Chapter 8 Health Basics

The Basics Health
13th Edition
Chapter 8
Recognizing and Avoiding
Addiction and Drug Abuse
Copyright © 2019, 2017, 2015 Pearson Education, Inc. All Rights Reserved
Learning Objectives
•
8.1 Define addiction, identify the signs of addiction, and describe
the impact of addiction on friends and family.
•
8. 2 Describe types of process addictions, such as gambling
disorder, exercise addiction, technology addictions, and
compulsive buying disorder
•
8.3 Identify the six categories of drugs and their routes of
administration.
•
8.4 Review problems relating to the misuse and abuse of
prescription drugs, including the use of illicit drugs among college
students.
Learning Objectives (cont.)
•
8.5 Discuss the use and abuse of controlled substances, including
stimulants, marijuana and other cannabinoids, depressants,
opioids (narcotics), hallucinogens, inhalants, and anabolic
steroids.
•
8.6 Discuss treatment and recovery options for addicts, as well as
public health approaches to preventing drug abuse and reducing
the impact of addiction on our society.
What Is Addiction?
• Addiction is defined as continued involvement with a substance or
activity despite its ongoing negative consequences.
• Classified by the American Psychiatric Association (APA) as a mental
disorder.
• Physiological dependence results in tolerance and withdrawal.
• Psychological dependence is the dependency of the mind on a
substance or behavior that can lead to psychological withdrawal
symptoms, such as anxiety, irritability, or cravings.
The Process of Addiction
• Compulsion, which is characterized by obsession with, or excessive
preoccupation with, the behavior and an overwhelming need to
perform it
• Loss of control, or the inability to predict reliably whether any isolated
occurrence of the behavior will be healthy or damaging
• Negative consequences, such as physical damage, legal trouble,
financial problems, academic failure, or family dissolution, which do
not occur with healthy involvement in any behavior
• Denial, the inability to perceive that the behavior is self-destructive
• Inability to abstain, continuance regardless of outcomes
Cycle of Psychological Addiction
Habit versus Addiction
• Addiction involves elements of habit, a repeated behavior in which the
repetition may be unconscious.
• A habit can be broken.
• Addiction involves repetition of a behavior that occurs with compulsion,
and considerable discomfort occurs if the behavior is not performed.
Addiction Affects Family and Friends
• Codependence: a condition in which a person is controlled by an
addict's addictive behavior
• Defined by lack of ability to set boundaries
• Living in a chaotic, crisis-oriented mode
• Assuming responsibility for meeting others' needs to the point of
subordinating own needs or even being unaware of personal
needs
• Enablers: people who knowingly or unknowingly protect addicts from
the consequences of their behavior
Addictive Behaviors
• Drug chemicals are not the only source of addiction. People can
become addicted to certain behaviors.
• Process addictions are behaviors known to be addictive because

they are mood altering.
• Gambling, compulsive buying, compulsive exercise, and
compulsive Internet or technology use are all process addictions.
Gambling Disorder
• More than five million people meet the criteria for having a gambling
addiction; still many others are impacted by the gambling behavior of
friends or relatives.
• Previously called pathological gambling and now referred to as

gambling disorder by the APA, it is recognized as a mental disorder.
• There is strong evidence for a biological component.
Compulsive Buying Disorder
• Shopping is often used as a way to make people feel better about
themselves, but for some people it becomes compulsive buying
disorder.
• Symptoms include the following:

• Preoccupation with shopping and spending
• Buying more than one of the same item
• Shopping for longer periods than intended
• Repeatedly buying more than is needed or can be afforded
• Buying to the point that it interferes with social activities or work
ABC News Video: Woman's Shopping
Addiction Revealed
ABC News Video: Woman's Shopping
Addiction Revealed
Discussion Questions
1. How can you identify if someone has a shopping addiction?
2. What methods can be used to help someone who has a shopping
addiction?
3. Discuss possible reasons someone may become addicted to
shopping. Are there psychological abnormalities that may manifest
in the need to overspend?
Exercise Addiction
• Addictive or compulsive exercise results in negative consequences
similar to those of other addictions.
• Warning signs include working out alone, rigid exercise patterns,
exercising for more than two hours daily, exercising when sick or
injured or to avoid social events, school, or work.
Technology Addictions
• Cell phones, video games, networking sites, and the Internet can all
be addictive.
• Approximately 9 percent of college students report that Internet use
and computer games have interfered with their academic
performance.
• Symptoms include general disregard for one's health, sleep
deprivation, neglecting family and friends, lack of physical activity,
euphoria when online, lower grades in school, and poor job
performance.
• Internet addicts may feel moody or uncomfortable when they are not
online.
What Is a Drug?
• Drugs are substances other than food that are intended to affect the
structure or function of the mind or body through chemical action.
• Scientists divide drugs into six categories: prescription, over-the-
counter (OTC), recreational, herbal preparations, illicit, and
commercial.
• Prescription medications; over-the-counter (OTC) medications; legal
substances such as alcohol, caffeine, and tobacco; and illegal
substances such as heroin and methamphetamines are all drugs.
Types of Drugs
• Prescription: obtained only with a prescription from a licensed
physician
• Over-the-counter (OTC): no prescription needed and more than
100,000 available
• Recreational: most are legal substances, such as alcohol, tobacco,
coffee, and so on
• Herbal preparations: products of plant origin
• Illicit (illegal): all are psychoactive
• Commercial: found in commercially sold products such as household
cleaners, pesticides, etc.
How Drugs Affect the Brain
• The brain is wired to repeat pleasurable experiences.
• Life-sustaining activities activate a "pleasure circuit" of nerve cells.
One nerve cell set uses dopamine, a neurotransmitter, and sits at the
top of the brain stem in the ventral tegmental area (VTA).
• This "pleasure circuit" is known as the mesolimbic dopamine system.
• All addictive drugs activate the brain's pleasure circuit, and addiction
alters the way the pleasure center and other parts of the brain
function.
• Psychoactive drugs: affect chemical
neurotransmission, either enhancing it, suppressing it,
or interfering with it
The Action of Cocaine at Dopamine
Receptors in the Brain
Routes of Administration
• Oral ingestion
• Inhalation
– Through the nose or mouth
• Injection
– Intravenous—into bloodstream
– Intramuscular—into muscle
– Subcutaneous—just under the skin
• Transdermal
– Through the skin
• Suppositories
– Through the vagina or anus
Drug Interactions
• Polydrug use
– Taking several substances simultaneously
• Synergism (Potentiation)
– Effects of both drugs are multiplied beyond the effects of each on
its own.
• Inhibition
– Effects of one drug are reduced or eliminated by the presence of
another at the same receptor site
• Antagonism
– Drugs work at same receptor site so that one drug blocks the
action of another.
Drug Interactions (cont.)
• Intolerance
– When drugs combine to produce extremely uncomfortable
reactions
• Cross-tolerance
– Tolerance for one drug creates a similar reaction to another drug
Drug Use and Misuse
• Abuse is often associated with illegal drugs, but many people abuse
and misuse legal drugs.
– Drug misuse: use for purpose not intended
– Drug abuse: excessive use
– Misuse and abuse may cause serious harm
– Approximately 27 million people report being current users of illicit
drugs.
–.
Drug Misuse and Abuse
• Over-the-counter drugs
– High doses can cause hallucinations, bizarre sleep patterns,
mood changes, and sometimes death.
– Those most vulnerable to abusing OTC drugs are teenagers,
young adults, and people over the age of 65.
• Sleep aids
– Excedrin PM, Sominex, Unisom, and Tylenol PM
– Can cause problems with the sleep cycle, weaken areas of the
body, or induce narcolepsy.
• Caffeine pills and energy drinks.
– Caffeine in large doses can result in tremors/shaking, restlessness
and edginess, insomnia, dehydration, panic attacks, heart
irregularities, and other symptoms.
Drug Misuse and Abuse (cont.)
• Cold medicines
– Robitussin, Vicks, Coricidin, and NyQuil
– Dextromethorphan (DXM) can cause hallucinations, loss of motor
control, and "out-of body" sensations.
• Diet pills
– Contain stimulants such as caffeine or Hoodia gordoni
– Marketed as dietary supplements, rather than drugs,
manufacturers may make unsubstantiated claims of effectiveness
or can use untested or unsafe ingredients.
Drug Misuse and Abuse (cont.)
• Prescription drug abuse:
– About 6.4 million Americans aged 12 and older used prescription
drugs for nonmedical reasons in the past month.
– It is particularly common among teens and young adults.
– The problem may be getting worse among the youngest segment
of society, with nearly 13 percent of 12th graders reporting
prescription drug abuse by the time they graduate.
– Risks vary from irregular heart rate to death. Injecting prescription
drugs may result in exposure to HIV, hepatitis B and C and other
bloodborne viruses.
College Students and Prescription Drug
Abuse
• A recent survey indicates 12 percent of students reported illegally
using prescription drugs in the last year.
• Commonly used painkillers (Vicodin, OxyContin, or Percocet) are used
to relax or get high.
• Student say they abuse Adderall and Ritalin (intended to treat
attention-deficit/hyperactivity disorder [ADHD]) for academic gain.
• Most commonly reported side effects are sleeping difficulties,
irritability, and reduced appetite.
30-Day Drug Use Prevalence, Full-Time College Students vs.
Respondents 1 to 4 Years beyond High School
Illicit Drugs
• Illicit drug use spans all age groups, genders, ethnicities, occupations,
socioeconomic groups.
• Marijuana use has risen in recent years.
• Close to 50 percent of college-aged students nationwide have tried an
illicit drug, most commonly marijuana.
• College offices are concerned about the link between substance
abuse and poor academic performance.
Illicit Drugs (cont.)
Why do some college students use Why don't some college students use
drugs? drugs?
•Positive expectations • Parental attitudes and behavior
•Genetics and family history
• Religion and spirituality
•Substance use in high school
•Social norms • Student engagement
•Curiosity
• College athletics
•Sorority and fraternity membership
•Stress • Healthy social network
Common Drugs of Abuse
• Stimulants: increase activity of the central nervous system.
• Cocaine
• White crystalline powder
• Derived from the leaves of the South American coca shrub
• Cocaine rapidly enters bloodstream.
• Exposed fetus is likely to suffer damage.
• Methods of use vary
• Freebase cocaine
• Crack
• Treatment for cocaine addiction involves mainly psychiatric counseling
and 12-step programs.
Drugs of Abuse: Uses and Effects
Drugs of Abuse: Uses and Effects (cont.)
Drugs of Abuse: Uses and Effects (cont.)
Insert Table 8.2
Common Drugs of Abuse (cont.)
• Amphetamines
– Synthetic agents that stimulate the central nervous system (CNS)
– Some are used for medicinal purposes.
– Ritalin and Adderall are used for attention-deficit/hyperactivity
disorder (ADHD).
– High potential for abuse
• Methamphetamine
– Affects brain and CNS
– Euphoria lasts 6 to 8 hours.
– Methods of use: snorted, injected, smoked, and ingested
– Short-term effects include increased physical activity, alertness,
rapid breathing, increased body temperature, insomnia, tremors,
anxiety, confusion, and decreased appetite.
Common Drugs of Abuse (cont.)
• Bath salts
– Designer synthetic drug (labeled "not for human consumption")
– Sold legally, but contains substances that were made illegal in
2012
– Contain various amphetamine or cocaine-like substances
– Effects include intense stimulation, alertness, euphoria,
elevated mood, and pleasurable rush
– Symptoms of use include:
▪ Tremor, shortness of breath, and loss of appetite, changes
in body temperature regulation accompanied by hot flashes
and sweating, with bleeding from the nose and throat from
ulcerations when snorted
– In addition, bath salts may affect the cardiovascular system..
Caffeine
• Most popular and widely consumed drug in the United States
– Caffeine is derived from the chemical family called xanthines,
which are found in plant products such as coffee, tea, and
chocolate.
– Enhances mental alertness and reduces feelings of fatigue.
– Side effects include wakefulness, insomnia, irregular heartbeat,
dizziness, nausea, indigestion, mild delirium, and heartburn.
– Caffeine meets the requirements for addiction: tolerance,
psychological dependence, and withdrawal symptoms.
Caffeine Content Consumption
Marijuana and Other Cannabinoids
• Derived from either the Cannabis sativa or Cannabis indica (hemp)
plant.
• Tetrahydrocannabinol (THC) is the psychoactive substance in
marijuana; average concentration is 15 percent, but some forms can
contain up to 27 percent.
– Has many medical purposes as it controls nausea and vomiting,
improves appetite, forestalls loss of lean muscle mass associated
with AIDS wasting syndrome, and reduces muscle pain and
spasticity caused by multiple sclerosis.
• Frequent and/or long-term use may increase risk for testicular cancer,
serious mental health problems, suppressed immune system, and
impaired memory.
THC - Resin
• Smoking THC-rich resin extracts, called dabbing, is becoming much
more common among marijuana users.
• Extracts contain high levels of THC
• Dangers include visits to the emergency room and fires resulting from
the extraction process.
Dangers of Marijuana Use
• The drug substantially reduces a driver’s ability to react and make
quick decisions
• Altered perception may linger for hours after use and the “high” has
subsided.
• Recent research indicates that a person having used marijuana is
two and a half times more likely to be involved in a motor vehicle
accident. The impairment is enhanced when mixed with alcohol.
• In Washington, where it is legal, one in six drivers involved in fatal
car crashes had recently used marijuana.
• Chronic users are affected by the same toxins and carcinogens as
tobacco users.
• Regarding impact on the lungs there is no discernable difference
between vaping and smoking marijuana
Synthetic Marijuana
• Products contain dried, shredded plant material and one or more
synthetic cannabinoids. Commonly known as: K2 (or spice), fake
marijuana, Yucatan Fire, Skunk, and Moon Rocks.
• K2 or spice:
– sold legally as herbal blend incense.
– used by nearly one in seven college students,
– 11.3 percent, of high school seniors are using this drug.
– health effects such as hallucinations, severe agitation,
extremely elevated heart rate and blood pressure, coma, suicide
attempts, and drug dependence are common.
Narcotics and Depressants
• Benzodiazepines and barbiturates
• Benzodiazepines (tranquilizers)
• The most common sedative-hypnotic drugs
• Valium, Ativan, and Xanax
• Barbiturates
• Sedative-hypnotic drugs
• Amytal and Seconal
• Less safe than benzodiazepines
• Synergistic effect, when combined with alcohol, can lead to
respiratory failure and death.
• Can produce physical and psychological dependence in several
weeks.
• Cross-tolerance is a complication specific to sedatives
Narcotics and Depressants (cont.)
• Rohypnol
– A tranquilizer and "date rape" drug
– Produces a sedative effect, amnesia, muscle relaxation, and
slowed psychomotor responses.
– Has gained notoriety as a growing problem on college campuses
as it has been added to punch and other drinks at parties in hopes
of incapacitating a woman so she is unable to resist sexual
assault.
• Gamma-hydroxybutyrate (GHB)
– CNS depressant known to have euphoric, sedative, and anabolic
(body-building) effects
– Another "date rape" drug
– Side effects include loss of memory, unconsciousness, amnesia,
hallucinations, and death.
Narcotics and Depressants
• Opioids
• Cause drowsiness, relieve pain, and induce euphoria
• Called narcotics
• Derived from opium
• Include morphine, codeine, heroin, and black tar heroin
• Depress CNS and lower heart rate, respiration, and blood
pressure
• Decrease sex drive
• Opioids (cont.)
• Physical effects of opioids
• Depress CNS and lower heart rate, respiration, and blood
pressure
• Cause weakness, dizziness, nausea, euphoria
• Decrease sex drive
• Cause visual disturbances and lack of coordination
• Heroin addiction
• In 2015, 591,000 Americans reported using heroin
• Deaths from heroin overdoses in recent years, rose from just over
1,800 deaths in 2000 to nearly 12,990 in 2015
• Heroin is a white powder derived from morphine.
• Black tar heroin is a sticky, dark brown, foul-smelling form of
heroin that is relatively pure and inexpensive.
• Heroin withdrawal is distinct, including an intense desire for the
drug, sleep disturbances, dilated pupils, and muscle tremors.
• Mainlining: intravenous injection of powdered heroin mixed in a
solution; the most common route of administration
ABC News Video: New Report Shows Surge
in Heroin Deaths
Hallucinogens
• Hallucinogens create auditory or visual changes in mood, thoughts,
and feelings.
• Synesthesia: mixing of sensory messages
• May "hear colors" and "smell tastes"
• Lysergic acid diethylamide (LSD) (acid)
• In 1970, it was placed on controlled substances list.
• It is estimated that 9.5 percent of Americans aged 12 or older
have used LSD at least once in their lifetime
• Commonly sold as a "blotter" on paper, it is one of the most
powerful drugs known to science, and minute quantities produce
strong effects.
Hallucinogens (cont.)
• Ecstasy (methylene-dioxymethamphetamine [MDMA])
• Most common club drug causes feelings of extreme euphoria,
openness, and warmth.
• Risks include inappropriate emotional bonding, jaw clenching,
tongue and cheek chewing, short-term memory loss or confusion.
• Chronic use can damage the brain.
• Combined with alcohol, Ecstasy can be fatal.
• Phencyclidine (PCP)
• Originally developed as a dissociative anesthetic
• Effects depend on dose and include slurred speech, impaired
coordination, fever, nausea, and total loss of sensitivity to pain.
• Doses greater than 10 mg can cause convulsions and death.
• Mescaline
• Derived from peyote cactus; Native Americans have used it for
religious purposes.
• It is a powerful hallucinogen and CNS stimulant.
• Generally induces immediate vomiting.
• Psilocybin
• Similar to LSD in effect
• Effects generally wear off in 4 to 6 hours.
• Cultivated from spores or harvested wild.
• Mushroom varieties can be easily misidentified, and mistakes can
be fatal.
• Ketamine (Special K)
• Used as an anesthetic in many hospitals and veterinary clinics.
• Causes hallucinations and sensory distortions.
Inhalants
• Users inhale chemicals causing hallucinations and euphoric effects.
• Legal to purchase and not commonly recognized as drugs, though
dangerous when used incorrectly
• Include glue, paint thinner, and rubber cement.
• Amyl nitrate and nitrous oxide are also abused.
• Users experience dizziness, disorientation, impaired coordination and
judgment; combined with alcohol, may be fatal.
Anabolic Steroids
• Artificial forms of the male hormone testosterone that promote muscle
growth and strength
• Produce state of euphoria, diminished fatigue, and increase bulk and
power in both sexes
• Adverse side effects include mood swings
("roid rage"), acne, liver tumors, elevated cholesterol, hypertension,
and kidney disease.
• In women, large doses trigger development of male attributes; in men,
anabolic steroids shut down testosterone production, causing men's
breasts to grow and testicles to atrophy.
Treating and Reducing Drug Abuse
• An estimated 20.8 million Americans aged 12 or older needed
treatment for an illicit drug or alcohol use problem in 2015. Of these,
only approximately 10 percent received treatment.
• Detoxification is an early abstinence period when the addict physically
and cognitively adjusts to being free from the addiction's influence.
Treatment Approaches
• Outpatient behavioral treatment
• Cognitive behavioral therapy
• Multidimensional family therapy
• Motivational interviewing
• Motivational incentives (contingency management)
• Residential treatment programs
• Therapeutic communities (TCs) are highly structured programs in
which addicts remain at a residence, typically for 6 to 12 months.
• 12-step programs
• Nonjudgmental treatment programs that aim to work on personal
recovery
Treatment Approaches (cont.)
• Vaccines against addictive drugs
• A promising new cocaine vaccine is in development.
• The vaccine does not eliminate the desire for cocaine; it prevents
the user from getting high by stimulating the immune system to
attack the drug when it is taken.
• Clinical trials are expected soon.
• Vaccines against nicotine, heroin, and methamphetamine are also
in development.
Treatment Approaches (cont.)
• Other pharmacological treatments
• Methadone, available for people addicted to heroin or other
opioids used to control withdrawal symptoms
• Naltrexone (Trexan) eliminates the compulsion to use opiods
• Buprenorphine (Temgesic), has much the same affect as
methadone and can be taken at home.
Drug Treatment and Recovery for College
Students
• Early intervention increases the likelihood of successful treatment.
• Private therapy, group therapy, cognitive training, nutrition counseling,
and health therapies all help with recovery.
• A growing number of colleges are offering special services to students
who are recovering from alcohol and other drug addictions and want to
stay in school without being exposed to excessive drinking or drug
use.
Drug Use and Abuse: Costs to Society
• Illegal drug use in the United States costs about $193 billion per
year.
• $11 billion in the cost of health care, $120 billion in lost productivity,
and $61 billion in costs to criminal justice system
• There are no simple solutions to this complex problem
Addressing Drug Misuse and Abuse in the
United States
• Drug abuse has been part of human behavior for thousands of years
and is not likely to disappear in the near future.
• Most agree that to combat the challenge:
• Multimodal approach is best
• Young people must be educated to understand how drug use,
misuse, and abuse differ.
• Harm reduction strategies
• Needle-exchange programs
• Changing legal sanctions and increasing treatment services
• Minimizing potential hazards with drug use rather than the use
itself

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Chapter 8 Health Basics

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The Basics Health

• Process addictions are behaviors known to be addictive because

• Previously called pathological gambling and now referred to as

• There is strong evidence for a biological component.

• Symptoms include the following:

Insert Table 8.2

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