Drug Use and Addiction

Drug Use and Addiction

Chapter 8

© McGraw Hill LLC. All rights reserved. No reproduction or distribution without the prior written consent of McGraw Hill LLC.
 Addiction
Drug: any chemical other than food intended to affect
the structure or function of the body:
• Medical
• Social

Psychoactive drugs: those that alter a person’s

perception, mood, behavior, or consciousness:
• In the short term, can cause intoxication

2
 What Is Addiction?
Today addiction is viewed as a complex disease, a pathological pursuit of
pleasure or relief by substance use and other behaviors:
• Addictive behaviors are any activities or uses of substances that are
pursued compulsively for physical or psychological reward, despite
unwanted physical, mental, or social consequences.

Changes in brain underlie addiction:

• One of these is tolerance, where the initial dosage no longer produces the
original emotional or psychological effects.

All addictions involve an initial voluntary step.

Vulnerabilities such as genetic risk, family history, or a stressful environment,

all contribute to the development of addiction.

3
 Table 8.1 Drug Misuse among Americans, 2020 (Percent Using
in Past Month)
YOUNG ADULTS YOUTHS ALL AMERICANS AGED 12
AGED 18–25 AGED 12–17 AND OVER
ILLICIT DRUGS* 4.8 1.2 3.4
Marijuana and hashish 3.0 5.9 11.8
Cocaine 1.3 0.0 0.7
Heroin 0.1 0.0 0.7
Hallucinogens 1.9 0.3 0.6
Ecstasy 0.6 0.1 0.2
Inhalants 0.5 0.4 0.3
Methamphetamine 0.2 0.0 0.6
MISUSE OF PSYCHOTHERAPEUTICS 2.3 0.7 1.9
Pain relievers 0.9 0.4 0.9
Tranquilizers 1.1 0.1 0.8
Stimulants 0.8 0.3 0.5

*Other than marijuana, which is permitted in many states.

SOURCE: Substance Abuse and Mental Health Services Administration. 2021. Key substance use and mental health indicators in the United States: Results from the 2020
National Survey on Drug Use and Health (HHS Publication No. PEP21-07-01-003, NSDUH Series H-56). Rockville, MD: Center for Behavioral Health Statistics and Quality

4
 Diagnosing Substance Misuse
and Substance Use Disorder 1
Substance misuse is use of a substance that is not
consistent with medical or legal guidelines.
In the DSM-5, the APA provides criteria for diagnosing a
substance use disorder (SUD). A person with problems
associated with habitual drug use is classified as having an SUD
based on symptoms ranging from mild to severe.

Severity determined by the number of criteria a person meets

(see next slide):
• Two to three criteria—mild disorder
• Four to five criteria—moderate disorder
• Six or more criteria—severe disorder

5
 DSM-5 Criteria for a Substance Use Disorder

Impaired control:
(1) Taking the substance in larger amounts or over a longer period than was originally
intended
(2) Expressing a persistent desire to cut down on or regulate substance use, but being
unable to do so
(3) Spending a great deal of time getting the substance, using the substance, or
recovering from its effects
(4) Craving or experiencing an intense desire or urge to use the substance
Social problems:
(5) Failing to fulfill major obligations at work, school, or home
(6) Continuing to use the substance despite having persistent or recurrent social or
interpersonal problems caused or worsened by the effects of its use
(7) Giving up or reducing important social, school, work, or recreational activities
because of substance use
Risky use:
(8) Using the substance in situations in which it is physically hazardous to do so
(9) Continuing to use the substance despite the knowledge of having persistent or
recurrent physical or psychological problems caused or worsened by substance use
Drug effects:
(10) Developing tolerance to the substance
(11) Experiencing withdrawal—physical and psychological symptoms that follow
the interrupted use of a drug that a person has become dependent on
6
 Diagnosing Substance Misuse
and Substance Use Disorder 2
The National Institute on Drug Abuse specifies that
more criteria, such as compulsive use, are required to
qualify for substance abuse and dependence.
Substance use disorder: a cluster of symptoms
involving cognitive, bodily, and social impairment
related to the continued use of a substance

7
 The Development of Substance Use
Disorder
Addiction often starts when a person does something
to bring pleasure or avoid pain:
• Reinforcement, tolerance, and withdrawal

Diverse factors must come together in a certain way

for SUD to develop:
• Personality, lifestyle, heredity, the social and physical
environment, and the nature of the substance or behavior
in question

8
 Behavioral Addictions
• Gambling disorder
• Gaming
• Compulsive exercising
• Work addiction
• Sex and pornography addiction
• Compulsive buying or shopping
• Internet addiction

9
 Why People Use and Misuse Drugs
Using drugs to alter consciousness is an ancient and
universal pursuit:
• People have used alcohol for celebration and intoxication for
thousands of years.

But many drugs have addictive properties and change

the chemistry of the brain; their use can open the
door to the problems of misuse and dependence.

10
 The Allure of Drugs
The main factors in the initial use of drugs are
availability and peer influence.
Reasons for using:
• To alter one’s mood
• To feel a euphoric high
• In pursuit of a spiritual experience
• To escape boredom, anxiety, depression, feelings of
worthlessness, or other distressing symptoms
• To cope with the difficulties of life
Beginning in March 2020, pandemic-related stress, isolation, and
job disruption likely elevated rates of drug misuse in the United
States.

11
 Table 8.2 Psychoactive Drugs and Their Potential for
Substance Use Disorder and Addiction

Very high Heroin

High Nicotine, morphine

Moderate/high Cocaine, pentobarbital

Moderate Alcohol, ephedra, Rohypnol

Moderate/low Caffeine, marijuana, MDMA (methylenedioxymethamphetamine),

nitrous oxide

Low/very low Ketamine, LSD (lysergic acid diethylamide), mescaline, psilocybin

SOURCE: Adapted from Gable, R. S. 2006. “Acute toxicity of drugs versus regulatory status.” Edited by J. M. Fish. Drugs and Society: U.S. Public Policy, 149–162. Lanham, MD: Rowman & Littlefield.

12
 Risk Factors for Drug Misuse
and Addiction 1
Drug misuse and addiction occur at all income and
educational levels, among all ethnic groups, and across
all age groups.
Factors associated with trying drugs:
• Male (males more likely than females)
• Troubled childhood
• Thrill-seeker
• Dysfunctional family
• Trouble at school
• Poor
• Adolescents engaged in risky sexual behavior

13
 Risk Factors for Drug Misuse
and Addiction 2
Factors associated with not using drugs:
• Perceiving drug use as risky, and disapproving of it
• Positive self-esteem and self-concept
• Assertive, independent thinkers able to resist peer pressure
• Self-control
• Social competence
• Optimism
• Academic achievement
• Religiosity
• Open communication with parents

14
 Risks Associated with Drug Misuse
Many emergency department visits are related to drug
misuse.
Serious concerns:
Intoxication
Unexpected side effects
Unknown drug constituents
Infection and injection drug use:
• HIV and hepatitis C
Legal consequences

15
Table 8.3 Estimated Drug-Related Emergency
Department (ED) Visits: 2017

NUMBER OF ED
REASON FOR ED VISIT VISITS*
Alcohol 1,284,000
Opioid 393,000
Cannabis 70,000
Sedative 43,000
Hallucinogen 15,000
Inhalant 3000
All drug poisonings 2,171,056

*Includes people who were treated and released or who died;

does not include people admitted to hospital.

SOURCE: Peterson, Cora, Mengyao Li , Likang Xu , Christina A Mikosz, and Feijun Luo. 2021. “Assessment of
annual cost of substance use disorder in US hospitals.” JAMA Network Open 4, no.3: e210242.

16
 How Drugs Affect the Body 1
Changes in brain chemistry:
• Once a psychoactive drug reaches the brain, it interferes with
the way neurons send, receive, and process signals sent by
neurotransmitters—a brain chemical that transmits nerve
impulses.
• Duration of a drug’s effect depends on many factors and may
range from 5 minutes to 12 or more hours.

17
 How Drugs Affect the Body 2
Physical factors:
• Body mass
• General health and genetics
• Concurrent use of other chemicals
• Pregnancy
Psychological factors:
The drug’s chemical properties seem to have the strongest effect on the
individual’s response:
• Placebo effect: when a person responds to an inert substance—as
in getting high—as if it were an active drug

Social factors—physical and social environment

18
 Groups of Psychoactive Drugs
Opioids
Central nervous system (CNS) depressants
Central nervous system stimulants
Marijuana and other cannabis products
Hallucinogens
Inhalants
Prescription drug misuse
New psychoactive substances

19
Figure 8.1 Commonly misused drugs and their effects 1

SOURCES: Indiana Department of Health. 2021. Signs and Symptoms of Drug Misuse
(https://www.in.gov/health/overdose-prevention/general-information/signs-and-symptoms-of-drug-misuse/).
20
Figure 8.1 Commonly misused drugs and their effects 2

SOURCES: Indiana Department of Health. 2021. Signs and Symptoms of Drug Misuse
(https://www.in.gov/health/overdose-prevention/general-information/signs-and-symptoms-of-drug-misuse/).
21
 Opioids
Opioids: natural or synthetic drugs that relieve pain,
cause drowsiness, and induce euphoria—an
exaggerated feeling of well-being
At prescribed doses, have beneficial medical uses:
• Can still lead to misuse and addiction

Tolerance can develop rapidly:

• Withdrawal symptoms include cramps, chills, sweating,
nausea, tremors, irritability, and feelings of panic.
The opioid epidemic in the United States claims the lives of
around 130 people each day.

22
 Figure 8.2

23
SOURCE: Centers for Disease Control and Prevention. 2021. “Understanding the Epidemic.” https://www.cdc.gov/drugoverdose/epidemic/index.html.
 Central Nervous System Depressants 1
Some definitions:
• Central nervous system (CNS): brain and spinal cord
• Depressant or tranquilizer, sedative-hypnotic: a drug that
decreases nervous or muscular activity, causing drowsiness or
sleep
• Sedation: the induction of a calm, relaxed, often sleepy state
Types: include alcohol, barbiturates, benzodiazepines, and
sedative-hypnotics
Effects: reduced anxiety, mood changes, impaired
muscular coordination, slurring of speech, drowsiness,
sleep, and effects on mental functioning

24
 Central Nervous System Depressants 2
From use to misuse: The CNS depressants are used for
their calming properties in combination with anesthetics
before operations and other medical or dental
procedures.
Most CNS depressants, including alcohol, can lead to
addiction.
Too much depression of the central nervous system
slows respiration and may stop it entirely.
Club drugs: Rohypnol and GHB

25
 Central Nervous System Stimulants 1
Stimulants speed up the activity of the nervous or muscular system.
Cocaine
Methods of use: snorted and absorbed through the nasal mucosa or
injected intravenously, with fast, intense effects.
Processing cocaine with baking soda and water yields the ready-to-
smoke form of cocaine known as crack.
Effects:
• Intense but short-lived effects.
• Euphoria ends abruptly with irritability, anxiety, or slight depression.
• Sudden death from excessive CNS stimulation.
• Persistent nose bleeds; paranoia and aggression.
• A woman who uses cocaine during pregnancy is at higher risk for
miscarriage, premature labor, and stillbirth.

26
 Central Nervous System Stimulants 2
Amphetamines:
Potent, synthetic CNS stimulants
Small doses make people feel more alert:
• Sometimes used to curb appetite
Misuse and addiction:
• Often starts as an attempt to cope with a temporary situation
Repeated use can lead to severe disturbances in behavior and
psychosis, with delusions of persecution and episodes of unprovoked
violence.
Methamphetamine is more addictive than other forms.
Women who use amphetamines during pregnancy risk premature birth,
stillbirth, low birth weight, and early infant death.

27
 Central Nervous System Stimulants 3
Prescription stimulants—used to treat ADHD
Caffeine:
• Very popular psychoactive drug, and one of the most ancient
• Rarely harmful, but withdrawal symptoms can develop

28
 Marijuana and Other Cannabis Products 1
Marijuana is the most widely used federally illegal drug
in the United States:
• Since the new laws took effect, general marijuana use among
twelfth graders has remained steady, although the number of
students vaping it has risen.
• THC (tetrahydrocannabinol) is the main active ingredient.
Short-term effects and uses are influenced by the
person’s expectations and experiences and by the dose:
• Low doses often produce euphoria and relaxation.
• Effects of moderate dose can include feelings of
depersonalization—mind seems to be separated from the
body.

29
 Marijuana and Other Cannabis Products 2
Long-term effects:
• Respiratory damage from smoking marijuana
• Impaired lung function and chronic bronchial irritation
• Learning, attention, and memory problems with heavy use
• May affect sperm productivity and quantity

Use during pregnancy may affect neural development

in the fetus:
• THC in breast milk may impair an infant’s early motor
development.

30
 Hallucinogens 1
Hallucinogens: a group of drugs that alter perceptions,
feelings, and thoughts
LSD:
• Synesthesia: feelings of depersonalization and other
alterations in the perceived relationship between the self and
external reality.
• Many effects involve an altered state of consciousness.
• Panic reactions and flashbacks can result.

31
 Hallucinogens 2
MDMA:
• Variants: Ecstasy and Molly.
• May be classified as a hallucinogen or a stimulant.
• Even low doses can affect concentration, judgment, and
driving ability.

Other hallucinogens:
• PCP
• Ketamine
• Certain mushrooms

32
 Inhalants
Inhaling certain chemicals can produce effects ranging from
heightened pleasure to delirium and death. Inhalants fall into
several major groups:
• Volatile solvents
• Aerosols
• Nitrites
• Anesthetics
Use tends to be highest among younger adolescents and
declines with age.
Inhalant use is difficult to control because inhalants are easy to
obtain.
Suffocation is among the many risks.

33
 Prescription Drug Misuse
Prescription drug misuse is described as the use of
medication without a prescription, in a way other than
as prescribed, or to feel euphoria.
Misuse has increased:
• Misused at a rate second only to marijuana, tobacco, and
alcohol.
• In 2020, over 16,000 people died from drug overdoses
involving prescription opioids.

34
 New Psychoactive Substances
Herbal or synthetic recreational drugs have become
increasingly available.
Two main groups:
Synthetic marijuana (“herbal incense” or “herbal highs”):
• Produces effects similar to THC
Stimulants sold as “bath salts”:
• Produce severe effects, from violent behavior, extreme
agitation, confusion, hallucinations, hypertension, chest pain to
suicidal thoughts.

35
 Preventing Drug-Related Problems 1
Drugs, society, and families:
• Economic cost is staggering.
• Drug possession, sale, and use is a crime.
• Alcohol and prescription and illicit drug use leads to hundreds
of thousands of emergency department admissions and nearly
188,000 deaths each annually.
• Children born to women who use drugs such as alcohol,
tobacco, or cocaine may have long-term health problems.

36
 Preventing Drug-Related Problems 2
Legalizing drugs:
• Because many social problems associated with drugs are
related to prohibition, some people argue for forms of drug
legalization or decriminalization.

37
 Preventing Drug-Related Problems 3
Treating drug addiction:
Treatment for addiction should assess for other mental
disorders as well as infectious disease.
Medication-assisted treatment
Treatment centers
Groups and peer counseling:
• Alcoholics Anonymous (AA) and Narcotics Anonymous (NA)

38
 Preventing Drug-Related Problems 4
Harm reduction strategies: Harm reduction strategies aim to
minimize the negative effects of drug use and misuse:
• Syringe exchange programs
• Safe injection facilities
• Provision of easy-to-use forms of naloxone, a drug that rapidly reverses
opioid overdose
• Free testing of street drugs

How family and friends cope: Codependency, in which a person

close to someone with an SUD is controlled by their behavior,
sometimes develops.

Many treatment programs involve the whole family.

39
 Preventing Drug Misuse
Governmental attempts have historically focused on
stopping production, importation, and distribution.
Antidrug education programs may offer the best hope.
Indirect approaches: building young people’s self-
esteem, improving academic skills, and increasing
recreational opportunities
Direct approaches: providing information about
adverse effects and helping students resist peer
pressure

40
 Review
• Define and discuss addiction.
• Explain factors that contribute to drug use and misuse
and addiction.
• List risks associated with drug misuse.
• Understand how drugs affect the body.
• List and describe the effects of the six major groups of
psychoactive drugs.
• Outline ways to prevent drug-related problems.
https://hubermanlab.com/
https://www.tarabrach.com/healing-addiction/
41