BBH 143_Exam 1

Exam 1

What is a Drug ?

any substance, natural or artificial, that by its chemical nature alters structure or function in the living organism

Natural: Willow bark 

Artificial: Acetylsalicylic acid (Aspirin)

Multiple effects of a drug

Can affect body, brain or both  

Alters one’s ability to function emotionally, physically, intellectually, financially or socially.

Psychoactive drug

Substance that alters mood, perception, or behavior

Is drug use bad?

Depends on

* Why you use the drug
* How you use drug
* How much of the drug you use
* Legal status of the drug (Illicit vs licit drugs)

Drug misuse

Intentional or inappropriate use of drugs

Drug abuse

Intentional or inappropriate use of drug RESULTING in problems

History of Drug Use

* When did drug use begin?
* How has drug use changed over time?
* How has opinion on drug use changed over time? Moral vs physical issue

Drugs of interest

* Alcohol
* Amphetamines
* Cannabis (Marijuana)
* Cocaine
* Nicotine
* Opiates
* Psychedelics
* Sedative Drugs

When did Drug Use begin?

Efforts to increase purity & concentration.

Deviant drug use

Use disapproved of by a social group which the group acts to connect.

Top Risk factors

* Correlated with higher rates of drug use.
* Early aggressive behavior
* Lack of parental supervision
* Exposure to substance abuse/Positive attitudes toward use
* Access to drugs
* Poverty

Top Protective Factors

* Correlated with lower rates of drug use
* Self- control
* Parental monitoring
* Academic competence
* Negative attitudes toward use/acceptance of anti-drug policies
* Strong community attachment/ strong religious connections
* Participating in extracurricular activities

Other Factors Associated with Drug Use

* Race
* Gender
* Level of education
* Personality variables
* Genetics

Why do people use drugs? **(Experimental Use/Curiosity**)

* Some drug awareness programs increase interest & curiosity.
* Media depictions of celebrities and well-known athletes using drugs may arouse curiosity.

Why do people use drugs? **(Pleasure/escape from boredom)**

* People like the feelings they get from drug use.
* Drugs become a source of reward.

Why do people use drugs? **(Peer influence)**

* Peer pressure is a strong influence for drug use.
* During adolescence, the greatest influence in their lives are their peers’ perceptions of them.
* Young adults tend to be highly influences by peers.

Why do people use drugs? **(Spiritual Purposes)**

Throughout history, drug use has played a role in enhanced spirituality.

Why do people use drugs? **(Social interaction)**

Drugs are sometimes used to help facilitate social interaction. 

Why do people use drugs? **(Rebelliousness)**

Sometimes people take drugs because they are told not to!

Drug dependence

* A state in which an organism functions normally only in the presence of a drug
* Tolerance & withdrawal

Addiction 

* Compulsive behavior that often involves little rational thought
* Use despite harmful consequences.

Tolerance

* Larger dose of the same drug is required to produce the original effect.
* Conditioned tolerance

Drug withdrawal

Somatic, cognitive, & emotional negative symptoms that arise with cessation of drug use.

Characteristics of Addiction

1. Loss of pleasure: substance abuse
2. Escalating loss of control
3. Persistent use despite harmful consequences
4. Denial: guilt over use
5. Relapse after attempts at abstinence: frustration.
6. Craving: fantasizing, obsessing

Is Addiction a Disease?

* Prevailing historical view was drug abuse was a personal choice.
* In the 1950's, AMA declared alcoholism a disease.
* Currently, addiction is described as a
disorder with similarities to a disease state
* Physiological
* Heritable
* Chronic, relapsing

Prevalence of Drug Use

* Nearly every American has used a mind-altering substance.
* In the U.S., nearly 1 in 10 persons aged 12 and over have an illicit drug.
* The use and abuse of drugs cost the U.S. an estimated $700. annually
* Over 50% of all state and federal prison inmates are in jail for drug offenses.

Impact of Drug Use and Abuse

* Over 50% of Americans see drug use as a serious problem in society.
* Alcohol-related deaths is the 4th preventable cause of death in the U.S
* College students use alcohol at rates higher than their non-college peers.

Binge drinking is linked to

* Deaths
* Weak academic performance
* Injuries, vandalism, and property damage
* Alcohol-related sexual abuse and rape

Impact of Drug Use & Abuse **(Family)**

A prominent factor in cases of child abuse and domestic abuse

Impact of Drug Use & Abuse **(**

**Impact on Prisons)**

US highest incarceration rates; 50% of prison population is drug offenders.

Impact of Drug Use & Abuse **(**

**Prenatal exposure)**

drug & alcohol affect the developing baby.

Impact of Drug Use & Abuse **(Education)**

* Higher dropout rate
* Lower academic performance
* Denied federal financial aid if convicted of a drug offense.

Impact of Drug Use & Abuse **(Employment)**

* Lower productivity
* Increased absenteeism & health care costs
* Drug users have less stable job history
* Earn significantly less money
* Higher accident rates on the job

Patterns of Drug Taking in Experimental Use

* Infrequent drug use motivated by curiosity
* Usually short-term (10 of fewer experiences with a drug)
* Does not usually go beyond experimental phase
* If a person continues to use the drug, it is no longer a matter of curiosity or experimentation

Patterns of Drug Taking in Social-Recreation Use

* The most common drug-taking pattern
* Drug use is done in certain social environments only
* Bars
* Sporting events
* Weddings
* Birthdays

Patterns of Drug Taking in Circumstantial-Situational Use

* When a drug is taken on a short-term basis to help deal with an immediate distress or pressure
* Stress influences drug use (Adolescents, Race, Gender minorities, Holidays)

Patterns of Drug Taking in Intensified Use

* Taking drugs on a steady, long-term basis to relieve a persistent problem or stressful situation
* Chronic drug use is the habitual use of drugs

Patterns of Drug Taking in Compulsive Use

* Obsessive drug use without regard to oneself or society
* Acquiring and using the drug becomes the focus for the individual
* The compulsive drug user takes the drug to avoid discomfort and pain
* This pattern is destructive to both the user and society

Monitoring the Future (NIDA)

* The survey began with senior classes in 1975, and each year about 16,000
students in approximately 133 public and private high schools nationwide
participate
* Beginning in 1991, similar surveys of nationally representative samples of 8th
and 10th graders have been conducted annually

The study's design permits the investigators to examine four kinds of change

* Changes in particular years reflected across all age groups (secular trends or “period effects”
* Developmental changes that show up consistently for all panels (“age effects”)
* Consistent differences among class cohorts through the life cycle (“cohort effects”)
* Changes linked to different types of environments (high school, college, employment) or role transitions (leaving the parental home, marriage, parenthood, etc.)

Drug Use by Older Adults

Considered an invisible epidemic

* 2.2 million older Americans have problems related to alcohol
* Between 6-11% of elderly patients admitted to hospitals exhibit signs of
alcoholism
* Substance use by the elderly accelerates the aging process

Risk is high for adverse drug interactions

* 30% of older adults take 5 or more medications
* As more medications are taken, there is an increase in risk for adverse
drug interactions
* Older adults also take more over-the-counter medications which is unknown by their physicians

Substance abuse in the workplace results in

* Lessened productivity
* Increased accidents, absenteeism, and healthcare costs

Drugs in the Workplace

* Highest rates of drug use are food service workers and construction workers
* Many companies use drug testing to deter drug use

Employee Assistance Programs (EAPs)

help workers deal with problems that
affect job performance, including alcohol or drug problems

* Employers benefit because absenteeism decreases and employee morale improves
* A positive relationship exists between workplace health promotion
programs and improved job performance

Drug Testing

Random workplace drug testing has identified frequent users of illicit drugs

Who gets screened?

* Military & Federal employee
* Transportation workers
* Private employers
* Public schools

Who else should be screened?

* Pregnant women
* Public assistance recipients

Factors affecting detectability of drugs

* Type of drug used
* Type of sample being tested
* Quantity of drug used
* Frequency of drug used
* Your weight
* Your percentage of body fat

False positive

A person tests positive for a drug even through no drug is present in the person’s urine

False negative

A person tests negative even though drugs are present in the person’s urine

Issues leading to US legislation between 1906 & 1918

* Social influences between 1890-1920: race relations
* Widespread use of opium as a medicine in early 1800’s
* Commercial production of morphine in 1830’s
* Legal distribution of patent medicines
* Conflict between medical science & patent medicine
* Increase in opium smoking (1875 San Francisco)
* Pure cocaine available in mid-1800’s
* Early 1900’s reformers claimed cocaine use in southern ‘negroes’ (unsubstantiated)

Teddy Roosevelt recommended law to 1906 Pure Food and Drugs Act

Regulate interstate commerce in misbranded and adulterated foods, drinks & drugs

1906 Pure Food and Drugs Act

Act defined any drug as

* any substance or mixture of substances intended to be used for cure, mitigation, or prevention of 'disease’
* misbranding referred only

Act specifically referred to

1906 Pure Food and Drugs Act

* Alcohol
* Morphine, Opium, Heroin
* Cocaine
* Cannabis indica

1906 Pure Food and Drugs Act

Administered by the Department of Agriculture

Developed into the Food and Drug Administration (FDA)

1914 Harrison “Narcotics” Act Teddy Roosevelt

established US Opium Commissioner

Dealers & dispensers of opioids & cocaine had to do what in 1914 Harrison “Narcotics” Act

* Register annually
* Pay a small tax
* Use special order forms provided by Bureau of Internal Revenue (Treasury Department)

Now have 2 Bureaus, 2 types of regulations

both acts covered the same drugs

Controlled Substances After the 1914 Harrison “Narcotics” Act

* In 1914, 1 in 400 Americans were dependent on opium or its derivatives
* From 1919-1929, arresting physicians & druggists for prescribing to
dependent users

1922, laws to increase penalties

* For dealing illegally imported drugs
* User is now a criminal

By 1928, more users were

in federal prison than being treated for dependence

1937 Marijuana Tax Act

* May have been linked to anti-Mexican feelings
* Media sensationalized marijuana as being a vicious drug
* Anslinger viewed drug addicts as immoral people who deserved a swift and harsh punishment

Specifics of the Marijuana Tax Act

* Forbade marijuana use for recreational purposes
* Anyone using marijuana was required to pay a tax -> Failure
to comply resulted in a high time or prison time
* Doctors were required to keep detailed records for patients
who were provided with a marijuana prescription
* The Federal government made it almost impossible to get
these tax stamps
* Big liquor producers supported illegalization of marijuana after prohibition

Food, Drug, and Cosmetic Act of 1938

* Pharmaceutical companies were required to file applications with the federal government demonstrating the new drug was safe and properly labeled
* Gave the Food and Drug Agency (FDA) more control over drugs

What it did not do in Food, Drug, and Cosmetic Act of 1938

– Cover drugs that were previously marketed

– Drugs had to be proven safe but not proven effective

– Little authority to enact penalties

– Drug manufacturers were given the responsibility for determining whether to require a prescription for the drug or make it available over-the-counter

– Drug manufacturers created their own tests to determine a drug’s effectiveness

Regulation of Pharmaceuticals by FDA

* FDA focuses on:
* Purity (1960 act)
* Safety (added in 1937)
* Manufacturers must test for toxicity & submit a NDA for approval
* Prevented Thaliodomide disaster in US
* Effectiveness (add between 1950-1960’s)

Narcotic control act of 1956

* Mandatory minimum sentences
* Selling heroin to under 18-year-olds = death penalty

Drug Abuse Control Amendments of 1965

* Amphetamines, barbiturates & hallucinogens now covered.
* Bureau of Narcotics now Bureau of Narcotics & Dangerous drugs

Controlled Substances After the 1938

Drug use and abuse continued to increase

Comprehensive Drug Abuse Prevention & Control Act of 1970

* Increased funding for research, treatment & prevention efforts
* Certain drugs controlled directly by Drug Enforcement Administration

Established 5 schedules of controlled substances

– The drug’s potential for abuse

– Scientific knowledge of the drug

– The drug’s capacity to produce psychic or physical dependence

– Drug’s risk to public health

– Drug’s patterns of abuse

Penalties for making and selling

more severe than possession

Anti-drug Abuse Acts of 1986 & 1988

Drug use continued to increase marijuana, cocaine, crack cocaine

1986 Law

* Increased penalties for selling
* Reinstituted mandatory minimum sentence & denied parole
* Instituted ‘Trafficking’ penalties

1988 Law

* Restriction on aircraft registrations
* Required banks to report transactions over $10,000
* Restricted firearms sales
* Restricted access to chemicals used to manufacture
* Increased conviction penalties
* Office of National Drug Control Policy

Coined term ‘Designer drug’

Chemically similar to controlled substance but not on schedules

How are drug laws enforced?

DEA, FBI, IRS, ATF & others

Focus on interdiction

Drug seizures are a good way to access drug trafficking, trends, and availability

Despite the millions of dollars being spent to reduce demand

illicit drug use remains high

Globally, in countries that experience high amounts of poverty, economic disadvantage, and unemployment

drug cultivation and production remain high

The Global Commission on Drug Policy

* recommends the end of drug criminalization
* This would allow countries to better regulate the use of drugs while undermining criminal organizations.

What is the biggest change in the US National Drug Control budget between 2016 & 2021? 

$40.4 billion dollars awarded to drug control 

Define decriminalization 

the action or process of ceasing to treat something as illegal as a criminal offense. 

What are the characteristics of parents who use and abuse? 

Parents/caregivers who abuse drugs are more likely to have poor parenting skills (including abuse), inadequate coping skills, a lack of basic resources, limited social support, and experience high employment rates and housing instability 

In surveys on drug use what is the difference in the information obtained from questions about substance use initiation, use in the last 12 months and use in the last 30 days? 

Those who are using it in the last 30 days have more of a risk of abusing drugs than those in 12 months 

Which drug is considered most risky and which is least risky? 

* Most risky - Heroin
* Least risky - Marijuana

What is the biggest difference between the perceived risk in 12–17-year-olds compared to 12 and older? 

Smoking is a greater risk between 12-17 than those 12 and older 

Which drug categories, licit and illicit, show the highest levels of use according to SAMHSA 2019 data? 

* Licit drugs: Tobacco, Alcohol
* Illicit: Marijuana, Misuse of prescription pain relivers

According to SAMHSA 2019 data, what is the most frequently used licit drug? What is the most frequently used illicit drug? 

* Licit drug: Alcohol
* Illicit drug: Marijuana

What is the relationship between mental illness and drug use? 

Those with a serious mental illness have a higher chance of using drugs 

Which age group has the highest risk for adverse drug interactions? 

18-25 

What types of samples can employers collect for testing? 

Blood, Mouth Swab, Hair, Breath, Urine 

Which drugs were widely available/used? 

Opium, morphine, patent meds, cocaine 

What were patent medicines? 

Term approved by royalty, sold to treat everything without much regulation. Historically, a drug sold through peddlers, shops or mail ordered ads. 

What were the main differences between the Pure Food & Drug Act & the Harrison Act? 

The 1906 legislation zones in on the purity of drugs and legitimate labeling while the 1914 act put regulations on the dealers and dispensers selling the drugs 

What are narcotics? 

a drug or other substance affecting mood or behavior and sold for nonmedical purposes, especially an illegal one. They can include opioids (such as heroin, morphine, and fentanyl), and some depressants (such as barbiturates). 

The 5 schedules of controlled substances were aimed at balancing what 2 aspects of drug use? 

The risk of consuming and selling drugs and trying to prevent the severe penalties of possession. (potential for abuse and medical use) 

What types of samples can a person provide for random or scheduled drug testing? 

Urine, Blood, Saliva, Hair, Sweat 

The term illicit is used to describe drugs that

Are illegal to use according to current legislation