DB notes ch 1

8/8/2019 DB notes ch 1

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Exam

586,000 On an average day in 2006,the

number of U.S.adolescents,aged

twelve to seventeen,who smoked

marijuana

1,200,000 On an average day in 2006,the

number of adolescents who smoked

cigarettes

Exam

According to a national survey, about one in five

males and about one in eight females between the ages

of twelve and seventeen have been approached in the

past month by someone selling drugs. For fifteen- or

sixteen-year-old youths, the number is approximatelyone in four.

Exam

The public-health concern

about underage cigarette smoking centers on the fact

that approximately 82 percent of regular smokers in the

United States, aged thirty to thirty-nine, smoked their

first cigarette²and more than half had become regular

smokers²before they were eighteen years old.2



Exam

The appear-

ance of Joe Camel, the Marlboro Man, and the Virginia

Slims Woman in print advertisements for cigarettes may

be increasingly distant memories, but at one time they

were dominant images that conveyed the attractiveness of

smoking to the public, particularly to young people.

They are gone now as a result of federal regulations estab-lished in 1998

Exam

officially classified since 1970 as a drug with a high poten-

tial for abuse and no accepted medical use, in the same

category as heroin

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psychoactive drugs:Drugs that affect feelings,thoughts,perceptions,or behavior.

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The development of

anti-craving medications, particularly with respect to

cocaine abuse (see Chapter 4), is a hopeful sign that we

can finally understand the biochemical basis for drug

dependence.

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First, we will examine the

biological, psychological, and sociological effects of con-

suming certain types of drugs.

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specific substances that alter our feelings, our

thoughts, our perceptions of the world, and our behavior.These substances are referred to as psychoactive drugs

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drug: A chemical substance that,when taken into the

body,alters the structure or functioning of the body in

some way,excluding those nutrients considered to be

related to normal functioning.

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because they influence the functioning of the brain andhence our behavior and experience.

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illicit (illegal) drugs:

heroin, cocaine, and marijuana, as well as club drugssuch as Ecstasy, LSD, PCP, ketamine, and GHB.

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licit(legal) drugs,such as alcohol, nicotine, and caffeine.

In the cases of alcohol and nicotine, legal access carries a

minimum-age requirement.



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Second, we will focus on the complex interplay of

circumstances in our lives that lead to drug-taking

behavior.

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drug use

is, at least in part, a consequence of how we feel about

ourselves in relation to our parents, to our friends and

acquaintances, to events occurring around us, and to thecommunity in which we live.

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biological factors that may predispose us to drug-taking behavior.

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reasons why some

individuals engage in drug-taking behavior, whereasothers do not, will be a primary topic of discussion.

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a vicious

circle can develop in which drug-taking behavior fosters

more drug-taking behavior, in a spiraling pattern that isoften extremely difficult to break

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understanding of drug dependence

requires an examination of both biological and sociolog-

ical factors

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psychoactive drugs modifies

the functioning of the brain, both at the time during

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which the drug is present in the body and later when

the drug-taking behavior stops.

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a ³switch´ in the

brain seems to be thrown following prolonged drug use.

It starts as a voluntary behavior, but once that switch

is thrown, a pattern of drug dependence takes over.

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Second, drug dependence is a result of a complex inter-

action of the individual and his or her environment.

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The standard approach is to characterize a drug as a

chemical substance that, when taken into the body, altersthe structure or functioning of the body in some way

Note: too broad

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we need to refine our definition,



adding the phrase excluding those nutrients considered to be related to normal functioning.

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effectively eliminate the cheese inyour next pizza from consideration as a drug,

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illicit drugs:Drugs whose manufacture,sale,or pos-

session is illegal.

licit drugs:Drugs whose manufacture,sale,or pos-

session is legal.

drug dependence: A condition in which an individual

feels a compulsive need to continue taking a drug.In

the process,the drug assumes an increasingly centralrole in the individual¶s life

Exam

First, there is probably no

perfect definition that would distinguish drugs from

nondrugs without leaving a number of cases that fallwithin some kind of gray area

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The best we can do is to

set up a definition, as we have, that handles most of the

substances we are likely to encounter

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We often make

thedistinction between drugs and nondrugs not in terms

of their physical characteristics but rather in terms of

whether the substance in question has been intended to be

used primarily as a way of inducing a bodily or psychologi-cal change.

Exam

Whether we

realize it or not, when we discuss the topic of drugs, we

are operating within a context of social and cultural

values, a group of shared feelings about what kind of

behavior (that is, what kind of drug-taking behavior) isright and what kind is wrong.

Exam

When we say ³drug misuse´ and

³drug abuse,´ for example, we are implying that some-

thing wrong is happening, that a drug is producing some

harm to the physical health or psychological well-beingof the drug user or to society in general

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We cannot judge on

the basis of whether the drug is legal or illegal, since the

legality of a psychoactive drug often depends more on

historical and cultural circumstances than on its chemi-

cal properties



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The difficulty of using a criterion based on

legality is further complicated by cultural differences

around the world.

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What is the intent or motiva-

tion on the part of the drug user with respect to this kindof behavior?

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Depending on the intent of the individual,

drug-taking behavior can be classified as either instru-

mental or recreational.7

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instrumental use, we mean that a person is

taking a drug with a specific socially approved goal inmind. The user may want to stay awake longer,

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In these cases, drug-taking behavior occurs as a means

toward an end that has been defined by our society as

legitimate.

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The instru-



mental use of drugs can also involve drugs that are illicitly

obtained, such as an amphetamine or other stimulant

drug that has been procured through illegal means to

help a person stay awake and alert after hours withoutsleep.

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recreational usemeans that a person is

taking the drug not as a means to a socially approved

goal but for the purposes of acquiring the effect of the

drug itself

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Whatever happens as a con-

sequence of the drug-taking behavior is viewed not as ameans to an end, but as an end unto itself

Note: The effect of the drug is WHY they are taking it.

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. Drinking an alcoholic beverage, for example,

is considered recreational drug-taking behavior under

most circumstances. If it is recommended by a physician

for a specified therapeutic or preventive purpose (see

Chapter 9), however, the drinking might be considered

instrumental in nature.

Exam

Drug



misusetypically applies to cases in which a prescriptionor nonprescription drug is used inappropriately.

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instrumental use:Referring to the motivation of a

drug user who takes the drug for a specific purpose

other than getting ³high.´

recreational use:Referring to the motivation of a drug

user who takes the drug only to get ³high´or achieve

some pleasurable effect.

drug misuse:Drug-taking behavior in which a pre-

scription or nonprescription drug is used inappro-

priately.

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drug abuse:Drug-taking behavior resulting in some

form of physical,mental,or social impairment.

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For

example, drug doses may be increased beyond the level

of the prescription in the mistaken idea that if a little is

good, more is even better.

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Drug misuse can be dangerous and potentially

lethal, particularly when alcohol is combined withdrugs that depress the nervous system.



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Drugs that have

this particular feature include antihistamines, antianxi-

ety drugs, and sleeping medications.

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elderly,

who often take a large number of separate medications.

This population is especially vulnerable to the hazards

of drug misuse.

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drug abuseis typically applied to cases

in which a licit or illicit drug is used in ways that producesome form of physical, mental, or social impairment

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primary motivation for individuals involved in drug abuse is recreational.

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Drugs

with abuse potential include not only the common street

drugs but also legally available psychoactive substances

such as caffeine and nicotine (stimulants), alcohol

andinhaled solvents (depressants), as well as a number

of prescription drugs designated for medical purposes

but used by some individuals exclusively on a recre-



ational basis

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In these particular cases, the distinction between drugmisuse and drug abuse is particularly blurry

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When there

is no intent to make a value judgment as to the motiva-

tion or consequences of a particular type of drug-taking

behavior, that behavior will simply be referred to as

druguse.

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. We need to understand the reasons why drug-taking

behavior has been so pervasive a phenomenon over the

many centuries of human history and the reasons why

drug-taking behavior remains so compelling for us inour society.

Exam

Taking Valium with a

prescription to relieve

anxiety

Taking No Doz to stay

awake on a long trip



Taking amphetamines

without a prescription to

stay awake the night before

a test

Taking morphine without a

prescription to relieve pain

Having an alcoholic drink

to relax before dinner

Smoking a cigarette or a

cigar for enjoyment

Smoking marijuana to

get high

Taking LSD for the

hallucinogenic effects

Exam

which our society has responded to problems associated

with drug use. How have our attitudes toward drugs

changed over time? How did people feel about drugs

and drug-taking behavior one hundred years ago, fifty

years ago, twenty years ago, or even ten years ago? These

are questions that we will now address.Note: how the stigma of drugs came to be

Exam

We cannot judge on



the basis of whether the drug is legal or illegal, since the

legality of a psychoactive drug often depends more on

historical and cultural circumstances than on its chemi-cal properties

Exam

The difficulty of using a criterion based on

legality is further complicated by cultural differences

around the world.

Exam

What is the intent or motiva-

tion on the part of the drug user with respect to this kindof behavior?

Exam

Depending on the intent of the individual,

drug-taking behavior can be classified as either instru-mental or recreational.7

Exam

shamanism:The philosophy and practice of healing in

which diagnosis or treatment is based on trance-like

states,either on the part of the healer (shaman) or the

patient.

shaman (SHAH-men):A healer whose diagnosis or

treatment of patients is based at least in part on

trances.These trances are frequently induced by



hallucinogenic drugs.

Ebers Papyrus:An Egyptian document,dated

approximately 1500 B.C.,containing more than eight

hundred prescriptions for common ailments and

diseases.

years ago, the process of discovery would have been as

Exam

The accumulation of knowl-

edge about consciousness-altering substances would

mark the beginning of shamanism, a practice among

primitive societies, dating back by some estimates more

than 40,000 years, in which an individual called a

shamanacts as a healer through a combination of

trances and plant-based medicines, usually in the con-

text of a local religious rite.

Exam

Egyptian scroll known as the Ebers Papyrus, named

after a British Egyptologist who acquired it in 1872. This

mammoth document, dating from 1500 B.C., contains

more than eight hundred prescriptions for practically

every ailment imaginable, including simple wasp stings

and crocodile bites, baldness, constipation, headaches,

enlarged prostate glands, sweaty feet, arthritis, inflam-

mations of all types, heart disease, and cancer.



Exam

improvements in the

patient¶s condition resulted from the patient¶s beliefthat

he or she would be helped, a phenomenon known as the placebo effect.

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n the early Middle Ages, Viking warriors ate the

mushroom Amanita muscaria, known as fly agaric, and

experienced a tremendous increase in energy, which

resulted in wild behavior in battle. They were called

Berserkers because of the bear skins they wore, and reck-less, violent behavior has come to be called berserk

Exam

witches operating on the periphery of medieval

society created ³witch¶s brews.´ They were said to induce

hallucinations and a sensation of flying by consuming

mixtures made of various plants such as mandrake, hen-

bane, and belladonna.

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We know now that the

sweat glands of toads contain a chemical related to

DMT, a powerful hallucinogenic drug, as well as bufote-

nine, adrug that raises blood pressure and heart rate.

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Morphine was identified as the active ingredient

in opium, a drug that had been in use for at least three

thousand years and had become the physician¶s most reli-able prescription to control the pain of disease and injury.

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invention of the syringe made it possible to deliver the morphine directly and speedily into the bloodstream.

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Cocaine, having been extracted from coca leaves, was

used as a stimulant and antidepressant. Sedative powers to

calm the mind or induce sleep had been discovered in bromides and chloral hydrate.

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Anesthetic drugs had been discovered that made

surgery painless for the first time in history. A few diseases

could actually be prevented through the administration

of vaccines, such as the vaccine against smallpox that had

been introduced by Edward Jenner in 1796 and the vac-cine against rabies introduced by Louis Pasteur in 1885.

Exam

The discovery of new pharmaceutical products marked

the modern era in the history of healing.11

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Remedies called patent medicines, sold through adver-

tisements, peddlers, or general stores, contained opium,

alcohol, and cocaine and were promoted as answers toevery common medical or nonmedical complaint.

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The respectable way wastodrink it, usually in a liquid form called laudanum

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the smoking of opium, as introduced by Chinese

immigrants imported for manual labor in the American

West, was considered degrading and immoral.

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tolerant attitude toward opium drinking, the

strong emotional opposition to opium smoking may beviewed as more anti-Chinese than anti-opium.

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The original formula for

Coca-Cola, as the name suggests, contained cocaine until

1903

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promoted cocaine as a ³magical drug.´ In an influential

paper published in 1884, Freud recommended cocaineas a safe and effective treatment for morphine addiction.



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1898,

heroin (a drug derived from morphine) was completely

legal and considered safe. Physicians were impressed

with its effectiveness in the treatment of coughs, chest

pains, and the respiratory difficulties associated with pneumonia and tuberculosis

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In 1920the Eighteenth Amendment to the U.S. Constitution took

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Violent gang

wars arose in major American cities as one group battled

another for control of the liquor trade.

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, whatever desirable health-related

effects Prohibition may have brought were perceived to

be overshadowed by the undesirable social changes that

had come along with it

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penicillin had been discovered in a particular

species of mold by Alexander Fleming in 1928, tech-

niques for extracting large amounts from the mold werenot perfected until the 1940s

DB notes ch 1

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