exam 1 study guide

what is a drug?

defined through two different perspectives
1) objective (essentialist)
→ what they are and what they do
→ pharmacology
2) subjective (constructionist)
→ how it it socially defined and reacted to
→ legality, media, deprivation, common perception

three relevant contexts of substance use (SU)

1) medical utility
2) illegality
3) psychoactivity

medical ulitity

a substance that is used to treat or heal the body/mind

illegality

a substance’s legal status
→ legal (not a drug), illegal (drug)
defined by the law and law enforcement (LE)
possession and sale generate legal punishment

psychoactivity

any substance that causes significant changes in cognition and behaviors
- thinking, mood, perceptions, emotions

objective (essentialists)

based on the material or essential properties

recreational use

for altered consciousness

basic pharmacological concepts

impacts how drug effects experienced and outcomes
basic concepts on the mechanisms of drugs and substance use
→ acute-chronic distinction
→ ED/LD ratio (effective dose / lethal dose)
→ tolerance

short-term

immediately or soon after administration
symptoms:
→ intoxication
→ changes in mood / cognition
→ dilated / constricted pupils
→ increased perspiration

chronic effects of SU / longitudinal outcomes

long-term outcomes
occur after continued use
can be direct and indirect

direct

SU → Y (ex: opioids → crime)
SU has a direct connection with Y
direct consequences

indirect

SU → ? → Y (ex: opioids → dep → crime)
involves a third variable
important policy implications

ED

effective dose
→ the amount required to produce an effect
→ ex) intoxication, pain

LD

lethal dose
→ amount required to kill a population
→ toxicity

ED/LD ratio example: 1:1

dead at the effective dose

ED/LD ratio example: 1:10

still very dangerous

ED/LD ratio example: 1:1000

very safe

tolerance

diminished effects due to repeated use
→ need a larger dose to get the same effects
impacts affinity and efficacy

affinity

how well a drug binds the receptor

efficacy

the ability to activate the receptor

agonist

affinity to efficacy

antagonist

affinity

behavioral tolerance

experienced users learn how to deal with the effects of a given drug
→ usual dose has decreasing behavioral impact

cross tolerance

diminished effects of drugs in the same class

the 4 key factors that influence drug action

1) route administration
2) injection
3) oral
4) dose

route adminstration

a method of taking a drug
impacts strength and duration of effects

injection

intravenous → veins
subcutaneous → skins
intramuscular

oral

smoking/huffing/vaping
snorting

dose

amount of a substance taken at one time
→ interconnected with effects

dose-responsive curve

higher the dose, the greater the effect is

potency

the quantity it takes to produce a given effect
→ the lower the amount that produces an effect, the greater the potency

purity

the degree of a drug is free from containments or adulterants
→ a general concern for street drugs
- cutting/binding agents
- other psychoactive substances

drug mixing (poly substance use)

the ingestion of 1 + drugs at the same time

antagonistic effect

one cancels the other out
1 + 1 = 0

additive effect

effects are compounding
1 + 1 = 2

synergistic effect

effects are amplified (multiplier effect)
1 + 1 = 4

pathology perspective

assumes all SU is abnormal/unnatural
all use is abuse
medical professionals are the gatekeepers of legitimate use
diagnosis criteria and testing

impartial (objective) perspective

no assumptions
use is not inherently good / bad
acknowledges different types of use
→ experimental, recreational, misuse/abuse

use

the act of ingesting a given substance(s)
general category that includes all forms

abuse

subcategory of use
ambigous
→ use that carries a higher risk than a lower likelihood of objectively determinable harm

the classical addiction model (or “physical dependence”)

an “addicting” drug is defined by the presence of certain withdrawal symptoms
→ fever, chills, body aches
→ vomiting and diarrhea
→ convulsions and seizures

cross-dependence

recognized by classical addiction model
withdrawal symptoms can be relieved by other drugs in the same class
→ alcohol and benzodiazepines
→ heroin and opioids
applies only to drugs that produce physical dependence

behavioral dependence

engaging in continued compulsive and harmful use despite detrimental consequences
→ harm to physical and social health

behavioral reinforcement

type of conditioning
drugs present a very positive stimuli
not the same as physical dependence

the dependence/reinforcement model

the classic conception of addiction does not explain most continued drug use
- most do not come with physical withdrawal
little distinction between drugs that cause physical and psychological dependence
reinforcement explains continued compulsive use

liability for dependence

substances vary in their potential for causing dependence
closely related to how reinforcing drug use is
→ how intensely enjoyable it is

immediate sensual appeal

capacity to generate “intense pleasure without the intervention of learning or other cognitive processes

the big three

1) cocaine
2) methamphetamine
3) heroin / fentanyl

theoretical

explain why people use
who uses and why
confirm / disprove theories

practical / policy

evaluate policy
improve living conditions and save lives

MTF

monitoring the future

NSDUH

national survey on drug use and health

examining SU

important to examine differences among
→ drug types / classes
→ rates of different drugs
various drugs attract users at substantially different rates
→ most are occasional users

prevalence rates

proportion of a population that uses a drug during a given time period

lifetime prevalence

never used a drug during their lifetime

period prevalence

used during a time period of interest

systematic empirical (scientific) data

nationally representative, quantitative
represent an accurate cross-sectional view of the phenomenon
→ this hasn’t happened much
reconstructed bits & pieces through archelogical & historical findings
empirical, localized rather than systemic

natural era

use of cannabis, peyote, psychedelic fungi, opium, coca leaves, alcohol
use in religious/ceremonial contexts or as medicine
innovation: the classification of alcohol
→ wine (13-14%) > liquor (40-50%)

transformation era / extractive era

start of the 19th century (1800s)
→ largely driven by innovations and discoveries"
- hypodermic syringe (1853)
created new substances by chemical extraction
→ much more potent
- morphine (1804)
- codeine (1831)
- cocaine (1855, 1860)
much more powerful & reinforcing than natural substances

synthetic era

early 20th century (1900s)
scientists created completely new substances
→2500 barbiturate compounds from 1903 - 1930
→ synthesized the first amphetamines from the 1920s
led to the “pharmacological revolution” in the 1950s
→ use of synthetic chemicals to treat mental illness
→ produce recreational & dependent users

SU during the beginning of the United States

in the “natural” era
alcohol was frequently used in colonial America
→ tradesman & farmers drank beer throughout the day
→ leaders drank and served large amounts of hard liquor and “punch” during political & social gatherings
alcohol had a near monopoly of SU in the U.S.
→ presented social problems

the United States & the transormative era

widespread use of morphine after the civil war
→ led to a number of dependent veterans
→ widowed by the way users
late 1800s, described as “dope fiends’ paradise”
→ availability of very powerful substances some without prescriptions
→ largely unregulated

bayer company’s “heroin”

cough, sleep, morphine addiction (dependence)

brown’s iron bitters (cocaine)

“give new life to the nerves”
the “cure” for a wide range of diseases

prohibition

the 18th amendment (1920)
→ the Volstead act
→ pressure from the temperance movement
made it illegal to manufacture / sell alcoholic beverages in the U.S
→ decline in alcohol consumption
→ created a criminal illicit market
repealed by the 21st amendment (1933)
due to public pressure
expensive to enforce & millions in lost tax revenue

early data on SU

late 1800s - early 1900s
some partial surveys from record-keepers
→ pharmacists’ surveys on drug-dependent customers
no systemic data until 1970s

drug use a medicine in the United States (late 1800s)

likely surpassing contemporary use
primitive medical practices
→ major medical procedures without anesthetic
→ more likely to cause harm than help
- bloodletting
- leeching
- lobotomy
opioids seemed to treat conditions
→ treated the symptoms

medical, scientific, & technological innovations

before 1800s, ingested substances were in a natural state → milder
several innovations
→ made substances more available
→ increased potency and purity
→ discovered more effective routes of administration

otc (over the counter)

contained opium, morphine, cannabis, cocaine
no prescription
low cost
marked as “cure-alls”
- flat feet to cancer
no requirement to list ingredients

Rx (prescriptions)

pure versions of otc meds
some states had laws requiring rx by the 1890s
→ largely unenforceable/ineffective

the pure food & drug act (1906)

meatpacking industry (the jungle)
exposed horrific conditions
public outrage & a call for change
congress passes this act to regulate consumer productions
→ creates FDA
→ ingredient labels and testing

early anti-opium legislation

the British east india company
→ owned the global trade of opium
→ smuggles opium into china and starts the opium wars

the 2 major international conferences on the international trade of opium

1) shanghai conference (1906)
2) hauge confrence (1911)

the Harrison act (1914)

first federal attempt to regulate drugs
→ mostly opioids
the most important national drug regulation
→ sets the framework for future national policy
regulates use by physicians
→ narcotics can only be “prescribed in good faith”
→ registry of prescribers & prescriptions
ambiguous, no general agreement on interpretation
→ especially on the treatment on physical dependence

early maintenance programs

a medical approach to treat opioid dependence
→ medical professionals provide doses of drugs on dependent patients
by 1918, there were 50 nationwide
→ ran by local, state, and federal governments
→ often a contentious issue
last program closed in 1923
→ interfered with efforts by law enforcement to identify sources
30,000 doctors arrested between 1914 - 1938 for prescribing narcotics
→ 3,000 served time, created a new class of criminals

the marihuana tax act (1937)

historical accounts suggest use was among mexican migrants and black jazz culture
federal law enforcement began a campaign to criminalize cannabis
→ yellow journalists sensationalized, fear-driven campaign
- “addicts” that became violent, dangerous, insane
rooted in anti-mexican and anti-black racism

the controlled substances act (1970) (comprehensive drug abuse prevention & control act)

originally designed to address funding for research, rehabilitation, and educational) programs
→ substantial funding for public hospitals
→ created the national institute on drug abuse (NIDA)
the most funding went to control through law enforcement
→ new “tough on crime” climate
→ moved federal enforcement from the Treasury to the DOJ
established categories of controlled substances
→ scheduling of controlled substances

schedule I

criteria
→ high potential for abuse, no accepted medical use, lack of safety under medical supervision
most dangerous
major contradiction:
→ medical value for some substances
- several have demonstrated utility for several mental and physical illnesses

schedule II

criteria
→ high potential for abuse (less than s1), limited accepted medical use, may lead to dependence

schedule III

potential for abuse, less than s1 and s2
accepted medical use
may lead to low-moderate physical dependence or high physiological dependence

schedule IV

criteria
→ low potential for drug abuse relative to drugs in higher schedules
→ accepted medical use widely
→ may lead to limited psychological and physical dependence
examples
→ xanax, valium, ambien, tramodel

schedule V

low potential for abuse relative to drugs in higher schedules
accepted medical use
may lead to limited psychological and physical dependence
examples
→ lyrica, robitussin AC

decisions on scheduling

made at DEA’s headquarters
professionals in these meetings include
→ drug researchers
→ medical doctors
→ 2-4 pharma lobbyists
→ DEA

prelude on the war of drugs

by the end of the 1960s, u.s was in turmoil
→ vietnam war
→ civil rights leader assassinated
June 1971, Nixon declared drugs were “public enemy number one”
→ increased size and prescence at federal agencies
→ introduced mandatory sentencing and no-knock warrant
→ majority funding to treatment

the white paper on drug abuse

ford administration
examined extent of drug abuse in the u.s
presents policy recommendations to reduce abuse
→ total elimination is “unlikely”
→ advised a balanced strategy
→ drugs not equally dangerous

the parents movement

end of 1970s, there was a growing drug movement
→ community college professor who was concerned about his daughter’s cannabis use
→ other parents and him pushed for stricter drug polices
formed advocacy groups
→ parental resources institute in drug education (PRIDE)
→ national federation of parents for drug-free youth (NFP)
Carter administration installed an NIDA director that was anti-cannabis

war on drugs (1980s)

regan administration (1981 - 1989)
→ cuts to rehab, increases enforcement
→ “zero tolerance” policy
arrests for drug use dramatically increase (70%)

just say no campaign

abstinence drug education

the comprehensive crime control act (1984)

establishes u.s sentencing commission
forfeiture of cash/property occurred with funds of drugs sales
increases penalties for distribution in elementary / secondary school zones

anti-drug abuse act (1988)

declared goal for drug-free america (1955)
→ three strikes for felony drug offenses
→ broadened drug-free juvenile areas
→ made non-criminal punishment for drug actions
- denial of federal benefits, denial of public housing

drug testing

regan’s executive order (1986)
“drug free workplace”
sensitive positions required testing
non-sensitive positions tested when accidents occurred
new hires get drug tested
positive tests must get treatment or they are fired
state/local government/private businesses began testing
→ usually pre employment screenings
→ tests students in extracurricular activities

race & drug policy

promote “war on drugs” through southern strategies
race-neutral language
played on white fears of black criminality
→ republicans gain political control
issue of drugs lack individual responsibility and morality
racial disparities in drug arrests

war on drugs (1990s)

increased rates on drug use between 1960 - 1980s > epidemic
→ seen as a threat to national security that required action
marked increased attention to enforcement efforts
→ domestic and abroad
increased major funding in 3 key areas
→ law enforcement efforts to address trafficking and use
→ prosecution of drug offenders
→ efforts internationally with intervention and collaboration
federal budget for the WOD doubled (1991 - 2001)
clinton commissioned 100k more officers for anti-drug operations
→ nearly 1mil drug arrests (mid 90s)
5.1 billion advocated for prisons in 1995
82% of arrests from cannabis use
→ increased heroin & cocaine

war on drugs (WOD) (2000s)

bush administration goals to reduce drug use
prevent use by it starts
treat current users
disruption of the illicit market
administration continued to emphasize enforcement
creation of drug courts
→ drug offenders offered treatment, with threat of punishment

second chance act (2008)

funding for re-entry services for ex-offenders
educational and employment services
program alternatives to incarceration

theories of SU

attempts to explain, a testable idea driven by hypothesis
→ do not compete with one another
→ none can fully answer the progression of SU
→ start broad, narrows down
try to answer the following:
1) given the benefits/setbacks, why do people use drugs?
2) which (kinds of) people are willing to take the chance of having terrible experiences to get high
the 3 theoretical frameworks for su
1) biological
2) psychological
3) sociological

perspectives of SU

general idea about causation of SU, no specific hypothesis

the 2 necessary preconditions for use

1) predispositions, motive, susceptibility
2) availability and access to substances

biological theories

medical and physiological mechanisms among particular individuals influence them to experiment and/or abuse drugs
some are constitutional
→ fixed mechanisms present at birth
gene environment interaction

(BT) genetic factors

substance use & addictions are due to inherited genetics
→ some are more prone than others
most research has focused on alcohol
other factors are needed