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Chapter 17.doc

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Wilfrid Laurier University
Leanne Hagarty

• The pathological use of substances falls into 2 categories o Substance abuse o Substance dependence  presence of at least 3 of the following  The person develops tolerance, indicated by larger doses of the substance being needed to produce the desired effect or the effects of the drug becoming markedly less if the usual mount is taken  Withdrawal symptoms (negative physical and psychological effects when they stop taking it)  The person uses more of the substance or uses it for a longer time than intended  The person recognizes excessive use of the substance, he/she may tried to reduce usage but has been unable to do so  Much of the person’s time is spent in efforts to obtain the substance or recover from its effects  Substance use continues despite psychological or physiological problems caused or exacerbated by the drug  The person gives up or cuts back participation in many activities • Substance dependence is diagnosed as being accompanied by physiological dependence (aka addiction) if either tolerance or withdrawal is present • For less serious diagnoses of substance abuse, the person must experience 1 of the following as a result of recurrent use of the drug o Failure to fulfill major obligations o Exposure to physical dangers o Legal problems o Persistent social or interpersonal problems • Substance intoxication: ingestion of a substance affects the CNS and produces maladaptive cognitive and behavioural effects • If a person addicted to a drug is denied it and then experiences withdrawal, the person receives a diagnoses of both substance dependence and substance withdrawal Alcohol Abuse and Dependence • Alcoholic doesn’t have a precise meaning • Alcohol abuse: used to refer to both aspects of excessive and harmful use of alcohol • Alcohol dependence: may include tolerance or withdrawal reactions (people who are physically dependent on alcohol) • In withdrawal the person is often anxious, depressed, weak, restless and unable to sleep • Delirium tremens (DTs): when the level of alcohol in the blood drops suddenly the person has hallucinations (happens when a person has been C h a p t e r 1 2 : S u b s t a n c e R e l a t e d D i s Page 14 r s drinking for a number of years). They may feel like spiders are crawling on them, feel feverish, disoriented and terrified • The person who abuses alcohol, in contrast to the person physically dependent on it, experiences negative social and occupational effects from the drug but does not show tolerance, withdrawal, or the compulsive drinking patterns seen in the person who is alcohol dependent • Alcohol abuse or dependence is often part of polydrug abuse using or abusing more than one drug at a time o Alcohol serves as a cue for smoking; smoking is 2x as frequent in situations where a person is also drinking o Comorbid with nicotine because nicotine can induce tolerance for the rewarding effects of alcohol and vise versa o These cause problem because drugs taken together are synergistic the effects of each combine to produce an especially strong reaction Prevalence of Alcohol Abuse and Comorbidity with other disorders • Prevalence 20% for men and over 8% for women  declines with age • Problem drinking is comorbid with mood and anxiety disorders and with other drugs use and schizophrenia • It’s a factors in 25% of suicides Course of the Disorder • The histories of alcohol dependent people do show a progression from alcohol abuse to alcohol dependence but data shows considerable fluctuations in drinking patterns from heavy drinking from some periods of time to abstinence or lighter drinking at others • Heavy use of alcohol may be restricted to weekends or long periods of abstinence may be interspersed with binges of continual drinking for several weeks • There is no single pattern of alcohol abuse • This Jellinek’s account doesn’t apply to women. For women the interval between the onset of heavy drinking and alcohol abuse is briefer than it is for men • Women with drinking problems tend to be steady drinkers who drink alone and are more unlikely than men to binge Costs of Alcohol Abuse and Dependence • Alcohol abuse is the 4 leading cause of worldwide disability than the use of tobacco or illegal drugs • Problem drinkers use health services 4x more than do non abusers, and their medical expenses are twice as high as those of non drinkers • Alcohol is associated with many problems, deaths, assaults and accidents Short-term effects of Alcohol • Alcohol is metabolized by enzymes after being swallowed and reaching the stomach • Most goes to the small intestines and is broken mostly by the liver (which can metabolize about 50%/hour) • The excess quantities stay in the bloodstream C h a p t e r 1 2 : S u b s t a n c e R e l a t e d D i s oPage 14r s • Absorption of alcohol is rapid but removal is always slow • The effects of the drug vary with the level of concentration of the drug in the bloodstream, which in turn depends on the amount ingested in a particular period of time, the presence or absence of food in the stomach to retain the alcohol and reduce its absorption rate, the size of a person’s body and the efficiency of the liver • It has biphasic effect which means the initial effect of alcohol is stimulating – the drinker experiences an expansive feeling of sociability and well-being as the blood-alcohol levels rises- but after the blood- alcohol level peaks and begins to decline, alcohol acts as a depressant that may lead to negative emotions • Motor coordination, balance, speech, and vision is also impaired • Large doses can cause sedation, sleep and even death • Alcohol stimulates GABA receptors, which may be responsible for reducing tension, it also increases the level of serotonin and dopamine (pleasurable effects) • Alcohol also inhibits glutamate receptors; which may cause the cognitive effects of alcohol intoxication (slurred speech and memory loss) • People who actually drink alcohol also report increased sexual arousal, even though alcohol actually lowers physiological arousal (which may be caused by cognition) Long-term effects of Prolonged Alcohol Abuse • Almost every tissue and organ of the body is affected adversely by prolonged consumption of alcohol  malnutrition may be severe • In older chronic alcohol abusers, a deficiency of B-complex vitamins can cause amnestic syndrome, a severe loss of memory for both recent and long-past events • Cirrhosis (some liver cells become engorged with fat and protein, impeding their function; some cells die- triggering the inflammatory process) of the liver is caused by prolonged alcohol use with reduced protein • Damage to the endocrine glands and pancreases, heart failure, hypertension, stroke, and capillary haemorrhages, which are responsible for the swelling and redness in the face (nose) • Prolonged use of alcohol appears to destroy brain cells • Reduces effectiveness of the immune system and increases susceptibility to infection and cancer • Women’s risk of breast cancer increases steadily with drinking • Heavy alcohol during pregnancy causes mental retardation (the growth of the fetus is slowed, and cranial ,facial and limb abnormality are produced) -- fetal alcohol syndrome • Some say that light amounts of alcohol may actually have its physiological gains but it’s still a controversy Inhalant use Disorders C h a p t e r 1 2 : S u b s t a n c e R e l a t e d D i s o Page 14 s • An alarming number of young people begin their substance abuse by inhaling such substances as glue, white-out correction fluid, spray paint, cosmetics, gasoline, household aerosol sprays and the nitrous oxide found in spray cans of whipped cream • Peak age of inhalant use is 14-15 years of age (initial onset as young as 6) • Involves behaviours such as sniffing, huffing and bagging • Most inhalants act as a depressant and can be seen as similar to alcohol and sedatives • End up feeling euphoria and psychic numbing, but inhalants can cause damage to the CNS too • Hallucinations, memory problems and dizziness can also occur • Nausea and subsequent headaches are experienced eventually in almost all cases Nicotine and Cigarette Smoking • Nicotine is the addicting agent of tobacco; it stimulates receptors called nicotinic receptors in the brain  stimulates the dopamine neurons in the mesolimbic area (involved in producing the reinforcing effects of most drugs) Prevalence and Health Consequences • Smoking has caused more than 45 000 deaths annually in Canada • Health risks for smoking are significantly less for cigar and pip smokers because they seldom inhale the smoke into their lungs, but cancer of the mouth are increased • Risks  lung cancer, emphysema, cancer of the larynx and of the esophagus, and a number of cardiovascular disease • The most harmful components of smoke from burning tobacco are nicotine, carbon monoxide and tar; the latter consists primarily of certain hydrocarbons, including known carcinogens • Smoking decline greatly after 10 years after quitting • Students smoke the most when not living at home but not compared to US students Consequences of Second-Hand Smoke • The smoke coming from the burning end of a cigarette contains higher concentrations of ammonia, carbon monoxide, nicotine and tar than does the smoke actually inhaled by the smoker  second hand smoke or environmental tobacco smoke (ETS) • 50 000 deaths/year in the US • 2x more nicotine is inhaled by the second person, 2/3 enters the air around the smoker • It aggravates symptoms in people with allergies and asthma, and can cause eye, nose, and throat irritations, headaches, dizziness, nausea, coughing and wheezing • Infants exposed to it have more chance of suffering chronic respiratory illness, impaired lung function, middle ear infections and food allergies • Smoking is banned in many public places now C h a p t e r 1 2 : S u b s t a n c e R e l a t e d D i s oPage 14r s Marijuana • Marijuana consists of dried and crushed leaves and flowering tops of the hemp plant • Cannabis sativa is the most often smoked, but may be chewed, prepared as eta or eaten in baked goods • Hashish: much stronger than marijuana and is produced by removing and ring the resin exudates of the tops of high quality cannabis plants • Originally the hemp plant was used in manufacturing cloth and rope but then it was noted for its treatment for rheumatism, gout, depression, cholera and neuralgia • When alcohol was banned more and more people started using this for pleasure Effects of Marijuana Psychological Effects • Intoxication depends on its potency and size of dose • Makes them feel relaxed and sociable • Large doses bring rapid shifts in emotion, to dull attention, to garment thought and to impair memory • Time seems to move more slowly • Extremely heavy doses – hallucinations and other effects similar to LSD (extreme panic) • Major active chemical in marijuana is delta-9-tetrahydrocannabinol (THC) • The amount of this is variable • Daily users are more likely to use multiple substances and suffer from an anxiety disorder • Being high on marijuana impairs the complex psychomotor skills necessary for driving • Studies show a diminished IQ score for heavy users but not light users Somatic Effects • Short term effects are bloodshot and itchy eyes, dry mouth and throat, increased appetite, reduced pressure within the eye and somewhat raised eye blood pressure • It elevates heart rate sometimes dramatically • Long term use seriously impairs lung structure and function • Marijuana users smoke fewer cigarettes than tobacco smokers but retain it in their lungs for much longer periods of time • The timing of starting marijuana matters a lot also • If people develop a physical dependency on marijuana, it is less serious than dependency on nicotine, cocaine and alcohol • Experienced smokers need only a few hits or puffs to become high from a marijuana cigarette, whereas less experienced users puff many times to reach a similar state of intoxication Therapeutic Effects C h a p t e r 1 2 : S u b s t a n c e R e l a t e d D i s o Page 14 s • THC and related drugs can reduce the nausea and loss of appetite that accompany chemotherapy for some cancer patients • Marijuana often appears to reduce nausea when other anti-nausea agents fail • It’s also a treatment for the discomforts of AIDS as well as glaucoma, epilepsy and multiple sclerosis • THC has been demonstrated to relieve pain by blocking pain signals from injuries or inflammations and thereby preventing them from reaching the brain Sedatives and Stimulants • Some are obtained legally with a prescription, and can be divided into 2 general categories, sedatives & stimulants Sedatives • Often called downers, slow the activates of the body and reduce its responsiveness • Includes opiates – opium and its derivatives, morphine, heroin and codeinie – and the synthetic barbiturates and tranquilizers, such as secobarbital and diazepam Opiates • Opiates are a group of addictive sedatives that relieve pain and induce sleep when taken in moderate doses • In 1806 the alkaloid morphine was separated from raw opium (bitter tasting powder) was a great pain reliever • Many soldiers used it before also and returned home addicted to the drug • In 1874 it was found that another powerful pain-relieving drug (heroine) could be used in cough syrups and other medicines but this later showed to be even more addictive and more potent than morphine • Opium and its derivatives, morphine and heroine produce euphoria, drowsiness, reverie, and lack of coordination • Heroin has additional effect – rush feeling, feeling of warm, suffusing ecstasy immediately following an intravenous injection. The user sheds worries of self confidence for 4-6 hours • Opiates produce its effects by stimulating neural receptors of the body’s own opioid system (because the body also produces opioids called endorphins and enkephalins; so these opium’s fit into their receptors and stimulate them) • Opiates are clearly addicting, for users show both increased tolerance of the drug and withdrawal symptoms when they are unable to obtain another dose • Reactions to not having a dose of heroin may begin within 8 hours of the last injection, at least after high tolerance has built up o The person has muscle pain, sneezes, sweats, becomes tearful and yawns a great deal over the next few hours o Symptoms resemble those of influenza o Withdrawal symptoms become more severe within 36 hours C h a p t e r 1 2 : S u b s t a n c e R e l a t e d D i s Page 14 r s o There may be uncontrollable muscle twitching, cramps, chills alternating with excessive flushing and sweating and a rise in heart rate/blood pressure o The addicted person is unable to sleep, vomits and has diarrhoea o Symptoms last for 72 hours and then diminish slowly over 5-10 day period • In recent years it has become a cool drug for middle and upper middle class college students and young professionals • The drugs cost a lot of money about $200 Synthetic Sedatives • Barbiturates is another major type of sedatives (made for sleeping and relaxation) • Today, Benzodiazepines (Valium) are more commonly abused • Sedatives relax the muscles, reduce anxiety and in small doses produce a mildly euphoric state • Like alcohol, they are thought to produce effects from stimulating the GABA system • With excessive doses, speech becomes slurred and gait unsteady; concentration, ability to work, lose of emotional control and irritability • Very large doses can be fatal because the diaphragm muscles relax to such an extent the t the individual suffocates • Frequently used as a means of suicide (with alcohol) • Types ofstbusers o 1 group fits the stereotype of the illicit drug abuser: adolescents and young adults, usually male and often antisocial, who use synthetic sedatives to alter their moods and consciousness, sndetimes mixing them with other drugs o 2 group is middle aged, middle class individuals who begin their use of sedatives under a physician’s order then use it as an addictive rd o 3 group comprises health professionals – physicians and nurses Stimulants • Stimulants or uppers (like cocaine) act on the brain and the sympathetic neurons system to increase alertness and motor activity • Cocaine is a natural stimulant extracted from the coca leaf • Amphetamines are synthetic stimulants Amphetamines • Before a plant, mahuang, was used by the Chinese to treat asthma • But relying on the shrub for the drug was not efficient, and so efforts to develop a synthetic substitute began  Amphetamines resulted from these efforts • Benzedrine was the first amphetamine  its was used first to relieve stuff noses, the public also discovered its stimulating effects  then it was also used for mild depression and appetite C h a p t e r 1 2 : S u b s t a n c e R e l a t e d D i s oPage 14r s • These produce their effects by causing the release of norepinephrine and dopamine and blocking the reuptake of these NTs (taken orally or intravenously and can be addicting) • Wakefulness is heightened, intestinal functions are inhibited, and appetite is reduced (thei
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