Substance Use Part 1 Flashcards
– Body has adjusted to substance and incorporates its use into normal
functioning of body’s tissues
– May experience tolerance but not necessary
– Craving
– “Psychological dependence” is used to describe any behavior that becomes part of one’s habitual manner of responding (e.g., exercise,
watching TV, gambling, etc.)
physical dependence
– Unpleasant symptoms, both physical and psychological, that people experience when they stop using a substance
on which they have become dependent
– Usually opposite of the drug’s effects
Withdrawal
A person has become physically dependent on a
substance following use over a period of time AND
experiences withdrawal symptoms when the drug is
discontinued
Addiction
• Respiration (breathing) has 3 functions
– To take in oxygen
– To excrete carbon dioxide
– To regulate the composition of the blood
• Involves a number of organs
– Nose, mouth, pharynx, trachea, diaphragm, abdominal muscles, and lungs
structure and function of respiratory system
Inspiration is active; expiration is passive
Coughing expels mucus in airways (forced
expiration)
• Seasonal allergic reaction
– Pollens, dust, etc.
• Allergens → ↑histamines →inflammation of lung capillaries → release of large amounts of fluid →violent sneezing & other allergy symptoms
Hay Fever
• Chronic inflammation in lungs
• Can be an allergic reaction
– Dust, dander, pollens, & fungi
• Stress or exercise
• Produce bronchial spasms & hyperventilation
• Muscle constriction, swelling, & inflammation of
airtubes → ↑mucus → bronchiole obstruction → ↓O & ↑CO2
• Dramatic increase in past 20-30 years
Asthma
common cold, flu, bronchitis
Viral Infections
strep throat; whooping cough(pertussis); diphtheria [ main concerns are secondary infection or damage to organs]
bacterial infections
• Viral or bacterial or by inhaling foreign substances • Lobar pneumonia – Primary infection of an entire lobe – Inflamed alveoli disrupt O-CO2 exchange – Infection can spread to other organs • Bronchial pneumonia – Typically a secondary infection – Confined to bronchi
Pneumonia
• Tuberculosis
– Bacteria are surrounded by macrophages & form clumps (tubercle)
– Tubercles turns into cheesy masses that produces cavities in the lung
– Cavities turn into permanent scars that hinder blood exchange at the alveoli
• Pleurisy
– Inflammation of the pleura surrounding the lungs
– Usually secondary symptom
Respiratory Diseases
• 3rd leading killer in the U.S. • 85% of all cases are due to smoking • Chronic bronchitis • Emphysema – Persistent obstruction of airflow – Alveoli lose elasticity & can’t constrict during exhalation – Decreased elimination of CO2
Chronic Lower Respiratory Diseases or
Chronic Obstructive Pulmonary Disease
(COPD)
• Increasingly common
• @85% of patients are current or past smokers
• Other environmental causes (air pollution,
asbestos)
Lung Cancer
How is Smoking Dangerous?
• Nicotine is the pharmacological agent in tobacco that
underlies addiction
– Stimulant drug or “upper”
– The peripheral nervous system and the brain contain receptors that respond to nicotine
• Promote release of catecholamines (epinephrine, norepinephrine,
dopamine), acetylcholine, and glutamate that produce the stimulant effects
• Promote release of beta-endorphins that produce pleasurable effects
– Increases metabolism & decreases appetite
– Reaches the brain in 7 seconds
– Half life is 30-40 minutes (addicted smokers rarely go longer than this amount of time without a “fix”)
• Tobacco contains at least 4,000 compounds in
addition to nicotine
– E.g., Acrolein, formaldehyde, nitric oxide, hydrocyanic acid
• Tobacco contains at least 60 known carcinogens
(substances that can cause cancer)
• Contains tars (the water-soluble residue of tobacco smoke condensate)
– Contains carcinogens
– Positive relationship between tars content and deaths from smoking-related diseases
– Low-nicotine cigarettes result in deeper inhalation and greater exposure to dangerous tars
• Single greatest cause of preventable death
• USA – accounts for about 1 in 5 deaths
• Smokers, compared to nonsmokers are
– Generally less health-conscious
– More likely to engage in other unhealthy behaviors
smoking
– Smokers have a relative risk of 2.0
– Smoking increases progression of atherosclerosis
– Increases clots, inflammation, & cholesterol
– Decreases availability of oxygen
– Nicotine activates the sympathetic nervous system causing increases in blood pressure, heart rate and cardiac output and
constriction of blood vessels leading to CVD
cardiovascular disesase
– Relative risk for male smokers is 23.3 – Lung cancer – Other cancers • Lip, pharynx, esophagus, pancreas, larynx, trachea, bladder, kidney, cervix, stomach
cancer
• More than 1,000 people die each year from fires started by cigarettes • Fatal and nonfatal burns • Periodontal disease • Multiple sclerosis • Diminished physical strength, poorer balance, impaired neuromuscular performance • More accidents and injuries • Common cold • Take off more sick time • Use more health benefits
smoking and health
- Hearing loss and macular degeneration
- Infertility, preterm delivery, stillbirth, low birth weight, SIDS
- Erectile dysfunction
- Look older and less attractive (men)
- Slower growth of lung function in adolescents
- More likely to have psychiatric diagnoses, especially depression
- More likely to have substance abuse disorders
- More likely to commit suicide
- Problems with cognitive functioning
- Studies of secondhand smoke reveal that family members and coworkers are at risk for a variety of health disorders.
smoking and health
Is smoking cigars or pipes safer?
What about chewing tobacco?
• They are less hazardous than cigarettes, but they are still not safe
• Smokeless tobacco also has adverse health effects
– Increased mortality from CVD and oral, pancreatic, and lung cancer
– Gateway
• e-cigarettes
– Safety not fully known
– No tobacco, only nicotine
– Not regulated, nicotine content varies, secondhand vapors
• A sophisticated habit of the male gentry
• 1940s
– Large numbers of women smoke
– Advertised as symbol of feminine sophistication
• 1964
– First U.S. Surgeon General’s warning is issued
– Male smoking declines, female smoking increases
• 1994
– Female teen smokers, 22.9%
– Male teen smokers, 28.8%
history of smoking
What factors predict smoking?
• Gender
– Males > females
• Ethnic groups
– American Indians: highest rates (40%)
– Asian Americans: lowest rates ( employed
– Below poverty line > at or above poverty line
• Education
– Higher education lower the rate (negative correlation)
– Exception: Italian and British men have positive correlation
• Current smoker
– People who smoked cigarettes on one or more days during the past 30 days
Frequent smoker
– Those who have smoked cigarettes on 20 of the previous 30 days
Why Do People Smoke?
• Optimistic bias
• Social pressure
– 70% of all cigarettes smoked by teens are smoked in the presence of a peer
– Siblings, parents and movies
• Pro-smoking advertising including merchandise
– Advertising that arouses curiosity is more powerful
• Weight control
• Genetic risk factors for smoking initiation and
nicotine dependence
– Genes involved in dopamine and serotonin pathways
Smoking is clearly an addiction
– It is reported to be harder to stop than heroin
addiction or alcoholism
– Addicted smokers who smoke low-nicotine cigarettes smoke more to compensate
– The exact mechanisms of nicotine addiction are not known
– Nicotine may be a way of regulating performance and affect
– Smoke to maintain blood levels of nicotine & to prevent
withdrawal symptoms
nicotine regulation theory
nicotine’s effects
– Alters levels of neuroendocrine factors like
acetylcholine, NE, dopamine, endogenous opioids, ADH
– Increases memory & task performance, improves mood,
decreases anxiety & tension
Positive and negative reinforcement
– Smoking is paired with rewarding experiences
• Positive reinforcement (pleasure, relaxation)
• Negative reinforcement (removal of withdrawal symptoms)
• Chippers: term used to describe light smokers
– High value placed on academic success – Supportive relationships at home – Little smoking among parents and peers • Number of “chippers” has increased • Surprising trend given addictive nature of smoking
• Most people who quit smoking do so on their
own
• Quitting may be easier than clinical trials indicate
– Selection bias in clinical trials
– Participants have already failed attempts to quit on their own
Quitting
Media campaigns have helped instill
antismoking attitudes among the general public
• Changes in social norms (from largely positive to strongly negative) have motivated many people
to quit
• BUT attitude-change campaigns by themselves
don’t help smokers quit
Interventions to reduce smoking
• Gradually decrease doses of nicotine
• Nicotine gum is disliked because the nicotine is
absorbed very slowly
• Transdermal nicotine patches release nicotine in steady doses
• Other types of nicotine replacement
– Inhalers, lozenges, spray
• Nicotine-replacement therapy produces significant smoking cessation
• Does have potential side effects
– Can’t use if pregnant or recent heart attack
nicotine replacement therapy
– Act on dopamine pleasure pathways in the brain
– varenicline (Chantix) and bupropion (Zyban)
Other Pharmacological Approaches to reduce smoking
– Usually theory based – Includes a combination of strategies • Behavior modification • Cognitive behavioral approaches • Contingency contract • Motivational interviewing • Group therapy • Social support • Relaxation • Stress management • Booster sessions – Effectiveness increases with contact time
Psychological Intervention to reduce smoking
Multimodal Interventions
• Specific interventions are geared to the stage of
readiness with respect to smoking
- precontemplation to contempation: focuse is on attitudes and adverse health consequences
- contemplation to action: smoker develops a timetable to quit and a program of how to go about it
- action phase:cognitive behavioral techniques used
– Would-be ex-smokers enlist support from others in their efforts to stop
• Practitioner support especially effective
• Tell family and friends
• Support helps to increase self-efficacy
– A strong image of oneself as a “nonsmoker” helps
– Stimulus control to rid environment of cues
– Relaxation training to replace smoking
• Most effective treatment is psychological
intervention and nicotine replacement combined
Social Support and Stress Management
What seems to work
– Intensive intervention with pharmacotherapy and
phone counseling
– Expensive
• For some people it may take 5-7attempts before
they are successful
• Multimodal Interventions
– High initial success rates followed by high relapse
rates (50-90%)
– No one approach has been identified as especially effective
– Many people relapse on the road to quitting
• 2/3 relapse after two days
• 75% relapse within 6 months
– A single lapse reduces perceptions of self-efficacy (abstinence violation effect)
– When self-efficacy wanes, vulnerability to relapse is high
Maintenance and Relapse Prevention
Relapse Prevention Strategies
• Identify reasons for relapse and then act to
reduce or eliminate them, such as
– Prepare for symptoms of withdrawal (7-11 days)
– Cardiovascular changes and increased appetite,
coughing, phlegm, etc.
– High risk situations
• Coffee, alcohol, eating
– Coping techniques to deal with stress
– Contingency contracting
– Buddy system & booster sessions
• Short-term
– Alternative methods for coping with stress and anxiety
– Social support & environmental support
– Self-efficacy
• Long-term
– Social support & environmental support
– Self-efficacy
Factors That Predict Maintenance
Who is best able to induce people
to stop smoking?
Physician recommendations – Especially effective for pregnant smokers – Patients with symptoms of CHD more likely to stop – Better if include intervention or referral – Area needs to be developed • Hospitalized patients
Deeply entrenched behavior that may be
influenced by
– Addiction that makes it difficult to stop
– Mood, since it elevates mood
– Weight control, it keeps body weight down
weight gain, health benefits,
Effects of Quitting
smoking prevention Two Theoretical Principles:
• Model “High Status” nonsmokers
• Behavioral inoculation
– expose students to a weak version of a persuasive message so they can resist the message in its stronger form
– Information about negative effects of smoking (appealing to adolescents)
– Image of nonsmoker is presented as independent and selfreliant
– Evaulation
• Appear to delay onset (4 years)
• May be more effective for experimenters vs. regular smokers
Social Influence Intervention Program
- Rationale: If adolescents are trained in self-esteem enhancement, then they will not feel the need to bolster self-image by smoking
- Evaluation: some success in delaying smoking onset
- Cons: Expensive, logistically difficult
- Variations: CD-ROM; marijuana
Life-Skills-Training Approach
- Liability litigation
- FDA Regulation of tobacco as a drug
- Heavy taxation
- Smoke-free facilities
Social Engineering and Smoking
larger doses needed to produce same effects, increased risk of dangerous side effects
tolerance
conditioning process is involved so that environmental cues trigger intense desire
craving
affecfts upper and soemtiems lower respiratory tract, 12-72 incubation, causes inflammation of mucus membranes
common cold
attacks lining of the respiratory tract and kills healthy cells
influenza
inflammation of mucosal membrane inside bronchi, large amounts of mucus and coughing
bronchitis
swelling and reddening of throat and soft palate
strep throat
affests upper respiratory tact, trachea and bornchi/produces viscous fluid and violent coughing
whooping cough(pertussis)
bacteria in upper respiratory tract secrete toxin that is circulated thru ody via the blood/ can damage nerves; cardiac muscles; kidneys and adrenal cortex
diphtheria
