8 substances of abuse Flashcards
What are current numbers of substance abuse (2019)?
2019 - estimated 35 million ppl suffer from drug use disorder (with psychoactive substances other than nicotine and alcohol)
107 million people have alcohol use disorder
what are the different types of drinkers that exist?
light-to moderate drinkers
binge drinkers
heavy drinkers
problem drinkers (half are alcoholics)
What harm does alcohol cause as a public health agenda?
- dependence
-> social, economic burden - 200 disease and injury conditions
cancer, tuberculosis, HIV/AIDS
What is alcohol-related harm determined by?
the volume of alcohol consumed, the pattern of drinking, and, on rare occasions, the quality of alcohol consumed.
Environmental factors such as economic development, culture, availability of alcohol and the level and effectiveness of alcohol policies are relevant factors in explaining differences and historical trends in alcohol consumption and related harm.
What are some statistics about alcohol consumption (2010)?
6.2l pure alcohol pP pD
quarter is unrecorded (homemade, illegally produced, …)
60% of 15+ population had not drunk alcohol in the past 12months
female are more often lifetime abstainers
considerable variance in abstention across regions
economic wealth -> more consumption
16% of 15+ engage in heavy episodic drinking
What are some health consequences of alcohol consumption?
2012
3.3mio deaths (6% of all deaths)
more males die
DALYs
5.1% of gobal burden of disease
How can alcohol use harm other individuals?
injury
neglect or abuse
default on social role
property damage
toxic effects (fetal alcohol syndrome)
loss of amenity or peace of mind
What are risk factors for alcohol dependency?
- genetics
- neurobiological factors
- psychological
.- environmental - social and cultural
- age and onset
- gender
- mental health disorders
- stressful life events
What is the problem of cigarette smoking?
cigarettes release 5000 different chemicals when they burn
carbon monoxide (in smoke) → physiological functioning
nicotine → addicitve, physiological effects
poisonous, at least 70 can cause cancer
What effects does smoking have on health?
- respiratory system
- pulmonary diseases
emphysema
chronic bronchitis - respiratory infections
- pulmonary diseases
- impairment of immune functions
- cancer (lung cancer)
mouth, oesophagus, kidney, bladder - pregnancy impairment
premature birth
miscarriages
perinatal deaths
risk of complications in general - higher risk for diabetes and obesity if mother smoked
- coronary heart disease (double the risk)
- aggravated by stress
- interplay between smoking and major risk factors for CHD physical inactivity, drinking
What are motives for smoking?
external, rather than by the substance itself
social validation, social influence
stress relief, boredom relief, enjoyment
improve concentration, stay alert, reduce withdrawal
=> first social desire, then physical addiction
What are different substances you can get addicted to?
- alcohol use disorders
- opiods
- cocaine and crack
- cannabis
- amphetamines etc
- sedative-hypnotics
- hallucinogens
- PCP/designer drugs/MDMA
- inhalants
- nicotine
- caffeine
- anabolic-androgenic steroids
What is cannabis?
psychoactive substances derived from plant cannabis sativa
used to alter consciousness or physical state
delta-9-tetrahydrocannabiol (THC)
marijuana + hashish
weed, pot, skunk, boom, gangster, kif, ganja
most widely used illegal substance in US
What is the history of cannabis use?
chinese culture - 4000-5000 years ago
was grown for its fiber (hemp)
clothing, paper, rope
medicine all over + spiritual properties
“holy” plant
Why is cannabis so disputed today?
- lack of consensus of legal status
(a) lax attitudes toward use of cannabis increasing the probability of use and misuse;
(b) reluctance of the public, scientists, and intervention specialists to consider cannabis a significant drug of abuse which may impede treatment seeking and the allocation of resources for development of effective treatment services;
(c) overly severe penal consequences for possession and use of cannabis; and
(d) the delay of science directed toward exploration of the potential of cannabis and/or its active compounds for treatment of physical and psychiatric disorders
What is the epidemiology of cannabis use?
more likely in males
multiracial ethic groups have highest prevalence
Interestingly, rates of past-year and -month use among 18to 25-year-old African Americans are lower than those of Whites, but among those 26 years and older rates are higher among African Americans, accounting for the overall disparity in use
lifetime cannabis dependence of 1 to 4%
conditional dependence = cannabis is less likely to lead to actual dependence (after continuous usage) than other illicit drugs
increase in prevalence over past years
increase in treatment admissions for CUD
What are cannabis withdrawal signs and symptoms?
- irritability or anger
- nervousness or anxiety
- sleep difficulty - disturbing dreams
- decreased appetite, weight loss
- restlessness
- depressed mood
- physical discomfort and symptoms
What does long-term cannabis use do to the brain?
impairs attention, memory, and complex cognitive abilities such as problem solving and mental flexibility
altered brain function in the prefrontal cortex, cerebellum, and hippocampus
greater propensity for risky decision making
=> but reversed following extended abstinence
What is the pharmacology behind cannabis use?
cannabinoids
90 have been identified
THC is primary component
What is the neurobiology of cannabis?
endogenous cannabinoud receptor system
two receptor subtypes and five endogenuous ligands have been identified
mediated by activation of CB1 receptor by THC
The CB1 receptor is a presynaptic G protein-coupled receptor, activation of which inhibits adenylyl cyclase and voltage-dependent Ca 2+ channels, and activates K + channels and MAP kinase. The CB1 receptor is abundant throughout the CNS, but is expressed in the brain at the highest concentrations in the basal ganglia (reward, learning, motor control), cerebellum (sensorimotor coordination), hippocampus (memory), and cortex (planning, inhibition, higher order cognition).
THC enhanves dopamine firing in reward pathway
enhances electrical brainstimulation
What genetic factors contribute to cannabis use?
heritable factors contribute between 30% and 80% to the development of CUDs
common genetic and environmental influences between cannabis and other types of drug dependence
common genetic basis for adolescent substance abuse and conduct problems
What environmental risk factors exist for cannabis use?
- availability of the substance
- policies
- use of other illicit drugs
- use of cannabis by close peer network
- use of cannabis by family member, immediate social environment
- delinquency
- abusive home
- low SES
- psychopathology
What are effective treatments for cannabis dependence?
adults:
- CBT
- motivational enhancement therapy
- contingency management
adolescents:
- CBT
- MET
- contingency management
- family therapy (functional, behaviour, brief strategic, multidimensional)
- multisystemic therapy
- community reinforcement approach
- assertive continuing care
What are commorbidity rates of cannabis use?
studies indicate that individuals with past-year or lifetime CUD diagnoses have high rates of alcohol abuse (18%), alcohol dependence (40%), and nicotine dependence (53%)
who reported cannabis to be their primary drug of concern, 74% reported problematic use of a secondary or tertiary substance: alcohol (40%), cocaine (12%), methamphetamine (6%), and heroin or other opiates (2%) (10). Among those younger than 18 years, 61% reported problematic use of a secondary substance: alcohol (48%), cocaine (4%), methamphetamine (2%), and heroin or other opiates (2%).
⇒ gateway drug
Major Depressive Disorder (11%), any anxiety disorder (24%), and Bipolar I disorder (13%) appear to be the most prevalent DSMIV Axis I disorders, and Antisocial (30%), Obsessive Compulsive (19%), and Paranoid (18%) are the most prevalent Axis II personality disorders among those with a past-year diagnosis of a CUD.
⇒ common explanation: self-medication, symptom coping
What are harms of opioid and cocaine use?
- Heroin as the first opioid of abuse has grown significantly in the past decade.
- Heroin as an initiating opioid now exceeds hydrocodone and oxycodone.
- Such increases among inexperienced opioid users could lead to increased risk of overdose.
=> increase from 9% to 34% in 10 years (2005-2015)
=> very limited tolerance, dosing imprecision contributes to this
and fatalities
How are women´s health and crack cocaine use related?
the context of health care
the context of smoking
historical trauma
everyday violence, poverty, inequalities
pain and PTSD
oral health and trauma
issues of addictive drug use practices might be overshadowing pressing health concerns
poverty and lack of income control are risk factors for abuse in relationships with men
what latest data about the drug market in the EU is available?
- innovation in drug production and trafficking has resulted in the higher
availability of both plant-based and synthetic drugs across the EU - consumers now have access to a wider variety of high-purity and highpotency products that are both more accessible and, in real terms, cheaper than they have been in the past;
- Europe is now a major producer of cannabis and synthetic drugs for the EU market and also a global supplier of MDMA;
- the drug market is becoming ever more globally linked and digitally
enabled with consumers increasingly able to access drugs through the surface web and darknet and social media applications; - production within Europe and changing business models of OCGs
are increasing competition and leading to increased violence and
corruption within Europe.
What can be said about synthetic drugs in the EU?
- global production and supply of MDMA
- manufactured from precursors
chemicals sourced from outside EU - netherlands, belgium
- methamphetamine -> Czechia
- dutch OCGs
criminals from turkish origin
heroin in exchange with synthetic drugs - darknet market offers
