Social Work - Ch.8
Learning Objectives
LO1 - Define drugs and substance abuse.
LO2 - Understand a brief history of our drug-taking society.
LO3 - Comprehend sociological theories of substance abuse.
LO4 - Describe drug subcultures.
LO5 - Summarize facts about and effects of commonly used substances.
LO6 - Describe rehabilitation programs for substance use disorders.
LO7 - Specify suggestions for curbing substance abuse in the future.
Drugs and Substance Abuse
Drug - any substance that chemically alters the function or structure of a body of an animal or person
In a social problems approach, a drug is any habit-forming substance that directly affects the brain and the nervous system. It is a chemical or substance that affects moods, perceptions, body functions, or consciousness, and that has the potential for misuse because it may be harmful to the user.
Substance Use Disorder - the regular or excessive use of a substance when, as defined by a group, the consequences endanger relationships with other people, are detrimental to the user’s health, or jeopardize society itself
This definition identifies two key factors that determine what is considered substance abuse in a society: substance effects and a group’s perception of the effects.
Perceptions of society’s use of certain drugs varies. Alcohol and tobacco aren’t considered bad if used in small doses, but it can cause health problems.
The dominant social reaction to a drug is influenced not only by the actual dangers of the drug but also by the social characteristics and motives of the groups that use it. Heroin is associated with crime while alcohol is associated with better terms but can still be seen as lazy
Certain demographics may get the pass for using certain drugs such as stress or pain relieving, but others won’t (middle-aged people vs college students)
Drug companies spend millions to convince people that their drugs can solve their problems
Many Americans take the easy way out by using drugs instead of making lifestyle changes
Summary:
Americans use and abuse drugs for numerous reasons: to feel good, to get high, to escape from reality, to obtain relief from pain or anxiety, and to relax or sleep. Drugs definitely meet a functional need (such as providing temporary relief from unwanted emotions) but can have serious side effects. Society reacts differently depending on the drugs, alcohol is more than likely associated with parties, while heroin is associated with crime so it’s lets acceptable. Depending on older age, you may be passed for using certain drugs that stress relief or pain relief, but younger adults are not.
A Brief History of Our Drug-Taking Society
1620s - Alcohol, when the pilgrims landed in America
1860s - Narcotic addiction due to them being sold over the counter (grocery store, pharmacy, etc). A lot of soldiers used this during WW1 to help with injuries but became addicted
1870s - In colonial times, tobacco was a popular substance for chewing, and after 1870 its use for smoking increased greatly.
1960s-1970s - Marijuana, The drug was then thought to lead to “unruly” behavior, and the first laws prohibiting its use and distribution were passed in the South during the start of the 20th century. In the 1960s and 1970s, it became popular among youths, college students, drug subcultures, and the general population. The effects remain a controversial issue but recently focus has been on the medical benefits
1980s - Crack Epidemic,
Summary:
The use of alcohol and substances have been used since the Pilgrims got here. Throughout history, the use of drugs has been a common problem. Shortly after 1900, tobacco’s sale was prohibited in 14 states because it seen as a “stepping-stone” to alcohol use and lead to other bad things. Marijuana has been controversial, in earlier societies, it was seen as bad, in 1937 the director of the Federal Bureau of Narcotics labeled marijuana the “assassin of youth. Marijuana use increased from the 1960s to 1970s and now, it has been used as a medical and recreational drug and legalized by most states. Following prohibition the use of alcohol surprisingly increased. People in the middle and upper-middle classes also began drinking more frequently As a result, alcohol was no longer viewed as the scourge of society.
Sociological Theories of Drug Abuse
Anomie (deviant) Theory
work of Emile Durkheim and Robert Merton
basically, people may be driven to do anything to achieve their goals. In society, making money is highly approved and a high paying job helps with that. When a person isn’t able to get either of these things, they may resort to other methods of making money. Such as substances or they may be used as substances for highs
Merton states that substances use can be reduced if society
sets realistic goals that people can attain and then
establishes legitimate means, available to everyone, for attaining these goals.
Labeling Theory
People may use substances secretly, after some time, they may be caught by family members or police. Then, they may be labeled as a “pothead” or “drunk”. Subsequently, they are more watched, and if they’re found again, the label is more confirmed to people.
Other labels: “alcoholic or pill popper”
Differential Association
developed by Edwin Sutherland
behavior is determined primarily by the values and actions that are considered important by the small, intimate groups one interacts with (peer pressure)
groups include family, neighborhood peer groups, religious groups, and social groups
Drug Subcultures (LO4)
A group of peers who advocates the use of one or more drugs can be called a drug subculture.
usually occur around illegal drugs
they do serve important functions for the user. They provide instruction on how to use the substance, different effects, and source of enjoyment
In a classic study, “Becoming a Marijuana User,” Howard Becker found that the peer group plays a large role in a person’s drug use as they teach the person how to smoke and help them experience a high
Facts about, and Effects of, Commonly Used Drugs (LO5)
Depressants
Alcohol
1) Who uses it? - primary factors related to whether an individual will drink and how much alcohol a drinker will use include
biological factors - close people of a relative are 4x more likely to become alcoholics showcasing how biological family matters
socioeconomic factors - more frequent in men at high socioeconomic levels and less frequent in women at less socioeconomic levels
gender - men are more likely to abuse alcohol but women have been using it more since the taboo of it has decreased and their roles have changed
age - Older people are less likely to drink than younger people. Heavy drinking is most common at ages 21 to 30 for men and ages 31 to 50 for women.
urban–rural residence - Urban residents are more likely to drink than rural residents.
In the past two decades, there has been an increase in awareness about the dangers of drinking
orgs created, laws created and stricter, increased age to drink
Despite these promising trends, however, rates of alcohol use and abuse in the United States remain high
Observable when the concentration of alcohol in the blood reaches one tenth of 1%
2) Reasons for Drinking? - Alcohol is expected at many rituals and ceremonies for adults: weddings, birthday parties, Christmas parties, graduations. Some formal religious rites also include alcohol (communion)
A lot of people drink to cope, relax, sleep, get rid of unwanted emotions (loneliness, trauma, etc.
3) Health Problems Caused by Drinking? - alcoholics life expectancy is 10-12 years lower than nonalcoholic
Alcohol has high amounts of calories. As a result, have a reduced appetite for nutritious food, may suffer from vitamin deficiencies, and are highly susceptible to infectious diseases.
Sometimes two drugs taken together have a synergistic interaction, meaning that they create an effect much greater than either would produce alone.
Other drugs tend to have an antagonistic response to alcohol, meaning that one drug negates the effects of the other.
Gradually destroys liver cells
Cancer
death by suicide (accidental or purposely
4) Drinking and Driving? - Alcohol is a contributing factor in approximately 30% of all automobile fatalities and in many serious automobile injuries.
5) Alcohol and Crime? - Alcohol is also commonly associated with major crimes and increases the likelihood of crimes
6) Effects of Alcohol Abuse on the Family? - in the past, the alcoholic of the family was mostly the father, but now that has changed, some women and teenagers may be the alcoholic
It can cause many family problems, marriage with an alcoholic often ends in divorce and children of alcoholics have higher rates internal and external problems
Family problems: child abuse, child neglect, spouse abuse, parent abuse, financial problems, unemployment of wage earners, violent arguments, and unhappy marriages
Sharon Wegscheider indicates that members of “alcoholic families” tend to assume roles that both protect the chemically dependent person from taking responsibility for their behavior
Roles:
Chief enabler - takes on more and more responsibility as the abuser releases control. Usually a parent a significant other
Hero - A positive influence is needed to offset the negative. Seen as perfect. Provides the family with self-worth.
Scapegoat - is targeted with the blame. Often behaves in negative ways (gets caught for stealing, runs away, becomes extremely withdrawn), which draws the spotlight to them. Helps the family avoid addressing the problem of the substance use disorder.
Lost Child - purpose is to provide relief to the family from some of the pain it is suffering
Mascot - might be suffering inside, they provide a little fun for the family
7) Alcohol and Industry? - use disorders cost businesses billions of dollars annually.
8) Alcoholism Gene Theory? - Biological research has primarily focused on the role of genetics in predisposing an individual to drug use. Research suggests that persons who experience severe early-onset alcoholism may be genetically predisposed
these people also may experience more pleasure from drugs
9) Avoiding Treatment for Alcohol Use Disorder? - Many people who struggle with alcohol abuse refuse to get help and are in denial. They make excuses for why they drink. Some see it as essential to their lives, using it to escape from their reality. This detachment can lead to the crumbling of their life. The denial is what must be confronted
10) Fetal Alcohol Syndrome? - Heavy alcohol consumption by pregnant mothers can cause a variety of conditions in the new baby that, taken together, have been labeled fetal alcohol spectrum disorder. This syndrome can lead to disabilities, deformations, emotional, etc
Barbiturates
Illegal unless prescribed by a physician
Depress the central nervous system.
Relieve insomnia and anxiety, used to treat epilepsy and high blood pressure, and to relax patients before or after surgery
Effects - similar to strong alcohol. Users experience relief from inhibitions, feeling of euphoria, feel “high” or in good humor, and are passively content. However, these moods can change rapidly to gloom, agitation, and aggressiveness. Physiological effects include slurred speech, disorientation, staggering, confusion, drowsiness, and impaired coordination.
Withdrawal symptoms can cause fatal convulsions
Act synergistically with alcohol
Taken orally, although some inject them intravenously
Benzodiazepines
Xanax, Librium, Ativan, Klonopin, Halcion, and Valium
They reduce anxiety, relax muscles, and act as sedatives
Usually taken orally
Effects - include slurred speech, disorientation, and behavior resembling intoxication
Withdrawal symptoms are similar to alcohol and barbiturates
Date-Rape Drugs
Rohypnol is one of them
Rohypnol often causes blackouts, with complete loss of memory.
smuggled in from Mexico and Colombia.
Relatively inexpensive
Hoffmann-LaRoche, announced it will only sell a new version that would cause any liquid that it is slipped into to have a blue color. In response to the reformulated blue tablets, people who intend to commit a sexual offense serve blue tropical drinks and to disguise the drug
Gamma hydroxy butyrate (GHB) is another
Can be made at home from a mixture of chemicals purchased in stores normally used in cleaning
Alcohol is another
PCP
Phencyclidine legal today only for veterinary medicine
It distorts the senses, disrupts balance, confusion, paranoia, emotional disturbances
easy to prepare as ingredients are widely available
Another dangerous effect is that one-time users sometimes have flashbacks in which hallucinations are reexperienced, even long after use has ceased
Effects of Alcohol in the Blood
Alcohol Effects
.05% Lowered alertness and a “high” feeling
.10 Decreased reactions; reduced coordination (legally drunk in most states)
.20 Massive interference with senses and motor skills
.30 Perceptions nearly gone; understanding nearly gone
.40 Unconsciousness
.50 Potential death
Stimulants
Caffeine
Effects: reduces hunger, fatigue, and boredom and improves alertness and motor activity
Excessive amounts of caffeine cause insomnia, restlessness, and gastrointestinal irritation and death.
Can be addictive
labeled as a nondrug in society and lack of criminal activity associated with it
Withdrawal: frustration and irritable
Amphetamines
Called uppers
Adderall, Ritalin, Methamphetamine, Dextroamphetamine, and Lisdexamfetamine.
increase alertness and performance for relatively short periods of time
Effects: Consumption of fat stored in body tissues is accelerated, heartbeat increased, respiratory processes stimulated, appetite reduced, and insomnia is common. Feel euphoric, stronger, increased concentration, and express themselves verbally more often.
Amphetamines are usually taken orally in tablet, powder, or capsule form. They also can be sniffed or injected.
An amphetamine that has maintained frequency in illegal use is methamphetamine hydrochloride, known on the street as “meth” or “ice.”
Withdrawal: sleep disturbances, apathy, decreased, activity, disorientation, irritable, exhaustion, and depression
Cocaine and crack
Cocaine
Taken through “sniffing”
Effects: leads to increased strength and endurance. It also is thought by users to increase creative and intellectual powers. Feeling of euphoria, excitement, restlessness, and a lessened sense of fatigue.
Longer uses can lead to hallucinations and some experience formication
Withdrawal: usually results in intense depression and despair
Babies who are exposed to crack
New technology has demonstrated that these babies do show more subtle deficits as they age that include behavior problems, difficulty regulating emotions, deficits in cognitive performance, and difficulty paying attention to tasks when compared to babies who were not exposed to cocaine
other factors matter as well though, not just cocaine
Crack
Obtained from cocaine by separating ingredients through mixing water and ammonium hydroxide
A lot agree crack is highly addictive as many people say they want another immediately after finishing one
The “rush” is more immediate than cocaine and intensified highs
Withdrawal effects include an irresistible compulsion to have the drug, as well as apathy, long periods of sleep, irritability, extreme fatigue, depression, and disorientation.
Cocaine and crack can have serious effects on the heart, high blood pressure, interrupted heart rhythm, and raised pulse rates. Cocaine and crack may also damage the liver. Severe convulsions can cause brain damage, emotional problems, and sometimes death. Smoking crack may also damage the lungs.
Amyl nitrate and butyl nitrate
Amyl nitrate
‘poppers”
legal only by prescription
If the vapor is sniffed, the user’s blood vessels are immediately dilated, and there is an increase in heart rate.
these physical changes create feelings of mental excitation (“head rush”) and physical excitation (“body rush”)
Side effects: fainting, headaches, dizziness
Butyl nitrate
legally available in some states without a prescription and has an effect similar to that of amyl nitrate
unpleasant side effects that may include fainting, headaches, and dizziness. A few deaths have been reported due to overdoses.
Narcotic
Most commonly used narcotic drugs in the United States are the opiates (such as opium, heroin, and morphine).a
Opium is usually smoked, although it can be taken orally. Morphine and heroin are either sniffed (snorted) or injected into a muscle or a vein (called “mainlining”), which maximizes the drugs’ effects.
Effects: Feelings of tranquility, drowsiness, euphoria, sense of well-being, which makes pain, anxiety, or depression seem unimportant.
Withdrawals: convulsions, coma, and in rare cases, death by respiratory failure.
There have been lawsuits against pharmaceutical companies for their role in “pushing” addictive opioids to physicians, and ultimately consumers.
Withdrawal process is very unpleasant. Symptoms include chills, cramps, sweating, nervousness, anxiety, runny eyes and nose, dilated pupils, muscle aches, increased blood pressure, severe cramps, nausea, and fever
The Centers for Disease Control and Prevention estimated that the total “economic burden” of prescription opioid misuse alone in the United States is $78.5 billion a year
Because the price of illicit narcotic drugs is so high, organized crime has made huge profits in the smuggling and distribution of these drugs. There is currently an opioid crisis.
Many first responders are carrying rescue medication such as naloxone or Narcan
Fentanyl
Fentanyl is said to be 10–50 times more potent than morphine
Heroine
Heroin slows the functioning parts of the brain. The user’s appetite and sex drive tend to be dulled. After an initial feeling of euphoria, the user generally becomes lethargic and stuporous.
Hallucinogens
Most common in the US are mescaline (peyote), psilocybin, psilocin, LSD, and ecstasy.
These drugs distort the user’s perceptions, creating hallucinatory impressions of “sights and sounds” that do not exist.
Taken orally
Peyote
Derived from a cactus plant. Mescaline is the synthetic form of peyote.
Psilocybin and psilocin
are found in approximately 90 different species of mushrooms (called “magic mushrooms”)
LSD
is a synthetic material derived from a fungus (ergot) that grows on rye and other plants. It’s one of the most potent drugs known
Users report “seeing” sounds and “hearing” colors. Colors may seem unusually bright and shift kaleidoscopically, and objects may appear to expand and contract.
Physical reactions include increased heartbeat, goose bumps, dilated pupils, hyperactivity, tremors, and sweating. Aftereffects include anxiety or depression. Flashbacks sometimes occur
Ecstasy
Developed and patented in the early 1900s as a chemical forerunner in the synthesis of pharmaceuticals.
Effects last approximately 3 to 6 hours, although confusion, depression, sleep problems, anxiety, and paranoia have been reported to occur even weeks after the drug is taken
sometimes used by young adults at all-night dance parties, such as “raves.”
high doses can be extremely dangerous. It can lead to dehydration, hypertension, and heart or kidney failure, increase in body temperature. Chronic use of ecstasy can produce long-lasting, perhaps permanent, damage to the neurons that release serotonin and thus result in memory impairment.
Tobacco
Recognized as one of the most damaging drug habits in the United States.
Causes emphysema, cancer of the mouth, ulcers, and lung cancer, reduced life expectancy. Smoking significantly increases the risk of strokes and heart disease, particularly in women who use birth control pills
Leads to 500,000 deaths per year and most are from heart disease and lung cancer
16 million with smoking related illness
Newer form of tobacco products is targeting adolescents called vaping or e-cigarettes.
E-cigarettes (also called e-cigs, vapes, or mods) are devices. Some labels do not inform consumers that the cigarettes contains nicotine. Additionally, users may also add other substances, such as marijuana, to the e-cigarette to intensify the effects.
Withdrawal from use leads people to become restless, irritable, and depressed and to have an intense craving to smoke.
In the biggest civil settlement in U.S. history, tobacco companies agreed in 1998 to pay more than $240 billion to the 50 states to settle claims against the industry for health care costs blamed on tobacco-related illnesses
A major objective of the deal is to discourage children from smoking
Marijuana
comes from the hemp plant Cannabis sativa
sense of relaxed well-being, decreased anxiety, and freedom from inhibition from smoking
may induce feelings of joyousness, hilarity, and sociability. It may lead to talkativeness, disconnected ideas, a feeling of floating, and laughter. Sometimes marijuana intensifies sensory stimulation, creates feelings of enhanced awareness and creativity, and increases self-confidence.
withdrawal, however, may be very unpleasant, with the user suffering from insomnia, hyperactivity, and loss of appetite.
voiced concerns about marijuana is that it will be a “gateway drug”
may be useful in treating illnesses such as epilepsy, managing some symptoms of multiple sclerosis, controlling severe nausea caused by cancer chemotherapy, and increasing appetite in HIV patients.
36 states and the District of Columbia have enacted laws to legalize medical marijuana and 17 states have legalized recreational marijuana.
Anabolic Steroids
are structurally similar to the male hormone testosterone
they are still used by some athletes, bodybuilders, and teenagers who want to increase muscle mass and increase strength
Steroids can cause temporary acne and balding, upset hormonal production, and can damage the heart and kidneys. Doctors suspect that they may also contribute to liver cancer and atherosclerosis.
Steroid drug users are prone to moodiness, depression, and irritability and are likely to experience difficulty in tolerating stress
Most users who try to quit wind up back on steroids. A self-image that relies on a steroid-enhanced physique is difficult to change.
Alcohol Treatment Programs
Describe Rehabilitation Programs for Substance Use Disorders (LO7)
Motivational treatment
William R. Miller and Stephen Rollnick (1981) are generally recognized as the founders of motivational interviewing
Motivational interviewers seek to convey an understanding of the challenges that clients face in recognizing they have an issue and being supportive of the efforts that clients need to make in order to make constructive changes
Other drug treatment programs
Inpatient and residential programs
Community mental health centers, specialized substance abuse rehabilitation centers, and some medical hospitals provide this
Detoxification, which occurs mainly in a medical setting, lasts from 24 hours to 3 weeks, sometimes even longer
For people individuals who are unable to end the dependency while remaining in the community or in need of medical support for substance
Outpatient programs
For people who no longer need inpatient care, as well as for those who have a good chance of terminating their habit without having to be hospitalized.
Less intense than inpatient, generally lasts 3 to 6 months.
provided by community mental health centers, specialized rehabilitation centers for treating chemical abuse, medical hospitals, and outpatient clinics
Self-help programs (Alcoholics Anonymous-AA)
Modeled after Alcoholics Anonymous, there are many self-help programs for abusers. They include Narcotics Anonymous, Heroin Anonymous, Cocaine Anonymous, Pills Anonymous, and Marijuana Anonymous
Halfway houses
Assist those who are detoxified and able to reenter their communities and people who are psychologically dependent and want to kick a habit but don’t need to be hospitalized
provide counseling services (both one-to-one and group) to help residents remain substance-free and work on resolving other personal problems they face
halfway houses emphasize the importance of residents’ assuming responsibility for their actions and behaviors.
slow transition into society, with support
Treatment using drugs
Medication-assisted treatment (MAT)
Antabuse - causes intense flushing, increased pulse rate, and nausea, often to the point of vomiting.
naltrexone - It has been found to reduce relapse rates after abstinence, as it reduces the craving for alcohol
prevent opioid users from feeling the euphoria they crave
acamprosate - used to reduce the craving for alcohol
believed to only work if combined with support groups and abstinence from alcohol
All of these substances are meant to help cure drinking problems
alcohol becomes a best friend or coping mechanism which helps a person relive their stress they encounter. Many are hesitant are giving up alcohol
confrontation should be made by family members, ensuring all are present, and it should be documented
One of the biggest reality shocks of a “new” social worker is that many clients are not motivated to make the necessary changes to improve their well-being
the process is not linear to helping someone become alcohol free
Nagging” the individual will only increase family arguments and may provoke the individual into verbally or physically abusing someone,
What is more productive for the other family members is to isolate themselves from the individual when they are drunk—perhaps by taking a walk, talking with support systems, or if need be, locking themselves in a room.
The best-known and most successful program for helping drinkers is Alcoholics Anonymous
AA stresses the following precepts:
(a) confessing to the group that one has a drinking problem,
(b) recounting to the group past experiences with the drinking problem and plans for handling the problem in the future, and
(c) phoning another member of the group whenever one feels an intense urge to drink.
AA does, however, assert that faith in some higher power is a tremendous help in recovery because such a belief offers a source of limitless power, hope, and support whenever one feels one has come to the end of one’s resources.
AA is very inclusive and create a safe space for people to not feel judges
It offers a sense of hope since people who are alcoholics see people who used to be, and realize they don’t need alcohol to cope with their life circumstances
Newcomers learn that AA is the means of staying away from that first drink. AA also serves to reduce the stress that compels people to drink by providing a comfortable and relaxed environment and by having members helping each other to find ways to reduce the stresses encountered in daily living. AA meetings and members become a safe port that is always there when storms start raging. AA helps members to be programmed from negative thinking to positive thinking. The more positive a member’s thinking becomes, the more stress is relieved, the better they begin to feel about themselves, the more the compulsion to drink decreases, and the more often and more effectively the person begins to take positive actions to solve their problems.
“Helper therapy principle”; that is, the helper gains psychological rewards by helping others. Helping others leads the helper to feel “good” and worthwhile and also enables the helper to put their own problems into perspective by seeing that others have problems that are as serious, or even more serious
Most therapists now believe that alcohol is used to meet some need—the need for socialization, relaxation, escape from trauma, self-medicating, and so on. If treatment is to be successful, it must provide alternatives for satisfying these needs: by helping the individual to find a new circle of friends, to learn other ways to relax, to address mental health issues, to learn to handle life’s problems better
People go through a process when they make positive changes in their lives. Prochaska and DiClemente (1982) have conceptualized this process:
Stage 1: Precontemplation - A person is not seeing a need for a lifestyle change.
Stage 2: Contemplation - A person is considering making a change but has not decided yet.
Stage 3: Preparation - A person has decided to make changes and is considering how to make them.
Stage 4: Action - A person is actively doing something to change.
Stage 5: Maintenance - A person is working to maintain the change or new lifestyle. There may be some temptations to return to the former behavior or even small relapses.