Midterm 1 Flashcards
What is a drug?
●substance that when taken effects a person’s perception, cognition, emotion, or behavior
●psychoactive effects
What are substances with psychoactive properties?
●illicit (illegal)
●prescription drugs
●food
●other substances (gasoline, glue)
Effects of Drug I
●biological and self
●doesn’t consider personal experience in ad
Effects of Drug II
●cultural/historical (consider popular drugs)
●self
●Biological
●psycho-social
Context of Drug Use
●medicinal
●recreational (pleasure, entertainment or curiosity)
●social (social contexts, group or social status)
●pragmatic (enhance behavior, reduce hunger, promoter alertness)
●ritual- religious
●dietary
Substance impact on us
●physiological (body)
●psychological (brain, thinking)
rat physical processes
●rats showed lost perception of time
●cocaine- speed up time
●marijuana- low down time
Psychological impact
●rewarding, curiosity, rebellion, impress, expectancies, social pressures, reduce experience/memory, escape, forget situations
Messages about substance
●celebrities: songs/music, movies/tv
Classify drugs
●drug scheduling: substances classified into 5 categories base on acceptable medical use and potential for abuse/dependency
Schedule I
●considered the most dangerous with highest abuse rate (no acceptable medical use and high potential for abuse, physiological and psychological dependence)
●marijuana (purposefully hold down groups), heroin, ecstasy, LSD)
Schedule V
●has less potential for abuse (lower potential than IV)
●cough medicine
Schedule II
●high potential for abuse, and potentially leading to dependency (ADHD, cocaine, methadone)
Schedule III
●Moderate to low potential for physical dependence (Tylenol)
Schedule IV
●low potential for abuse and physiological and psychological dependence (Xanax)
Trends in drugs used
●synthetic marijuana (shredded plant, think about the packaging, initially perceived as healthier and safe, actual effects are unpredictable- overdose/death)
●molly (“gentler drug”, glamorized, socially acceptable, promote feelings, harmful- dehydration risk)
●Fentanyl (potent synthetic opioid, more potent than heroin, high risk of overdose/death, rainbow fentanyl)
●Carfentanil (potent animal opioid sedative, strongest opioids, can be mixed with heroin)
●e-cigarettes (highest level of nicotine, many teens, kid-friendly marketing/apple juice)
Amount of Carfentanil
●SMALL AMOUNT OF CARFENTANIL FOUND CAN BE EXTREMELY LETHAL
prescription drug abuse
●use medication without prescription, used in way that is not intended, or dosage other than prescribed
What are the 3 types of prescription medications used by adolescents
●opioids (painkillers)
●CNS depressants (anxiety, sleep)
●stimulants (ADHD, narcolepsy)
Why do Teens Use Stimulants off Label?
●availability: access of prescriptions or medicine (increases risk)
●5 million to 45 million
●family/community: lack of awareness and education of risk/misuse, peer pressure
Reasons for prevalence on prescription medication
●various motivations: school performance, bored, pain, coping
●developmental factors: brain development, peer influences
●misconceptions on safety (81% college students, 56% adolescents, 40% teens, 1/3 teen not addictive)
●less stigmatizing, normalizing: decreased perceived risk, decreased disapproval, exposure to message
Hookah
●water pipes for smoking special tobacco
●diff flavors
●originates in India and Persia
●popular social activity, less health risks
●harmful: addition, higher levels of arsenic, can contain charcoal or wood cinder (cancer and heart disease)
Emerging Trends
●N-bomb: hallucinogenic
●Ketamine: anesthetic in vet practice
●Delta-8: variant of THC
●Xylazine: non-opioid vet tranquilizer
What are the 5 models/theories of substance use and abuse?
●diathesis-stress model
●developmental perspectives
●social learning model (Dynamic cascade model)
●coping/self-medication theory
●expectancy theory
Diathesis-Stress Model
●not specific to substance use
●considers diathesis and stress with development of disorder
●diathesis- predisposition or vulnerability
●stress- environmental factors
●stronger diathesis= less stress needed to produce disorder
Developmental Features of Adolescents’ Use
●biological and psychological factors may predispose teens to using substance
●lower sensitivity to effects of drugs (may need more for the same effects)
●emotions are more intense/labile (negative <- = increased use)
●more prone to sensation and novelty seeking behavior (cortex not fully mature, more likely to engage in impulsive behavior)
Developmental Perspective
●age specific
●stress is just one developmental factor
●common or shared factors (problem behavior)
●personality traits (impulsivity)
●identity development (independence, rebellion)
●social development (fit in)
●psychological processes (coping skills, hormones)
●limited personal experiences, no negative consequences
Social learning model
●cascading risk factors leading to substance use initiation
●consider socio-cultural risk
Coping/Self-Medication Theory
●drug use is a means to reduce negative emotions or stabilize mood
●neg mood from temperament, stress AND/OR psychological disorder
●key is self-regulation (if not may use drugs)
●almost cascade
Expectancy Theory
●belief one holds about events in world
●if-then
●act in certain way because of expectancies
●positive expectancy- favorable or expected outcome (pros outweigh cons), more likely to do behavior
●negative expectancy- less favorable or desirable outcome
●expectancies formed in childhood before experiences (learn through parental behavior, social norms, peer groups, pop culture, music, media)- experiences reinforced with experiences through life
Impact of Expectancies: Alcohol
●heaviest drinkers tend to have more positive expectancies than light drinkers
●influence if to drink or how much to drink
Prenatal Exposure
●teratogens: environmental agents that cause damage (legal and illegal substances)
●dose-response relationship (increased exposure=greater probability of defects)
●individual difference also influence the effects of teratogens
●sleeper effects: impact of given agent may not be apparent for many years
●there are periods of sensitivity to development abnormal
Prenatal Exposure- Fetal Alcohol Syndrome
●heavy drinking
●result: decrease number of neurons, abnormal location of neurons, gross malformation of brain
●think about getting women to talk to physicians to try and lower amount of intake
●slow growth, facial abnormalities, brain & behavior
Prenatal Exposure- Cigarettes
●linked to slowed growth and low birth weight
●also linked to SIDS (sudden death), respiratory problems, increased health problems
Prenatal Exposure- Marijuana
●miscarriage risk increases if used in early pregnancy (animal study)
●developmental and hyperactivity disorders, low birth weight, mixed research
●in breast milk
Prenatal Exposure- Aspirin
●most common drug taken during pregnancy
●regular use: low birth weight, infant death, poor motor development
Neonatal Abstinence Syndrome
●withdrawal syndrome experienced by some opioid-exposed infants after birth
●rates increasing
Paternal Risk Factors
●lead, radiation, pesticides before conception
●drug use- sperm affected
●age
●most often affect fertility
What are the general patterns of adolescent substance use in the United States? (data from monitoring the future)
●8th graders have most abstainers
●Overall rates of abstinence have increased
●rates of illicit drugs use since the pandemic have decreased
●Illicit drug use in 8-12th graders is driven by marijuana
●8th graders use more inhalants
●12th have highest rates of use
●8th graders use inhalants because of accessibility, not knowing what they’re doing, cheap, often at home, legal to buy
●DAILY GRAPHS SHOULD ALWAYS BE LOWER
What are the patterns of Marijuana Use? (in teens)
●about 31% of 12th graders use marijuana
●different than what perceived (we think more ppl are using)
●rates of marijuana use in teens today is lower than 1970s
●rate of daily marijuana use is lower than use in past 12 months (due to social context, phrasing of survey questions)
●after pandemic, vaping marijuana remained the same
●teens are more likely to use marijuana (use alcohol more tho)
●rates of cigarette use has declined while rates of marijuana use have remained the stable
Correlates of Teen Substance Use?
●% of teens who report using illicit drugs and marijuana are about the same % of teens who report their friends use
●top two sources of prescription drugs for teens are prescription and given by friend
●supply reduction does not work to reduce availability and therefore use
●as perceived risk increases use tends to decrease (not consistent data)
●Perception of risk globally has decreased while drug potency has increased
Combating honeymoon period
●knowledge of benefits spreads faster than adverse consequences
●prevention must be specific (people will not generalize adverse consequences)
Patterns of Use Across Lifespan (National Survey on Drug Use and Health from SAMHSA)
●12th graders use alcohol most, illicit drug=marijuana
●more 12th graders abstain from drug use
●18-25 use the most substances
●26 older use most cigarettes (older generation where cigs were more common, info, public shift, demographic)
●Highest % of people in currently using alcohol group
●18-25 have highest rate of substance use disorders
●Alcohol use disorder is most diagnosed past year substance use disorder
Differential relative risk of adverse outcome from drinking
●52% for male drivers 16-20 (brain not developed, less experience w/ alcohol
Main reason for most prescription pain reliever misuse
●relieve physical pain
●we should move away from meds for pain
●obtained from provider or friends
Initiation of Substance Use
●Alcohol use before 21 and marijuana
●nicotine vaping/cigarettes tried after 21
●hard drugs start later
International Rates (Per UN world drug report)
●slight increase but drug use disorder stayed about the same
●US uses most prescription drugs
●America uses cocaine most
●different drugs across the world used
Africa Drug rates
●Africa projected to have a large increase in substance use
●having increase exposure to substances
Impact of COVID per Drug Report
●social distancing
●changes to production, distribution and use during pandemic
●by 2021 drug trafficking continued at same pace as before or even faster
●more maritime and water routes
●after initial decrease, there was an increase
●increase use of private aircrafts
●contactless delivery (thinking about safety)
●internet ordering
New trends in use in covid
●all age groups
●harder drugs used less
●increase use of cannabis and pharmaceutical drugs
●trends are about 1/3, 1/3, 1/3 (decreased, same, increase)
●why? boredom, income loss, loneliness, reduced availability, anxiety, more money to spend toward drugs
Rates of Use by Gender (Monitoring the Future)
●females take fewer types of drugs and use less freq than males
●fewer gender differences in use in lower grades
●some drugs females use more
●males heavier use and more prevalence in older groups
●trendlines are parallel (women less)
●men binge-drink more
Higher prevalence in females
●higher rates of females in 8th grade and switch in later ages
●marijuana slightly higher for women
●vaping nicotine and vaping marijuana were higher in women for all grades
Gender Differences in Adults Who Enter Treatment
●women less likely to enter treatment (socio-cultural, socio-economic, legal/child custody, lack of dual-diagnosis for treatment)
●consider mental health
●women: more severe psychological problems, worse self-image, family related problems, sexual abuse
●males: worse school performance, more legal problems
3 explanations for gender differences
●Social: gender roles & masculinity
●psychological: comorbidity/coping, prescriptions, motivations/reasons for use
●Physiological: vulnerability by gender, hormones
Social or gender roles explanation
●drug use incompatible with traditional female roles and responsibilities
●relative social disapproval for female drug use in society
●drug use viewed as badge of masculinity or manhood in some countries
Psychological explanation for gender diff
●Comorbidity (2 diagnosis at same time): male= higher comorbidity with externalizing (social deviance), female= higher comorbidity with internal problems (depression)
●Prescription medicine: women less likely to self-disclose about mental health, women prescribed medication more often than men
●Expectancies: strong predictors of initiation and continued use
●Motivations: different motivation and reasons for use, (female=coping performance, appearance), (male= sensation seeking, seeking high, experimentation)
Physiological explanations for gender diff
●women become intoxicated from smaller amounts, achieve higher blood alcohol concentrations from equal amounts, develop liver disease in shorter and less intense drinking
●telescoping: women more vulnerable to adverse effects of substance abuse, women more likely to telescope (zoom in quicker) of substance use disorders, advance more rapidly from initiation to regular use to first treatment episode, occurs even if women use smaller amounts
Why are women more vulnerable?
●lower body weight and organ sizes, less body water, lower concentrations of enzymes, hormonal changes (estrogen= higher response, progesterone=less), possible brain structure
Sexuality and Substance Use
●1 in 4 have problems
●more likely to use drugs and alcohol than heterosexual
●190% teens more likely
●340% bisexual
●400% lesbians
●earlier initiation (harder to get off drugs)
●1.5 to 2.5 times higher smoking
●WHY? psychological factors, societal and legal discrimination, social stigma and discrimination, internalized homophobia and less comfort with sexual identity (can be unconscious), lack of parental support, harassment, bullying, victimization, advertising
Advertising to LGBT individual
●tobacco companies
●bars frequented
●outdoor signs
●corporate donations (want more customers- not good intentions)
●higher than normal brand loyalty
What are the general patterns of substance by race and ethnicity in United States? (MTF data, Lewis Article- SES, race and substance use)
●Used to be reversed, but now 12th grade african americans use more
●Alcohol: higher use (57%) in black 12th, also higher in getting drunk, black have greater telescoping cuz SES (hispanic 43%)
●Cigarettes: black have higher use of nicotine, prevalence was higher, prevalence of nicotine vaping in blacks (5% teens, 1.9% hispanic) (25% nicotine, 13% hispanic)
●whites initiate use earlier
●Marijuana: white had marijuana earlier
●white had higher transition from problem drinking to treatment earlier
Why are minorities at risk for substance use
●minority stress model: similar to self-coping hypothesis, chronic social stressors place youth at risk negative health outcomes (bad coping)
●consider intersecting identities: look at moderators (relationships) and patterns for specific substances, race/ethnicity relationship between sexual orientation and polysubstance use (difficult to figure out who is affected)
Comorbidities and Substance Use
●comorbidity: presence of one or more disorders/diagnoses in addition to primary disorder/diagnosis, interaction of disorders can affect course and prognosis of either disorder
Why do disorders co-occur?
●substance use may bring up symptoms of another mental illness (mood)
●psychiatric disorders can lead to drug abuse (self-medication) (alcohol for depression)
●3rd variable: same underlying personality traits or behaviors, shared risk factors for different disorders (genetic, brain regions)
What psychopathology is most diagnosed with substance use disorders (SUD)?
●Disruptive Disorders (externalizing disorders- ADHD)
Internalizing Disorders
●depression is second most common diagnosed comorbid disorders in community samples
Internalizing Disorders and Substance Use
●co-occurring more rare than disorder
Smoking & Psychiatric Disorders
●1/4 have psychiatric illness or substance use disorder
●higher smoking with disorder
●less likely to quit if they have psychiatric illness
●public health concern
●Why? historic, mood-altering effects, medication less effective, stressful living conditions, marketing
●having mental health disorder has higher chance of substance use
Self-medication hypothesis
●internalizing/externalizing disorder -> drug abuse
Substance-induced enhancement theory
●drug abuse -> internalizing/externalizing disorder
Which path wins?
●majority say mental health disorders first, less time differential for mood disorders, self-medication hypothesis
●other studies find opposite
●is more complicated
●we cannot assume one appeared first
●bi-directional: one path doesnt win
●reciprocal: both factors share common etiologies (origins) (reacting to one another)
●need more research: longitudinal research to establish cause-effect
Risk Factors
●genetic, individual, familial, social or community factors:
●impede development
●increase likelihood that adverse behaviors and/or negative consequences will occur
●Risky behaviors tend to cluster in same individuals
Protective Factors
●genetic, individual, familial, social or community factors:
●buffer against the impact of risk factors and promote development or
●decrease the likelihood of adverse behaviors and/or consequences occurring
●prevent or reduce vulnerability of disorder or event
Resilience
●healthy development and optimal outcomes despite the presence of risk factors
Risk and Protective Factor Approach
●more risk a child has the more likely they are to have difficulties later
●if we address risk factors in childhood, less likely to have difficulties later
●BUT- not all children exposed to risk have negative outcomes
●to prevent problem- necessary to identify both the factors that increase and decrease likelihood of problem developing
●identification of risk and protective factors can help design prevention and intervention programs
What are risk factor domains organized into?
●individual
●family
●school
●peer
●community
Individual risk factors
●temperament, self-regulation or coping skills, poor impulse control, hopelessness, lower expectancies of success, low self-esteem, rebellion, oppositional behavior, antisocial, early puberty, poor social adjustment, access to substance, positive expectancies, knowledge about drugs, favorable attitudes or low disapproval
Family Risk Factors
●family history, favorable parental attitudes toward substance, parental psychopathology, prenatal exposure, genetic predisposition, family management problems, family conflict, chaotic home, high expectancies by parents, neglect and abuse
School and Peer Risk Factors
●academic failure, low commitment bonding to school, deviant peers, rejection from peers, no college plans
Community Risk Factors
●availability, lenient laws about drug use, perceived approval about substance-abuse behaviors, lack of law enforcement, competitive athletics, low community attachment, transitions, neighborhood disorganization, low SES economic disadvantage, exposure to violence, media portrayal of substances
Protective factors listed
●individual: commitment to learning, social competencies, strong coping skills
●family: parent supervision, secure family, family harmony, parent involvement
●peers & school: affiliation with peers, successful academic performance, positive attitude, attachment to teachers, positive school climate, school norms that discourage
●community: norms against use, activities promoting health, strong bonds, strong cultural identity or ethic pride, support services, media-PSAs
Public Policy
●course of action and decisions by governments regarding a particular social issue
●address social, moral, and economic issues
●tax stamp: seal bottle (baby= safety)
●no federal drug regulations in past: violated states rights to regulate law, invasion of personal spaces by government
●changes due to cultural, historical, and social issues: taxation as regulation measure, social pressure due to harm, propaganda, societal changes
●legal -> medicinal -> illegal
Examples of opiates
●poppies: alleviate pain, control body temp, undisturbed sleep
●morphine as treatment for alcoholism
●WWI, mail order, prescriptions
●illegal due to influx of chinese immigrants on west coast who smoked opium (discrimination)
Example of marijuana policy
●propaganda to ban marijuana
●related to danger, murder, rape, suicide,
●caught up in Mexican immigration issues
●jazz musicians
●stigmatizing and demonizing marijuana
●no evidence- bills passed anyway to block it
●accepted as medicinal aid at times
●make certain drugs illegal as intent to discriminate (vietnam war)
War on Drugs
●discourage production, distribution, and use of illegal drugs
●Decrease use and associated health risk by: decreasing drug availability and sales, working with other governments and on border control, criminalizing and prosecuting dealers and users
Why War on Drugs?
●Nixon era, drug abuse, 1971
●penalties against possession
●3rd wave
Cost of War on Drugs
●cost a lot of money
●1/2 federal prisoners for drug offenses
●1/3 of drug offenses for marijuana possession
●over 2/3 prison cost
●increase spending amount, not much toward treatment
Domains of potential change
●availability and use
●health risks and outcomes
●boarder control and international relationships
●criminalization as deterrent
Availability and Use
●US 50% of global drug use (use a lot more than our world population)
●US spending increase
●decrease in price (something not working)
●should be harder to access
●purity increase in drugs should make them more expensive
●americans spend a lot on illegal drugs
●FAILED: neutral or use increased
Health Risks and Outcomes
●drug misuse damages health
●fatal drug overdose increase
●opioids more likely to kill than car crashes or suicide
●1 in 4 who needed treatment received it
●FAILED: not doing well
Border Control and International Relations
●decrease drug availability/sales
●goal- control borders and gangs, decrease drug cultivation
●but- sale of drugs continue, trafficking moved to mexico (instead of colombia), drug prices dropping
●destabilized other countries- increased violence in mexico, traffickers, cultivation moved to other places (collaborating with other countries)
●FAILED
Criminalization as Deterrent
●2/3 prison population for drug offenses
●increase prison population
●drug arrests- 8 out 10 arrest for possession, 1/2 for marijuana (5-10 year first offense)
●burden justice system- costs and outcome: a lot of time toward marijuana arrest, not really followed up in prosecution, lot of money toward prison
●increase jail time leads to increased drug abuse, only 14% get treatment for substance use
●criminalization disparities: blacks/hispanics are 56% of incarcerated population, higher rates, women 2x more than white women, black kids also higher rates
●usage the same, higher arrest in blacks (similar trend in several cities)
●if incarcerated at same rate, prison population decrease by 40%
●EPIC FAIL
Effects of Incarceration
●10-20% mental illness
●5x likely HIV
●lose rights
●increase probability of cigarette smoking and early death
●family and community impact (1 in 6 black men gone)
Trends in marijuana arrest
●starting to decrease
policies and laws to address drug problem
●supply reduction-restrict supply
●demand reduction- restriction of use
●harm reduction- alternative approaches
●US largest focus on prohibition or drug use reduction rather than harm reduction
Supply reduction
●restrict supplies and decrease availability by disrupting the manufacturing and distribution of drugs through- law enforcement, foreign policy, border control & drug trafficking
Demand reduction
●restriction of use, prohibit use
●efforts aimed at reducing public desire for substances
●Prohibition
●theoretically addresses problem by: fear of arrest, increased cost, socially unacceptable
●sale limitation
●smoking: increased price lowered use
●CVS doesn’t sell tobacco- less use
●states have different restrictions (second-hand smoke)
●advertising, marketing, public service announcement, prevention, abstinence treatment
Harm Reduction
●Public health approach: minimizes the problems associated use, alternative to moral, criminal and medical/disease models
●benefits of harm reduction: accept that abuse occurs, address drug-related health problems, decrease accidental deaths, provide approach to treatment
●examples: Naloxone (narcan), good samaritan laws, dance safe (community), needle exchange programs, prescription of injectable opiates, nicotine patches, shelters for alcoholics
What can be done?
●education
●monitoring
●proper disposal
●enforcement
Education
●educate health care providers and public about prescription drug misuse, abuse, suicide, and overdose
Monitoring
●track prescription drug overdose trends to better understand epidemic
●id requirement
●prescription monitoring program
Disposal
●Take-back events: drop off unused or expired prescription drugs
●October 2014: collect unused prescription drugs in hospitals, pharmacies, and clinics
Enforcement
●health care providers- discuss pain treatment options, follow guidelines for prescribing, drug monitoring programs
●patients: use only as directed, discuss all medications, women- pregnancy talk with doctor, dispose of drugs properly
Decriminalization and its effects
●removal of criminal penalties for drug violations
●reduce number of arrests and incarcerations
●minimize stigma related to seeking treatment
●increase individuals in treatment
●countries that have decriminalized have not seen increase in drug use, drug related harm or drug-related crime
●US has largest rates of lifetime drug use despite practices
Which country in Europe has the most liberal drug laws?
●Portugal
●abolish criminal penalties for illicit drugs
●replaced jail time with therapy
●Believed that fear of imprisonment kept users underground
●illegal drug use decreased in teens
●rates of drug-related HIV dropped 17%
●drug-related deaths cut in half
●treatment seeking doubled
●shows sustained effects
Legalization
●Different definitions for different groups
●removal of drug-related offenses from criminal law
●support for marijuana increasing
●1 in 10 adults say marijuana should not be legal
Considerations about Marijuana Legalization
●legalizing could lead to fewer opioid painkiller death
●still has issues
●marijuana has increased in adults in states that have legalized
●differential risks in adults vs kids
Uruguay
●first in world to fully regulate the cultivation, trade and consumption of marijuana for medical, industrial and recreational purposes
●money goes toward more important things
Legalization advantages
●decrease: cost to society, arrest, violation, drug cartel profits
●increase: fear prosecution, use of treatment, alternative for pain
Legalization Pro
●monetary
●health
●decrease trafficking-related violence and black market
●personal choices, human rights of choice
Legalization Against
●drug cartels will still continue and profit from other drugs
●dropped prices -> drive millions to use
●targets drug dealing but problems of drug about worse
●violence and crime will still be increased
●public safety concern
●no real revenue
●using drugs is morally wrong
Legalization of marijuana on teens
●marijuana not good for developing brain
●get the message that marijuana is safe
Prescription in college students
*Most use prescription drugs as intended
*1 in 4 report using non-medically at least once
*Twice as likely to use stimulants for non-medical reasons in past year, compared to non-college or part-time students
*By sophomore year, half of students are offered the opportunity to use a prescription drug
*Students who take prescription drugs for non-medical reasons are 5x more likely to develop a drug abuse problem
