WHY A COURSE ON ADDICTIVE BEHAVIORS?

1. WHY A COURSE ON ADDICTIVE BEHAVIORS? • Study of Drug Use and Misuse Important • A part of life in our culture - pervasive • Affects everyone: we all have choices to make about what we do and don’t do, what we ingest and what we avoid • Can have harmful consequences for individual, family, community, and society • Substance use disorders are both preventable and treatable • We are constantly being presented with information about licit and illicit substances and activities - how do we evaluate it?

2. OVERARCHING PRINCIPLES • Study of Drug Use and Misuse has Experiential and Scientific Basis • Drugs are Neither Good Nor Bad: Context • The Continuum: Drug Use, Misuse, and Dependence • All Drugs and Potentially Addictive Behaviors Have a History and Cultural Context • e.g., religious, spiritual usage; use for health / medical reasons

3. Drug Use, Misuse, and “Addiction” • What is a drug? • What is an addiction? An addict? • ___________ • Themes associated with “addiction” • Conceptions and definitions vary

8. Major Stimulants - Cocaine street cocaine: coca paste and hydrochloric acid = type of salt--powder sniffed or snorted more addictive uses: can inject it--IV quicker smoking: freebase - powder and ether crack - dissolve cocaine salt in baking soda solution, boil off water, left with rock Cocaine - ETOH combo (coca-ethylene) - may alter metabolics of cocaine, which may be more cardiotoxic via increased half-life of cocaine

10. Major Stimulants - Speed Amphetamines ephedrine, principal chemical in these drugs, has been known for thousands of years; used as Chinese medicinal herb ephedrine first isolated in late 1800's, and synthesized in 1920s when it was named “amphetamine” first medically used in 1920's for treating obesity, narcolepsy, colds, and much later ADHD used to enhance performance, decrease fatigue – sport & military applications (e.g., go and no-go pills)

11. Classes/Types of Depressants • 1. Anesthetics (ex. ether, nitrous oxide) • 2. Barbiturates • 3. Benzodiazepines (anxiolytics - ex. ? ) • 4. Buspar • Many labels have been used to describe them, which can be confusing: -tranquilizers -anti-anxiety pills -sleeping pills -sedatives

15. Hallucinogens Types 1. Serotonergic hallucinogens chem similar to serotonin 2. Methylated amphetamines chem similar to norepinephrine...alterations in mood without much change in senses 3. Anticholinergic - (Ach) found in plants: belladonna, mandrake, jimson weed trance or dream-like states 4. Dissociative anesthetics can remain conscious in surgery; causes euphoria, numbness, aggressive behavior, and tactile sense disturbances

17. MDMA

19. Cannabis Negative effects - withdrawal symptoms that may occur after heavy use include: 1. nausea 2. irritability 3. sleep problems - apathy, decrease in motivation - short-term memory impairment (hippocampus, 2-AG may play role in memory loss) - impaired driving - may trigger paranoia, usually mild forms

20. Cannabis - Negative Effects -chronic use associated with low sperm count, abnormal sperm formation and motility, and possible male impotence; enlarged breasts in males has also been reported. - in females, failure to ovulate has been noted - if used during pregnancy may be associated with low birth weight, premature birth (but these women may also be smokers, drinkers) - pot as a “gateway” drug (Adolescents tend to use drugs in this sequence: cigarettes, alcohol, pot, cocaine-heroin) **

21. OPIOIDS I. Where do they come from? • poppy plant: from middle east and Asia • dried sap from plant isopium; cultivated annually • major active ingredient in opium: morphine (3-10 x as strong) / synthesized in 1803 / named after the Greek god of dreams Morpheus / morphine altered in late 1800s into heroin-a “heroic” TX (10 x as strong as morphine) / Fentanyl

22. OPIOIDS II. Medical Uses • As pain reliever (morphine, demerol, codeine, lortab, lorcet, percodan, percocet, vicodin) • with chronic pain or terminal patients • in some cough suppressants • treatment of diarrhea, which is dehydrating

23. ALCOHOL

24. Alcohol’s Pharmacology • It is a CNS depressant • Peak concentrations are reached between 30-90 minutes after drinking is stopped • Alcohol is distributed to all tissues in the body and passes to the brain easily • LD 50 is 25 drinks in 1 hour; BAC of .45 - .55 (BAC is expressed as a ratio of milligrams or weight of alcohol per 100 milliliters - about 3 ounces of blood)

25. most of the consumed alcohol metabolized in liver broken down to acetaldehyde (by ADH - alcohol dehydrogenase and then to acetic acid by aldehyde dehy.) carbon dioxide and water excreted by lungs excreted in urine

26. Addiction and Withdrawal Indicators • Is it Addictive? How do we know? • Tolerance (cellular & metabolic) develops • Withdrawal symptoms occur • BAC can still be above .00 for withdrawal sx to begin

27. Long-term Consequences cont. • Physical: • fatty liver, alcohol hepatitis, and cirrhosis • increased risk of CAD and various types of cancers • increased susceptibility to illness; lower immune system functioning • GI problems such as pancreatitis • FAS: small eyes, droopy eyelids, small head, low intellectual functioning; associated with low SES

28. Long-term Consequences cont. • Cognitive: • impairs memory, problem-solving, learning and reaction time • neuropsychological damage can be reversed with prolonged abstinence • Wernicke-Korsakoff Syndrome • unable to learn new material due to failure to transfer • confabulation

29. College binge drinking • 1997 Harvard Study: • 43% binged in prior 2 weeks (48% men; 39% women) • about 65% of the members of frats/sor. Binged • Reasons for drinking 1993 1997 • “get drunk” 39% 52% • READ: Alcohol in the Lives of College Women