A pattern of behavior in which people rely on a drug excessively and regularly, bringing damage to their relationships, functioning poorly at work, or putting themselves or others in danger.

A pattern of behavior in which people organize their lives around a drug, possibly building a tolerance to it, experiencing withdrawal symptoms when they stop taking it, or both. Also called addiction.

The adjustment that the brain and the body make to the regular use of certain drugs so that even larger doses are needed to achieve earlier results.

Unpleasant, sometimes dangerous reactions that may occur when people who use a drug regularly stop taking or reduce their dosage of the drug.

Any beverage containing ethyl alcohol, including beer, wine, and liquor.

*Alcohol helps GABA shut down neurons and "relax" the drinker.

First the brain area affected is that which controls judgement and inhibition.Next affected are additional areas in the central nervous system, leaving the drinker even less able to make sound judgements, speak clearly, and remember well.

SUBSTANCE ABUSE (DSM-IV-TR)

1. A maladaptive pattern of substance use leading to significant impairment or distress.

2. At least one of the following features occurring within one year:

(a) Recurrent substance abuse, resulting in failure to fulfill major role obligations at work, school, or home.

(b) Recurrent substance use in situations in which it is physically hazardous.

(c) Recurrent substance-related legal problems.

(d) Substance use that continues despite its causing or increasing persistent social or interpersonal problems.

1. A maladaptive pattern of substance use leading to significant impairment or distress.

2. At least three of the following:

(a) Tolerance; (b) Withdrawal; (c) Substance often taken in larger amounts over a longer period than was intended; (d) Persistent desire for substance or unsuccessful efforts to control substance use; (e) Considerable time spent trying to obtain, use, or recover from the substance; (f) Substance use in place of important activities; (g) Substance use that continues despite its causing or increasing persistent physical or psychological problems.

Any substance other than food that affects our bodies or minds. Current language uses the term "substance" rather than "drug" to include alcohol, tobacco, and caffine.

Key Difference between Substance Abuse and Substance Dependence is:

• Depressants
• Stimulants
• Hallucinogens
• Cannabis
• Polydrug use

Slow the activity of the central nervous system. They reduce tension and inhibitions and may interfere with a person's judgement, motor activity, and concentration.

Three most widely used groups of depressants are:

• Alcohol
• Sedative-hypnotic Drugs
• Opioids

Five or more drinks on a single occasion.

24% of people over age 11, mostly male, binge drink each month.

 7% of people over age 11 binge-drink at least five times a month. **They are considered "Heavy Drinkers."

a chemical that is quickly absorbed into the blood through the lining of the stomach and the intestine.

"All alcoholic beverages contain ethyl alcohol."

Concentration

"Blood Alcohol Concentration"

Levels of impairment are closely tied to the concentration or proportion of ethyl alcohol in the blood.

BAC = 0.06: Relaxtion and comfort.

BAC = 0.09: Intoxication.

BAC = > 0.55: Death

*most people lose consciousness before they can
  drink this much.

Stomach Enzyme that breaks down alcohol in the stomach before it enters the blood.

Women have less of the enzyme. So women become more intoxicated then men on equal doses of alcohol.

The average amount of alcohol metabolized or broken down, by the liver into carbon dioxide and water, which can be exhaled and excreted in one hour is:

25 percent of an ounce

** Only time and metabolism can make a person sober

People who abuse alcohol drink large amounts regularly and rely on it to enable them to do things that would otherwise make them anxious.

Eventually the drinking interferes with work and social functioning.

Approx 8% of US adults meet the criteria for alcohol abuse or  dependence each year.

Between 9 and 18% will display one of the patterns in their lifetime, men outnumbering women 2:1

For many people, the pattern of alcohol misuse includes dependence:

* They build a physiological tolerance and need to drink
   greater amounts to feel its effect.

* They may experience a withdrawal, including nausea
   and vomiting, when they stop drinking.
* A small percentage of alcohol-dependent people
   experience a dramatic and dangerous withdrawal
   symptom known as "delirium tremens." (the DTs).
          *Can be fatal

A dramatic withdrawal reaction experienced by some people who are alcohol-dependent. It consists of confusion, clouded consciousness and terrifying visual hallucinations. Also called alcohol withdrawal delirium.

An alcohol related disorder marked by extreme confusion, memory impairment, and other neurological symptoms.

A cluster of problems in a child, including low birth weight, irregularities in the heads and face, and intellectual deficits, caused by excessive alcohol intake by the mother during pregnancy.

A drug used in low doses to reduce anxiety and in higher doses to help people sleep. Also called anxiolytic drug.

Like alcohol - they calm people by binding to receptors on the neurons that receive GABA and by increasing GABA's activity at those neurons.

Addictive sedative-hypnotic drugs that reduce anxiety and help produce sleep.

*At to high a level, they stop respiration, lower blood pressure, and can cause death.
Similar to alcohol, they are metabolized by the liver.

A great danger of barbiturate dependence is that the lethal dose of the drug remains the same even while the boby is building a tolerance for the sedative effects.

BENZODIAZEPINES

The most common group of antianxiety drugs, which includes Valium and Xanax.

*Most popular sedative-hypnotics available.

Benzodiazepines relieve anxiety without causing related drowsiness. As a result they are less likely to slow breathing and lead to death by overdose.

Can cause intoxication and lead to abuse or dependence, 1% US adults abuse or become physically dependent at some point in their lives.

Opium or any of the drugs derived from opium, including morphine, herion, and codeine.
This class of drugs includes both natural (opium, herion, morphine, codeine) and synthetic (laboratory-blended)(ex: methadone) compounds and is known collectively as "narcotics".

 Opioids bind to the receptors in the brain that ordinarily receive endorphins. When these sites receive opiods, they produce pleasurable and calming feelings just as endorphins do.  In addition to reducing tension, opioids can cause nausea, narrowing of the pupils, and constipation.

A highly addictive substance made from the sap of the opium poppy.

A highly addictive substance derived from opium that is particularly effective in relieving pain.

One of the most addictive substances derived from opium.

After just a few weeks, users may become caught in a pattern of abuse. Users quickly build a tolerance for the drug and experience withdrawal when they stop taking it.

Early withdrawal symptoms include anxiety and restlessness; later symptoms include twitching, aches, fever, vomiting, and weight loss from dehydration.

Neurotransmitters that help relieve pain and reduce emotional tension. They are sometimes referred to as the body's own opioids.

Injected by needle just under the skin.

Injected directly into the bloodstream.

A rush/spasm followed by several hours of pleasant feeling.

During a high, the drug user feels relaxed, happy, and unconcerned about food, sex, or other bodily needs.

A spasm of warmth and ecstasy that is sometimes compared with an orgasm.

Substances that increase the activity of the Central Nervous System.

*Cause increase in blood pressure, heart rate, and alertness.

* Cause rapid behavior and thinking.

The Four most common: Cocaine, Amphetamines, Caffine, & Nicotine.

The central active ingredient of the coca plant, found in South America, the most powerful natural stimulant now known.

28 million people in the US have tried it. 2 million are currently using it. 3% of the population will become dependent at some point in their lives.

Produces a euphoric rush of well being - it stimulates the central nervous system and decreases appetite.

It seems to work by increasing dopamine at key receptors in the brain by preventing the neurons that release it from reabsorbing it.

It also appears to increase norepinephrine and serotonin.

High doses produce intoxication; symptoms include mania, paranoia, and impaired judgement.

Regular use may lead to abuse - the person remains under the effect of cocaine for much of each day and functions poorly in major areas of life.

Dependance may also develop.

As the stimulant effects of the drug subside, the user experiences a depression-like let down.

A technique for ingesting cocaine in which the pure cocaine basic alkaloid is chemically seperated from processed cocaine, vaporized by heat from a flame, and inhaled with a pipe.

A powerful, ready-to-smoke free-base cocaine.

A stimulant drug that is manufactured in the laboratory.

Most often taken in pill form - can be injected or taken in "ice" and "crack" form; counterparts of free-base cocaine and crack.

The greatest risk of use is the risk of overdose.

*Excessive doses depress the respiratory of the brain and stop breathing.

*Cocaine use can also cause heart failure.

Increase energy & alertness & lower appetite when taken in small doses. Produce a rush, intoxication, & psychosis in high doses.

Cause an emotional let down as they leave the body.

Stimulate the CNS by increasing dopamine, norepinephrine, & serotonin.

Tolerance builds quickly, so users are at great risk of becoming dependent. When people dependent stop taking it, serious depression and extended sleep follow. 2% US will become dependent.

A powerful amphetamine drug that has experienced a surge in popularity in recent years, posing major health and law enforcement problems.

The WORLD's most widely used stimulant, most often consumed in coffee.

80% of the world consume it daily. Most consumption is in the form of coffee; the rest is in the form of tea, cola, chocolate, and over-the-counter medications.

More than 2-3 cups of brewed coffee can lead to caffeine intoxication.

Seizures and respiratory failure can occur at doses greater than 10 grams of caffine (about 100 cups of coffee)

Many people who suddenly stop or cut back their usual intake experience withdrawal symptoms: headaches, depression, anxiety, and fatigue.

HALLUCINOGENS

A substance that causes powerful changes primarily in sensory perception, including strengthening perceptions and producing illusions and hallucinations. Also called psychedelic drug.

*Produce delusions, hallucinations, and other sensory changes.

Natural Hallucinogens: Medcaline & Psilocybin

Synthetic Hallucinogens: LSD & MDMA(Ecstasy)

A hallucinogenic drug derived from ergot alkaloids.

**One of the most famous and powerful hallucinogens**

Within 2 hrs of being ingested, it brings on a state of hallucinogen intoxication: increased and altered sensory perception - hallucinations may occur.

The drug may cause different senses to cross, effect called synesthia - may produce strong emotions - may have physical effects. Effects wear off in about six hours.

Drugs produced from the varieties of the hemp plant Cannabis sative.  They cause a mixture of hallucinogenic, depressant, and stimulant effects.

Hashish - the solidified resin of the cannabis plant. Marijuana - a mixture of buds, crush leaves, and flowering tips.

The greater the THC content, the more powerful.

The main active ingredient of cannabis substances.

Hallucinogens appear to produce symptoms by binding to serotonin receptors (blocks the transporters) - these receptors control visual information & emotions, thereby causing the various effects.

More than 14% US have used Hallucinogens at some point in their lives. 2% in the past year.
tolerance and withdrawal are rare - But they do pose physical dangers - bad trips - flashbacks.

The experience of enormous unpleasant perceptual, emotional, and behavioral reactions.

FLASH-BACKS

Hallucinogen persisting perception disorder.

*Can occur a year or more after drug use.

At low doses the user feels joy and relaxation - May become anxious, suspicious, or irritated. This overall high is called cannabis intoxication.

At high doses, cannabis produces odd visual experiences, changes in body image, and hallucinations.

Most effects can last 3-6 hours, mood changes may continue longer.

Marijuana was once thought not to cause abuse or dependence. Today many users are caught in pattern of abuse. Some users develop tolerance and withdrawal, experiencing flu-like symptoms and irratability when the drug use is stopped.

2% display abuse or dependence within last year. 5% will fall into patterns at some point in their lives.

**Key Fact "The marijuana available today is significantly more potent than the drug used in the late 1960's"

Marijuana has been linked to poor concentration and impaired memory. May cause panic reactions similar to those casued by hallucinations and because of its sensorimotor effects, it has been implicated in accidents.

Long-term use poses additional dangers:

May cause respiratory problems and lung cancer.

May affect reproduction: In Males, it may inhibit sperm production. In females, it may block ovulation

Tolerance for a substance one has not taken before as a result of using another substance similar to it.

Sometimes two or more drugs are so similar in their actions on the brain and body that as people build a tolerance for one drug, they are similtaneously developing a tolerance for the other (even if they have never taken it)

Users displaying this cross-tolerance can reduce the symptoms of withdrawal from one drug by taking the other. Ex: alcohol and benzodiazepines

In pharmacology, an increase of effects that occurs when more than one substance is acting on the body at the same time.

When different drugs are in the body at the same time, they may multiple, or potentiate, each other's effects.

One kind of synergistic effect occurs when two or more drugs have similar actions. EX: alcohol, barbiturates, benzodiazepines, and opioids.

A different kind of synergistic effect results when drugs have opposite effects. Ex: Stimulants or cocaine with barbiturates or alcohol.

A long-term pattern of maladaptive behavior centered on abuse of or dependence on a combination of drugs.

*People often take more than one drug at a time, a pattern called polysubstance use.

Each year tens of thousands of people are admitted to hospitals because of polysubstance use.

May by accidental or intentional. - As many as 90% of people who use one illegal drug are also using another to some extent.

Drug in vapor form is inhaled through mouth and lungs into circulatory system.

Drug in powdered form is snorted into the nose. Some of the drug lands on the nasal mucous membranes, is absorbed by blood vessels, and enters the bloodstream.

Drug in liquid form directly enters the body through a needle. Injection may be intravenous or intramuscular (subcutaneous). intravenous/intramuscular.

Drug in solid or liquid form passes through esophagus and stomach and finally to the small intestines. It is absorbed by blood vessels in the intestines.

Drugs can be absorbed through areas that contain mucous membranes. Drugs can be be placed under the tongue, inserted anally and vaginally, and administered as eyedrops.

A dopamine-rich pathway in the brain that produces feelings of pleasure when activated.

A condition, suspected to be present in some individuals, in which the brain's reward center is not readily activated by the usual events in their lives.

A treatment in which clients are repeatedly presented with unpleasant stimuli while performing undesireable behaviors such as taking a drug.

A cognitive-behavioral approach to treating alcohol abuse and dependence in which clients are taught to keep track of their drinking behavior, apply coping strategies in situations that typically trigger excessive drinking, and plan ahead for risky situations and reactions.

Biological Treatment: Systematic and medically supervised withdrawal from a drug. Can be inpatient or outpatient

Two strategies: Gradual withdrawal by tapering doses of the substance; Induce withdrawal but give additional medication to block symptoms.

Detox programs seem to help motivated people withdraw from drugs. For people who fail to receive psychotherapy after withdrawal, however, relapse rates tend to be high.

Drugs that block or change the effects of an addictive drug.

An aid to resist falling back into a pattern of substance abuse or dependence, antagonist drugs block or change the effects of the additive substance.

Ex: disulfiram (Antabuse) for alcohol

      naltrexone for narcotics, alcohol

DRUG MAINTENANCE THERAPHY

(METHADONE MAINTENANCE PROGRAM)

A drug-related lifestyle may be a greater problem than the drug's direct effects. Ex: herion addiction.

Thus, methadone maintenance programs are designed to provide a safe substitute for herion.Methadone is a laboratory opiod with a long half-life, taken orally once a day.

Programs were roundly criticized as "substituting addictions" but are regaining popularity, partly because of the spread of HIV/AIDS.

A self-help organization that provides support and guidance for persons with alcohol abuse or dependence.

People are most likely to develop patterns of substance abuse or dependence when living in stressful socioeconomic conditions. Ex: higher rates unemployment correlate with higher rates of alcohol use/ people with lower SES have higher rates of substance use in general.

Other theorists propose that substance abuse and dependence are more likely to appear in societies where substance use is valued or accepted. Ex: rates of alcohol use varies between cultures (Asians less likely)

People who abuse substances have powerful dependency needs that can be traced to their early years.

Caused by lack of parental nurturing - some people develop a substance abuse personality as a result.

Operant conditioning may play a key role in the development and maintenance of substance abuse.

They argue that the temporary reduction of tension produced by a drug has a rewarding effect, thus increasing the likelihood that the user will seek this reaction again.

Similarly, the rewarding effects may also lead users to try higher doses or more powerful methods of ingestion.

Cognitive theorists further argue that such rewards eventually produce an expectancy that substances will be rewarding, and this expectation is sufficient to motivate individuals to increase drug use at times of tension.

Studies have found that many subjects do in fact drink more alcohol or seek herion when they feel tense.

In a manner of speaking, the model is arguing a "self-medication" hypothesis.

*Studies have found higher rates of substance use among people with mood disorders, PTSD, eating disorders, and schizophrenia.

The brain is structured such that pleasurable emotions inevitably lead to opponent processes-negative after effects - that leave the person feeling worse than usual.

The opponent processes eventually dominate, and avoidance of the negative after effects replaces pursuit of pleasure as the primary factor in drug taking.

Although a highly regarded theory, the opponent-process explanation has not received systematic-research support.

Other behavioral theorists have proposed that classical conditioning may play a role in drug abuse, dependence, & withdrawal.

Objects present at the time drugs are taken may act as classically conditioned stimuli and come to produce some of the pleasure brought on by the drugs themselves.

*No widespread research support.

Drug misuse may have biological causes.

Studies on genetic predisposition and specific biochemical processes have provided some support for this model.

Research with alcohol preferring rats has demonstrated that their offspring have similar alcohol preferences.

 Research with human twins has suggested that people may inherit a predisposition to abuse substances. Identical 54%, Fraternal 28%

Research with adoptees whose biological parents were dependent on alcohol with adoptees who were not dependent - by adulthood, those whose biological parents were dependent showed higher rates of alcohol use themselves.

An abnormal form of the dopamine-2(D2) receptor gene was found in the majority of subjects with alcohol dependence but in less than 20% of non-dependent subjects.

Recent brain imaging studies have suggested that many (perhaps all) drugs eventually activate a single "reward center" or "pleasure pathway" in the brain.

The reward center apparently extends from the brain area called the ventral tegmental area to the nucleus accumbens and on to the frontal cortex.

The key NT appears to be dopamine - when dopamine is activated at this center, a person experiences pleasure.

Certain drugs stimulate the reward center directly. Ex: Cocaine and amphetamines. Other drugs stimulate the reward center indirectly. EX:alcohol, opiods, cannabis.

Theorists suspect that people who abuse substances suffer from a reward-deficiency syndrome. Their reward center is not readily activated by "normal" life events so they turn to drugs, especially during times of stress.

Defects in D2 receptors have been cited as a possible cause.

Today treatments are used in combination on both an outpatient and inpatient basis.

Multi-Dimentional Approach needed:

DETOX (inpatient)

AA/NA (outpatient)

Counseling (change behavior)

PSYCHODYNAMIC THERAPIES

Help those with substance-related disorders become aware of and correct underlying psychological problems.

Research has not found this model to be very effective

Tends to be of greater help when combined with other approaches in a multidimentional treatment program.

BEHAVIORAL THERAPIES

AVERSION

A widely used aversion therapy, an approach based on classical conditioning principals.

Individuals are repeatedly presented with an unpleasant stimulus at the very moment they are taking a drug. After repeated pairings they are expected to react negatively to the substance itself and lose their craving for it.

Aversion therapy is most commonly applied to alcohol abuse/dependence.

BEHAVIORAL THERAPIES

COVERT SENSITIZATION

Covert sensitization is another version of aversion therapy.

Requires people with alcoholism to imagine extremely upsetting, repulsive, or frightening scenes while they are drinking.

The pairing is expected to reproduce negative responses to liquor itself.

BEHAVIORAL THERAPIES

OTHER

Teaching alternative behaviors to drug taking- has been applied to alcohol abuse and dependence more than to other substance-related disorders.

Contingency management has been successful in short-term treatment.

Behavioral Interventions are of limited success and are best when used in combination with either biological or cognitive approaches.

Two popular combined approaches, both applied particularly to alcohol use:

*Behavioral self-control training (BCT): clients keep track of their own use and triggers; learn coping strategies for such events; learn to set limits on drinking; learn skills (relaxation, coping, problem-solving)

*Relapse-Prevention Training: Clients are taught to plan ahead for drinking situations, Used particularly to treat alcohol use; also used to treat cocaine and marijuana abuse.

Three main sociocultural approaches to substance-related disorders:

1. Self-Help and residential treatment programs
2. Culture and Gender sensitive programs
3. Community Prevention Programs

SOCIOCULTURAL THERAPIES

SELP-HELP AND RESIDENTIAL TREATMENT PROGRAMS

Most Common: AA

Offers peer support along with moral and spiritual guidelines to help people overcome alcoholism.

Many self-help programs have expanded into residential centers or therapeutic communities.

People formerly dependent on drugs live, work, and socialize in a drug free environment while undergoing individual, group, and family therapies.

SOCIOCULTURAL THERAPIES

CULTURE AND GENDER SENSITIVE PROGRAMS

A growing number if treatment programs try to be sensitive to the special sociocultural pressures and problems faced by drug abusers who are poor, homeless, or members of ethnic minority groups.

Similarly, therapists have begun to focus on the unique issues facing female substance abusers.

SOCIOCULTURAL THERAPIES

COMMUNITY PREVENTION PROGRAMS

Perhaps the most effective approach to substance-related disorders is to prevent them.

Prevention programs may focus on the individual, the family, the peer group, the school, or the community at large. The most effective of these prevention efforts focus on multiple areas to provide a consistent message about drug use in all areas of life.