Chapter 13

Habits that have gotten out of control, with a

resulting negative effect on a persons health. Addiction is the habitual use of a drug produced chemical changes in the users body. Drug Addiction (four important characteristics)
Compulsive desire 2. Need to increase the dosage 3. Harmful effects to the individual 4. Harm to society
1.
2

 Often starts to bring pleasure or to avoid pain.

Harmless or even beneficial if done in moderation

Examples of addictive behaviors: Gambling Compulsive Exercising Work Addiction Sex and love addiction Compulsive buying or shopping Internet addiction Characteristics of people with addition (e.g., risk takers or genetic disposition)
3

 Drugs are chemicals other than food that are intended

to affect the structure or function of the body

Prescription medicines Over-the-counter substances Caffeine Tobacco Alcohol Illegal substances

 The APAs Diagnostics and Statistical Manual of

Mental Disorders authoritative reference Abuse

APA definition Failure to fulfill major responsibilities Drug use in situations that are hazardous Drug related legal problems Drug use despite persistent social or interpersonal problems

Physically dependent may or may not present

 Substance dependence

1. Developing tolerance to the substance 2. Experiencing withdrawal 3. Taking in larger amounts 4. Expressing a persistent desire to cut down 5. Spending great deal of time obtaining 6. Giving up or reducing important activities 7. Continual usage even with recognition of a problem
Diagnosed with at least 3 or more symptoms

during a 12-month period

6

All income and education levels All ethnic groups All ages Young people are at a higher risk Males (Twice as likely) Troubled adolescent Thrill-seeker Dysfunctional families Peer group or family that accepts Low Socio-economical status Dating young
7

 Experiment Escape Reliance Magnification of residence (i.e. the need for escape

from poverty becomes more compelling)

 Psychological risks

Difficulty in controlling impulses Strong need for excitement Feelings of rejection Hostility Aggression Anxiety Mental illness Dual (co-occurring disorders)

 Social Factors
Growing up in a family with drug abuse Peer group Poverty

10

 Intoxication

Side effects
Unknown drug constituents Risks associated with injection drug use

Legal consequences

11

Changes in Brain chemistry Drug factors:

Pharmacological properties Dose-Response function Time-action function Drug use history Method of use (e.g., inhalation, injection, ingest)

12

 Opioids (narcotics)
Natural or synthetic (laboratory-made) Opium, morphine, heroin, methadone, codeine, hydrocodone, oxycodone, meperidine, and fentanly Effects on the body: induced euphoria Methods of administration Injection, snorting, sniffing or smoking Symptoms of overdose: respiratory depression, coma,

constriction of the pupils, or death.

13

 Slow down the overall activity of the CNS

Sedative-hypnotics Types: barbiturates, valium, methaqualone, GHB Effects on the body: reduce anxiety, impair muscle

coordination, induce drowsiness Medical uses: Treat insomnia and anxiety disorders; control seizures From use to abuse (Club Drugs) Overdosing may result in respiratory complications
15

 Speed up the activity of the nervous or muscular

system
Cocaine Methods of use (snort or injection) Effects (euphoria sensation for ~5 to 20 minutes) Use during pregnancy (consequences include: miscarriage, premature labor, stillbirth, and low-birth-weight baby)

16

 Amphetamines Effects (increase in alertness) Dependence (may lead to the development of a temporary state of paranoid psychosis or delusion)
Ritalin (used to treat attention-deficit/hyperactivity

disorder, ADHD) Ephedrine (a less potent form of amphetamines) Caffeine

18

19

 Cannabis Sativa

THC (tetrahydrocannabinol)
Short term effects and uses: euphoria, increases in

sensation, relaxed attitude Long-term effects and uses: respiratory damage such as impaired lung function and chronic bronchial irritation

21

 Altered state of consciousness, perceptions, feelings and

thoughts LSD, Mascaline, DMT, MDMA, Ketamine, PCP (angel dust), and certain mushrooms Altered states of consciousness Flashbacks are perceptual distortions and bizarre thoughts that occur after the drug has been entirely eliminated from the body.

23

 Nearly all inhalants produce effects similar to those of

anesthetics, slow down the bodies functions Volatile solvents Nitrates Anesthetics Methods of use

Sniffing Snorting Bagging Huffing

24

 Medication-assisted treatment Drug substitution Treatment centers Self-help groups and peer counseling

Harm reduction strategies

Codependency
http://www.youtube.com/watch?v=J46pvxFWNTY

25

Tobacco

Use of Tobacco

71 Million Americans, including 13.7 million college-aged Americans. 2008, nearly 21% of Americans age 18 describe themselves as current smokers.

Nicotine Addiction Powerful psychoactive drug Reaches Brain via bloodstream in seconds Most physically addictive of the psychoactive drugs. Loss of control Tolerance and Withdrawal

27

Why Start in the First Place?

Children and teenagers make-up 90% of all new smokers in this country. Thousands of children and adolescents (12-17) start smoking everyday. Average age

13 for smoking 10 for spit tobacco

28

Characteristics which could increase the potential for use.

A parent or sibling uses tobacco Peers use tobacco Child comes from blue-collar family Child comes from low-income home Single parent. Performs poorly in school Child drops out of school Has positive attitudes towards tobacco

29

Reasons Why College Students Smoke

Health Hazards
Contains hundreds of damaging chemical substances,

including acetone (nail polish remover), ammonia, hexamine (lighter fluid), and toluene (industrial solvent). Unfiltered cigarettes = 5 billion particles per cubic mm 50,000 times more than polluted urban air Condensed particles in the cigarette produce the tar (brown, sticky mass)

Chapter 8

31

Health Hazards (cont)

Carcinogens and Poisons
43 chemicals are linked to cancer (Carcinogen)
Benzo(a)pyrene (yellowish tar) Urethane (ex: solution used in making foams)

Cocarcinogens
Combine with other chemicals to cause cancer (e.g., formaldehyde)

Poisonous substances
Arsenic (e.g., insectides and weed killers) Hydrogen cyanide (e.g., flammable liquid used in dye)

Carbon monoxide
400 times greater than is considered safe in industrial workplaces Displaces oxygen in red blood cells

Additives
Nearly 600 chemicals

Chapter 8

32

33

Light and Low-Tar Cigarettes

Low-tar, low-nicotine, or filtered cigarettes No such thing as a safe cigarette Often smoke more

34

The effects of smoking a cigarette

35

Additional Health, Cosmetic, and Economic Concerns

Ulcers Impotence Reproductive health problems Dental diseases Diminished physical senses Injuries Cosmetic concerns Economic costs

36

Cumulative Effects
Males before 15 yrs. old are half as likely to live to 75 versus those who did not smoke Females with similar habits reduce life expectancy by more than 10 years Female smokers spend 17% more sick days in bed than nonsmokers Both men and women show a greater rate of acute and chronic diseases

37

Other Forms of Tobacco

Spit (Smokeless) Tobacco

More than 6.6 million adults 8% of all high school students

Cigar and Pipes

Cigar smoking has increased by 148% from 1993-2006. Cigars contain more tobacco than cigarettes.

Clover cigarettes and Bidis

Twice the tar, nicotine, and carbon monoxide

38

39

The Effects of Smoking on the Nonsmoker

Environmental Tobacco smoke (ETS)

Environmental Protection Agency (EPA) designated

ETS as a class A carcinogen Department of Health and Human Services National Toxicology Program - known human carcinogen Surgeon General 2006 there is no safe level of exposure to ETS; even brief exposure can cause serious harm.

40

Environmental Tobacco Smoke

Mainstream smoke

Smoke exhaled by smokers Smoke from the burning end of a cigarette, cigar, or pipe.

Sidestream smoke

85% of smoke in a room is second hand Twice the tar and nicotine Three times the benzo(a)pyrene Three times the ammonia
Smoke from a cigar can be even more dangerous

30 times more carbon monoxide

41

ETS Effects

Develop cough, headaches, nasal discomfort, eye irritation, breathlessness and sinus problems Allergies will be exacerbated Causes 3,000 deaths due to lung cancer Contributes to about 35,000 overall deaths each year. 20% increase in the progression of atherosclerosis. Contributes to increased asthma attacks

42

How Cigarette Smoking Damages the Lungs

Lung Cancer from Tobacco Smoking

44

Oral Cancer from Tobacco Smoking

45

Oral Cancer from Tobacco Smoking

http://www.youtube.com/w atch?v=0hySFt8O11A

46

Cancer Survivor

47

Infants, Children, and ETS

More likely to develop

Bronchitis, pneumonia,& respiratory infections More complications from asthma Increased chance of SIDS (sudden infant death syndrome) Low-birth weight Bronchitis

Chemicals from smoking show up in breast milk Children inhale three times more pollutants per unit of body weight than adults.

48

Smoking and Pregnancy

Estimated 4,600 infant deaths in the U.S. Miscarriage, premature birth, low birth weight, long term impairments in growth and intellectual development Possible higher risks of getting cancer 16% of pregnant women smoke

49

Cost of Tobacco Use to Society

Lost productivity from sickness, disability, and premature death makes it close to $167 billion per year. 1998 Master Settlement Agreement (MSA)

43 states filed suit against tobacco companies to recoup public health care expenditures Tobacco companies have to pay $206 billion over 25 years. Limits or bans certain types of advertising, promotions, and lobbying.

50

How A Tobacco User Can Quit

50.2 % of all adults who have smoked have quit. The Benefits of Quitting Options for quitting Smoking cessation programs 1-800-QUITNOW

Department of Health and Human Services

Chantix (Varinicline) Zyban (Bupropion)

Smoking cessation products

Nicotine replacement products

Patches, gums, lozenges, nasal sprays, and inhalers

http://www.videojug.com/interview/the-benefits-of-quitting-smoking-2
51

Alcohol

The Nature of Alcohol

Psychoactive ingredient Depressant Ethyl Alcohol only alcohol that can be consumed Beer 3-6% alcohol by volume Malt Liquors 6-8% alcohol by volume Table wines 9-14% alcohol by volume
Fortified wines 20% alcohol by volume Sugar added Extra alcohol is added Hard liquors 35-50% alcohol by volume Distilling or fermented
Fermenting

Proof Value Ingestion

Two times the percentage concentration 7calories per gram 1 drink 14-17 grams or 100-120 calories

53

Absorption
20% is rapidly absorbed from the stomach 75% is absorbed in the upper small intestines Remain is absorbed along the GI track Absorption Carbonation Food in the stomach slows the absorption Eventually all the alcohol ingested will be absorbed

54

Metabolism and Excretion

Transported throughout the body via the

bloodstream. Easily moves through most biological membranes Main site for metabolism is the Liver. 2-20% of ingested alcohol is not metabolized.

55

Chapter 8

56

Alcohol Intake and Blood Alcohol Concentration

Blood Alcohol Concentration(BAC) A measure of intoxication Body weight Percentage of body fat Sex Genetic factors Drinking Behavior Metabolism is the same if the person is

awake or asleep

57

The Immediate Effects of Alcohol on Health

Depends on the individual.

Low Concentrations .03% -.05%.

Higher Concentrations 0.1% -0.2%. Concentration of .35% and higher. Alcohol hangover Alcohol poisoning

Using Alcohol with other drugs

58

Drinking and Driving

In 2004
250,000 were injured in alcohol related automobile

crashes 42,000 people are killed in alcohol related accidents

Dose-response function
Driving with a BAC of 0.14% is more

than 40 times more likely to be involved in a crash. Greater than 0.14% the risk of fatal crash is estimated to be 380 times higher.

59

60

Angels Pitcher Nick Adenhart Killed In Car Crash

April 9, 2009

Two people who were with him were also killed when, according to police, a minivan ran a red light at a Fullerton intersection and broadsided the gray Mitsubishi they were in. The driver of the minivan, Andrew Thomas Gallo, 22, of Riverside, was arrested on suspicion of drunken driving, hit and run and manslaughter.

61

Approximate blood concentration and body weight

2010 McGraw-Hill Companies. All Rights Reserved.

62

The Effects of Chronic Use

Diseases of the digestive, cardiovascular systems and some cancers Digestive system Liver function liver cell damage and destruction (cirrhosis) Pancreas inflammation Cardiovascular system moderate doses may reduce the risk of HD Higher doses elevates BP, may weaken heart muscle or cardiac myopathy. Cancer

Mouth, throat, larynx, and esophagus

Responsible for the most common form of liver cancer Breast cancer
Hepatitis speeds the growth of this cancer Increase risk when 2-3 drinks per day

5-6 total drinks

Brain Damage

Cognitive impairments Memory loss, dementia, and compromised problem-solving Wernicke-Korsakoff syndrome (brain damage) Alcoholics average life expectancy is about 15 years less than non-alcoholics

Mortality

63

64

The Effects of Alcohol use During Pregnancy

Effects are dose-related.

Fetal Alcohol Syndrome (FAS) Full-blown FAS occurs in up to 15 out of every 10,000 live births in the U.S. Under weight, flat nasal bridge, and long upper lip. Small and have heart defects. Physical and mental growth is slowed. Remain mentally impaired. Fine motor skill problems, coordination, learning and behavioral problems (ADS). Alcohol-related neurodevelopment disorder (ARND).

65

Possible Health Benefits of Alcohol

Abstainers and light to moderate drinkers live longer

than heavy users. 35 years old and younger, your odds of dying increase in proportion to the amount consumed Moderate drinking = one drink per day for women and two drinks per day for men.

May lower coronary heart disease. Raising blood levels of HDL. May lower risks of diabetes, arterial blockages, Alzheimers

66

Alcohol Abuse and Dependence

Alcohol abuse is recurrent use that has negative

consequences.

problems, tolerance and withdrawal Warning signs of alcohol abuse

Alcohol dependence or Alcoholism more extensive

Drinking alone Using deliberately and repeatedly Feeling uncomfortable on certain occasions Escalating consumption Getting drunk regularly Drinking in the morning or unusual times

67

Alcohol Abuse and Dependence

Binge Drinking The National Institute on Alcohol Abuse and Alcoholism

defines:

National Survey on Drug Use and Health defines: Having five drinks in row for a man or four in a

Pattern of alcohol use that brings a persons BAC up to 0.08 or above (typically four drinks for a male or three for a women) within two hours. a women within two hours.

row for

Frequent binge drinking in college were three to seven

times more likely than non-binge drinkers to engage in unplanned or unprotected sex Healthy People 2010 Reduce the rate of binge drinking to 20% among college students
68

Alcoholism
Patterns and Prevalence 1. Regular daily intake of large amounts 2. Regular heavy drinking limited to weekends 3. Long periods of sobriety interspersed with binges or daily heavy drinking 4. Heavy drinking limited to periods of stress Health Effects DTs (delirium tremens) paranoia Social and Psychological effects Causes of Alcoholism
Video: http://www.youtube.com/watch?v=gTPjlN7VR7c

70

Treatment Programs
Not one program works for everyone.
AA. 12-step program Employee Assistance. Inpatient hospital rehabilitation Pharmacological treatments. Disulfiram (Antabuse) Inhibits the metabolic breakdown Naltrexone (ReVia, Depade) Reduces the craving for alcohol and decreases its pleasant effects. Injectable Naltrexone (Vivtrol) single monthly shot Acamprosate (Campral) Acts on brain pathways related to alcohol abuse.

71

Gender and Ethnic Differences

Men

teens or twenties) Other men (remain controlled drinkers until later in life) Women (alcoholism often occurs later in life) African Americans (alcohol abuse usually found in African Americans) Latinos (drinking patterns vary) Asian Americans (low rate of alcohol abuse) American Indians and Alaska Natives (excessive drinking varies from tribe to tribe)
http://www.cbsnews.com/video/watch/?id=5024746n

White American men (excessive drinking often begins in the

Chapter 8

72

Video Segment: The Effects of Drug Use on Brain Chemistry

http://www.youtube.com/watch?v=J46pvxFWNTY http://www.aetv.com/intervention/video/?bcpid=534114 97001&bclid=129113967001&bctid=115543473001 http://www.aetv.com/intervention/video/?bcpid=534114 97001&bclid=64419253001&bctid=64670639001

73