Module One — Introduction to Drug Use and Abuse: Comprehensive Notes (English)

Module One — Introduction to Drug Use and Abuse: Comprehensive Notes

General Points about Psychoactive Drugs

• Drugs are not intrinsically good or bad.
• Every drug has multiple effects.
• The size and the quality of a drug’s effect depend on the amount the individual has taken.
• The effect of any psychoactive drug depends on the individual’s history and expectations.
• A lot of beliefs about the effects of drugs have been distorted and/or exaggerated by the media, politics, and other claims-makers.
• To understand drugs, and drug use, scholars must examine social contexts that influence and define use.
• Concepts of “drug use,” “drug abuse,” and “drug addiction” are socially constructed.
• Understanding psychoactive substance use requires investigation of subjective dimensions of drug use and drug abuse in society.

The Drug Problem and Talking About Drug Use

• “The Drug Problem” involves evaluating the extent of a particular problem and proposing solutions, or understanding common societal reactions to ostensible drug problems by asking questions: Who? What? When? Where? Why? How? How much?
• Always consider and evaluate the source of the information.

Talking About Drug Use (Key Questions)

• Who is taking the drug? (e.g., age, level of responsibility for others?)
• What drug are they taking?
• When and where (i.e., context) is the drug being used? (e.g., at work, at home, at social functions?)
• Why is the drug being used? (e.g., instrumentally, recreationally?)
• How is the drug being taken? (e.g., route of administration)
• How much of the drug is being used? (e.g., dose, purity?)
• Does the pattern of drug use meet criteria for a substance use disorder?

Clemson Context Exercise (Discussion Prompt)

• Do you think drinking and/or drug use among Clemson students is a problem? (use categories like Who? What? etc.)
  • Options: Yes, it is a problem; No, not a problem at all; Yes, but it is isolated in certain groups
• If you see it as problematic, what needs to happen to solve the problem?
• What efforts does Clemson make to reduce drug and alcohol use among its population?
• Are these efforts adequate and/or effective?

Key Concepts and Definitions

• Drug: Any substance, natural or artificial, other than food, that by its chemical nature alters structure or function in a living organism.
  • Broad reference: ingestion of chemical substances that act like, or are believed to act like, drugs.
  • Includes a wide range of both legal and illegal drugs and every level of involvement with psychoactive substances, from the most occasional user to the frequent social user to the person who uses habitually.
• Illicit drug: A drug that is unlawful to possess or use.
• Psychoactive drug: A drug that specifically affects thoughts, perception, emotions, or behavior.
  • The majority of Americans, including adolescents and older individuals, use some type of psychoactive substance (most common? caffeine).
  • Psychoactive drugs affect: central nervous system functions, thought processes, emotional responses, perceptions of the world around us.

Drug Use, Misuse, Abuse, and Addiction (Definitions)

• Drug use: Broadly refers to ingestion of chemical substances that act like, or are believed to act like, drugs.
• Drug misuse: Use of drugs or chemicals in greater amounts than prescribed by a doctor, or for purposes other than those intended by the manufacturer.

- Drug abuse: Substance use in a manner, an amount, or in situations such that it causes social, occupational, psychological, or physical problems; it refers to drug use that leads to measurable personal, interpersonal, or social consequences.

• “Drug addiction” (Faupel text, as cited by Inciardi and McElrath 1998:xiii): “a drug craving accompanied by physical dependence, which motivates continued usage, resulting in a tolerance to a drug’s effects and a syndrome of identifiable symptoms when the drug is abruptly withdrawn.” (This definition refers to both physical and psychological drug dependence.)

Drug Dependence and Tolerance

• Drug dependence: A state in which an individual uses a drug so frequently or consistently that it would be difficult for the person to stop.

  • May be physical and/or psychological.
  • Do not necessarily occur at the same time, nor does one necessarily occur before the other.

• Physical Drug Dependence: when the body has adapted to the drug’s presence such that if use is stopped suddenly, withdrawal symptoms (from mild to severe) will occur.

• Psychological Drug Dependence: Often what is referred to when we use the word “addiction.”

  • Marked by high frequency of drug use, craving for the drug, tendency to relapse after stopping use.
  • Behavior (drug use) is psychologically reinforced by the consequences.

• 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.
  • Also can build behavioral tolerance.
  • Three main types of tolerance (will be discussed in Module 3).

Is Dependence Caused by the Substance?

• Some drugs are more likely than others to lead to dependence (physical and/or psychological).
• Psychological dependence is more likely to occur under certain contexts (e.g., biological, psychological, social).
• Context matters: method of use (route of administration), dose, as well as genetics and other social and psychological factors influence the risk for dependency.
• The “War on Drugs” reflects the perspective that drugs are themselves evil: “Try it once, and you will be hooked.” This is an overgeneralized statement and a distorted simplification of a complex issue.
• We must consider the context of drug use to understand drug use and related social problems.
• Dependency rates after first initiation: the majority of those who experiment with drugs do not go on to use regularly or become addicted.

Substance Use Disorders (DSM-5)

• DSM-5 has one category for the pathological use of substances: Substance Use Disorder (SUD).
• Categorized by specific substance: Alcohol; Amphetamine; Cannabis; Cocaine; Hallucinogen; Inhalant; Opioid; Phencyclidine; Sedative/Hypnotic/Anxiolytic; Tobacco.
• Severity:
  • Mild: 2–3 symptoms out of the 11.
  • Moderate: 4–5 symptoms.
  • Severe: 6 or more symptoms.

DSM-5: 11 Symptoms (Criterion Set)

• A problematic pattern of substance use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period:

  1. The substance is often taken in larger amounts or over a longer period than was intended.
  2. There is a persistent desire or unsuccessful efforts to cut down or control the substance use.
  3. A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects.
  4. Craving, or a strong desire or urge to use the substance.
  5. Recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home.
  6. Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance.
  7. Important social, occupational, or recreational activities are given up or reduced because of substance use.
  8. Recurrent substance use in situations in which it is physically hazardous.
  9. Substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance.
  10. Tolerance, as defined by either of the following:
      a. A need for markedly increased amounts of the substance to achieve intoxication or desired effect.
      b. A markedly diminished effect with continued use of the same amount of the substance.
  11. Withdrawal, as manifested by either of the following:
      a. The characteristic withdrawal syndrome for the substance (refer to criteria A and B of the criteria set for alcohol or other substances withdrawal).
      b. Substance (or closely related substance, such as benzodiazepine with alcohol) is taken to relieve or avoid withdrawal symptoms.

• With physiological dependence: evidence of tolerance or withdrawal (i.e., either item 10 or 11 is present).

• Without physiological dependence: no evidence of tolerance or withdrawal (i.e., neither item 10 or 11 is present).

• 10 and 11 are not considered met if you are under the care of a physician for solely medical purposes.

• There has been a substantial increase in the percentage of US adults with a SUD in the last 10 years.

DSM-5 Tables and Figures (Substance-Specific and Past-Year SUD)

• Table 1 (DSM-5 SUD Criteria for Substances and Types of Use in the 2021 NSDUH): Methamphetamine Use But Not Misuse; Use But Not Misuse; (criteria 1–11 with indications whether each criterion applies or does not apply).

• Past Year SUD figures (illustrative):

  • 2014: No SUD in the Past Year: $243.6 ext{ million}$ people (91.9%);
  • SUD in the Past Year: $21.5 ext{ million}$ people (8.1%);
  • Substances include: Marijuana use disorder $4.2 ext{ million}$; Pain Reliever use disorder $1.9 ext{ million}$; Cocaine $0.9 ext{ million}$; Heroin $0.6 ext{ million}$; etc.

• 2021 Past Year SUD (NSDUH):

  • Total past-year SUD: $46.3 ext{ million}$ (16.5%) of adults aged 12+.
  • Alcohol Use Disorder: $29.5 ext{ million}$.
  • Drug Use Disorder: $16.3 ext{ million}$.
  • Marijuana Use Disorder: $24.0 ext{ million}$.
  • Rx Pain Reliever Use Disorder: $5.0 ext{ million}$.
  • Rx Stimulant Use Disorder: $1.5 ext{ million}$.
  • Methamphetamine Use Disorder: $1.6 ext{ million}$.
  • Cocaine Use Disorder: $1.4 ext{ million}$.
  • Heroin Use Disorder: $1.0 ext{ million}$.
  • Note: Numbers are not mutually exclusive; individuals may have disorders for more than one substance.

• 2022 Past Year SUD:

  • No Past Year SUD: $233.3 ext{ million}$ (82.7%)
  • Past Year SUD: $48.7 ext{ million}$ (17.3%)
  • Alcohol Use Disorder: $29.5 ext{ million}$
  • Drug Use Disorder: $27.2 ext{ million}$
  • Marijuana Use Disorder: $19.0 ext{ million}$
  • Rx Pain Reliever Use Disorder: $5.6 ext{ million}$
  • Rx Stimulant Use Disorder: $1.8 ext{ million}$
  • Methamphetamine Use Disorder: $1.8 ext{ million}$
  • Cocaine Use Disorder: $1.4 ext{ million}$
  • Heroin Use Disorder: $0.9 ext{ million}$

Mental Illness and Substance Use Disorders in America (SUD Context)

• 2014: 20.2 million adults with SUD = $20.2 ext{ million}$, about 8.3 ext{%} of adults.
• 2020: 38.7 million adults with SUD = $38.7 ext{ million}$, about 15 ext{%} of adults (the year prior to the pandemic was around 7.7%).
• 2022: In the past year, notations show overlapping conditions with AMI/SMI.

Past Year SUD and AMI/SMI (Overlap and Categories)

• 2022: No Past Year SUD: $233.3 ext{ million}$ (82.7%)
• Past Year SUD: $48.7 ext{ million}$ (17.3%)
• Adults Had SUD but Not AMI: $46.5 ext{ million}$? (note: read as the portion labeled under “Adults Had SUD but Not AMI”)
• Adults Had SUD and AMI (with or without SMI): $21.5 ext{ million}$
• Adults Had AMI (with or without SMI) but Not SUD: $39.1 ext{ million}$
• Adults Had SMI but Not SUD: $7.4 ext{ million}$
• Adults Had AMI (with or without SMI): part of the total; 84.2 million adults had either SUD or AMI (with or without SMI)
• Note: 46.5 million adults with SUD in 2022 = about 17.8 ext{%} of adults.

Effects of Drugs: Objective vs Subjective (Pharmacology vs Experience)

• Objective drug effects: measurable outcomes from direct ingestion of drug; influenced by routes of administration, dose, potency, purity, tolerance, and drug interactions (polydrug use).
  • These concepts will be revisited in Module Three (The Pharmacological Perspective).
• Subjective drug effects: grounded in the experiential reality of the user; influenced by set and setting.
  • Set: expectations, emotional state, or mood.
  • Setting: environment in which use takes place.
  • Set and setting are important nonpharmacological influences.

Effects of Drugs: Acute vs Chronic; Behavioral vs Physiological

• Effects can be positive, negative, or neutral.
• Acute effects (short-term) vs Chronic effects (long-term).
• Behavioral effects:
  • Acute: e.g., reduced inhibitions (as with alcohol).
  • Chronic: e.g., decrease in OCD symptoms after long-term SSRI use.
• Physical/Physiological effects:
  • Acute: e.g., increased heart rate (cocaine).
  • Chronic: e.g., lung cancer from smoking.

Toxicity and Toxic Effects

• Sometimes the effect of a drug may be toxic: poisonous, deadly, or dangerous.
• What makes a drug toxic?
  • Amount used.
  • How it is used.
  • What the user does while on the drug.
• Types of toxicity (to be explored in more depth in future modules):
  • Acute behavioral toxicity
  • Chronic behavioral toxicity
  • Acute physiological toxicity
  • Chronic physiological toxicity

Additional Notes on Context and Caution

• The material emphasizes the importance of context in understanding drug use (biological, psychological, social factors).
• It also highlights the evolving landscape of SUD prevalence over time and its relationship with mental health (AMI/SMI).
• The content cautions against simple, sensational explanations (e.g., “try it once, you’ll be hooked”) and encourages nuanced analysis of social and individual factors.

Quick Reference: Key Formulas and Numbers (LaTeX)

• Past Year SUD prevalence in 2014: 21.5 ext{ million} / 243.6 ext{ million} o 8.1 ext{%}
• Past Year SUD prevalence in 2021: 46.3 ext{ million} o 16.5 ext{% of those aged 12+}
• Alcohol Use Disorder (2021): $29.5 ext{ million}$
• Drug Use Disorder (2021): $16.3 ext{ million}$
• Marijuana Use Disorder (2021): $24.0 ext{ million}$
• Rx Pain Reliever Use Disorder (2021): $5.0 ext{ million}$
• Rx Stimulant Use Disorder (2021): $1.5 ext{ million}$
• Methamphetamine Use Disorder (2021): $1.6 ext{ million}$
• Cocaine Use Disorder (2021): $1.4 ext{ million}$
• Heroin Use Disorder (2021): $1.0 ext{ million}$
• No Past Year SUD (2021): 233.6 ext{ million} o 83.5 ext{%}
• No Past Year SUD (2022): 233.3 ext{ million} o 82.7 ext{%}
• Past Year SUD (2022): 48.7 ext{ million} o 17.3 ext{%}
• SUD total in 2022: 46.5 ext{ million} o 17.8 ext{% of adults}

End of Notes