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Chapter 13. Substance Use and Abuse. Addictive Behavior. Habits that have gotten out of control, with a resulting negative effect on a person’s health. Addiction is the habitual use of a drug produced chemical changes in the user’s body . Drug Addiction (four important characteristics)

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Chapter 13 l.jpg

Chapter 13

Substance Use and Abuse

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Addictive Behavior

  • Habitsthat have gotten out of control, with a resulting negative effect on a person’s health.

  • Addiction is the habitual use of a drug produced chemical changes in the user’s body.

  • Drug Addiction (four important characteristics)

    • Compulsive desire

    • Need to increase the dosage

    • Harmful effects to the individual

    • Harm to society

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Development of Addiction

  • Often starts to bring pleasure or to avoid pain.

  • Harmless or even beneficial if done in moderation

  • Examples of addictive behaviors:

    • Gambling

    • Compulsive Exercising

    • Work Addiction

    • Sex and love addiction

    • Compulsive buying or shopping

    • Internet addiction

  • Characteristics of people with addition (e.g., risk takers or genetic disposition)

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Drug Use, Abuse, and Dependence

  • Drugs are chemicals other than food that are intended to affect the structure or function of the body

    • Prescription medicines

    • Over-the-counter substances

      • Caffeine

      • Tobacco

      • Alcohol

    • Illegal substances

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Drug Abuse and Dependence

  • The APA’s Diagnostics and Statistical Manual of Mental Disorders – authoritative reference

  • Abuse

    • APA definition

      • Failure to fulfill major responsibilities

      • Drug use in situations that are hazardous

      • Drug related legal problems

      • Drug use despite persistent social or interpersonal problems

    • Physically dependent may or may not present

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  • Substance dependence

    1. Developing tolerance to the substance

    2. Experiencing withdrawal

    3. Taking in larger amounts

    4. Expressing a persistent desire to cut down

    5. Spending great deal of time obtaining

    6. Giving up or reducing important activities

    7. Continual usage even with recognition of a problem

  • Diagnosed with at least 3 or more symptoms during a 12-month period

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Who uses drugs?

  • All income and education levels

  • All ethnic groups

  • All ages

  • Young people are at a higher risk

  • Males (Twice as likely)

  • Troubled adolescent

  • Thrill-seeker

  • Dysfunctional families

  • Peer group or family that accepts

  • Low Socio-economical status

  • Dating young

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Why Do People Use Drugs?

  • Experiment

  • Escape

  • Reliance

  • Magnification of residence (i.e. the need for escape from poverty becomes more compelling)

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Risk Factors for Dependence

  • Psychological risks

    • Difficulty in controlling impulses

    • Strong need for excitement

    • Feelings of rejection

    • Hostility

    • Aggression

    • Anxiety

    • Mental illness

    • Dual (co-occurring disorders)

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Risk Factors for Dependence

  • Social Factors

    • Growing up in a family with drug abuse

    • Peer group

    • Poverty

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Other Risks of Drug Use

  • Intoxication

  • Side effects

  • Unknown drug constituents

  • Risks associated with injection drug use

  • Legal consequences

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How Drugs Affect the Body

  • Changes in Brain chemistry

  • Drug factors:

    • Pharmacological properties

    • Dose-Response function

    • Time-action function

    • Drug use history

    • Method of use (e.g., inhalation,

      injection, ingest)

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Representative Psychoactive Drugs

  • Opioids (narcotics)

    • Natural or synthetic (laboratory-made)

      • Opium, morphine, heroin, methadone, codeine, hydrocodone, oxycodone, meperidine, and fentanly

    • Effects on the body: induced euphoria

    • Methods of administration

      • Injection, snorting, sniffing or smoking

    • Symptoms of overdose: respiratory depression, coma, constriction of the pupils, or death.

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Central Nervous System Depressants

  • Slow down the overall activity of the CNS

  • Sedative-hypnotics

  • Types: barbiturates, valium, methaqualone, GHB

  • Effects on the body: reduce anxiety, impair muscle coordination, induce drowsiness

  • Medical uses: Treat insomnia and anxiety disorders; control seizures

  • From use to abuse (“Club Drugs”)

  • Overdosing may result in respiratory


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Central Nervous System Stimulants

  • Speed up the activity of the nervous or muscular system

    • Cocaine

      • Methods of use (snort or injection)

      • Effects (euphoria sensation for ~5 to 20 minutes)

      • Use during pregnancy (consequences include:

        miscarriage, premature labor, stillbirth, and low-birth-weight baby)

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Central Nervous System Stimulants

  • Amphetamines

    • Effects (increase in alertness)

    • Dependence (may lead to the development of a temporary state of paranoid psychosis or delusion)

  • Ritalin (used to treat attention-deficit/hyperactivity disorder, ADHD)

  • Ephedrine (a less potent form of amphetamines)

  • Caffeine

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  • Cannabis Sativa

  • THC (tetrahydrocannabinol)

  • Short term effects and uses: euphoria, increases in sensation, relaxed attitude

  • Long-term effects and uses: respiratory damage such as impaired lung function and chronic bronchial irritation

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  • Altered state of consciousness, perceptions, feelings and thoughts

  • LSD, Mascaline, DMT, MDMA, Ketamine, PCP (angel dust), and certain mushrooms

    • Altered states of consciousness

  • Flashbacks are perceptual distortions and bizarre thoughts that occur after the drug has been entirely eliminated from the body.

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  • Nearly all inhalants produce effects similar to those of anesthetics, slow down the bodies functions

  • Volatile solvents

  • Nitrates

  • Anesthetics

  • Methods of use

    • Sniffing

    • Snorting

    • “Bagging”

    • “Huffing”

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Treatment for Drug Dependence

  • Medication-assisted treatment

    • Drug substitution

  • Treatment centers

  • Self-help groups and peer counseling

  • Harm reduction strategies

  • Codependency

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Use of Tobacco

71 Million Americans, including 13.7 million college-aged Americans.

2008, nearly 21% of Americans age 18 describe themselves as current smokers.

Nicotine Addiction

Powerful psychoactive drug

Reaches Brain via bloodstream in seconds

Most physically addictive of the psychoactive drugs.

Loss of control

Tolerance and Withdrawal


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Why Start in the First Place?

Children and teenagers make-up 90% of all new smokers in this country.

Thousands of children and adolescents (12-17) start smoking everyday.

Average age

13 for smoking

10 for spit tobacco


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Characteristics which could increase the potential for use.

A parent or sibling uses tobacco

Peers use tobacco

Child comes from blue-collar family

Child comes from low-income home

Single parent.

Performs poorly in school

Child drops out of school

Has positive attitudes towards tobacco


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Health Hazards

Contains hundreds of damaging chemical substances, including acetone (nail polish remover), ammonia, hexamine (lighter fluid), and toluene (industrial solvent).

Unfiltered cigarettes = 5 billion particles per cubic mm

50,000 times more than polluted urban air

Condensed particles in the cigarette produce the tar (brown, sticky mass)

Chapter 8


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Health Hazards (cont)

Carcinogens and Poisons

43 chemicals are linked to cancer (Carcinogen)

Benzo(a)pyrene (yellowish tar)

Urethane (ex: solution used in making foams)


Combine with other chemicals to cause cancer (e.g., formaldehyde)

Poisonous substances

Arsenic (e.g., insectides and weed killers)

Hydrogen cyanide (e.g., flammable liquid used in dye)

Carbon monoxide

400 times greater than is considered safe in industrial workplaces

Displaces oxygen in red blood cells


Nearly 600 chemicals

Chapter 8


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“Light” and Low-Tar Cigarettes

Low-tar, low-nicotine, or filtered cigarettes

No such thing as a safe cigarette

Often smoke more


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Additional Health, Cosmetic, and Economic Concerns



Reproductive health problems

Dental diseases

Diminished physical senses


Cosmetic concerns

Economic costs


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Cumulative Effects

Males before 15 yrs. old are half as likely to live to 75 versus those who did not smoke

Females with similar habits reduce life expectancy by more than 10 years

Female smokers spend 17% more sick days in bed than nonsmokers

Both men and women show a greater rate of acute and chronic diseases


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Other Forms of Tobacco

Spit (Smokeless) Tobacco

More than 6.6 million adults

8% of all high school students

Cigar and Pipes

Cigar smoking has increased by 148% from 1993-2006.

Cigars contain more tobacco than cigarettes.

Clover cigarettes and Bidis

Twice the tar, nicotine, and carbon monoxide


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The Effects of Smoking on the Nonsmoker

Environmental Tobacco smoke (ETS)

Environmental Protection Agency (EPA) designated ETS as a class A carcinogen

Department of Health and Human Services’ National Toxicology Program - “known human carcinogen”

Surgeon General – 2006 – “there is no safe level of exposure to ETS; even brief exposure can cause serious harm”.


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Environmental Tobacco Smoke

Mainstream smoke

Smoke exhaled by smokers

Sidestream smoke

Smoke from the burning end of a cigarette, cigar, or pipe.

85% of smoke in a room is second hand

Twice the tar and nicotine

Three times the benzo(a)pyrene

Three times the ammonia

Smoke from a cigar can be even more dangerous

30 times more carbon monoxide


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ETS Effects

Develop cough, headaches, nasal discomfort, eye irritation, breathlessness and sinus problems

Allergies will be exacerbated

Causes 3,000 deaths due to lung cancer

Contributes to about 35,000 overall deaths each year.

20% increase in the progression of atherosclerosis.

Contributes to increased asthma attacks


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Lung Cancer from Tobacco Smoking

Healthy Lung

Lung Cancer


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Oral Cancer from Tobacco Smoking


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Infants, Children, and ETS

More likely to develop

Bronchitis, pneumonia,& respiratory infections

More complications from asthma

Increased chance of SIDS (sudden infant death syndrome)

Low-birth weight


Chemicals from smoking show up in breast milk

Children inhale three times more pollutants per unit of body weight than adults.


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Smoking and Pregnancy

Estimated 4,600 infant deaths in the U.S.

Miscarriage, premature birth, low birth weight, long term impairments in growth and intellectual development

Possible higher risks of getting cancer

16% of pregnant women smoke


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Cost of Tobacco Use to Society

Lost productivity from sickness, disability, and premature death makes it close to $167 billion per year.

1998 Master Settlement Agreement (MSA)

43 states filed suit against tobacco companies to recoup public health care expenditures

Tobacco companies have to pay $206 billion over 25 years.

Limits or bans certain types of advertising, promotions, and lobbying.


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How A Tobacco User Can Quit

50.2 % of all adults who have smoked have quit.

The Benefits of Quitting

Options for quitting

Smoking cessation programs


Department of Health and Human Services

Smoking cessation products

Chantix (Varinicline)

Zyban (Bupropion)

Nicotine replacement products

Patches, gums, lozenges, nasal sprays, and inhalers


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The Nature of Alcohol


  • Psychoactive ingredient

  • Depressant

  • Ethyl Alcohol – only alcohol that can be consumed

    • Beer 3-6% alcohol by volume

    • Malt Liquors 6-8% alcohol by volume

    • Table wines 9-14% alcohol by volume

      • Fermenting

    • Fortified wines 20% alcohol by volume

      • Sugar added

      • Extra alcohol is added

    • Hard liquors 35-50% alcohol by volume

      • Distilling or fermented

  • Proof Value

    • Two times the percentage concentration

  • Ingestion

    • 7calories per gram

    • 1 drink 14-17 grams or 100-120 calories

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    • 20% is rapidly absorbed from the stomach

    • 75% is absorbed in the upper small intestines

    • Remain is absorbed along the GI track

    • Absorption

      • Carbonation

      • Food in the stomach slows the absorption

      • Eventually all the alcohol ingested will be absorbed

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    Metabolism and Excretion


    Transported throughout the body via the bloodstream.

    Easily moves through most biological membranes

    Main site for metabolism is the Liver.

    2-20% of ingested alcohol is not metabolized.

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    Alcohol Intake and Blood Alcohol Concentration


    • Blood Alcohol Concentration(BAC)

      • A measure of intoxication

      • Body weight

      • Percentage of body fat

      • Sex

    • Genetic factors

    • Drinking Behavior

    • Metabolism is the same if the person is awake or asleep

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    The Immediate Effects of Alcohol on Health


    • Depends on the individual.

    • Low Concentrations .03% -.05%.

    • Higher Concentrations 0.1% -0.2%.

      • Concentration of .35% and higher.

    • Alcohol hangover

    • Alcohol poisoning

    • Using Alcohol with other drugs

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    Drinking and Driving


    • In 2004

      • 250,000 were injured in alcohol related automobile crashes

      • 42,000 people are killed in alcohol related accidents

    • Dose-response function

      • Driving with a BAC of 0.14% is more

        than 40 times more likely to be

        involved in a crash.

      • Greater than 0.14% the risk of fatal

        crash is estimated to be 380 times higher.

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    Angels Pitcher Nick Adenhart Killed In Car Crash

    April 9, 2009

    Two people who were with him were also killed when, according to police, a minivan ran a red light at a Fullerton intersection and broadsided the gray Mitsubishi they were in. The driver of the minivan, Andrew Thomas Gallo, 22, of Riverside, was arrested on suspicion of drunken driving, hit and run and manslaughter.


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    Approximate blood concentration and body weight

    © 2010 McGraw-Hill Companies. All Rights Reserved.


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    The Effects of Chronic Use


    • Diseases of the digestive, cardiovascular systems and some cancers

    • Digestive system

      • Liver function

        • liver cell damage and destruction (cirrhosis)

      • Pancreas inflammation

    • Cardiovascular system

      • moderate doses may reduce the risk of HD

      • Higher doses elevates BP, may weaken heart muscle or cardiac myopathy.

  • Cancer

    • Mouth, throat, larynx, and esophagus

      • 5-6 total drinks

    • Responsible for the most common form of liver cancer

      • Hepatitis speeds the growth of this cancer

    • Breast cancer

      • Increase risk when 2-3 drinks per day

  • Brain Damage

    • Cognitive impairments

    • Memory loss, dementia, and compromised problem-solving

    • Wernicke-Korsakoff syndrome (brain damage)

  • Mortality

    • Alcoholics average life expectancy is about 15 years less than non-alcoholics

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    The Effects of Alcohol use During Pregnancy


    • Effects are dose-related.

      • Fetal Alcohol Syndrome (FAS)

        • Full-blown FAS occurs in up to 15 out of every 10,000 live births in the U.S.

        • Under weight, flat nasal bridge, and long upper lip.

        • Small and have heart defects.

        • Physical and mental growth is slowed. Remain mentally impaired. Fine motor skill problems, coordination, learning and behavioral problems (ADS).

      • Alcohol-related neurodevelopment disorder (ARND).

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    Possible Health Benefits of Alcohol


    • Abstainers and light to moderate drinkers live longer than heavy users.

    • 35 years old and younger, your odds of dying increase in proportion to the amount consumed

    • Moderate drinking = one drink per day for women and two drinks per day for men.

      • May lower coronary heart disease.

      • Raising blood levels of HDL.

      • May lower risks of diabetes, arterial blockages, Alzheimer’s

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    Alcohol Abuse and Dependence


    • Alcohol abuse is recurrent use that has negative consequences.

    • Alcohol dependence or Alcoholism more extensive problems, tolerance and withdrawal

    • Warning signs of alcohol abuse

      • Drinking alone

      • Using deliberately and repeatedly

      • Feeling uncomfortable on certain occasions

      • Escalating consumption

      • Getting drunk regularly

      • Drinking in the morning or unusual times

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    Alcohol Abuse and Dependence


    • Binge Drinking

      • The National Institute on Alcohol Abuse and Alcoholism defines:

        • Pattern of alcohol use that brings a person’s BAC up to 0.08 or above (typically four drinks for a male or three for a women) within two hours.

      • National Survey on Drug Use and Health defines:

        • Having five drinks in row for a man or four in a row for a women within two hours.

      • Frequent binge drinking in college were three to seven times more likely than non-binge drinkers to engage in unplanned or unprotected sex

      • Healthy People 2010

        • Reduce the rate of binge drinking to 20% among college students

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    • Patterns and Prevalence

      • Regular daily intake of large amounts

      • Regular heavy drinking limited to weekends

      • Long periods of sobriety interspersed with binges or daily heavy drinking

      • Heavy drinking limited to periods of stress

    • Health Effects

      • DTs (delirium tremens)

      • paranoia

    • Social and Psychological effects

    • Causes of Alcoholism


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    Treatment Programs


    • Not one program works for everyone.

      • AA.

        • 12-step program

      • Employee Assistance.

      • Inpatient hospital rehabilitation

      • Pharmacological treatments.

        • Disulfiram (Antabuse)

          • Inhibits the metabolic breakdown

        • Naltrexone (ReVia, Depade)

          • Reduces the craving for alcohol and decreases its pleasant effects.

        • Injectable Naltrexone (Vivtrol) – single monthly shot

        • Acamprosate (Campral)

          • Acts on brain pathways related to alcohol abuse.

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    Gender and Ethnic Differences


    White American men (excessive drinking often begins in the teens or twenties)

    “Other men” (remain controlled drinkers until later in life)

    Women (alcoholism often occurs

    later in life)

    African Americans (alcohol abuse

    usually found in African Americans)

    Latinos (drinking patterns vary)

    Asian Americans (low rate of alcohol abuse)

    American Indians and Alaska Natives (excessive drinking varies from tribe to tribe)

    Chapter 8


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    Video Segment: The Effects of Drug Use on Brain Chemistry