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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
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?

3
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.

4
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.

5
Psychological dependence
  • A condition characterized by intense drive or
    cravings for a drug.

6
IS DRUG ABUSE A PROBLEM?egMarijuana?Other
drugs?
7
How do you reliably assess the extent of the
problem?
8
Illicit drug use reported by state
Problem How to measure(Reactivity and return
rate issues)
9
Accuracy of surveys?
10
Overdoses? DAWN
11
Heroin overdose
12
Alcohol is also a drug
13
And Tobacco!
14
And..
15
For the Sake of Argument
  • Lets say there is significant drug use and/abuse
    in our society.

16
Not just our problem
17
AGAIN, how big is the problem?COSTS of DRUGS in
SOCIETY?
18
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19
Incarceration costs- not including lost
productivity for families
20
money is being lost
21
The costs of Psychological WORRY?
22
Other Psychological Impacts?
23
Costs Drugs and Violence
Though evidence in regard to violence associated
with the pharmacological effects for most illicit
substances is weak at best.
24
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25
So Lets War on Drugs!
26
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27
But this entails more cost
28
it does cost lots of money to WAR
29
The WAR on Drugs has led to an increase in
prosecuting drug offenders
30
People are being incarcerated
31
And sent up for treatment
32
But prosecution has not apparently affected drug
availability
33
e.g. Cocaine production is not down
34
And cocaine prices are relatively stable
35
Some think the war on drugs has adown side.
36
And aimed in the wrong directions
37
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38
Costs of the War on Drugs
39
A coincidence?
40
Our cultural concern with illicit drug use also
has psychological impact
41
On the Plus side, it does create its own economy
42
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43
Should we use drug testing at work?
44
Maybe drug testing is effective!
45
What if tests are too sensitive??
46
Watch out have you been passively exposed to
illicit drugs?
47
DRUG TESTS BRING WORRIES OF ACCURACYApril 16,
1998 "I go to extraordinary lengths before I
call a positive."Dr. DavidBerg, Medical review
officer said.The water-cooler talk is true
Poppy seeds can produce a positive test for
heroin, and cold medicine can suggest
methamphetamine.
DRUG TESTS BRING WORRIES OF ACCURACY

DRUG TESTS BRING WORRIES OF ACCURACY

DRUG TESTS BRING WORRIES OF ACCURACY

April 16, 1998 "I go to extraordinary lengths before I call a positive."Dr. DavidBerg, Medical review officer said.The water-cooler talk is true Poppy seeds can produce a positive test for heroin, and cold medicine can suggest methamphetamine.
April 16, 1998 "I go to extraordinary lengths before I call a positive."Dr. DavidBerg, Medical review officer said.The water-cooler talk is true Poppy seeds can produce a positive test for heroin, and cold medicine can suggest methamphetamine.
April 16, 1998 "I go to extraordinary lengths before I call a positive."Dr. DavidBerg, Medical review officer said.The water-cooler talk is true Poppy seeds can produce a positive test for heroin, and cold medicine can suggest methamphetamine.
48
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.
49
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.

50
What are the causes of drug Addiction?
  • A difficult question.
  • MORAL MODEL-character
  • MEDICAL MODEL-disease
  • LEARNING MODEL-reinforcement
  • ENLIGHTENMENT MODE-multifactorial

51
??
  • Genetics
  • Environment
  • Concordance rates in identical twins separated at
    birthdoes not completely rule out environmental
    factors.

52
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53
  • Whatever the original causes,
  • 2 additional factors are necessary before drug
    addiction will occur..

54
  • Availability prohibition?
  • Trying it.-turning on.
  • But what then leads to dependence?

55
Commonalities in Drug Addiction
  • Taking the drug
  • Decreased initial drug effect (tolerance)
  • Cravings
  • (psychologicalbut obvious physical dependence is
    not a common denominator.
  • Dose stabilization
  • Periods of abstinence

56
And unfortunately..RELAPSE
57
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58
Is treatment effective?
59
Other contributing factors to drug
dependence/abuse
  • Type of drug
  • Route of administration

60
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61
Consider heroin vs. an oral opiate drug
62
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63
Structure of heroindiacetylmorphine
64
Factors influencing drug effectsSystems that the
drug affects..opioid receptors in the brain
65
And receptor subtypes affected
66
Drugs may affect neural transmission in many
different ways
67
Drug Agonism and Antagonism
  • Agonism- drug effects that are in the direction
    of or promote the natural effects of a given NTs
    at its synapse.
  • Antatgonism- drug effects that are in the
    opposing direction of or inhibit the natural
    effects of a given NTs at its synapse.

68
Drug addiction and the brain?
69
REWARD SYSTEMS OF THE BRAIN?
70
Animal Models of reward
  • James Olds and Intra-cranial Self-administration
    (ICSS) an accidental discovery
  • Place preference
  • 2 lever choice
  • Lab rats will lever press to the point of
    exhaustion for ICSS in certain brain regions

71
ICSS and brain reward centers?How easy it is to
misinterpret the meaning of brain study results
  • LH
  • MFB
  • VTA-Accumbens
  • DA agonist and antagonist effects
  • Implication of the DA-ergic mesolimbic pathaway

72
From ICSS to ICDSA (intracranial drug
self-administration)
73
Lab animals self-administer through intravenous
catheters almost any drug that humans will.
74
Brain ccts of drug reward
1. Intra-cranial drug infusion a small tube
(cannula) is implanted, minute concentrations of
drug can be delivered after bar presses
These are very difficult studies to conduct.
ICDS is supported when the cannula targets the VTA
75
2. Another powerful approach Microdialysis
techniques
This diagram represents a study where ICSS and
Microdialysis are combinedto measure effects of
stimulation on NT release at cct. terminations
76
Microdialysis probes are implanted at a targeted
brain site.
The probe tip allows NTs to diffuse through a
membrane where they are then pumped up and out
for continuous collection over time.
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78
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79
ICCS increases DA release in Nucleus Accumbens
80
Drugs increase DA release in accumbens
81
Recent trends?
  • -VTA-cortex (mesocortical DA pathway)
  • -Amygdala-cortex pathway

82
Of course, it gets much more complicated!
83
Special Issue-MJ
  • Quotes
  • On September 12, 2002, the Drug Enforcement
    Administration, the White House Office of
    National Drug Control Policy, and the Surgeon
    General, in response to the expanding world
    dialog concerning the legalization of marijuana
    (including our main ally Great Britain, our
    neighbor Canada and some of our own states),
    jointly launched a campaign to "dispel the myths
    about marijuana, and teach parents and children
    the REAL facts surrounding this drug."
  • This initiative will cost the American taxpayers
    billions of dollars spent by these agencies on
    commercials, advertisements and policies that
    they themselves admit are totally ineffective and
    fail to achieve their objective (which is the
    decrease in marijuana use among adolescents).
    According to the Office of National Drug Control
    Policy, "Marijuana use has doubled among teens in
    the last decade."

84
  • ONDCP says, "NO drug matches the threat posed by
    marijuana."ONDCP is currently spending hundreds
    of millions of dollars on commercials solely
    targeting marijuana use with themes taken
    straight out of the script of the film "Reefer
    Madness". They have written an open letter to
    American prosecutors urging them to prosecute
    marijuana cases more severely, and to work with
    local authorities and law makers to help enact
    tougher marijuana legislation. And they have
    written an open letter to parents filled with
    lies and scare tactics, such as marijuana causes
    reckless and criminal activity, pregnancy,
    problems with learning and comprehension,
    psychosis and mental illness. These same "facts",
    however, do not stop our government from
    sanctioning the manufacture and sale of alcohol.

85
  • The Surgeon general says, "Marijuana has three to
    five times the carcinogens as tobacco."Yet
    Federal Bureau of Mortality statistics state that
    no deaths have ever been caused by marijuana,
    while hundreds of thousands of deaths are caused
    by tobacco every single year! Now shouldn't
    marijuana be killing three to five times the
    people that tobacco kills annually? Also, the
    average tobacco user smokes four to eight times
    the number of cigarettes versus the number of
    joints the average marijuana smoker consumes.
    Now, according to them, this would equal up to
    266 more damaging carcinogens than marijuana,
    yet this is totally legal.

86
  • The DEA and ONDCP both say, "Marijuana is an
    addictive drug. In 1999 over 200,000 people
    entered treatment centers for help."This is
    however not voluntary admissions, as they would
    like for us to think, but the number of people
    out of over 700,000 arrests for marijuana use,
    who were forced by the court system to enter
    substance abuse treatment programs as part of
    their sentences. Also, this number includes the
    people who were forced to enter treatment
    programs to remain employed after failing a urine
    test.

87
  • The DEA and ONDCP say, "More children are
    addicted to marijuana than alcohol and all
    illicit drugs combined."The lie here is again
    the word "addicted". "More children USE marijuana
    than alcohol and other illicit drugs". This is a
    result of marijuana being more prevalent than
    these drugs in today's schools, and not that it
    is more addicting. A recent study showed that
    children say that marijuana is easier to get than
    tobacco and alcohol. This says two things first,
    that if marijuana were legal, with the
    restrictions that are placed on tobacco and
    alcohol, it would be harder for children to
    obtain, and second, that the war on marijuana is
    not working!

88
  • The real truth about marijuana's addictiveness
    can be found on the webpage of UNIMED
    Pharmaceuticals, the manufacturer and distributor
    of Marinol(a FDA approved synthetic version of
    the active ingredient in marijuana)."In 1999,
    the U.S. Drug Enforcement Administration(DEA),
    based in part from a concurring recommendation
    from the U.S. Department of health and Human
    Services, reclassified Marinol(dronabinol)
    Capsules from a Schedule II substance to Schedule
    III. This action was taken after thorough review
    of the abuse potential of Marinol, which found
    that the drug has lower abuse potential than
    drugs or substances in Schedules I and II. The
    DEA also found little evidence of actual Marinol
    abuse, despite increased number of prescriptions
    issued."

89
  • Now consider this, Marinol is 95 pure THC.
    Meanwhile, the most potent marijuana, even at the
    exaggerated potency levels that the
    prohibitionists claim, is only a third of this.
    In reality the average marijuana being smoked in
    America is less than 10 THC.

90
  • ONDCP and the DEA say, "87,000 annual emergency
    room visits are people seeking treatment for
    marijuana related traumas."What they're not
    telling you is that hospitals do drug testing,
    and whether you're pregnant, or you experience
    any emergency that requires a blood or urine
    test, at the hospital's discretion, you could be
    drug tested. A positive marijuana result ends up
    being a marijuana related emergency room
    statistic regardless of the injury or
    circumstances.

91
  • The DEA and ONDCP say, "Marijuana affects a
    child's learning abilities, and that a child with
    a "D", or lower, average grade score is four
    times more likely to smoke marijuana than a child
    with an "A" average."Now what are they saying
    here? That a dumb child is more likely to smoke
    pot, or that a kid who smokes pot will more than
    likely become dumb? And what formula did they use
    to calculate the percentage? "D"4X, "C"3X,
    "B"2X ? Based on this a student with an "A"
    average will be just as likely to smoke marijuana
    as any other "A" student who already does.

92
  • ONDCP and the DEA say, "Marijuana not only
    affects the user but others as well because as
    many car crashes are caused by marijuana as are
    caused by alcohol."Yet FBI and state police
    statistics state that up to 50 of all highway
    accidents and fatalities are alcohol related. Now
    this would mean that the other 50 are marijuana
    related, leaving these two causes as the only
    factors contributing to accidents on our nation's
    roads. In Virginia, in both state police and DMV
    highway reports, marijuana is not even listed as
    a cause of crashes or accidents. In spite of
    this, right now, the federal government is
    proposing a "zero tolerance" drugged driving law
    which targets marijuana users.

93
  • An officer can administer a roadside drug
    test(pulse and/or blood pressure check, saliva,
    blood or urine samples), and ANY positive result
    results in an immediate DUI (whether you've
    recently smoked any amount of marijuana or within
    days or weeks). Meanwhile, UNIMED Pharmaceuticals
    has this to say about Marinol and driving
    "Patients receiving treatment with Marinol should
    be specifically warned not to drive, operate
    machinery, or engage in any hazardous activity
    until it is established that they are able to
    tolerate the drug and to perform such tasks
    safely." The DEA has changed this statistic
    from 50 to 40 to 1 out of 3 reckless drivers
    "who were tested for drugs" tested positive for
    marijuana. Now, even if all reckless drivers not
    under the influence of alcohol were tested for
    drugs then, according to their claims, this would
    amount to 16 at the highest. In reality, the
    actual percentage would be negligible when
    compaired to alcohol!

94
  • The DEA and ONDCP say, "Marijuana is a major
    factor in crime."Based on a survey of a small
    select group of prisoners they claim that 40 of
    all arrestees tested positive for marijuana. But
    what select group, and from where? Why not a
    study of every prisoner from every local, state
    and federal prison? The U.S. Justice Department
    already has the crime reports and past histories
    of every prisoner, past and present. And they
    already drug test in every jail and prison
    throughout the country. What are the real numbers
    based on the entire penal system? (Then again,
    with over 730,000 annual arrests for marijuana
    use, far more than 1/3 of all total arrests,
    maybe 40 of all arrestees did test positive for
    marijuana.) Of course, as long as marijuana
    remains illegal, this statement will always be
    true based solely on the fact that the possession
    and consumption of marijuana is a criminal act.

95
  • ONDCP and the DEA say, "Marijuana will always be
    a dangerous drug because it inevitably leads its
    users to harder more dangerous drugs."I will use
    their own statistics to expose this lie. John
    Walters, ONDCP director, says, "Marijuana use
    among teenagers has doubled over the last
    decade." But Asa Hutchinson, director of the DEA,
    says, "Cocaine use has dropped 75 over the last
    15 years and that other illicit drug use has been
    cut by 50." Now if marijuana use has doubled and
    marijuana leads to harder drugs shouldn't we be
    seeing an increase in harder drug use and not a
    50 decrease? Also, based on Mr. Hutchinson's
    statistics, we should expect to see a complete
    elimination of cocaine use in America after the
    next five years. (75 in 15 years/ 5 years 25)
    In May, 2002, ONDCP stated that marijuana use
    had tripled in recent years. In September, 2002,
    marijuana use had doubled over the last decade.
    In November, 2002, ONDCP said marijuana use had
    declined by 50 since 9-11, proving, they said,
    "that teenagers were acknowledging the connection
    between drugs and terrorism". In spite of this
    ONDCP is cancelling their "drugsterrorism" ads
    because it was found that they are totally
    ineffective, and may actually incite pro-drug
    attitudes among teenagers.

96
  • The DEA and ONDCP both say that "medical
    marijuana and/or industrial hemp are nothing more
    than camouflaged attempts to legalize a dangerous
    drug." Right now they are attempting to ban all
    products containing hemp, hemp seed and hemp seed
    oil, while they themselves currently both grow
    and import hemp, not only for industrial
    purposes, but for medicinal use also! And they
    are waging a compassionless war on both the sick
    and dying who use marijuana, and the care-givers
    who supply it, while endorsing synthetic
    marijuana (Marinol) for these same people! This
    is all the federal government's camouflaged
    attempts to keep marijuana illegal, in all forms
    and at all costs, and to quash these legitimate
    industries with lies and the long arm of the law!
    The U.S., by the way, is the only industrialized
    nation that doesn't allow legitimate hemp
    cultivation, and one of the very few that
    prohibit medical cannabis.

97
  • The DEA and ONDCP say, "Not only the illicit drug
    trade, but also the casual use of marijuana,
    directly supports domestic and international
    terrorism."Although they are cancelling their
    T.V. terrorism ads the Federal government is
    still emphasizing this theme. They have appointed
    Asa Hutchinson, DEA director, as the Under
    Secretary of Borders and Transportation in the
    Department of Homeland Security. And DHS has
    already created a new Anti-Narcotics department
    with a former CIA operative as its "Czar". This
    is all a deceptive maneuver to coerce support for
    the failing 90 year old War on Drugs by playing
    on the fears and emotions of a post 9-11 America!
    If we are going to start blaming the casual user
    because somewhere down the trafficking line blood
    might have been spilled, then everyone take all
    the money out of your wallets and purses and
    throw it away because somewhere down the line
    blood was spilled for that dollar bill. The
    violence and terrorism involved in the drug trade
    is created, not because of the psychoactive
    properties of the drugs themselves, but because
    of the enormous wealth generated by illegal
    drugs, which is created through the illicit black
    market, which is created by the prohibitive laws
    of the War On Drugs. If I could grow marijuana
    in my home, as I can grow tobacco, make wine and
    brew beer, for my own personal use within my
    home, as I can enjoy a pipe, or a glass of wine,
    liquor or beer, how would that aid domestic or
    international terrorism?

98
  • The DEA and ONDCP say, "Not only the illicit drug
    trade, but also the casual use of marijuana,
    directly supports domestic and international
    terrorism."Although they are cancelling their
    T.V. terrorism ads the Federal government is
    still emphasizing this theme. They have appointed
    Asa Hutchinson, DEA director, as the Under
    Secretary of Borders and Transportation in the
    Department of Homeland Security. And DHS has
    already created a new Anti-Narcotics department
    with a former CIA operative as its "Czar". This
    is all a deceptive maneuver to coerce support for
    the failing 90 year old War on Drugs by playing
    on the fears and emotions of a post 9-11 America!
    If we are going to start blaming the casual user
    because somewhere down the trafficking line blood
    might have been spilled, then everyone take all
    the money out of your wallets and purses and
    throw it away because somewhere down the line
    blood was spilled for that dollar bill. The
    violence and terrorism involved in the drug trade
    is created, not because of the psychoactive
    properties of the drugs themselves, but because
    of the enormous wealth generated by illegal
    drugs, which is created through the illicit black
    market, which is created by the prohibitive laws
    of the War On Drugs. If I could grow marijuana
    in my home, as I can grow tobacco, make wine and
    brew beer, for my own personal use within my
    home, as I can enjoy a pipe, or a glass of wine,
    liquor or beer, how would that aid domestic or
    international terrorism?

99
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