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/ 36
ADDICTION
Learning outcomes
By the end ofthis chapter, you should be able to:
LO 4.1 Define addiction, identify the signs of addiction, and describe the impact of addiction on friends
and family.
LO 4.2 Describe types of process addictions, such as gambling disorder, exercise addiction, technology
addictions, and compulsive buying disorder.
LO 4.3 Identity the six categories of drugs and their routes of administration.
LO4.4 Review problems relating to the misuse and abuse of prescription drugs, including the use of illicit drugs.
LO 4.5 Discuss the use and abuse of controlled substances, including stimulants, marijuana and other
cannabinoids, depressants, opioids (narcotics), hallucinogens, inhalants, and anabolic steroids.
LO 4.6 Discuss treatment and recovery options for addicts, as well as public health approaches to preventing
rug abuse and reducing the impact of addiction on our society.
THE IMPACT OF DRUG ABUSE
‘You might think drugs are helping you relax, improv- life and health. Sooner or later, drug misuse and abuse
ng your concentration, or enhancing your social _ is likely to catch up with you and cause problems, be
enjoyment, but those effects are transient-—and often they academic, social, career, legal, financial, or
illusory—and they are nothing compared to the many health related. Are a few moments of excitement
negative effects those same drugs can have on your really worth a lifetime of trouble?
anc, at wa ont
Copyright © 2019 Pearson Austala (a dvson of Pearson Australia Group Py Ltd) — 9780655700494 — Donatelle/ HBS110 Health Behaviour 3e 108 PART B © HEALTH-RISK BEHAVIOURS
addiction Chapter outline
Continued In this chapter, you will study addiction, how to recognise the signs of addiction and understand its
provement th | pact on te acces family and fends Techie cescibes he afer oes of acetone
aautstance ‘xamines in rater copth, the iss surouncing dug adition, andthe methods of tesing and
cone preventing dr ain
conequenses
These days it's easy to find high-profile eases of compulsive and destructive behay-
jour. Stories of celebrities, athletes, and politicians struggling with addiction
‘common, Heroin deaths have reached epidemic levels. In Australia in 2016, 1808
deaths were classified as being drug induced (AIHW, 2018). Millions of people
from a wide range of backgrounds are waging battles with adaliction, In this chap-
ter, we will examine addictions to common activities such as eating, gambling, and
shopping, as well as specific drugs that are addictive and commonly abused. (Alco-
hhol and tobacco are discussed in detail in Chapter 5,
What is addiction?
Addiction is defined as continued involvement with a substance or activity despite
‘ongoing negative consequences. The American Psychiatric Association (APA) elassi-
fies addiction as a mental disorder. Addictive behaviours initially provide 2 sense of
pleasure or stability that is dificult for some people to achieve in other ways,
“To be addictive, a substance or behaviour must have the potential to produce pos
tive mood changes, such as euphoria, anxiety reduction, or pain reduction. The danger
| ‘develops when the person comes to depend on these substances or behaviours to feel
94.1 Addletion acts allkinds normal or function on a daily bass, Signs of addiction become apparent when people
cf people. Acacemy Avaré-winning continue to use the substance despite knowing the hart that it causes to themselves
acior Philip Seyrnaur Hofiman, wisely
expected for his work, was found
ea in his New York parent
andothers
People with physiological dependence on 2 substance, sch as an addictive
pes PS. Neo pa | deyg, experince tolerance when they req increased amounts of the dg #0
winareoze wham: Amo A ee ded ee They abo experience withdrawal sero tenporay
Sith poe ot Physical and peychologicalsyptom tht occur shen substance ane stops. Toler
nce and withdrawal re important eitera for determining whether or aot some-
one is addicted
Psychological dependence can also play an important role in adtion
sila Behaviours unrelated to the use of rg, sch a8 gambling, working, and sex, can create changes
‘dependence at the cellular level along with positive mood changes (Potenza, 2015; Alavi et al. 2012). A person
The taste sate chan intense, uncontrollable urge to continue engaging in a pariclar activity said t have
gears ts developed a psychological dependence. Infact psychological and physiological dependence ae
Bese wetteguar — Satertwined that it nat really posible to separate them. Although the mechanism isnot well
understood all forms of aietion probably relleet dysfunction of certain biockerscal ystems i
the bran Volkows Koo & Meal, 2016)
Aacdictve behaviour
Common characteristics of addiction
soa
tolerance (Our brains are wired to ensure that we will repeat life-sustaining activities by associating those
Ropnenamenon in activities with reward or pleasure. We all engage in potentially addictive behaviours because some
win progressvely behaviours that are essential to our survival are also highly reinforcing, such as eating, drinking,
lige” doses of and sex. At some point, however, some individuals are notable to engage in these behaviours mode
2 drug or moro
ecrugormoe rately and these individuals become addicted.
renee vole Addiction has five common characteristics: (1) eomapulsion, which is characterised by obses=
edad topreduce Sin (excessive preoccupation) with the behaviour and an overwhelming need to perform it; (2) Loss
fed eiects, oF control, or the inability to predict reliably whether any isolated occurrence of the behaviour will
Copyright © 2019 Pearson Austala (a cvson of Pearson Australia Group Py Ltd) — 9780655700494 — Donatelle /HBS110 Health Behaviour 3e CHAPTER 4 * ADDICTION 109
be healthy or damaging; (3) negative consequences, such as physical damage, legal trouble,
financial problems, academic failuee, oF family dissolution; () denial, the inability to perceive that
the behaviour is selEdestructive; and (5) inability to abstain. These five components are present
inall additions, whether chemical or behavioural (American Society of Addition Medicine, 2011)
Addiction is a process that evolves overtime (Figure 4.1) It begins when a person repeatedly
seeks the illusion of relief to avoid unpleasant feelings or situations. This pattern, known as muaring
rough avoidance, isa maladaptive way of taking eare of emotional needs. As a person increasingly
depends on the addictive bebaviour, there is a corresponding deterioration in relationships as well
as personal and professional lie. Eventually, addicts do not find the addictive behaviour pleasur-
able but consider it preferable to the unhappy realities they seck to escape.*
Harmful use
‘The harmful use of a substance or substances is use that is causing damage to the health of the
person. The damage may be physical, such as hepatitis from intravenous substance use, or mental,
such asthe experience of a mood disorder secondary to the persistent use of alcohol
Dependence syndrome
‘Acdependence syndrome is a cluster of physiological, behavioural and cognitive phenomena
Which the use of a substance takes on a much higher priority than other behaviours that once had
greater value lor the individual, A key descriptive characteristic of dependence syndrome is the
desire (Frequently strong, sometimes overpowering] to take a substance or substances, Dependence
rulers to both physical and psychological elements, Psychological dependence refers to the experi=
cence of impaired control over substance use, while physiological or physical dependence refers to
tolerance and withdrawal symptoms.”
Addiction affects family and friends
‘The family and friends of an addicted person also suifer many negative consequences. Often, they
struggle with codependence, aseiefeating relationship pattern in which a person is controlled by
anaddicr’s addictive behaviour: A cadependent person will aften put his or her needs aside to take care
of the addict. They find it hard to set healthy boundaries and often lve in a chaotic, ersi-oriented
Figure 4.1 The cyce of psychological adietion,
Source: Adapt tom Recovery Conecton, Cele ot Adkcten, 2016, wen ecovonconnecton rpc adtion
withdrawal
A soies of
temporary physical
and psychological
symatoms that
‘occur when an
‘dct aruaty
abstain ram an
aridctve chemical
‘or behaviour.
psychological
‘dependence
Dependency
‘af the mind on
2 substance
or behaviour,
which ean lead
to psychological
wthramal
symptoms such 2s
analy, tail, oF
cravings.
‘compulsion
Preoccupation with
‘behaviour and an
‘overwhelming ne
to perform
‘obsession
Excessive
preoccupation
wth an accictive
Substance or
benaviut
loss of control
Inability to arediet,
reliably whether @
partite instance
‘of invoverent|
wth an acaictive
substance or
behaviour will
be heathy or
damaging
legal rouble,
financial in,
‘academic faire,
family cisolution,
and other severe
probioms that do
ot occur wth
heathy involernent
in any behaviour
denial
Inability to perceive
‘or accuratey
interpret the set
destctve effects
ofan addictive
st Ctl pa ager SON. eran
Copyright © 2019 Pearson Austala (a cvson of Pearson Australia Group Py Ltd) — 9780655700494 — Donatelle /HBS110 Health Behaviour 3e 110 PART B + HEALTH-RISK BEHAVIOURS
inability to abstain
Foire to avoid drug
use over a sustained
pero of time
codependence
Bsol-deteating
Felatonsnip pattern
Inwhich 2 porson
helps or encourages
addictive benavour
In anather
enabler
AN person who
krowingy
Uunenowinay
protects an
fddet from the
consequences of the
addet’s behaviour,
process addiction
Deoneiion in
‘which a person
is dependent on
(adaitas to) some
‘moot altering
behawour |
process, such as
garmbing, buying, of
‘gambling disorder
Ast of behaviours
including
preoccupation
with gaming
Unsuccesstu efforts
te cutback or quit,
sing gambing to
escape problems,
ard ying to fry
membre to
conceal the extent
of rwovement with
garbing,
Copyright © 2019 Pearson Austala (a cvson of Pearson Australia Group Py Ltd) — 9780655700494 — Donatelle /HBS110 Health Behaviour 3e
mode. Although the word caddis used les frequently today treatment professional sill eeognise
the importance of helping addicts see how thee behaviour affect those around thers and of working
‘with family and friends establish healthier relationships.
Family and fiends can play an important roe in getting an addict to seck treatment, particulary
when they refuse to be enablers, tha is, people who knowingly or unknowingly protect addicts
from the natural consequences of their bebaviout. IP addlcts don't have to deal with the conse-
aqucnces, they cannot see Use self-destructive nature of their behaviour and will continue Enabling
is rarely conscious or intentional
Addictive behaviours
Drugs are not the only source of addiction. New knowledge about the brain’s reward system suggests
‘hat, for the brain, a reward isa reward, whether brought on by a chemical or a behaviour (National
Institute on Drug Abuse, 2007), Process addictions arc behaviours that are known to be addictive
because they are mood altering, Examples include disordered gambling, compulsive buying, compu
sive Internet or technology use, work addiction, compulsive exercise, and sexual addiction
Gambling disorder
Gambling isa form of recreation and entertainment for millions of Americans. Most people who
gamble do so casually and moderately to experience the excitement of anticipating a win. How=
ever; more that 5 million people in the United States meet the criteria for having a gambling
addiction, and many others are diteclly or indirectly flected by the gambling behaviour of fiends
or relatives (National Couneil on Problem Gambling, 2016). The APA recognises gambling dis-
order as an addictive disorder. According tothe fifth edition of the APNs Diagnatic and Statistical
Manual of Mental Divrders (DSM-5), characteristic bebaviours include a preoccupation with gaa
bling, unsuccessfil efforts to cut back or quit, gambling when feeling distressed, and lying to family
‘members to conceal the extent of gambling American Psychiatric Association, 2013)
A gambling addiction typically progresses through four phases (Grohol, 2016)
The winning phase often begins with a large win, which reinforces the excitement and reward
associated with gambling. The gambler begins to feel as though he or she cannot lose.
1 In the losing phase, gamblers become preoccupied with gambling, trying to win back what they
hhave lost. This often interferes with work and family life
1 In the desperate phase, gamblers lose the ability to control their gambling. ‘They feel ashamed.
and guilty but cannot stop, They may resort to stealing or cheating to continue their
gambling.
= In the hopeless phase, gamblers give up the hope of quitting. They don't believe that anyone
cares or that help is possible.
Strong evidence suggests that disordered gambling has a biological component, Gambling
addiction has come to be viewed as a disorder of the dopamine aeurotranstnitter system coupled
‘with deereased blood flow to a key tection of the brain's reward system. Individuals with gaan
bling disorder may compensate for this reward deficiency by overdoing it and getting hooked.
(Nutt, Lingford-Hughes, Erritzoe & Stokes, 2015). Like drug abusers, gambling addicts show
tolerance—needing to increase the amount of their bets—and have withdrawal symptoms,
including sleep disturbance, sweating iritability, and craving (Nott, 2016}.
Although gambling is illegal for anyone under the age of 21 in the United States, college stu-
dents have easier access to gambling opportunities than ever before, The peteentage of college
students who gamble—close to 75 percent—is consistent with these growing opportunities
inker, Rodriguez, Krieger, Tackett & Neighbors, 2015). Nearly 18 percent of those students
reported gambling once a week or more (National Center for Responsible Gambling, 2016). Its
estimated that 6 percent of college students in Uae United States have a serious gambling problem,
Which can result in psychological difficulties, debt, and filing grades (National Center for Respon
sible Gambling, 2016) Compulsive buying disorder
In the United States, many people shop to make themselves Feel
better. But people who engage in ‘retail the
ning their credit cards to the limit, may have compulsive
py" in excess, ran
buying disorder. Compulsive buyers are preoccupied with
shopping and spending, and they exercise litle control over
their impulses. Compulsive buying is estimated to afllict up to 6
percent of adults (National Genter for Responsible Gambling,
2016), Most compulsive buyers are women (Miller, Mitchell &
De Zwaan, 2015)
Symptoms that a person has erossed the line into compulsive
buying include preoceupation with shopping and spending,
buying more than one of the same item, shopping for loy
T Photo 4.2 Once a persone
than intended, repeatedly buying much more than the person change i the hoi
ognises a habit and decides
usualy be broken. With
needs or can afford, and buying that interferes with social activi- addiction, nowover, the sense of ompu'sion ‘sa strong
ties oF work and creates financial problems. Compulsive buying that 2 betavour cart be cortalled. For example, you m
frequently results in psychological distress as well a conflict with _A°t9 Shop or spen ime online hunting fr bargain, but
friends and between couples (Weinstein, Maraz, Griffiths,
Tejoyeue & Demetrovics, 2016; Muller ct al, 2015),
he Internet provides instant access to millions of tempting
purchases, information about the newest fashions, and contin-
ual alerts about new products, These features enable a compulsive buyer to be alone with his or her
addiction, shopping with litle or no direct interaction, either verbal or face to face. Compulsive
buyers offen do not want others (including fiunily members) to know what, how frequently, and
how much they buy (Weinsten, Mezig, Mizrachi & Lejoyeux, 2015; Trotzke, Starcke, Maller &
Brand, 2015; Derbyshire et a., 2013}. It is not uncommon for the goods they buy to be use
left unused (Weinstein, Griffiths, Maraz & Lejoyeux, 201
Source: Juce ImagesiNGE Fotstock
Exercise addiction
Generally speaking, most Americans get too litle physical activity not too much, However, when
taken to extremes, exercise can become addictive as a result of its powerful mood-enhancing
effects. Bxeref
‘macy, selFesteem, and self-competency—that an abject or activity cannot truly mect. Addictive or
compulsive exercise results in negative consequences similar to those of other addictions: alien
more, Warning signs
exercise addiction include injuring and reinjuring the body through excess or lack of proper rest;
difficulty «
burning calories or losing weight; cancelling social plans, skipping work, oF missing class to exer
cise; or working out beyond the point of pain (Szabo, Grifths, De la Vega Marcos & Mervé, 2015;
Weinstein & Weinstein, 2014),
addicts use exercise compulsively to try to meet needs—for nurcurance,inti=
ation of fanily and friends, injures from overdoing it, and a eravin
rncentrating; feeling restless; adhering to a rigid workout plan; becoming fixated on
Technology addictions
Are your your friends more concerned with texting or tweeting than with eating, studying, or hav
ing a face-to-face conversation? These attitades and behaviours are not unusual; many experts
suggest that technology addiction is veal and can present serious problems. An estimated one in
cight Internet users will ikely experience Internet addietion (Net Addiction, 2016; Pontes, Kuss
& Griffiths, 2015), Younger people are mote likely to be addicted to the Internet than are riddle
aged users (Li, O'Brein Snyder & O'Howard, 2015). Approximately 9 percent of college students
report that Internet use and computer games have interfered with their academic performance
(American College Health Association, 2016). To read about students taking part in an ‘unplug
fom technology day.’ see the vei « uizattt box,
Copyright © 2019 Pearson Austala (a cvson of Pearson Australia Group Py Ltd) — 9780655700494 — Donatelle /HBS110 Health Behaviour 3e
itis considered an addcton unless you have lst contol
‘ver where and when you shop and how much you spend,
compulsive buying
disorder
‘preoccupation
with shopping
ard spencing
accompanied by
litle contol aver the
impulse to buy
exercise addict
person whe
aways works out
‘aioe, fling the
same rigid patter
fexereses for more
than 2 hous
cal,
and when
injured
oa weignt iss or
cates burned
bxer'ses tothe
point of pain and
beyond and skips
socal actives for
Internet addition
Compulsive use
of the computer,
POR, mabie hone,
crater form of
technology |
access the Inernet
for actives such
as ermal, games,
shopping, anc
ble ne 112 PART B + HEALTH-RISK BEHAVIOURS
se TECH & HEALTH
Mobile devices, media and the Internet—Could you unplug?
If someone asked you to unplug
for 24 hours, how hard would it
‘be? Judging from the results of a
study with participants from 37
countries on six continents, it
‘would be extremely hard! All stu:
dents followed the same assign-
ment: Give up. Internet,
newspapers, magazines, TV,
radio, phones, ;Pods/MP3 play-
ers, movies, video games, and
any other form of electronic or
social media for 24 hours,
Students around the world
repeatedly used the term addiction
to speak about their media
dependence and likened their
reactions to feelings of with:
drawal. ‘Media is my drug; with-
‘out it Twas los, said one student
from the United Kingdom. A
student from the United States noted: ‘Twas itching, lke a crackhead, because T could not
‘use my phone.’ A student from Slovakia simply said, ‘felt sad, lonely, and depressed.”
‘Students also reported that media—especially mobile phones—have become virtual exten-
sions of themselves, Going without made it seem as though they had lost part of
themselves
Despite the withdrawal symptoms, many students found that there were definite benefits
to being unplugged for 24 hours. Some students found that they had more time total, listen,
and share with others, Students also reported feeling liberated. They took time to do things
they normally would not do, such as visiting relatives and having face-to-face conversations
How do you ‘unplug’ without the anxiety of ignoring your frends online? Apps can actually
hep! Some apps can post automatic status updates to Facebook and Twitter, send you reminders
about scheduled technology breaks, or temporarily lock out your access to the Internet. Here are
a couple:
Off time. htp://Oftime.co//
1» Unplug and Reconnect. (Free: Android) wonwanplugreconnect.com
Photo 43 As the word goes wirless, many of us aro
increasingly attached to our eel phones, laptops, ard tablet
comouters.
Source: Wiel DoringeaPearson Eastin ne:
Sur: Adapted en The Word Unplugged, Going 24 Hour without Media’ 2011, up /Uueweridanplageed
crores i
Some online activities, such as gaming and cybersex, seem to be more compelling and poten
tially addictive dhan others. Internet addicts typically exhibit symptoms such as general disregard
for their health, sleep deprivation, neglecting family and friends, lack of physical activity, euphoria,
when online, low grades, and poor job performance. Internet addicts may feel moody or uncom
fortable when ofline. They may use their behaviour to compensate for loneliness, marital or work
problems, an unsatisfying social lif, or financial problems.
Copyright © 2019 Pearson Austala (a cvson of Pearson Australia Group Py Ltd) — 9780655700494 — Donatelle /HBS110 Health Behaviour 3e CHAPTER 4 * ADDICTION 113
Work addiction
Work addiction isthe compulsive ue of work and the work persona to full needs of intimacy, power,
and success The disorder is characterised by excessive time spent working dficlty disengaging from,
work, going above and beyond what the jab calls for, a compalsive work style, high levels of stress, low
lie satisfaction, marital conflict, and work burnout (Addetion Help Center, 2016), Work adits may
feel too busy to take care of their health, and there is some evidence that work addition can case
physical symptoms such as seep problems and exhaustion, high blood pressure, anxiety and depres-
sion, weight gain, ulcers and chest pain, or more chronic health conclions such as heart disease and
asthmatic atacks (Addietion Help Center, 2016) Figure 4.2 identities other signs of work addition,
‘Work addiction is found among all age, racial, and socioeconomic groups but typically develops
in people in their 40s and 50s, Male work addiets outnumber female work addicts, but this i
changing as women gain equality in the worklarce (Clark, Michel & Zbdanova, 2016), Most work
addicts come from homes in which one or more parenis were work addicts, rigid, violent, or other
wise dysfunctional (Kravina, Falco, De Carlo, Schou & Pallesen, 2014). While work adleton ean
bring admiration, asthe addicts often excel in their professions the negative elfects on individuals
and those around them may be far-reaching (Clark et al., 201
Work binges
Memory oss
‘uote metal
pieocinaon
comers eae)
Figure 4.2. Signs of work addiction
Source: Doigachov Z3RF
Compulsive sexual behaviour
[Everyone needs love and intimacy, but the sexual practices of people addicted to sex involve nek
ther. Sexual addietion is compulsive involvement in sexual activity
‘Compulsive sexual behaviour may involve a normally enjoyable sexual experience that becomes an
‘obsession, or it may invole fantasies or activities outside the bounds of culturally, legally, or morally
acceptable behaviour (Weiss, 2016). People with compulsive sexual behaviour may participate in a
wide range of sexual activities, including affairs, sex with strangers, prostitution, voyeurism, exhibi-
Lionism, rape, incest, or pedophilia, They frequently experience erushing episodes of depression and
anxiety teled by the fear of discovery. Compulsive sexual behaviour ear lead to los of imacy with
loved ones, family disintegration, and other related problems.
Copyright © 2019 Pearson Austala (a cvson of Pearson Australia Group Py Ltd) — 9780655700494 — Donatelle /HBS110 Health Behaviour 3e
‘work addiction
The compuisive
Use of work and the
work persona
te full nee for
intimacy, pone,
and success,
sexual addition
Compulsive
Irvotvement in
sexual actly 114 PART B + HEALTH-RISK BEHAVIOURS
While compulsive sexual behaviour is most common in men, it can affect anyone, regardless of
sexual preference. Many sex addicts have a history of physical, emotional, and/or sexual abuse, oF
trauma (Weiss, 2016),
Although process addictions are becoming more commonly recognised in society, drug addic-
tion sill garners most public attention,
What is a drug?
drugs Drugs are substances other than food that are intended to affect the structure or function of the
Nor-nutiional nn~ mind or the body through chemical action. Many drugs have important benefits. However the
food subsarces | potential for addiction is great for even the most therapeutic substances, owing to theie potent
trate ended © eect an the brain.
sree Scientists divide drugs into six categories: prescription, over-the-counter (OTC), recreational,
thems tosy _berbal preparations, ilit, and commercial. Bach category includes some drugs that stimulate the
throush cremical Body, some that depress body functions, and some that produce ballucinaions (sounds, images, or
action other sensations that are perceived but ate not real. Each eategory also inchudes prychouctve drs.
= Prescription dug: Prescription drugs can be obtained only with a prescription from a licensed
health practitioner In the past 12 months, 67.4% of Australians in cites received a preserip-
tion, 71.3% in regional centres and 695% in remote or very remote regions of Australia. Tt
has been reported that the average daily filled prescription rate that uses the Pharmaceutical
Benefits Scheme (PBS) is 770000 prescriptions (AIHW, 20189). The percentage of people take
ing live or more prescription drugs is 11 % (Centers for Disease Control and Prevention,
2017) Close to 75 M% of physician office visits involve receiving some drug therapy (Centers for
Disease Control and Prevention, 2017)
1 Ocer-the-couer drugs: OVC. drugs, used to treat everything from headaches to athlete's foot, are
available without a prescription. They ereate substantial savings for the health care system
‘through decreased visits to health care providers and decreased use of prescription medications
(Gonsumer Health Care Products Association, 2016). However, they can be misused (US.
National Library of Medicine, 2017),
1 Reevational digs: Generally, people use recreational drugs to relax or socialise, Most of them are
Jegal even though they are psychoactive. Alcohol, tobacco, and caffeine products ae included in
this category
1 Herbal preparations: Herbal preparations encompass approximately 750 substances, including teas
‘and other produets of botanical (plant origin, that are believed to have medicinal properties,
Mii (iegad) drags: Ulieit drugs are the most notorious type of drug. Although laws governing
their use, possession, cultivation, manufacture, and sae dilfer from state to state, illicit drugs are
generally recognised as harmful. All are psychoactive
1 Commrial drug: Commercial drugs are those found in commercially sold products, More than
1000 exis, including those used in seemingly benign items such as perfumes, cosmetics, house-
hold cleaners, paints, gues, inks, dyes, and pesticides.
How drugs affect the brain
Pleasure, which scientists call ravard, is a powerful biological force for survival, The brain is wired
such that you tend to want to repeat pleasurable experiences. Life-sustaining activities, such as eat-
ing, activate a circuit of specialised nerve cells devoted to producing and regulating pleasure. One
important set of nerve eels, which uses a chemical neurotransmitter called depaning sls at the
very top of the brain stem. These dopamine-containing neurons relay messages about pleasure
neurtransmitter
Rehemical tat
relays messages
bebwean rene cals
Criommoveceis’ through their nerve fibres to nerve cells in the limbic system, structures in the brain that regulate
to other body cols, emotions. Sill other fibres connect to a related part of the frontal region of the cerebral cortex, the
area of the brain that plays a key role in memory, perception, thought, and consciousness. Th
this ‘pleasure circuit,” known as the mesolimbic dopamine sistem, spans the survival-oriented brain
stem, the emotional limbic system, and the thinking frontal cerebral cortex,
All addictive substances and behaviours can activate the brain’s pleasure cieuit. Drug addiction
isa biological, pathological process that alters the way in which the pleasure centre, as well as other
Copyright © 2019 Pearson Austala (a cvson of Pearson Australia Group Py Ltd) — 9780655700494 — Donatelle /HBS110 Health Behaviour 3e CHAPTER 4 * ADDICTION 115
Figure 4.3. The action of cocaine at dopamine receptors inthe bean, (a In normal neural communication, dopamine is
released into the synapse between neurons. It binds temporal to dopamine receptors onthe receiving neuron and then
is recycled back info the vansmiting neuron by a transporter. (b) Wren cocaine molecules are present, they attach to
the dopamine vensporter and book the recycling process. Excess dopamine remains actve in the synantc gaps between
reurons, creating feoings of excitement and euphoria
“Source: Ades fom NIDA “Cecaine—Haw the Bran Responds to Coie,” February 2016, Avast htpuiwwwrugabiee
sade creut how bran-erpandeecacane, peychoactve drugs
‘ago Sourc rage SaurcstGty rages Drugs that ect
bran chemistry ard
have the potaital
to aker mood
parts of the brain, functions. Almost all psychoactive drugs (those that change the way the behaviour
brain works) affect chemical neurotransmission by enhancing it, suppressing it, or interfering with eal ingestion
it, While some drugs mimic the effects of natural neurotransmitter, others block receptors and iriake of drugs
thereby prevent neuronal messages from getting through. Still other drugs block the reyptake of —_‘hvough the mouth
neurotransmitters by neurons, thus increasing the concentration of the neurotransmitters in the ghaation
synaptic gap, the space between individual neurons (Figure 4.3), Finally, some drugs cause neu- The intteducton
rotransmitters to be released in greater amounts than is normal, of drugs into the
body through the
respiratory rac
Routes of drug administration
: Route of adninsration vefers to the way a given drug i taken into the body. The most common ‘mieten
: sncthod is by swallowing a able, cael, lige (Oral ingestion). Dry take orally may not, "ulucton of
: reach the bloodstream for a long as 30 minutes, oe eee
i ‘Drags can also enter the body through the respiratory tract via snifing, smoking, oF ialing jose
i (inhalation), Drugs that are inhaled and absorbed by the lungs travel the most rapidly ofall the
i routes of drug administration. ‘ansderma
: ‘nether api orm of against iy ijeetion det ino theboodsweamfinea- —eetcton ot
g senouly into a muscle Gtramusculary, or just under the skin (subewsancousl). Inavenous sto he 2
: injection, which involves inserting @ hypodermic needle directly into vein, is the most common.
; method of injection for drug users, owing to the rapid speed (within seconds in mast cases) suppositories
which a drug's effect is felt. Itis also the most dangerous method because of the risk of damaging Mixtures of crags
blood vessels and contracting HIV (human immunodeficiency virus) and hepatitis, ae sow et
‘Drugs ear aioe absorbed through the skin ore lining ramsdermal}—the nicotine patchis GEeree TN
common example of a drug that sadminisered this way-—or through the micous membranes such She’ gee feared
fas those in the nose (sorting) oF inthe vagina oF anus suppositories). Suppositories are typically yn ne grus 0"
mixed with a way meelum tha melts at body temperatire, releasing the drug into the Moodstream. vagina
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aon Hs 2h Piet ek Ca baton ieiaahrD A 116 PART B + HEALTH-RISK BEHAVIOURS
etd se Drug interactions
ject mute 8 UIC
sedans, Polydrug wee—taking veveral medications, vita
vitamins, ining, recreational drugs, oilegal drugs smltane-
‘creator dues, gusly ean be dangerous. Aleokol in particular
or ic crags frequently has dangerous interactions with other
‘simultaneously. Ereauently bas dang ne
rags. Hazardous interactions include synergism,
synergism inhibition, antagonism, intolerance, and
Interaction oftwoChoss-tolerance
‘x mare drugs that Synergism, also called fenton, isan interac
Braces mete on of mo or tore dry in which te efecto the
fesou tec aida das ae mtitied bound what would
Delete orally be expected f Uy were taken alone You
Surswereten igh Wik smegim as? 2 10.8 synrge
Story asa feasdon canbe very dangeour ren deal
‘called potentiation. “Antagonism, although usually less serious than Photo 4.4 Using 2
antes synergic ako produce unwed and unpleas rent as
poses heath threats
type ol nection ane effects In an antagonistic reaction, drugs work at Tord ther afocts ofthe
in which two or the same receptor site, and one drug blocks the
mere crags okt Sign of the other The blocking drug occapis the oe
the same receptor Souee: Crag Waco
eee receptor site and prevents the other drug from et
attaching, thus altering its absorption and action.
With inhibition, the eflects of one drug are
climinated or reduced by the presence of another drug at the receptor site, Intoleranee occurs
when drugs combine in Uxe body to produce extremely uncomfortable reactions. The drug Anta:
bse, which is used to help aleoholics give up aleohol, works by producing this type of interaction.
Cross-tolerance occurs when a person develops a physiological tolerance to one drug that
drug intercon
In which th effects
of one crug are
Simnated or ako inereases the body’s tolerance to ather substances that act smulaly on the body
Feducec by the
ieancase” Drug misuse and abuse
receptor sie. Drug misuse involves using a drug fora purpose for which twas not intended. For example, take
ing a friends prescription painkllerfor your headache is misuse. So is using Adderall or Ritalin as
intolerance a study aid. This isnot too far removed from drug abuse, or the excessive use of any drug, and
‘type of interaction may cause serious harm
levwhich two Although drug abuse is usually referred to in connection with illicit drugs, many people also.
more CFE. abuse and misuse prescription, OTC, and recreational drug. I hissection, we discuss these drug
precs owe related behaviours and focus in particular on university stents drug use.
reactors
z Abuse of over-the-counter drugs
: ceeleanee 4 Over-the-counter medications come in many different forms, including pills, Tiquids, nasal
BRERQAPE? sprays, and topical creams. Although many people asume that no harm can come from legal
cerry egies nonprescription drugs, OTC medications ean be abused, with resultant health complications
2 theeteciso and potential addiction, Teenagers, young adults, and people over the age of 65 appear to be
| Momecsiniar most vulnerable to abusing OTE drugs.
Bane ‘OTC drug abuse can involve taking more than the recommended dosage, combining the drug
a with other drug. or taking drug overa longer period of time than i recommended, Abuse of an
3 dueiminuse | adgition to OTC drugs can be aecidental. A person may develop tolerance from continued ws,
Seton iota eating an unintended dependence. However, teenagers and yourg alls sometimes intentionally
S aoe eerintedad abuse OTC medications in search of a cheap high—by drinking large amounts of cough medicine,
i for instance, The following area fow types of OTC drug that are subject to anise and abuse
drug abuse
tee ae ola Caine pills and energy drinks: Energy drinks, OTC caffeine pills, and pain relievers containing caf
ane feine are commonly abused for the enengy boost they provide. Caffeine in large doses can result
Copyright © 2019 Pearson Austala (a cvson of Pearson Australia Group Py Ltd) — 9780655700494 — Donatelle /HBS110 Health Behaviour 3e in tremors/shaking, restlessness and edginess, insomnia, dehydration,
panic attacks, heatt irregularities, and other symptoms, }
Cold medicines cough saps and tablets): OF particular conc
that is present in many cough and cold medicines is dextromethorphan,
DXM). As many as 5 percent of high school seniors report taking drugs
containing DXM to get high (lohnston, O'Malley, Micch, Bachman &
Schulenberg, 2015). Large doses of products containing DXM can cause
hallucinations loss of motor control, and ‘out-of body’ (dissociative) sensa:
tions, In combination with alcohol or other drugs, large doses of DXM can
be deadly
1 Divt pills: Aithough dict pills arc intended to help people lose weight,
some teens use them as a way of getting high. Diet pill often contain
one ingredient
stimulant such as caffeine or an herbal ingredient that is claimed to pro-
mote weight loss, such as Hosdia gordnit, Although they can sometimes
‘cause serious side effects, many diet pills are marketed as dietary supple
‘ments and so are regulated by the Food and Drug Administration (FDA)
ig. This means that their manufacturers may make
unsubstantiated claims of ellectiveness or can use untested and unsafe
a food, not as
Photo 4.5 Qverthe-counter
cough syrup seq
ingredients
1 Sie aids: Using sleep ais in excess may be harmful, as they can cause Suse Us youre peor
p eye, weaken areas of the body, or induce nareo- _ngreont DKW.
problems with the sl
lepsy (a condition of excessive, intrusive sleepiness. Continued use can
: ue: Lon SpriShlerstock
Tead to tolerance and dependence,
Non-medical use or abuse
of prescription drugs
The ‘burden’ of disability-adjusted
lifespan attributed to the use of illicit
drugs is significantly less than that
attributed to alcohol, smoking or even
to physical inactivisy: Approximately 40
deaths per million of the population
aged between 15 and 64 were attrib
uated to ilicit drug use in 2012, which
2011 (United Nations
Statisties Division, 201), The figutes in
terms of prevalence of use, as pre-
sented earlier, are small in comparison
to alcohol or tobacco, however, the
mere mention of illicit use of drugs
ome legally obtained, ex valium,
Photo 4.6 Abusing prescription drugs s na safer than some nol, eg. heroin) can cause anxiety
cay demonstrated by the in teachers, parents, the police, the gov
was lower than
an overdose of fentanyl, 9 ernment and in young people them:
cided to eat pain selves, Further stigmatisation of certain
ur lagon MacraiZUM& Presa Nawecom Grugy in Australia has led to underre=
porting, which has consequences for
epidemiological studies and treatment policies (Chalmers, Lancaster & ITughes, 2016). The method
of ingestion, perhaps more than the substance itself, has led people to associate some forms of drug
use {ie injecting drug use) with serious diseases including HIV and Hepatitis C. It s estimated
that, worldwide, approximately 12.7 million people (this figure ranges from 8.9 to 22.4 million
depending on the report inject drugs, of whom approximately 13% have an HIV diagnosis (reports
Copyright © 2019 Pearson Austala (a cvson of Pearson Australia Group Py Ltd) — 9780655700494 — Donatelle /HBS110 Health Behaviour 3e Copyright © 2019 Pearson Austala (a cvson of Pearson Australia Group Py Ltd) — 9780655700494 — Donatelle /HBS110 Health Behaviour 3e
ne
PART B » HEALTH-RISK BEHAVIOURS.
range from 0.9 t0 4.8 million) and more than half have Hepatitis C (Accijas & Rhodes, 2007;
Mathers et al., 20085 United Nations Office on Drugs and Grime, 201-4; WITO, 2009)
Use and abuse of illicit drugs
‘The problem of ict (legal drug use touches us all, We may use ict substances ourselves, watch
someone we love struggle with drug abuse, or become the vietin of a drug-related crime. At the
very leas, we pay inereasing taxes for law enforcement and drug rebabilitation, When our eawork:
crs use drugs, the ellectiveness of our own work may be diminished,
Illicit drug use spans all age groups, genders, ethnicities, occupations, and socioeconomic
groups. Hlicit drug use peaked around 25 milion users between 1979 and 1986, declined nti
1992, rose up to around 27 million users per year, and has remained stable over the past several
decades (Center for Behavioral Health Statistics and Quality, 2016). Among youth, however illicit
rug use, notably of marijuana and heroin, has been rising in recent years (Center for Behavioral
Tlealth Statistics and Quality, 2016)
‘Compared to alcohol and tobacco, illicit drug use is low. For all Australians aged 4 and above,
443% had used an illicit drug in their lifetime and approximately 15% had used illicit drugs in the
previous 12 months. The top four most prevalent were cannabis, ecstasy, meth/amphetamines and
cocaine (see Figure 4.4). There are ako considerable age dillerences as can be seen in Figure 4.5
Between 3.5% and 7% of the world’s population will have used an illicit drug in the past year,
with regular drug use tending to relate to cannabis use, whereas dependent or problematic use,
classed asa drug abuse disorder, ends to correspond to opiate use. About one-quarter of a percent
‘will have injected across the global population. Even cannabis, which ie ‘top’ of the lst of ict,
drugs used, has a relatively low prevalence in terms of use ‘in the past year’ (7.6%).
Why do people initiate potentially addictive
substance use behaviours?
‘Smoking, drinking and substance use is generally adopted in youth. For example, the Norwegian
Longitudinal Health Behaviour Seudy of over 1000 participants followed from age 13 10 30, found.
that smoking rates increased from 3% to 31% between ages 13 and 18 (Tjora, Metland, Aare &
Overland, 2011). There ate a significant number of young people smoking and accumulating hing.
and airway damage, or drinking and promoting liver damage that will, for many, create significant
health and social problems in the future, Itbas long been known that there isan inereased risk of |
lung cancer in those that initiate smoking in childhood about 66% of smokers start before 18
Photo 4.7. Painkilers such as OxyContin, Percoca, Percdan, and Veudin are highly addict. they are
{ken daily for several weeks, thet fs enough time for addiction to cevelop, OxyContin In particular can be &
highly addictive and dangerous narectic when abused
Source: Thomas M Peckin/Shaterstack CHAPTER 4+ ADDICTION 119
»
3
2 = wanaratare — toto
Sehr — Slam
te rise
i
2
:
¢
‘
—0oh——_—_—_—_————————
°
en
Figure 44 Recent use* of selected ict drugs by people aged 14 and ever, 2001 to 2016.
“Used inte at 12 mans
Source: Austaon rst of Heath anes Weta AW) (2017e), Nations! Drug Seategy Household Suny (NOSHS) 2016. Key nding, Tbe
25. Canbe, AM, Rebeed fom