3. Consequences for 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
Blood borne illnesses
4. Getting Information on Drug
Use
Surveys
Hospital reports
Police reports
Can show trends over
time
What’s missing?
5. Extent of Drug Use
National Survey on Drug Use and Health
Door-to-door survey of randomly selected
households
Measures drug use in adults and adolescents
Monitoring the Future
Questionnaires given to 8th, 10th and 12th grade
students
6. Have you used marijuana in
the last 30 days?
ANONYMOUS
A. Yes
B. No
Yes
No
100%
0%
7.
8. Have you had 5 or more drinks in one sitting
in the last 30 days? ANONYMOUS
A. Yes
B. No
Yes
No
83%
17%
9.
10. Have you used non-prescribed
narcotics in the last 30 days?
ANONYMOUS
A. Yes
B. No
Yes
No
100%
0%
11.
12. Drug Abuse Warning
Network
DAWN is a reporting system
that collects information on the
number of times drugs are
implicated in both non-lethal
and lethal visits to emergency
rooms
Illicit drugs were responsible
for the most emergency room
visits, followed by
pharmaceutical drugs
Data reflect acute drug
problems, not chronic drug
use
13. DAWN gives information
on:
A. The number of people
jailed for drug offenses
B. The number of times
drugs are implicated in
emergency room visits
C. The number of people
who admit drug use to
their doctors Thenum
berofpeople
jail..
Thenum
beroftim
esdru..
Thenum
berofpeople
w
..
0%
33%
67%
14. Changing Attitudes
What made the
government change
from the laissez-faire
attitude of the 1800s to
one of control?
Toxicity
Dependence
Crime
15. Society’s perception of drugs:
Influenced by social and psychological
factors
Illegal drugs are condemned more than
legal drugs
16. What do you think about government
regulation of drug use?
A. The government
should be more
involved
B. The government
should be less
involved
C. Our government is
doing a good job
currently
Thegovernm
entshould
..
Thegovernm
entshould
b...
Ourgovernm
entisdoing..
60%
20%20%
17. Toxicity
Physical toxicity:
Danger to the body as a result of taking the
drug
Behavioral toxicity:
Drug interferes with one’s ability to function
Acute toxicity:
Danger from a single experience with a drug
Chronic toxicity:
Danger posed by repeated exposure to the
drug
18. Driving while drunk is an
example of:
A. Acute physical
toxicity
B. Chronic physical
toxicity
C. Acute behavioral
toxicity
D. Chronic
behavioral toxicity Acutephysicaltoxicity
Chronicphysicaltoxicity
Acutebehavioraltoxicity
Chronicbehavioraltoxicity
33%
0%
50%
17%
19. Cirrhosis of the liver is an
example of:
A. Acute physical
toxicity
B. Chronic physical
toxicity
C. Acute behavioral
toxicity
D. Chronic behavioral
toxicity
Acutephysicaltoxicity
Chronicphysicaltoxicity
Acutebehavioraltoxicity
Chronicbehavioraltoxicity
0%
17%
0%
83%
20. Patterns of Use
Experimental Use
Infrequent use motivated by curiosity
Social-Recreational Use
Taking drugs to share pleasurable experiences
among friends
Circumstantial-Situational Use
Short-term use to contend with immediate distress
or pressure
21. Patterns of Use
Intensified Use
Taking drugs on a steady basis to relieve a
problem
Chronic Use
Indicates some extent of physical or
psychological dependence
Compulsive Use
Acquiring and consuming drugs is the main
focus of life
22. Changing View on
Dependence
Early medical model
True addiction involves physical dependence; key
is treatment of withdrawal symptoms
Positive reinforcement model
Drugs can reinforce behavior without physical
dependence
Psychological dependence is
increasingly viewed as the driving force
behind repeated drug use
This refutes the sometimes common belief that
drugs that aren’t as strongly physically
addicting are less dangerous
23. What do you think? Is
addiction
A. Biological
B. Genetic
C. Environmental
D. Psychological
E. Personality
Weakness
F. A combination of
above Biological
Genetic
Environm
ental
Psychological
PersonalityW
eakness
A
com
bination
ofabove
0% 0%
100%
0%0%0%
24. Substance Use Disorder DSM-
5
Substance use disorders span a
wide variety of problems arising
from substance use, and cover 11
different criteria:
1. Taking the substance in larger amounts
or for longer than you meant to
2. Wanting to cut down or stop using the
substance but not managing to
3. Spending a lot of time getting, using, or
recovering from use of the substance
25. 4. Cravings and urges to use the substance
(psychological dependence)
5. Not managing to do what you should at
work, home or school, because of
substance use
6. Continuing to use, even when it causes
problems in relationships
7. Giving up important social, occupational
or recreational activities because of
substance use
26. 8. Using substances again and again,
even when it puts you in danger
9. Continuing to use, even when the you
know you have a physical or
psychological problem that could have
been caused or made worse by the
substance
10. Needing more of the substance to get
the effect you want (tolerance)
11. Development of withdrawal symptoms,
which can be relieved by taking more of
the substance. (physical dependence)
27. Impacts of Drug Use
Family stability
Social behavior
Education and career
aspirations
Personal and social
maturation
29. A correlate is:
A. A variable that
causes something
B. A thing you keep
horses in
C. A variable that is
associated with
something
A
variablethatcausess...
A
thingyou
keep
horsesin
A
variablethatisassocia...
25%
75%
0%
30. Family
Association between drug use and the likelihood that
a couple will separate or divorce
Women subjected to violence have higher rates of
alcohol dependence and other drug abuse problems
Family interventions into adolescent alcohol use
reduce the initiation and frequency of alcohol use
Marijuana use by young Black males is significantly
reduced when both parents are present
31. Family
Parental substance abuse is a factor for
1/3 to 2/3 of all children involved with the
child welfare system
Substance abuse is a factor in many cases
of child abuse and domestic abuse
Alcohol use is associated with the
perpetration of sexual aggression,
especially toward boys **
32. Effects of drug use by pregnant
women
Women whose babies test
positive for drugs such as
cocaine are subject to losing
custody of their children
Risks to the baby:
Low birth weight
Premature birth
Miscarriage
Birth defects
Difficulty bonding
Learning disabilities
33. Which of the following is NOT
associated with drug use in the family?
A. Increased
violence
B. Higher divorce
rates
C. Low IQ
D. They are all
associated
Increased
violence
Higherdivorcerates
Low
IQ
Theyare
allassociated
0% 0%0%0%
34. Social Behavior
Drug users display more independence,
rebelliousness, acceptance of deviant behavior,
and rejection of moral and social norms than
nonusers
Children of parents who use
drugs are more likely to engage
in delinquent behaviors
Stimulants such as methamphetamines and
cocaine are associated with violence, while
marijuana and heroin are more likely to produce
a passive response
35. Social Behavior
Alcohol is the drug involved with the most
violent incidents
The level of aggression associated with
alcohol is dose related
Binge drinking is associated with unsafe
sex and violence, and with nonconsensual
sex
36. Drug users show higher levels of
acceptance of deviant behavior
A. True
B. False
True
False
17%
83%
38. Education
There is a higher dropout rate from school for those
who used alcohol, illicit drugs, and cigarettes
There is a relationship between academic
performance and drug use
Drug use is assumed to be a predictor
of welfare dependency
Higher Education Act of 1965: College students who
are convicted of a drug offense are denied federal
financial aid
39. Do you feel that the regulations about
financial aid and drug convictions are
fair?
50%
17%
17%
17% A. Yes
B. No
C. Sometimes
D. I’m undecided
40. Employment
Employed drug users have less stable job
histories than nonusers
Alcohol abusers earn significantly less money
than moderate drinkers and abstainers
Drug use is associated with higher accident rates
on the job and lower productivity
41. Drugs in the
Workplace
Substance abuse in the workplace results in:
Lessened productivity
Increased accidents, absenteeism, and health care costs
Highest rates of drug use are food service workers
and construction workers – identifying drug
problems in top-level managers is more difficult
Employee Assistance Programs (EAPs) help
workers deal with problems that affect job
performance, including alcohol or drug problems
42. Drug Testing
In 2011, the federal government
earmarked $283.1 million for
drug-related activities in schools
Random workplace drug testing has effectively
identified frequent users of illicit drugs
In many jurisdictions, physicians are required
to report women who use drugs during
pregnancy or infants who test positive for drug
use by their mothers
43. Types of Drug
Testing
Immunoassay is fast and less
expensive than other methods but may give false
positive readings
Gas chromatography is more expensive and time-
consuming than other methods
Thin-layer chromatography is simple and
inexpensive, but requires expert interpretation
Gas chromatography/mass spectrometry is
highly sensitive, but is time-consuming and
expensive http://www.aa
fp.org/afp/201
0/0301/p635.
html
44. Problems with Drug
Testing
False positive
A person tests positive for a drug even
though no drug is present in the person’s
urine
False negative
A person tests negative
even though drugs are
present in the person’s
urine
45.
46. Legality of Drug Testing
Debated in two
cases before the
U.S. Supreme
Court:
Skinner v. Railway
Labor Executive
Association
National Treasury
Employees Union v.
von Raab
In both cases, the
Supreme Court
ruled that the testing
program was
justified http://www.nolo.com/legal-
encyclopedia/free-books/employee-
rights-book/chapter5-3.html
47. How is drug use related to
crime?
Intoxication causes behavior and personality
change
Crimes may be committed while intoxicated
Drug use/possession is a crime
Crimes to fund cost of drug use
Society tries to protect itself through regulation
Current laws may not be part of a logical plan,
ineffective or unrealistic
48. Crime: Drug Business
Drug trade is a big business with no signs
of slowing down
Tactics for stopping drug flow into the US –
military force, reducing aid to drug-
producing countries, and promoting crop
substitution – are ineffective
Results in thousands needing medical care
for drug overdoses, and has an economic
impact on the criminal justice system and
environment
49.
50. Crime: Drug
Business
Colombia is the leading
producer of cocaine
In Laos, Burma, and Thailand,
opium production has largely been
replaced by methamphetamines
In addition to domestic production,
marijuana is grown in Asia, the
Caribbean, and Mexico – Colombia
is the largest exporter
52. Crime: Drug Enforcement
• The narcotics trade is
tremendously profitable
• Even after billions of dollars
were spent on curbing drug
production, coca growth in
Colombia rose 27%
• Preventing drugs from
entering the United States or
reducing the amount of drugs
grown in the country is a
matter of demand, not supply
53. How should we deal with drug
problems?
50%
0%
17%
33%
0%
0% A. Legalize drugs
B. Stop drugs at borders
C. Reduce demand (treatment/education)
D. Prevent production in other countries
E. End the “War on Drugs”
F. I’m not sure
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?
Survey questionnaires
Easy to use– inexpensive, efficient
Drawbacks
Bias in student population (e.g., dropouts not counted)
Potential inaccuracy of self-reports (among both users and non-users)
National Survey on Drug Use and Health
Face-to-face, computer-assisted interviews
68,000 individuals; carefully sampled households across the United States
Broken down into different age groups
Results published annually
Marijuana use among persons ages 12-25, by age group:1971-2006 (National Survey on Drug Use and Health)
In 2008 the percentage use for the age groups of 18-25 and 12-17 remained the same as they were in 2005; 16.5% and 6.7% respectively.
Finding similar patterns in two different studies, using different sampling techniques, is a stronger indication that these trends are real and reflect broad changes in American society over time
II. How Did We Get Here?
A. Have Things Really Changed?
1. Humans have used psychoactive drugs for thousands of years for therapeutic and recreational purposes.
2. Drug use has affected society in many areas: religion, law, government, economics, language, and education.
III. Drugs and Drug Use Today
A. Extent of Drug Use
1. Current information on drug use comes from several sources, including survey questionnaires done in junior highs, high schools, and colleges, but accurate statistics are hard to attain.
2. Self-reports may include a biased sample and be inaccurate or dishonest.
3. The Monitoring the Future Project follows nationwide trends over time in drug use among young people.
National Survey on Drug Use and Health
22.6 million Americans used illicit drugs
7 million used psychotherapeutic drugs non-medically
1.5 million were current cocaine users
28.8 million drove a car under the influence of alcohol
695,000 Ecstasy users, and 353,000 meth users
16.3% of pregnant women smoked cigarettes
2.5 million received substance abuse treatment for alcohol
69.6 million Americans smoked cigarettes
B. Trends in Drug Use
1. The perceived risk decreases as drug use increases; as drug use decreases the perceived risk increases.
2. The perceived availability of marijuana has changed little over time and, therefore, does not appear to explain differences in rates of use.
3. The National Survey on Drug Use and Health is a door-to-door survey estimating drug use in adolescents and adults in the United States.
4. Alcohol and cocaine use in 18- to 25-year-olds stays fairly consistent over time.
5. Drug use patterns seen in multiple surveys are most likely to be accurate.
6. Decreases or increases in drug use are not related to changes in government legislation, but are related to social trends.
Have Things Really Changed?
1. Humans have used psychoactive drugs for thousands of years for therapeutic and recreational purposes.
2. Drug use has affected society in many areas: religion, law, government, economics, language, and education.
https://nsduhweb.rti.org/respweb/homepage.cfm
Survey questionnaires
Easy to use– inexpensive, efficient
Drawbacks
Bias in student population (e.g., dropouts not counted)
Potential inaccuracy of self-reports (among both users and non-users)
National Survey on Drug Use and Health
Face-to-face, computer-assisted interviews
68,000 individuals; carefully sampled households across the United States
Broken down into different age groups
Results published annually
Marijuana use among persons ages 12-25, by age group:1971-2006 (National Survey on Drug Use and Health)
In 2008 the percentage use for the age groups of 18-25 and 12-17 remained the same as they were in 2005; 16.5% and 6.7% respectively.
Finding similar patterns in two different studies, using different sampling techniques, is a stronger indication that these trends are real and reflect broad changes in American society over time
II. How Did We Get Here?
A. Have Things Really Changed?
1. Humans have used psychoactive drugs for thousands of years for therapeutic and recreational purposes.
2. Drug use has affected society in many areas: religion, law, government, economics, language, and education.
III. Drugs and Drug Use Today
A. Extent of Drug Use
1. Current information on drug use comes from several sources, including survey questionnaires done in junior highs, high schools, and colleges, but accurate statistics are hard to attain.
2. Self-reports may include a biased sample and be inaccurate or dishonest.
The Monitoring the Future Project follows nationwide trends over time in drug use among young people.
The National Survey on Drug Use and Health (NSDUH) provides national and state-level data on the use of tobacco, alcohol, illicit drugs (including non-medical use of prescription drugs) and mental health in the United States. NSDUH is sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA), an agency of the U.S. Public Health Service in the U.S. Department of Health and Human Services (DHHS).
Monitoring the Future is an ongoing study of the behaviors, attitudes, and values of American secondary school students, college students, and young adults. Each year, a total of approximately 50,000 8th, 10th and 12th grade students are surveyed (12th graders since 1975, and 8th and 10th graders since 1991). In addition, annual follow-up questionnaires are mailed to a sample of each graduating class for a number of years after their initial participation. The Monitoring the Future Study has been funded under a series of investigator-initiated competing research grants from the National Institute on Drug Abuse, a part of the National Institutes of Health. MTF is conducted at the
Survey Research Center in the Institute for Social Research at the University of Michigan.
http://www.monitoringthefuture.org/
Current laws trace back to two pieces of legislation from the early 1900s
Racist fears about deviant behavior, including drug misuse, played a role in the development of drug regulation
Laws were developed to regulate undesirable behaviors
Fraud in patent medicines that were sold directly to the public
False therapeutic claims
Habit-forming drug content
In the early 1900s, Collier’s magazine ran a series of articles attacking patent medicines—
“Great American Fraud”
Opium and the Chinese
U.S. was involved in international drug trade
Opium smoking brought to U.S. by Chinese workers
Laws passed against the importation, manufacture, and use of opium– racism involved?
Cocaine
Present in many patent medicines (and, yes, Coca-Cola!)
Viewed as a cause of increasing crime
Racist connections
Toxic = poisonous, deadly, or dangerous
What makes a drug toxic?
Amount used
How it is used
What the user did while on the drug
Specific toxicity for users who inject drugs
AIDS, HIV infection, and hepatitis B and C
Sharing needles passes infectious agents directly into the bloodstream
Some states, cities prohibit
needle purchase without Rx
Syringe exchange programs
Examples of acute toxicity
Behavioral: “Intoxication” that impairs the actions of drug users and increases the danger to themselves and others
Physiological: Overdose that causes the user to stop breathing
Examples of chronic toxicity
Behavioral
Personality and lifestyle changes
Effects on relationships with friends and family
Physiological
Heart disease
Lung cancer
Cirrhosis
Other health effects
What do “addicts” look like?
What drug do they take or what behavior do they engage in (alcohol, cigarettes, illicit drugs, food, sex, gambling, shopping, computer time)?
How much time do they spend on their habit?
How much of a drug do they take?
How do you decide on the definition of dependence?
Three basic processes
Tolerance
Physical dependence
Psychological dependence
Diminished effect on the body after repeated use of the same drug
The body develops ways to compensate for the chemical imbalance caused by the drug
Regular drug users may build up tolerance to the extent that their dosage would kill a novice user
Physical dependence is defined by the occurrence of a withdrawal syndrome
Tolerance typically precedes physical dependence
If drug use is stopped suddenly, withdrawal symptoms occur, ranging from mild to severe
Physical dependence means the body has adapted to the drug’s presence
Psychological or behavioral dependence
High frequency of drug use
Craving for the drug
Tendency to relapse after stopping use
Behavior is reinforced by the consequences
Over time, this becomes the biggest reason users report they continue to use
Early medical model = true addiction involves physical dependence; key is treatment of withdrawal symptoms
Positive reinforcement model = drugs can reinforce behavior without physical dependence
Psychological dependence is increasingly viewed as the driving force behind repeated drug use
This refutes the sometimes common belief that drugs that aren’t as strongly physically addicting are less dangerous
Some drugs are more likely than others to lead to dependence
Method of use, as well as other factors, influences risk of dependence
The “war on drugs” reflects the perspective that drugs are themselves evil
Is dependence due to biochemical or physiological actions in the brain?
Still no way to scan the brain and know if a person has/had developed dependence
Genetic physiological or biochemical markers have been sought as well, but none has proven reliable
No way to know if the drug or the drug use changes a person’s personality
Many other factors affect personality
Sensation-seeking = a personality characteristic statistically associated with early substance use and abuse
Alcohol dependence often exists within a dysfunctional family
Evidence suggests that dysfunctional relationships play a role in dependence, but they aren’t the only factor
Founders of AA characterized alcohol dependence as a disease
Others argue that dependence doesn’t have all the characteristics of a disease
There are ways to test and treat the effects of alcoholism but not the disease itself
There is some disagreement over how to define disease as well
Dependence is related to dysfunctions of:
Biology
Personality
Social interactions
Antecedent = a factor that occurs before an event such as the initiation of drug use
Still not labeled “causes”
Examples of antecedents
Aggressiveness
Conduct problems
Poor academic performance
Attachment to a drug-using peer group
Parental and community norms that support drug use
Alcohol and tobacco are sometimes considered gateways to the use of illicit drugs
Kandel & Faust’s 1975 study
Gateway substances are perhaps best thought of as early indicators of a basic pattern of deviant behavior resulting from a variety of risk factors
Correlate = a variable that is statistically related to another variable, such as drug use
IMPORTANT: Correlates are not causes
Socioeconomic status does not correlate well with drug use
Personality problems are poor predictors of drug use
IV. Correlates of Drug Use
A. What Factors Are Considered?
1. Surveyors look for common characteristics in those who use drugs, as compared with those who do not use drugs.
2. Study limitations can make it difficult to determine the effects of some factors.
B. Risk and Protective Factors
1. Risk factors are correlated with higher rates of drug use.
2. Risk factors for drug use include having friends who use drugs, engaging in fighting or stealing, perceiving that substance use is prevalent at school, knowing adults who use drugs, and having a positive attitude towards drugs.
3. The kids most likely to use marijuana frequently live in a rough neighborhood, have little parental monitoring, steal and get into fights, may not be involved in religious activities, and do poorly in school.
4. Protective factors are correlated with lower rates of drug use.
5. Protective factors for drug use include perceiving strong sanctions against drug use at school, having supportive parents, being committed to school, being involved in religious activities, and participating in two or more extracurricular activities.
6. Overall, studies of risk and protective factors suggest that adolescents who are more likely to smoke cigarettes, drink heavily, and smoke marijuana are also more likely to engage in other deviant behaviors, such as stealing, fighting, and early sexual behaviors.
C. Gender
1. Males are more likely to use alcohol, use tobacco, smoke marijuana, and use cocaine than are females.
D. Race
1. Stereotypes regarding drug use by different races may not be supported by findings from the National Survey on Drug Use and Health.
E. Level of Education
1. Those with more education (college degrees, compared with those who completed high school only) are much more likely to drink alcohol and somewhat less likely to use tobacco, marijuana, or cocaine.
F. Personality Variables
1. Evidence for correlations between traditional personality traits and drug use is somewhat weak and inconsistent.
2. Several studies focus on “impulsivity” as correlating with rates of substance use.
3. Personality factors may play a small role in whether someone decides to try alcohol or marijuana, but they may play a large role in whether drug use develops into a serious problem.
G. Genetics
1. Genetic studies are beginning to show clear association with substance-use disorders.
Having low-birthweight babies is a side effect of drug use by pregnant women.
How is drug use related to crime?
Intoxication causes behavior and personality change
Crimes may be committed while intoxicated
Drug use/possession is a crime
Crimes to fund cost of drug use
Society tries to protect itself through regulation
Current laws may not be part of a logical plan, ineffective or unrealistic
Drug use may change a person’s personality
People under the influence may commit crimes (e.g., many cases of homicide, domestic violence, etc.)
Crimes may be carried out to obtain money for drugs
Drug use is a crime
We want to protect society from the dangers of some types of drug use = legitimate social purpose
Some laws are not developed as part of a rationally devised plan and may not be realistic or effective
Current laws
These “Pot-Tarts,” seized by law enforcement in 2006, demonstrate the ingenuity of some illicit drug distributors. Upon raiding this facility, investigators found hundreds of marijuana-laced candies and soft drinks, including “Stoney Ranchers,” “Munchy Way,” “Rasta Reece’s,” and “Buddafingers.”
The benefit to farmers makes it hard to combat illegal drug production.
Figure 2.1 U.S. National Drug Control Budget—FY 2012 Funding Highlights
The federal government has steadily increased funding to interdict drugs.
Figure 2.4 Poll Responses to the Question: “Which of the Following Do You Feel Is the Single Best Way to Handle the War on Drugs?” (n = 4,730)