid the consequences of physical withdrawal symptoms • Heroin withdrawal symptoms: a running nose, chills and fever, inability to sleep, and hypersensitivity to pain • Barbiturate withdrawal symptoms: anxiety, inability to sleep and sometimes lethal convulsions • Chronic alcohol abusers withdrawal include tremors, nausea, weakness, and tachycardia (a fast heart rate), include delirium, seizures and hallucinations • Though the drug, previously a foreign substance, has become a normal part of the nervous system, and its removal and absence become abnormal Psychological Dependence • Avoid the feared consequences of withdrawal • May even feel that they need the drug to functional at all • Psychological dependence: a model of drug dependence based on the idea that the drug abuser is motivated by a craving for the pleasurable effects on the drug • Positive reinforcers Drug-TakingBehaviorandTreatment:TheHealth ProfessionalPerspective Monday, September 12, 2016 9:38 PM • A system of guidelines must be in place to establish an appropriate diagnosis • The goal is to reduce the incidence of drug-related problems in an individual's life through a therapeutic intervention • Substance use disorder: a diagnostic term is DSM-5 (issued in 2013) identifying an individual with varying degrees of behavioral difficulties that are related to some form of drug-taking behavior • 11 possible behavioral circumstances (or criteria) ○ Impaired control Taken in larger amounts or over a longer period of time than the individual originally intended Persistent desire to cut down or regulate substance use or there may be multiple unsuccessful attempts to cut down or discontinue substance use Great deal of time may be spend obtaining the substance, using it or recovering its effects Intense urges or craving to engage in substance use or times in which the individual cannot think of anything else ○ Social impairment Failure in fulfilling a major role obligation of work, at school, or at home as a consequence of substance use Continued despite the persistence or recurrence of social or interpersonal problems associated with use May withdraw from, reduce, or give up on important social, occupational, or recreational activities because of substance use ○ Pharmacological effects Development of tolerance to the effects of the substance being used Significant withdrawal symptoms have been documented in humans Withdrawal symptoms may be observed • Severity of substance use disorder ○ Presence of two or three criteria indicates a mild level of substance use disorder ○ Four to five criteria indicates a moderate level ○ Presence of six or more criteria indicates a severe condition ○ Four major points 1. "Substance use" 2. "Addiction" is not used in any diagnostic classification or criteria □ The word is considered to be difficult to define, and the negative connotation of the word might cause its use to be an obstacle to successful treatment 3. Substance abuse: Prior to 2013, a diagnostic term in DSM-IV-TR identifying an individual who continues to take a psychoactive drug despite the fact that the drug-taking behavior creates specific problems for that individual □ Substance dependence: Prior to 2013, a diagnostic term in DSM-IV-TR identifying an individual with significant signs of a dependent relationship upon a psychoactive drug □ Clinical treatment of drug-related problems is more easily carried out within a singular diagnosis and a scale of severity-of-symptoms □ Fulfilling six or more criteria for substance use disorder can be considered equivalent to the diagnosis of substance dependence 4. The DSM-5 establishes separate diagnoses of opioid use disorder (when heroin is involved), stimulant use disorder, hallucinogen use disorder, cannabis use disorder, or alcohol use disorder Discussion Question Tuesday, August 30, 2016 10:53 AM Discuss the problems of the globalization of drugs and trafficking. What has changed and how has this impacted the use, trafficking, and law enforcement response? Marijuana is currently listed as a Schedule I drug. Summarize what it means to be considered a Schedule I drug and determine if it should remain a Schedule I or if it should be re-categorized. Provide supporting evidence as to why it should remain a Schedule I or what category it should be moved to? Drug use, addiction and trafficking incorporates the entire world, from consumer countries like the United States who have high numbers of individuals that use the drugs to producing countries such as Mexico and Colombia in where the production heavily affects life in the country. Countries that fuel the world drug trade are often full of violence and corruption. As the demand for drugs continue to rise, the suppliers adjust their strategies to evade being caught and increase their sales. This has made the law enforcement's job extremely difficult, as their smuggling processes can be swiftly changed. Schedule I drugs are the highest category of drug under the Controlled Substance Act. These drugs have no known medical use and very high potential for abuse. Examples include heroin, LSD and Ecstasy (MDMA). One of the drugs that are located in this category is marijuana. Based on technical standards, since medical benefits have been found, it could be moved down to Schedules II. Schedule II drugs have a high tendency of being abused.