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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?
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3. Changing Attitudes
 What made the government change
from the laissez-faire attitude of the
1800s to one of control?
 Toxicity
 Dependence
 Crime
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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
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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
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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?
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14. Substance Dependence
 Three basic
processes
 Tolerance
 Physical
dependence
 Psychological
dependence
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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
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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
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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.