CH 9.1 and 2 (psychopharm)

Recreational drug

Psychoactive substances consumed voluntarily: has the potential to be used problematic way

Illegal drug use

• Most common is marijuana

• Most prevalent among young adults

Legal drugs

Alcohol and tobacco

The paradox of addiction

Continued use of drugs despite aversive consequences

Alcohol temperance

Advocated for reduced consumption of alcohol

Movement that culminated in prohibition (complete ban of alcohol) equated drug use with criminal behavior

• ended in 1933

Advances in chemistry

Events led to current drug use: Led to a more concentrated form of drugs, these were more addictive

• ex: morphine was purified from opium & cocaine from coca

Hypodermic syringes

Events led to current drug use: Development of this allowed injection into the bloodstream & faster route of administration

No drug control laws

Events led to current drug use: Cocaine and heroin were used in tonics and cough syrups

• heroin synthesized by Baylor and marketed as non addictive alternative to codeine

Medicalization of drug addiction

Events led to current drug use: now thought that addiction was a disease and addicts should be treated by medical establishment

• alcoholism was declared a disease by the WHO

• In the second half of 20th century

• Disease model of addiction: promoted by self help organizations

Harrison Act

1914: regulated opiates and cocaine, prohibiting nonmedical use; addicts turned to street dealers

• Goal: not to abolish but to control use of narcotics and revenue for federal government

Pure Food and Drug Act of 1906

Accurate labeling of food and drugs; increasingly controlled the commercialization of drugs

• Goal: not to abolish but control use of narcotics, and revenue for federal government

Alcohol prohibition (18th amendment)

In 1920: spawned organized crime movement of basement alcohol

• ended in 1933

Marijuana tax act of 1937

This drug was banned for non medical use. Levied a tax on importers, sellers, and dispensers

Controlled substances Act

Established five schedules of controlled substances and created the Drug enforcement Agency

Clinics/Physicans treating addicts

Began providing maintenance doses to addicts, but then addicts were cut off from this source. This avenue of treatment was largely ineffective.

Physical Dependence

Abstinence leads to highly unpleasant withdrawal symptoms that motivate the person to return to drug use

• some drug only produce minor ________

Compulsive drug seeking

Highly motivated to seek; the addict is driven by a craving a strong urge to take the drug

Remissions

Individuals cease drug use for periods

Relapses

Individuals begin to take drugs again

Chronically relapsing disorder

Characterized by compulsion to seek and take the drug, loss of control in limiting intake, and emergence of a negative emotional state when access to the drug is prevented

DSM5 SUD drugs

Activate the neural circuitry that mediates the rewards commonly experienced as a drug induced high

• alcohol

• Caffeine

• Cannabis

• Hallucinogens

• Sedative Hypnotics and anxiolytic drugs

• Inhalants

• Opioids

• Stimulants

• Tobacco

• Etc

Substance use disorders

A cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues using the substance despite significant substance related problems

Substance induced disorders

Development of a reversible substance specific syndrome due to recent ingestion of a substance

• eg. substance induced psychotic disorder

• Eg substance induced depressive disorder

Do i need to know the dsm 5 criteria

Behavioral addictions

(Non substance related disorders)

• gambling, eating disorders, compulsive sexual behaviors, etc

Gambling

is the only one in the dsm5 that meets several of the criteria for substance abuse disorder

• shows similar neurobiological and cognitive dysfunctions

Gateway theory

Young people often progress from legal substances like alcohol or tobacco or marijuana; a few go on to try cocaine, heroin, or illegally obtained prescription drugs

Non problematic or recreational use

Progression of drug use from nonproblematic to problematic: First stage

Escalation of drug use

Progression of drug use from nonproblematic to problematic: Second Stage

Compulsive or problematic use

Progression of drug use from nonproblematic to problematic: Third Stage

Abstinence (withdrawal)

Progression of drug use from nonproblematic to problematic: Fourth Stage

Relapse

Progression of drug use from nonproblematic to problematic: Last stage

Schedule of controlled substances

5 classes of potentially addictive drugs; based on degree of potential misuse and medicinal value

Schedule 1 drugs

No medicinal value and can only be obtained for research use

• heroin, LSD, Mescaline, Marijuana, THC, MDMA

Schedule II drugs

Substances have a high abuse potential with severe psychic or physical dependence liability

• opium, morphine, codeine, meperidine, cocaine, amphetamine, methylphenidate, PCP, pentobarbital

Schedule III drugs

Substances that have an abuse potential less than other, including compounds containing limited quantities of certain narcotics and nonnarcotic drugs

• paregoric, barbiturates other than those listed in other schedule

Schedule IV drugs

Substances that have an abuse potential less than prior

• phenobarbital, chloral hydrate, diazepam, alprazolam

Schedule V drugs

Have a low abuse potential and mild dependence