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Drug use, Drug abuse and DRUG TAKING BEHAVIOR

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Title: Drug use, Drug abuse and DRUG TAKING BEHAVIOR


1
Drug use, Drug abuse and DRUG TAKING BEHAVIOR
2
IS DRUG ABUSE A PROBLEM?egMarijuana?Other
drugs?
3
How large is the problem
4
Problem How to define
  • Drug addiction? Is once enough? A repetitive
    behavior pattern associated with increase risk of
    disease or social problems (Marlatt, 1988)..often
    characterized by immediate gratification and high
    relapse ratesbut is this the same as abuse?
  • Drug abuse-how to define?

5
Drug Abuse
  • The self-administration of any drug in a manner
    that deviates from the approved medical or social
    patterns within a given culture (Jaffe).
  • Drug Dependence- a condition in which an
    individual requires a drug to function normally.
    A distinction is often made between Physical
    dependence and Psychological dependence.

6
Physical Dependence
  • An adaptive state produced by repeated use of a
    drug which manifests itself by intense
    physiological disturbances (withdrawal syndrome)
    when use of the drug is halted (abstinence).
  • Withdrawal syndrome- a constellation of symptoms
    that occur when an individual stops using the
    drug to which dependence has developed. Symptoms
    typically in reverse direction of the effects
    caused by the drug.

7
Psychological dependence
  • A condition characterized by intense drive or
    cravings for a drug.

8
Problem How to measure(Reactivity and return
rate issues)
SO AGAINHow big is the problem?
9
Illicit drug use reported by state
10
Accuracy of surveys?
11
  • B.3.1 Screening and Interview Response Rate
    Patterns
  • In 2004, respondents continued to receive a 30
    incentive in an effort to improve response rates
    over years prior to 2002. Of the 142,612 eligible
    households sampled for the 2004 NSDUH, 130,130
    were successfully screened for a weighted
    screening response rate of 90.9 percent
    (Table B.2). In these screened households, a
    total of 81,973 sample persons were selected, and
    completed interviews were obtained from 67,760 of
    these sample persons, for a weighted interview
    response rate of 77.0 percent (Table B.3). A
    total of 9,362 (15.2 percent) sample persons were
    classified as refusals or parental refusals,
    2,918 (3.9 percent) were not available or never
    at home, and 1,933 (3.9 percent) did not
    participate for various other reasons, such as
    physical or mental incompetence or language
    barrier (see Table B.3, which also shows the
    distribution of the selected sample by interview
    code and age group). Among demographic subgroups,
    the weighted interview response rate was highest
    among 12 to 17 year olds (88.6 percent), females
    (78.5 percent), blacks (81.9 percent), in
    nonmetropolitan areas (79.2 percent), and among
    persons residing in the South (78.7 percent)
    (Table B.4).
  • The overall weighted response rate, defined as
    the product of the weighted screening response
    rate and weighted interview response rate, was
    70.0 percent in 2004. Nonresponse bias can be
    expressed as the product of the nonresponse rate
    (1-R) and the difference between the
    characteristic of interest between respondents
    and nonrespondents in the population (Pr - Pnr).
    Thus, assuming the quantity (Pr - Pnr) is fixed
    over time, the improvement in response rates in
    2002 through 2004 over prior years will result in
    estimates with lower nonresponse bias.

12
And How the questions are askedeg
13
VS. selected age ranges by month
14
Drug use in the Military?
15
In Different Ethnic groups?
16
  • So maybe marijuana use is not so overwhelming?

17
But Alcohol is a drug
18
And Tobacco!
19
And..
20
For the Sake of Argument
  • Lets say there is significant drug use and/abuse
    in our society.
  • BUT AGAINHow big is the problem?

Depends on how you measure it.
21
Overdoses? DAWN
22
Heroin overdose
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Not just our problem
25
COSTS of DRUGS in SOCIETY?
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And money is being lost
28
Incarceration costs- not including lost
productivity for families
29
And Psychological WORRY?
30
Psychological Impacts?
31
Drugs and Violence
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So Lets War on Drugs!
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More money (lost?)
36
it does cost lots of money
37
The WAR on Drugs
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People are being incarcerated
40
And sent up for treatment
41
But is it working?
42
Cocaine production is not down
43
Prices are relatively stable
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Is the War aimed in the right directions?
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Costs of the War on Drugs
48
Effectiveness of War?
49
AND CONCERNS/COSTS in the home and Work place
50
It does create its own economy
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Should we use drug testing at work?
53
Maybe its necessary
54
What if tests are too sensitive??
55
Watch out here they come!
56
The wild eyed claim that a third of all people
accused of drug use will be innocent is not so
ridiculous after all. Figure 4 shows that the
proportion of spurious results among people
identified as drug users is surprisingly
sensitive to test accuracy. An accuracy of 99 is
marginal at best. However the biggest surprise is
the fact that the proportion of spurious results
among people failing drug tests approaches 100
as the proportion of drug users in the general
population approaches zero. Drug testing in a
drug free population amounts to a witch hunt.
57
SO ?
  • Whatever your perspective on drug use and abuse,
    its difficult to argue that drug use is in no way
    problematic.
  • Especially when considering the harmful effects
    of drug addiction/Abuse to the individual and to
    society.

58
What are the causes of drug Addiction?
  • A difficult question.
  • MORAL MODEL-character
  • MEDICAL MODEL-disease
  • LEARNING MODEL-reinforcement
  • ENLIGHTENMENT MODE-multifactorial

59
??
  • Genetics
  • Environment
  • Concordance rates in identical twins separated at
    birthdoes not completely rule out environmental
    factors.

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  • Whatever the original causes,
  • 2 additional factors are necessary before drug
    addiction will occur..

62
  • Availability prohibition?
  • Trying it.-turning on.
  • But what then leads to dependence?

63
Commonalities in Drug addiction/abuse
  • Availability/ Taking the drug
  • Reward
  • Tolerance
  • Dose-stabilization
  • Periods of abstinence
  • Cravings
  • relapse

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Dose-stabilization
66
Periods of abstinence
  • Associated with Cravings
  • (psychologicalbut obvious physical dependence is
    not a common denominator.

67
And unfortunately..RELAPSE
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RELAPSE
71
Principles of drug study-Multiple effects
(side-effects)-No new behaviors-Drug use is
neither good nor bad
72
Other factors contributing to drug effect
  • Type of drug

73
Different drugs can produce different effectsbut
class systems only take us so far
  • Drugs of Abuse
  • Acid/LSD
  • Alcohol
  • Club Drugs
  • Cocaine
  • Ecstasy/MDMA
  • Heroin
  • Inhalants
  • Marijuana
  • Methamphetamine
  • PCP/Phencyclidine
  • Prescription Medications
  • Smoking/Nicotine
  • Steroids (Anabolic)

74
MJ
  • euphoria, slowed thinking and reaction time,
    confusion, impaired balance and
    coordination/cough, frequent respiratory
    infections impaired memory and learning
    increased heart rate, anxiety panic attacks
    tolerance, addiction

75
For sedatives, benzodiazepines, Rohypnol
  • reduced anxiety feeling of well-being lowered
    inhibitions slowed pulse and breathing lowered
    blood pressure poor concentration/fatigue
    confusion impaired coordination, memory,
    judgment addiction respiratory depression and
    arrest, death Also, for barbituratessedation,
    drowsiness/depression, unusual excitement, fever,
    irritability, poor judgment, slurred speech,
    dizziness, life-threatening withdrawal. for
    benzodiazepinessedation, drowsiness/dizziness
    for flunitrazepamvisual and gastrointestinal
    disturbances, urinary retention, memory loss for
    the time under the drug's effects

76
Ketamine, PCP and analogs
  • increased heart rate and blood pressure, impaired
    motor function/memory loss numbness
    nausea/vomiting Also, for ketamineat high
    doses, delirium, depression, respiratory
    depression and arrest for PCP and
    analogspossible decrease in blood pressure and
    heart rate, panic, aggression, violence/loss of
    appetite, depression

77
Hallucinogenics
  • altered states of perception and feeling nausea
    persisting perception disorder (flashbacks)
    Also, for LSD and mescalineincreased body
    temperature, heart rate, blood pressure loss of
    appetite, sleeplessness, numbness, weakness,
    tremors for LSD persistent mental disorders
    for psilocybinnervousness, paranoia

78
Opiate compounds
  • pain relief, euphoria, drowsiness/nausea,
    constipation, confusion, sedation, respiratory
    depression and arrest, tolerance, addiction,
    unconsciousness, coma, death Also, for
    codeineless analgesia, sedation, and respiratory
    depression than morphine for heroinstaggering
    gait

79
For stimulants
  • increased heart rate, blood pressure, metabolism
    feelings of exhilaration, energy, increased
    mental alertness/rapid or irregular heart beat
    reduced appetite, weight loss, heart failure,
    nervousness, insomnia Also, for
    amphetaminerapid breathing/ tremor, loss of
    coordination irritability, anxiousness,
    restlessness, delirium, panic, paranoia,
    impulsive behavior, aggressiveness, tolerance,
    addiction, psychosis for cocaineincreased
    temperature/chest pain, respiratory failure,
    nausea, abdominal pain, strokes, seizures,
    headaches, malnutrition, panic attacks for
    MDMAmild hallucinogenic effects, increased
    tactile sensitivity, empathic feelings/impaired
    memory and learning, hyperthermia, cardiac
    toxicity, renal failure, liver toxicity for
    methamphetamineaggression, violence, psychotic
    behavior/memory loss, cardiac and neurological
    damage impaired memory and learning, tolerance,
    addiction for nicotineadditional effects
    attributable to tobacco exposure, adverse
    pregnancy outcomes, chronic lung disease,
    cardiovascular disease, stroke, cancer,
    tolerance, addiction

80
Other factors contributing to drug effect
Dose and time -All drug effects are dose and
time dependent
81
Other contributing factors to drug
dependence/abuse
  • Type of drug
  • Route of administration

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Consider heroin vs. an oral opiate drug
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Structure of heroindiacetylmorphine
86
Other contributing factors
  • Set and setting

87
Effects also determined by brain specific
circuits affectedreceptor binding
88
Factors influencing drug effectsSystems that the
drug affects..opioid receptors in the brain
89
And receptor subtypes affected
90
Agonism and antagonism
91
Agonism and antagonism
  • Agonist drugs- promote what ever the natural
    effect of the NT receptor interaction would
    normally be
  • Antagonist drugs- block or inhibit what ever the
    natural effect of the NT receptor interaction
    would normally be
  • Consider agonism and antagonism at the GABA
    synapse vs the Glut synapse

92
Direct vs Indirect actions
93
How drugs can affect the nervous system
94
EgDrugs can affect synthesisL-DOPA
95
Reuptake
96
Indirect agonism ACHE inhibitors
97
Direct receptor antagonism
98
Competitive vs non-competitive drug actions
99
Noncompetitive binding
100
Drug addiction and the brain?
101
REWARD SYSTEMS OF THE BRAIN?
102
Animal Models of drug reward and dependence
  • James Olds and Intra-cranial Self-administration
  • Place preference
  • 2 lever choice
  • Progressive ratio
  • Conflict tests

103
ICSS and brain reward centers?
  • LH
  • Medial forebrain bundle (MFB)
  • VTA-Accumbens
  • DA agonist and antagonist effects

104
From ICSS to DSA
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Brain ccts of drug rewardIntra-cranial drug
infusion
108
Microdialysis techniques
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ICCS increases DA release in Nucleus Accumbens
113
Drugs increase DA release in accumbens
114
What about ICSS in Humans
115
What about reward Circuits in the Human? Human
ICSS
  • Heath 1962

116
  • The pleasure seekers
  • Hedonism makes our world go round, but it goes a
    lot deeper than our obsession with sex, drugs,
    rock 'n' roll and chocolate. Neuroscientists are
    completely rethinking how our brains give us
    pleasure, and as a result are starting to believe
    that the quest for pleasure may underpin every
    decision we make. It may even have laid the
    foundations of consciousness, as Helen Phillips
    explains.
  • IT WAS an outlandish, ethically questionable
    experiment, but this was the 1960s after all.
    Psychiatrist Robert Heath of Tulane University in
    New Orleans hoped to cure his patients'
    depression, intractable pain, schizophrenia,
    suicidal feelings, addiction, and even
    homosexuality - which in those days was
    considered a psychiatric disorder - by drowning
    them out with pleasure, induced by an electrode
    implanted deep in their brains.

117
  • In our own experience, pleasurable sensations
    were observed in three patients with psychomotor
    epilepsy. The first case was V.P., a 36-year-old
    female with a long history of epileptic attacks
    which could not be controlled by medication.
    Electrodes were implanted in her right temporal
    lobe and upon stimulation of a contact located in
    the superior part about thirty millimeters below
    the surface, the patient reported a pleasant
    tingling sensation in the left side of her body
    "from my face down to the bottom of my legs." She
    started giggling and making funny comments,
    stating that she enjoyed the sensation "very
    much." Repetition of these stimulations made the
    patient more communicative and flirtatious, and
    she ended by openly expressing her desire to
    marry the therapist. Stimulation of other
    cerebral points failed to modify her mood and
    indicated the specificity of the evoked effect.
    During control interviews before and after ESB,
    her behavior was quite proper, without
    familiarity or excessive friendliness.
  •           The second patient was J.M., an
    attractive, cooperative, and intelligent
    30-year-old female who had suffered for eleven
    years from psychomotor and grand mal attacks
    which resisted medical therapy. Electrodes were
    implanted in her right temporal lobe, and
    stimulation of one of the points in the amygdala
    induced a pleasant sensation of relaxation and
    considerably increased her verbal output, which
    took on a more intimate character. This patient
    openly expressed her fondness for the therapist
    (who was new to her), kissed his hands, and
    talked about her immense gratitude for what was
    being done for her. A similar increase in verbal
    and emotional expression was repeated when the
    same point was stimulated on a different day, but
    it did not appear when other areas of the brain
    were explored. During the control situations the
    patient was rather reserved and poised.

118
  • In another controversial experiment in 1972, Dr.
    Heath wired up a homosexual man's pleasure
    centers in order to help him "cure" his
    homosexuality. During the initial three-hour
    session, subject "B-19" stimulated himself some
    1,500 times. Dr. Heath wrote of the experiment,
    "During these sessions, B-19 stimulated himself
    to a point that he was experiencing an almost
    overwhelming euphoria and elation, and had to be
    disconnected, despite his vigorous protests."
    Since unnatural methods can bring about unnatural
    results, energizing the man's electrodes as he
    looked at erotic pictures of women temporarily
    "cured" him of his homosexuality, but once the
    electrodes were removed, he went back to normal.

119
  • It is interesting to note that while the animal
    literature suggests that brain stimulation has
    positive, reinforcing effects, the human
    literature indicates that relief of anxiety,
    depression and other unpleasant affective
    conditions may be the most common "reward" of
    electrical brain stimulation in humans. Patients
    with electrodes in the septum, thalamus, and
    periventricular gray of the midbrain often
    express euphoria because the stimulation seems to
    reduce existing negative affective reactions
    (even intractable pain appears to loose its
    affective impact). However, many psychiatrists
    caution that this may not reflect an activation
    of a basic reward mechanism (Delgado, 1976 Heath
    et al., 1968). Relief from chronic anxiety has
    been reported during and even long after
    stimulation of frontal cortex. Again, the
    experiential response appears to be relief rather
    than reward per se (CrowCooper, 1972).

120
  • Compulsive thalamic self-stimulation a case with
    metabolic, electrophysiologic and behavioral
    correlates byPortenoy RK, Jarden JO, Sidtis
    JJ,Lipton RB, Foley KM, Rottenberg DA. Pain.
    1986 Dec27(3)277-90ABSTRACT
  • A 48-year-old woman with a stimulating electrode
    implanted in the right thalamic nucleus ventralis
    posterolateralis developed compulsive
    self-stimulation associated with erotic
    sensations and changes in autonomic and
    neurologic function.

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