WHY PEOPLE USE SUBSTANCES

1. WHY PEOPLE USE SUBSTANCES Semi-medicinal uses • alcohol to intoxicate a weary mind • belladonna to calm an angry intestine or to poison an adversary • opium to overcome worry and strain. • the relief of pain, in particular, is an age-old aim of humankind • various narcotic and sleep-producing agents were probably used by primitive people.

2. WHY PEOPLE USE SUBSTANCES Consciousness changing uses • expand their vision • enhance their appreciation of their world • change their mood • alter their inner existence • stupefy their awareness

4. Some Important Historical Instances • Genesis (9:20)—Noah planted a vineyard, "and he drank of the wine, and became drunk, and lay uncovered in his tent." Alcohol has been used by many cultures and has been worshipped as a god • Homer tells how some of Odysseus' crew succumbed to forgetfulness in the land of the Lotus-eaters; Opium has also been used extensively, at least since the time of ancient Greece • the ancient Vedic philosophers of India spoke of soma, a mysterious and probably mythical plant

5. HISTORY OF ALCOHOL • Fermentation--any sugar-containing mishmash, left exposed in a warm atmosphere, yeasts converting sugar to alcohol and carbon dioxide • Alcoholic beverages probably discovered accidentally • early man presumably liked the effects, and proceeded to purposeful production & regular cultivation of the vine and other suitable crops • Few preliterate people did not learn to convert some of the fruit of the earth into alcohol

6. Primitive Society Motivations for Alcohol Use • important nutritional value • best medicine available for some illnesses and especially in relieving pain • facilitated religious ecstasy and communion with mystical powers • enabled periodic social festivity, personal jollification, mediator of popular recreation • helped reduce anxiety, tension, and fears connected with concerns over subsistence, safety, warfare, etc.

7. Primitive Society Motivations for Alcohol Use (cont’d) • calm anger or tranquillize hostility and reduce suspicion, making possible peaceful associations and commercial or ceremonial relations • in individuals with extraordinary responsibilities, helped to assuage the personal anxieties • formalized public binge, permissive loosener of interpersonal aggressions, which otherwise the mores of the cohesive small society necessarily forbade

8. earliest civilizations manufactured & sold alcoholic beverages • oldest known code of laws, Hammurabi of Babylonia (c. 1770 BC), regulated drinking houses • Sumerian physician-pharmacists prescribed beer (c. 2100 BC) • Egyptian doctors (c. 1500 BC) included beer or wine in 15% percent of their prescriptions • Semitic cuneiform literature of the northern Canaanites contains abundant references to the ubiquitous religious and household uses

9. Turning Water Into Wine • Water probably the original fluid used as offering in worship rites • alcoholic beverages displaced water due to its capacity to help priest/participants reach a desired state of ecstasy • This ectasy naturally attributed to supernatural spirits and gods • The red wine eventually perceived as symbolizing the blood of life, ultimately passed into the Christian Eucharist • Egyptian & Mesopotamian civilizations drinking and drunkenness became common practice, often troublesome to government and accompanied by acute and chronic illnesses

10. Drunkenness • The Roman philosopher Seneca classified it as a form of insanity • “alcoholism” appears first in the classical essay "Alcoholismus Chronicus" (1849) by the Swedish physician Magnus Huss • rapidly became a medical term for the condition of habitual inebriety conceived as a disease • the bearer of the disease was called an alcoholic or alcoholist (e.g., Italian alcoolisto, French alcoolique, German Alkoholiker, Spanish alcohólico, Swedish alkoholist)

11. Alcohol control in modern societies • lack of consensus around many issues of right and wrong or proper and improper behavior • drinking, since the latter part of the 18th century, has been a focus of disagreement • In US, the late 18th-century temperance movement became 19th century anti-alcohol movement that culminated 20th century Prohibition (1919-1933) • Currently crazy quilt of local regulations

12. U.S. Regulations vary across municipalities • total prohibition • prohibition only of distilled spirits and strong wines • liquor sold only by the bottle, not by the drink • liquor sold only in “airplane bottles” • drinks may be served only together with food, in others only without food • Etc.

13. HISTORY OF DRUG CONTROL • first major national efforts by Chinese in the 19th century • commerce in poppy (opium) and coca leaf (cocaine) organized basis during the 1700sEnglish East India Company was engaged in the profitable export of opium from India to China • monopoly of the China trade was eventually abolished in 1839-42 • the Opium War between the Chinese and the British followed

14. U.S. Drug Control • the nation most preoccupied with drug control • largely the "Americanized" countries have made narcotics regulation a matter of public policy • principal U.S. legislation has been: • Harrison Narcotics Act of 1914 • Opium Poppy Control Act of 1942 • Narcotic Drug Control Act of 1956 • Drug Abuse Control Amendment of 1965

15. Opium & Cocaine Addiction in U.S. • 1800s opiates and cocaine were mostly unregulated drugs • 1890s the Sears & Roebuck catalogue offered a syringe and a small amount of cocaine for $1.50 • 1886, Coca-Cola was named after its two key ingredients -- coca leaves and kola nuts.; by 1904 it was as little as 1/400th of a grain per once of Coca-Cola syrup; by 1929, Coke became cocaine-free • estimated that one US. citizen of 400 was an addict of opium in 1914; user were mostly white or Chinese. • "Of all the nations of the world,the United States consumes most habit-forming drugs per capita. Opium, the most pernicious drug known to humanity, is surrounded, in this country, with far fewer safeguards than any other nation in Europe fences it with." (Dr. Hamilton Wright, United States first Opium Commissioner, New York Times, 1911)

16. Early U.S. Drug Regulations and Racism • JAMA (1900) editorial “Negroes in the South are reported as being addicted to a new form of vice--that of 'cocaine sniffing' or the 'coke habit'.” • newspapers claimed cocaine caused blacks to rape white women and was improving their pistol marksmanship • Chinese immigrants blamed for importing the opium-smoking habit • 1903 Committee on the Acquirement of the Drug Habit concluded, "If the Chinaman cannot get along without his dope we can get along without him". • Dr. Hamilton Wright stated • "Cocaine is often the direct incentive to the crime of rape by the Negroes of the South and other sections of the country;“ • "One of the most unfortunate phases of smoking opium in this country is the large number of women who have become involved and were living as common law wives or cohabitating with Chinese in the Chinatowns of our various cities".

17. Continuum of substance involvement Abuse/Dependence Treatment Secondary Intervention Hazardous Use Secondary Prevention Users No Use Prevention

18. Treatment Models of Addiction MODEL PROBLEM ORIGIN TREATMENT ACTION MORAL Individual Willpower TEMPERANCE The substance Ban the substance SPIRITUAL Individual Turn life over to higher power DISPOSITIONAL/DISEASE Individual, w/o blame Medical treatment EDUCATIONAL Deficient knowledge Educate CHARACTEROLOGICAL Personality abnormalities Character restructuring CONDITIONING Learned behavior Relearn behaviors SOCIAL LEARNING Social pressures/examples Relearn behaviors; alter interactions COGNITIVE Thoughts and expectancies Challenge and restructure cognitions SOCIOCULTURAL Societal controls Decrease/regulate availability/desirability SYSTEMS Family Alter family patterns BIOLOGICAL Genes Counsel the susceptible PUBLIC HEALTH Agent/host/risk factors Harm reduction

19. Stepped Care • used in situations where the same condition • can have a wide degree of manifestations • may vary in severity from person to person • the level and degree of medical intervention may be increased incrementally, "step by step” • used with "spectrum disorders" for which one standard solution would not cover all patients’ needs

20. Continuum of Care • Inpatient • day hospital • intensive outpatient • standard outpatient • brief treatment • mailed feedback • medication (addiction and/or psychotropic)