week 8 Flashcards
prevelance of any illicit drug use in past year-
12-15 year olds: ~5-10% 16-17 yolds: ~20-25% 18-19 yolds: ~30-35% 20-29yolds: ~30-35% 30-39 yolds = ~20% 40+ = ~5-10%
Legal Status
psychoactive substances can be classified into how many groups?
what are the groups?
Medications
- -Available via prescription only
- –eg.Morphine
Illegal / Illicit Use
- —Use and possession is unlawful for non-medical purposes
- —-eg—-Heroin, cannabis, d-LSD25, amphetamine
Legal
Use for any purpose, including non-medical is lawful
egAlcohol, tobacco, caffeine
Harmful Effects of Substances
4 categories
Harmful effects can be grouped into four categories
Chronic Health Effects
Cirrhosis, Lung cancer
Acute / Short Term Biological Effects
Overdose, Impaired judgement
Acute Social Problems
Relationship breakup, arrest
Chronic Social Problems
Problems in work life, problems in family role
WHO Definitions
harmful use and hazardous use
Harmful Use
A pattern of psychoactive substance use that is causing damage (physical or psychological) to health.
Hazardous Use
A pattern of psychoactive substance use that increases risk of harmful consequences for the user.
WHO Definitions
Substance Abuse
Substance Abuse
Persistent or sporadic use inconsistent with or unrelated to current medical practice. A maladaptive pattern of substance use leading to clinically significant impairment or distress
—Failure to fulfill major role obligations
—Use in situations where it is physically hazardous
—Recurrent legal problems
—Continued use despite problematic consequences
Tolerance
Either…
A need for increased amounts of the substance to achieve intoxication or the desired effect; or
Markedly diminished effect with continued use of the same amount of the substance.
Withdrawal
Either: The characteristic withdrawal syndrome for the substance; or The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms.
Substance Dependence (DSM)
Three or more of the following in the same 12 month period
- -Tolerance
- -Withdrawal
- -Substance taken in larger amounts, or for longer periods than intended
- -Desire or unsuccessful efforts to cut down on use
- -Excessive time spent in activities related to the substance
- -Reduction in important social, occupational, etc. activities
- -Continued use despite negative consequences of use.
Other Features
Narrowing of interest
Narrowing of social circle
Rapid reinstatement
Rapid Reinstatement
“An addict may be ten years off junk, but he can get a new habit in less than a week; whereas someone who has never been addicted would have to take two shots a day for two months to get any habit at all.”
William S. Burroughs, Junky
Psych Mechanisms:
Classical Conditioning
Associative learning between drug cues and drug use.
Automatic elicitation of urges to use through associated cues
>e.g., Increase in urges to drink alcohol when others are drinking
>e.g., Increase in urges to smoke when seeing a film with an actor smoking.
Operant Conditioning
Reinforcement of substance use
>Positive reinforcement of drug use through subjective positive effects (e.g., euphoria) – Speed of effect
>Negative reinforcement of drug use through removal of negative emotional states (e.g., reduction in anxiety).
>Punishment of refusal (e.g., through increased urges, frustration, anger, etc.).
Modelling
Modelling of drug use behaviour by significant others
>Observing positive effects in friends
>Children witnessing drug use behaviour in adults
Expectancies
Cognitions involving conditional statements regarding the effect of the substance
>If I have a cigarette, then I will feel more relaxed
>If I have a drink, then I will become more sociable
>If I have a pill, then I will have a better time.
>If I don’t smoke a joint, then my friends will think I am a nerd.
>If I don’t shoot up, then I am going to go into withdrawal and that will be unbearable.
Refusal Self-Efficacy
An individual’s beliefs about their ability to refuse a substance under different conditions.
>If I am at a pub then there is no way I can refuse a drink
>If I am really angry after a hard day at work then I cannot go without a stiff whiskey
>Even if my friends are passing a joint, I can still say no.
High Risk Situations
Situations in which the individual’s ability to abstain from substance use are reduced
>Driving past the pub
>Going out with certain friends
>Cooking using wine
Idiosyncratic to individuals
Seemingly Irrelevant Decisions
Decisions made without full conscious awareness that place the individual in high risk situations
»Having the choice to go to a number of parties, but choosing to attend one where other substance-users are present
»Having the choice to drive home via many different routes, but choosing to drive home past a bottle shop.
Abstinence Violation Effect
> > The tendency to continue substance use once abstinence has been violated
Cognitions that equate lapse with relapse
Major Classes of Substances
Stimulants
depressants
hallucinogens
opioids
Alcohol
In Australia
>9% drink daily
>41% drink weekly
>34% drink less than weekly
These figures have been constant since 1991
>35% of adults drink to levels that increase risk of health problems
>In 2004-5FY the government made $5 billion in revenue from sale of alcohol
Costs of Alcohol Use in Australia
($AUD millions)
road accidents : 1875.5 Crime: 1,235.3 Health: 225 lost production in the workplace: 1949.9 lost production in the home: 402.6
Severe Alcohol Withdrawal
Delirium Tremens (“DTs”) Commencing a few hours after cessation Peaking 48-72 hours later Life-threatening in up to 35% of cases Symptoms Seizure Confusion Hallucinations Severe agitation
Alcohol Safe-Use Guidelines
Men
≤ 4 standard drinks per day; and
≤ 6 standard drinks in any one day; and
1 or 2 alcohol free days per week
Women
≤ 2 standard drinks per day; and
≤ 4 standard drinks in any one day; and
1 or 2 alcohol free days per week
weed
In Australia... Cannabis is the most commonly used illicit drug. 34% of adults have tried cannabis. Cannabis accounts for 71% of illicit drug arrests
Cannabis Effects
Sense of well-being and relaxation Intensification of sensory experience Increased heart rate and blood pressure Dry mouth Increased appetite Sedation Bronchodilation Anxiety Paranoia Changes in subjective time Memory effects
Heroin - overdose rates
In Australia…
46% of IV drug users have
overdosed at some time.
Opiate Effects
Intense euphoria Analgesia Sedation Sluggish movement and reflexes Pupil constriction Slowed respiration
Amphetamine
In Australia…
9% of those over 14 have
tried amphetamine
3% of those over 14 have used amphetamine in the last year
Stimulant Effects
Euphoria, well-being Confidence Increased activity Talkativeness Improved attention Alertness, wakefulness Increased heart rate, respiration rate Increased body temperature (‘hyperthermia’) Appetite suppression
Effects of Large Doses
Unlike other substances (e.g., cannabis), sufficiently large doses of amphetamine will produce psychotic symptoms in all users Paranoid delusions Agitation Confusion Compulsive symptoms, stereotypies
CocaineCoke, Charlie, Crack, White, Blow
In Australia…
Less widely used than in USA
Increased availability since 1990s
Stimulant Effects
Euphoria, well-being Confidence Increased activity Talkativeness Improved attention Alertnesss, wakefulness Increased heart rate, respiration rate Increased body temperature (‘hyperpyrexia’) Appetite suppression Local anaesthesia
MDMAEcstacy, E, Pills
In Australia... MDMA use has steadily increased 7.5% have tried MDMA (2004) 3.4% have used MDMA in the last month The mean age of first use of MDMA is 22.8 years
Ecstasy Use in Past Year by age group
2007 data
12-15 ~0-2% 16-17 ~2-4% 18-19 ~8.5% (6-12%) 20-29 ~12% (11-14%) 30-39% ~4% 40+ ~ 0-1%
overall percent using in past year (ecstasy)
1991 - 1 93 - 1.5 95 - 1 98 - 2.5 2001 - 3 2004 - 3.5
MDMA Effects
Euphoria Enhanced empathy Enhanced interoceptive perception Pupil dilation Reduced appetite Dry mouth Tachycardia Hyperthermia Polydipsia
mdma midweek blues
come down
saturday - take pills - wednesday = highest depression scores
Lysergic AcidLSD, Acid, Trips
In Australia…
Low prevalence compared
with other drugs
Low abuse and dependence rates
Hallucinogen Effects
Visual hallucinations --Geometric shapes, patterns, movement, traces Increased intensity of stimuli ---Enhancement of colour Synaesthesia Depersonalization and derealisation Appetite suppression Euphoria Subjective insightfulness Paranoia Anxiety, panic (‘bad trip’)
Elephants on Acid
West, Pierce & Thomas (1962)
LSD administration to Tusky the Elephant
297mg (approx 3000x normal human dose)
“Tusky reacted as if he had been shot by a gun. He trumpeted around his pen for a few minutes and then keeled over.”
Hallucinatory Movement
Optical Illusions that simulate typical illusory movements
Treatment of Substance Problems
Harm Minimization
Based upon recognition of substance use as a pervasive behaviour observed in all societies throughout history
Rather than aiming for abstinence, focus is on attempting to reduce risk of harm through continued use.
—Shooting galleries, needle exchanges, legalisation of substances
Controversy, ignorance and denial
Transtheoretical Model
precontemplation contemplation preparation action maintenance
going back up the path = relapse, down -= progress
Motivational Interviewing
Aims to assist a person in moving towards action and abstinence
- Examination of advantages and disadvantages of continued use versus change in behaviour
- Examination of likely long-term trajectory of current use patterns
- Examination of compatibility of current use pattern with long-term goals
- Attempts to reach a commitment for change
Aversive Conditioning
Application of aversive consequences for substance use behaviours
Disulfiram (“Antabuse”)
—Produces unpleasant reaction when alcohol is consumed
—Inhibits metabolism of acetaldehyde
—-Flushing, nausea, headache
—–“Instant hangover”
Problems
Poor generalization
Planned drinking after non-adherence to disulfiram
Stimulus Control
Reduction or elimination of stimuli associated with substance use
Avoiding pubs
Ensuring that alcohol is absent from the home
Reducing contact with other users
Cue Exposure
Following period of stimulus avoidance Graduated exposure to cues that are associated with substance use --Extinction processes ---Increases in refusal self-efficacy ----Rehearsal of refusal behaviours.
