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HSCI180 CH1-3 Intro, Drug use as a Social Problems, Regulations.docx

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Simon Fraser University
Health Sciences
HSCI 180
Julian Somers

CHAPTER 1–Overview 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  Psychoactive drug = A drug that specifically affects thoughts, emotions, or behavior  Illicit drug = A drug that is unlawful to possess or use  Harm Reduction = Initiative of Canada‘s Drug Strategy to use public education programs to significantly reduce the damage associated with alcohol and other drugs o Open to outcomes other than abstinence or cessation of use - eg safe injection site,alternative transportation programs  Drug misuse = Use of drugs or chemicals in greater amounts than prescribed by a doctor, or using the drug in a way that was not intended by its manufacturer  Drug abuse = Substance use in a manner/amount/situations such that it causes social, occupational, psychological, or physical problems  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 or cut down, may cause severe physical and psychological withdraw o tolerance = after repeated use, reaction to drug decreases so larger doses are required to achieve same effect – uncontrolled escalating doses may lead to drug overdose and death o withdraw = abnormal physical and psychological effects that occur after stopping a drug,  eg sweating, tremors, vomiting, anxiety, insomnia, muscle aches and pains  Addiction = When a person is given over to a practice or habit (Psychological, though it may involve physiological processes) Trends in Drug Use in Canada  According to a recent study, 20% of teens took a prescription drug in the past year to get high.  Among Canadian University students, 77.1% are current users of alcohol and 12.7% current users of tobacco.  Less than 20% are current marijuana users, and less than 3% are current user of other illicit drugs  Both alcohol and illicit drug use reached an apparent peak around 1980, and then decreased until early 1990s, with a slower increase after that Correlates of Drug Use  Correlate = a variable that is statistically related to another variable, such as drug use (*Correlates are not causes) o Socioeconomic status does not correlate well with drug use o Personality problems are poor predictors of drug use  Risk factors include: o Community, parental, and peer attitudes and behaviors (have drug-using friends, aren‘t involved in religious activities, parents don‘t care, rough neighbourhood, perceive substance is prevalent, know adults who use it, have a positive attitude) o Antisocial/problem behaviors (fight, steal) o Poor school performance  Protective factors include: o Involvement in religious activities, school, sports, extracurricular activities o Perceived risk of drug use and strong sanctions against use o Parents as a source of social support  Factors related to Drug Use o Gender, Race and ethnicity, Level of education, Personality variables, Genetics  Antecedent = characteristics that predict later initiation of drug use o Eg Aggressiveness, Conduct problems, Poor academic performance, Attachment to a drug-using peer group, Parental and community norms that support drug use  Gateway Substances – one of the first drugs used by drug users eg alcohol, tobacco o Don‘t think of it as a ‗cause‘ of later illicit drug use, but instead as early indicators of the basic pattern of risk-taking behaviour resulting from a variety of psychosocial risk factors o No evidence shows that using one of the gateway substances causes a person to escalate to more risky forms of drug use Motives for Drug Use  Identification with a particular subculture is a key factor  Fads and cultural trends influence what drugs are used  Characteristics of drugs can reinforce their use – each time you take the drug you increase slightly the probability that you will take it again  Some seek an altered states of consciousness – different perception of the world that the normal  Societal, community, and family factors play an important role in whether an individual tries a drug  Drug factors play an important role in whether an individual continues to use a drug Motives for Addiction  Human beings require a role in their communities – psychosocial integration  The failure to achieve psychosocial integration results in a state of profound dislocation (Alexander, 2001)  Addiction is a consequence of dislocation Alexander’s Recommendations  Change the discourse on addiction – not about drugs or disease, but about people and communities  Focus on ensuring that all people have opportunities – and support – to achieve meaningful integration to society  Actions include opportunities for housing, education, employment in one‘s home community Influences on Drug Use CHAPTER 2–Drug Useasa SocialProblem Changing Attitudes in 1990s  Before 1900s, government had virtually no laws governing the sale or use of drugs.  Laissez-Faire – hands off approach to government interference in the working of the (drug) market  Three principal concerns have universally driven the development of drug laws: o Toxicity – dangerous/toxic chemicals were sold without label/warning o Dependence – health endangered by using habit-forming drugs, without labels/warnings o Crime – widespread attitude that drug-crazed user would often commit horrible violent crimes Toxicity  Toxic means = poisonous, deadly, or dangerous o Effects of drugs that interfere with normal functioning in such a way as to produce dangerous consequences  Physiological toxicity = physiological poisoning o eg too much alcohol suppresses respiration, breathing stops long enough to induce brain damage or death  Behavioral toxicity = dangerous disruption of behavior o eg person is so disoriented that normal behaviours (driving, swimming) becomes dangerous  Acute effects = sudden, short term effects of a single dose o Direct result of the actual presence of the drug in the system at the time  Physiological - overdose of heroin causing breathing to stop  Behavioral – intoxication from drugs that impair behaviour and increase danger to self  Chronic effects = long-term effects from repeated use o Effects are present whether or not substance is actually in the system at a given point  Physio – lung cancer from smoking, liver damage from chronic alcohol exposure  Behave – personality and lifestyle changes, effects on relationship with friends/family  Heroin and cocaine have high risks of toxicity per user, but their overall public health impact is low compared with tobacco and alcohol Drug Abuse Warning Network (DAWN)  A system for collecting data on drug-related deaths and emergency room visits at some U.S. metropolitan hospitals  DAWN collects data on improper use of legal prescription and over-the-counter drugs as well as illicit drugs  Alcohol is reported only in combination with other drugs  Drug-alcohol and drug-drug combinations are very common Canadian Institute of Health Information ( CIHI)  Information related to drug incidence is collected by CIHI, a federally charted institution that provides information for health services and research initiatives  The Canadian Centre on Substance Abuse provides information on mortality due to alcohol, illicit drugs and tobacco.  The Canadian Vital Statistics system collects national data on causes of drug related emergency room visits and deaths Blood-Borne Diseases  Specific toxicity for users who inject drugs  AIDS, HIV infection, and hepatitis B and C  Sharing needles passes infectious agents directly into the bloodstream o Some states, cities prohibit needle purchase without Rx  Needle exchange programs reduce the rates of HIV infections by enabling IDUs (intravenous drug users – commonly use opioids, cocaine, heroin, steroids, etc)) to use clean syringes Dependence Three basic processes Tolerance  Repeated exposure to the same dose of the drug results in a lesser effect  Tolerance can be overcome by increasing the dose of the drug  Regular drug users may build up tolerance to the extent that their dosage would kill a novice user Physical Dependence  Defined by the occurrence of a withdrawal syndrome, typically follows after tolerance develops  Drug initially disrupts the body‘s normal physiological balances  The body develops ways to compensate for the chemical imbalance caused by the drug  If drug use is stopped suddenly, these compensating mechanisms produce an imbalance  Withdrawal symptoms occur, eg chills, fever, diarrhea, etc  Physical dependence means the body has adapted to the drug‘s presence, so it depend on the presence of some amount of that drug to function normally Psychological Dependence  Psychological or also called behavioral dependence - can be defined in terms of observable dependence  Indicated by: o High frequency of drug use o Emotional desire/craving for the drug to elicit positive effect o Tendency to relapse after stopping use  Reinforcement: A behavior is followed by some consequences that is pleasurable or as a ‗reward‘, which increase the tendency to repeat the behaviour o These consequences may be an escape form pain or discomfort o Over time, this becomes the biggest reason users report they continue to use Changing Views of Dependence  Early medical model = true addiction involves physical dependence; key is treatment of withdrawal symptoms  Positive reinforcement model = drugs can reinforce behavior without physical dependence o Research shows that heroin uses often voluntarily go through withdraw so to redce their tolerance level to get back to lower doses where they can more easily afford – they often do not need a large amount, but still many who had already gone through withdrawal has a high probability of returning to active users o Psychological dependence is increasingly viewed as the driving force behind repeated drug use  This refutes the sometimes common belief that drugs that are not strongly addicting are less dangerous ***Diagnostic Criteria for Abuse and Dependence: DSM-IV-TR Substance Dependence:  A maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring at any time in the same 12-month period: 1. Tolerance 2. Withdrawal 3. Substance often taken in larger amounts or over a period longer than intended 4. Persistent desire or unsuccessful efforts to cut down or control substance use 5. A great deal of time is spent in obtaining the substance 6. Important social, occupational, or recreational activities are given up or reduced because of substance use 7. Substance use continues despite knowledge of having a persistent or recurrent problem that is caused or exacerbated by the substance (can be with or without physiological dependence) Substance Abuse:  A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by one or more of the following occurring at any time in the same 12-month period: 1. Recurrent substance use resulting in failure to fulfill major role obligations at work, school, or home 2. Recurrent substance use in situations in which it is physically hazardous 3. Recurrent substance-related legal problems 4. Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance Broad Views of Substance Dependence Is Dependence Caused by the Substance?  Some drugs are more likely than others to lead to dependence, but the substance itself cannot be seen as the entire cause of the problem
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