Drugs in Perspective, 4Th Edition

DRUGS IN PERSPECTIVE, 4TH EDITION

By Richard Fields, Ph.D.

INSTRUCTOR’S MANUAL

Chapter 1 Etiology – A Better Understanding of Drug Use –

Models, Functions and Meanings

Key Teaching Points

• Drugs will continue to be used to alter one’s state of consciousness.
• We will never do away with drugs because people will always seek to
• Alter their state of consciousness.
• Drugs are an easy way to alter consciousness. It doesn’t take much effort.
• All you have to do is take the drug in and wait for the desired effect.
• That’s why we consider drug use a “passive activity”. Even though the outcome
• May be to be more active.
• Drugs serve people; they have specific functions, and meanings.
• At low doses, and occasional use, drugs can be used to change mood, view one’s world differently, or just to relax.
• However continued escalation in frequency of use, and increases in dose can lead to significant negative consequences, and problems of abuse and dependence.

Chapter Outline

A.Why Do People Abuse Alcohol/Drugs?

1. No simple solution – “the solution to a complicated problem that is simple is usually wrong” H.L. Mencken, Philosopher
2. Many reasons for drug/alcohol use
3. Primary reason or drive – innate drive to alter consciousness – much like our innate drive of hunger, thirst and sex
4. Drug use is a passive activity – you take the drug in, and wait for the effect

B.Models of Drug Use

1. Disease concept of alcoholism – defined by AMA as a disease in 1957

based on three criteria – known cause (etiology), progressive

symptoms and known outcome

1. Genetic Model – adoption studies and twin studies confirm a genetic model.

3.Personality – no such thing as an addictive personality, more appropriate to talk about psychological vulnerability

– certain personality traits associated with substance abuse (see page 6)

antisocial, borderline, and narcissistic personality disorders show high incidence of substance abuse.

1. Mood and Feeling (Affect) Disorders – depression and bipolar disorder

make one more vulnerable to substance abuse

1. Risk-Taking Behavior – Impulsivity/Disinhibition
2. Tension Reduction Models
3. Attention-Deficit Hyperactivity Disorder (ADHD)
4. Family Models
5. Self-Concept
6. Adolescence – just the fact that you are an adolescent makes one vulnerable to substance abuse.
7. Conditioning

11.Psychological Models – Social Learning Theory

12.Sociocultural Models

1. Psychoanalytical Models

C.Factors that Contribute to Substance Abuse

Hopelessness, Pessimism and Poor Future Orientation

The loss of hope, negative attitude and negative thinking, and

a sense that one’s future doesn’t look good can influence the decision

to use or abuse drugs.

D.FUNCTIONS OF DRUGS

Each drug has a different function

Narcotics – painkillers or numbing

CNS Depressants (including alcohol) – decreases activity, disinhibits

CNS Stimulants – increase activity

Hallucinogens – change the user’s view of the world

E.MEANING OF DRUGS

1. Power – the initial user may be motivated to feel more powerful, but

with time and increased levels of use, the users becomes powerless over

their use, and the drug takes control.

1. Self-destruction – continued use despite negative consequences leads to

significant problems and self-damaging behaviors and attitudes.

1. Seduction and Sexuality – at low doses and occasional use drugs are

used as social lubricants, and for loss of inhibition. As use increases, dose and frequency, there is loss of intimacy and they cause isolation, and emotional detachment.

Chapter 2: Alcohol/Drugs and Our American Society

At-Risk Factors

Key Teaching Points

• Drugs have always been portrayed as more harmful than alcohol.
• Heroin, cocaine, even marijuana are often referred to as hard drugs, or inappropriately labeled as narcotics, when alcohol and nicotine are the two largest drug problems.
• The moral, and political systems take positions “Against Drug Abuse”, but they are less actively opposed to alcohol abuse. The “Just So No” approach illustrates how out of touch the Reagan administration was with the depth of the drug problem.
• The emphasis on the supply side of the problem, and the neglect of the demand side, just continues the status quo and prevents us from ever limiting availability.
• The profit margin for drug trafficking is so large, that until we look at legalization we will continue to have drugs as a major import.
• Historically we continue to ignore drug problems of people of color.
• It is when drugs impact the middle and upper class Caucasian populations that funding for prevention, intervention, and treatment programs will be made available.
• Drugs may be a choice due to academic failure, and the shattered hope for a successful future. Socioeconomic inequities may shatter the American Dream, and drugs become a way of life, whether using, and/or dealing.

Chapter Outline

1.Alcohol and Nicotine – The Two Largest Problem Drugs in the U.S.

Too often emotional, political and moral judgments block the perception of the two most problematic drugs – alcohol and nicotine

• Alcohol problems well documented – child and spouse abuse,

• Aggression and violence, driving under the influence, teenage drinking and driving, homicides, accidents, suicide, crime, traffic accidents.
• Tobacco as the most deadly drug – 20% of the deaths in the U.S. are caused by cigarette smoking, 90% of lung cancer deaths are caused by smoking

2. At-Risk Factors for Problems with Alcohol/Drugs

• Denial of parental alcoholism and addiction
• Academic failure
• Trauma, violence, and violation

(see table 2.6 Risk Factors and Correlates to Alcohol/Drug Use

3.Emphasis on the Supply Side and Neglect of the Demand Side

• The continued emphasis on the supply side of drugs, fails to adequately address and fund programs that deal with prevention, intervention and treatment of substance dependence. A balanced approach is necessary to impact drug use, abuse and addiction.

4. Neglect of the Alcohol/Drug Treatment Needs of People of Color

Historically drug use by people of color and minorities has been neglected. It is only when drugs impact mainstream Caucasians that the government seems to create programs and make funding available.

5. Academic Failure and the Failure of the U.S. Educational System in Motivating and Educating Young People to Strive for Productive Lives

1. Socioeconomic Inequities Undermining the American Dream

The lack of hope for a secure future and the attainment of the basic American dream of a good job, home, financial stability, and a good future contributes to feelings of despair that can lead to drug use and abuse. The inequities in the planning field further contribute to feelings of resentment, prejudice and lack of equal opportunity.

1. The Major Perspectives of Alcohol/Drug Use

The five (5) perspectives are:

Moral- Legal Perspective – law enforcement and the criminal justice system

Medical – Health Perspective – medical and health treatment fields

Psychosocial Perspective – alcohol/drug treatment agencies – mental health agencies

Sociocultural Perspective – most social service agencies and institutions

Your own Personal Perspective

Emphasis in helping others to maintain a Perspective of Hope

Chapter 3 Drug Specific Information

Drugs on the Street Where You Live

Key Teaching Points

• Drugs are the vehicle to alleviate pain, to change the way we feel, to distort reality, to feel pleasure not pain, to avoid, and several other functions.
• A drug, is a drug, is a drug, they only differ in the effect on the mind and body. Abuse, addiction are traps that have significant consequences on the soul.
• The history of American drug use is fascinating. From the credo of
• “Drugs, sex and rock n’roll”, to cocaine, crack, designer drugs, and ecstasy.
• There will always be a new drug that affects the mind and body in a different way, and certainly there are a variety of drugs in different categories, most of them with an addiction potential.

Chapter Outline

1. DRUGS IN OUR SOCIETY

- Drugs, Sex and Rock n’Roll –

-Drug revolution of the 60s and 70s was more than exploration it was a revolution against the Protestant work ethic, moral and sexual values, and societal values in general – “turn on and tune out” - it was a symbol of the conflict in Viet Nam and the stress of the draft for adolescent and young adults, many of them college students

-In the 1980s the rise in cocaine use had a major impact through the deaths of major media personalities and its impact on a middle to upper class population

-“Crack” was the natural progression to lower socioeconomic populations, create a new epidemic, complicated by freebase cocaine use that made the drug quicker acting and of even shorter duration

- Designer drugs, “ice” and methamphetamine came on the scene in the late 80s and early 90s

- Other modern drugs – rohypnol, ecstasy, purer heroin

2. DEFINITION OF TERMS

1. Physical Dependence
2. Withdrawal
3. Psychological dependence
4. Routes of Administration
5. Set and setting

f.Tolerance

1. Cross tolerance
2. Synergism

• This is an important factor, as the use of more than one drug is not additive but instead multiplied.
• 1 drug taken + another drug taken does not equal two units of potency
• Instead it may have a “synergistic effect” of being 5 times more powerful an action.

i. Antagonism

1. Classification of Drugs

• Non-Psychoactive drugs are substances that in normal doses do not directly affect the brain, such as vitamins, antibiotics, and topical skin preparations.
• Psychoactive drugs affect brain functions, mood and behavior and are subdivided primarily on the basis of physiological and psychological effects.

Psychoactive drug classification

1. Narcotic Analgesics
2. Central Nervous System Depressants
3. Central Nervous System Stimulants
4. Hallucinogens
5. Cannabis sativa: marijuana and hashish
6. Inhalants: volatile solvents
7. Phyncyclidine (PCP)

3. NARCOTIC ANALGESICS

• Term narcotic comes from the Greek term narcosis, which means to numb
• Narcotic analgesics (morphine, codeine and heroin) come from the poppy plant
• Term narcotic was inappropriate applied to marijuana, cocaine,
• Hallucinogens, as an emotional-laden moral response

1. Brief History of the Narcotic Analgesics
2. Routes of Administration
3. Major Effects

Pain relief (analgesia)

Euphoria (sense of well being)

Cough suppressant (antitussive)

Respiratory Depression

Sedation or Drowsiness

Constriction of the pupils (pinpoint pupils)

Nausea and vomiting

Itching

Decrease in gastrointestinal activity (constipation)

1. Hazards
2. Tolerance
3. Withdrawal
4. Opiates and Pregnancy

4. CENTRAL NERVOUS SYSTEM DEPRESSANTS

• Of course alcohol is the major drug in this category
• This category refers to drugs as sedative-hypnotics (alcohol, barbiturates, and tranquilizers)

a. Alcohol

• Alcohol acts as a depressant on the central nervous system

a.1 Brief History

a.2 Estimates –the most widely used psychoactive drug known

(other than tobacco products)

a.3 Major Effects on the brain, peripheral nerves, gastrointestinal tract,

heart and blood vessels, the lungs.

a.4 Sobering up – time is the only thing that works

a.5 Tolerance

a.6 Withdrawal Symptoms

a.7 Related Illnesses

a.8 Fetal Alcohol Syndrome

a.9 Antabuse

b. Barbiturates

• Prescribed to induce sleep, relax the nervous system
• Barbiturates and barbiturate like drugs seem to affect the cortex of the brain or those areas related to sleep more than other sedative hypnotics

b.1 Estimates of use and addiction

b.2 Routes of administration – usually taken orally and readily absorbed

b.3 Major Effects

b.4 Barbiturates and Sleep

b.5 Barbiturates and Pregnancy

b.6 Tolerance

b.7 Withdrawal

b.8 Overdose Signs and Symptoms

b.9 Barbiturates Used with Other Drugs

b.10 Methaqualone

Nonbarbiturates with Barbiturate-like Action

1. Chloral hydrate
2. Methaqualone
3. Flurazapame (Dalmane)
4. Glutethimide (Doriden)
5. Ethchlorvynol (Placidyl)
6. Methprylon (Noludar)
7. Paraldehyde

c. Tranquilizers

c.1 Classification of tranquilizers – see chart on page 77

c.2 Medical uses

c.3 Estimates of Use

c.4 Routes of administration

c.5 Major effects – don’t be fooled by the word “minor tranquilizers

c.6 Tolerance

c.7 Dependence and Withdrawal

c.8 Addiction Potential with Alcoholics/Addicts – this is a major teaching point – there is a cross tolerance, and high addiction potential to minor tranquilizers by about only 5 percent of the population – those people are alcoholics/addicts

1. CENTRAL NERVOUS SYSTEM STIMULANTS
2. Amphetamines

a.1 Street Names

a.2 Estimates of use

a.3 Routes of Administration

a.4 Major effects

a.5 Adverse Effects

a.6 Dependence and Withdrawal

a.7 Bootlegged amphetamines

1. Cocaine

b.1 Brief History

• Cocaine has a very unique, even romantic history that is almost a metaphor for its intrigue and subtle but powerful addiction. From the original use of coca by the Incans, to its discovery by Sigmund Freud as a remedy for “neurasthenia” (nervous anxiety) to Freud’s own addiction and subsequent description of its addiction in his book Fear of and Craving for Cocaine.

b.2 Street names

b.3 Estimates of Use

b.4 Routes of Administration

• Cocaine is Cocaine HCL add ether and a base and heat and you end up with NaCl (salt) plus H2O (water) and Cocaine free of its base, hence the term cocaine freebase

b.5 major effects

b.6 Adverse effects

b.7 Tolerance and withdrawal

b.8 Cocaine additives

1. Tobacco

• Tobacco is the most widely abused drug
• Tobacco use is the single leading cause of preventable death in this country

c.1 Diseases Related to Smoking Tobacco

• Heart disease, peripheral vascular disease, cerebrovascular disease, cancer, chronic obstructive lung disease

c.2 health consequences

1. HALLUCINOGENS

• The term hallucinogen is derived from the Latin word hallucinari, which means to dram or to wander in the mind.
• LSD – 1960s timothy Leary advocated LSD as a means of “turning on, tuning in, and dropping out” of mainstream lifestyles and thinking
• See table 3.11 – page 87 – other hallucinogens

7.a Common Street Names for LSD

7.b Brief History of LSD

7.c Estimates of Use

7.d Routes of Administration

7.e Major Effects

7.f Adverse Effects

7.g Tolerance and Dependence

CANNABIS SATIVA

Cannabis refers to any product of the plant Cannabis sativa

7.h Street names

7.i Brief history of marijuana

7.j Estimates of use

7k. Medical use

7l. Routes of administration

7m. Major effects

7 n Increased potency of marijuana

• 1960s THC content of marijuana was 1-2 percent, today THC level
• Averages 6 percent, hashish 10 percent, hashish oil up to 20 percent

7.o Adverse Effects

Damage to the Respiratory system

• Combination of cannabis smoking and cigarette smoking is most damaging, and increases risks of lung cancer

Immune System Effects

• Tends to suppress the body’s immune response when used
• Regularly, and ability to combat infections, temporarily arrests the maturation of developing t-cells, which protect the body from colds and other bacterial infections

Reproductive System Effect

• Chronic use of cannabis decreases sperm motility and serum testosterone in men, and interferes with the menstrual cycle in women

Brain System Effects

• Debate continues over the effects of cannabis on the brain
• Impairment of Maturational Process

Marijuana and Driving

• Impairs short-term memory, alters the user’s sense of time and space, impairs overall coordination, and impairs motor functioning, and impairs tracking of other vehicles, an important aspect of driving

INHALANTS

7.p Brief history

7.q Route of administration

7.r Available forms of inhalants

7.s Major Effects

7.t Tolerance and Dependence

7.u Acute adverse effects

7.v Long-term effects

PHENCYCLIDINE

7w. Street Names

7.x Estimates of use

7.y Routes of administration

7.z Major Effects

7aa. Adverse Effects

7bb. Accidents

7cc. Violence

7dd. Tolerance and Dependence

1. ATHLETES AND DRUGS

8a. Caffeine

8b. Chewing tobacco

8c. Amphetamines

8d. Steroids

• Brief History, terminology, major effects, and adverse effects

8e. Other Drugs/Alcohol in Sports

Chapter 4 Screening and Assessment of Alcohol/Drug Problems

Key Teaching Points

• Emphasis on a functional definition of addiction – 3 “C”s of addiction
• Emphasis that early stages of alcohol/drug use are easy to screen and assess, however excessive use, periodic excessive use and actual addiction are sometimes harder to assess
• A screening tool is a broad based tool to determine if there might be a drug problem
• An assessment tool is used to determine the level and extent of the drug problem, assess the nature, scope and severity of the problem, to better determine treatment recommendations
• In assessing a drug problem, your first question is “Is there a family history of any alcohol or drug problems?” Of course the initial response may be no, so it is important to ask again and clarify what you mean by an alcohol/drug problem
• History of alcohol/drug problems are a significant red flag that there may be a genetic predisposition to addiction
• Adolescent alcohol/drug problems are difficult to assess because many adolescent behaviors are so similar to alcohol/drug abuse problems
• In assessment, especially with adolescents “trust the known facts” not necessarily what someone says or explains – behavior speaks louder than words

Chapter Outline

A.Definition of Addiction

• The functional definition developed as a result of cocaine addiction in the 1980s, developed by David Smith, M.D. of the Haight-Ashbury Center is the 3 “C”s:
• Compulsion - (obsessive- thinking, and compulsive doing of the drug)

• Control – inability to control drug use (failure to abstain for significant period of time)
• Consequences – continued use of drugs despite significant consequences

B. Stages of Drug Use (see chart page 110)

• Non-use, initial contact, experimental (situational, or circumstantial use), integrated use, periodic excessive use, excessive use, addiction

1. Jellinek’s types of Alcoholics

• Alpha, beta, gamma, delta, epsilon
• Helped create the awareness that there are different types of alcoholics, not just the same.

D.Diagnostic Criteria of Substance Abuse and Dependence

• The Diagnostic and Statistical Manual - DSM-IV describes substance abuse, substance dependence in specific diagnostic criteria

E.Vulnerability to Relapse

• The most relapses occur from 30-120 days

1. Family and Recovery

• Alcohol/Drug History – important to take a good family history to determine genetic at-risk (parents, relatives who might have or had an alcohol/drug problem), age of onset of drinking to periods of excessive use
• Important to assess any significant periods of abstinence or sobriety from drugs/alcohol

• Individual Vulnerability to Alcohol/Drugs

(see Chapter 11 – Treatment and Relapse Prevention)