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PSYC 3170
Jennifer S Mills

1 Lecture 4: Substance Use and Abuse Also talk about eating disorders Smoking  major health issue  relevant to a lot of students, university aged people  tobacco is the leading cause of preventable illness and premature death in Canada  40000 Canadians die from smoking causes, first hand and second hand smoke  2/3 people die are men  infants die - Sudden infant death syndrome & second hand smoke  tobacco use is responsible for deaths of half pack a day smokers  likely to die from coronary heart disease  1/3 of all cancer deaths - smoking  Box 1: Top 6 toxins in tobacco products, as identified by Health Canada  Tar, Nicotine, Carbon monoxide, Formaldehyde, Hydrogen cyanide, Benzene  there are a lot more but these are top 6 most dangerous toxins - these are produced not because cigarette smokers trying to poison us, but they are the byproducts of burning tobacco - when tobacco burns these chemical products are used  other additives, moisturiizers, preservatives burn  complex chemical issue - there are toxic compounds produced in the cigarette smoke Smoking Tobacco: Who Smokes?  majority of people who will become regular smokers begin by age 20-  if don’t smoke before 20 wont likely to smoke after  1/5 Canadians smoke - not the norm but a common behavior and varies with age  most people starting with teenagers then habit and adult peak smoking  after age of majority aloud to purchase cigarettes - smoking increase when aloud to buy cigarettes  and also disposable cigarettes  35-45 middle ages highest age  more men than women smoke  well documented that gender gap has narrowed - some studies show women smoking just as much as men and women just as much risk  gender gap narrowed for couple of reasons - larger numbers of men than women have stopped smoking  more men than women taking advantage of smoking cigarette cessation programs  more women taken it up  branding cigarettes as more appealing to women in 1970s/1980s branding cigarettes of more feminine and appealing to women - "lighter" "slimmer" cigarettes - got more women smoking  branding of smoking behavior seems more desirable - social significance  you've ocme along way baby - used by major cigarette companies  smoking dub tailed with feminist movement - women can do it in public, society more relaxed, accepting, more liberal minded toward women  those implicit theories of meaning of smoking - played a role in more women taking up smoking  trend back up to higher prevalence among men - but see women catching up  bad news is more women smoking, good news is more men quitting 2  but interesting to note that people can be persuaded to avoid or quit smoking - these trends are not set in stone, thye do come and go  this gives optimism about shaping behavior if want to get people to stop smoking  lower educated smokers more likely to take up smoking  people lower SES , lower education less likely to quit  low SES - see themslees as in poor health, lower health beliefs, they believe they are less healthy im already unhealth may as well keep smoking  lower educated groups smoke earlier - which is risk factor to become regular smoking  harder to quit earlier Geneitc Factors in Smoking  biopsychosocial model  credit to biological agents  one of the most fascinating biological discoveries - researchers identified specific gene pattern - this gene pattern affects smoking behavior - individuals who have gene patterns less likely to become smokers and more able to quit after they start smoking  as always genetic mysterious - there are indirect routes between genetics and behavior  could be genetics affects taste preferences - whether like tobacco or not, also could be personality, whether inherit certain personality type - certain personality traits like risk taking rebelliousness  genes can also have direct routes - how easily/strongly how person becomes physically addicted to tobacco, metabolizing tobacco - when talk about metabolizing tobacco refering to nicotine  nicotine is addictive substance - has interesting effects on body  immediate effects of nicotine - increase in BP, increase heart rate, increase in respiration, also effects on cardiovascular system including narrowing of arteries  arteries carrying oxygenated blood actually shrink, and blood gets thicker, the platelets in blood become stickier and more adhesive - this is risky for people with any heart disease, could lead to blood clots  another immediate effect of nicotine is decrease in skin temp, may notice hand feets feel cold and take several minutes for temp to get back to normal  another effect is gastric emptying, the stomach contents empty more quickly and more forcefully - in other words nicotine has laxative effects  immediate effects quick - nicotine metabolized quickly by body and brain in partiuclar  over long term these immediate effects can become chronic - chronic high BP chronic narrowing and blockage of blood vessels  depletion of vitamin C - nicotine interfere with absorption of vitamin C  reduction of immune system - lose some helpful immunity to various pathogens, viruses, bacteria and of course cancer linked to smoking but nicotine in particular linked to cancer of mouth, throat, lung  bronchitis, emphysema, stomach ulcers, weight loss, drying skin, abnornal sperm  many side effects of nicotine in particular* not just smoking  not everyone agrees with this - controversy over whether nicotine is the dangerous substance in tobacco - recently seen increase in electronic cigarettes - cigarettes that don’t use tobacco, but vaporize nicotine  battery and mechanism that takes nicotine capsule but smoke coems out of cigartte but not smoke really water vapor  nicotine is stimulant and has side effects - jury out if pure nicotine related to some of the longer side effects mentioned 3  electronic and pure nicotine devices safe? Biobehavioral Model of Tobacco Dependence  cant just look at biology - think about interplay between biology and psychology  proposes people continue to smoke and hard time quitting, use and come to depend on effects of nicotine to alter their cognitive states  nicotine starts affecting brain in 5 seconds, quick delivery - nicotine activates reward system as do other drugs of abuse - although to a lesser degree  dopaminergic system - reward system activated by nicotine  nicotine responsible for positive feelings because of dopamingeric system  people who smoke say nicotine gives mental alertness, enhances mental performance and it does this through its effects on dopamine pathways in brain  however over time same effect on dopamine pathways in brain can lead to brain  dopamine not only chemical implicated in addiction - acetylcholine and norepinephrine - these increase alertness, concentration, improve memory and give individual feeling of pleasure or relaxation, also decrease symptoms of nitocine withdrawl, anxiety, tension and pain  once nicotine hits brain sets into motion chemical cascade, positive effects and takes away negative effects -very desirable reinforcing effects begin soon after first puff  smokers learn to use nicotine as coping mechnaism  supplement and fine tune other emotional procces to nicotine used to regulate emotional state - nicotine becomes relied upon as coping mechanism  this is all what biobehavioral model of tobacco dependence says*  so emotional regulation explanation & nicotine as a coping mechanism Starting to Smoke  cant get addicted to nicotine if don’t try it in first place  its worth looking at psychology of starting to smoke  what is it that begins people to smoke -  smoking not all that pleasant when first start to smoke - teenagers that try first cigarette usually around 15, in company in friends, encouragement with friends - some peer pressure  modelling effects - more the case when more people were smoking, more normative behavior and seen as more glamorous, celebriites smoking in interview  now a days don’t see celebrities smoking, more stigmatized  kids might be persuaded to try if see favorurite movie star doing it  personal characteristics - not everyone suscptible to modelling effects and peer pressure,  being rebellious and risk taking -  smoking can ehnance social image - teens belueve this -  especially if someone we look up to or admire does it -  for teenagers might be other friends, celebriities - regardless of who looking to might have idea that smoking might enhance social image  smoking will make them look more mature, more interested in opposite sex, more glamorous  family members that smoke is more closely linked to girls than boys  could be girls more vulnerable to effects of social desirability  another thing is girls might want to lose weight and take up smoking  youn ggirls vulberabile to body dissatisfaction - most girls say start smoking to lose weight or curb their appetitie - powerful social drive to be thin, look a certain way that works against our health  girls percieve smoking as somehting they can do to control weight 4  nicotine will icnrease metabolism but no gauruntee people will lose weight once start smoking  on the other hand, nicotine associated with GAINING weight once STOP smoking Becoming a Regular Smoker  once try smoking, might think im never doing that again  on other hand people go on to beocme regular smokers - whether soicla smoker or someone who smokes all of time  different reasons people give for smoking on regular basis  Psychological reasons:  if ask people what main reason they smoke, generally give you one reason that fits into one category  positive affect: smoking gives positive feeling, feeling of stimulation, relaxation or pleasure  negative affect: smoking takes away anxiety, tension,  habitual behavior: automatic, they do without being aware of it  psychological dependence (addiction): wont talk about specific definition of adiction, dependence or addiction is a clinical term that has strict diagnostic criteria it has to meet, but for this course think of addiction as both getting pleasurable effects from drug and having negative effects when take away the drug (withdrawal)  with smoking noticine withdrawal - depdning on persons makeup and biological factors may be able to go days without cigarettes or minutes  people can be classified according to chief reason they express for smoking  it suggests may be clues to custom tailoring and intervention to smoking  if person says I smoke because I like the taste - they would be considered a positive affect smoker- it gives them positive feelings, they like it - ifi we alter cigarttes person smokes to taste less pleasant, they will smoke less  altering taste for someone who is a habitual smoker probably wont make a difference  these catgeories important if thinking about intervention and ways in which help someone smoke lesss SMoking and Stress Reduction  complex relationship  correlation between stress and smoking  more smoking, more stress feel - could be other way around, more sttess more they smoked  one study found teenaggers related to amount of stress in lives - more stress more smoke  adult smokers report less anxiety and less stress and were able to express opnions more comfortably if they smoked--- but remember these were smokers, people who already smoke  and even if smokers perform better and feel relaxed while IN stress ful situation - it dosnt mean that they perform better and feel more relaxed than NON smokers do  overall non smokers lower on stress level  smokers feel less stress when smoking, immediate effect of nicotine, chemical cascade gives feelings of relaxation but its all relative*  as soon as done cigarette - stress levels bounce up  on average they are still way above the non smokers  correlation between stress and smoking - some clues that could be cause and effect relationship  new smokers, people just taken up smoking, do report that when start smoking their stress levels go up 5  it could be that when feel more stressed to begin with likely to take up smoking, then could be that when you are a smoker stress goes up, realizing cost of smoking, taking out time, negative comments get from other people  act of smoking although in short term gives person benefits mood wise and bilogically, in long term that smoking will do more harm than good  in next section were going to talk about social factors related to smoking - and talk about group of inidviduals who is especially at risk for tobacco use  Figure 1: Graph shows percentage of Canadians that smoke, broken down to various demographic groups  what will see quickly is startling three fold increase in smoking rates people cosnidered to be first nations and inuit people - specific to canada  these demographic groups together - present high risk group for smoking behavior  first nations smoking groups are tripple the rate for Canadians in general - among teenage girls in first nations groups they have smoking rate of 61% - Canadians girls in same age range 15%  first nation boys 15-17 have smoking rate 47% compared to national average same age 13%  very concerning numbers in this at risk group  an issue related ot this is that of contraband cigarettes  contraband cigarettes are non commercial cigarettes are manufactured and available by law to residents of first nations reseerves  law allows people on first nations reserves to manufacture, buy and sell legally these contraband cigarettes  problem and what makes them contraband is also get sold illegally outside of reserves - they get smuggled and sold to people in urban and rural areas  so heres a social factor that has direct and indirect health implications for people  from health perspective, these cigarettes seem to be more dangerous - more dangerous because they are cheaper - they are 1/10 the cost of commercial cigarette  because cheaper, buy more, smoke more bigger health risks  illegal cigarette users have more health problems than those that use commercial cigarettes - probably because they smoke more of them  problem could also be in cigarettes themselves  because they are manufactured in reserves, content NOT regulated in any way by government - toxiicity in cigarettes may be higher than commercial cig  this is a controversial issue and what makes it so is that it is contentious to launch anti tobacco campaigns against aboriginal youth  tobacco has important role in these groups traditions, tobacco seen as healing drug, used in traditional rituals = and aboriginal youth get mixed messages  commercial tobacco seen as bad, tratitional tobacco seen as good - confusion in messages shockingly in poster Quitting Smoking  people report may reasons for smoking - pschological motivations for smoking can include wanting to become aroused - improved concentrationa nd memory  some people smoke to reduce tension  seems logical to try using other drugs - theraist try using drugs to mimic desired effects of tobacco use - use tranquilizers and stimulant medication to mimic effects of smoking and reduce needs to smoke  this approach does NOT seem to work very well - even if smoke to relax and take drugs to relax this does not seem to make you smoke less 6  a more useful approach is having smoker take nicotine directly, chewing nicotine gum, nicotine patch on skin to absorb nicotine, electronic cigarettes deliver nicotine in concentrated and vaporized form  electronic cigarettes mimic real cigarettes so get tactile stimulation in fingers - can even get them flavored so they taste like real cigarettes  the more desirable and more appealing the mode of delivery the more effective these tend to be - some people don’t like wearing patch or don’t like nicotine gum but nevertheless, no argument that any kind of nicotine device will help reduce cravings for smoking  nicotine can gradually be tapored off over few months  nicotine less risky and less dangerous than smoking - a lot of risk comes from burning tobacco and all the chemicals in there  however nicotine is stil highly addictive and dangerous to use for reasons talked about biological effects  nicotine replacement therapies seem to work, better for some than others - question of what you like to use - but in end swapping one addiction for another, people can come addicted to nicotine patches and electronic cigarettes but have to weigh pros and cons  behavoiral methods - many behavoiral methods to help people stop smoking  can be classified into two different categories:  aversion strategies: involve use of unpleasent stimuli to discourage smoking behavior - getting a shock when have cigarette, negative scene in head like diseased lung, imagine negative scene very time took cigarette - offputting  or ceasation - over doing it with smoking, smoking so many cigarettes in a row, you feel ill from doing so- you become conditioned to not wanting to do it anymore because it becomes aversive  it works to some extent, works better for some people than others, for some kinds of problems than others  prof is not convinced it works very well for smoking, the aversive stimuli has to be quite strong, highly unpleasent, and timing of pairing smoking and negative stimulus has to be just right - requires custom tailoring to get it to work as well as it can  another category would be self management strategies - this oculd involve any technqiue a therapist would teach person to use to help them gain control over enviornmental conditions that sustain the undesirable behavior  ex. rewarding yourself for NOT smoking, punishing for smoking  conditioning yourself from positive reinforcement, or positive punishment, negative punishment, negative reinforcement  rewarding or punishing self for smoking or not smoking  research showing some of drug methods aversions strategy and self management strategy useful in controlling smoking but NONE is highly effective alone  what seems to work best is really individual - whatever fit your lifestyle, usually some multidimensional approach is necessary  could be one technique works well - because don’t know whats going to work best for you untl you try a number of things and see what works best Behavioral Methods: Applications for Stopping Smoking  Self monitoring o as weve seen before, self monitoring involves tracking your behavior - self monitoring as related to smoking can result temporary decrease in smoking behaviour o self monitoring tends to normalize behavior and bring it alin to desired behavior 7 o with smoking however utlity of self monotirng seems to be less than with things like eating - smoking utlity seems to be in gathering information that can be used for other techniques, patterns and trends urges to smoke so can see where triggers are  Stimulus Control o address triggers by altering elements of environment that serve as cues and lead you to perform the problem behavior - smoking o if know every time go to bar and drink going to want to smoke - avoid it o if always smoke when watch tv- avoid watching tv o person needs to have awareness of triggers and antecedents before start stimulus control  Response substitution o replacing problem behavior with alternative response - particularly one incompatible with or not likely to be performed at same time as problem behavior o can think of few diffeent things incompatible with smoking - ex. eating or having a shower when having urge to smoke o looking for replacement behaviors that are difficult to do at same time as one trying to stop  Behavioral contracting o conditions and consequences regarding problem behavior that are spelled out ina contract - you would contract with self these are conditions you are trying to commit to and these are consequences if don’t stick to it o punishments and rewards as a system - usually done best with another person like therapist - o could also be family member or friend who contracts with you - want them to be significant enough consequences to motivate you to stick to contract Addiction to Other Drugs  focussing on smoking so far  but this point talk more generally about addiction - not just to nicotine or tobacco but to other drugs as well  as summary or overview of biopsychosocial model well take each categories one at a time  to start with - considering biological factors, great video available on youtube Video: The Chemistry of Addiction  brain evolved to reward and encourage us when we do stuff to help us survive and spread genes - like eating and sex having, running from danger  for hundreds of years this has served us well - but brains got too smart for own good  we figured out how we can stimulate brain when we are not even doing those things- by inventing drugs  we also figued out how we can do those things recreationally (eating, sex,) recreationally instead of for our own survival - by doing these things we have invented addiction  behaviors can be addicted to - eat candy bars, gambling, sex, eatig - affect same part of brain  chemisry of addiction takes place in brains limbic system - the set of structures in center of brain that controls emotional and behavior responses to info we receive - referred to as brains reward center - it responds to new information from nervous system by releasing chemical messengers called neurotransmitter- that pass signals to neurons to next or another cell it wants to activate  brain produces 100 neurotransmitters - and finding new one 8  most important neurotransmitters when it comes to addiction ones that are released when do something key to survival and success - once there done getting word out reabsorbed back into whatever neuron they originated from  there are two major kinds of neurotransmitters - and in healthy brain in balance - excitatory neurotransmitters - which get their target cells all fired up with chemical energy  and inhibitory neurotransmitters which keep their target cells calm and mellow  serotonin is an inhibitory neurotransmitter that helps with regulate mood, appetite, sleep cycle  but excitatory neurotransmitters are ones you have to watch out for*  endorphin - released with exercise, stressed or physical pain- it helps with coping and painkilling  most important reward chemical is dopamine* it's released whenever our brain believes we should take strong note of our current behavior- to remember it  its levels rise in response to pleasurable experience - eating, baby making - also released when bull moose charging at us  exciting sensation you feel when dopamine level u p reminds brain to dothings important to survival - but also large part of what drives addiction  addictive drugs good at not only messing with levels of dopamine and neurotransmitters - exploit brain to ability to vividly remember unnatural highs and motivate more of them in future  scientists have recently started to debate whether dopamine actually makes you feel good or makes you just want things more  we based assumption that dopamine feel good - makes people and rats repeat activities that increase dopamine levels  dopamine is implicated in desire -whther or not there is a pleasurable outcome - that’s why maybe a lot of addictions continue long after pleasure is gone  when brain met with intense stimuli that drugs cause - it has defenses restore balance  after using drug for long time - brain reduce neurotransmitters or receptors available to it to moderate its effects - this leads to hypofunctioning reward system  which makes artificial and natural highs to come by  brain on drugs not fried egg, it is a significantly altered egg  this is why we have tolerance to drugs and why we have shiny new psychological disorders that they didn’t have before taking the drug  drugs that cause addiction screw with brain activities in two ways  immitate natural neurotransmitters  or artifically change levels of neurotransmitters- iether by overstimulating release or inhibiting reabsorbtion  heroin and other opiates like codiene and morphine are addictive because structure similar to endorphin -they bind to nerve cell receptors reserved to endorphin in huge number which magnified endorphins pain killing effects and feelings of
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