Understanding Substance Use and Dependence: A Comprehensive Overview, Study notes of Community Health

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Chapter 2

Chapter 2

Drug Use as a Social

Drug Use as a Social

Problem

Problem

Costs of Drug Use to Society

Costs of Drug Use to Society



Deaths



Emergency room visits



Drugs in the workplace and lost productivity



Broken homes, illnesses, shorter lives, etc.



Cost of maintaining habit



Cost of criminal behavior



Cost of treating patients



Fetal alcohol syndrome



Others?

Toxicity

Toxicity

Toxic = poisonous, deadly, or dangerous

What makes a drug toxic?



Amount used



How it is used



What the user did while on the drug

Toxicity

Toxicity

Physiological toxicity vs. behavioral toxicity

Physiological toxicity vs. behavioral toxicity

Acute effects vs. chronic effects

Acute effects vs. chronic effects

Acute behavioral toxicity (drunk driving) Chronic physiological toxicity (cirrhosis)

Drug-Related Toxicity

Drug-Related Toxicity

Examples of chronic toxicity

Examples of chronic toxicity



Behavioral

Behavioral



Personality and lifestyle changes

Personality and lifestyle changes



Effects on relationships with friends and family

Effects on relationships with friends and family



Physiological

Physiological



Heart disease

Heart disease



Lung cancer

Lung cancer



Cirrhosis

Cirrhosis



Other health effects

Other health effects

D

D

rug

rug

A

A

buse

buse

W

W

arning

arning

N

N

etwork

etwork

A system for collecting data on drug-

A system for collecting data on drug-

related deaths and emergency room visits

related deaths and emergency room visits

at

at some

some U.S.

U.S.

metropolitan

metropolitan hospitals

hospitals

DAWN collects data on

DAWN collects data on

improper use of legal

improper use of legal

prescription and over-

prescription and over-

the-counter drugs as

the-counter drugs as

well as illicit drugs

well as illicit drugs

D

D

rug

rug

A

A

buse

buse

W

W

arning

arning

N

N

etwork

etwork

Toxicity Data

Toxicity Data

ER Visits

ER Visits

Cocaine

Cocaine

Alcohol-in-

Alcohol-in-

combination

combination

Marijuana

Marijuana

Prescription Opioids

Prescription Opioids

Benzodiazepines

Benzodiazepines

(anxiety, sedatives, sleeping pills)

(anxiety, sedatives, sleeping pills)

muscle spasms) muscle spasms)

Deaths

Deaths

Prescription Opioids

Prescription Opioids

(

( used mostly to tx pain)

used mostly to tx pain)

Cocaine

Cocaine

Alcohol-in-

Alcohol-in-

combination

combination

Benzodiazepines

Benzodiazepines

Methadone

Methadone

D

D

rug

rug

A

A

buse

buse

W

W

arning

arning

N

N

etwork

etwork

What it tells us about how dangerous a

What it tells us about how dangerous a

drug is

drug is



Simply gives us total deaths/ER visits

Simply gives us total deaths/ER visits

What it does not tell us about how

What it does not tell us about how

dangerous a drug is

dangerous a drug is



Consider relative danger vs. total impact of

Consider relative danger vs. total impact of

the drug

the drug



Number of users vs. number of reported

Number of users vs. number of reported

problems

problems

Substance Dependence

Substance Dependence



What do “addicts” look like?

What do “addicts” look like?



What drug do they take or what behavior do they

What drug do they take or what behavior do they

engage in (alcohol, cigarettes, illicit drugs, food,

engage in (alcohol, cigarettes, illicit drugs, food,

sex, gambling, shopping, computer time)?

sex, gambling, shopping, computer time)?



How much time do they spend on their habit?

How much time do they spend on their habit?



How much of a drug do they take?

How much of a drug do they take?



How do you decide on the definition of

How do you decide on the definition of

dependence?

dependence?

Substance Dependence

Substance Dependence

Three basic

Three basic

processes

processes



Tolerance

Tolerance



Physical

Physical

dependence

dependence



Psychological

Psychological

dependence

dependence

Physical Dependence

Physical Dependence

Physical dependence is defined by the

Physical dependence is defined by the

occurrence of a withdrawal syndrome

occurrence of a withdrawal syndrome

Tolerance typically precedes physical

Tolerance typically precedes physical

dependence

dependence

If drug use is stopped suddenly, withdrawal

If drug use is stopped suddenly, withdrawal

symptoms occur, ranging from mild to

symptoms occur, ranging from mild to

severe

severe

Physical dependence means the body has

Physical dependence means the body has

adapted to the drug’s presence

adapted to the drug’s presence

Psychological Dependence

Psychological Dependence



Psychological or

Psychological or

behavioral dependence

behavioral dependence



High frequency of drug use

High frequency of drug use



Craving for the drug

Craving for the drug



Tendency to relapse after

Tendency to relapse after

stopping use

stopping use



Behavior is reinforced by

Behavior is reinforced by

the consequences

the consequences



Over time, this becomes the

Over time, this becomes the

biggest reason users report

biggest reason users report

they continue to use

they continue to use

Substance Abuse and

Substance Abuse and

Dependence: DSM-IV-TR

Dependence: DSM-IV-TR

APA diagnostic criteria for abuse and

APA diagnostic criteria for abuse and

dependence (page 36)

dependence (page 36)

Complex behavioral definitions

Complex behavioral definitions

Dependence can occur with or without

Dependence can occur with or without

physiological dependence (i.e., withdrawal)

physiological dependence (i.e., withdrawal)

Substance Dependence:

Substance Dependence:

DSM-IV-TR

DSM-IV-TR



A maladaptive pattern of substance use leading to clinically significant

A maladaptive pattern of substance use leading to clinically significant

impairment or distress, as manifested by three (or more) of the following,

impairment or distress, as manifested by three (or more) of the following,

occurring at any time in the same 12-month period: occurring at any time in the same 12-month period:

Tolerance

Tolerance

Withdrawal

Withdrawal

Substance often taken in larger amounts or over a period longer than

Substance often taken in larger amounts or over a period longer than

intended

intended

Persistent desire or unsuccessful efforts to cut down or control substance

Persistent desire or unsuccessful efforts to cut down or control substance

use

use

A great deal of time is spent in obtaining the substance

A great deal of time is spent in obtaining the substance

6. 6. Important social, occupational, or recreational activities are given up orImportant social, occupational, or recreational activities are given up or

reduced because of substance use

reduced because of substance use

Substance use continues despite knowledge of having a persistent or

Substance use continues despite knowledge of having a persistent or

recurrent problem that is caused or exacerbated by the substance recurrent problem that is caused or exacerbated by the substance