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Hart13 ppt ch02
- 1. Chapter 2
Drug Use as a Social
Problem
© 2011 McGraw-Hill Higher Education. All rights reserved.
- 2. Costs of Drug Use to Society
Deaths
Emergency room visits
Drugs in the workplace and lost productivity
Broken homes, illnesses, shorter lives, etc.
Cost of maintaining habit
Cost of criminal behavior
Cost of treating patients
Fetal alcohol syndrome
Others?
© 2011 McGraw-Hill Higher Education. All rights reserved.
- 3. Changing Attitudes
What made the government change
from the laissez-faire attitude of the
1800s to one of control?
Toxicity
Dependence
Crime
© 2011 McGraw-Hill Higher Education. All rights reserved.
- 4. Toxicity
Toxic = poisonous, deadly, or dangerous
What makes a drug toxic?
Amount used
How it is used
What the user did while on the drug
© 2011 McGraw-Hill Higher Education. All rights reserved.
- 5. Toxicity
Physiological toxicity vs. behavioral
toxicity
Acute effects vs. chronic effects
Acute behavioral toxicity (drunk driving) Chronic physiological toxicity (cirrhosis)
© 2011 McGraw-Hill Higher Education. All rights reserved.
- 6. Drug-Related Toxicity
Examples of acute toxicity
Behavioral: “Intoxication” that impairs the
actions of drug users and increases the
danger to themselves and others
Physiological: Overdose that causes the
user to stop breathing
© 2011 McGraw-Hill Higher Education. All rights reserved.
- 7. Drug-Related Toxicity
Examples of chronic toxicity
Behavioral
Personality and lifestyle changes
Effects on relationships with friends and family
Physiological
Heart disease
Lung cancer
Cirrhosis
Other health effects
© 2011 McGraw-Hill Higher Education. All rights reserved.
- 8. Drug Abuse Warning Network
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
© 2011 McGraw-Hill Higher Education. All rights reserved.
- 9. Drug Abuse Warning Network
Alcohol is reported only
in combination with
other drugs
Drug-alcohol and drug-
drug combinations are
very common
© 2011 McGraw-Hill Higher Education. All rights reserved.
- 10. Drug Abuse Warning Network
Toxicity Data
ER Visits Deaths
1. Cocaine 1. Prescription Opioids
2. Alcohol-in- (not heroin)
combination 2. Cocaine
3. Marijuana 3. Alcohol-in-
4. Prescription Opioids combination
5. Benzodiazepines 4. Benzodiazepines
5. Methadone
© 2011 McGraw-Hill Higher Education. All rights reserved.
- 11. Drug Abuse Warning Network
What it tells us about how dangerous a
drug is
Simply gives us total deaths/ER visits
What it does not tell us about how
dangerous a drug is
Consider relative danger vs. total impact of
the drug
Number of users vs. number of reported
problems
© 2011 McGraw-Hill Higher Education. All rights reserved.
- 12. 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
Some states, cities prohibit
needle purchase without Rx
Syringe exchange programs
© 2011 McGraw-Hill Higher Education. All rights reserved.
- 13. Substance Dependence
What do “addicts” look like?
What drug do they take or what behavior do they
engage in (alcohol, cigarettes, illicit drugs, food,
sex, gambling, shopping, computer time)?
How much time do they spend on their habit?
How much of a drug do they take?
How do you decide on the definition of
dependence?
© 2011 McGraw-Hill Higher Education. All rights reserved.
- 14. Substance Dependence
Three basic
processes
Tolerance
Physical
dependence
Psychological
dependence
© 2011 McGraw-Hill Higher Education. All rights reserved.
- 15. Tolerance
Diminished effect on the body after
repeated use of the same drug
The body develops ways to compensate
for the chemical imbalance caused by the
drug
Regular drug users may build up tolerance
to the extent that their dosage would kill a
novice user
© 2011 McGraw-Hill Higher Education. All rights reserved.
- 16. Physical Dependence
Physical dependence is defined by the
occurrence of a withdrawal syndrome
Tolerance typically precedes physical
dependence
If drug use is stopped suddenly,
withdrawal symptoms occur, ranging from
mild to severe
Physical dependence means the body has
adapted to the drug’s presence
© 2011 McGraw-Hill Higher Education. All rights reserved.
- 17. Psychological Dependence
Psychological or
behavioral dependence
High frequency of drug use
Craving for the drug
Tendency to relapse after
stopping use
Behavior is reinforced by
the consequences
Over time, this becomes the
biggest reason users report
they continue to use
© 2011 McGraw-Hill Higher Education. All rights reserved.
- 18. 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
Psychological dependence is increasingly viewed as
the driving force behind repeated drug use
This refutes the sometimes common belief that drugs that
aren’t as strongly physically addicting are less dangerous
© 2011 McGraw-Hill Higher Education. All rights reserved.
- 19. Substance Abuse and
Dependence: DSM-IV-TR
APA diagnostic criteria for abuse and
dependence (page 36)
Complex behavioral definitions
Dependence can occur with or without
physiological dependence (i.e., withdrawal)
© 2011 McGraw-Hill Higher Education. All rights reserved.
- 20. Substance Dependence:
DSM-IV-TR
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
© 2011 McGraw-Hill Higher Education. All rights reserved.
- 21. Substance Abuse:
DSM-IV-TR
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
© 2011 McGraw-Hill Higher Education. All rights reserved.
- 22. Is Dependence
Caused by the Substance?
Some drugs are more likely
than others to lead to
dependence
Method of use, as well as
other factors, influences risk
of dependence
The “war on drugs” reflects
.
the perspective that drugs are
themselves evil
© 2011 McGraw-Hill Higher Education. All rights reserved.
- 23. Is Dependence Biological?
Is dependence due to biochemical or
physiological actions in the brain?
Still no way to scan the brain and know if a
person has/had developed dependence
Genetic physiological or biochemical markers
have been sought as well, but none has
proven reliable
© 2011 McGraw-Hill Higher Education. All rights reserved.
- 24. Is There an “Addictive
Personality”?
No way to know if the drug or the drug use
changes a person’s personality
Many other factors affect personality
Sensation-seeking = a personality
characteristic statistically associated with
early substance use and abuse
© 2011 McGraw-Hill Higher Education. All rights reserved.
- 25. Is Dependence a Family
Disorder?
Alcohol dependence
often exists within a
dysfunctional family
Evidence suggests that
dysfunctional
relationships play a role
in dependence, but
they aren’t the only
factor
© 2011 McGraw-Hill Higher Education. All rights reserved.
- 26. Is Substance Dependence a
Disease?
Founders of AA characterized alcohol
dependence as a disease
Others argue that dependence doesn’t
have all the characteristics of a disease
There are ways to test and treat the effects of
alcoholism but not the disease itself
There is some disagreement over how to
define disease as well
© 2011 McGraw-Hill Higher Education. All rights reserved.
- 27. Biopsychosocial Perspective
Dependence is related to
dysfunctions of:
Biology
Personality
Social interactions
© 2011 McGraw-Hill Higher Education. All rights reserved.
- 28. Drugs and Crime
Drug use may change a
person’s personality
People under the
influence may commit
crimes (e.g., many cases
of homicide, domestic
violence, etc.)
© 2011 McGraw-Hill Higher Education. All rights reserved.
- 29. Drugs and Crime
Crimes may be
carried out to obtain
money for drugs
Drug use is a crime
© 2011 McGraw-Hill Higher Education. All rights reserved.
- 30. Why We Regulate Drugs
We want to protect society from the
dangers of some types of drug use =
legitimate social purpose
Some laws are not developed as part of a
rationally devised plan and may not be
realistic or effective
Current laws
© 2011 McGraw-Hill Higher Education. All rights reserved.
- 31. Chapter 2
Drug Use as a Social Problem
© 2011 McGraw-Hill Higher Education. All rights reserved.
Editor's Notes
- Image sources: Brand X Pictures (Image Ch02_01SocialProblem) Creatas/PunchStock (Image Ch02_14Syringe)
- Image sources: C. Sherburne/PhotoLink/Getty Images (Image Ch02_02AcuteBehavior); CDC/ Dr. Edwin P. Ewing, Jr. (Image Ch02_03ChronicPhysiological)
- Image source: Getty Images (Image Ch02_04EmergencyRoom)
- Image source: Dynamic Graphics/JupiterImages (Ch02_05DrugAlcoholCombo)
- Image source: Dynamic Graphics/JupiterImages
- Image source: © Creatas/PunchStock (Image Ch02_06Syringe)
- Image source: Ryan McVay/Getty Images (Image Ch02_07ToleranceWithdrawal)
- Image source: The McGraw-Hill Companies, Inc./Gary He, photographer (Image Ch02_08CravingReinforcement)
- Image source: The McGraw-Hill Companies, Inc./Jill Braaten, photographer (Image Ch02_09SoloDrinker)
- Image source: Jack Star/PhotoLink/Getty Images (Image Ch02_10DysfunctionalFamily)
- Credit Text: Getty Images/Doug Menuez (Image Ch02_11BiopsychosocialApproach)
- Image source: © Mikael Karlsson (Image Ch02_12DrugsCrimeArrest)
- Image source: Brand X Pictures (Image Ch02_13DrugSale)