The Basics of Drugs

1. The Basics of Drugs • Neurology and Chemistry • Neurons are nerve cells • Neurons send electrical impulses • Different body parts • Different cells • Neurons determine: • Autonomic functions • Voluntary functions

2. The Basics of Drugs (2) • Neurons release chemicals called: • Neurotransmitters • Neurotransmitters act on specific sites called: • Receptors • Specific Neurotransmitters fit into specific receptors (key in lock)

3. The Basics of Drugs (3) • The relationship between transmitter and receptor is relative, not specific! • The better the fit the greater the stimulation • Transmitter/Receptor Affinity • High Affinity = Strong Effect • Low Affinity = Weak Effect

4. The Basics of Drugs (4) • Psychoactive Drugs • Cross the blood-brain barrier • No blood-brain barrier crossing, no psychoactive effect • Different routes of administration result in different levels of blood-brain cross over

5. The Basics of Drug Pharmacology • All drugs have multiple effects • Main effects –the intended result of a drug • Side effects – the effects of the drug that are not intended • Effect Dose (ED) – is the amount of a drug needed to produce the intended effect • ED50 – is the amount needed to produce the effect in 50% of a species • ED100 – the amount needed for 100% of the population

6. The Basics of Drug Pharmacology (2) • Toxicity – refers to the drugs ability to kill the organism • Cause harm to one or more of the organs in an organism • Lethal Dose (LD) – the amount need to kill an organism • LD50 – kill 50% of the population • LD100 – kill 100%

7. The Basics of Drug Pharmacology (3) • Drug Margin of Safety • How far apart is the ED from the LD for a given drug? • Barbiturates have a low margin of safety • Marijuana has a high margin of safety • Multiple Drugs Complicate • Additive – greater effect • Antagonistic – cancel effect • Synergy – multiply effect

8. Drug Classifications • Stimulants – methamphetamines, amphetamines (Dexedrine), cocaine, caffeine, Ritalin, nicotine • Antidepressants – Prozac, Zoloft, Lithium • Sedatives – Barbiturates, Quaalude, Valium • Hallucinogens – LSD, mescaline, peyote, MDMA (ecstasy), psilocybin • Analgesics – opiates (opium, morphine, heroin, codeine), opioids (methadone,, Demerol, Darvon) non-narcotic - Tylenol, ibuprofen, aspirin • Cannabis

11. Three Major Neurotransmitters: • Serotonin • Effects sleep, mood, and dreams - is increased by the use of Methamphetamine • Dopamine • Effects motor movement, is involved in pleasure and is related to psychosis • Norepinephrine • Effects heart rate, blood pressure, sweating, • Dilates pupil, lungs and constricts blood vessels

12. Addiction • No universally accept definition • Four common definitions in competition for dominance • Quantity and frequency definition • Psychological dependence definition • Physical dependence definition • Life problems definition • Brain Injury definition

13. Quantity and Frequency Definition of Addiction • Once per week • 3-5 times per week • Everyday Use • Problems: • Individual factors influence the effects based on quantity (Habituation, age, weight, etc.) • Binge users don’t fit into the definition • Yearly average may be low but, the pattern of use reveals excessive amounts in short periods of time

14. Psychological Dependence Definition of Addiction • Experience psychological discomfort as a withdrawal symptom • Do you use after a bad time? • Do your friends use less than you? • Problems: • Moderate users could also answer yes to many of the questions • Definition is very subjective • Difference between habit and dependence?

15. Physical DependenceDefinition of Addiction • Clear physical withdrawal symptoms must be present • Shakes • Cramps • Problems: • Too restrictive to be useful • Problem abusers are not included

16. Life-ProblemsDefinition of Addiction • Medical problems (e.g. liver) • Family problems (divorce, abuse) • Career problems (loss of job, no promotion) • Criminal Justice problems (arrests, convictions) • Problems: • Sub-culture/ cultural definitions of problems • Medical problems are not straight per dose outcomes (not all develop a common medical problem)

17. Brain Injury Definition • Both neurotransmitters and receivers • Damaged so that only the active chemical will trigger the release of dopamine (or serotonin, or norepinephrine) • Only the chemical can generate happiness • Thus, there is no way to scare someone out of addiction • Similar to “if you breath I am going to hurt you.” • What things make you really happy? • Research shows that most injuries begin to heal after 8 or 9 month of abstinence • Some drug require longer periods of abstinence to begin healing

18. Chronic use depletes dopamine and is toxic to the neuron.

19. HOW DRUGS WORK • Multidimensional • Economic • Political • Pharmacological • Psychological • Sociological

20. Drugs A Symbolic Phenomena • Drug Effect are Contingent • Pharmacology represents potential effects • Potential effects are dependent on the social context • 1970’s Reports on the effects of THC • Lab animal studies • Real life experience

21. The Basics of Drug Pharmacology (4) • Physical Tolerance • Certain quantity of drug • Extended period of time • Diminished effects • Behavioral Tolerance • Experience user • Learns the effects • Compensates for effects • Reverse Tolerance • Over time • Users become more sensitive to the effects • Cross Tolerance • Tolerance to a drug in one category • General tolerance to other drugs in the category

22. Drug Effects/Objective and Subjective • Factors Influencing Drug Effects • Identity • Dose • Potency (purity) • Drug mixing • Route of administration • Habituation

23. Identity • What is actually in the drug? • Bogus substances • Is the drug as advertised? • Regular mushrooms as psilocybin • Oregano as pot

24. Dose • What is the amount of the drug that has been taken? • Some dose levels will have no effects on anyone • Some dose levels can have negative effects no matter what the drug

25. Potency and Purity • Potency is the quantity of drug that will produce a given effect • Potency varies between drugs, but also within the same drug • Marijuana with 1% THC verses 10-12% • Alcohol 4-5% verses 10-12% • Purity is the percent of the active ingredient present • Cocaine varies in purity from 20 to 50 or more percent purity • Most drugs are stepped on, cut with non active fillers

26. Mixing • Many (most) people rarely take one drug at a time • Which drugs are mixed can have a powerful effect on the effect • John Belushi mixed cocaine and heroin in an injection • To understand drug effects something must be known about interaction effects (additive, multiplier, or synergy)

27. Administration Route • In general the fast the route to the brain the stronger the effect of the drug • Smoking a drug is the fastest route • All the bodies blood passes through the lungs every minute • Injecting a drug causes the drug to be mixed with (diluted) non drugged blood

28. Habituation • How accustomed is the user to the drug? • The tolerance factor decreases the drug effect • Experienced drinkers can handle much more alcohol and still act straight than non-experienced drinkers

29. Set and Setting • Set refers to the psychic, mental state of the user • Expectations • Mood • Setting refers to the social and physical environment of the drug use • Micro level – living room, or party • Macro level – culture, normative culture

30. DRUGS AS SOCIAL • Drug taking is close to cultural universal • 2-3 million prescription/year • Average $37.50/each • $15 billion in over counter sales/year • 52% drink alcohol • 29% smoke tobacco • $150 billion in illegal drug sales • 65 million have tried marijuana

31. What is a Drug? • Chemical Properties • Definable Biological Effect • One Common Definition • Any substance that causes or creates significant psychological or physiological changes in the body. • Would include: vitamin C, chocolate, and car exhaust

32. What is a Drug? • The term “drug” is a social construction • Does not mean, imaginary effects • Does not mean, no objective effects • Does not mean, calling something a drug will make it a drug • Definitions change over time and place • Alcohol, tobacco, cocaine

33. Drug Definition Categories • Medical – Substances used in connection with healing the body or mind • Penicillin, aspirin, morphine, lithium • Psychoactive – Substances used in connection with altering the state of consciousness • LSD, alcohol, amphetamine, Salvia • Illegal – Substances that have been defined as against the law for the general public by a political authority • marijuana, heroin • Public – Substances the general population thinks of as a drug. • Crack, ice, ecstasy

34. What is Drug Abuse? • A Disease? • A Medical Pathology? • A Sickness? • There is an implication that abuse invariably involves observable physical damage • Most definition do not include physical or mental harm

35. Drug Abuse • Use of a psychoactive substance in a manner that is illegal or outside medical practice. or • Use of a drug that is outside the legally accepted list of substances. Using illegal drugs is abuse.

36. Drug Abuse (2) • In 1973 the National Commission on Marijuana and Drug Abuse recommended: • The term drug abuse “be deleted from official pronouncements and public policy dialogue. The term has no functional utility and has become no more than an arbitrary codeword for that drug use which is presently considered wrong.”

37. Drug Abuse (3) • For the class purpose: • Abuse will refer to the use of a substance (legal or illegal) in a way that causes clear physical or mental harm. • Does not include getting into trouble while using a drug • But, does include an inability to function on important social levels • Dropping out of school • Getting fired from work • Domestic upheaval

38. Drug Use as a Social Problem • Objective level of understanding • A phenomenon that creates societal harm or damage • Causes death • Social deterioration • Impairs quality of life • The greater the number of people involved the more important the social problem.

39. Drug Use as a Social Problem (2) • Subjective level of understanding • Social problems do not exist in an objective way. They are not like trees! • Social problems are constructed through social definitions • Phenomenon become social problems through a four stage process: • Agitation • Legitimation • Legislation • Re-emergence

40. Drug Use as a Social Problem (3) • Combining the objective and subjective levels of social problems • Most social problems should be considered from both perspectives: • Objective: Tobacco kills more than other drugs • Subjective: • Dose-for-dose basis • Years of life lost • Acute v. Combined effect

41. Drug Panic • Several key factors are generally involved in constructing a drug panic: • Explosion of a new evil drug (Crack in 1985) • Deaths of notable people (Len Bias & Crack Babies) • Media coverage (placement of stories in coverage) • Public concern (Independent of objective numbers) • Political expression (Leaders take advantage of issue) • Prominent spokesperson (Nancy Reagan)

42. The Process of Criminalization • What is a Crime? • A behavior that has been formally prohibited by a political authority. • Who is a Criminal? • Those who have been labeled as criminal by a political authority (Judge). • Criminalization has an objective and subjective component: • Objectively: Behavior is illegal based on the potential extent of harm to society. • Subjectively: Behavior is illegal based on the extent that they interfere with the interests of the influential.

43. Criminalization of Drugs • Objectivist – See drug legislation as a matter of public health and safety • Subjectivists – See drug legislation as a matter of cultural, political, and economic concerns

44. Criminalization of Drugs (2) • Most drug legislation in the 20th century was motivated by political, moral, and economic reasons, rather than genuine concern for public health. • Cocaine 1914 from fear that blacks using cocaine committed violent acts • Alcohol 1919 from fear that poor immigrant Catholics using alcohol were committing violent acts • Marijuana 1933 from fear that Mexicans using marijuana committed violent acts • The more poor the users of a drug are perceived to be the more likely the passing of legislation against the use of the drug.

45. Sex and Drug Use • Does drug use represent a “special” problem for women? • Women value love relationships more than men • Drugs interfere with love oriented relationships • Women, more often than men, are responsible for child rearing • Women are responsible for fetal health • Drug addiction frequently represents unique problems for women.

46. Sex and Drug Use (2) • Drug use is a gendered phenomenon • Stigmatization is greater for women than men • Prostitution is a faster way of making money than most other options available to women • Distribution is usually controlled by men, while women are almost as likely to use as men • Many men conceptualize sex as exploitation; the sex for drugs transaction degrades women, but leaves men's identity intact

47. Sex and Drug Use (3) • The odds of male to female transmission of AIDS is 10 times greater than the likelihood of female to male transmission • Drug use is troubling for mother who are held responsible for the fate of the fetus they carry • Society arrests mother who use crack, but no punishment has been devise for alcohol use • Most treatment programs are designed for men • Peer confrontation techniques provoke poor responses from women • Some will not even admit women

48. Theories of Drug Use • Biological Theories • Genetic Factor • A gene or combination of genes influences the specific biological mechanism for substance abuses • Animals can be breed to prefer alcohol over other beverages • No researcher asserts that genetic factors are the only, or even principle factor in compulsive drinking

49. Biological Theories (2) • Metabolic Imbalance • Some inability or over-ability to metabolize specific chemicals produces a “craving” for the drug • Heroin addicts physiology craves opiates the same way that diabetics crave insulin • No biological mechanism has been discovered • No proposed hormonal imbalance has been identified

50. Psychological Theories • Positive Reinforcement • The euphoria generated by the drug causes the user to want to repeat the use experience. • The more positive the drug experience, the greater the tendency to re-use the drug. • Addiction is not necessary for continued (or continuous) use of the drug. • A sufficient history of reinforcement will compel a high rate of use in the drug user. • Addiction is simply the end point along the continuum of use. (Euphoria Seekers)