FINAL Flashcards
Marijuana Prevalence
Most abused drug in the US
Almost 50% of HS seniors report having tried it at least once
Debate of its effects being beneficial
Cannabis (or marijuana / hemp)
A plant
-Hemp is the agricultural product (containing little THC or CBD)
-Marijuana/cannabis is the drug form
*Name used to stigmatize it with Mexican folk
-All the same species of plant
Cannabinoids / Main psychoactive chemicals in cannabis
Delta-9-tetrahydrocannabinol / 9-THC / THC
-Agonist at the CB1 and CB2 receptors
8-THC / CBD - cannabidiol that is a less potent psychoactive version
Synthetic cannabinoids - Spice, K2
World History of Cannabis: Plant to product
-First agricultural product cultivated
-Grown easily in a range of environments (Causing slang of weed/grass)
-Cultivated to make bags, rope, ect
*Made from fibrous stem. Seeds produce oils
World History of Cannabis: Origin
-Thought to originate in E or S Asia (C/W China specifically), then spread through Europe and Africa
-Shen Nung described psychoactive & medicinal properties in 2737 BC
-Greek historian Herodotus, 500 BC, tells of peoples from Scythia and the Araxes River, grew hemp to throw on fire and inhale
-1545, cannabis in the W hemisphere, Spanish introduced the plant to Chile in order to make fiber
Hashish
Preparation of cannabis
-Use of marijuana not known to Europe until the 1800s when Napoleon’s army smoked in N Africa
The Indian Hemp Drugs Commission Report
British govt concerned about India’s marijuana use b/c of effects on their $
-Wanted to criminalize and benefit from addiction treatment
-Report of the Commission, released in 1894, was over 3,000 pages, most extensive study on it ever, concluding
*Traditional medicine use (Indian hemp)
*NBD aside from heavy usage
American History of Marijuana
More commonly used to made products, not originally thought of as a drug
-1619 permitted and required by King James I to grow hemp
*used in PA and other colonies as money
-Little evidence of recreational or industrial use during colonial times
-1840s, drugs w/ cannabis sold in US and UK, Irish doctor and scientist named William O’Shaughnessy
-Laws put in against those who used w/out prescription
Anslinger and “Reefer Madness”
Movie dramatizing the effects of weed, blaming it for changes happening. Anslinger went of using to suddenly against it.
Marijuana Tax act (1937)
Similar to Harrison Narcotics Tax Act, to control/limit who could grow, possess, or sell weed.
LaGuardia Report (MJ)
Committee of doctors studying weed after the tax act
-Did not show the effects of “Reefer Madness”
1963 Unconstitutional (MJ)
-Grown during WWII for hemp
-Leery showed to follow the tax act, they would have to break the 5th amendment
-Tax act was deemed unconstitutional
1970 marijuana is put onto Sched. I
1973, decriminalization by state follows
-1973 Oregon decriminalized
-1990s San Francisco did too, CA entirely following by 1996 under Proposition 215: Allowed use w/ doctor permission
2005 Gonzalez VS Raich (MJ)
DEA would come in and arrest people despite it being legal for the area
-Fed govt had constitutional right to ban it
2012-2018 State Legalization (MJ)
-States begin legalizing marijuana with restrictions (Washington and Colorado started)
-Only about 10 consider it to be illegal
-2014, Rohrabacher–Farr amendment prevents Dept of Justice from prosecuting in legalized states
-2018, hemp derived CBD is legal
Marijuana types and percents
Marijuana - Plant material that is dried and smoked. 6.7% (now 15-28% THC)
Sinsemilla 11.1% - Sexually immature female plant
Hashish 27.7% - Dark resin oil stuff
-THC is very lipophilic
-Kief - Steel wool and brush to get trichomes
-Most potent
Hash Oil 24.9% (can be almost 100% now)
-Dabs, HBO, Wax
-Extremely potent!
Bhang - Legal form (milkshake)
Synthetic Cannabinoids (sCB’s)
Used in vaping or in plant
-Similar effects
* OD or EXTREME effects
-Can be dirty
-Pyrolytic compounds: heating and metabolism causing adverse effects
-Can be laced
Trichome
Small hairlike growths, producing THC
-Delta 9 and Phyto-cannabinoids
-Warmer grow environment = INC THC
Pharmacokinetics of marijuana
11-OH-THC
-CB1 agonist
-Body turns THC into “super weed”
-Crosses BBB faster than THC
THC-COOH
-Carboxy-THC
-Inert substance
Made from 11-OH-THC
Lipophilic, which is why it stays in the body’s fatty tissue for so long, up to 95 days
Peaks after 10 minutes when smoked
Drug testing Marijuana
-Looking for the metabolites of marijuana, only in the system w/ ingestion or smoking
-Cannot test how high but how many metabolites
Pharmacodynamics of MJ
CB1 and CB2 receptors
-1 causes psychological effects
-2 causes immune response
*anti-inflammatory effects, little found in the brain,
2-AG and anandamide
-Endocannabinoids
Acute Psych effects of MJ
Motor Control: Basal ganglia and cerebellum, sedation and DEC movement
Euphoria
Paranoia, psychosis, sociability, and relaxation
Attention, judgment, decision making
Memory: Impairment of STM, acting on CB1 receptors in hippocampus
Appetite: CB1 receptors in the hypothalamus
Is marijuana the gateway drug? Sequence, association, and causality
By sequencing, yes. If someone has done hard drugs, they likely tried MJ first
-1/5 support this claim
Association: Using MJ is correlational to other drugs but its small
-Those who use more than 50 times/yr, 140x chance of using harder
Causality: no
-INC use, INC time w/ other users, INC chance of going harder
-Possible + outlook for other drugs
-Environment and sociocultural outlook
Cannabis Use Disorder (CUD)
It is addictive
-9% of 22.2M past month users
-Withdrawal: Opposite of effects
-50% of US has tried weed (but thats likely actually higher)
Amotivational syndrome.
Little evidence of MJ > amotivational but rather that depression > MJ use > amotivational
-MJ > Loss of interest > Is cultural
Schizophrenia risk, Cog impairments, and MJ
INC Schz risk in those w/ genetic risk for Schz
-Especially in youngers, possible brain DEC development
-INC alcohol toxicity
Lasting cognitive impairments/Improvements:
-cell death by activating proteins that respond to stress and injury, hippocampus vulnerable
-THC &CBD antioxidants, protecting against cell death, protecting against strokes
-Possible help on TBI and MDMA abuse
-Memory and verbal impairment
-LT users may tolerate COG impairments
Lung harms of MJ
-Same lung damage cigarettes do BUT no lung cancer in animals but double risk in humans
*INC holding in and INC ammonia
-Not too sure about cancer
Body harms of Mj
-Hormonal and cardiovascular effects: Some cortisol (tolerance happens), DEC in BP and HR (paranoia?)
-Immune suppression: Possible pro- and anti-immunity signals, possible help in some illnesses, INC illness susceptibility
-Reproduction: DEC sperm and movement in men
-Pregnancy and childbirth: DEC weight and IQ, hyperactive behavior
Cannabinoids in medicine
Helping w/ Appetite stimulation, nausea, pain, MS, glaucoma, PTSD and anxiety, Spasticity and movement disorders, and cancer.
CB1 antagonists
Having the opposite effect as MJ
-Help people lose weight and quit smoking
-Can cause nausea, anxiety, and depression
-Not FDA approved
Alcohol / ethyl alcohol or ethanol
A chemical that interacts w/ receptors in the body to change how we feel and act.
-Long history of recreational and religious use
-AOD (alcohol and other drugs), originating from food
Fermentation
Yeast consumes sugar, excretes alcohol and carbon dioxide as waste products
-Naturally reach up to 15%
Alcohol and Religion
People knew of the positive and negative effects of alcohol
-Major religions address morality
-Ancient Greece and Rome had cults of the god known as Dionysus or Bacchus, whose ceremonies included heavy alcohol use, rape, and other violence. Islam prohibits drinking. Buddhists usually don’t drink, calling it heedlessness. Hinduism and Christianity do not prohibit drinking, but warn about overindulgence.
Alcohol and American History
-Pre-colonization NA rarely drank, influenced by Aztecs. N had little manufacturing.
-Europeans brought beer, wine, and distilled spirits
*Religion permissive
*Fermentation = preservation
*Was safer to drink than water during illness breakout
-Post-Colo.: Brewed from crops, pilgrims afraid of the water (despite being safer than Europe’s), breweries and taverns became popular
*Rum and molasses import, slave trade but was easier to make liquor from local crops
-German, Polish, and Czech immigration, 1850s INC German-style lager, especially in Midwestern cities
*Budweiser, Coors, Miller, Schlitz, and Yuengling
*1873, there was 1 brewery for every 10,000 Americans, making 9 million barrels of beer per year
*18th and 19th centuries, Americans drank two or three times as much as they do today.
Taverns and alcohol
Center of life in many communities, late hours
*Used for town meetings, elections, mail delivery, and places to stay
*PRE Revolutionary War, the British saw them as places to discuss resistance against the government.
Temperance of Alcohol
Abstaining from alcohol
-Grows in 1800s
-F issue, Alcohol = Anti Family.
*women’s suffrage (M doesn’t make money, gets drunk, goes home and beats wife)
*Anti-Saloon League and the Women’s Christian Temperance Union
-Benjamin Rush supported heavy taxation of alcohol.
-States start to go dry
-Carrie Nation, was notorious for “hatchetations:” she would enter saloons and smash liquor with an ax.
-Church leaders would give fiery sermons from the pulpit about the evils of alcohol
-Teetolers were those completely obstinate
18th amendment starts Jan 1920
-Volstead act: Banning beverages (0.5% and up) for all uses
-Was not a coin flip/monolithic
-Breweries and distilleries out of business
-DS of approval for self and not others
-Speakeasies and moonshine/bathtub gin
*Speakeasies/bars melting pot as everyone was breaking the law
*Illegal production = bad alcohol and the invention of cocktails = deaths
*Cheap alcohol containing methanol (wood alcohol) causing blindness
*INC gambling and organized crime
-21st amendment in DEC 1933, repealed 18th, alcohol is legal
Post prohibition
-Organized crime shifted to other illegal drugs
-13 states still allow dry cities/counties within certain population size
-Prohibition MAY have had a DEC in drinking but definitely in cirrhosis
Brewing
Grain soaked in water until sprout (malt), creating enzymes, water > starches > sugars and alcohol
-Leading to resurgence of microbrewing and small brewpubs
-stronger flavors and higher alcohol content
-Accounting for +12% of beer sales in the US
Distillation (liquor or spirits)
Heating regular alcohol, its potency in vapor, accelerating the fermentation process
-Yeast dies after living in own feces, preventing it from becoming more powerful than 8%
-Relies on alcohol being more volatile than water, evaporating at a lower temperature
-A liquid that is about 10% alcohol can be made into a product that is much more potent (usually 40 to 50%, but often much higher)
Beer
3-9% at 12oz
Number 1
Ale, Lager, and light beer
Ale - Fermented at warm temperatures for a short time, creating a stronger flavor
- British Isles (and early US)
Lager - Fermented in cold temperatures (originally in caves), and usually has a milder flavor and golden color
-Germany, the Czech Republic, and the Netherlands, and was popularized in the US when waves of immigrants came from there
Light beer - Removing carbohydrates and/or watering down the beer
-Light beer has been really popular (accounting for 6 of the top 10 beer brands sold), there are INC brands, but DEC sales of beer all around.
-Fewer calories, similar alcohol content, less flavor, similar to lager
Wine, fortified wine, liquor, Liqueurs, and proof
Wine - 13% at 5oz
Fortified wine - Combining wine and a distilled liquor
-Brandy
-cheap, sweetened versions (Mad Dog 20/20, Wild Irish Rose) “bum juice” meant to be drank fast and inexpensively
Liquor - 40%+ at 1.5oz
-Number 2
Liqueurs - Adding sweet or strong flavors
-Baileys, Cointreau, Kahlua, Sambuca, or schnapps
Proof - Older unit of alcohol potency, twice the percentage
Caffeinated alcoholic drinks
Caffeine makes the drinker think they are sober
Can cause extreme intoxication
Appeals to underage drinkers because of the
caffeinated drink
Who drinks?
-In the US, 2.4 gallons of pure alcohol / year = 1.75 drinks/day
-30% adults don’t drink
*½ of the adults aren’t really drinking
-1 in 6 American adults are binge drinking
-Spending x amount of time drinking
-four (for women) or five (for men) drinks on one occasion
Heavy Drinking
5 or more drinking binges in a month
one or more drinking binges a week
Drinking is higher in
-M
-White folk
-During college years
-Those between the ages of 18-29
-13% if underage people binge drank in the past month
-INC in occurrence for older adults
Underage drinking and drinking in college students
-¼ of 8th graders and 60% of 12th graders report having had alcohol at least once
*DEC since 1990
-13%, 12-20 binge drank in the past month.
*INC chance of becoming addicted.
*M = F.
*23% of 12th graders saw harm in drinking every day, and 40% saw no harm in drinking four or five drinks nearly every day.
Alcohol use and binge drinking peak at age 21, then DEC
*College students drink more than those their age who aren’t students but are much less likely to become lifetime users
*1/5 college students w/ Alcohol Use Disorder
Pharmacodynamics of alcohol
GABA-A receptor modulator while inhibiting excitatory glutamate receptors
-Dirty, other things also happen
-Some effects may be due to actions on other
receptors, (nicotinic acetylcholine receptors, ion channels, and cell membranes)
-Not very potent, standard drink contains about 14 grams (about half an ounce) of pure ethanol (100s of times more than MJ, opioids, ect)
Pharmacokinetics
Each drink = 0.002-0.03% of your blood is alcohol
-Drink size role
-Carbonation pushes alcohol into the intestines
-Drinking on an empty stomach leads to INC and quicker impact
-Sex plays a role: M are bigger than F and have more stomach enzymes to break down alcohol
-Individual metabolism - Some people have INC, some people have DEC tolerance
-About 1 drink/hour
-At a constant, No half-life
Brain, periphery, the BBB, and alcohol
Brain
Alcohol >(Catalase) acetaldehyde >(alcohol dehydrogenase (ADH)) acetate
BBB
Periphery
Alcohol >(ADH) Acetaldehyde >(ADH) acetate
Acute effects of alcohol I
-Impairs impulse control
-Impairs judgment, memory, thinking, & coordination
-Depressant effects at high dose (Passing out)
-Sleep isn’t restful
-Nausea & vomiting
-Blackouts
-Alcohol Poisoning
Acute effects of alcohol II
-Interactions
*With a drug, or with other activities
*Alcohol has its OWN action, doesn’t give AF
-Feeling warm - Vessels become inflamed
*Can make people feel warm and cause them to die (especially those that are homeless)
-Hangovers
*Caused by the acetaldehyde
*Many Asians lack aldehyde dehydrogenase, causing a build up and making them sick
*DEC in alcoholism in E Asia
*ANTABUSE can be prescribed off label to cut substance cravings
What to do if someone has had way too much to drink
-Don’t be afraid to get help
-Signs to look for:
Unconsciousness, irregular breathing (needs THOUGHT), clammy, blue skin
-Alcohol is a date rape drug
*Perp encourages too much drinking, wants to take advantage of impaired judgment of victim
-Avoid Falls
*If head injuries occur, can cause internal bleeding and death
-Lie person on their left side
-Stimulation is good
-Don’t let them drive (duh)
Long-Term Health Effects of alcohol
-#3 Cause of preventable deaths
-Cardiovascular system issues
-Cancer
*Acetaldehyde - Gross & does mean things to DNA
*Throat, stomach, cologne, breast
-Liver Disease
*Fatty liver - inflammation, storing fat,
*Alcoholic hepatitis - inflammation of liver, jaundice
*Cirrhosis - That part is dead, if fully then need new liver, will die if untreated
LT cognitive issues of alcohol
-Alcohol-related-dementia
*Excessive drinking doesn’t let liver filter out toxins, getting to the brain
*Once happened, doesn’t go away, does help to stop drinking
-Wernicke-Korsakoff syndrome - Lack of Vitamin B1
*Hippocampus Wernicke
*Korsakoff fills in blanks from malfunctioning hippocampus
Fetal Alcohol Syndrome / FASD
-Short stature (height)
-Craniofacial abnormalities
*Small eye opening, smooth philtrum, thinner upper lips, eyes wider apart, small head circumference
-Many intellectual / developmental disabilities
-Drinking can contaminate breast milk
*Waiting until out of system is fine
*Some pump and dump (but can be an issue if someone is a low producer)
Alcoholism - Alcohol Use Disorder
-Legal
-Social drinking > problem / symptomatic drinking
-Drinking to excess
-Drinking alone CAN be a symptom, but isn’t detrimental
-Denial / enabling
-Behavioral tolerance
-Type I and II
*I: Over 25, genetic and environment cause, F = M, symptoms worsen over time, low novelty seeking, usually drinking to lower anxiety
*II: Under 25, genetic cause, mostly M, harsh symptoms that are violent and illegal, may not get worse, high novelty seeking, usually drinking to induce euphoria
Withdrawal of alcohol
-Starts 4-24 hours later
-Sweating, INC HR, anxiety, shaking
-Insomnia, troubled sleeping, vivid dreaming
*Possible REM rebound from sleeping incorrectly due to alcohol
-Delirium tremens (DTs)
*Formication - Hallucination seeing bugs or snakes crawling on or underneath the surface of something (such as skin)
-Death
*Extreme dehydration, cardiovascular issues
Treatment for alcoholism
-Detoxification - Getting someone sober
-Seeking treatment
Less common in those <30, people of color, and F
-Quitting is HARD, people spend a lot of time in denial
-Alcoholics Anonymous (AA)
-12 step program
*Spirituality - Some people try to see God controls alcohol, alcohol controls me, if God controls me, alcohol cannot
*Sponsorship (shared-problem group therapy)
*Complete sobriety is the goal
*Acknowledgment that they HAVE A PROBLEM, alcohol has POWER over them
-SMART recovery
*Motivational Interviewing
*CBT
What makes nicotine so different from other drugs?
-How its effects and dangers are displayed
-Nicotine has been part of two major innovations in how people use drugs (smoking and vaping), which were spaced apart by centuries
-Smoking is the number 1 or 2 cause of preventable death in the US. China (smokes 42% of cigarettes in the world) is the number one producer and consumer of tobacco.
Tobacco
-Nicotine acts as a natural pesticide in tobacco.
*Tomatoes, peppers, and eggplants are cousins of tobacco and so have very small quantities
-Tobacco leaves are dried to:
*Be smoked in cigarettes, cigars, or in pipes
Cigars are tobacco rolled in leaves, cigarettes are just rolled in paper with a filter
Little cigars / cigarillos - Tobacco rolled in leaves w/ or w/out a filter
Smoke through a water pipe or hookah, in which smoke is pulled through a water vessel to cool it
*Be chewed as smokeless tobacco (dip, chew, or snuff)
History of tobacco I
-Native to the Americas
-Arawak and Taino Caribbean natives introduced tobacco leaves to Christopher Columbus. Europeans were then introduced to tobacco and smoking ROA.
-A counter-blaste
A Counter-blaste to Tobacco
Early example of anti-drug propaganda in Great Britain
The rise of cigarettes
-Starting in the late 1800s, especially after the invention of the cigarette-making machine in 1880.
*Cigars and chewing tobacco were more common along with using pipes and snuff
-Seen as girly, men only should smoke cigars, but also it was wrong for girls to smoke cigarettes
-Each century moving forward, cigarettes caught popularity.
-By the 1950s, people take in an average of ten pounds of tobacco through smoking cigarettes alone. Smoking was convenient, especially for soldiers in WWI.
-Advertising plays a major role.
*Shows actors happy and clean in happy and clean environments
*Advertised to help lose weight
*Famous people paid to support cigarettes, pushed to be in movies and shows
Snuff
tobacco that was pulverized into powder
Changes in culture and laws about smoking
1964 - Surgeon General’s warning against smoking.
1966 - First warning labels required for the government
1993 - Secondhand smoke
1998 - Master settlement agreement
*States sue tobacco companies for selling their products knowing they were dangerous
*Resulting in a lot of restrictions and money going to the states
2009 - Family smoking prevention and tobacco control act
*FDA controls
*Larger warning labels but aren’t able to show diseased lungs
*Banned flavored cigarettes and cartoon characters that appeal to children
*Banned “light” or words of flavoring to stop implications (light = safer! NO)
*This all only applied to cigarettes tho
Vaping or ENDS (Electronic Nicotine Delivery System)
-VG or PG - Vegetable glycerin and propylene glycol
-EVALI - E-cig or vaping associated lung injury
*DEC risks in Britain where juuling is regulated, Restrictions on amount of nicotine and temperature
-2003 Cigalikes - People used them to help stop smoking ORIGINALLY
-2014 - 242 new flavors world wide every month
-Can have nicotine, other drugs (THC), or none at all
*Ideal to stop flavoring but those who are quitting say the flavor helps
-INC use in men, white people, and LGBTQ teens
1.5% in 2011, 21% in 2018, 11% in 2017. DOUBLED in a YEAR!
Harm avoidance > social image
*Vaping went from being used to help quit smoking to now younger people think its cool
Pharmacokinetics (more aimed to cigarettes but also applies to vaping)
-Very fast = Very addicting
*Ammonia was added to cigarettes to make them more addicting
-Titration - Smoking faster, more often, or inhale more deeply when smoke is weaker, which may mean that smokers of lighter cigarettes may compensate by smoking more.
-Nicotine has a half-life of 1 or 2 hour
*Metabolized into cotinine
Pharmacodynamics of tobacco
-Nicotine is an agonist at nicotinic acetylcholine receptors.
-Nicotine can be used to tell the difference between subtypes of acetylcholine receptors.
How much nicotine is in:
-Cigarette = 1 to 2 mg
-Little cigar = 3.8 mg
-Regular cigar = 13 mg
-Can of snuff = 88 mg
Effects of tobacco
-Stimulant / Sympathomimetic
-Release of adrenaline - Activating nicotinic receptors in the SNS
-INC in HR and BS, slowing digestion, INC motility of the lower intestine
*DEC in appetite, INC BM, INC in appetite if you quit smoking
*Tolerance of the appetite suppression doesn’t last long
-Insulin resistance, insulin no longer used to reduce BS well, Can cause diabetes
-Atherosclerosis - Constriction of blood vessels, causing twitching
*Nicotinic receptors at the junction between the NS and skeletal muscles
-Toxic effect from vaping
-Concern of children consuming e-juice
Very high doses can cause muscle spasms, intoxication, and nausea and vomiting
-Cognitive enhancer
*Helping with working memory, episodic memory, different kinds of attention, and fine motor control
*Could be positively skewed due to asking participants not to smoke shortly before the test, so partially due to relieving withdrawal
Chronic Health Effects of tobacco
-480,000 deaths in the US/yr attributed to tobacco use, Only 88,000 from alcohol and 100,000 from other drugs
-5 MILLION deaths worldwide!!!
*Intake of carbon monoxide can make you sleepy
-Intake of particulate phase
*Microscopic solid particles made of plant material that are carried by the smoke into the lungs
*The particles made of plant material contains tar
*Filters on cigarettes stop from smoking the tar
Issues w/ measuring machine not being able to replicate a person smoking
Cancer from smoking
Can directly cause lung, liver, and colon cancer. *Indirectly causing breast and pancreas cancer.
-85-90% of lung cancer is caused by cigarette smoking.
-Cigar smoking is associated with lip, mouth, and throat, especially for those who don’t inhale the smoke.
-Chewing / dipping can cause lesions/ulcers in mouth that can interfere w/ speaking and eating, and can become cancerous.
-The highest risk area is where it is intaken.
Carcinogens
Cancer-causing substances
-TSNAs - Tobacco-specific nitrosamines
-Benzene
-Heavy metals - Arsenic and cadmium that are absorbed by the roots of the tobacco plant
Respiratory Diseases/Lung Disease from tobacco
-Tar accumulation in breathing passageways, causing mucus development, stopping cilia function
-COPD - Chronic Obstructive Pulmonary Disease - Long-term breathing difficulties, and related problems like cough, lack of energy, frequent respiratory infections, and swelling in the legs and feet
-Chronic bronchitis - Inflammation of breathing passages, including excess mucus and tightening of the airways
-Emphysema - Permanent damage to the alveoli, causing a DEC in lung tissue, smoke gets cause in the lungs
*Worse over time and can cause death
*Lifetime smokers have a 50% chance of developing emphysema
-Vaping controversy - EVALI
*A major concern is that ingredients can legally be added to food or drug products if they are listed by the FDA as Generally Regarded As Safe for consumption, not for smoking (Diacetyl flavoring used can cause popcorn lung)
*Shortness of breath, difficulty breathing, fever, nausea, vomiting, and diarrhea, lung/bronchiolitis obliterans
*Possible irritation in the lining of the lungs and *INC risk of infections, and acutely lead to difficulty breathing
*EVALI is most common in those who vape THC due to Vitamin E acetate exposure.
More bad things caused by tobacco usage
-Cardiovascular disease
*Carbon monoxide + nicotine + DEC lung function from tar
*INC HR + hardened blood vessels + DEC oxygen intake to the heart and other body parts
Stroke potentiality, Blocked arteries potentially causing pain, numbness, and infection, and Aneurysm of the atora
-INC wrinkling - Pulls blood away from the vessels, DEC blushing and slower wound healing
-DEC fertility
*DEC sperm movement, INC miscarriage risk, disruptions of reproductive hormones DEC infertility
-INC chance of macular degeneration - fovea in the retina die off, causing blindness
-Diabetes
-Pregnancy and development issues
*Premature birth, low birth weight of child
*Potential cognitive and emotional issues later in life (especially if using nicotine)
-Gum and dental issues
-DEC bone density
Secondhand smoke
-Causes 1.2 MILLION deaths, 65,000 of those being children
-All smoker’s diseases listed above
-INC disease and disability risk
-Asthma
-INC ear and sinus infection risk
-SIDS
Nicotine Addiction, and Strategies to Fight It
-Not intoxicating, no OD, No “sobering up” and realizing the damage they’re doing to themselves
-Association with daily experience, Smoking after a meal, ect
-Withdrawal - Intense cravings, irritability, anxiety, and sleep disturbances
*Changes to ANS
-So addicting: Activation of acetylcholine receptors, impacting serotonin and dopamine intake,
*Present enzyme preventing the breakdown of norepinephrine, dopamine, and serotonin
-Potential genetics role
-Vaping: Gateway drug or harm avoidance
Quitting
-Only 7.5% of smokers who try to quit are successful each year
-Using longer counseling = better
-Nicotine replacement - gum, transdermal patches, lozenges, nasal sprays, or inhalers containing nicotine to help a person quit tobacco
*Usually starting at a higher dose, lowering over time
*INC chance of quitting, especially when pairs w/ counseling
-Zyban
Doesn’t contain nicotine, Doesn’t work on nicotinic receptors
-Wellbutrin use
-Chantix
*Partial agonist - Doesn’t do a full action, binds to receptor, may have no action
Society’s Techniques for Reducing Nicotine Addiction
-Warning labels
-Anti-smoking education
*Potentially ineffective and actually encourage
-Taxes (excise taxes)
*$1.01 federal, $0.17 (MO) to $4.35+$1.50 (NYC)
*Good for companies selling these drugs
-Public bans
Caffeine
Most popular addictive recreational substance
Stimulant drug
-Less potent
-Ergogenic - Help you work
Who Drinks Caffeine
Those ages 50-64 intake the most coffee and tea, Those ages 35-49 intake the most CSD, and those ages 18-24 intake the most energy drinks
-165 or 191 mg average consumption
-Only substance that INC w/ age
-Recommended:
<400 mg for adults
<200-300 mg during pregnancy
<2.5 mg/kg for children
*10% of people go over the recommended limit
Caffeine History
Story of guy who noticed his lambs being excited while eating these berries from a bush, he eats some too, and also finds that he is also excited.
-Coffee berries have been eaten for a long long time. Spreading from N Africa to the N peninsula. Wine of Islam (Muslims don’t drink)
-Coffee has been blessed by a priest. Coffee used to help people stop drinking.
Coffeehouses - Places people could gather to drink coffee
-“Penny universities” For really cheap you could get an education because intellectuals would gather at coffee houses
-Not so much anymore, people are hushed in coffee houses now
-80 -150 mg per cup, up to 475!!!
Energy and Soft Drinks
Soft Drinks
-Kola nut
-56-115 mg per 20 oz bottles
-Sugar may not cause hyperactivity
Energy Drinks
-80-350 mg
-Yerba mate, guarana, vitamin B, ect, BS
Present in weight loss supplements.
-Makes you feel more full, like all stimulants
-Doesn’t really help lose weight
Tea and caffeine
-Any form of caffeinated tea, it comes from Camellia sinensis
Oolong, black, green, ect, No herbal teas
-Leaves are fermented, INC preservation period
-1773: Boston Tea Party causes DEC in tea consumption, INC coffee consumption
*Association w/ King of Great Britain at the time
*Britains INC tea consumption, causing Opium Wars
*England needed tea from China
-Iced Tea was invented in 1904
*Polyphenols & flavonoids
*Healthy chemicals in white and green tea, killed when fermented to make brown or black tea
Chocolate and Caffeine
-Comes from cocoa bean
-“Drink of the Gods”
*Word chocolate comes from Aztecs
*Made from chocolate liquor, more similar to coffee
*Can be healthy
-Europe first introduced to chocolate in 1519
*Germany begins changing it
-By 1879 chocolate has found its milk-chocolate form
-Theobromine
*Dangerous to pets, some animals don’t have the necessary enzyme to break down theobromine
-Flavonoids
*Tried to be used to say chocolate is good for the heart but Chocolate is heavy in saturated fats
Pharmacodynamics of caffeine
Is considered to be a xanthine
-Caffeine
-Theophylline
-Theobromine
All of these are considered adenosine antagonists
Xanthines mimic adenosine, blocking the receptors
Pharmacokinetics (when drank)
-Peaks in 30 minutes - 2 hours
-T1/2 (half life) = 3-6 hours
*Faster half life for smokers
*Slower in pregnant women and those on BC
*WAY slower for newborn children
-Active Metabolites w/ longer T1/2
-Genetic difference, Some people just don’t break it down as easily
Why caffeine keeps you awake: Adenosine Triphosphate (ATP)
Chemical reactions in the body use energy. The phosphates can be used to power the body for these necessary processes. Adenosine is left over. INC amounts of adenosine binding to its receptors will make someone drowsy.
Antagonism alters GABA and acetylcholine release, waking you up and enhancing cognition
*INC reaction time and attention
Breaking down caffeine
Caffeine is broken down by the CYP1A2 in the liver (part of the CYP450 family of enzymes). It is metabolized into:
-Paraxanthine
-Theobromine
-Theophylline
The half-lives theobromine and theophylline are about twice as long as caffeine. those who don’t
metabolize caffeine as well often feel its effects (wakefulness, but also anxiety and increased
heart rate) much more strongly at lower doses.
Effects of caffeine
Adenosine makes people sleepy, and high doses keep people in the deep, slow-wave
sleep stages.
-Levels are high in the basal forebrain when sleep deprived
*Has gabaergic and cholinergic cells, necessary for triggering sleep, attention, and memory when people are awake
-Caffeine is an antagonist, blocking the adenosine sleep signal
*Effects in the body amplify the awakeness
-Caffeine causes adrenaline release in the body, and INC HR, BP, and body heat.
-Adjuvant: a drug that is more effective added on to other drugs, than it is by itself by constricting blood vessels under the skull
-Diuretic - makes you pee , INC how fast people excrete water and electrolytes
-Stimulates bowel movements
Cognitive Effects of Caffeine
-INC reaction time and helps with accuracy in attention, particularly sustained attention (focus on one task for a long time)
-At some point, doses of caffeine or other stimulants can be high enough where they disrupt, rather than enhance, your abilities
-DEC appetite
-INC calorie use (INC weight loss)
-Improves muscle performance, fights fatigue, and speeds recovery in some situations
-Exercise takes less effort and is more joyful
-Headaches
*Too much, cause headache, Just enough, helps cure headache
Caffeinism
Caffeine tolerance (usually) leading to INC caffeine intake, causes an OD state of overstimulation
-Irritability
-Tremor, Muscle twitching
-INC breathing and HR
-Insomnia
-No appetite
-Nausea
-Gastrointestinal issue
-Skin flushing
-Sensory disturbances
85% of Americans drink it daily, and many would say they can’t live without it.
Health Risks of too much caffeine
Heart
-INC BP
-High doses (>6 cups/day)
-Smoking effects
-Heart condition effects
-Genetics (Those w/ slower metabolism for caffeine or prone to heart effects)
Osteoporosis or Brittle Bones
-More common in older ladies
-Caffeine reduces calcium in bones
-Could be because those who have an INC caffeine use may have a DEC calcium intake
Anxiety Disorders
-INC anxiety
-Those w/ panic attacks, intaking caffeine may cause a cycle of triggering anxiety and a panic attack
-INC SNS activity
Pregnancy and dogs
Health Benefits: Neurodegenerative Diseases and caffeine
(Alzheimer’s and Parkinson’s)
-DEC alzheimer’s risk
-DEC risk of dementia symptoms
-Acts as an antioxidant, and prevents brain cell death
-INC memory
-DEC risk of Parkinson’s in M
-Reduce motor systems of Parkinson’s
Health benefits: Stroke, diabetes, and caffeine
Stroke
-Low caffeine levels are sometimes found to reduce risk of heart attacks and heart failure
-Possible INC risk after a stroke
-May limit some of the damage to brain cells that a stroke causes
Diabetes - DEC insulin effects, correlation between drinking caffeine and getting diabetes (Especially in F)
Health benefits: Cancer and caffeine
-Correlation between drinking caffeine and lower cancer risk
-Coffee INC survival in colorectal cancer patients
-May reduce breast cancer in postmenopausal women
-Chance it reduces risk of cancer of the uterus, prostate, and liver, and some evidence it helps with other kinds of cancer
Evidence Based treatment and prevention and what doesn’t work
Program does what it claims.
Preventative Education Programs that don’t work:
-Scare tactics
-Lectures
-Affective Education
Levels of prevention
-Primary (prevention) - Educating
-Secondary (treatment) - Intervention
-Tertiary (Rehabilitation) - Getting help for those w/ SUD
*Evidence Based
Programs principals
16 total:
-Addressing all drugs
-Should address them to all ages and types of people
-Tailor to target audience
*it’s not a one-size-fits-all approach
-Employ more of the techniques that reduce use, and disregard those that may seem good, but are ineffective
Preventative programs that do work
-Role playing refusal
-Generic skills and Social norms
-Tailoring by age, culture, drug, linking across development
-Training teachers
Fewer kids in an evidence-based program end up on drugs later on, compared to a control group that got a different experience.
Doesn’t Work: Scare Tactics
Usually when someone you know is going to do something thats not good for them and they know it, leaving self to feel the need to over emphasize
-With graphic imagery, can put people on the defensive, create a negative relationship with the presenter, or push people into a fatalistic (“what’s the use”) mindset
-Those at high-use risk are sensation seeking and may see scare-tactics as a challenge
Doesn’t Work: Lectures
Traditional Classroom setting a teacher speaks most of the time, maybe with visual aids and props, about drugs and their effects and dangers
-Premise: people use drugs because they don’t know enough about them, and won’t use them if we tell them the facts
*Learning about drugs doesn’t change views
*It can be hard to remember what you learned in one environment, and apply it in a completely different environment
Doesn’t Work: Affective Education
Enhancing self-esteem and encouraging better insight into one’s emotions and values
-Doesn’t reduce, and may even increase, drug abuse
-Children w/ self-esteem that started low due to parental neglect, but then INC, were more likely to abuse drugs
Effective education and lecturing both rely on students not interacting with each other, but instead focus on themselves.
Works: Role-Playing Refusal Skills
Students rehearse what they would say in situations where their peers are using drugs
-Social influence approach - Kids use drugs due to social pressure, not only from peers, but media portrayals
-Use combinations of peer refusal and social norms education
Works: Working on Generic Skills
Protective factors in role-playing refusal:
-Assertiveness
-Confidence in cognitive and problem -
solving abilities
-Coping and social skills
Works: Social Norms Education
Descriptive Norms - How commonplace an activity is,
Injunctive Norms - Attitudes about what people should do
Educating people that drug abuse is not as common or accepted as they can seem, is a part of many evidence-based programs.
Descriptive norms caused people to hang up and reuse their towels in a hotel room.
Based on facts
Harm Reduction in Education
Teaches people to reduce harm and risk from drug use, rather than focusing on remaining abstinent completely.
-More trusting relationship between teacher and student
-Able to discuss drugs realistically
-Focus is on safety of drug use, not criminality
Success of SHAHRP, SCIDUA, and DEVS in the UK, Canada, and Australia due to the harm reduction education in combination with refusal skills and some other effective traditional techniques. Use DEC in some part with the use of these programs.
Acknowledging that there will be people who use the drug
Examples of Popular Drug Education Programs
Life Skills Training (EX: Botvin lifeskills training)
6-15 lessons/year, 30-45 minutes each
-Interactive and integrated across age
*Integrated - students work on similar areas throughout development, in an age-appropriate way
-Peer refusal and general skills
-Assertiveness and peer refusal, coping with stress and anxiety, social skills, decision making about drugs, and how to keep healthy relationships, both with peers, and within the family
-Cognitive Component
-Heavy use of small group discussion, brainstorming, practicing (e.g., breathing exercises to reduce stress), and writing
*Does not work for all cases nor all groups of people
*The difficulty of changing people’s behavior on a permanent basis
DARE (Drug Abuse Resistance Education)
-Founded in 1983
-Founded with good intentions
-One of the first major anti-drug program
-After 10 years, evidence showed that their program wasn’t working
-Slow to change in the face of evidence of its shortcomings, and occasionally hostile, questioning the agenda of researchers (such as that they are anti-police or pro-drug), starting student letter-writing campaigns against them, and even trying to interfere with peer-reviewed publication.
-“Keeping it REAL” developed to be evidence-based (Refuse, Explain, Avoid, Leave)
Beyond the Classroom: The Role of Families and Communities in Drug Prevention
Risk and Protective Factors in Families and Communities
-Families and communities
-Peer pressure
-Community and cultural value
*Children in poverty have DEC drug abuse (except smoking),&safer drug injection behavior
*No relationship between income and drug abuse potential
*Single mothers and house vacancy, INC risk, poverty and unemployment, DEC risk
-Community resources
-Correlation DOES NOT equal causation
-Prevention in college
Pro-drug media messages
-INC smoking in movies before, not as much now
-Correlation between seeing use in tvs/movies is very low with actual use
-It is reasonable to think that watching drug use in media has a small impact on a person’s own behavior
Anti-Drug media messages
-Reefer Madness
*its humor value was so recognized that it was used as a fundraiser to make money for a marijuana legalization group
-The Partnership to End Addiction - People donated their anti-drug use in pair with the Office of National Drug Control Policy
-Memorable commercials w/ celebrities, Overly dramatic, scare tactics, possible INC of use
-Inoculation theory, people are more persuaded by an idea after they refute weak arguments against it
-Later ads backfired by saying that drug use is a part of growing up
*Just because ads were beloved by old people in suits didn’t mean they resonated with kids
Drug Testing
Any bodily fluid or your breath can be used
-Urine, saliva, blood, ect
Varying windows of detection depending on metabolites
-LOOK AT TABLE 3
Two methods of drug testing
Immunoassay (EIA) - Quick and dirty
-Okay, easy to do
Gas Chromatography and Mass Spectrometry (GC/MS)/confirmatory
-Requires a lot of training
-Used to confirm a positive immunoassay result
-Very expensive and delicate equipment
-False Positives and Negatives
Beating a drug test
-Tests can detect flusher drugs
-Testing and the law
-You cannot be forced to take a test
*You can get in trouble if you don’t (necessary for job or if caught drinking and driving)
-Places do NOT have to test you
*Companies make your own policies
The 5 stages of change in addiction
Precontemplation - Not ready to quit
Contemplation - Continued use but noticing use is becoming a problem and considering getting help
Preparation - Making plans of what to do
Action - Executing plan, quitting
Maintenance - Continued treatment, avoiding relapse, and not seeing relapse as failure, but needs continued help
Only 5% of those who need it, admit they need help, and only 2% made an effort to get it. Some people just aren’t ready to quit. Its important to try to stop drug abuse and addiction, especially in violent people as their violence usually worsens with drug use and substantially DEC with help.
Alura’s 5 stages
1) Condoning (The drug use)
2) Contemplating (Quitting the drug)
3) Constructing (A plan of action)
4) Conducting (The plan of action)
5) Continuing (Even in the face of failure)
Types of treatment for addiction
-Detox - Getting them sober
-Medication - Replacement therapy
*Only two drug classes: opioids and nicotine
*Drugs that cut cravings
Psychotherapy Approaches:
-Cognitive therapy - Needing to see connections
*CBT
-MI (motivational interviewing) - More directed to substance use issues. Therapists ask questions to make someone realize the negative consequences of drug use.
-12-step program
*AA, NA (spiritual component), Al-anon, al-a-teen (family groups), ect
*Sponsorship
-Reinforcement - Role of conditioning
*CM - Contingency Management
*CRA, CRAFT, CRA-V - Role of community in treatment
-Multiple strategies (Like MAT)
Settings and Addiction Treatment
-Inpatient/residential treatment
-Inpatient: Short term hospital stay
*Get away, main focus is getting clean, application at facility VS at home may be hard,
*Residential: Longer stay, INC freedom,
-Halfway house and sober-living homes
*Becoming independent with some supervision and monitoring, Living w/ people w/ similar issues, better resources compared to living alone
-Outpatient - Once in a while you attend therapy or *AA/meeting
*Still have school, work, ect. Have to pick local things. Things learned in therapy can be immediately used.
-Warm handoff - Needs have changed over time, patient and new doctor are debriefed together, communication
Families, communities, and social support
-Rat Park - Better housing for rats that are used for experimentation
*Better results in research, more realistically reflects human addiction, Attempts to say addiction is a social disease (not true, extreme take on rat park)
-Workplace treatment - Employee Assistance Program (EAP)
-Watching for denial and not enabling
Harm reduction and addiction
-Instead of focusing on NO DRUGS, which is what is ideal but is much easier said than done, but rather encouraging SAFE USAGE.
-Needle exchange program
*Controversial because it is supporting addiction
-Drug replacement
*There is not a better option
-Changes in zero-tolerance rules
Racial Disparities in Criminal Justice
-Use rates in black VS white people are pretty much the same but rates of arrest are drastically higher for black people.
-Black Americans are 2.7 times as likely to be arrested for drugs, and 6.5 times as likely to be incarcerated, compared to Whites
-People with convictions for drug-related crimes can also be banned from public housing, or from receiving government assistance like food stamps.
The War on Drugs
-Possession, trafficking, and manufacturing is different in varying places
-Deterrence - Some people do not internalize being told not to do drugs
-Legalization - Substances become legalized
*People feel safer about opening up about their addiction because they won’t be arrested
*Preventing from dangerous outcomes like cutting substances into drugs and deaths from unregulated drugs
-Lessons from the Prohibition
*Industrial alcohol being poisoned by the government
*Bad batch of heroin causing the “Frozen addict” when poorly-made synthetic heroin turned into a toxin that killed dopamine cells, resulting in paralysis
Alternatives to incarceration
-Treatment is cheaper and more effective than imprisonment.
-Residential Drug Abuse Program and other prison programs
-Getting through your addiction/the program could lead to a lighter sentence
-Drug court - The goal is to stop use, not punishment sentencing non-violent offenders to treatment programs
*See table 7
