Chapter 13

Substance Abuse

Substance Abuse: What Is It, and Why Is It Important?

• Substance abuse: the overuse, misuse, or addiction to any chemical substance

• There are many forms of substance abuse, including the single greatest preventable cause of deaths in the United States

Key Terms

• Drugs

• Recreational drugs

• Drug misuse

• Drug abuse

• Psychological dependence

• Tolerance

Drugs and the Law

• The lines between drugs that are legal and illegal can change.– Prohibition– LSD and heroin were developed for medical use– Marijuana is legal in some situations in 12 U.S. states, but

illegal at the Federal level• Many drugs that are legal can still be very harmful and easy

to abuse (alcohol, tobacco, prescription drugs)

Effects of Drug Use

• Physiological changes• Mental dependence• Conflicts in interpersonal relationships• Drug-related crime• Creation of treatment facilities• Loss of individual productivity• Care for children of drug-dependent parents• Policing of illicit drug availability• Treatment of medical complications

Sociocultural Dimensions

Substance Use and Abuse

Factors increasing likelihood of drug abuse

• Significant life stressors

• Sexual and physical abuse

• Low self-esteem, self-deprecation, anxiety, conflict

• Lower socioeconomic status

Legal Dimensions

• Illicit drug use disproportionately affects people of color.

• Hispanic and African American drug offenders have a greater chance of being sentenced to prison than white offenders; African Americans also receive longer prison sentences than do white offenders.

• Compared to 35 years ago, nearly 10 times the women are currently incarcerated for drug use

• Drug use during pregnancy: new laws focusing on punishment rather than treatment

Economic Dimensions:Illicit Drugs

• Illicit drug use causes about 50,000 deaths a year and costs $200 billion a year in the U.S. (includes direct and indirect effects)

• $26 billion a year in federal spending to prevent drug use, offer treatment services, fight drug trafficking, and improve drug enforcement and development in other countries

Economic Dimensions: Legal drugs

• Tobacco use causes about $200 billion in economic damages every year (directly and indirectly) and about 440,000 deaths per year (9x deaths from illicit drugs)

• Pack-a-day smokers spend more than $1,000/year on cigarettes

• Economic impact of alcohol abuse: $225 billion a year, mostly through lost productivity

Who Is Smoking?

Most smokers begin their habits during the years of high school, often before it is legal to do so.

Legal Dimensions of Tobacco Use

Examples of recent smoking legislation include:

• Taxes (2009 SCHIP increase)

• Youth access

• Tobacco product vending machine sales

• Advertising and promotion

Discuss: What are the short-term and long-term goals of each of these efforts? What are the pros and cons for each?

Physiological Effects of Cigarette SmokingHealth Consequences

Cigarette smoking during pregnancy also has serious consequences for a growing fetus.

U.S. Deaths (Male and Female) Attributable to Cigarette Smoking

Cigarette smoking is a major cause of heart disease, cancer (lung and other kinds), and respiratory diseases.

Quitting Tobacco

• Often the best decision a woman can make for her health

• Not easy, but it can be done (often on 2nd, 3rd, or 4th attempt)

• Many options available: nicotine replacement therapy, medications, support groups, and therapy.

• 1-800 QUIT NOW for more resources

Alcohol• Alcohol: a colorless

liquid obtained by fermentation of a sugar-containing liquid (ethyl alcohol)

• Moderate drinking (1 drink a day for women) may reduce the risk for heart disease.

• Heavier drinking (especially binge drinking) can have serious harmful effects on health.

Epidemiological Trends and Issues• 47% of females age 12 and older report current

alcohol use

• 57% of women aged 18–25 report current alcohol use

• Underage drinking:

– 24% of female teenagers drank within the past month

– 14% engaged in recent binge drinking

– 4% had many recent binge drinking episodes

• Alcohol use is higher in the Northeast (58%), Midwest (55%), West (51%), South (48%)

Complications from Chronic Alcohol Consumption

• Cancer• Cardiovascular effects• Organ damage• Diabetes• Fetal alcohol syndrome• Impotency and infertility• Diminished immunity• Sleep disturbances

Warning signs of alcoholism

Alcoholism

• Having five or more drinks per day• Needing a drink to start off the day• Denial of alcohol problem• Changing brands to control drinking• Depression and paranoia• Failure to recall what happened during a drinking

episode• Dramatic mood swings• Doings things while drinking and regretting them

afterward

Alcohol Use: Gender Differences

• Men metabolize alcohol faster than women

• A person’s size also influences the effects of a given amount of alcohol

• Hormones affect alcohol metabolism

• Alcohol consumption can affect pregnancy

Illicit Drugs• Stimulants (caffeine, cocaine, crack,

amphetamines, anabolic steroids) • Depressants and antianxiety drugs (alcohol,

barbiturates, benzodiazepines such as Xanax and Valium)

• Cannabis (marijuana, hashish)• Psychedelics and hallucinogens (LSD) • Narcotics (opium, heroine, morphine, codeine)• Inhalants• Designer drugs (MDMA or ecstasy)

Epidemiological Trends and IssuesIllicit Drugs

Who Uses Illicit Drugs*?

• About 45% of Americans drug over the age of 12 have tried an illicit drug.

• Women are less likely to have tried a drug than men (41% vs 50%).

• Whites (49%) and Native Americans (59%) are more likely to have tried a drug than people who are black (43%), Asian (24%) or Hispanic (35%).

• About 8% of Americans (6% of women) have used an illicit drug in the past month.

*Illicit drugs include marijuana, cocaine, crack, heroin, hallucinogens, inhalants, methamphetamines, and prescription drugs for nonmedical purposes. Source: SAMHSA

Physiological Effects of Drugs

Stimulants: Increase heart rate, blood pressure, strength of heart contractions, blood glucose level, muscle tension

Depressants: Relax the CNS and decrease functions

Cannabis: Causes alterations in perception and reactions; increases heart rate

Psychedelics and hallucinogens: Alter perception, thoughts, reality, mood, sensation, heart rate, body temperature; possible acute anxiety attack

Physiological Effects of Drugs

Narcotics: Slow respiration, pain levels; high potential for abuse; over time, heart infections, skin abscesses, lung congestion

Inhalants: Slow bodily functions; over time, liver failure, kidney failure, respiratory failure, destruction of bone marrow and skeletal muscles

Designer drugs: Chronic use may cause brain damage, significant impairment in visual and verbal memory

Prescription Drugs

Three classes most commonly abused

•Opioids prescribed for pain, which include morphine, codeine, oxycodone (OxyContin, Percocet, Percodan)•Depressants for anxiety and sleep disorders, such as benzodiazepines and barbiturates (Valium, Librium, Xanax)•Stimulants for sleep disorders and attention-deficit hyperactivity disorder (Dexedrine, Ritalin)

Every year, more than 6 million Americans reported using prescription drugs for nonmedical purposes.

Drug DependencyTreatment Dimensions

Detoxification: Supervised withdrawal with or without medication

Therapeutic communities: Highly structured, drug-free environments

Outpatient drug-free programs: Self-help programs such as Narcotics Anonymous (NA) or Pills Anonymous (PA)

Gender differences in treatment programs: Only about 60% of U.S. substance abuse treatment facilities provide special programs or services for women

Informed Decision Making

Personal Responsibilities

• Virtually everyone has used some drug at one point or another

• Have you ever noticed a harmful consequence of a drug you ingested?

• What other consequences can drug use bring?

• How do you decide how to keep yourself at a safe, acceptable level?