Chptr 2 Drug Use as a Social Problem

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Chapter 2Drug Use as a Social

Problem

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Costs of Drug Use to Society

Deaths Emergency room visits Drugs in the workplace and lost productivity Broken homes, illnesses, shorter lives, etc. Cost of maintaining habit Cost of criminal behavior Cost of treating patients Fetal alcohol syndrome Others?

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Changing Attitudes

What made the government change from the laissez-faire attitude of the 1800s to one of control? Toxicity Dependence Crime

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Toxicity

Toxic = poisonous, deadly, or dangerous

What makes a drug toxic? Amount used

How it is used

What the user did while on the drug

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Toxicity

Physiological toxicity vs. behavioral toxicity Acute effects vs. chronic effects

Acute behavioral toxicity (drunk driving) Chronic physiological toxicity (cirrhosis)

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Drug-Related Toxicity

Examples of acute toxicity Behavioral: “Intoxication” that impairs the

actions of drug users and increases the danger to themselves and others Physiological: Overdose that causes the

user to stop breathing

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Drug-Related Toxicity

Examples of chronic toxicity Behavioral Personality and lifestyle changes Effects on relationships with friends and family

Physiological Heart disease Lung cancer Cirrhosis Other health effects

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Drug Abuse Warning Network

A system for collecting data on drug-related deaths and emergency room visits at some U.S. metropolitan hospitals

DAWN collects data on improper use of legal prescription and over-the-counter drugs as well as illicit drugs

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Drug Abuse Warning Network

Alcohol is reported only in combination with other drugs Drug-alcohol and drug-

drug combinations are very common

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D.A.W.N. Toxicity Data

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Drug Abuse Warning NetworkToxicity Data

ER Visits1.Cocaine2.Alcohol-in-

combination3.Marijuana4.Prescription Opioids5.Benzodiazepines

Deaths1.Prescription Opioids

(not heroin)2.Cocaine3.Alcohol-in-

combination4.Benzodiazepines5.Methadone

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Drug Abuse Warning Network

What it tells us about how dangerous a drug is Simply gives us total deaths/ER visits

What it does not tell us about how dangerous a drug is Consider relative danger vs. total impact of

the drug Number of users vs. number of reported

problems

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Blood-Borne Diseases

Specific toxicity for users who inject drugs AIDS, HIV infection, and hepatitis B and C Sharing needles passes infectious agents

directly into the bloodstream Some states, cities prohibitneedle purchase without Rx Syringe exchange programs

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Substance Dependence

What do “addicts” look like? What drug do they take or what behavior do they

engage in (alcohol, cigarettes, illicit drugs, food, sex, gambling, shopping, computer time)?

How much time do they spend on their habit? How much of a drug do they take? How do you decide on the definition of

dependence?

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Substance Dependence

Three basic processes Tolerance Physical

dependence Psychological

dependence

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Tolerance

Diminished effect on the body after repeated use of the same drug The body develops ways to compensate

for the chemical imbalance caused by the drug Regular drug users may build up tolerance

to the extent that their dosage would kill a novice user

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Physical Dependence

Physical dependence is defined by the occurrence of a withdrawal syndrome Tolerance typically precedes physical

dependence If drug use is stopped suddenly,

withdrawal symptoms occur, ranging from mild to severe Physical dependence means the body has

adapted to the drug’s presence

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Psychological Dependence

Psychological or behavioral dependence High frequency of drug use Craving for the drug Tendency to relapse after

stopping use Behavior is reinforced by

the consequences Over time, this becomes the

biggest reason users report they continue to use

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Changing Views of Dependence

Early medical model = true addiction involves physical dependence; key is treatment of withdrawal symptoms

Positive reinforcement model = drugs can reinforce behavior without physical dependence

Psychological dependence is increasingly viewed as the driving force behind repeated drug use This refutes the sometimes common belief that drugs that

aren’t as strongly physically addicting are less dangerous

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Substance Abuse and Dependence: DSM-IV-TR

APA diagnostic criteria for abuse and dependence (Table on page 36) Complex behavioral definitions Dependence can occur with or without

physiological dependence (i.e., withdrawal)

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Substance Dependence: DSM-IV-TR

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. Tolerance2. Withdrawal3. 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

use5. A great deal of time is spent in obtaining the substance6. Important social, occupational, or recreational activities are given up or

reduced because of substance use7. Substance use continues despite knowledge of having a persistent or

recurrent problem that is caused or exacerbated by the substance

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Substance Abuse: DSM-IV-TR

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 home2. Recurrent substance use in situations in which it is physically

hazardous3. Recurrent substance-related legal problems4. Continued substance use despite having persistent or

recurrent social or interpersonal problems caused or exacerbated by the effects of the substance

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Is Dependence Caused by the Substance?

Some drugs are more likely than others to lead to dependence

Method of use, as well as other factors, influences risk of dependence

The “war on drugs” reflects the perspective that drugs are themselves evil

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Table 2.3: Dependence Potential of Psychoactive Drugs

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Is Dependence Biological?

Is dependence due to biochemical or physiological actions in the brain? Still no way to scan the brain and know if a

person has/had developed dependence Genetic physiological or biochemical markers

have been sought as well, but none has proven reliable

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Is There an “Addictive Personality”?

No way to know if the drug or the drug use changes a person’s personality Many other factors affect personality Sensation-seeking = a personality

characteristic statistically associated with early substance use and abuse

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Is Dependence a Family Disorder?

Alcohol dependence often exists within a dysfunctional family Evidence suggests that

dysfunctional relationships play a role in dependence, but they aren’t the only factor

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Is Substance 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 ways to test and treat the effects of

alcoholism but not the disease itself There is some disagreement over how to

define disease as well

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Biopsychosocial Perspective

Dependence is related to dysfunctions of: Biology Personality Social interactions

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Drugs and Crime

Drug use may change a person’s personality People under the

influence may commit crimes (e.g., many cases of homicide, domestic violence, etc.)

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Drugs and Crime

Crimes may be carried out to obtain money for drugs Drug use is a crime

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Why We Regulate Drugs

We want to protect society from the dangers of some types of drug use = legitimate social purpose Some laws are not developed as part of a

rationally devised plan and may not be realistic or effective Current laws: How did we get to these?

- assignment

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Chapter 2

Drug Use as a Social Problem??????????