Conventional medicine, environmental health, Alcohol use, drug use Flashcards

Question

Reiki

Answer 1

A CAM practice intended to correct disturbances in the flow of life energy and improve the body’s healing powers through the use of 13 hand positions on the patient.

Answer 2

A CAM practice based on the premise that healers can identify and correct energy imbalances by passing their hands over the patient’s body.

Answer 3

The traditional medical system of China, which views illness as the result of a disturbance in the flow of qi, the life force; therapies include acupuncture, herbal medicine, and massage.

Answer 4

* Self-care saves money and keeps the health-care system from being overwhelmed. * Most medical symptoms are self diagnosed in self treated * Effectively managing one’s medical problems requires developing several skills, including the ability to observe your own body, to know what you can and cannot treat, and to know how to safely treat yourself for common medical problems. * Everyone should develop a partnership with physicians and other health-care providers. * Informed self-care requires knowing how to evaluate symptoms. * A physician should be consulted for symptoms that are: * Severe * Unusual * Persistent * Recurrent

Answer 5

Symptoms are often an expression of the body’s attempt to heal itself Carefully observing symptoms lets you identify those signals that suggest you need professional assistance * Self-assessment means knowing what is normal for your body and being able to detect the occurrences that are unusual. * Understanding what a symptom means and what is happening in your body helps reduce anxiety and enables you to practice self-care. * Medical self-tests help users make decisions about self-treating and seeking medical care.

Answer 6

Major trauma or injury such as head injury, broken bone, deep wound, severe burn, eye injury, or animal bite Uncontrollable bleeding or internal bleeding Intolerable and uncontrollable pain Severe shortness of breath Persistent abdominal pain, especially with nausea and vomiting Poisoning or drug overdose Loss of consciousness or seizure Stupor, drowsiness, or disorientation Severe or worsening reaction to an insect bite or sting or to a medication, especially if breathing is difficult.

Answer 7

Health literacy refers to the skills to enable access, understanding and use of information for health Three vulnerable populations when it comes to health literacy are seniors, immigrants, and the unemployed

Answer 8

Self-treatment is based on intelligent consideration of symptoms and knowledge of appropriate measures. Patience and careful self-observation of symptoms is often the best course of treatment. Many ailments improve after only symptomatic treatment and without using drugs. Nondrug options such as adequate rest, increased exercise, changes in diet, and stress-management techniques may prevent or relieve many common health problems. Over-the-counter (OTC) medications are medications or products that can be purchased by the consumer without a prescription OTC drugs can be effective, but some are unnecessary or divert attention from better ways of coping • If one chooses self-medication, many over-the-counter (OTC) preparations will relieve minor symptoms and sometimes cure illness. • Some drugs that were once available only by prescription are now available over the counter. Increased choices in OTC drugs also increase each person’s responsibility to use self-treatment wisely and be aware of risks and side effects of each drug.

Answer 9

* Safe and effective treatment with OTC or prescription drugs requires following certain guidelines: * Always read labels and follow directions carefully. If you have any questions, ask a pharmacist or another qualified health care provider. * Do not exceed recommended dosages. * Use caution when taking other medications or supplements at the same time. OTC drugs and herbal supplements can interact with some prescription drugs. * Medications with one active ingredient are preferable to combination products that may contain more chemicals than you need. * Know the key ingredients of medications and buy generic drugs when possible. Generics contain the same active ingredients as brand-name drugs but cost much less. * Do not take drugs from an unlabeled container or in the dark when you cannot read the label. * Women who are pregnant or nursing and people who have a chronic disease should consult a physician before self-medicating. * Check expiration dates on all medications. The expiration date is an estimate of how long the medication is likely to be safe and effective. The safest ways to dispose of outdated medication is to take it to a pharmacy or hospital. * Store medication in a cool, dry place, away from the reach of children. * Take special caution with aspirin. Because of the risk of Reye’s syndrome, aspirin should not be given to children or adolescents who have any viral illness.

Answer 10

Therapies or practices that are not part of conventional or mainstream health care and medical practice as taught in most Canadian medical schools and available at most Canadian health-care facilities Examples are acupuncture and herbal remedies • When self-treatment if not appropriate or sufficient, you need to seek professional medical care, whether by going to a hospital emergency room, by scheduling an appointment with your physician or by accessing some other conventional health care. These systems contain a broad network of professionals and organizations, including independent practitioners, health care providers, hospitals, clinics, and public and private insurance programs. * In recent years, many Canadians have also sought health care from practitioners of complementary and alternative medicine (CAM), defined as those therapies and practices that do not form part of conventional, or mainstream, healthcare and medical practices as taught in most Canadian medical schools and offered in most Canadian hospitals. * CAM connotes a concept of ‘along with’ rather than ‘instead of’ when paired with conventional or allopathic medicine. Traditional medicine focuses on integration of mind, body, and spirit and on ways to restore harmony to the whole person, so health can be regained. * Anecdotal and testimonial evidence is common. * There is still very little evidence obtained by scientific methods supporting the effectiveness and safety of many types of CAM. One should use caution. CAM practices are grouped into five domains: alternative medical systems, mind-body interventions, biological-based therapies, manipulative and body-based methods, and energy therapies.

Answer 11

• Through the Natural Health Products Directorate, Health Canada ensures that all Canadians have ready access to natural health products that are safe, effective, and of high quality, while respecting the freedom of choice and philosophical and cultural diversity. • Products requiring prescriptions are regulated by the Canadian Food and Drug Regulators. Reasons vary, but users may turn to CAM to: Boost immune system Lower cholesterol levels Lose weight Quit smoking Enhance memory Despite growing in popularity, many CAM practices remain controversial About 71% of Canadians regularly take natural health products (NHP) such as vitamins and minerals, herbal remedies, homeopathic medicines, traditional medicines, probiotics, and amino acids and essential fatty acids

Answer 12

The practice of health-care in which the practitioner systematically finds, appraises, and uses the most current and valid research findings as the basis for health-related decisions When research studies are published, health professionals can publicize the findings, which often prompts further research to replicate and confirm the findings, challenge the conclusions, or pursue a related experiment.

Answer 13

• Western medicine identifies the causes of disease as pathogens, such as bacteria and viruses, genetic factors, and unhealthy lifestyles that result in changes at the molecular and cellular levels • The concept that every disease is defined by a certain set of symptoms and that those symptoms are similar in most patients suffering from the disease is also a basis of Western medicine • The effort to control pathogens brought about public health measures, such as chlorination of drinking water, sewage disposal, food safety regulations, vaccination programs, and education about hygiene that are responsible for increased life expectancy of Canadians. • The use of pharmaceuticals (prescription drugs and over-the-counter medications) is closely identified with Western medicine, as is a reliance on surgery and advanced medical technology. • Western medicine is based on the scientific method of obtaining knowledge and explaining health-related phenomena. Scientific explanations have these characteristics: empirical, rational, testable, parsimonious, general, rigorously evaluated, and tentative. • Using the scientific method means approaching a problem by carefully defining its parameters, seeking relevant information, and subjecting proposed solutions to rigorous testing • This method is translated into practice through a highly refined approach to exploring the causes of disease and ensuring the safety and efficacy of treatment. • Research ranges from case studies describing a single patient’s illness and treatment to randomized controlled trials. • Drug development is equally rigorous. After testing, and if the drug is approved by Health Canada, the drug’s effects are monitored even after it is on the market. This process can take 12 years or more and only 20% of drugs are eventually approved for marketing. A system of medicine based on the application of the scientific method Diseases are thought to be caused by identifiable physical factor and characterized by a representative set of symptoms Also called biomedicine or standard Western medicine Pharmaceuticals (medical drugs, both prescription and over-the-counter) Surgery and advanced medical technology Scientific method to obtain knowledge and explain health-related phenomena

Answer 14

Empirical Rational Testable Parsimonious General Rigorously evaluated Tentative

Answer 15

* Since 1962, Canada has a government-funded national healthcare system founded on five basic principles of the Canada health Act. * Universally available to permanent residents and citizens * Comprehensive in the services it covers * Accessible without income barriers * portable within and outside the country * Publicly administered

Answer 16

``` • Canada’s provinces and territories are responsible for administering their own healthcare plans and must provide residents with prepaid coverage for all medically necessary hospital and physician services. Providers of conventional medicine include a variety of health-care professionals. Medical doctors, osteopaths, podiatrists, optometrists, and dentists are permitted to practice independently. • Several kinds of Conventional Medicine are practiced by a wide range of health care professionals in Canada, including medical doctors, osteopaths, podiatrists, optometrists, and dentists are permitted to practice independently. • The various healthcare professionals in Canada are: • Registered nurses and registered psychiatric nurses. • Licensed practical nurses • Medical laboratory technologists • medical laboratory technicians • respiratory therapists • Medical radiation technologists • Medical sonographers • Audiologists/speech-language pathologists • Physiotherapists • Occupational therapists • Dentists • Dental hygienists and therapists • Dental assistants • Ergonomists • Pharmacists • Physicians • Optometrists Medical doctors (MD) Doctors of osteopathic medicine (DO) Podiatrists (DPM) Optometrists (OD) Dentists (DDS) Allied health care providers who provide services under the supervision or control of independent practitioners (e.g., registered nurses, physical therapists, social workers) ```

Answer 17

* Medical doctors hold a Doctor of Medicine (MD) degree from one of 17 accredited Canadian medical schools. * Education has four stages: 3-4 years of premedical education, with emphasis on the sciences; 3-4 years of medical school, which teaches basic medical skills and awards the MD degree; a residency lasting from 2 to 5 years, during which a specialty is studied, and a medical license is obtained; and continuing medical education. * Doctor of Osteopathic Medicine (DO) receive a medical education like that of medical doctors, but training emphasizes musculoskeletal problems and manipulative therapy. * Podiatrists specialize in the medical and surgical care of the feet. They can prescribe drugs and do minor surgery in their offices. * Optometrists are trained to examine the eyes, detect eye diseases, and treat vision problems. All states permit them to prescribe drugs in only seven jurisdictions nationally and prescribe drugs for diagnostic purposes and most permit them to use drugs to treat minor eye problems. * Dentists specialize in the care of the teeth and mouth. They can perform surgery and prescribe drugs within the scope of their training. * Other trained health-care professionals, known as allied health-care providers, include registered nurses (RNs), licensed vocational nurses (LVNs), physical therapists, social workers, registered dietitians (RDs), and physician assistants (PAs).

Answer 18

Begin making a list of possible choices Check insurance limits Ask for recommendations Once you have a list of physicians, call their office and find out some information • Choosing a primary care physician requires careful consideration. * A primary care physician treats and coordinates referrals to specialists when needed. Primary care physicians include those certified in family practice, internal medicine, pediatrics, and obstetrics-gynecology. * At all ages it is important for men and women to obtain recommended health care screenings and immunizations. Preventive care throughout life is important to maximize wellness. * Ask for recommendations from family, friends, coworkers, local medical societies, and the physician referral service at a local clinic or hospital. * When you have a list of possible physicians, learn whether a consumer group or other independent group has rated doctors in your area.

Answer 19

Is the physician accepting new patients? What are the office hours? Which hospitals does the physician use? How many other physicians are available to cover when unavailable? How long does it usually take to get an appointment? Does the office send reminders Does the physician give advice over the phone?

Answer 20

• Getting the most from the medical health-care system requires good communication between patient and physician. • A successful physician-patient partnership requires good communication. Patients should be assertive but not aggressive and be persistent if questions are not answered adequately. You should consider changing physicians if you and your physician cannot establish a healthy partnership. • You should prepare for a visit to the physician by: • Making a written list of concerns, questions, and notes about your symptoms. • Bringing a list of all medications (prescription, non-prescription, and herbal) you are taking and medical records or tests your physician may not have already. • Guidelines to follow during the visit include: • The first step in the diagnostic proves is the medical history, which includes your primary reason for the visit, your current symptoms, your past medical history and your social history. • The next step is the physical exam, which usually begins with a review of vital signs: blood pressure, heart rate/pulse, breathing rate, and temperature. • In addition, the physician may order medical tests to complete the diagnosis. Physicians can order X-rays, biopsies, blood and urine tests, scans and endoscopies to view, probe or analyze almost any part of the body. • At the end of your visit, briefly repeat the physician’s diagnosis, prognosis, and instructions. Be sure you understand your next steps, such as making another appointment, phoning for test results, and watching for new symptoms. • Approximately 300 million prescriptions are filled in Canada each year, or about 14 prescriptions for each man, woman and child. Health Canada notes that drug use among seniors is notably higher compared to the rest of the population. • Medication errors: Physicians may over-prescribe drugs, sometimes in response to pressure by patients. Adverse effects can occur if a physician prescribes the wrong drug or a dangerous combination of drugs. • Off-label drug use: Another potential problem is off-label drug use. Once a drug is approved, by Health Canada for one purpose, it can legally be prescribed for purposes not listed on the label. • Online pharmacies: Although convenient, some online pharmacies may sell products or engage in practices that are illegal in the offline world, putting consumers at risk of receiving adulterated, expired, ineffective, or counterfeit drugs. • Costs: International Marketing Services (IMS) Health estimates that Canadians spent $21.4 billion on prescription medications in 2008. Consumers may be able to lower their drug costs by using generic versions of medications. The physician-patient partnership Your appointment with your physician The diagnostic process Medical and surgical treatments

Answer 21

Are there nondrug alternatives? What is the name of the medication, and what is it supposed to do, within what period of time? How and when do I take the medication, how much, and for how long? What if I miss a dose? What other medications, foods, drinks, or activities should I avoid? What are the side effects, and what do I do if they occur? Can I take a generic drug rather than a brand-name one? Is there written information about the medication?

Answer 22

Who runs this site? Who pays for this site? What is the purpose of this site? Where does this information come from? What is the basis of the information? How is the information selected? How current is the information? How does the site choose links to other sites? What information about you does this site collect and why? How does the site mange its interactions with visitors?

Answer 23

Why do I need surgery? Are any nonsurgical options available? What are the risks? Can the operation be performed on an outpatient basis? What can I expect before, during, and after surgery? • Surgery: The overall number of surgeries being performed in Canadian hospitals has increased by 17% between 1995-1996 to 2005-2006, and by another 5% over 2007 according to Canadian Institute for Health Information. • This indicates that the number of surgeries performed has increased, hence one should be careful prior to electing surgery and ensure that it is absolutely required.

Answer 24

Health systems are responsible for delivering services that improve, maintain or restore the health of individuals and their communities. This includes the care provided by hospitals and family doctors, but also less visible tasks such as the prevention and control of communicable disease, health promotion, health workforce planning and improving the social, economic or environmental conditions in which people live. -Tax funded model -Employment based insurance model -National health insurance model CANADA -Private insurance model USA -Out of pocket model people in the states without insurance

Answer 25

Evidence exists that investing in public health and primary prevention delivers significant health and economic dividends Reform towards health systems that are more resilient and better centred around what people need

Answer 26

* There are a variety of alternative medical systems. * Many cultures have complete systems of medical philosophy, theory, and practice long before the current biomedical approach was developed. The western allopathic medicine is only about 150 years old, while the Indian Ayurvedic system has been around for thousands of years. The complementary system that are best known in North America are probably the traditional Chinese medicine (TCM), chiropractic, naturopathy and homeopathy. * Alternative medical systems have common concepts, such as the concept of life force or energy. * Most traditional medical systems think of disease as a disturbance or imbalance, not just of a physical process but also of forces and energies within the body, the mind, and the spirit. * Treatment aims to re-establish equilibrium, balance, and harmony. * Because the whole patient is treated, rather than an isolated set of symptoms, a variety of treatments are used and adjusted according to the changes in the patient’s health status.

Answer 27

* Traditional Chinese medicine is based on abstract concepts; a set of techniques and methods; and individualized diagnosis, treatment, and prevention. * No identical disease exists in any two patients in TCM. Two patients with the same symptoms receive different treatments. * The free and harmonious flow of life force, or “qi,” produces health. Illness occurs when the flow of qi is blocked or disturbed; therefore, the treatment is to restore and balance the flow of qi.

Answer 28

* Acupuncture works to correct disturbances in the flow of qi, which is believed to flow through the body along several meridians. One corrects disturbances by inserting long, thin needles at certain points in the skin and then manipulating the needles. * A National Institutes of Health (NIH) consensus statement has found clear evidence that acupuncture was effective in cases of nausea and vomiting after chemotherapy and pain after surgery. Newer studies show that acupuncture may help relieve the painful symptoms of fibromyalgia and reduce joint pain and stiffness of osteoarthritis. There is not enough evidence to show that acupuncture is effective in treating menstrual cramps, asthma, tennis elbow, carpal tunnel syndrome, or certain other conditions. • Very few negative side effects have been reported in conjunction with acupuncture, but problems can result from improper insertion and manipulation of needles and from the use of unsterile needles. The insertion of thin needles into the skin at points along meridians, pathways through which qi is believed to flow The most common treatments in TCM are herbal remedies and acupuncture. Herbal remedies have yin and yang properties. Remedies with yin characteristics are used for treatment when disease is perceived to be due to a yang deficiency, and vice versa. Several different plants are combined in precise proportions, often to make a tea or soup. Most provinces in Canada regulate licensing for acupuncture practitioners, but requirements vary widely.

Answer 29

* Homeopathy is a medical system of Western origin that is based on two principles: “like cures like” and remedies become more effective with greater dilution. * “Like cures like” summarizes a concept that a substance that produces symptoms of an illness in a healthy person can cure the illness when given in small quantities. * Remedies containing small quantities of a substance are obtained by * repeatedly diluting the original solution. * Even with many scientific experiments supporting homeopathy as being compatible with biomedical observations, homeopathy remains one of the most controversial forms of CAM. * Regulators have not found any serious adverse events associated with homeopathy. • In Canada homeopathic medicine is within provincial jurisdiction, while the regulation of homeopathic medicine is federal in jurisdiction. The medicines are regulated under the Natural Health Products Regulations, 2004. Homeopathy is an alternative medical system that treats illnesses by giving very small doses of drugs that in larger doses would produce symptoms like those of the illness More than 1,000 substances can be used to prepare homeopathic remedies that are thought to have different effects at different dilutions. The treatment is determined by the overall condition of the patient rather than by specific signs and symptoms. In Canada, the practice of homeopathic medicine is within provincial and territorial jurisdiction while the regulation of homeopathic medicines is federal

Answer 30

Makes use of the integral connection between mind and body and the effect each can have on the other. Meditation Yoga Visualization Taijiquan – Read this article and the abstract of this article. Biofeedback Hypnosis • Mind-body interventions make an integral connection between mind and body and the effect each can have on the other. • They include many stress-management techniques, such as meditation, yoga, visualization, t’ai chi ch’uan, and biofeedback. • The placebo effect is one of the most widely known examples of mind-body interdependence. • Some forms of hypnosis are considered CAM therapies. • Hypnosis is the practice of inducing a state of deep relaxation during which a patient is easily influenced. • Practitioners try to help patients change an unwanted behavior or deal with pain or other symptoms during the hypnotic state. It is used for smoking cessation programs, for anxiety disorders, and for pain control for chronic conditions. It has been shown to help some women deal with the pain of childbirth with less medication. • It can be practiced by MDs, DOs, DDSs, and hypnotherapists. Physicians are licensed by their own associations; however, hypnotherapy is not an insured physician service in Canada.

Answer 31

* Biological-based therapies include substances derived from plant or animal origin. They consist primarily of herbal remedies, botanicals, extracts from animal tissues (such as shark cartilage) and dietary supplements. * Herbal remedies include a variety of compounds other than just herbs, such as botanicals, algae, bacteria, fungi, and minerals. They are a major component of many forms of medicine and are a common element of most systems of traditional medicine. * A variety of botanical products are sold as dietary supplements in the form of tablets, pills, liquid extracts, and teas. * Like foods, dietary supplements must carry ingredient labels, and manufacturers must ensure that they are safe and properly labeled. * Extract from animal tissues * The Natural Health Products Directorate branch of Health Canada regulates these products. * Well-designed clinical studies have been performed on only a small number of biologically-based therapies. Participants in clinical trials with St. John’s wort, ginkgo, and echinacea experienced only minor adverse events. * Most clinical trials lasted only a few weeks, so these tests do not indicate the safety of botanical consumption over a long period of time. * Studies also do not examine the effects of different dosages or how these therapies interact with conventional drugs. * Although most drug-herb interactions are relatively minor compared to conventional drug-drug interactions, some can be potentially serious. An example is concurrent herb use that has anticoagulant properties, such as ginkgo biloba, with the commonly prescribed anticoagulant Coumadin. * Studies show that most people do not reveal their use of CAM therapies to their conventional health care providers which can have severe health consequences.

Answer 32

* Manipulative and body-based methods are long-standing forms of health care. * Manual healing techniques are based on the idea that misalignment or dysfunction in one part of the body can cause pain or dysfunction in another part. Realignment can return the body to optimal health. * This is an integral part of physical therapy and osteopathic medicine. * Massage, acupressure, Feldenkrais, and Rolfing are some of the other physical healing methods. * The most commonly used CAM healing method is chiropractic. * This method focuses on the relationship between structure, primarily of joints and muscles; and function, primarily of the nervous system, to maintain and restore health. * An important procedure is the manipulation of joints, particularly those of the spinal column. Other techniques that chiropractors use include exercise, patient education, lifestyle modification, nutritional supplements, and orthotics. They do not use conventional drugs or surgery. * Chiropractors are trained for a minimum of four academic years at accredited chiropractic colleges and can complete postgraduate training in many countries. * Chiropractic care is accepted by health-care and insurance providers to a far greater extent than other CAM therapies. * Spinal manipulation is included in the federal guideline for the treatment of low back pain. In fact, electro-diagnostic tests show that chiropractic is effective in controlling back pain. Treatment also has shown promising results in treating neck pain and headaches.

Answer 33

* Energy therapies are based on the idea that energy fields surround and penetrate the body and can be affected by movement, touch, pressure, or the placement of hands in or through the energy fields. It uses energy originating either within the body, Biofield, or from other sources, electromagnetic fields. * Reiki * Qigong, a component of TCM, combines movement, meditation, and regulation of breathing to improve qi, blood circulation, and immune function. * Therapeutic touch is based on the premise that healers can identify and correct energy imbalances by passing hands over the patient’s body. Reiki is one form of healing touch. * Bioelectromagnetics is the study of the interaction between living organisms and electromagnetic fields produced by the organism itself and outside sources. * The recognition that the body produces electromagnetic fields has led to the development of many diagnostic procedures in Western medicine, such as electroencephalography (EEG), electrocardiography (ECG), and nuclear magnetic resonance (NMR) scans. * Bioelectromagnetic-based therapies involve the use of electromagnetic fields to manage pain and to treat conditions such as asthma. * Although these therapies are promising, the available research is insufficient to make firm conclusions about the efficacy of such treatments.

Answer 34

* It is important to carefully evaluate complementary and alternative therapies before choosing treatment. * Your first source of information should be your physician or primary health-care provider for an evaluation and diagnosis of symptoms. * Discuss and try conventional treatments that are known to be helpful for your condition. * Inform your physician if you are thinking of trying a CAM therapy to avoid dangerous interactions with conventional treatments. * Discuss the following issues related to CAM therapies with your physician or pharmacist: safety, effectiveness, timing, cost, and whether the immediate use of conventional treatment is necessary. * Your physician should take you and your concerns seriously, respect your interest in CAM therapy, be informed about CAM approaches or at least try to learn about them, and be willing to discuss the evidence for and against them with you * If appropriate, schedule a follow-up visit with your physician to assess your condition and progress after using CAM for a certain period. * Keep a symptom diary to track your symptoms and gauge your progress. * If you plan to pursue therapy against your physician’s advice, you need to tell him or her. * You can also get information from your CAM practitioner, professional organizations, and state licensing boards. * Ask your practitioner about education, training, licensing, and certification. * Ask whether the practitioner believes the therapy will be beneficial for your condition and whether there are any potential side effects. Demand an evidence-based approach. * Describe any conventional treatments you are receiving or plan to receive. * Discuss how long therapy should continue before you can determine its effectiveness. * Ask about the expected cost of the treatment and whether your health insurance will pay for some or all the expenses. * Check with local and state regulatory agencies and consumer affairs departments to determine whether any formal complaints have been lodged against the practitioner. * Do your own research by investigating websites of government agencies, universities, and organizations that conduct government-sponsored research on CAM approaches. Erroneous information about CAM is rampant among unscientific and “pop” resources. * Talk with people with the same condition who have received the same treatment you are considering. * Controlled scientific trials usually offer the best information and should be consulted whenever possible.

Answer 35

Canada’s national health insurance program, known as medicare, is designed to ensure that all residents have reasonable access to medically necessary hospital and physician services, on a prepaid basis The roles and responsibilities for Canada’s health care system are shared between the federal and provincial or territorial governments Paying for health care • The cost of healthcare spending in Canada was projected to excced $242 billion in 2017 or $6,604 per person. Many factors contribute to the high cost of health care in Canada, including the cost of advanced equipment and new technology, expensive treatments for some illnesses, the aging of the population, high earnings by some people in the healthcare industry, and the demand for profits by investors. • The Canadian national healthcare insurance program often referred to as medicare, is designed to ensure that all residents have reasonable access to medically necessary hospital and physician services on a prepaid basis. • Instead of having a single national plan, we have a national program that is composed of 13 interlocking provincial and territorial health insurance plans. • All plans are framed by the Canada Health Act, the principles of governing our health care system are symbols of underlying Canadian values of equity and solidarity. • Roles and responsibilities for Canada’s health care system are shared between the federal and provincial-territorial governments. • As per the Canada Health Act, the federal health insurance legislation, criteria and conditions are specified that must be satisfied by the provincial and territorial health care insurance plans, for them to qualify for their full share of the federal cash contribution available under the Canada Health Transfer (CHT). • Provincial and territorial governments are responsible for the management, organization and delivery of health services for their residents.

Answer 36

* Health insurance is a method of budgeting in advance for health-care costs that may otherwise be ruinously high. * In 2007, out-of-pocket expenses by individual Canadians represented 15% of total health expenditure, or $ 23.4 billion. Private insurance accounted for 12% or $19.5 billion. Thus 73% of the total health care costs were paid for by the provincial and federal governments. * Health insurance enables people to receive health care they might not otherwise be ale to afford. • Hospital care costs hundreds of dollars a day, and surgical fees can cost thousands, hence the health insurance is important for everyone, especially as healthcare costs continue to rise. Health insurance enables people to receive health care they might not otherwise be able to afford Health insurance enables people to receive health care they might not otherwise be ale to afford. Become literate in how to utilize the insurance plan that comes with school or work Ask your health providers questions if you don’t understand something Contact your insurance company and ask questions about what is covered, not covered Maximizing your insurance takes time, be your own self-advocate and stay motivated. Stay on top of submitting receipts Seek out care that is covered in your benefits

Answer 37

A measure to indicate whether air pollution levels pose a health concern for Canadians

Answer 38

A lung condition caused by inhalation of microscopic asbestos fibres, which inflame the lung and can lead to lung cancer.

Answer 39

Refers to the ability of some materials to break down naturally and disappear back into the environment.

Answer 40

The variety of living things on the earth, including all the different species of flora and fauna and the genetic diversity among individuals of the same species.

Answer 41

The accumulation of a substance in a food chain.

Answer 42

Chemicals used as spray-can propellants, refrigerants, and industrial solvents, implicated in the destruction of the ozone layer.

Answer 43

A unit for expressing the relative intensity of sounds on a scale from 0 for the average least perceptible sound to about 120 for the average pain threshold.

Answer 44

The collective interactions of humans with the environment and the short-term and long-term health consequences of those interactions.

Answer 45

The community of organisms (plants and animals) in an area and the nonliving physical factors with which they interact.

Answer 46

The addition of fluoride to the water supply to reduce tooth decay.

Answer 47

The transfers of food energy and other substances in which one type of organism consumes another.

Answer 48

Buried deposits of decayed animals and plants that are converted into carbon-rich fuels by exposure to heat and pressure over millions of years; oil, coal, and natural gas are fossil fuels.

Answer 49

An increase in the earth’s atmospheric temperature when | averaged across seasons and geographical regions; also called climate change.

Answer 50

A warming of the earth due to a buildup of carbon dioxide and certain other gases.

Answer 51

A gas (such as carbon dioxide) or vapour that traps infrared radiation instead of allowing it to escape through the atmosphere, resulting in a warming of the earth (the greenhouse effect).

Answer 52

A metal with a high specific gravity, such as lead, copper, or tin.

Answer 53

The use of controlled nuclear reactions to produce steam, which in turn drives turbines to produce electricity.

Answer 54

A layer of ozone molecules (O3) in the upper atmosphere that screens out UV rays from the sun.

Answer 55

Chemicals used to prevent the spread of diseases transmitted by insects and to maximize food production by killing insects that eat crops.

Answer 56

An industrial chemical used as an insulator in electrical transformers and linked to certain human cancers.

Answer 57

Energy transmitted in the form of rays, waves, or particles.

Answer 58

An illness caused by excess radiation exposure, marked by low white blood cell counts and nausea; possibly fatal.

Answer 59

A naturally occurring radioactive gas emitted from rocks and natural building materials that can become concentrated in insulated homes, causing lung cancer.

Answer 60

The use of waste materials as raw materials in the production of new products.

Answer 61

A disposal site where solid wastes are buried.

Answer 62

A self-contained sewage disposal system, often used in rural areas, in which waste material is decomposed by bacteria.

Answer 63

Hazy atmospheric conditions resulting from increased concentrations of ground-level ozone and other pollutants

Answer 64

• Humans should protect the world for future generations, and for other forms of life. • Although many environmental problems are complex and seen beyond the control of the individual, there are ways that people can make a difference to the future of the planet. -Environmental Health is the collective interactions of humans with the environment and the short-term and long- term health consequences of those interactions.

Answer 65

• Environmental health grew out of efforts to control communicable diseases • When certain insects and rodents were found to carry microorganisms that cause disease in humans, steps were taken to control these animal hosts, called vectors. • Systematic garbage collection, sewage treatment, water protection, food inspection, and public health agencies all evolved from these early discoveries. • Canadians rarely contract cholera, typhoid fever, plague, diphtheria, or other diseases that once killed large numbers of people, but these diseases have not been eradicated worldwide (this is why many travellers have to get vaccines before entering these countries) • It is important to understand that clean water, sanitary waste disposal, safe food, and insect and rodent control continue to be major issues throughout the world.

Answer 66

* In Canada, a huge, complex, public health system is constantly at work behind the scenes attending to the details of critical health concerns * Over the last few decades, the focus of environmental health has expanded and become more complex * Countering effects of natural disaster, terrorism or a human made disaster with quick restoration of public health services becomes crucial to human survival.

Answer 67

* The world’s population is increasing at a rate of about 83 million per year – 160 people every minute * United Nations projects that world population will reach 11.2 billion by 2100 * Much of the growth is taking place in the developing world. * A growing population makes it difficult to provide the basic components of environmental health and is a driving force behind newer environmental health concerns, such as chemical pollution, global warming, and thinning of the ozone layer of the atmosphere. * Recent rapid population growth is responsible for most of the stress humans put on the environment. * The world’s population is 7.6 billion and is increasing at a rate of 83 million per year. * The United Nations projects that world population will reach 8.6 billion by 2030, 9.8 billion in 2050, and 11.2 billion in 2100. * All this increase is observed in the less-developed regions of the world. In 1950, the more-developed regions accounted for 32% of the worlds population, which dropped to 20% in 2000 and is expected to further decline to 13% in 2050. * Changes also are projected for the world’s age distribution. The number of people age 60 and over will increase from 962 million in 2017 to 2.1 billion in 2050 and 3.1 billion in 2100.

Answer 68

* Factors that may limit the world’s population include: * Food. Today, economic and sociopolitical factors rather than production problems have led to food shortages and famine. To continue to supply adequate nutrition, the makeup of the world’s diet may need to change. * Available land and water. A growing population cuts forests, depletes soil, and withdraws water. Habitat destruction and species extinction also result. * Energy. A shift to renewable resources such as hydropower, solar, and wind is necessary * Minimum acceptable standard of living. The earth cannot support our current levels of energy consumption on a worldwide basis. Population must be limited to a number that the earth’s available resources can support.

Answer 69

* The current population explosion is fueled by interconnecting factors: * High fertility rates in the developing world, caused by a combination of poverty, high child mortality, and lack of social services. * Lack of family planning resources. * Lower death rates. * To be successful, population management must change the condition of people’s lives to remove the pressure for large families. Improved health, better education, increased literacy, and more jobs for women all help to reduce fertility rates.

Answer 70

* Improve the conditions of people’s lives * Remove the pressures for having a large family * Improve health * Provide better education * Increase literacy * Increase employment opportunities for women * Provide family planning resources

Answer 71

• Air pollution is not a human invention or even a new problem. The air is polluted naturally with every forest fire, pollen bloom, and dust storm, as well as with countless other natural pollutants. • Air pollution is linked to a wide range of health problems; the very young and elderly are among those most susceptible to air pollution’s effects. • Health Canada and Environment Canada have developed a new measure called the Air Quality Health Index (AQHI) to indicate whether air pollution levels pose a health concern for Canadians. The AQHI is calculated based on the relative risks of a mixture of air pollutants listed below. • Nitrogen dioxide (NO2). Major sources include motor vehicles and power plants. In people with upper respiratory diseases, NO2 affects lung function and may increase the risk of respiratory infections. • Particulate matter (PM) is released into the atmosphere by the combustion of fossil fuels, crushing or grinding operations, industrial processes, and dust from roadways. PM can accumulate in the respiratory system and aggravate cardiovascular and lung diseases and increase the risk of respiratory infections. • Ground level ozone is formed when pollutants emitted by cars, power plants, chemical plants, industrial boilers, and refineries chemically react in the presence of sunlight. Ozone can irritate the respiratory system, reduce lung function, aggravate asthma, increase susceptibility to respiratory infections, and inflame and damage the lining of the lungs. • AQHI values range from 1 to 10+; the higher the AQHI, the greater the level of pollution and associated health danger. When the AQHI exceeds 7, the health risk is considered high, particularly for sensitive groups of people and then for everyone as AQHI values get higher. Smog, a term coined in London in the early 1900s, is a combination of smoke and fog. However, what we typically call smog today is a mixture of pollutants with ground-level ozone being the key ingredient.

Answer 72

* The greenhouse effect is the phenomenon in which the temperature of the earth’s atmosphere depends on the balance between the amount of energy the planet absorbs from the sun (mainly as high-energy ultraviolet radiation) and the amount of energy radiated back into space as lower-energy infrared radiation. * The various key components of temperature regulation are carbon dioxide, water vapour, methane and other greenhouse gases. * The levels of these gases are being increased by consumption of fossil fuels and deforestation is reducing the number of trees that convert carbon dioxide to oxygen, the effect is intensifying. * Carbon dioxide levels in the atmosphere have increased rapidly in recent decades. The use of fossil fuels pumps more than 20 billion tones of carbon dioxide into the atmosphere every year. * Some experts believe that carbon dioxide may account for about 60% of the greenhouse effect. * The year 2016 was the warmest on record, globally, since record keeping began in 1880. 2017 was the second warmest year, according to NASA. The average global temperature has risen approximately one degree Celsius since 1880. * There is growing agreement among scientists that temperatures will continue to rise, although estimates vary as to how much they will change. If global warming persists, experts say the impact may be devastating.

Answer 73

* Increased rainfall and flooding * Increased mortality from heat stress * Poleward shift in the location of vegetation zones * Rapid and drastic melting of the polar ice caps

Answer 74

• The ozone layer, a fragile invisible layer 11-40 km above the earth, shields the earth from the dangerous ultraviolet rays of the sun. • Since the mid-1980s, scientists have observed the seasonal appearance of a “hole” in the ozone layer over Antarctica and thinning over areas of the north. • The ozone layer is being destroyed primarily by the release of chlorofluorocarbons (CFCs) from refrigerants in air conditioners and discarded refrigerators, foaming agents in some rigid foam products, propellants in aerosol sprays (most have been banned now), and solvents in the electronic industry. CFCs react with air-borne ice crystals, releasing chlorine atoms, which destroy ozone. • Worldwide production of CFCs declined rapidly, but they can persist in the atmosphere for more than a century. • The ozone layer is a layer of ozone molecules (O3) in the upper atmosphere that screens out UV rays from the sun. It is a fragile, invisible layer about 16-48 km above the Earth’s surface • The ozone layer is being destroyed primarily by chlorofluorocarbons (CFCs) - Coolants in refrigerators and air conditioners - Foaming agents in insulation - Propellants in aerosol sprays - Solvents

Answer 75

* Canadians are large consumers of energy. North Americans use energy to create electricity, transport, power our industries, and run our homes. About 40% of the energy we use in Canada comes from oil, followed by natural gas (34%), hydroelectricity (23%), and coal (1%). The reminder comes from nuclear power and renewable energy sources (wind and solar). * Energy consumptions is at the root of many environmental problems, especially those relating to air pollution. * Car exhaust and industrial oil burning, and coal burning are primary causes of smog, acid precipitation, and the greenhouse effect. * The mining of coal and the extraction and transportation of oil cause pollution on land and in the water; coal miners often suffer from serious health problems related to their jobs. * Nuclear power generation creates hazardous wastes and carries the risk of dangerous releases of radiation. * Conservation and development of renewable energy sources are key strategies for controlling energy use. * North Americans use energy to create electricity, transport us, power our industries, and run our homes * About 41% of the energy we use in Canada comes from oil

Answer 76

* Fossil fuels that are relatively difficult to access and extract from the environment * Methods used to acquire these energy sources may pose new environmental risks

Answer 77

• Electricity from wind energy is one of the fastest growing methods of electrical generation in the world. • Kinetic energy from moving air is converted into electricity by wind turbines that are mounted in locations where there are favourable weather patterns. • Energy derived from wind may also be converted to hydrogen and use as a form of fuel for transportation or stored for subsequent power generation. -Some people may find the sound from the wind turbines bothersome, however the sound level from wind turbines is not sufficient to cause hearing impairment or other adverse health outcomes. • Renewable energy sources are those sources that are naturally replenished and essentially inexhaustible (wind, sunlight) • Canada is recognized as a global leader in the production and use of renewable energy

Answer 78

* The Government of Canada and some provincial governments have encouraged researchers and automobile manufacturers to develop and use alternative fuels such as ethanol. * Ethanol is produced from fermenting plant sugars. Most of these vehicles can run on a mixture of 90% gasoline and 10% ethanol (known as E10), a fuel that is now available at many service stations across Canada. * E85 is another alternative fuel consisting of 85% ethanol and 15% gasoline. This is not commercially available in Canada. * Ethanol requires more energy to produce than it yields when burned as fuel, and has been linked to skyrocketing food prices and even world-wide food shortages. * Ethanol is a renewable transportation fuel produced from fermenting plant sugars * Some critics suggest that ethanol causes more harm than good

Answer 79

* Hybrid and electric vehicles are gaining popularity in Canada. Hybrid vehicles use two or more distinct power sources to propel the vehicle. * Hybrid vehicles have two or more distinct power sources such as an internal combustion engine and electric motor. * Another type of alternative vehicle is an all-electric. Running on energy stored in batteries, which must be recharged after a certain number of kilometres. The battery packs must be replaced every few years, adding to the overall cost of electric vehicles. * Hybrid vehicles use two or more distinct power sources to propel * Greater fuel economy, fewer polluting emissions

Answer 80

* Indoor pollutants have been linked to a range of problems, from allergic responses to cancer. Common pollutants include environmental tobacco smoke, carbon monoxide and other combustion by-products, formaldehyde gas, biological pollutants, and indoor mould. * Environmental tobacco smoke (ETS), a human carcinogen that also increases the risk of asthma, bronchitis, and cardiovascular disease. * Carbon monoxide and other combustion by-products, which can cause chronic bronchitis, headaches, dizziness, nausea, fatigue, and even death. Common sources in the home are woodstoves, fireplaces, kerosene heaters and lamps, and gas ranges. * Volatile organic compounds, formaldehyde gas, which can cause eye, nose, and throat irritation; shortness of breath; headaches; nausea; lethargy; and, over the long term, cancer. This gas can seep from certain construction materials, paints, floor finishes, permanent press clothing, and nail polish. * Biological pollutants, including bacteria, dust mites, mould, and animal dander, which can cause allergic reactions and other health problems. These allergens are typically found in bathrooms, damp or flooded basements, humidifiers, air conditioners, and even some carpets and furniture. * Indoor mould, the fuzzy black substance growing on shower tiles and damp basement walls, is an indoor pollutant not to be taken likely. Even though more than 100 common indoor moulds have been classified as potentially hazardous to people, only a few are serious threats to human health.

Answer 81

• You can take steps to prevent air pollution. • Cut back on driving. • Keep your car tuned up and well maintained, use unleaded gas, and keep tires inflated to recommended levels. Have your car serviced by a station that uses environment-friendly refrigerants. • Use energy-efficient appliances and cut back on their use as much as possible. • Replace incandescent bulbs with compact fluorescent bulbs. • Insulate your home with ozone-safe agents; lower your thermostat in winter and use fans rather than air conditioners in summer. • Promote tree growth in yards and neighbourhoods. • Check with your waste hauler or local government to ensure that ozone-depleting refrigerants are removed from refrigerators, air conditioners, or humidifiers before disposal. • Ventilate your home adequately and keep houseplants. • Keep chemical products in original, tightly sealed containers. • Do not smoke or allow others to smoke in your home. Clean and maintain chimneys, furnaces, and appliances.

Answer 82

Water Quality and Pollution • Close to 90% of the water processed by Canada’s drinking water plants comes from surface water sources such as lakes and rivers. Clean water is one of the fundamental important resources to humans. • Purification includes physical and chemical processes, such as screening, filtration, and disinfection (often with chlorine). • Fluoridation, a water treatment process that reduce dental decay by 15-40% was introduced into Canadian communities more than 60 years ago. However as recently as 2007, less than half of the Canadian population had access to fluoridated water supplies. • In most areas of Canada, water systems have adequate, dependable supplies, can control waterborne diseases, and provide water without unacceptable colour, odour or taste. • 104 long-term drinking water advisories were in effect in First Nation communities across Canada • as of October 2018. Anothere 71 had been lifted since 2015. • On October 1, 2018, the Government of Canada announced a commitment that involves working • with First Nation communities to: • improve water infrastructure on reserve. • end all long-term drinking water advisories on public systems on reserve. • prevent short-term advisories from becoming long-term advisories.

Answer 83

* Water shortages also are a concern in many regions of the world, however in general Canada is a ‘water rich’ country. * Water shortages are a serious problem throughout the world, where human demand outstrips the ability of natural water supplies to provide adequate water to all. * According to WHO, 2.1 billion people do not have safe drinking water, and 4.5 billion do have access to safe sanitation. * Groundwater pumping and the diversion of water from lakes and rivers for irrigation reduce the amount of water available for communities.

Answer 84

* Sewage disposal has improved tremendously over the past 150 years and has led to a decrease in the incidence of typhoid, cholera, and hepatitis A. * In Canada, the development of sanitary outhouses reduced the contamination of potential water sources. * When plumbing moved indoors, systems became more complicated, with a septic system in rural areas and sewers in the cities. * Contemporary sewage-treatment plants separate fecal matter from water, treat it so it cannot transmit disease, and release the water. The sludge can be used as fertilizer if it does not contain heavy metals. * If heavy metals such as lead, cadmium, copper, and tin continue through the food chain, they can cause illness and death, as can mercury and polychlorinated biphenyls (PCBs). * Many cities have expanded sewage-treatment measures to remove heavy metals and other dangerous chemicals. * Sewage treatment centers separate fecal matter from water so that it cannot transmit infectious diseases * Sludge that remains is handled as hazardous waste and is contaminated with heavy metals

Answer 85

* Ways you can help to protect the water supply include the following steps: * Minimize consumption by taking showers instead of baths; turn off water when not in use; and run full dishwasher and washing machine loads. * Install faucet aerators and water-efficient showerheads. * Purchase a water-saver toilet, or put a displacement device in the toilet tank, such as a plastic bottle or bag filled with water. * Fix any leaky faucets in your house. * Use organic rather than chemical fertilizer and do not overfertilize your lawn and garden; any excess can contaminate groundwater. * Dispose properly of toxic materials, such as cleaning solvents, bleach, or motor oil. * Do not pour old medicines down the drain or flush them in the toilet. Instead mix them with cat litter or coffee grounds, seal them in a container and put them in the trash.

Answer 86

* The bulk of the organic food garbage in Canadian kitchens is now dumped in the sewage system through a mechanical garbage disposal. Solid waste presents an enormous disposal and contamination problem. * The average Canadian generates more than 700 kg of household waste every year. The biggest single component of household trash by weight is organic waste from kitchens and yards, followed by paper products, including newspapers, junk mail, and other paper fibres. * Plastic, metals, and glass, as well as animal waste, textiles, tires, and wood are other significant waste components. * Relatively small percentage of solid waste is toxic, although a new and growing source of toxic waste is the disposal of computer components in both household and commercial waste. * Burning reduces the bulk of solid waste, but it pollutes the air. * Mining and manufacturing produce toxic wastes that cannot be dumped safely.

Answer 87

* The most common way to dispose of waste in Canada is to bury it in sanitary landfill disposal sites. * Landfills are placed in locations where they are not likely to contaminate nearby groundwater, streams, or other sources of water. * Soil is studied to ensure it is not conducive to leakage. * The site may be lined, and nearby monitoring wells are required for testing. * Layers of solid waste are covered with thin layers of dirt until the site is filled. * The top may be turned into a park, or trees and grass are replanted. The landfill is stable because of the firmly packed layers. * Solid landfills do have some disadvantages: * Chemical containers may leak into surrounding soil and groundwater. * Burial is expensive and requires an enormous amount of space.

Answer 88

* Biodegradable materials can break down naturally, safely and quickly into raw materials of nature, and then return to the environment. * Many communities encourage recycling of trash – not only paper, glass, and cans, but also tires and used oils. These programs have succeeded in reducing the proportion of solid waste sent to landfills. * Discarded technology is the newest solid waste problem. Canadians scrap about 140,000 metric tons of electronic waste each year. * “E-waste” includes old computers, televisions, and other electronic devices. * These devices are toxic, containing varying amounts of lead, mercury, and other heavy metals. * Biodegradation is the process by which organic substances are broken down naturally by living organisms * Organic materials can be degraded either aerobically (with oxygen) or anaerobically (without oxygen) * Biodegradable means that products can break down naturally

Answer 89

• Canadians are encouraged to recycle • Recycling is the use of waste materials as raw materials in the production of new products • Waste paper can be recycled into new paper products; old bicycles can be melted down and used in the production of appliances

Answer 90

* New problem of discarded old computers, televisions, cell phones, MP3 players, other electronic devices * e-waste is the fastest-growing portion of our waste system * Many components can be recycled and reused

Answer 91

• Buying products in bulk or with minimum packaging. • Buying recycled and recyclable products; avoiding disposables. • Avoiding disposable foam or paper cups and plastic stirrers and packing your lunch in reusable containers. • Storing food in reusable glass or plastic containers. • Recycle your newspapers, glass, cans, paper and other recyclables. • Do not throw electronic items, batteries, or fluorescent lights into the trash. • Composting organic garbage. Taking steps to cancel junk mail.

Answer 92

• Chemical pollution and hazardous waste has been around since the days of ancient Rome, when people suffered from lead poisoning. • Industrial chemicals have claimed countless lives over the past few centuries. • In the late 1980s, the International Joint Commission identified 43 areas of concern (AOC) in the Great Lakes Basin area in Canada and in the US; 17 of which are in Canada, and only two have fully been restored according to Environment Canada. • Today, new chemicals are constantly being developed, and their long-term effects are not always known. • Concentrations often are high, and exposure can be dangerous. • Chemicals have been responsible for environmental disasters, including thousands of deaths in Bhopal,India. • Many chemicals are harmless by themselves but become deadly in combination. • Inhalation of the tiny fibres in asbestos, widely used to protect against fire and to insulate buildings, causes lung damage (asbestosis) and lung cancer. • Coal miners and textile workers experience similar conditions from inhaling coal dust (black lung disease) and cotton fibres (brown lung disease). • Lead poisoning causes central nervous system damage, mental impairment, hindered oxygen transport in the blood, and digestive problems. • Neurological damage can be permanent. • According to Health Canada the blood levels of lead in Canadian children under age 16 is generally low. • Long term exposure to low levels of lead may cause kidney disease; it can also cause lead to build up in bones, where it may be released into the bloodstream during pregnancy or when the bone mass is lost from osteoporosis. • Pesticides are used to prevent spread of insect-borne disease and to maximize food production. • In the case of the pesticide DDT, long-term costs outweigh any short-term benefits of its use; it has been banned in Canada since 1985. • Most pesticide hazards to date have been a result of overuse and abuse, but long-term exposure to small amounts in food also could turn out to be a health hazard, especially for children. • Coal-fired power plants are the largest producers of mercury, along with mining and smelting operations and the disposal of consumer products containing mercury. • Mercury is a toxin that affects the nervous system and may damage the brain, kidneys, and gastrointestinal tract, increase blood pressure and heart rate, and cause cancer. • It slows fetal and child development and causes irreversible deficits in brain function. • Because large, long-lived fish may carry high levels of mercury, they should be avoided. • The sale of mercury thermometers has been banned in some cities. Disposal of thermometers or broken thermometers should be treated as a safety hazard. Other concerns are arsenic in drinking water; formaldehyde in synthetic building materials; prescription medications and hormones in streams; and hazardous wastes in the home, including automotive supplies, paint supplies, art and hobby supplies, insecticides, batteries, computer and electronic components, and household cleaners containing sodium hydroxide (lye) or ammonia.

Answer 93

* Strategies for preventing chemical pollution include: * Buying the least toxic products available. * Disposing of hazardous household wastes properly. * Buying organic or locally grown produce and washing, scrubbing, and peeling fruits and vegetables. * Storing pesticides and toxic household products securely. * Hiring a licensed exterminator if you need to fumigate your home.

Answer 94

* Radiation is energy that comes in different forms, such as ultraviolet rays, microwaves, or x-rays, and from different sources, such as the sun, uranium, and nuclear weapons. * Gamma rays produced by radioactive sources, such as nuclear weapons, nuclear energy plants, and radon gas, are the biggest health concern. High doses can cause radiation sickness and death. Lower doses can cause chromosome damage, sterility, tissue damage, cataracts, and cancer. * Exposure to UV radiation from the sun or from tanning salons can increase the risk of skin cancer. * The effects of some sources of radiation, such as cell phones, remain unclear.

Answer 95

* Accidentally discharge and from the possibility of failure or leakage of nuclear generating plants. * The failure of the nuclear power plant at Chernobyl demonstrates the potential for disaster in such a failure. The area around Chernobyl could be unsafe for up to 24,000 years. * Another problem is disposing of the radioactive wastes generated by the power plants. Wastes cannot be dumped in landfills because radiation exposure could not be prevented. * Safe disposal requires deposit sites in which the wastes will be safe for tens of thousands of years. * Nuclear power is the use of controlled nuclear reactions to produce the steam, which in turn drives turbines to produce electricity * Developed as an alternative to oil and coal * Deposit sites have to be developed that will be secure for tens of thousands of years

Answer 96

* Medical uses of radiation have changed ways to diagnose and treat illness and injury, but exposure to x- rays can be hazardous because the effect is cumulative. * X-rays are still valuable tools but are used carefully to keep exposure as low as possible; newer equipment uses lower doses. * Any x-ray should have a definite purpose.

Answer 97

* Research on adverse effects of radiation in the home and workplace from microwave ovens, computer monitors, cellular telephones, and high-voltage power lines is inconclusive. * Radon, found in soil, rocks, and building materials, increases the incidence of lung cancer, but other short-term and long-term effects are poorly quantified. * Ways to avoid radiation include asking your physician whether x-rays are necessary, investigating local radon problems, and taking community action to clean up radioactive sites. * Microwave ovens, computer monitors, high-voltage power lines * To limit possible radiation from cell phones, you can text instead of call, use a wired headset or speakerphone, carry your phone one inch from your body * Radon is a naturally occurring radioactive gas found in soil and building materials

Answer 98

• Only get X-rays when necessary • Follow Health Canada’s recommendations for radon testing • Use sunscreen to protect yourself from UV rays.

Answer 99

* Noise pollution also is a health hazard. * Prolonged exposure to sounds of 80 decibels (a measure of the intensity of a sound wave) for 8 hours, can cause permanent hearing loss. Two common sources of noise at this level or higher are the workplace, large gatherings of people at sporting events, and rock concerts. * Federal and provincial governments have set standards for the workplace, but there are no such standards for rock concerts, which can be much louder than most workplaces. * Steps to take to avoid noise pollution include wearing ear protectors around noisy machinery, keeping the volume on headphones to no more than 6 on a range of 1 to 10, avoiding loud music, avoiding exposure to extremely loud sounds, and avoiding repeated exposure to sounds over 80 decibels. * Prolonged exposure to sounds above 80-85 decibels can cause permanent hearing loss. * Two common sources of excessive noise are the workplace and large gatherings of people at sporting events and rock concerts * Federal and provincial or territorial governments set limits for noise in the workplace, but not rock concerts

Answer 100

* Wear ear protection around noisy machinery * When listening to music with headphones, you should be able to hear the people around you when they are speaking in a normal tone of voice. Earmuff style headphones are less damaging than earbuds. * Avoid loud music * Avoid exposure to painfully loud sounds

Answer 101

* Measures to reverse these environmental problems range from international and national efforts to individual changes in lifestyle and increased respect for the environment that sustains life. * Large corporations and manufacturers are responsible for cleaning up their workplaces and using more environmentally sound methods of production, distribution, and waste removal. * Methods of individual action include: * Making sure friends and family are informed about the issues. * Joining, supporting, or volunteering time to environmental organizations. * Contacting elected representatives and communicating your concerns.

Answer 102

The intoxicating ingredient in fermented or distilled beverages; a colourless odorless liquid.

Answer 103

A chronic psychological disorder characterized by excessive and compulsive drinking.

Answer 104

The use of alcohol to a degree that causes physical damage, impairs functioning, or results in behaviour harmful to others.

Answer 105

A pathological use of alcohol or impairment in functioning due to alcohol; characterized by tolerance and withdrawal symptoms; alcoholism.

Answer 106

Cognitive and behavioural problems seen in people whose mothers drank alcohol during pregnancy.

Answer 107

Periodically drinking alcohol to the point of severe intoxication.

Answer 108

The amount of alcohol in the blood in terms of weight per unit volume; used as a measurement of intoxication.

Answer 109

Weakening of the heart muscle through disease.

Answer 110

A disease in which the liver is severely damaged by alcohol, other toxins, or infection.

Answer 111

A state of confusion brought on by the reduction of alcohol intake in an alcohol-dependent person; other symptoms are sweating, trembling, anxiety, hallucinations, and seizures.

Answer 112

A characteristic group of birth defects caused by excessive alcohol consumption by the mother, including facial deformities, heart defects, and physical and mental impairments.

Answer 113

A false perception that does not correspond to external reality, such as seeing visions or hearing voices that are not there.

Answer 114

The chemical transformation of food and other substances in the body into energy and wastes.

Answer 115

The amount of a beverage that typically contains about 13.6g of alcohol; also called a standard drink.

Answer 116

A mental disorder characterized by persistent delusions – fixed, false beliefs that would not be accepted by the individual’s culture.

Answer 117

Two times the percentage of alcohol by volume; a beverage that is 50% alcohol by volume is 100 proof.

Answer 118

* Historically, alcohol has been associated with good times as well as with self-destructiveness and escape * Alcohol has been more popular than any other drug in the Western world despite many prohibitions against it. * Alcohol affects different people in different ways. * The Nature of Alcohol * There are many kinds of alcohol, each is an organic compound. The term alcohol refers only to ethyl alcohol. Several kinds of alcohol are similar to ethyl alcohol, such as methanol and isopropyl alcohol, however they are highly toxic, and can cause serious illness, blindness and even death. * Alcohol is the intoxicating ingredient in fermented or distilled beverages; a colourless, pungent liquid * Alcohol is an organic compound * The term alcohol here refers to only ethyl alcohol

Answer 119

* There are several basic types of alcoholic beverages; ethanol is the psychoactive ingredient in each of them: * Beer is a mild intoxicant brewed from a mixture of grains. By volume, beer usually contains 3-6% alcohol. * Ales and malt liquors, which are similar to beer, typically contain 6-8% alcohol by volume. * Wines are made by fermenting the juices of grapes or other fruits. During fermentation, sugars from the fruit react with yeast to create ethanol and other by-products. In table wines, the concentration of alcohol is about 9-14%. A more potent type of wine, called fortified wine, is so called because extra alcohol is added during its production. Fortified wines – such as sherry, port, and Madeira – contain about 20% alcohol. * Hard liquor – such as gin, whiskey, rum, tequila, vodka, and liqueur – is made by distilling brewed or fermented grains or other plant products. Hard liquors usually contain 35-50% alcohol but can be much stronger. * In Canada any beverage containing 1.1% or more alcohol by volume is considered an alcoholic beverage. By law, all labels on alcoholic beverages must include the amount of alcohol in the product.

Answer 120

• A standard drink refers to the amount of a beverage that typically contains about 13.6 grams of alcohol. * Alcohol provides 7 calories per gram, and the alcohol in one drink supplies about 100 to 120 calories. * Typical serving of most alcoholic beverages is larger than a single standard drink. * The “light” in light beer refers to calories; a light beer typically has close to the same alcohol content as a regular beer and about 100 calories. * A 142 ml or 5oz glass of red wine has 100 calories; white wine has 96. A 3oz margarita supplies 157 calories and a 177 ml, or 6oz rum and Coke contains about 180 calories. * 1 standard drink: beer (341 ml/12 oz/5% alcohol) = cider (341 ml/12 oz/5% alcohol) = wine (142 ml/5 oz/12% alcohol) = distilled alcohol (43 ml/1.5 oz/40% alcohol)

Answer 121

• Alcohol provides 7 calories per gram; the alcohol in one drink (14-17 grams) supplies about 100-120 calories • 1 beer = approximately 150 total calories • ‘Light’ beer refers to calories (approximately 100 calories) but has the same alcohol content

Answer 122

* About 20% of alcohol ingested is rapidly absorbed from the stomach into the bloodstream; about 75% is absorbed through the upper part of the small intestine. * Any remaining alcohol is absorbed along the gastrointestinal tract * Once in the bloodstream, alcohol produces feelings of intoxication. The rate of absorption is * affected by a variety of factors. For instance, carbonation increases the rate of absorption. Artificial sweeteners (commonly used in drink mixers) have been shown to have the same effect. * The presence of food in the stomach slows the rate.

Answer 123

* Carbonation * Food in the stomach * Alcohol concentration * Eventually all alcohol ingested will be absorbed

Answer 124

• Most alcohol is converted to acetaldehyde, then to acetate, which is either burned for energy or converted to fat. • Alcohol is rapidly metabolized and spread through the body tissues. • About 2% to 10% is not metabolized but is excreted unchanged by lungs, kidneys, and sweat glands. • Excreted alcohol forms the basis for breath and urine analyses of alcohol concentrations in the blood. • Alcohol readily crosses the blood brain barrier. • Alcohol affects neurotransmitters, this temporary change alters the messages the brain receives. Chronic heavy use will make these changes permanent, changing both brain structure and function. Alcohol interferes with production of new brain cells in unborn children, young children, adolescents, and young adults whose brain is still developing. • Metabolism is the chemical transformation of food and other substances in the body into energy and wastes • The main site of alcohol metabolism is the liver, though a small amount of alcohol is metabolized in the stomach • Alcohol affects neurotransmitters and the ability of the brain’s cells to receive messages is changed • Variances in alcohol-metabolizing enzymes explain why people have different reactions to alcohol • With chronic heavy usage, alcohol’s effects become permanent resulting in lasting disruption of brain function and changes in brain structure

Answer 125

* Blood alcohol concentration (BAC), a measure of intoxication in a given amount of time, is determined by the amount of alcohol consumed and by individual factors. * Body weight, percent body fat, and gender help determine BAC. * A smaller person develops a higher BAC than a larger person after drinking the same amount of alcohol. A smaller person has less overall body tissue into which alcohol can be distributed. * A person with a higher percentage of body fat will usually develop a higher BAC than a more muscular person of the same weight. Alcohol does not concentrate as much in fatty tissue as in muscle and most other tissues, in part because fat has fewer blood vessels. * Women metabolize less alcohol in the stomach than men do because the stomach enzyme that breaks down alcohol before it enters the bloodstream is four times more active in men than women. This means that more unmetabolized alcohol is released in the bloodstream in women. * Since women also are generally smaller than men and have a higher percentage of body fat, women will have a higher BAC than men after consuming the same amount of alcohol. * Hormonal fluctuations also may affect the rate of alcohol metabolism, making a woman more susceptible to high BAC at certain times during her menstrual cycle – usually just before the onset of menstruation.

Answer 126

* BAC also depends on the balance between rate of alcohol absorption and rate of alcohol metabolism. * A 69kg man with normal liver function metabolizes 6.8g of alcohol per hour, the equivalent of about half a 12oz bottle of beer or a 5oz glass of wine. * Metabolic rate is largely determined by genetics and drinking behaviour; it cannot be affected by exercising, breathing deeply, eating, drinking coffee, or taking other drugs. * If a person absorbs less alcohol per hour than he or she can metabolize, BAC remains low. * Drinking alcohol this way means large amounts can be consumed over a long period of time without a person’s becoming noticeably intoxicated, although this behaviour is a danger to health in the long term. • Absorbing alcohol more quickly than it can be metabolized leads to intoxication. • Blood alcohol concentration (BAC), a measure of intoxication, is the amount of alcohol in the blood expressed as the percentage of alcohol in a decilitre of blood • Individuals factors affect BAC, including body weight, percentage of body fat, sex Rate of metabolism is largely determined by genetic factors and drinking behaviour • Metabolism can be slowed by food but not by exercising, breathing deeply, eating, drinking coffee, or taking other

Answer 127

* BAC is the primary factor for determining the effects of alcohol. * Alcohol is a central nervous system (CNS) depressant; its effects vary because body systems are affected to different degrees at different BACs. * At low concentrations, alcohol makes people feel relaxed, jovial, and euphoric, while higher concentrations lead to feelings of anger or sedation. * Effects of alcohol are as follows: * At a BAC of 0 to 0.05, slight change in feelings, usually relaxation and euphoria. Decreased alertness. * Low concentrations (BAC of 0.03 -0.05 percent) produce feelings of light-headedness, relaxation, release of inhibitions * In social settings alcohol seems to act as a stimulant as it depresses inhibitory centres in the brain

Answer 128

* At a BAC of 0.05 to 0.10 emotional instability, with exaggerated feelings and behaviour. Reduced social inhibitions. Impairment of reaction time and fine motor coordination. Increasingly impaired during driving. Legally drunk at 0.08% and subject to license suspensions at 0.05% and over. * At a BAC of 0.10 to 0.15, unsteadiness in standing and walking. Loss of peripheral vision. Driving is extremely dangerous. * At a BAC of 0.15 to 0.30, staggering gait. Slurred speech. Pain and other sensory perceptions greatly impaired. * At a BAC greater than 0.30, stupor or unconsciousness. Anaesthesia. Death possible at 0.35% and above. Can result from rapid or binge drinking with few earlier effects. * Small doses may improve sexual functioning if an individual is especially anxious, but higher doses usually have a negative effect. * High doses can impair the body’s ability to regulate temperature, causing sharp drops in internal temperature, especially in cold environments. * Alcohol changes sleep patterns – it may help a person fall asleep, but it is often a light sleep from which the sleeper periodically awakens. * Alcohol can cause or worsen sleep apnea, a breathing disorder in which the air passage at the back of the mouth narrows or closes during sleep. * Higher concentrations (BAC 0.1-0.2 percent) results in interference with motor coordination, verbal performance, and intellectual functions * BAC 0.35% induces a coma, and any higher concentration could be fatal

Answer 129

• Hangover is probably caused by a combination of toxic products of alcohol breakdown, dehydration, and hormonal effects. During a hangover, heart rate and blood pressure increase, making some people more vulnerable to heart attack. -Drinking large amounts of alcohol over a short period of time can result in alcohol poisoning and death. A drinker who loses consciousness has ingested close to a fatal dose of alcohol and is in great danger because the body continues to absorb alcohol. • Alcohol hangover is caused by a combination of the toxic products of alcohol breakdown, dehydration, and hormonal effects • Coordination and cognition can be impaired in a person with a hangover • The best treatment is prevention

Answer 130

• One of the leading causes of drug-related deaths is the practice of combining alcohol and other legal and illegal drugs, particularly other drugs that cause CNS depression. • The combination can lead to coma, respiratory depression, and death. Examples of such drugs include barbiturates, narcotics, antidepressants, and antihistamines. -Illegal drugs such as cocaine and heroin are very dangerous in combination with alcohol. • Using alcohol with other drugs is a leading cause of drug-related deaths • Illegal drugs are especially dangerous when combined with alcohol • Combined effects of alcohol and caffeine can be dangerous

Answer 131

* Alcohol contributes to or is involved in many homicides, suicides, automobile crashes, and other traumatic incidents. * Approximately 5,000 Canadian deaths linked to alcohol annually. * Among suicide related deaths, alcohol use is common; a recent analysis of 5,550 suicide deaths found that one-third involved alcohol. * Alcohol contributes to over 50% of all murders, assaults, and rapes. * Antisocial personality disorder describes people who become violent under alcohol’s influence. * Alcohol can also negatively affect home life in the form of domestic violence and marital discord. * Alcohol consumption affects a person’s ability to make wise decisions about sexual activity. * Heavy drinkers are more likely to have multiple sex partners and to engage in high-risk sexual behaviour. * Women who binge drink are at increased risk of rape and other forms of non-consensual sex. * Alcohol-related injuries and violence are a result of impaired judgment, weakened sensory perception, reduced inhibitions, impaired motor coordination, and increased aggressiveness and hostility * Alcohol is associated with more acts of aggression and violence than any other legal or illegal drug

Answer 132

* Alcohol seriously affects a person’s ability to make wise decisions about sex * Unplanned sexual activity, unprotected sex. multiple partners, high-risk behaviour

Answer 133

* Drunk driving is a serious health and safety problem in Canada, and it is single largest criminal cause of death. * According to Mothers Against Drunk Driving (MADD) Canada, more than 55% of the 2,297 crash fatalities in 2014 were impairment related. * In 2015, the highest rate of impaired driving charges occurred among those aged 20-24; notably this was down 36% from the rate reported in 2009. * The dose-response function means that higher doses are associated with a greater probability of crashes. * Driving while intoxicated has serious legal consequences. * Drivers should remain alert to signs that another driver is impaired and know how to drive defensively. * If you are away from your home and drinking, find an alternative means of transportation or follow the practice of having a designated driver. • For those with BAC above 0.14%, the risk of fatal crashes is estimated to be 380 times higher. • In Canada, drinking and driving remains the single largest criminal cause of death • The highest rate of impaired driving deaths occurs at age 19 • Dose-response function – A person driving with a BAC of 0.14% is more than 40 times more likely to be involved in a crash. When BAC is greater than 0.14%, the risk of fatal crash is estimated to be 380 times higher.

Answer 134

* Wide, abrupt, illegal turns * Straddling centre line or lane marker * Driving against traffic * Driving on the shoulder * Weaving, swerving, nearly striking objects or vehicles • Following too closely * Erratic speed * Driving with headlights off at night * Driving with window down in the cold

Answer 135

* Chronic alcohol use is associated with diseases of the digestive and cardiovascular systems and some cancers. * Alcohol alters liver function in even small amounts. * Continued use of alcohol leads to liver cell damage and eventual destruction. Destroyed cells are replaced by fibrous scar tissue, a condition called cirrhosis. * Cirrhosis causes a drinker to lose tolerance for alcohol because few healthy cells remain to metabolize it. * Alcoholics are susceptible to infection with hepatitis C, especially those who inject drugs, which greatly increases the risk of cirrhosis and liver cancer. * Treatment for cirrhosis includes a balanced diet and complete abstinence from alcohol. * Alcohol can also inflame the pancreas, causing pancreatitis, and irritate the stomach lining. Violent vomiting can tear blood vessels in the wall of the esophagus. * Effects on the cardiovascular system depend on the amount of alcohol consumed. * Moderate doses may reduce the risk of heart disease. * Higher doses can elevate blood pressure; excessive consumption may lead to weakening of the heart muscle, or cardiac myopathy. * Both the International Agency for Research on Cancer and the United States National Toxicology Program have identified alcohol as a known human carcinogen. * Chronic alcohol consumption increases the risk of mouth, throat, larynx, and esophagus cancers. * 5 or 6 daily drinks, combined with smoking increases the risk of these cancers by a factor of 50 or more. * Alcohol increases the risk of breast cancer. * Heavy social drinkers and alcoholics show evidence of brain damage. Imaging studies show a loss of grey and white matter, reduced blood flow, and slowed metabolic rates in some brain regions. * Average life expectancy among alcoholics is about 15 years less than non-alcoholics; heavy drinkers may die in their twenties or thirties. About half the deaths caused by alcohol are due to chronic conditions such as cirrhosis and cancer; the other half are due to acute conditions or events such as car crashes, falls, and suicide.

Answer 136

* Liver functioning is affected * Fatty liver can develop * Inflammation of the liver * Cirrhosis is a disease in which the liver is severely damaged by alcohol, other toxins, or infection

Answer 137

* Moderate consumption may reduce the risk of heart disease and heart attack in some people * Cardiac myopathy is weakening of the heart muscle through disease

Answer 138

* Alcohol is a carcinogen and a risk factor for breast, colon, rectum, esophagus, larynx, liver, mouth, and pharnyx cancer * Alcohol is largely responsible for the most common form of liver cancer

Answer 139

* Tempered by an individual’s physiology and genetics * Brain shrinkage with loss of both grey and white matter, reduced blood flow, slowed metabolic rate in some regions * Chronic alcohol use may lead to cognitive impairments

Answer 140

* Alcohol consumption is related to more than 200 conditions, diseases, and injuries, and causes approximately 6 percent of all deaths worldwide each year * Average life expectancy among people with alcoholism is about 15 years less than among non-alcoholics

Answer 141

* Alcohol consumed during pregnancy crosses the placenta and harms the fetus. * Moderate to heavy alcohol use can cause fetal alcohol syndrome (FAS). * Characteristics include physical abnormalities and mental impairment. * FAS is the most common preventable cause of mental retardation in the Western world. * Alcohol-related neurodevelopmental disorder (ARND) causes learning and behavioural disorders. * Getting drunk just one time during pregnancy can cause fetal brain damage. * More damage occurs during the first trimester of pregnancy when the nervous system is being developed. * ARND children appear physically normal but have significant learning and behavioural disorders. * Fetal alcohol spectrum disorder (FASD) is considered the full range of FAS and ARND. * A study in 2002 found that children born to mother who drank one and a half drinks per week during their pregnancy showed physical differences to those who did not drink. * Alcohol consumed by a nursing mother quickly enters the breast milk. * Damage to the fetus depends on the amount of alcohol consumed and the stage of the pregnancy * Fetal alcohol syndrome (birth defects caused by alcohol consumption by the mother) * Alcohol-related neurodevelopment disorder (ARND)

Answer 142

• Data show 14% increase in per capita alcohol consumption among Canadians since 1996. • According to the 2015 Canadian Tobacco, Alcohol, and Drugs Survey, 77% of Canadians (ages 15 and older), 59% of minors (ages 15-19), and 83% of youths (ages 20-24) drink alcohol, whether infrequently or routinely. • Canada’s Low Risk Drinking Guidelines • 1. Women should not exceed more than 10 drinks per week, with no more than 2 drinks/day. • 2. Men should not exceed more than 15 drinks per week, with no more than 3 drinks/day. • 3. Everyone should plan non-drinking days each week. • 4. Women should consume no more than 3 drinks and men should consume no more than 4 drinks on any single occasion. • 5. Youth and pregnant women and when driving or taking medication – alcohol should be avoided 1.Reduce long-term risk of diseases and conditions caused by several years of alcohol consumption – Women drink no more than 10 drinks/week, 2 drinks/day; men drink no more than 15/week, 3/day 2. Reduce short-term risk of injury, harm, and/or acute illness 3. Population specific guidelines: – Delay youth drinking until their late teens – Young adults should not excessively drink and have non-drinking days – Older adults should be aware of prescriptions and follow guidelines for limited alcohol intake

Answer 143

• Alcohol use disorder is defined by the Diagnostic and Statistical Manual of Mental Disorders as recurrent alcohol use that has negative consequences, such as drinking in dangerous situations or drinking patterns that result in academic, professional, interpersonal, or legal difficulties. • Mild alcohol use disorder requires an individual display 2-3 symptoms from a list of 11 possible criteria within a 12-month period; moderate alcohol use disorder requires 4-5 symptoms; and severe alcohol use disorder requires at least 6 symptoms. • Many of the health effects of alcoholism result from the fact that as the alcoholic drinks, he or she develops a tolerance and must drink more alcohol to achieve the same effect. These health risks include: • Withdrawal symptoms as the alcoholic stops or reduces consumption: shakiness, rapid pulse and breathing, insomnia, anxiety, and gastrointestinal upset. In a very few cases, delirium tremens (DTs) occurs, with severe disorientation, confusion, seizures, and hallucinations. • All the physical problems associated with excessive use of alcohol Nutritional deficiencies, leading to organ damage and increased susceptibility to disease • Memory defects or psychiatric problems, progressing in some people to paranoid delusions, and profound memory gaps (“blackouts”) that may be filled by conscious or unconscious lying

Answer 144

Alcohol use disorder criteria are: 1. Consuming alcohol in larger amounts or over a longer period than was intended. 2. Having a persistent desire or making unsuccessful efforts to cut down or control alcohol use. 3. Spending a great deal of time in activities necessary to obtain alcohol, use alcohol, or recover from its effects. 4. Craving, or a strong desire or urge to use alcohol. 5. Recurrent alcohol use resulting in failure to fulfill major role obligations at work, school, or home. 6. Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol. 7. Giving up or reducing important social, school, work, or recreational activities because of alcohol use. 8. Recurrent alcohol use in situations in which it is physically hazardous. 9. Continued alcohol use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or worsened by alcohol. 10. Developing tolerance to alcohol, as defined by a need to consume increased amounts of alcohol to achieve the desired effect, or a markedly diminished effect with continued use of the same amount of alcohol. 11. Experiencing alcohol withdrawal resulting in unpleasant physical and cognitive symptoms (such as nausea/vomiting, insomnia, seizures, etc.) or consuming alcohol (or another substance) to reduce or avoid withdrawal symptoms. • Alcoholism, or previously alcohol dependence, refers to more extensive problems, usually involving physical tolerance and withdrawal. • Signs of impending problems with alcohol include: • 1. Drinking alone or secretively. • 2. Using alcohol deliberately and repeatedly to perform or get through difficult situations. • 3. Feeling uncomfortable on certain occasions when alcohol is not available. • 4. Escalating alcohol consumption beyond an already established drinking pattern. • 5. Consuming alcohol heavily in risky situations, such as before driving. • 6. Getting drunk regularly or more frequently than in the past. • 7. Drinking in the morning or at other unusual times. Alcoholism is characterized by tolerance and withdrawal • 1. Tolerance means a drinker needs more alcohol to achieve intoxication or the desired effect • 2. Different patterns of alcohol dependence include: • a. Regular daily intake of large amounts • b. Regular heavy drinking limited to weekends • c. Long periods of sobriety interspersed with binges of daily heavy drinking lasting for weeks or months • d. Heavy drinking limited to periods of stress • Patterns and Prevalence (anyone is susceptible) • Health Effects (seizures, hallucinations, delirium tremens) • Social and Psychological Effects (family trouble, mental illness) • Causes (genetics) • Treatment (counselling, medical treatments)

Answer 145

* Men and women and members of various ethnic groups typically exhibit different patterns of alcoholism. * Men who become alcoholics usually start drinking early in life and are identified as alcoholics by their thirties and forties. Canadian males report significantly higher rates of heavy drinking than Canadian females. * Women tend to become alcoholics at later ages and with fewer years of drinking. They are less likely than men to seek treatment. * According to the 2015 Canadian Tobacco, Alcohol, and Drugs Survey, some notable differences in drinking patters occur throughout the country. The overall rate of drinking in the year before the survey was about 77%, with Quebec having the highest rate in the country and Prince Edward Island having the lowest rate. In terms of exceeding Canada’s low-risk “chronic” drinking guidelines, Newfoundland and Labrador had the highest rates at approximately 20%, and Alberta had the lowest rate at about 13%. For the low-risk “acute” drinking guidelines, Newfoundland and Labrador also had the highest rate in Canada, while New Brunswick had the lowest. • Alcohol abuse is a widespread and severe health problem in many First Nations communities, especially for adolescents and young adults. • Men more than women report drinking patterns that exceed Canada’s low-risk drinking guidelines for both chronic and acute effects • Women tend to become addicted to alcohol later in life than men and have fewer years of heavy drinking • Alcohol abuse is widespread and a severe health problem in First Nations Communities

Answer 146

* Binge drinking, defined as a pattern of alcohol use that brings a person’s BAC up to 0.08% or above or having five drinks in a row for men or four in a row for women. * Statistics Canada defines “heavy drinking” as having five or more drinks on one occasion, at least once a month over the past year. * Binge drinkers are more likely to miss classes, get behind in schoolwork, and argue with their friends. There is evidence that binge drinking can lead to: * High-risk sexual behaviour * Automobile crashes * Injuries and violence * Suicide

Answer 147

* A variety of factors are involved in the cause of alcoholism, including: * Genetic factors. Studies of identical twins have shown that genetics is a factor. Adoption studies show that children of alcoholics are at increased risk, even when adopted by non-drinkers. Many genes are thought to be involved in shaping the risk for alcoholism. * Personality disorders * Having grown up in a violent or otherwise troubled household * Imitation of parents and peers * Those beginning excessive drinking in their teens are especially prone to binge drinking and alcoholism later in life. * Psychological tendencies such as denial and rationalization • Social factors, including urbanization, disappearance of extended family, loosening of kinship ties, increased mobility, and changing values • The social implications of alcoholism are great. – For every person who is an alcoholic, at least three or four other people are directly affected. – Alcoholics are likely to suffer other mental disorders in addition to their substance dependence. Many alcoholics also have other substance-abuse problems.

Answer 148

* Alcoholics Anonymous (AA) uses a 12-step program that requires recognition of powerlessness over alcohol and the need for help from a “higher power.” * The alcoholic may rely on a sponsor for support and crisis intervention. * AA shows that abstinence can be achieved and provides a sober peer group. * Alternatives to AA may avoid any emphasis on a “higher power.” * Al-Anon is a program for friends and families of alcoholics to help them explore how they enabled the alcoholic to drink and to learn how to change codependent behaviour. * Employee assistance and school-based programs can deal directly with school and work issues that might be sources of stress for the abuser. * Some programs focus on effective coping responses; some help the abuser learn new cognitive concepts. * Inpatient hospital rehabilitation can help those with serious medical or mental problems, but treatment should continue after a patient returns to the community. * Pharmacological treatments include disulfiram, which causes people to become violently ill when they drink; naltrexone, which reduces the pleasant effects of alcohol and usually does not make the user ill; and Acamprosate which helps people maintain alcohol abstinence after they have stopped drinking. * Success rates of conventional treatment programs are about the same for men and women and for members of different ethnic groups. Women, minorities, and the poor often face social and economic obstacles to receiving treatment. * Most alcoholics require a treatment program, although approximately one-third stop drinking on their own or reduce their drinking enough to eliminate problems. * No single treatment works for everyone. * Because many alcoholics have patterns that fluctuate, their alcoholism is probably a response to environmental factors such as stress and may be helped by treatment.

Answer 149

• Strategies for helping a friend or relative with an alcohol problem include: • Making sure you do not become an enabler or codependent by making excuses for the abuser. -Encouraging the use of available resources for treatment and going with him or her to the appointment. • Be sure you are not enabling someone to continue excessively using alcohol • Don’t label the person • Be open, honest • Guide the individual to appropriate help

Answer 150

* Drinking Behaviour and Responsibility * The responsible use of alcohol means drinking in such a way as to keep BAC low and behaviour under control. * Be aware of why you drink and examine your attitudes about alcohol use. Common reasons college students give for drinking are to increase feelings of sociability; to relieve anxiety or tension; to reduce inhibitions of thought, speech, and action; to go along with friends; and to experience an altered state of consciousness. * The “CAGE” screening test can help determine whether you, or someone close to you, may have a drinking problem. If you answer “yes” to more than one question below, it is likely you have a problem. * Have you ever felt that you should: * Cut down on your drinking * Have people Annoyed you by criticizing your drinking? * Have you ever felt bad or Guilty about your drinking? * Have you ever had an Eye-opener (a drink first thing in the morning to steady your nerves or get rid of a hangover)? Tips to keep drinking under control include: 1. Drinking slowly, in sips – not to quench thirst. 2. Spacing out drinks by interspersing non-alcoholic drinks; learning to refuse. 3. Eating before and during drinking. 4. Knowing your limits, the percentage of alcohol in your drinks, and the effects your surroundings have on your response to alcohol. Ways to promote responsible drinking include: 1. Cultivating and modelling responsible attitudes toward alcohol. 2. Learning to be a responsible host or hostess regarding alcohol. 3. Planning social functions without alcohol. 4. Holding drinkers responsible for their behaviour. 5. Learning about prevention programs. 6. Taking community action, such as joining a group like Students Against Destructive Decisions (SADD).

Answer 151

availability, appropriate ect.

Answer 152

Psychological or physical dependence on a substance or behaviour, characterized by a compulsive desire and increasing need for the substance or behaviour, and by harm to the individual and/or society.

Answer 153

Any habit that has gotten out of control, resulting in a negative effect on one’s health.

Answer 154

Profound changes in mood, thinking, and perception.

Answer 155

A drug that produces a loss of sensation with or without a loss of consciousness.

Answer 156

The brain and spinal cord.

Answer 157

A relationship in which a non-substance-abusing partner or family member enables the other’s substance abuse.

Answer 158

A state in which a person loses the sense of his or her own reality or perceives his or her own body as unreal.

Answer 159

A drug that decreases nervous or muscular activity, causing drowsiness or sleep.

Answer 160

The relationship between the amount of a drug taken and the intensity or type of the resulting effect

Answer 161

Any chemical other than food intended to affect the structure or function of the body.

Answer 162

The presence of two or more mental disorders simultaneously in the same person; for example, drug dependence and depression.

Answer 163

An exaggerated feeling of well-being.

Answer 164

A perceptual distortion or bizarre thought that recurs after the chemical effects of a drug have worn off.

Answer 165

Similar to addiction, involving the routine use of a substance, but without the level of compulsion or increasing need that characterizes addiction.

Answer 166

Any of several drugs that alter perception, feelings, or thoughts; examples are LSD, mescaline, and PCP.

Answer 167

The subjectively pleasing effects of a drug, usually felt quite soon after the drug is taken.

Answer 168

The state of being mentally affected by a chemical (literally, a state of being poisoned).

Answer 169

A brain chemical that transmits nerve impulses.

Answer 170

Any of several natural or synthetic drugs that relieve pain and cause drowsiness and/or euphoria; examples are opium, morphine, and heroin; also called a narcotic.

Answer 171

The overall effects of a drug on a person’s behaviour, psychology, and chemistry.

Answer 172

The result of physiological adaptation that occurs in response to the frequent presence of a drug; typically associated with tolerance and withdrawal.

Answer 173

A response to an inert or innocuous medication given in place of an active drug.

Answer 174

A drug that can alter a person’s consciousness or experience.

Answer 175

A severe mental disorder characterized by a distortion of reality; symptoms might include delusions or hallucinations.

Answer 176

The induction of a calm, relaxed, often sleepy state.

Answer 177

A situation in which information learned in a drug-induced state is difficult to recall when the effect of the drug wears off.

Answer 178

A drug that increases nervous or muscular activity.

Answer 179

A maladaptive pattern of use of any substance that persists despite adverse social, psychological, or medical consequences. The pattern may be intermittent, with or without tolerance and physical dependence.

Answer 180

A cluster of cognitive, behavioural, and physiological symptoms that occur in an individual who continues to use a substance despite suffering significant substance-related problems, leading to significant impairment or distress; also known as addiction.

Answer 181

A condition in which a stimulus evokes not only the sensation appropriate to it but also another sensation of a different character, such as when a colour evokes a specific smell.

Answer 182

The relationship between the time elapsed since a drug was taken and the intensity of its effect.

Answer 183

Lower sensitivity to a drug so that a given dose no longer exerts the usual effect and larger doses are needed.

Answer 184

A CNS depressant that reduces tension and anxiety.

Answer 185

Physical and psychological symptoms that follow the interrupted use of a drug on which a user is physically dependent; symptoms may be mild or life-threatening.

Answer 186

* A drug is any chemical other than food intended to affect the structure or function of the body * A psychoactive drug is a drug which alters a person’s experiences or consciousness and is most often associated with abuse and addiction * Intoxication is a short-term state in which sometimes unpredictable physical and emotional changes occur

Answer 187

* Addictive behaviours are habits that are out of control and that negatively affect a person’s health. * Definitions of addiction can encompass drug use and other behaviours. * Addiction has historically been defined as involving chemical changes in a user’s body, such as physical tolerance to a certain drug. * Certain activities, such as eating or gambling, may trigger the release of brain chemicals that produce pleasure in the same way that psychoactive drugs do. * Although brain chemistry seems to influence addiction, an individual still bears responsibility for his or her addictive behaviour. Other factors, such as lifestyle and personality traits, play key roles in the development of addictive behaviours. * Scientists view addition as a chronic disease that involves disruption of the brain’s systems related to reward, motivation, and memory. Dysfunction in these systems leads to biological, psychological, and social effects associated with pathologically pursuing pleasure or relief by substance use and other behaviours.

Answer 188

• Addiction is a chronic disease that disrupts the brain’s system of motivation, reward, and memory – Characterized by a compulsive desire and increasing need for a substance or behaviour, and by harm to the individual and/or society • Tolerance is a physical state in which the body adapts to a drug so that the initial dose no longer produces the original physical or psychological effects

Answer 189

Certain characteristics help distinguish between a habit and an addiction: 1. Reinforcement – the behaviour produces a pleasurable state or relieves a negative one 2. Compulsion or craving – the individual is compelled to engage in the behaviour 3. Loss of control – the individual cannot block the impulse to do it 4. Escalation – the individual devotes increasing resources to the behaviour 5. Negative consequences – the behaviour continues despite serious negative consequences

Answer 190

• Many potentially addictive behaviours can be harmless or even beneficial if done appropriately and in moderation. Problems develop when a person becomes increasingly dependent on the behaviour, even when it is no longer pleasurable. Any substance or activity that becomes the focus of a person’s life at the expense of other needs and interests can be damaging to health. * Many common behaviours – shopping, drinking, eating, exercising – are potentially addictive. Factors that influence whether they become problematic include personality, lifestyle, heredity, the social and physical environment, and the nature of the substance or behaviour. * Often starts when a person does something to bring pleasure or avoid pain; if it works, the behaviour is repeated * Withdrawal is a set of symptoms including anxiety, pain, irritability, sweating, tremors, vomiting, and insomnia

Answer 191

* People with addictions seem to share some characteristics, such as difficulty in dealing with stress, genetic predisposition to addiction to a substance, and difficulty in controlling impulses. * Addictive behaviours include compulsive or pathological gambling, sex and love addiction, compulsive spending or shopping, exercising, work, and internet addiction. * Use substances as a coping strategy * May be genetically predispositioned * Have difficulty with impulse control and self- regulation * Engage in risk taking

Answer 192

* Gambling * Compulsive exercising * Work addiction * Sex and love addiction * Compulsive buying or shopping • Internet addiction

Answer 193

* The drug tradition * Drugs have been used to alter consciousness since prehistory – plants often were used for religious, medicinal, and personal reasons. * By the 1800s, chemists had extracted active elements from medicinal plants, starting the field of pharmacy – the art of compounding drugs, and of pharmacology – the science and study of drugs. * Chemists began extracting the active chemicals from medicinal plants, such as morphine from the opium poppy and cocaine from the cocoa leaf. * Legislation to protect consumers was passed, and drug use by the middle class dropped sharply during the first half of this century. Drug use became restricted to and identified with criminal subcultures. * In North America during the 1960s and 1970s, nonmedical drug use became more prevalent, peaking in 1979. Drug use rates declined until the early to mid 1990s, when rates began to rise in certain age groups. * Pharmacy, the art of compounding drugs from various substances, began in the nineteenth century * Pharmacology is the science and study of drugs * One used for medicinal purposes, non-medical (recreational) drug use expanded in Canada during the 1960s and 1970s

Answer 194

• The American Psychiatric Association (APA) has adopted the terms substance (drug) abuse and substance dependence rather than addiction. These terms are more precise and more directly related to drug use. • The most recent diagnostic manual (DSM-5) combines the previously defined categories of substance abuse and substance dependence into a single condition called substance use disorder. A diagnosis of mild substance use disorder requires that an individual displays 2-3 symptoms from a list of 11 possible criteria. For a diagnosis of moderate or severe substance use disorder, individuals must exhibit 4-5 symptoms or 6-11 symptoms, respectively. The list of criteria is as follows: • Developing tolerance to the substance. When a person requires increased amounts of a substance to achieve the desired effect or notices a markedly diminished effect with continued use of the same amount, he or she has developed tolerance. • Experiencing withdrawal. In an individual who has maintained prolonged, heavy use of a substance, a drop in its concentration within the body can result in unpleasant physical and cognitive withdrawal symptoms. Withdrawal symptoms are different for different drugs. For example, nausea, vomiting, and tremors are common for alcohol, opioids, and sedatives. Some drugs have no significant withdrawal symptoms. • The APA’s Diagnostics and Statistical Manual of Mental Disorders (DSM-5) is the authoritative reference for defining all sorts of behavioural disorders • The APA uses the term ‘substance use disorder’ • Mild substance use disorder requires an individual displays 2-3 symptoms • Moderate or severe disorder requires an individual exhibit 4-5, or 6-11 symptoms, respectively

Answer 195

1. Developing tolerance 2. Experiencing withdrawal 3. Taking substance in larger amounts over time 4. Cravings 5. Making unsuccessful efforts to cut down or regulate substance use 6. Spending a great deal of time obtaining, using, and recovering from effects of the substance 7. Giving up or reducing important activities 8. Continuing to use the substance in spite of recognizing that it is contributing to a psychological or physical problem 9. Using the substance repeatedly, resulting in failure to fulfill obligations at work, school, or home 10. Using the substance repeatedly, resulting in hazardous situations 11. Continuing to use the substance despite social or interpersonal problems • Taking the substance in larger amounts or over a longer period than was originally intended. • Craving, or a strong desire or urge to use a substance. • Unsuccessful efforts to cut down or regulate substance use. • Spending a great deal of time obtaining the substance, using the substance, or recovering from its effects. • Giving up or reducing important social, school, work, or recreational activities because of substance use. • Continuing to use the substance despite recognizing that it is contributing to a psychological or physical problem. • Repeated use resulting in failure to fulfill obligations at work, school, or home. • Repeated use resulting in hazardous situations. • Continued use despite social or interpersonal problems.

Answer 196

* All income and education levels * All ethnic groups * All ages * Drug users come from all income and educational levels, all races and ethnic groups, and all age groups. * Special risk factors for trying illegal drugs are chiefly socioeconomic, not racial or ethnic. These include: * Being male – males are twice as likely as females to use drugs. * Being a troubled adolescent-teens are more likely to try drugs if they have poor self-image or self-control, use tobacco, or suffer from certain mental or emotional problems. * Being a thrill-seeker – a sense of invincibility is a factor in drug experimentation. * Being in a peer group that accepts drug use – young people who are uninterested in school and earn poor grades are more likely to try drugs. * Being in a dysfunctional family – chaotic home life or parental abuse increases the risk of drug use. Risk is also higher for children from single-parent families or whose parents did not finish high school. * Being poor – young people who live in disadvantaged areas are more likely to be around drugs at a young age. * Dating young – adolescent girls who date boys two or more years older than themselves are more likely to use drugs. * Those who do not use drugs share certain characteristics: * High self-esteem and self-concept * Strong family with a clear policy on drug use * Open communication with parents * Social competence * Academic achievement * Regular attendance at religious services

Answer 197

* Being male * Being a troubled adolescent * Being a thrill-seeker * Being in a dysfunctional families * Being in a peer group that accepts drug use * Being poor * Dating young

Answer 198

* Reasons for drug use depend on both the user and the drug. * Young people are drawn to drugs by the allure of the exciting and illegal. * They are curious, rebellious, or vulnerable to peer pressure. * They need to appear daring and to be part of the group. * They imitate adult models. * Most people try drugs to experiment but do not continue use. * Many users are motivated by a desire to escape boredom, anxiety, depression, feelings of worthlessness, or other symptoms of psychological problems. * Widespread reliance on both illegal and prescription drugs may partly reflect society’s practice of looking for a drug solution to every problem. * Reasons for using drugs are magnified in inner cities, where problems are more devastating and buying and selling of drugs becomes an economic opportunity.

Answer 199

• Risk factors for substance dependence seem to be a combination of physical, psychological, and social factors. • Physical risk factors include genetic factors, prenatal exposure to drugs, and chronic pain. • Psychological risk factors include difficulty in controlling impulses; need for excitement, stimulation, and immediate gratification; feelings of rejection, hostility, anxiety, or depression; and a need to blot out emotional pain. Existing mental illness is a very significant risk factor. • Social risk factors include drug abuse in the family; belonging to a peer group that encourages abuse; and poverty. Health-care professionals also have higher risk because they have easy access to drugs. • A combination of physical, psychological, and social factors • Social factors include family drug use, peer drug use, and living in • Due to ease of access, health care professionals are also at higher risk • Dual diagnosis (having two or more coexisting psychological problems) • Psychological risk factors for drug dependence include: – Difficulty in controlling impulses – Strong need for excitement, stimulation, immediate gratification – Feelings of rejection, hostility, aggression, anxiety, or depression – Mental illness (dual disorders)

Answer 200

* Drug abuse brings about symptoms of another mental illness * Mental disorders can lead to drug abuse * Overlapping genetic vulnerabilities * Overlapping environmental triggers * Involvement of similar brain regions * Drug use disorders and other mental illness are developmental disorders

Answer 201

* Intoxication * Unexpected side effects * Unknown drug constituents * Risks associated with injection drug use * Legal consequences * There are several other serious potential consequences of drug use besides dependence. * People under the influence of drugs are more likely to be injured from a variety of causes, including falls, drowning, and automobile crashes; to engage in unsafe sex, increasing risk of STIs and unintended pregnancy; and to be involved in incidents of aggression and violence, including sexual assault. * Side effects can range from nausea and constipation to paranoia, depression, heart failure, and the risk of fatal overdose. * As there is no quality control in the illegal drug market, the composition, dosage, and toxicity of street drugs is highly variable. * Many injection drug users share or reuse needles, syringes, and other injection equipment, which can easily become contaminated with the user’s blood. Blood can carry the HIV virus and the hepatitis C virus. * Syringe or needle exchange programs, in which injection drug users turn in a used syringe or needle and get back a new one free, have been advocated to help slow the spread of HIV and reduce rates and cost of other health problems associated with injection drug use. * Opponents argue that supplying addicts with syringes and needles give them the message that illegal drug use is acceptable. * Since psychoactive drugs are illegal, using them can result in large fines and/or imprisonment.

Answer 202

* Drug use changes brain chemistry in predictable ways, but the noticeable effects may vary depending on drug factors, user factors, and social factors * When a psychoactive drug reaches the brain, it affects neurotransmitters, for example cocaine works by keeping dopamine active. The more quickly a drug reaches the brain, the more likely the user is to become dependent. * A drug reaches the brain and acts on neurotransmitters, chemicals that transmit nerve impulses * Neurotransmitters’ concentration and actions are either increased or decreased

Answer 203

1. Pharmacological properties (overall effects of a drug) 2. Dose-response function (relationship between amount of drug and intensity/type of effect) 3. Time-action function (relationship between time elapsed since drug was taken and intensity of its effect) 4. Drug use history (tolerance) 5. Method of use (ingestion, inhalation, injection, or absorption) • Drug factors, the properties of the drug itself and differences in how it is used, are classified into five types: • Pharmacological properties of a drug are its overall effects on body chemistry, behaviour, and psychology. • These properties include the amount of a drug required to exert various effects and the time course of these effects. • Other characteristics include a drug’s chemical composition. • Dose-response function is the relationship between the amount of drug taken and the intensity and type of effect, which may not be direct or proportional to the volume consumed. • Time-action function is the relationship between time elapsed since the drug was taken and the intensity of the effect; effects are generally greatest when concentrations are changing most quickly in the tissues, especially if they are increasing. • Drug-use history influences the effects of, and response to, a drug, meaning that users may have to refrain from using a drug for a while before the same dosage will exert its original effects. • The method of use, or the route of administration, affects the strength of the response.

Answer 204

• User factors include body mass, general health, genetic factors, concurrent use of other chemicals, and pregnancy. • Any use of drugs during pregnancy has an adverse effect on the fetus. Response can be affected by user expectations, the psychological set; psychological and social factors are especially important when small doses are given. The placebo effect occurs when a person responds to an inert substance as if it were an active drug. • Body mass • General health • Genetic factors • Metabolic rate • Biochemical state • Pregnancy

Answer 205

* Psychological set (expectations about how one will react to the drug) * High (pleasing effects of a drug) * Placebo effect (response to an inert or innocuous medication given in place of an active drug)

Answer 206

* Social factors include the setting, that is, the physical and social environment surrounding the drug use. * Use at home might have effects different from use at a party or in a laboratory setting. * Setting and user’s expectations can have greater effects than the drug itself.

Answer 207

* The major psychoactive drugs are opioids; central nervous system (CNS) depressants; central nervous system stimulants; cannabis and other cannabis products; hallucinogens; and inhalants * Opioids * Central nervous system depressants * Central nervous system stimulants * Marijuana and other cannabis products • Hallucinogens * Inhalants

Answer 208

* Opioids (narcotics) are natural or synthetic drugs designed to relieve pain, cause drowsiness, and induce euphoria. In small doses opioids have beneficial medical uses, including pain relief and cough suppression. * Examples are opium, morphine, heroin, methadone, codeine, hydrocodone, oxycodone, meperidine, and fentanyl. * Opioids reduce anxiety and produce lethargy, apathy, and an inability to concentrate. * Opioids can be injected, absorbed through the digestive tract, or inhaled. * Although the opioids are taken to produce euphoria, many first-time users experience vague uneasiness, nausea, vomiting, or unpleasant sensations. * Abuse of opioids often results in dependence, and tolerance develops rapidly. * The rate of heroin use, while still low, has nearly doubled among high school students. * Symptoms of heroin overdose include respiratory depression, coma, and constriction of the pupils; death can result. * Also called narcotics * Relieve pain, cause drowsiness, induce euphoria * Types of opioids include opium, morphine, heroin, methadone, codeine, hydrocodone, oxycodone, meperidine, and fentanyl * In small doses, have medical benefits (pain relief and cough suppressant) * People become less active and less responsive to frustration, hunger, sexual stimulation * Typically injected or absorbed into the body from the stomach, intestines, nasal membranes, or lungs * The use of opioids often results in dependence * Prescription pain killers may lead to addiction

Answer 209

• Central nervous system depressants (sedative-hypnotics) slow the activity of the CNS; effects range from mild sedation to death. • The most common CNS depressants are alcohol, barbiturates, and other sedatives. • Barbiturates can be taken orally or injected. Common antianxiety agents, or tranquilizers, include Valium, Xanax, Librium, clonazepam, and flunitrazepam. Other CNS depressants include methaqualone, ethchlorvynol, chloral hydrate, and gamma hydroxybutyrate. • CNS depressants reduce anxiety and cause mood changes, impaired muscular coordination, and drowsiness. Mental functioning also is affected, although effects differ in degree. • CNS depressants are used to treat insomnia and anxiety disorders and to control seizures. They can be used to calm people before surgical or medical procedures. • People usually start to use CNS depressants either because they have a prescription or because they are given some by drug-using friends. It is then easy to increase the dose or frequency to increase the effect, which can lead to dependence. • Most CNS depressants can lead to classical physical dependence, tolerance, and withdrawal. • Withdrawal can be characterized by anxiety, shaking, weakness, convulsions, and possible cardiovascular collapse and death. • Tranquilizers can produce physical dependence even when taken at prescribed doses. • Use of depressants can produce mental confusion and negative emotional effects, as well as impaired judgment and physical coordination. • Overuse of CNS depressants can lead to death. CNS depressants taken with alcohol can be deadly, and each can increase the effects of the other when taken concurrently. • Sedative-hypnotics slow down the overall activity of the CNS • Types include ‘downers’ and anti-anxiety agents (sedatives, tranquilizers) • Reduce anxiety, mood changes, impaired muscular coordination, slurring of speech, and drowsiness or sleep. • Medical uses include antianxiety, insomnia, seizure disorders • Person may go from use to abuse • Overdosing (combining with another depressant is dangerous) and can cause the CNS to stop

Answer 210

* Central nervous system stimulants (cocaine, amphetamines, nicotine, ephedrine, and caffeine) speed up the activity of the nervous system: heart rate accelerates, blood pressure rises, gastric and adrenal secretions increase, and muscular tension and motor activity increase. Pupils and bronchial tubes dilate, blood vessels constrict, and wakefulness is common. * Cocaine, derived from leaves of coca shrubs, originated in the Andes mountains. Called “coke” or “snow,” it produces an intense euphoria. * Although initially used to treat addiction to alcohol or morphine, its side effects and dangers became apparent. * The number of casual cocaine users has declined since 1985; the introduction of “crack” cocaine has shifted much of the use to poor, inner-city users. * It is usually snorted and absorbed through nasal mucosa or injected for most intense effects. Cocaine is also processed with baking soda and water, producing crack – a ready-to-smoke form of cocaine available as small beads or pellets. Crack has made cocaine more accessible to those without the money to buy cocaine. * Cocaine produces almost immediate, intense, short-lived effects, including 5 to 20 minutes of euphoria, followed by irritability, anxiety, or depression. * The larger the dose and the more rapidly it is absorbed, the greater the immediate and potentially lethal effect * Sudden death is most commonly the result of excessive CNS stimulation that causes convulsions, respiratory collapse, irregular heartbeat, and blood clots that can lead to heart attack or stroke. * Speed up the activity of the nervous or muscular system (accelerated heart rate, increased blood pressure, constricted blood vessels, dilated pupils and bronchial tubes, increased gastric and adrenal secretion) * Most common CNS stimulants are cocaine, amphetamines, nicotine, ephedrine, and caffeine

Answer 211

* Chronic users often develop irritation of the nasal mucosa and bleeding and ulceration of the nasal septum. * Long-term use of cocaine may cause paranoia and/or aggressiveness. * Cocaine must be taken frequently to produce its desired effect and to relieve the depression that accompanies withdrawal. * Use of cocaine during pregnancy can have serious effects because cocaine passes from the mother’s bloodstream into the placenta. * Cocaine use increases the risk of miscarriage, premature labour, stillbirth, and low birth weight. * Infants exposed to cocaine prenatally are more likely to have a small head circumference and defects of the genitourinary tract, cardiovascular system, central nervous system, and extremities. * Cocaine produces a feeling of euphoria * Usually snorted or injected intravenously * Can also be smoked as ‘crack’ * Sudden death may occur from excessive CNS stimulation

Answer 212

* Amphetamines are synthetic chemicals that are potent CNS stimulants. They include dextroamphetamine, d-l-amphetamine, and methamphetamine. “Ice” is a smokable form of methamphetamine that quickly leads to dependence. * Small doses of amphetamines usually make people feel more alert. * In addition, they increase motor activity but do not alter a rested person’s ability to do complex physical tasks or perform high-level thinking. * Because they speed up body processes and suppress the appetite, amphetamines have been used as diet aids and for weight control. Their effect is short-lived, however, and not recommended. * Amphetamine abuse begins with attempts to cope with a temporary situation and may lead to bad judgment and sudden exhaustion. * State dependence, the inability to recall information learned in a drug-induced state when in a normal state, leads students’ performance to drop radically when the drug is not available. * Continued use leads to tolerance, and increased doses can produce temporary psychosis in some cases, characterized by episodes of paranoia and unprovoked violence. Signs of brain damage, including impaired memory and motor coordination, have been identified in long-term users. * Chronic, high-dose use is often associated with psychological cravings. * Amphetamine use during pregnancy is associated with premature birth, stillbirth, low birth weight and early infant death. Infants exposed prenatally are at increased risk of cleft palate, cleft lip, and deformed limbs. Babies also can experience withdrawal from amphetamines. * ‘Uppers’ * Benzedrine, Dexedrine, Methedrine (‘meth’) * Small doses help people feel more alert; may help curb appetite * Abuse begins as an attempt to cope with a temporary situation * State dependence or psychosis may occur

Answer 213

* Ritalin is a stimulant with effects similar to those of amphetamine. When take orally as prescribed, it has little potential for abuse, but dependence can quickly develop if it is injected or snorted. * Used to treat attention deficit hyperactivity disorder (ADHD) * When taken orally at prescribed doses, there is little potential for addiction * When injected or snorted, addiction can result

Answer 214

* Ephedrine is somewhat less potent than amphetamine but has some stimulant effects. It has been linked to heart arrhythmia, stroke, psychotic reactions, and some deaths, and it may be particularly dangerous at high doses or when combined with another stimulant such as caffeine. * Use is linked to heart arrhythmia, stroke, psychotic reactions, seizures, some deaths * Maybe dangerous at high doses, especially when combined with another stimulant

Answer 215

* Caffeine, one of the oldest and most popular stimulants, is found in tea, coffee, cocoa, some soft drinks, headache remedies, and over-the-counter (OTC) preparations. * Caffeine produces alertness and a sense of well-being and reduces feelings of fatigue or boredom. It stimulates the heart and respiratory system, increases muscular tremor, and increases gastric secretion. Caffeine use by people who are hypertensive can cause blood pressure to rise further above normal. * In higher doses it may cause nervousness, irritability, headache, sleeplessness, and gastric irritation or peptic ulcers. * Some people, especially children, are vulnerable to adverse effects, becoming hyperactive and excessively sensitive to any stimulation in their environment. In people with type 2 diabetes, caffeine may cause insulin levels to rise after meals. * Although caffeine-containing drinks are rarely harmful for most people, caffeine does induce dependence. Reactions to caffeine withdrawal often include irritability, headache, or mild depression. * One of the most popular and most ancient psychoactive drugs * Found in coffee, tea, cocoa, soft drinks, headache remedies, OTC preparations * Can produce alertness and sense of well-being but use is followed by a sudden letdown

Answer 216

• Cannabis, a crude preparation of parts of the Indian hemp plant, Cannabis sativa, is one of the most widely used drugs in Canada. • More than 44% of Canadians have tried marijuana at least once. • THC, (tetrahydrocannabinol) is the active ingredient. The potency of various marijuana preparations depends on their THC concentration. The average potency of street marijuana has increased. • Marijuana can be smoked or ingested. • Short-term effects and uses include: • Low-dose effects are influenced by the user’s expectations and past experiences. Low-dose effects include euphoria, heightened subjective sensory experiences, a slowed sense of time, and relaxation. • Moderate doses can lead to impaired memory function, disturbed thought patterns, lapses of attention, and feelings of depersonalization, in which the mind seems to be separated from the body. • Effects at higher doses are determined by the drug itself rather than by expectations and setting. Very high doses produce feelings of depersonalization, sensory distortion, and changes in body image. Inexperienced users may become anxious or even panic at these sensations. Unexpected reactions have resulted in an increase in emergency room visits. • Marijuana causes increases in heart rate and dilation of blood vessels in the eyes. • Long-term use has been shown to cause chronic bronchial irritation and precancerous changes in the lungs, although at least one study raises doubts about the seriousness of some of these risks. There may also be an increased risk of emphysema and cancer of the head and neck. Among people with chronic conditions like cancer and AIDS, marijuana use is associated with increased risk of fatal lung infections. • Heavy users may experience learning problems, as well as subtle impairments of attention and memory that may or may not be reversible with prolonged abstinence. • Long-term use has been shown to cause chronic bronchial irritation and precancerous changes in the lungs, although at least one study raises doubts about the seriousness of some of these risks. There may also be an increased risk of emphysema and cancer of the head and neck. Among people with chronic conditions like cancer and AIDS, marijuana use is associated with increased risk of fatal lung infections. • Heavy users may experience learning problems, as well as subtle impairments of attention and memory that may or may not be reversible with prolonged abstinence. • Long-term use may reduce testosterone levels and sperm counts and increase sperm abnormalities. • Use during pregnancy may impair fetal growth and development and may act synergistically with alcohol to increase the damaging effects of alcohol on the fetus. • Dependence does not develop in the same manner as with other drugs; however, marijuana may become the focus of the user’s life to the exclusion of everything else. Common symptoms of withdrawal include anger, aggression, irritability, nervousness or restlessness, sleep difficulties, and decreased appetite or weight loss. • As of October 17, 2018, the recreational use of cannabis is legal in Canada based on the new Cannabis Act. It permits adults to: • Possess up to 30 grams of legal cannabis, dried or equivalent in non-dried form in public. • Share up to 30 grams of legal cannabis with other adults. • Buy dried or fresh cannabis and cannabis oil from a provincially-licensed retailer. • Grow, from licensed seed or seedlings, up to four cannabis plants per residence. • Make cannabis products, such as food and drinks, at home as long as organic solvents are not used • to create concentrated products. • The Cannabis Act takes a public health approach to cannabis legalization and regulation and aims to accomplish three specific goals: • to keep cannabis out of the hands of youth. • to keep profits out of the hands of criminals. • to protect public health and safety by allowing adults to access safe, legal cannabis. • Law enforcement officers are trained to detect drug-impaired driving, and consequences for driving impaired could include a fine, criminal charges, or even jail time for those who drive impaired by cannabis or other drugs. If police have a reasonable suspicion that a driver has a drug in their body, they may demand an oral fluid sample to test for drug presence at the roadside. With reasonable grounds, police may also pursue drug recognition evaluation or take a blood sample. • Comes from the hemp plant Cannabis sativa • THC (tetrahydrocannabinol) is the main active ingredient • Usually smoked but can also be ingested • Short term effects and uses – Euphoria, depersonalization • Long-term effects – Respiratory damage • Dependence may develop • Withdrawal symptoms can occur

Answer 217

* Hallucinogens are drugs that alter the user’s perception, feelings, and thoughts. * Common hallucinogens are LSD, mescaline, psilocybin, STP, DMT, MDMA, ketamine, and PCP. * LSD produces powerful results in the form of altered sense of time, visual disturbances, improved hearing, changes in mood, distorted body perception, dilated pupils, dizziness, weakness, and nausea. Larger doses of LSD produce synesthesia, feelings of depersonalization, and other alterations in the perceived relationship between self and external reality. * Hallucinogens induce tolerance so quickly that users must stop using after several days and abstain for a while to receive the desired effect. * Hallucinogens do not produce drug-seeking behaviour, physical dependence, or withdrawal symptoms. * Effects from low doses are largely determined by expectations and setting; effects are difficult to describe because they involve altered states of consciousness. * Some people have used LSD to experience altered states or to explore their own psyche through religious or mythical drug-induced experiences. * Users are always subject to panic reaction, or “bad trip,” regardless of dose or situation. Spontaneous flashbacks, perceptual distortions, and bizarre thoughts can occur long after the drug is eliminated from the body. * Other hallucinogens are similar to LSD but differ in the timing of their effects and in the amount of intellectual impairment and confusion they cause. * MDMA has both hallucinogenic and amphetamine-like properties. Risks of MDMA include overdose, hyperthermia, and damage to the brain nerve cells that produce serotonin. * PCP (also known as “angel dust”) reduces and distorts sensory input, especially proprioception, the sense of body position and movement. It creates a state of sensory deprivation. * The effects of ketamine include confusion, agitation, aggression, and lack of coordination. * Mescaline, derived from the peyote cactus causes effects similar to those of LSD. It is expensive, so most street mescaline is diluted LSD or a mixture of other drugs. * Certain mushrooms, seeds, and other botanical products produce psychedelic effects but have unpleasant side effects. * Lead to altered perceptions, feelings and thoughts * LSD is a very powerful psychoactive drug, with tiny doses producing noticeable effects in most people; large doses may lead to synaesthesia * Flashbacks may occur after the drug has been entirely eliminated from the body

Answer 218

• Inhaling certain chemicals can produce effects ranging from heightened pleasure to delirium and death. • Inhalants fall into several major groups: volatile solvents, nitrites, and anesthetics. • Inhalant use is difficult to control because inhalants are found in a variety of seemingly harmless products that are legal and inexpensive. • Methods of using include sniffing, snorting, “bagging” (inhaling fumes from plastic bags), and “huffing” (placing an inhalant-soaked rag in the mouth). • Inhalants slow bodily functions. At low doses, they may cause users to feel slightly stimulated; at higher doses, they lead to lowering of inhibitions. • Inhalant use can lead to loss of consciousness; heart failure; nervous system impairment; hearing loss; increased risk of cancer; damage to the liver, kidneys, and bone marrow; and death. • Inhalant use tends to be highest among younger adolescents and declines with age. • Inhaling certain chemicals can produce effects ranging from heightened pleasure to delirium and death. Inhalants fall into several major groups: – Volatile solvents – Aerosols – Nitrates – Anesthetics

Answer 219

* Intended to have pharmacological effects similar to those of illicit drugs, but to be chemically distinct from them and therefore either legal or impossible to detect in drug screening * ‘Designer drugs’

Answer 220

* Drug research will continue to discover effects of drugs, both therapeutic and recreational. Honest and unbiased information about drugs may lead to a decrease in abuse. * Drugs carry a cost to society both financially and in human suffering. * The relationship between drugs and crime is complex. People accused of crimes related to drug possession, sale, or use have flooded the criminal justice system. Violence and use of guns are more prevalent in areas with heavy drug trafficking. * Drug abuse affects not only drug users but also their families, especially children. * Justice-related cost to society is $2 billion annually * Illegal drug use leads to more than 47 000 deaths each year * Drug abuse takes a toll on families

Answer 221

* Supporters of some form of drug legalization or decriminalization argue that legalization would eliminate much of the crime associated with drug use; opponents argue that legalization would foster greater drug abuse and dependence. * Some argue that legalizing drugs could eliminate many of the problems related to drug use * Opponents of drug legalization argue that allowing easier access to drugs would expose many more people to possible abuse and addiction

Answer 222

* In June 2018, the Government of Canada passed the Cannibis Act. On October 17, 2018 it became legal to purchase and possess marijuana for recreational use in Canada. * Each province has determined their own age limits to purchase and possess marijuana, as well as where smoking is allowed

Answer 223

* Professional treatment programs use either drug substitution or treatment centres as the basis for therapy. Successful treatment programs deal with the reasons for drug abuse and help people develop a drug-free lifestyle. Preventing relapse is an exceedingly complex medical goal. * Medication-assisted treatment involves using medications to reduce the craving for the abused drug or to block or oppose its effect. The best-known medication for drug abuse is methadone, which is a synthetic drug substituted for a more damaging one, such as heroin. * Methadone reduces the craving for heroin. Although methadone also is addictive, it allows the addict to function normally in daily activities. * Relapse rates for medication-assisted treatment are high but decrease when psychological and social services are provided concomitantly. * Treatment centers offer short-term and long-term services, including hospitalization, detoxification, counselling, and other mental health services. * One type is the therapeutic community, which is a residential program administered by ex-addicts who use confrontation, strict discipline, and peer pressure to resocialize the addict with a different set of values. * “Halfway houses” offer a transition from residential programs to independent living. * Self-help groups like Alcoholics Anonymous and Narcotics Anonymous help people acknowledge that they have a problem over which they have no control. Peer counselling is another approach. * Harm reduction strategies attempt to minimize the negative effects of the drug use and abuse; a common example is the use of designated drivers to reduce alcohol-related motor vehicle crashes. * Many treatment programs offer counselling for people close to drug abusers. These individuals can develop behaviours, known as codependency, that help or enable the drug abuser to remain drug dependent. Codependent people often engage in behaviours that remove or soften the effects of the drug use on the user – so-called enabling behaviours. * Medication-assisted * Treatment centres * Self-help groups & peer counselling • Harm-reduction strategies * Codependency

Answer 224

• Prevention of drug abuse is based on education, along with indirect approaches to building young people’s self-esteem, improving academic skills, and increasing recreational opportunities. • Teaching young people strategies to resist peer pressure is a highly effective method. • Prevention efforts need to focus on motivational theories and on approaching different groups with different techniques. • Where do you as individual fit into this complex picture of drug use and abuse? Before you try a psychoactive drug, consider the following questions: • What are the risks involved? • Is using the drug compatible with your goals? • What are your ethical beliefs about drug use? • What are the financial costs? • Are you trying to solve a deeper problem? • Responsible decisions about drug use are based on information, knowledge, and personal insight. • Governmental attempts • Anti-drug education programs • Indirect approaches – Building self-esteem, improving academic skills, recreation • Direct approaches – Provide information about the adverse effects – Peer pressure resistance • Prevention efforts need to focus on the different motivations individuals have for using and abusing specific drugs at different stages.