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PSY 320 - Ch 6 - Stimulants

by: Elliana

PSY 320 - Ch 6 - Stimulants PSY 320

Marketplace > University of Miami > Psychlogy > PSY 320 > PSY 320 Ch 6 Stimulants
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Combined lecture & textbook notes
Drugs & Behavior
Dr. Marc Gellman
Class Notes
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This 9 page Class Notes was uploaded by Elliana on Wednesday March 9, 2016. The Class Notes belongs to PSY 320 at University of Miami taught by Dr. Marc Gellman in Spring 2015. Since its upload, it has received 27 views. For similar materials see Drugs & Behavior in Psychlogy at University of Miami.


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Date Created: 03/09/16
PSY 320 Drugs & Behavior Chapter 6 CNS Stimulants Overview • S▯mulants - Substances that keep a person "going" mentally & physically • Cocaine & amphetamine restricted s▯mulants: ◦ Originate from plants ◦ More similar than different ◦ Alike in subjec▯ve effects, toxici▯es, pa▯erns of abuse, tolerance, & dependence • Produce heightened awareness • Decrease sleep & appe▯te • Increase motor ac▯vity • High intake = psychosis ◦ Important difference in oral availability & dura▯on of ac▯on • Amphetamines orally swallowed & last longer History Cocaine • Coca: bush primarily growing in the Andes ◦ Harvested for thousands of years ◦ Ac▯vely cul▯vated for over 800 years • Na▯ve workers chew leaves for a boost the same way we drink coffee for s▯mula▯on ◦ Important part of the Inca culture se i no me r ec suo i g i l e r n i de ◦s U ◦ Used as currency • Colonizing/se▯ling Spaniards: ◦ Disgusted by chewing prac▯ce ◦ Tried to take it away ◦ Realized it was the backbone of the economy & labor ◦ Let workers keep chewing it to maintain produc▯on & mining of gold, etc. • 1800s scien▯sts started to study plant & medicinal effects ◦ Put extracts into products like patent medicines, teas, coca cola, lozenges, wine, etc. ◦ Coca Wine • Angelo Mariani • French chemist, developed wine w/ coca leaf extract • Indirectly introduced coca leaf to the general public ◦ Con▯nues to serve as an important medica▯on • Schedule 2 substance b/c it has medicinal use • 1860 Anesthe▯c use discovered by den▯st Dr. W. S. Halsted ▪ Not used medically un▯l 1884 ▪ Used as local anesthesia (injected into gums) ▪ 1905 Novocain - Synthe▯c drug modeled a▯er cocaine w/ similar proper▯es • Cheaper to manufacture, doesn't come from plant, easier to control, doesn't produce "high" ▪ Synthesized drugs have largely replaced cocaine for medical use 1 PSY 320 Drugs & Behavior ◦ Very popular drug in late 1800s • Sherlock Holmes stories highlighted posi▯ve & nega▯ve psychological effects • Early psychiatric use by Freud ◦ Used cocaine as treatment for depression & morphine dependence ◦ Wrote extensively about studies on use ◦ Later in career opposed use a▯er nursing a friend thru cocaine psychosis • 1980s used frequently by athletes • Legal controls on cocaine: ◦ 1887 - 1914 46 states passed laws regula▯ng use/distribu▯on ◦ Use increased at end of 1960s ◦ 1914 Harrison Act • Taxed importa▯on/sale of coca & opium ◦ Rela▯vely expensive, use associated w/ status, wealth, & fame ◦ Supply was in such surplus manufacturers didn't know what to do w/ it • 1986 An▯-Drug Abuse Act ◦ Powder cocaine is more expensive & consumed typically by white upper class ◦ Crack cocaine is sold at cheaper prices & reaches lower income popula▯ons including oppressed African American neighborhoods ◦ Law targeted crack cocaine dealers & manufacturers (lower class, less wealthy) ◦ 100:1 quan▯ty ra▯o btwn amounts of powder & crack cocaine needed to trigger mandatory minimum trafficking sentences • Basically punishes crack dealers/users but not coke users/dealers ◦ Law revised 2 yrs later to apply to possession of just 5 grams of crack ◦ Basically punishes primarily lower income popula▯ons & doesn't really address use of coke by wealthy popula▯on ◦ Ra▯o reduced to 18:1 in 2010 Amphetamines • Chinese used medicinal tea made from ephedra/Ma Huang herb ◦ Ac▯ve ingredient = ephedrine (sympathomime▯c drug used in trea▯ng asthma) • Ephedrine is a sympathomime▯c drug ◦ S▯mulates sympathe▯c branch of autonomic nervous system • Amphetamine ◦ New synthesized chemical similar to ephedrine 2391 n i de t ne t◦a P • Amphetamine used medically: ◦ Asthma - dilator of nasal & bronchial passages ◦ Narcolepsy - disorder where brain is over-excited & prepares itself to fall asleep/shut down ◦ Hyperac▯vity in children ◦ Appe▯te suppressant ◦ S▯mulant • History: ◦ Use by soldiers in WW2 to fight fa▯gue • Addic▯on remained when they came home ◦ 1920s & 30s: Amphetamines (cocaine) + heroin injected together = speedball s06 ◦ 1 2 PSY 320 Drugs & Behavior • Most street amphetamines came from prescrip▯ons • "Speed scene" = a ▯me & place in which ppl used & became dependent on intravenous amphetamine • Liquid methamphetamines formerly used as s▯mulant treatment for ge▯ng pa▯ents who Oded on sleeping pills to breathe again ◦ Amphetamines became more ▯ghtly controlled • 1970s restric▯ons passed to limit manufacture • Many look-alikes appeared • Some users switched back to cocaine • Illicit manufacture of methamphetamine grew Marke▯ng Crack • Inexpensive form of smokable cocaine became available 01$ - ◦5 $ ◦ Gets you high much faster ◦ Much higher poten▯al for abuse • Legal controls ◦ Media & poli▯cians focused on crack use among urban black ppl • Associated w/ violence & dependency • Coke & Marijuana: ◦ Reagan presidency & Bush vice presidency • Focused on limi▯ng/control influx of marijuana by smugglers • Smugglers shi▯ed to impor▯ng cocaine ▪ Government indirectly contributed to growth of cocaine importa▯on & cheaper forms like crack ◦ An▯-drug abuse acts of 1986 & 1988 • Penal▯es for sale of crack cocaine significantly more severe than penal▯es for pwder cocaine • Tougher penal▯es for first ▯me users of crack • Dispropor▯onately affects black community Amphetamines • Limited amphetamine availability increased # of illicit laboratories making methamphetamine • Manufacture of meth is dangerous & associated w/ toxic fumes & residue ◦ Ice or crystal meth ◦ Smokable • Abuse began in western US & now spread east • Now considered a club drug • Abuse mainly remains concentrated in mid-west US • Beneficial uses: ◦ Weight control • Widely used to reduce food intake & body weight • Effect real, but small • Combina▯on of fenfluramine & phentermine associated w/ heart valve damage & lung disease in some individuals ◦ Narcolepsy • S▯mulants keep pa▯ents awake during day • Newer drug modafinil (Provigil) promotes wakefulness 3 PSY 320 Drugs & Behavior • Increases ac▯vity of norepinephrine & dopamine • Low abuse poten▯al • Doesn't induce tolerance ◦ ADHD • S▯mulant medica▯ons can reverse catecholamine-associated deficits underlying ADHD • Side effects & concerns lead to use of other treatments for ADHD being studied • Longitudinal studies suggest majority of children/adolescents w/ ADHD display symptoms into adulthood • Manifesta▯on of symptoms change over ▯me ◦ Treatment op▯ons in ADHD: • Psychoeduca▯on for pa▯ent & family members ▪ Support groups ▪ Coaching • Behavioral ▪ Psychotherapy ▪ Cogni▯ve behavioral therapy • Pharmacologic ▪ Pharmacotherapeu▯c interven▯ons ▪ S▯mulants ▪ Non-s▯mulants ▪ Treatment typically requires mul▯modal approach tailored to meet needs of the individual ◦ Some▯mes used as adjunc▯ve therapy for depression ◦ An▯depressant effects work within days Names & Forms/Manufacture Forms of Cocaine • Leaves ◦ Slow absorp▯on ◦ Slow onset of effects ◦ 45-60 min un▯l feeling effects • Coca Paste ◦ Crude extract created during manufacture of cocaine ◦ Coca leaves mixed w/ organic solvent (kerosene or gasoline) ◦ Soaked/mixed/mashed & then excess liquid filtered out to form coca paste deko ms y l no m◦o C • Rapid & brief effects (peak 1.5 min) • Cocaine Hydrochloride ◦ Most common form ◦ Stable water-soluble salt ◦ Typically intra-nasal use • Snor▯ng • Rapid absorp▯on • Up to 15 min un▯l onset of effects ◦ Can be injected • Rapid & brief effects (peak 3 min) 4 PSY 320 Drugs & Behavior ◦ Can be used topically (rubbing on gums, numbing effect) • Freebase/Crack Rock ◦ Lumps of dried smokable cocaine ◦ Produced by mixing cocaine w/ baking soda & water Amphetamines • Methylphenidate (Ritalin) ◦ One of the oldest of the s▯mulant medica▯ons used in the treatment of a▯en▯on & concentra▯on problems ◦ Generally well tolerated & works well to increase concentra▯on & a▯en▯on while decreasing hyperac▯vity ◦ Works about 80% of the ▯me to reduce up to 80% of the symptoms a person is experiencing ◦ Side effects: • Decreased appe▯te, decrease/disturbance of sleep, some▯mes headaches & gastrointes▯nal pains • At ▯mes motor or vocal ▯cs emerge • Problems w/ mood instability & irritability • Overdose: psycho▯c symptoms or delirium ◦ Problems can also arise from short half-life • Crystal Meth ◦ Made from household products ◦ OTC medica▯on pseudoephedrine mixed w/ iodine, phosphorus, organic solvents, drano, paint thinner, an▯freeze, etc. • Mixed amphetamine salts ◦ Available for many years in treatment of a▯en▯on & concentra▯on for many years ◦ Currently available of Adderall & AdderallXR Mechanism of Ac▯on Cocaine • Binds differen▯ally to dopamine, serotonin, & norepinephrine proteins • Binds to DAT1 transporter, inhibi▯ng reuptake w/ more efficacy than methamphetamines ◦ Directly prevents re-uptake of dopamine, serotonin, & norepinephrine into pre-synap▯c neurons • Inhibi▯on of re-uptake subsequently elevates synap▯c concentra▯ons of each of these neurotransmi▯ers ◦ Prolongs effects of these neurotransmi▯ers ◦ Also produces number of indirect ac▯ons • Alter other neuromodulatory systems • Opiodergic, glutamatergic, GABAergic systems • **Behavioral effects based upon interac▯on of mul▯ple neurotransmi▯ers ◦ Some may be allergic & die on first-▯me use ◦ In consump▯on w/ alcohol, combine in the liver to form cocaethylene - more euphorigenic & higher CV toxicity • Absorp▯on: ◦ Chewing/sucking leaves - slow absorp▯on thru mucous membranes ◦ Snor▯ng powder - rapid absorp▯on into the brain ◦ Intravenous injec▯on - rapid/brief onset, high concentra▯on in the brain 5 PSY 320 Drugs & Behavior ◦ Smoking crack - equally fast onset of effects • Ac▯on: ◦ Cocaine molecules metabolized by enzymes in blood & liver • Elimina▯on: ◦ Metabolized by enzymes in the blood & liver ◦ Half-life of ~an hour • Considerable variability depending on method of administra▯on Amphetamines • Chemical structure similar to catecholamine neurotransmi▯ers ◦ Less than 15% of users become addicted • Structure allows it to more easily cross blood-brain barrier ◦ Structurally similar to molecules of dopamine & norepinephrine (catecholamine neurotransmi▯ers) ◦ Ephedrine & PPA less able to cross barrier & produce more peripheral than central nervous system effects • Causes increased ac▯vity of monoamine neurotransmi▯ers (dopamine, norepinephrine, serotonin) by s▯mula▯ng their release • Amphetamines cause an increase in synap▯c dopamine levels thru 2 mechanisms: 1. Amphetamines expel dopamine from the neuron thru dopamine membrane transporters • S▯mulate release • Cause a reversal in the direc▯on of the dopamine transporter 2. @ high doses amphetamines prevent dopamine storage • Enter dopamine storage vesicles thru vesicular transporter & displace dopamine from the vesicle • S▯mula▯on of dopamine pathways create euphoria & increase motor ac▯vity • Increased doses produce repe▯▯ve movements that could lead to psycho▯c reac▯ons • Absorp▯on: ◦ Consumed orally, intranasally, intravenously, & thru smoking ◦ Peak effects: • 1.5 hours a▯er oral inges▯on • 15-30 minutes a▯er intranasal administra▯on • 5-10 minutes following injec▯on, intranasal, or smoking • Half-life: ◦ 10-12 hrs for amphetamine ◦ 4-5 hrs for methamphetamine • Rapid tolerance (tachyphylaxis) can occur a▯er high doses Harms Cocaine • Acute cocaine toxicity causes profound CNS s▯mula▯on ◦ Can lead to convulsions, respiratory or cardiac arrest • Significant individual varia▯on in the uptake & metabolism of cocaine ◦ Difficult to es▯mate size of a lethal dose • Rare, severe, unpredictable reac▯ons can cause cardiac failure se i g r e l◦l A • Risks of regularly snor▯ng: 6 PSY 320 Drugs & Behavior ◦ Damage to nasal septum • Suscep▯bility to infec▯on • May erode a hole btwn septal passages ◦ Paranoid psychosis • O▯en results from not sleeping • Irritability, restlessness, paranoia ◦ Damage to heart muscle • Reproduc▯ve effects: ◦ Suppresses appe▯te, will effect nutri▯on of mother & baby • Infant will not develop properly ◦ Increased risk of miscarriage & torn placenta • "Crack Baby" phenomenon ◦ Babies born w/ severe developmental abnormali▯es ◦ More due to insufficiency of nutri▯on than direct contact w/ cocaine ◦ Studies: • Longitudinal study following "crack babies" & re-assessing them every 5 years • Individuals/adults 30 years later seem to have "caught up" • Now func▯on more or less typically • Cocaine & alcohol ◦ Combina▯on in the body forms cocaethylene ◦ Shown to be more toxic than cocaine in mice ◦ Tho less potent than cocaine in humans Crystal Meth • Ini▯al effects pleasurable to many users ◦ Euphoria, confidence, wakefulness • Ini▯al high bloods brain w/ dopamine, feels very pleasurable, use con▯nues despite severity of nega▯ve consequences • Nega▯ve effects include: s sens se l pee l s f o sdo i r ep dedne t◦x E ◦ Paranoia, anxiety, agita▯on ◦ Violent mood swings ◦ Increased HR & BP • Acute toxicity: ◦ Increases in feelings of power, suspicion, paranoia ◦ Poten▯al risk of violent behavior • Very high doses may destroy catecholamine neurons • Contaminants formed during manufacture of illicit methamphetamine may have toxic effects on brain cells • Under study: Risk of developing movement disorders like Parkinson's disease • High dose use: ◦ Higher risk among those who inject ◦ Compulsive & repe▯▯ve stereotyped ac▯ons • I.E. Spending a night coun▯ng corn flakes • Chronic toxicity: ◦ Development of paranoid psychosis Dependence & Treatment 7 PSY 320 Drugs & Behavior Cocaine Chronic toxicity/Dependence • Animal & human studies show it is a powerfully reinforcing drug ◦ Animals will readily self-administer the drug by lever-pressing • A▯er binge use, many experience withdrawal symptoms: ◦ Craving, irritability, anxiety, depressed mood, increased appe▯te, fa▯gue 3 main withdrawal stages: 1. Crash ◦ Ini▯al abs▯nence a▯er binge consis▯ng of depression, agita▯on, suicidal thoughts, fa▯gue 2. Withdrawal ◦ Mood swings, craving, anhedonia, obsession w/ drug-seeking .xEn ◦ Normal pleasure returns, cues trigger craving & mood swings Treatment • Medica▯ons ◦ Beta-andrenergic blocking drugs for irregular heart rate & blood pressure gurd c▯o hc y sp - ▯ ◦ A halperidol controls psycho▯c symptoms ◦ An▯-depressant drug despramine helps promote abs▯nence • Behavioral Approaches ◦ Con▯ngency approaches ◦ Relapse preven▯on ◦ Group support Amphetamines • Dependence ◦ O▯en no obvious withdrawal symptoms ◦ Produce psychological dependence ◦ Capable of producing dependence as defined by DSM criteria ◦ Potent reinforcer Current Use & Future Trends • Surveys indicate ~ 1% of adults currently use cocaine (2012 data) ◦ Down from peak of 12% in the 1980s • Usage rates of cocaine & amphetamine tend to cycle in opposi▯on to each other ◦ When cocaine use decreases, amphetamine use may increase • Len Bias ◦ 22 y/old college basketball player ◦ Dra▯ed to the NBA ◦ Died from trying coke his first ▯me, probably had allergies ◦ Followed 8 days later by coke-related death of Cleveland Browns player Don Rogers Amphetamines • Nonmedical use popular on college campuses • Prevalence rates among college students range 5.3% to 34% • For purposes other than described: ◦ Diversion, recrea▯onal use, illicit use, misuse, abuse • Growing problem on college campuses • Main mo▯va▯ng reasons for misusing prescrip▯on s▯mulants: 8 PSY 320 Drugs & Behavior ◦ Improve academic performance ◦ Help w/ concentra▯on & focusing ◦ Improve test performance ◦ Recrea▯onal purposes 9


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