Drugs Use and Abuse Chapter 5, 6, 7, 8, 14 Flashcards
1
Q
How many people are sent the hospital a year because of side effects?
A
700,000
2
Q
Dose-response
A
correlation between the amount of a drug given and its effects
3
Q
Factors that affect responses to drugs
A
- size of the individual,
- stomach contents,
- different levels of enzymatic activity in the liver,
- acidity in the urine,
- time of the day,
- and state of person’s health
4
Q
Margin of safety
A
range in dose between the amount of drug necessary to cause a therapeutic effect and that needed to create a toxic effect
5
Q
Does a magic bullet drug exist?
A
None found yet (perfect drug)
6
Q
Potency
A
amount of drug necessary to cause an effect
• The smaller the dose the greater the potency
7
Q
Toxicity
A
– capacity of one drug to damage or cause adverse effects in the body
• Toxic compounds = poisons
8
Q
o 3 types of drug interactions:
A
- 1) Additive
- 2) Antagonistic (inhibitory)
- 3) Potentiative (synergistic)
9
Q
Additive interactions
A
summation of effects of drugs taken concurrently; happens when drugs are similar and actions are added together
10
Q
Antagonist interactions
A
– effects created when drugs cancel one another
11
Q
Synergism
A
– ability of one drug to enhance the effect of another; also called potentiation
12
Q
PHARMACOKINETIC FACTORS THAT INFLUENCE DRUG EFFECTS (5)
A
- Administration (how the drug enters the body)
- Absorption
- Distribution
- Activation (where does the drug produce its effects)
- Biotransformation and elimination (How inactivated or metabolized)
13
Q
Pharmocokinetics
A
Study of factors that influence the distribution and concentration of drugs in the body
14
Q
4 Principal forms of drug administration
A
- 1) Oral ingestion
- 2) Inhalation
- 3) Injection
- 4) Topical application
15
Q
Oral ingestion
A
o Most common and convenient ways
o Introduces drug into the body by way of stomach or intestines
o Difficult to control amount of drug that reaches the site of action for 3 reasons:
• 1) Drug must enter bloodstream after passing through the wall of the stomach or intestines without being destroyed or changed to an inactive form, the drug must diffuse to the target area and remain there in sufficient concentration to have effect
• 2) Materials in the stomach like food can interfere with the passage of some drugs through the gut lining and thus prevent drug action
• 3) Liver might metabolize orally ingested drugs too rapidly, before they are able to exert an effect
16
Q
Inhalation
A
o Through mouth or nose
o Because of large capillaries in lungs, chemicals can enter the blood rapidly as they can via IV and can be equally dangerous
o One serious problem is the potential for irritation to the mucous membrane lining of the lungs
o Drug may have to be continually inhaled to maintain the concentration necessary for an effect
o Common to prevent contracting AIDS which can be contracted via injection with a contaminated needle
17
Q
Injection
A
o Intervenous (IV) (in the vain), intramuscular (IM) (into the muscle, or subcutaneous (SC) (drug injection been the skin)
o Advantage is the speed of action, delivered rapidly and direction and often less drug is needed
o Impurities may irritate the vein (needle sharing)
• Same site injection elasticity of the vein is reduced causing the vessel to collapse
o Intramuscular can damage the muscle
• If nerve is destroyed, the muscle will degenerate (atrophy)
o Subcutaneous may damage skin
o Needle sharing common problem
18
Q
Topical application
A
o Skin, lining of the nose, and under the tongue for systemic (whole-body) effects
19
Q
4 Factors affecting drug distribution
A
o 1) Ability to pass across membranes and through tissues
o 2) Their molecular size
o 3) Their solubility properties
o Drugs that are soluble in fatty solutions are most likely to pass across these capillary membranes
o 4) Their tendency to attach to proteins and tissues throughout the body
20
Q
Threshold dose
A
minimum drug dose necessary to cause an effect
21
Q
Plateau effect
A
- maximum drug effect, regardless of dose
- o OTC drugs have a limit on their effect
- o Other drugs may cause distinct or opposite effect (ex: small dose of alcohol stimulant, large doses sedative effects)
22
Q
Half-life
A
time required for the body to eliminate and/or metabolize half of a drug dose
o Body eliminates the drug either directly without altering it chemically or in most instances after it has been metabolized or modified
23
Q
Biotransformation
A
process of changing the chemical properties of a drug usually by metabolism
24
Q
Primary organ for metabolism of drugs
A
o Liver primary organ that metabolizes drugs in the body
• Contains hundreds of enzymes that continually synthesize, modify, and deactivate biochemical substances
• Metabolizing enzymes highly regulatable
• Genetic variations on their structures can account for a wide variations in their activity, influencing onset, duration, and potency of drug effects
o Kidneys next most important organ for drug elimination because they remove metabolites and foreign substances from the body
• Kidneys constantly eliminate substances from the blood
• Rate of excretion of some drugs by the kidneys can be altered by making the urine more acidic or more alkaline
o Body may eliminate small portions of drugs through perspiration and exhalation
25
Metabolites
chemical products of metabolism
26
3 Physiological variables that modify drug effects
1. Age
2. Gender
3. Pregnancy
27
Tetratogenic
something that causes physical defects in a fetus
28
Dependence
physiological and psychological changes or adaptations that occur in response to the frequent administration of a drug
29
Reverse Tolerance
enhanced response to a given drug dose, opposite of tolerance
o Same response to a lower dose than an original higher dose
o Some researchers believe that its development depends on how often, how much, and in which setting the drug is consumed
o May reflect adaptive changes in the nervous tissues
30
Rebound effect
form of withdrawal; paradoxical effects that occur when a drug has been eliminated from the body
• Paradoxical because symptoms are nearly opposite to the direct effects of the drug
31
Cross-dependence
dependence on a drug can be relieved by other similar drugs
32
Psychological dependence
dependence that results because a drug produces pleasant mental effects
o Does not produce the physical discomfort, rebound effects, or life-threatening consequences that can be associated with physical dependence
o Psychological aspects may be more significant that physical dependence in maintaining chronic drug use
o Fact that their dependence does not typically induce antisocial and destructive behavior distinguishes them from most forms of dependence-producing drugs (ex: tobacco or coffee)
33
Mental set
the collection of psychological and environmental factors that influence an individual’s response to drugs
34
Drug craving (3 assessments)
* 1) Questioning patients about the intensity of their drug urges
* 2) Measuring physiological changes such as increases in heart and breathing rates, sweating, and subtle changes in the tension of facial muscles
* 3) Determining patients’ tendency to relapse into drug-taking behavior
o Distinct from the phenomenon of withdrawal
o Not likely that craving itself causes drug addiction
35
Dysphoric
characterized by unpleasant mental effects; the opposite of euphoric
36
4 Other Factors affecting drug abuse
o 1) Peer pressure
o 2) Home, school, and work environments
o 3) Mental state
o 4) Excessive stress
o 30% - 60% of drug abusers have some underlying psychiatric illness
37
2nd only to narcotic medications as the most frequently abused group of prescription medications
CNS depressants
38
Why are CNS depressants so problematic
* Prescription
* Use of CNS depressants can cause alarming, even dangerous behavior if not monitored closely
* Several seemingly unrelated drug groups have some ability to cause CNS depression and all too frequently are the cause of death by drug overdoses (Drugs mix and can be deadly)
* CNS depressants can cause disruptive personality changes that are unpredictable and sometimes very threatening
39
History of CNS depressants
1800s introduce bromides
1900s Barbiturates
1950s benzodiazepines
1970s and 1980s epidemic of prescription CNS depressants
40
Sedatives
CNS depressants used to relieve anxiety, fear, and apprehension
• Anxiolytic – drug that relieves anxiety
• Many have muscle-relaxing properties that enhance their relaxing effects
41
Hypnotic
CNS depressants used to induce drowsiness and encourage sleep
• Produce amnesiac effect as well
• Amnesiac – cause the loss of memory
42
Most frequently prescribed CNS depressant?
Benzodiazepines (like Valium)
o Large margin of safety
o Were originally referred to minor tranquilizers
o 1st benzodiazepine, chlordiazepodxide, 1960
• Valium came around the market the same time
o Valium 1972-1978 was the top-selling prescription drug in the US
o Benzodiazepine Schedule IV drugs because of dependence problems
43
Benzodiazepines affect what receptors of neurontransmitters
Neurotransmitter GABA (gamma aminobutyric acid)
44
GABA
o GABA is a very important inhibitory transmitter in several regions of the brain: the limbic system, the reticular activating system, and the motor cortex
o Benzodiazepines the inhibitory effects of GABA are increased
o Alter mood (limbic function), cause drowsiness (reticular activating system function), relax muscles (cortical function)
o Flumazenil, highly selective antagonist drug used to treat benzodiazepine overdoses
45
How many benzodiazepines available in US
15
46
Side effects of benzodiazepines
o Drowsiness, lightheadedness, lethargy, impairment of mental and physical activities, skin rashes, nausea, diminished libido, irregularities in the menstrual cycle, blood cell abnormalities, increased sensitivity to alcohol and other CNS depressants
o Only very high doses have a significant impact on respiration unlike barbiturates
o Serious suppression occurs when drugs combined with other depressants most often alcohol
o Used 50% of the time to treat persistent disorders such as chronic insomnia
o Have less effect on REM sleep than do barbiturates
• REM sleep – the restive phase of sleep associated with dreaming
o On rare occasion, cause paradoxical effects, like nightmares, anxiety, irritability, sweating, and restlessness
o These drugs should be prescribed at the lowest dose possible and for the shortest time possible or withdrawal problems can result
o Relatively new for insomnia, Ambien and Sonata Schedule IV
47
Barbiturates History
First synthesized by Bayer in 1864
o 1st barbiturate, barbital (Veronal) was used in 1903
o Since then more than 2500 barbiturates have been synthesized ; only 50 actually approved for human use
o Due to serious side effects only a few are still prescribed for medical purposes
o Names of barbiturates traditionally end in –al
48
Mechanisms of action and elimination of Barbiturates
o Precise mechanism of action for barbiturates is unclear
o Likely interfere with activity in the reticular activating system, limbic system, and motor cortex
o Do not seem to act at a specific receptor site; probably generally effect the inhibitory transmitter GABA
o Benzodiazepines and barbiturates have overlapping effects
o Different pharmacological features
o Fat solubility of barbiturates is another important factor in the duration of their effects
o Move rapidly in and out of tissues and are likely to be shorter acting
o Fat-soluble barbiturates are likely to be stored in fatty tissue, fat content of the body can influence the effects on the user
• Therefore men and women differ
49
Barbiturate-like drugs
o All of these drugs cause substantial tolerance, physical and psychological dependence, and withdrawal symptoms
o Likely replaced by safer benzodiazepines
o Safety closer to barbiturates
o Significant abuse potential
o Methaqualone – Schedule II
o Glutethimide and Methyprylon – Schedule III
o Chloral Hydrate – Schedule IV drug
50
Chloral hydrate
o Noctec of “knock-out drops)
o Slipping into people’s drinks to make them unconscious
o In 1800s mix of chloral hydrate and alcohol given name Mickey Finn when sailors short on supply on Barbary Coast of San Francisco
• Drink, wake up as a crew member
o Good hypnotic
o Narrow margin of safety
o Stomach irritant especially if given repeatedly and in fairly large doses
o Schedule IV
51
Glutethimide
o Doriden
o Can be abused and that causes severe withdrawal symptoms
o Induces blood abnormalities (anemia and abnormally white cell counts)
o If taken regularly in moderate doses, can cause nausea, fever, increased heart rate, and convulsions
o Schedule III
52
➢ Methyprylon
o Noludar
o Short-acting nonbarbiturate
o Used as a sedative and hypnotic
o Similar to Doriden
o Schedule III
53
Methaqualone
o Schedule II
o Few drugs have become so popular so quickly as methaqualone
o Sedative-hypnotic
o Introduced in India in the 1950s as an antimalarial agent
o Available in US as Quaalade, Mequin, and Parest
o Since 1985 not manufactured in the US
o Side effects: fatigue, dizziness, anorexia, nausea, vomiting, diarrhea, sweating, dryness of moutn, depersonalization, headache, and paresthesia of the extremities (pins and needles sensation of the extremities)
o Hangover
54
Antihistamines
o Both nonprescription and prescription medicinal products
o Relieve symptoms associated with the common cold, allergies, and motion sickness
o Many antihistamines cause significant CNS depression are used both as sedatives and hypnotics
o Exact mechanism of CNS depression cause by these agents not totally known
o Seems to relate to their blockage of acetylcholine receptors in the brain (antagonize the muscarinic receptor types)
o Anticholinergic activity helps cause relaxation and sedation
55
Propofol, An Abused General Anesthetic
o Diprivan
o Initially made available in 1986 and used intravenously for rapid sedation, analgesia, and general anesthesia in hospital or outpatient clinics
o Used off-label to relieve severe chronic or migraine headaches in pain clinics or for sleep induction in patients suffering from insomnia
o Initially thought to be free of abuse
o Physical dependence is rare
o Drug can cause euphoria and relive stress and pain, and has been abused and involved in suicides and accidental deaths
o Recent abuse problems have particularly involved droctos and nurses who have access to this anesthetic
o Not a scheduled substance, so easy to obtain and its effects wear off in a matter of minutes
56
GHB (Gamma-hydroxybutrate): The Natural Depressant
o GHB is colorless, tasteless, and odorless found naturally in the body resulting from metabolism of the inhibitory neurotransmitter GABA
o Some evidence that GHB is itself a neuromodulator with its own receptor targets in the brain
o Has been used in Europe as an adjunct for general anesthetic, a treatment for insomnia, and narcolepsy, treatment for alcoholism and alcohol withdrawal and narcotic dependence
o During 1980s, GHB became available OTC in health food stores and was used by body builders to stimulate the release of growth hormone to reduce face and build body muscle
o More recently, became popular for recreational use due to pleasant, alcohol-like, hangover-free high with aphrodisiac properties
o Because of abuse potential, GHB restricted by DEA in 2000
o Became known as a club drug
57
Substance abuse can be diagnosed when 3 of the following 8 criteria met
* 1) Person need greatly increased amounts of the substance to achieve the desired effect
* 2) Characteristic withdrawal occurs when drug use is stopped, encourages continued use of the substance
* 3) Substance is consumed in larger amounts over a longer period of time than intended
* 4) Person shows persistent desire or repeated unsuccessful efforts to decrease substance use
* 5) Great deal of time is spent obtaining and using the substance or recovering from its effects
* 6) Daily activities revolve around the substance
* 7) Person withdraws from family activities and hobbies to use substance privately or spend more time substance-using friends
* 8) Person continues use of the substance despite recognizing that it causes social, occupational, legal, or medical problems
58
Those who chronically abuse the CNS depressants prefer 3 things
* 1) Short-acting barbiturates such as pentobarbital and secobarbital
* 2) Babiturate-like depressants such as glutethimide, methyprylon, an d methaqualone
* 3) Faster acting benzodiazepines such as Valium, Xanax, or Ativan
59
Treatment of CNS depressant withdrawal
o Withdrawal symptoms include: anxiety, tremors, nightmares, insomnia, anorexia, nausea, vomiting, seizures, delirium, and maniacal activity
o Duration and severity of withdrawal dependent on the particular drug taken
o Approach to detoxifying a person who is dependent on a sedative-hypnotic depends on the nature of the drug, the severity of dependence, and the duration of action of the drug
o General objective to eliminate drug dependence in a safe manner while minimizing discomfort
o In reality, detoxification is rarely sufficient by itself to assure long-term abstinence from the drug
o Often basic approach is substitution with either pentobarbital or the longer-acting Phenobarbital then gradually reduced
o Using a substitute is necessary because abrupt withdrawal for a person who is physically dependent can be dangerous
o Problem of psychological dependence maybe more difficult to handle
• These types of patients require intense psychological counseling and must be trained to deal with their difficulties in a more constructive and positive fashion
• Without such psychological support, benefits from detoxification will only be temporary
60
Natural depressants
o Some plants that contain naturally occurring CNS depressants are included in herbal products or made into teas for relaxation or a treatment for sleep problems
o Best known – kava kava plan (piper methysticum)
• Belong to the pepper family and grows on South Pacific islands
• Popular in Polynesian populations and sometimes used in religious ceremonies
• Extract prepared from the part of the kava kava plant beneath the surface of the ground
• Small amounts cause euphoria and increased sociability, large doses cause substantial relaxation, lethargy, relaxed lower limbs, and eventually sleep
o 2nd type of common herb that contains CNS depressants is the Datura family of plants
• Typically associated with hallucinogenic effects
• Smaller amounts can cause sedation and even induce sleep
• Ex: Devil’s trumpet (Datura inoxia) and Jimson weed or thornapple (Datura Stramonium)
• Active ingredient typically anticholinergic drugs such as atropine or scopolamine
• Actions of the herbs are somewhat similar to the OTC antihistamine-containing sleep aids
• Higher doses cause hallucinogenic effects
• Cause constipation, dry mouth, blurred vision
61
Most consumed drug in the world
Alcohol (ethanol)
62
Only alcohol used for human consumption
Ethanol
63
Lethal level of alcohol dose
between 0.4% and 0.6% BAC
64
4 basic ingredients condition to make alcohol
* Sugar
* Water
* Yeast
* Warm temperatures
65
Fermentation
biochemical process through which yeast converts sugar to alcohol
66
Mead
fermented honey often made into an alcoholic beverage
• May have been first alcoholic beverage
67
Distillation
heating fermented mixtures of cereal grains or fruits in a still to evaporate and be trapped as purified alcohol
• Developed by Arabs around 800 AD
• Introduced to Europe 1250 AD
• Still increase concentration of alcohol potentially by 50% or higher
• Greatly intensified the problem of alcohol abuse
68
4 reasons why do people have to be reminded that alcohol is a drug?
* 1) Alcohol is legal
* 2) Widespread advertising, the media promote the notion that alcohol consumption is normal and safe
* 3) Distribution, advertisement, and sale of alcoholic beverages are widely practiced
* 4) Alcohol use has a long tradition dating back to 4000 BC
69
2 explanations for underage drinking
* 1) Altered expression of genes
* 2) Interference with normal development of critical brain systems important for learning, memory, attention, information processing, and proper decision making
70
o APA recommends physicians discourage underage drinking by:
1) Screening their adolescent patients for alcohol use
• 2) Discussing hazards of alcohol use with their teenage patients
• 3) Encouraging parents to be good role models for their children
• 4) Supporting the continuation of 21 as the minimum age for drinking
71
Properties of alcohol
o Alcohol is a chemical structure that has a hydroxyl group (OH) attached to a carbon atom
o Methyl alcohol – (methanol or wood alcohol)
• Metabolites poisonous
• Small amounts (4 mL) cause blindness and large amounts are usually fatal
• Methyl alcohol added to ethyl alcohol (ethanol or gain alcohol drinking type) that is intended for industrial use so people will not drink it
• Similar mixture “bootleg” liquor
o Ethylene glycol – alcohol used in antifreeze
o Isopropyl alcohol – rubbing alcohol, sometimes used as an antiseptic
o Ethylene and Isopropyl alcohol poisonous if consumed
o Pure ethyl alcohol (ethanol) recognized as an official drug in the US
o Amount of alcohol based on percentage by volume or older proof system
• Gun powder add a park, if alcohol content exceeded 50% it would burn and ignite the gunpowder
• % of alcohol volume is one-half the proof number
72
6 steps to how alcohol is absorbed in the body
* 1) Mouth
* 2) Stomach
* 3) Small Intestine
* 4) Bloodstream
* 5) Liver – changes alcohol to water, carbon, dioxide, and energy (oxidation) (can only oxidize 0.5 ounce of alcohol an hour)
* 6) Brain
73
What organ and enzyme digest alcohol?
o Alcoholic beverages contain almost no vitamins, minerals, protein, or fat, just large amounts of carbohydrates
o Metabolized by liver by the enzyme alcohol dehydrogenase
74
Behavioral tolerance
compensation for motor impairments through behavioral pattern modification by chronic alcohol users
75
Polydrug use
concurrent use of multiple drugs
o Occurs in 64% of alcoholics
o Can intensify intoxication
o 64% of those seeking treatment for alcoholism also were diagnosed with another drug dependence
o Explanations for mixing:
• Alcohol enhances the reinforcing properties of other CNS depressants
• Decreases the amount of an expensive and difficult-to-get drug required to achieve the desired effect
• Helps diminish the unpleasant side effects of other drugs of abuse, such as withdrawal of CNS stimulants
• Common predisposition to use alcohol and other substances of abuse
76
Diuretic
drug or substance that increase the production of urine which sometimes results in dehydration
• 1) water content increases the volume of urine
• 2) Alcohol depresses the center in the hypothalamus of the brain that controls release of a water conservation hormone
77
Treatments for hangover
o Common treatment for a hangover is to take a drink of the same alcoholic beverage that caused the hangover
• “taking the hair of the dog that bit you”
• May help the person who is physically dependent
• May work by depressing the centers of the brain that interpret pain or relieving a withdrawal response
o Another remedy is to take an analgesic compound such as aspirin-caffeine combination after drinking
• These ingredients have no effect on the actual sobering-up process
• Can make person feel worse
78
Alcohol dependence
o 140 million people around the world are afflicted with alcohol-related disorders
o 12.5 million in the US
• Men x3 likely than women
o Some degree of psychological dependence often develops
o Prototypic withdrawal patterns:
• Stage 1 (minor): Restlessness, anxiousness, sleeping problems, agitation, tremors, and rapid heartbeat
• Stage 2 (major): Minor plus hallucinations, whole-body tremors, increased blood pressure, vomiting
• Stage 3 (delirium tremens): Fever, disorientation, confusion, seizures, and fatality in 3% to 5% of cases
o Recovery from alcohol dependence is a long-term process
79
3 medications for alcohol dependence
o Alcohol dependence afflicts about 4% if the adult population only 10-15% of these patients receive appropriate treatment
• Due to misconception that alcoholism best dealt with will power
o Currently 3 medications approved by the FDA for adjunctive intervention
• 1) Oldest drug – disulfiram (Antabuse)
• Less popular because it makes the user very sick and nauseous when they consume alcohol
• Works by interfering with the metabolism of alcohol
• Typically only helpful in treatment of highly motivated alocholics
• 2) Naltrexone (opiate antagonist)
• Relieves alcohol craving and helps to reduce the relapse rates in alcohol-dependent patients
• 20% positive response, 80% nonresponsive
o Lack of such opioid receptor variant gene in the majority of alcoholics explain lack of response
• 3) Acamprosate (Campral)
• Blocks the release of the exciting neurotransmitter glutamate which reduces the withdrawal in abstinent alcoholics
o Far from being universally effective
80
Alcohol and genetics
o Alcoholism are among the most inherited types of mental illness
o Differences in the intensity of a hangover or the negative effects of drinking such as nausea and dizziness can also be influenced by genetics
o Environment equally important
81
BAC depends on
* size of the person,
* presence of food in their stomach,
* rate of drinking,
* amount of carbonation,
* ratio of muscle mass to body fat
82
Alcohol and the Brain and Nervous System
o Every part affected and in extreme cases damaged
o Even moderate consumption of alcohol can cause shrinkage of brain size
o In low moderate doses, alcohol suppresses subcortical inhibitions of the cortical control center, disinhibition
o In higher doses, depresses the cerebellum, causing slurred speech and staggering gait
o Very high doses depress the respiratory centers of the medulla, resulting in death
o Figure 7.2 pg. 196
o Alcohol alters the production and functioning of transmitters such as dopamine, serotonin, GABA, and brain endorphins, cannabinoid receptors
83
Liver and 3 stages of alcohol-liver disease
o Among alcoholics, liver damage 10-15% if deaths
o 3 stages of alcohol-induced liver disease
• 1) Alcoholic fatty liver
• Hepatotoxic effect – Liver cells increase the production of fat (enlarged liver)
• Reversible and can disappear if alcohol use is stopped
• 5-6 drinks several days for male; 2 drinks several days for female
• 2) Alcohol hepatitis – chronic inflammation occurs, reversible if alcoholic consumption ceases
• Develops as the fat cells continue to multiply
• Can be fatal
• 3) Cirrhosis – scarring of the liver and formation of fibrous tissues; results from alcohol abuse; irreversible
o Liver damage, can cause problems when taking drugs that affect liver function
➢ DIGESTIVE SYSTEM
84
Alcohol effects on blood
o High concentration of alcohol diminish effective function of the hematopoietic (blood building) system
o Problems with clotting and immunity to infection
o Lowers resistance to disease
o Affect bone marrow and can cause anemia
85
Alcohol effects on digestive system
o Digestive system includes the gastrointestinal structures involved in processing and digesting food and liquids; mouth, pharynx, esophagus, stomach, and small and large intestines
o Alcohol irritates tissues as it causes acid imbalances, inflammation, and acute gastic distress
• Results in gastritis and heartburn
o Heavy drinking has double the probability of developing cancer of the mouth and esophagus
o Prolonged use of alcohol may cause ulcers, hiatal hernia, and cancers throughout the digestive tract
o Likelihood of cancers in the mouth, throat, and stomach dramatically increases (15x) if person is also a heavy smoker
o Pancreas also damaged by heavy drinking
• Can cause pancreatitis, pancreatic cancer, pancreatic cirrhosis, and alcoholic diabetes
86
Alcohol and cardiovascular system
o Much remains unknown
o Alcohol causes dilation of blood vessels, especially in skin
• Flushing and sensation of warmth
o Regular light to moderate drinking actually reduces the incidence of heart diseases by 20 – 40% in some populations
• Maybe because increasing blood concentration of high-density lipoproteins (HDL)
• HDL molecular complex used to transport fat through bloodstream
• Mostly benefit men older than 50 and postmenopausal women
• Moderate drinking – 1 for women; 2 for men
• Race specific (help whites, increase in blacks)
o Alcohol kills 100,000 per year
87
Wernicke-Korsakoff’s syndrome
– psychotic condition connected with heavy alcohol use and associated with vitamin deficiencies
Vitamin B1 thiamine deficiency
88
Fetal alcohol syndrome (FAS)
condition affecting children born to alcohol-consuming mothers that is characterized by facial deformities, growth deficiency, and mental retardation
• Severity of FAS dose dependent
o 30-45% of women who are moderate to heavy alcohol consumers will give birth to a child with FAS
89
Gender difference for alcohol
o Women heavy alcohol drinkers will cause accelerated damage to the brain, liver, heart, and muscles compared to male users
o Women metabolize alcohol more slowly than men
o Females more likely experience depression whereas men are more likely to binge drink and engage in fighting
90
Current drinkers
o 51% Americans age 12 or older current drinkers (at least 1 drink in the past 30 days can include binge and heavy use
91
Binge drinkers
o 23.3% 12 and up binge drinking (5 or more drinks for men and 4 or more drinks for women on a single occasion)
92
Heavy use of alcohol
o 6.9% 12 and up heavy use (5 or more drinks on the same occasion on each of 5 or more days in the past 30 days)
93
Statistics for alcohol use
o 40% of men prefer beer, women prefer wine
o As they age, wine becomes favorite alcoholic drink
o Highest rate of family drinking problems is among 18-29 year olds
o 42% of pop report family disputes caused by excessive drinking (only 17% in 1996)
o 40% prefer beer, 34% prefer wine, 22% prefer harder forms of liquor
o 26% reported they drink more than they should
o $18.8 billion spent on health care for alcohol problems and medical consequences of alcohol consumption (higher than other drugs)
o $82 billion lost in potential productivity
o Worldwide on average adults consume on average 5 liters of pure alcohol per year
o Average alcohol consumption in Europe followed by America and Africa
o Consumption increase with economic development, low where majority Muslim pop
o Highest per capita consumption Romania (10.5 liters), Austria, Hungary, Russia, lowest Norway and UK midway
o Alcohol consumption in Europe mostly stable but feel in France and Italy
o Higher level of education attained, the higher the likelihood of current alcohol use (College grad 93%)
94
Teetotalers
individuals who drink no alcoholic beverages whatsoever; a term in common usage in decades past
o Teetotalers 35%, occasionally 13%, 52% drink regularly, 5.5% heavy
o Majority of 61% of US current drinkers were infrequent drinkers or light drinkers
95
Alcohol use: age 12 or older by ethnicity and race
o White most likely (56%), 2 or more race (47.5%), American Indians, Hispanics, blacks, Asians (37%)
o Asians lowest rate of current drinker 12-17 (5.7%), blacks, 2 or more races, hispanics, white
o Rate of binge drinking, lowest among Asians (5.7%), highest among Hispanics then American Indians, whites, 2 or more races, then blacks
96
Driving under the influence of alcohol
o Highest among 21-25 (26.1%) decline after
o 2002-2008 driving under the influence decline slightly
➢ Education and Alcohol Use
97
College students and alcohol use
o Full time students more likely then part-time students
o Among full-time 61% current, 40.5% binge, 16.3% heavy
o Rates of current alcohol use and binge use decline from 2007
o Full-time versus others their age has remained consistent since 2002
98
Employment Status and Alcohol Use
o Full-time drink more than unemployed (63% versus 55.5%) but unemployed higher for heavy use (8.8% versus 12.8%)
o Most binger and heavy alcohol users were employed high 70s % range
99
Alcohol and the very young
o Alcohol and cigarettes most widespread than any of the illicit drugs
o On a daily basis for this group of minors, marijuana usage now exceeds alcohol usage
o Of greater concern than just any use of alcohol is its use to the point of inebriation
o US, Pakistan, Palau, and Sri Lanka only 4 countries that set drinking age at 21
o Boys more likely to drink on a daily basis than girls 12th grade 4% versus 1.7%
o Boys more likely to drink large quantities in one sitting (28% versus 21%)
100
o In estimating cost of alcohol abuse must be included (3 things):
* 1) expenditures on medical treatment
* 2) loss of productivity
* 3) losses to society from premature deaths due to alcohol
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3rd leading cause of preventable deaths
Alcoholism
102
How much does alcohol cost the US annually?
$185 billion annually (half from loss of productivity due to alcohol related disabilities) cost rises 12.5% annually
o Globally costs $250 billion yearly ($235 billion in US – including health and crime)
o 70% due to loss of productivity
o Much of the economic burden of alcohol abuse falls on segments of the population other than the alcohol abusers themselves (45% to family)
o 40% alcohol related traffic fatalities
o Alcohol abuse estimated to contribute to 25% - 30% of violent crime
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➢ HISTORY OF ALCOHOL IN AMERICA
➢ DRINKING PATTERNS
o Peak 1830 Americans consume 7.1 gallons
o Declined continuously, and went under just before Prohibition
o During last half of the 20th century alcohol consumption stayed constant 2-3 gallon range
o Wine and beer gained popularity while the popularity of hard liquor declined
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Temperance movement
o1830-1850
Very turbulent period in the history of alcohol in America
o Heaviest drinking 1800-1808 (Jefferson’s term)
o Temperance movement never began with the intention of stopping alcohol consumption but rather the goal of encouraging moderation
o Temperance leaders recommended abstinence from only distilled spirits not from beer or wine
• Later, went against all other forms of alcohol, partly in connection with religious revivals
o Temperance movement closely tied to abolitionist movement, and African Americans were preeminent promoters of temperance
• Frederick Douglass
o By late 19th and early 20th centuries number of countries either passed legislation or created alcohol restrictions
• Most end in failure
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Prohibition Era 1920-1933
o 18th amendment of the Constitution was ratified in 1919 in an attempt to stop the rapid spread of alcohol addiction (Prohibition)
o Speakeasies – places where alcoholic beverages were illegally consumed and sold during the Prohibition era
o Bootlegging – making, distributing, and selling alcoholic beverages during the Prohibition era
o During the temperance and Prohibition movement, doctors prescribed whiskey and other alcohol known as patent medicines – ingredients in these uncontrolled “medicines” were secret, often consisting of large amounts of colored water, alcohol, cocaine, or opiates
o 1928 doctors made an estimated $40 million per year writing prescriptions for whiskey
o Violent gang wars broke out because of bootlegging
• General disregard for law developed
• Corruption among law officials and widespread crime
o Repeal of Prohibition (18th amendment) by 21st amendment
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o 3 main developments occurred because of prohibition
* 1) Alcohol use continued to diminish 2-3 years after Prohibition was in effect
* After 3 years of decline, the use of distilled liquors rose every year afterward
* Even minors were becoming addicted to alcohol during this period
* 2) Enforcement of laws against alcohol use were thwarted by corrupt law officials
* 10%
* 3) Among the Western Europeans who immigrated to the US consumption of alcohol was culturally prescribed
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Alcoholism and cultural differences
o ¾ problem drinkers are men and ¼ are women
• Proportion of women have risen in recent years this increase occurred because
• 1) Women as problem drinkers are more visible because they make up about half of the workforce
• 2) Women are more likely to acknowledge the problem and seek treatment
o Alcoholism - state of physical and psychological addition to ethanol, a psychoactive substance
• Before more of a sin than a disease
o Royce and Scratchley list 3 major factors of definition of alcohol
• 1) Some loss of control but need not be total
• 2) Dependence or need can be psychological or physiological
• 3) Interference with normal functioning
o Craving
o Very impaired loss of control
o Physical dependence
o Tolerance
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Jellinek's types of alcoholics (6 types)
1. • Alpha alcoholism
2. • Beta alcoholism
3. • Gamma alcoholism
4. • Delta alcoholic
5. • Epsilon alcoholic
6. • Zeta alcoholic
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Alpha alcoholics
Mostly psychological dependence on alcohol to deal with life; constantly needs alcohol and becomes irritable and anxious when not available
110
Beta alcoholism
Mostly social dependence on alcohol; continues to meet social and economic obligations, some nutritional deficiencies can occur
111
Gamma alcoholic
Most sever form of alcoholism; emotion and psychological impairment, this type of alcoholic believed to suffer from a true disease; psychological and physical dependence
112
Delta alcoholic
Maintenance drinker; loses control over drinking, many wine-drinking countries feature delta alcoholics; tipsy but never truly inebriated
113
Epsilon alcoholic
Binge drinker, dependence on alcohol both physical and psychological, drink excessive then abstain, loss of control over amount consumed
114
Zeta alcoholic
Moderate drinker who becomes abusive or violent, mad drunk, may not be addicted to alcohol
115
o Dr. Moss 5 alcohol-dependent subtypes (more recent)
* 1) Young adult subtype
* 2) Young antisocial subtype
* 3) Functional subtype
* 4) Intermediate familial subtype
* 5) Chronic sever subtype
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Young adult subtype
* 31.5% of alcoholics
* (low rates of co-occuring substance abuse or mental illness, low rate of family alcoholism, and who rarely seek any kind of help for their drinking
117
Young antisocial subtype
* 21% of alcoholics
* Mid twenties, had early onset of regular drinking and alcohol problems
* Half come from families with alcohol problems, half psychiatric disorder antisocial personality disorder
* 75% smoke cigarette and marijuana
* 1/3 seek help for their drinking
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Functional subtype
* 19.5% of alcoholics
* Middle-aged, well educated, and stable jobs and families
* 1/3 have multigenerational alcoholism, ¼ have major depressive illness, 50% smokers
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Intermediate familial subtype
* 19% of alcoholics
* Middle-aged
* 50% with multigenerational alcoholism
* ½ have depression, 20% bipolar
* Most smoke cigarettes
* 25% seek treatment
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Chronic severe subtype
* 9% of alcoholics
* Mostly middle-aged with early onset of drinking and alcohol problems
* High rates of antisocial personality disorder and criminality
* 80% come from multigenerational alcoholism
* Highest rates of other psychiatric disorders
* 2/3 of these alcoholics seek help, most prevalent alcoholics in treatment
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Wet and dry cultures
o Wet cultures, alcohol is integrated into daily life and activities
• Widely available and accessible
• Abstinence rates are low and win largely a beverage of preference
• European countries bordering Mediterranean
o Dry cultures alcohol consumption is not common during everyday activities
• Abstinence more common, but when drinking occurs intoxication results
• Wine consumption less common
• Ex: US, Canada, Scandinavian countries
o Today wet and dry cultures not as evident and not as clear-cut
o Especially in Europe wet/dry distinction seems to be disappearing
o Room and Makela have reconsidered these distinctions and made one that considers a variety of drinking behaviors such as the regularity of drinking and extent of drunkenness
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o Drunken comportment
– behavior exhibited while under the direct influence of alcohol; determined by the norms and expectations of a particular culture
• 1st formulated by MacAndrew and Edgerton
123
Set and setting
set refers to the individual’s expectation of what a drug will do to his or her personality; setting is the physical and social environments where the drug is consumed
• Some psychologists contend that both set and setting can overshadow the pharmacological effects of most drugs
• Far more influential in determining a drug users experience
124
Pseudointoxicated
– acting drunk even before alcohol has had the change to cause its effects
• Amount of alcohol consumed has far less effect on how drinkers comport themselves, instead the cultural values, beliefs, mental maps, and norms cause a particular behavioral outcome
125
Binge drinking in college
50% of college students
o Half of college students often binge drink
o Main reason given for binge drinking is to get drunk
o Being white, involved in athletics, or fraternity or sorority more likely to binge drink
o Whites x2 as likely to be binge drinkers
o Community college students less likely to binge drink
o American Indian highest frequency of drinking episodes followed by white, Hispanic, African American, and Asian students
126
o 3 reasons why women respond differently than men:
* 1) Women have a smaller body size
* 2) Women absorb alcohol sooner than men because on average they posssess more body fat and does not dilute alcohol as well as water (males have more water)
* 3) Women possess less of a metabolizing enzyme that function to get rid of alcohol
127
Codependency
behavior displayed by either addicted or nonaddicted family members who identify with the alcohol addict and cover up the excessive drinking behavior, allowing it to continue and letting it affect the codependent’s life
128
Enablers
– those close to the addict who deny or make excuses for enabling his or her excessive drinking
o Often both codependency and enabling are done by the same person
129
Children of Alcoholics
o Children of alcoholics are at high risk of developing problems with alcohol and other drugs
o Often do poorly in school, live with pervasive tension and stress, have high levels of anxiety and depression, and experience coping problems
o 14 million Americans 7.4% of population meet the diagnostic criteria for alcohol abuse or alcoholism
o 9.7 million children living with one or more adults that are alcohol dependent or abusers
o Children of alcoholics are 2-4x more likely to develop alcoholism
o More likely to marry into a family where alcoholism is prevalent
o 1/3 of alcoholics come from families in which one parent was or is an alcoholic
o Young children excessive amount of crying, bed-wetting, sleep problems
o Teenages display excessive perfectionism, hoarding, loners, and excessive self-consciousness
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Treatment of alcoholism
o Few “pure” alcoholics and drug addicts exist anymore; most addicts drink in addition to their other drug addictions
o Alcoholism and its treatment have a few special features:
• Socially acceptable nature of alcohol makes it easier to be in denial of alcoholism
• Alcohol rehabilitation differs from other addiction treatments in its medical ramifications; alcohol devastating to the body physically
• Alcoholic is typically more emotionally fragile than other addicts in treatment
• Withdrawal from alcohol and withdrawal from barbiturates are the 2 most sever withdrawal syndromes; many individuals succumb to acute alcohol withdrawal syndrome
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Going through alcohol withdrawal
o An acutely ill alcoholic needs medically supervised care
o General hospital ward is best for preliminary treatment
o Symptoms typically appear within 12-72 hours after total cessation of drinking or after BAC level drops below a certain point
o Alcoholic experiences severe muscle tremors, nausea, and anxiety
o In extremely acute alcohol syndrome, delirium tremens (DTS) occurs – the most severe, even life-threatening form of alcohol withdrawal involving hallucinations, delirium, and fever
o Withdrawal reaches its peak intensity within 24-48 hours
o Phenobarbital, chlordiazepoxide, and diazepam are commonly prescribed to prevent withdrawal symptoms
o Pneumonia frequent complication
o Antabuse is an aid to other supportive treatments not the sole method of therapy
o In addition Naltrexone and Nalmefene also known as Revex
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Helping the alcoholic's family recover
o Goal is to break cycle of alcohol abuse within families
o Family system adapts to dysfunction by rearranging itself around the problem
• Persons may be blamed lost or forgotten
• By adjusting around addiction, the family members enable the addict to progress further along the disease path
• Scapegoat “identified patient”
o When an older child plays a parental part in the family, it may represent culturally routine behavior or it may be indicative of a response to addiction in the family
• The “super-responsible one”
• Can be harmful in the long run
• May undermine recovery
o Family counselor can help family members understand the roles they are playing and start a process of change
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Psychodrama
or role playing, family therapy system developed by Jacques Moreno in which significant interpersonal and intrapersonal issues are enacted in a focused setting using dramatic techniques
134
Genogram
family therapy technique that records information about behavior and relationship on a type of family tree to elucidate persistent patterns of dysfunctional behvior
135
Volatile
readily evaporated at low temperatures
o Introduced to the body through the lungs
136
Euphorigenic
– having the ability to cause feelings of pleasure and well-being
137
History of inhalants
o Traced to 1776 when British chemist Joseph Priestley synthesized nitrous oxide
• Colorless gas with a slightly sweet odor and no noticeable taste
• Use in anesthetic
• Its abuse popular into the early 19th century because drunkenness like alcohol
• Horace Wells, dentist use as anesthesia
o Abuse of inhalants came to public attention in the 1950s (sniffing glue)
o Term “glue sniffing” is still used today, but it is often used to describe inhalation of many products besides glue
o Table 14.1 Inhalants (Over 1000 different products) pg. 421
o These chemicals are not regulated like other drugs of abuse so are readily available to young people
138
Inhalants can be divided into 3 groups
* 1) Volatile substances
* 2) Anesthetics
* 3) Nitrites
139
Volatile substances
o Include aerosols (spray paint, air fresheners), art or office supplies (correction fluids, felt-tip markers), adhesives, fuels, industrial or household solvents (paint thinners, nail polish remover)
o Some volatile substances exist as gases (nitrous oxide)
140
Some inhale directly from the container
Sniffing or snorting
141
Some inhale from plastic bags
Bagging
142
Some inhale from bandanna soaked in the solvent fluid and held over the mouth
Huffing
143
Hypoxia
– state of oxygen deficiency
144
Potential toxic consequences of inhalants:
* SSDS
* Hypertension, damage to the cardiac muscle, peripheral nerves, brain, and kidneys
* Lose their appetite, continually tired, and experience nosebleeds
145
Aerosols
o Popular among young inhalant abusers
o Include spray paints, deodorant and hair sprays, vegetable oils
o Abused because effects of propellant gases and not principal ingredients
o Inhalation of these can be dangerous because these devices are capable of generating very high concentrations of the inhaled chemicals
146
Toluene
o Chemical found in some glues, paints, thinners, nail polishes, and typewriter correction fluid, Texas shoe shine
o Because this molecule is highly lipid-soluble the brain, heart, and liver rapidly absorb it.
o Can cause brain damage
o Impaired cognition and gait disturbances, loss of coordination, equilibrium, hearing, and vision can also occur
o Liver and kidney damage have also been reported
o Activates dopaminergic activity in the brain
147
Butane and propane
o Found commonly in lighter fluid and hair and paint sprays
o Serious burn injuries and SSDS via cardiac effects have resulted from their abuse
148
Gasoline
o Young people often in rural setting sometimes abuse gasoline
o Mixture of volatile chemicals, including toluene, benzene, and triorthocresyl phosphate
o Benzene is an organic compound that causes impaired immunologic function, bone marrow injury, increased risk of leukemia, and reproductive system toxicity
o TCP is a fuel additive that causes degeneration of motor neurons
149
Freon
o Freon and other fluorinate hydrocarbons are used in a # of products including refrigerators, air conditioners, and airbrushes
o Can cause serious liver damage and SSDS
150
Anesthetics
o Ether, chloroform, halothane, nitrous oxide
o Only nitrous oxide available widely enough to be a significant abuse concern
151
Nitrous oxide
* Produces unique profile of stimulant, hallucinogenic, and depressant effects
* Health professional themselves are most likely to abuse nitrous oxide
* Whippets and ballons, whipped cream dispensers
* Can cause loss of sensation, limb spasms, altered perception and motor coordination, blackouts, and depression of heart muscle functioning
* For the most part, nitrous oxide does not a pose a significant abuse problem for the general public
152
Nitrites
o Nitrites are chemicals that cause vasodilation (dilates blood vessels, decreases blood pressure)
• Amylnitrite available by prescription to treat angina
o 1st abuse in the 1960s when ampules of the compound were available OTC
o “Poppers” – held to the nostrils for inhalation
o Mainly adults and older adolescents abuse nitrites
o Typically individuals who abuse nitrites are attempting to enhance sexual pleasure and function
o Contribute to unsafe sexual practices
o May be an association between the abuse of nitrites and the development and progression of tumors and infectious diseases
153
Legislation on inhalants
o Inhalants of abuse are generally not regulated under the Controlled Substances Act
o 38 states had adopted laws preventing use, sale, and or distribution to minors of various products abused commonly as inhalants
154
Why inhalants popular
* Legally obtained
* Readily available in most households
* Inexpensive
* Easy to conceal
* Most users are uniformed about the potential dangers
* Causes feelings of intoxication and euphoria much more rapidly that does the consumption of agents such as alcohol and less withdrawal
155
Adolescent and Teenage usage of inhalants
o Adolescents most commonly use inhalants, with usage decreasing as students grow older
o Older individuals often view use of inhalants with disdain and consider it unsophisticated and a kid’s habit
o Considerable concern that inhalant abuse can start as early as preschool
156
Signs of inhalant abuse
o Uncoordinated, disoriented, and appear drunken
o Red watery eyes, slurred speech, nausea, headaches, and nosebleeds are also common
o Rashes around the nose or unexplained paint on the hands and mouth can be signs of inhalant abuse
o Children who are frequent users of inhalants have the following characteristics:
• Often collect unusual assortment of chemicals
• Have breath that occasionally smells of solvents
• Often have sniffles similar to cold
• Appear drunk for short periods of time (15-60 minutes) but recover quickly
• Do not do well in school, unkempt
• Sitting with a pen or marker near nose
• Constantly smelling clothing sleeves
• Hiding rags, clothes, or empty containers
• Possessing chemical-soaked rags, bags, or socks
• Abusable household items missing
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Dangers of inhalant abuses
o Damage to heart, lungs, liver and brain
o Choking on own vomit, fatal injury from accidents including car crashes
o Use by pregnant women also may put newborns at risk of development deficits
o Mild withdrawal syndrome and compulsive use can occur with long-term inhalant abuse
o Inhalant users on average, initiate use of all other drugs at younger ages that those who don’t abuse inhalants
o 1 in 20 adolescents with @ least 1 of 4 respiratory conditions (asthma, bronchitis, pneumonia, or sinusitis) also reported past-year use of inhalants
o Can exacerbate existing medical conditions
158
Hepatotoxic effect
– Liver cells increase the production of fat (enlarged liver)
• Reversible and can disappear if alcohol use is stopped
• 5-6 drinks several days for male; 2 drinks several days for female
159
Alcoholic cardiomyopathy
– congestive heart failure due to the replacement of heart muscle with fat and fiber
