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Abnormal psych FINAL: Substance use and addictive D/o

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blood alcohol level

-As stated previously, the extent of the effect of ethyl alcohol is determined by its concentration or proportion in the blood (e.g., blood alcohol level or BAL). -Thus, a given amount of alcohol will have less effect on a larger person than on a small one. -For example, 2 glasses of wine consumed in 1 hour will typically lead to a BAL of .09 in a 100 lb. female, but a BAL of only .037 in a 200 lb. male. -Women vs. men have less of the stomach enzyme alcohol dehydrogenase, which breaks down or metabolizes alcohol in the stomach before it can enter the bloodstream. Thus, women absorb up to 30% more alcohol than men of similar height and weight. -Women also have higher % of body fat and lower water body content than men, which promote alcohol absorption (fat does not absorb alcohol so it ends up in higher levels in the blood). -Hormone changes during the menstrual cycle further negatively affect the metabolism of alcohol, increasing alcohol absorption. -So, women become more intoxicated than men on equal doses of alcohol.

women and alcohol

-Women are at increasing risk of alcoholism; researcher Sharon Wilsnack calls it a "global epidemic" of women's drinking. -According to Justice Department statistics, DUI arrests among women have gone up almost 30 percent in the past nine years while men's rates have decreased. -The number of women age 45-54 seeking treatment for alcohol abuse has tripled in 15 years, according to SAMHSA. -Women born after 1978 are more likely to binge drink and develop alcoholism than their older counterparts (Keyes, 2011). -Young professional women are more likely to develop an alcohol use disorder than are women in "blue collar" occupations. This is attributed to going to college or adopting the same norms as college men re: drinking and competing for success. -According to the Centers for Disease Control and Prevention, while young adults ages 18-34 are the most likely to binge drink, 10 percent of women between 45 and 64 say they binge drink and so do 3 percent of those over 65. -Marketing campaigns targeting women promote alcohol use: wines with names like Girls' Night Out, MommyJuice, Cupcake, and Happy Bitch; Skinnygirl Vodka; and chocolate and fruit flavored cocktails.

Withdrawal syndrome

A characteristic cluster of symptoms following the sudden reduction or cessation of use of a psychoactive substance after physiological dependence has developed. Alcohol detoxification is more dangerous and can more easily prove fatal for an addict going through withdrawal than most drugs, including heroin. Typically, detox is done in a hospital setting, due to the medical risks of withdrawal from alcohol. •Marijuana and the hallucinogens, such as LSD, are not physiologically addicting, although they may certainly be psychologically addicting, so (physical) withdrawal is not an issue.

Amphetamines

A class of synthetic stimulants that activate the central nervous system, producing heightened states of arousal and feelings of pleasure. Seeking a treatment for asthma, the Chinese American pharmacologist Chen studied ancient Chinese descriptions of drugs. He found a desert shrub called mahuang identified as an effective remedy. Chen was able to isolate an alkaloid of mahuang, ephedrine, which proved highly successful in treating asthma. Amphetamine was the result of efforts to develop a synthetic substitute. They are usually taken orally or intravenously and can be addicting. Wakefulness is heightened, intestinal functions are inhibited, and appetite is reduced - hence their use in dieting. The heart rate quickens, the blood vessels in the skin and mucous membranes constrict. The individual becomes alert, euphoric, and outgoing and is possessed with seemingly boundless energy and self-confidence. Larger doses can make a person agitated, nervous, and confused; the person may experience heart palpitations, headaches, dizziness, and sleeplessness. Sometimes the heavy user becomes so suspicious and hostile that he or she can be dangerous to others. Large doses taken over a period of time can induce a state quite similar to mania or paranoid schizophrenia, including its delusions Tolerance develops rapidly so that more and more of the drug is required to produce the same effect. One study demonstrated tolerance effects as quick as 6 days of repeated use. As tolerance increases, the user may stop taking pills and inject Methedrine, the strongest of the amphetamines, directly into the vein. So-called speed freaks give themselves repeated injections of the drug and maintain intense and euphoric activity for a few days, without eating or sleeping (a run), after which, exhausted and depressed, they sleep (or crash) for several days. Then, the cycle starts again. The physical and social functioning of the individual deteriorates considerably. Behavior is erratic and hostile, and the person may become a danger to him- or herself and to others. Amphetamine use in the workplace has increased. In the past decade, under time pressure to produce - to do more with less - many white-collar workers turned to speed to stay awake, be more productive, and to feel more energized or euphoric. Over time, extreme irritability sets in and the person may take more and more of the drug to combat the angry feelings. Sometimes the person uses alcohol in the evening to wind down. The emotional and physical costs are high as the addict's personal relationships begin to be adversely affected along with his or her job performance.

The Stepping-Stone Theory

A common concern of marijuana use is that it can be a "first step" for young people to become addicted to other drugs, such as heroin. About 40% of regular pot smokers do not go on to use such drugs as heroin or cocaine. African Americans in particular rarely go from pot use to "hard" drugs. On the other hand, many individuals who abuse heroin and cocaine began their drug experimentation with marijuana. In the U.S., users of pot are more likely than non-users to experiment later with heroin and cocaine. The single best predictor of cocaine use in adulthood is heavy use of marijuana during adolescence.

physiological dependence

A condition in which the drug user's body comes to depend on a steady supply of the substance.

depressants

A depressant is a drug that slows down or curbs the activity of the central nervous system. It reduces feelings of tension and anxiety, slows movement, and impairs cognitive processes. In high doses, depressants can arrest vital functions and cause death.

naltrexone

A drug that blocks the high from alcohol as well as from opiates. The drug doesn't prevent the person from taking a drink or using heroin, but seems to blunt cravings for these drugs (Anton, 2008; Myrick et al., 2008). Evidence shows that naltrexone and similar drugs are useful in treating alcohol, opiate, and amphetamine dependence.

marijuana

A hallucinogenic drug derived from the leaves and stems of the plant Cannabis sativa. Marijuana is derived from the Cannabis sativa plant or the hemp plant. It grows in warm climates throughout the world. The drugs produced from varieties of hemp are called cannabis. Marijuana is generally classified as a hallucinogen because it can produce perceptual distortions or mild hallucinations, especially in high doses or when used by susceptible individuals The most powerful of them is hashish or "hash", the dried resin from the top of the female cannabis plant. The best known form of cannabis is marijuana (pot), a mixture of the crushed leaves and flowering tops. When smoked, cannabis produces a mixture of hallucinogenic, depressant, and stimulant effects. At low doses, the smoker typically has feelings of joy and relaxation and may become quiet or talkative. Some smokers become anxious, suspicious, or irritated, especially if they have been in a bad mood or are smoking in an upsetting environment. Many report sharpened perceptions and fascination with the intensified sounds and sights around them. (Perhaps this is why some people believe that smoking pot "makes" them better drivers.) The reality is far different as cannabis significantly impairs psychomotor perception and coordination. Time seems to slow down (judgment of time and speed is impaired), and distances and sizes seem greater than they actually are, increasing the probability of motor vehicle accidents. This overall "high" is called cannabis intoxication In high doses, cannabis causes odd visual experiences, changes in body image, hallucinations, temporal disintegration - difficulty retaining and organizing information, lapses in attention and concentration - confusion, impulsivity, and paranoia. Most of the effects of cannabis last 3 to 6 hours. Changes in mood, however, may continue longer. Because marijuana can interfere with the performance of complex sensorimotor tasks and with cognitive functioning, it has been implicated in many automobile accidents, highway fatalities, and DUIs. Research using flight simulators has also shown that marijuana impairs psychomotor performance. Such performance decrements can persist up to 8 hours after a person believes he or she is no longer high, creating the very real danger that people will attempt to drive or fly when they are not functioning adequately Many users often fail to recall information, especially anything that has been recently learned, no matter how hard they try to concentrate. Thus, heavy pot smokers are at a serious disadvantage at school or work. Chronic marijuana use can also lead to the development of the amotivation syndrome. The individual becomes apathetic and unmotivated; lacking drive, they no longer care enough about goals to put in the effort to reach them Consequences of prolonged use and abuse may lead to certain types of deficits on neuropsychological tests involving sustained attention, learning, and decision making. These deficits may reflect residual drug effects, cognitive withdrawal symptoms, or toxic brain effects Many regular users also become physically dependent on marijuana. They develop a tolerance for it and may experience flu-like symptoms (not as intense as those flu-like symptoms seen in heroin withdrawal), restlessness, and irritability when they stop smoking. Between 4-5% of adults in the U.S. have marijuana-use disorders. The increases in marijuana related problems that have been seen over the past 40+ years are largely due to changes in the THC concentration in marijuana Marijuana is now grown primarily in places with a hot, dry climate, which increases the THC content. The hemp plant, an annual herb, reaches a height of between 3 and 15 feet and can be grown in a wide range of altitudes, climates, and soils. As the strength and use of pot has increased, researchers have discovered increased dangers. It occasionally causes panic reactions similar to those caused by hallucinogens. Some smokers fear they are losing their minds. Typically, such reactions or "bad trips" end in 3 to 6 hours, along with the drug's other effects

Risk Factors for Alcoholism

A number of factors place people at increased risk for developing alcoholism and alcohol-related problems. These include the following: -Gender: Men are twice as likely than women to develop an alcohol use disorder and to binge drink. -Family history -Age -Antisocial personality disorder -Sociodemographic factors

Substance intoxication

A pattern of repeated episodes of intoxication, which is a state of drunkenness or of being "high."

Amphetamine psychosis

A psychotic state characterized by hallucinations and delusions, induced by ingestion of amphetamines.

Residential Approaches

A residential approach to treatment requires a stay in a hospital or therapeutic residence. Most inpatient programs use an extended 28-day detoxification period. Most people with alcohol-use disorders do not require hospitalization.

methadone

A synthetic opiate that is used to help people who are addicted to heroin to abstain from it without a withdrawal syndrome. Because methadone in normal doses does not produce a high or leave the user feeling drugged, it can help heroin addicts hold jobs and get their lives back on track (Schwartz et al., 2006). However, like other opioids, methadone is highly addictive.

Liver disease - alcoholic hepatitis

About 35% of heavy drinkers will develop alcoholic hepatitis and more than 1/3rd of these will die within 6 months after signs and symptoms, such as yellowing of the skin and whites of the eyes (jaundice), increased girth due to large and noticeable retention of fluid in the abdominal cavity (ascites), loss of appetite, nausea & vomiting, abdominal pain and tenderness, confusion and behavior changes due to brain damage from buildup of toxins (encephalopathy), weight loss, and kidney and liver failure Habitual drinkers tend to be malnourished, which can put them at risk of complications arising from nutritional deficiencies

Methamphetamines

Abuse of this derivative of amphetamine skyrocketed in the 1990s. Some estimates indicate that as many as 4.7 million people in the U.S. have tried methamphetamine at some point. Methamphetamines are extremely addicting and very difficult to quit. A major reason is that methamphetamine increases dopamine activity, such as in the mesolimbic region (the seat of pleasure), more so than any other known substance. To put this in context, sex or marijuana produce a 150% increase in dopamine binding in the mesolimbic cortex versus at rest; methamphetamines lead to a 1200% increase (Grow, 2012) Methamphetamine-related deaths nearly tripled between the years 1991 and 1994. Hospital admissions for methamphetamine intoxication have also increased dramatically. In the early 1990s, admissions for methamphetamine abuse across 42 states increased 43%. In the mid-90s, 35% of admissions to California drug treatment centers were for methamphetamine abuse, compared with 27% for heroin and 24% for cocaine. Since 1999, rates of methamphetamine use among teens have decreased (SAMSA). The problem was more serious in California than elsewhere in the U.S. because of the high concentration of "meth labs" that manufacture this easily made and inexpensive drug. However, abuse has now become more widespread in the Midwestern and Southwestern U.S. (The five states that produce the most methamphetamine are now all in the Midwest.) The popular TV series, "Breaking Bad", had as its main character Walter White, a New Mexico high school chemistry teacher diagnosed with terminal lung cancer who turns into a methamphetamine producer and major drug lord in order to secure his family's financial future before he dies Other studies have documented the cognitive deficits associated with chronic meth use as well. Use of meth by pregnant women can have severe consequences for the developing fetus. In 2003, a California woman was convicted of manslaughter; she was held responsible for causing the death of her infant via methamphetamine poisoning ingested by the infant through her breast milk. Chemicals for manufacturing methamphetamine are readily available, though laws, such as the Methamphetamine Control Act of 1996, have been passed to try and cut off the supply. When supplies of ephedrine became low, pseudoephedrine, a common substance in many over-the-counter decongestants, was substituted, but these substances are now also better regulated. Some chemicals used to make meth are highly volatile and dangerous to breathe. The hazardous chemicals cause damage ranging from eye irritation and nausea to coma and death. They also create risks for fires and explosions.

Binge Drinking and Prescription Drug Use Among College Students

According to a Columbia University study, almost half of full-time college students binge drink or abuse prescription drugs. Almost a quarter of those college students meet the medical definition of having a problem with substance abuse or a dependence. That is 3x the rate of the general population.

Controlled Drinking: A Viable Goal?

According to the disease model of alcoholism, having even one drink causes people with alcoholism to lose control and go on a binge. Some argue that many people with alcohol abuse or dependence can develop self-control techniques that allow them to engage in controlled drinking (Sobell & Sobell, 1973a, 1973b, 1984). This contention remains controversial.

Psychodynamic Perspectives

According to traditional psychodynamic theory, alcoholism reflects an oral-dependent personality. Psychodynamic theory also associates excessive alcohol use with other oral traits, such as dependence and depression, and traces the origins of these traits to fixation in the oral stage of psychosexual development. Excessive drinking or smoking in adulthood symbolizes an individual's efforts to attain oral gratification.

CNS Depressants: Alcohol

Alcohol has a biphasic effect. Initially, the effect seems stimulating; the drinker experiences an expansive feeling of sociability and well-being as his or her BAL rises. At first (phase one), ethyl alcohol depresses the areas of the brain that controls judgment and inhibition; people become more talkative and often more friendly. As their inner control breaks down, they may feel relaxed, confident, and happy. But after the BAL peaks and begins to decline, alcohol acts as a depressant, and the drinker may experience increases in negative emotions, interference in complex thought processes, and impaired sensory functioning. After the BAL peaks and begins to decline, phase two begins. As more alcohol is absorbed, it slows down additional areas of the CNS, leaving drinkers less able to make sound judgments, their speech less clear, their motor coordination less able, their memory weaker; some become highly emotional and perhaps loud and aggressive. As drinking continues, motor difficulties increase and reaction times slow. Vision becomes blurred, particularly side vision, and they have trouble hearing. As a result, people may have great difficulty driving or solving simple problems. One important group of neurons to which ethyl alcohol binds are those that normally receive the neurotransmitter GABA. GABA carries an inhibitory message (e.g., stop firing) when it is received at certain neurons. When alcohol binds to receptors on those neurons, it apparently helps GABA to shut down the neurons, thus causing an initial relaxation effect on the drinker. Alcohol myopia refers to the impairment of mental control functions - intoxicated individuals have difficulty sustaining concentration, are inattentive and easily distracted. Subsequently, they often show a very narrow attention focus, usually on immediate stimuli. Alcohol also initially increases levels of serotonin and dopamine, and these effects may be the source of alcohol's ability to produce pleasurable effects. Finally, alcohol also inhibits glutamate receptors, which may cause the cognitive effects of alcohol intoxication, such as slurred speech and memory loss.

nicotine health problems

Among other medical problems associated with and almost certainly caused or exacerbated by chronic smoking are: Emphysema and other lung diseases Cancer of the lungs, larynx, and/or of the esophagus Cardiovascular diseases High blood pressure Stroke Birth complications, such as premature delivery and underweight babies Second-hand smoke related health problems, including lung cancer Erectile dysfunction

alcoholism

An alcohol dependence disorder or addiction that results in serious personal, social, occupational, or health problems. The most widely held view of alcoholism is the disease model, the belief that alcoholism is a medical illness or disease.

Adderall

An amphetamine used in the treatment of the symptoms of attention deficit hyperactivity disorder (ADHD) is Adderall, which may have replaced Ritalin as the drug of choice in this category and accounted for the decline in Ritalin abuse in the past 15 years. The absolute prevalence rates are fairly high, particularly among college students (9.0% in 2010) and young adults generally (7.0%).

antidepressants

Antidepressants may help reduce cravings for cocaine following withdrawal. These drugs stimulate neural processes that promote feelings of pleasure derived from everyday experiences. However, antidepressants have yet to produce consistent results in reducing relapse rates for cocaine dependence, so it is best to withhold judgment concerning their efficacy.

cocaine process

At first, cocaine stimulates the higher centers of the CNS, making users feel excited, energetic, talkative, and even euphoric. As more is taken, it stimulates other centers of the CNS, leading to a faster pulse, higher blood pressure, faster and deeper breathing, and further arousal and wakefulness Cocaine produces these effects largely by increasing supplies of dopamine at key neurons throughout the brain. Excessive amounts of dopamine travel to receiving neurons throughout the CNS and overstimulate them. Also, cocaine appears to increase the activity of norepinephrine and serotonin in some areas of the brain Blocking the reuptake of dopamine in mesolimbic areas that are thought to yield pleasurable states, cocaine facilitates neural transmission and results in heightened positive feelings. Reports of pleasure induced by cocaine are strongly related to the extent that cocaine has blocked dopamine reuptake. Sexual desire increases, as does self-confidence, well-being, and indefatigability High doses produce cocaine intoxication, whose symptoms are poor muscle coordination, grandiosity, bad judgment, anger, aggression, compulsive behavior, anxiety, and confusion. Some experience hallucinations or delusions or both, a condition known as cocaine-induced psychotic disorder. As the stimulant effects of the drug subside, the user experiences a depression-like letdown, popularly called crashing, a pattern which can also include chills, nausea, insomnia, headaches, dizziness, and fainting. The aftereffects usually disappear within 24 hours for occasional users; they may last longer for chronic users or users who have taken a particularly high dose. These individuals may sink into a stupor, deep sleep, or in some cases, coma. Regular use of cocaine may lead to a pattern of abuse in which the person remains under its effects much of each day and functions poorly in social relationships and at work. Furthermore, regular use of cocaine may cause problems in short-term memory or attention. Dependence effects include tolerance and withdrawal symptoms of depression, fatigue, sleep problems, irritability, and anxiety. Chronic use can lead to personality changes, which include heightened irritability, impaired social relationships, paranoid thinking, and disturbances in eating and sleeping. These withdrawal symptoms may last for weeks or even months after drug use has stopped.

the network theory

Better than a stepping-stone theory may be the network theory. Network implies a complex set of relationships in which cause-and-effect is impossible to isolate, but some degree of association among many variables is acknowledged

The Conditioning Model of Craving: nicotine

Classical conditioning may help explain drug cravings. In this view, cravings reflect the body's need to restore high blood levels of the addictive substance and thus have a biological basis. But they also come to be associated with environmental cues associated with prior use of the substance (Kilts et al., 2004).

psychological dependence

Compulsive use of a substance to meet a psychological need; also known as craving. -People take the drug to control how they feel, to relieve negative mood states, or to prepare for certain activities, e.g., public speaking.

craving meth

Craving for methamphetamine is particularly strong, and can last several years after use of the drug is discontinued. Animal studies indicate that chronic use of meth causes damage to the brain, affecting both dopamine and serotonin systems. Recent neuroimaging studies with humans have found similar effects in the brain, particularly in the dopamine system. Methamphetamine abusers had a significant reduction in dopamine transportation, and performed slowly on several motor tasks.

drugs of abuse

Depressants, such as alcohol and opioids (narcotic analgesics or painkillers) like heroin and morphine Stimulants, such as amphetamines and cocaine Hallucinogens

Nonprofessional Support Groups

Despite the complexity of the factors contributing to substance abuse and dependence, these problems are frequently handled by lay people or nonprofessionals. The most widely used nonprofessional program, Alcoholics Anonymous (AA), is based on the belief that alcoholism is a disease, not a sin. The AA philosophy holds that that people suffering from alcoholism will never be cured, regardless of how long they abstain from alcohol; rather, people with alcoholism who remain "clean and sober" are seen as "recovering alcoholics."

substance induced disorders

Disorders, such as intoxication, that can be induced by using psychoactive substances. (For this class, we will be focusing on substance-use disorders.)

Sociocultural Perspectives

Drinking is determined, in part, by where we live, whom we worship with, and the social or cultural norms that regulate our behavior. Cultural attitudes can encourage or discourage problem drinking. Peer pressure and exposure to a drug subculture are important influences in determining substance use among adolescents and young adults (Dishion & Owen, 2000; Hu, Davies, & Kandel, 2006).

Stats of drugs

Drug overdose deaths exceed 64,000 per year in the U.S. Drug related fatalities have increased for 15 successive years and doubled in the last decade. Drug overdoses are now the number one cause of accidental deaths, overtaking motor vehicle accidents. The number of fatal overdoses due to opioid drugs increased 2.8x between 2002-2015. Despite the popular stereotype that drug dependence is more frequent among ethnic minorities, this belief is not supported by evidence. To the contrary, African Americans and Latinos have comparable or even lower rates of substance use disorders than do European Americans (non-Hispanic Whites) (Breslau et al., 2005; Compton et al., 2005). In college students studied in 2010, the Treatment Episode Data Set (TEDS) found that: 72% of those admitted to public substance abuse programs did so for an alcohol use disorder 55.7% for marijuana use disorder 31.6% prescription drug addiction About one out of every six American young adults (between the ages of 18 and 25) battled a substance use disorder in 2014 (NSDUH). This represents the highest percentage out of any age group at 16.3 percent. Heroin addiction among young adults between 18 and 25 years old has doubled in the past 10 years (AARP).

moderate drinking

Evidence shows that moderate use of alcohol (1 to 2 drinks per day for women, 2 to 4 drinks for men) is linked to lower risks of heart attacks and strokes, as well as lower death rates overall (D. Castelnuovo et al., 2006; King, Mainous, & Geesey, 2008; Mukamal et al., 2003). Higher doses of alcohol are associated with higher mortality (death) rates. Health promotion efforts might be better directed toward finding safer ways of achieving the health benefits associated with moderate drinking than by encouraging alcohol consumption, such as by quitting smoking, lowering dietary intake of fat and cholesterol, and exercising more regularly.

Cognitive Perspectives

Evidence supports the role of cognitive factors in substance abuse and dependence, especially the role of expectancies. Alcohol or other drug use may also boost self-efficacy expectations—personal expectancies we hold about our ability to successfully perform tasks. Expectancies may account for the "one-drink effect"—the tendency of chronic alcohol abusers to binge once they have a drink.

pathways to drug dependence

Experimentation Routine use Addiction or dependence

heroin

Heroin use exemplifies the kinds of problems posed by opioids. After taking heroin repeatedly for just a few weeks, users may become caught in a pattern of abuse. The drug interferes significantly with social and occupational functioning. In most cases, heroin abuse leads to a pattern of dependence as well, and users soon center their lives on the substance, build a tolerance for it, and experience a withdrawal reaction when they stop taking it. Withdrawal symptoms initially are anxiety, restlessness, sweating, and rapid breathing. Later, they include severe twitching, aches, fever, vomiting, diarrhea, appetite loss, high blood pressure, and weight loss of up to 15 lbs (due to loss of bodily fluids), often similar to a bad case of the flu. These symptoms usually peak by Day 3, gradually subside, and disappear by the 8th day. A person in withdrawal can either wait out the symptoms or end withdrawal by taking heroin again. People who are dependent on heroin soon need the drug just to avoid going into withdrawal, and they must continually increase their doses in order to achieve even that relief. Most users organize their lives around efforts to get their next dose, in many cases turning to criminal activities (e.g., theft, prostitution) in order to support their (expensive) addiction. Close to 1% of adults in the U.S. are addicted to heroin at some time in their lives. The rate of addiction dropped considerably during the 1980s, rose in the early 1990s, fell in the early 2000s, and now is on the rise once again. The most immediate danger of heroin use is an overdose, which closes down the respiratory center in the brain, almost paralyzing breathing and in many cases causing death. Death is particularly likely during sleep, when a person is unable to fight this effect by consciously working to breathe. People who resume heroin use after a period of sobriety often make the fatal mistake of taking the same dose they had built up to before. Actor Cory Monteith accidentally OD'd on heroin and alcohol after a stint in rehab. Each year, about 2% of heroin users die under the drug's influence, usually from an overdose. Other risks include that often drug dealers mix heroin with a cheaper drug such as a barbiturate or LSD, or even a deadly substance such as cyanide or battery acid. Dirty needles and other non-sterile equipment which spread infections such as HIV, hepatitis, and skin abscesses, are additional risks. In some areas of the U.S., the HIV infection rate among heroin addicts is reported to be as high as 60%.

addiction

Impaired control over the use of a chemical substance, accompanied by physiological dependence.

Aversive Conditioning

In aversive conditioning, painful or aversive stimuli are paired with substance abuse or abuse-related stimuli to condition negative emotional responses to drug-related stimuli. In the case of problem drinking, tasting alcoholic beverages is usually paired with drugs that cause nausea and vomiting, or with electric shock. Unfortunately, aversive conditioning effects are often temporary and fail.

Prescription Drug Use in the U.S.

In the last 20 years in the U.S., the consumption of prescription stimulants increased from 5 million to 45 million. In 2013, nearly 2 million Americans abused prescription painkillers. It is possible to become addicted with just one prescription. Oxycodone (OxyContin), Hydrocodone (Vicodin), Oxymorphone (Opana), Methadone, benzodiazepines like Xanax, and other potent pain and anxiety medications are among the most commonly involved prescription drugs in overdose deaths. The sharpest rise in the past 2 years has been seen in fentanyl ODs.

Benzodiazepines/ Anxiolytics

Initially, they seemed so safe and effective that physicians prescribed them generously, and their use spread. Over time, it became clear that in high enough doses, the drugs can cause intoxication and lead to abuse or dependence. They can also cause death but typically in conjunction with other CNS depressants, such as alcohol. Close to 1% of adults in the U.S. become dependent on these anti-anxiety drugs (also known as anxiolytics) at some point in their lives. People age 18-29 are most likely to develop benzodiazepine-use disorders, with high co-morbidity of alcoholism, other CNS depressants, and mood and anxiety disorders. Treatment admissions for people addicted to both benzodiazepines and narcotic pain relievers jumped 569.7 percent between 2000 and 2010.

routes of administration

Injection Snorting Inhaling/smoking Oral ingestion Other: Under tongue; inserted anally; inserted vaginally; eyedrops

Contingency Management Programs

Learning theorists believe that our behavior is shaped by rewards and punishments. Contingency management (CM) programs provide reinforcements (rewards) contingent on performing desirable behaviors such as producing drug-negative urine samples (Petry et al., 2005; Poling et al., 2006; Roll et al., 2006). On average, the CM (reward) group achieved longer periods of continual abstinence than the standard methadone treatment group.

tension-reduction theory

Learning theorists have long maintained that one of the primary reinforcers for using alcohol is relief from states of tension or unpleasant states of arousal. According to the tension-reduction theory, the more often one drinks to reduce tension or anxiety, the stronger or more habitual the habit becomes. We can think of some uses of alcohol and other drugs as forms of self-medication—as a means of using the pill or the bottle to ease psychological pain, at least temporarily (Robinson et al., 2009).

learning perspective on nicotine

Learning theorists propose that substance-related behaviors are largely learned and can, in principle, be unlearned. They focus on the roles of operant and classical conditioning and observational learning. Substance abuse problems are not regarded as symptoms of disease but rather as problem habits

effects of cocaine

Like heroin, cocaine directly stimulates the brain's reward or pleasure circuits. It also produces a sudden rise in blood pressure and an accelerated heart rate that can cause potentially dangerous, even fatal, irregular heart rhythms. Overdoses can produce restlessness, insomnia, headaches, nausea, convulsions, tremors, hallucinations, delusions, and even sudden death due to respiratory or cardiovascular collapse. Regular snorting of cocaine can lead to serious nasal problems, including ulcers in the nostrils.

health and alcohol

Liver disease - alcoholic hepatitis Increased risk of some cancers/compromised immune system functioning Coronary heart disease Brain damage/neurological disorders Other common physical problems Fetal alcohol syndrome (FAS)

marijuana and health

Long-term health problems for chronic marijuana smokers include lung disease and lung cancer, and human reproduction problems. Marijuana smoke contains more tar and benzopyrene than tobacco smoke. Both of these substances have been linked to cancer. Marijuana smoking also reduces the ability to expel air from the lungs even more than cigarette smoking does, promoting lung diseases such as emphysema.

bio theories for nicotine

Many drugs of abuse, including nicotine, alcohol, heroin, marijuana, and especially cocaine and amphetamines, increase levels of the neurotransmitter dopamine in the brain's pleasure or reward circuits—the networks of neurons responsible for producing feelings of pleasure or states of euphoria. Over time, regular use of these drugs may sap the brain's own production of dopamine. Consequently, the brain's natural reward system—the "feel good" circuitry that produces states of pleasure associated with the ordinarily rewarding activities of life, such as consuming a satisfying meal and engaging in pleasant activities—becomes blunted. Evidence links genetic factors to various forms of substance use and abuse, including alcohol abuse and dependence, heroin dependence, and even cigarette smoking (nicotine dependence). Alcoholism tends to run in families (APA, 2000). Familial patterns provide only suggestive evidence of genetic factors, because families share a common environment as well as common genes

Culturally Sensitive Treatment of Alcoholism

Members of ethnic minority groups may resist traditional treatment approaches because they feel excluded from full participation in society. Native American women, for example, tend to respond less favorably to traditional alcoholism counseling than White women (Rogan, 1986). Hurlburt and Gade (1984) attribute this difference to the resistance of Native American women to "White man's" authority. They suggest that Native American counselors might be more successful in overcoming this resistance.

meth users

Men tend to abuse methamphetamine more often than women, in contrast with other forms of amphetamine use, where few gender differences occur. Although White males are the typical meth abusers, recent data suggest that use among Hispanic and Native Americans is on the rise. Like other amphetamines, meth can be taken orally or intravenously. It can also be taken intranasally (i.e., snorted). In a clear crystal form, the drug is often referred to as "crystal meth" or "ice".

Observational Learning: nicotine

Modeling or observational learning plays an important role in determining risk of substance abuse problems. Parents who model inappropriate or excessive drinking or use of illicit drugs may set the stage for maladaptive drug use in their children (Kirisci, Vanyukov, & Tarter, 2005). Evidence shows that adolescents who have a parent who smokes face a substantially higher risk of smoking than do their peers in families where neither parent smokes (Peterson et al., 2006).

Prescription drug overdoses

More accidental deaths each year are now due to drug overdoses than motor vehicle accidents. In the U.S., an individual dies of a drug overdose every 19 minutes, and 44 people die each day from prescription painkillers alone. Prescription drugs now account for more fatal drug overdoses than heroin and cocaine combined. Over the past decade, the rate of drug-related deaths has doubled to now over 64,000 fatalities per year, largely due to prescription drug abuse. For every unintentional overdose death related to an opioid analgesic: -9 are admitted for substance abuse treatment -35 visit emergency rooms -161 report drug abuse or dependence -461 report nonmedical uses of opioid analgesics

Nicotine Replacement Therapy

Most regular smokers, perhaps the great majority, are nicotine dependent. The use of nicotine replacements in the form of prescription gum (brand name Nicorette), transdermal (skin) patches, and nasal sprays can help smokers avoid unpleasant withdrawal symptoms and cravings for cigarettes. After quitting smoking, ex-smokers can gradually wean themselves from the nicotine replacement.

nicotine

Nicotine is the addicting agent of tobacco. It stimulates nicotinic receptors in the brain. The neural pathways that become activated stimulate the dopamine neurons in the mesolimbic area that seem to be involved in producing the reinforcing effects of most drugs. Cigarette smoking is responsible in some way for 1 of every 6 deaths in the U.S. each year, killing more than 1,100 people each day, or over 443,000 per year. WHO estimates 1 billion people worldwide smoke and more than 3 million die each year from smoking-related causes. The most probable harmful components in cigarette smoke are nicotine, carbon monoxide, and tar (which consists primarily of certain hydrocarbons, many of which are known carcinogens). Second hand smoke or environmental tobacco smoke (ETS) contains higher concentrations of ammonia, carbon monoxide, nicotine, and tar than does the smoke actually inhaled by the smoker. ETS is blamed for more than 50,000 deaths a year in the U.S. The children of smokers are more likely to have upper-respiratory infections, bronchitis, and inner ear infections than their peers whose parents do not smoke Nicotine abuse remains the single most preventable cause of premature death in the U.S. as well as in other parts of the world. Tobacco kills more Americans each year than AIDS, car accidents, cocaine, crack, heroin, homicide, and suicide combined. Lung cancer kills more people than any other cancer, and smoking is the probable cause of as many as 87% of lung cancers Regular users develop a tolerance for nicotine and must smoke more and more in order to achieve the same results. When people try to stop smoking, they experience withdrawal symptoms - irritability, increased appetite, sleep disturbances, slower metabolism, cognitive difficulties, and a powerful craving or desire to smoke. Nicotine acts on the same neurotransmitters (dopamine, serotonin, and norepinephrine) in the reward center of the brain as amphetamines and cocaine. Inhaling a puff of cigarette smoke delivers a dose of nicotine to the brain faster than it could be delivered by injection into the bloodstream (efficient route of administration, which promotes addiction).

Negative Reinforcement and Withdrawal: nicotine

Once people become physiologically dependent, negative reinforcement comes into play in maintaining the drug habit. In other words, people may resume using drugs to gain relief from unpleasant withdrawal symptoms. In operant conditioning terms, relief from unpleasant withdrawal symptoms is a negative reinforcer for resuming drug use (Higgins, Heil, & Lussier, 2004).

opiates

Opiates or opioids include opium - taken from the sap of the opium poppy - and the drugs derived from it, such as morphine, codeine, and heroin. More recently, prescription pain medications, including oxycodone (OxyContin) and hydrocodone have become opiates of abuse. Opium has been in use for thousands of years. In the past, it was used widely in the treatment of medical disorders because of its ability to both reduce physical and emotional pain. Physicians eventually discovered, however, that the drug was physically addictive. Morphine: In 1804, a new substance, morphine, was derived from opium. It relieved pain even more effectively than opium and was originally touted as safe. However, wide use of this drug eventually revealed that it too could lead to addiction. Heroin is a synthetic opiate made by modifying the morphine molecule. In 1898, morphine was converted into heroin for medicinal purposes of pain relief. For several years, heroin was viewed as a wonder drug and was used for a wide range of medical purposes, including cough medicine. Heroin: Eventually, however, physicians learned that heroin was even more addictive than the other opioids. By 1917, the U.S. Congress concluded that all drugs produced from opium were addictive and it passed a law making opioids illegal except for medical purposes. Still other drugs have been derived from opium and synthetic (laboratory blended) opioids such as methadone have been developed. Codeine is another opioid usually prescribed to relieve pain. All these opioid drugs, natural and synthetic, are known collectively as narcotics or narcotic analgesics (painkillers). Endorphins are also known as endogenous opioids; these are neurochemicals produced in the brain, types of neurotransmitters, that help relieve pain and reduce emotional tension. The good feeling that we get after working out is due to the release and actions of endorphins. Opioids work by depressing the CNS, particularly the centers that help control emotion. The drugs attach or bind to brain receptor sites that ordinarily receive endorphins. When neurons at these endorphin receptor sites receive opioids, they produce pleasurable and calming feelings just as they would if receiving endorphins. In addition to reducing pain and tension, opioids cause nausea, narrowing of the pupils ("pinpoint pupils"), and constipation, bodily reactions that can also be brought about by releases of endorphins in the brain. Narcotics are smoked, inhaled, snorted, injected by needle just beneath the skin ("skin popped"), or injected directly into the bloodstream ("mainlined"). Injection seems to be the most common method of narcotic use, although other methods have been increasing in recent years. Injection brings on a rush - a spasm of warmth and ecstasy that is sometimes compared with orgasm. The brief spasm is followed by several hours of a pleasant feeling called a high or nod. During a high, the user feels relaxed, happy, and unconcerned about food, sex, or other bodily needs.

operant conditioning on nicotine

People may initially use a drug because of social influence, trial and error, or social observation. In the case of alcohol, they learn that the drug can produce reinforcing effects, such as feelings of euphoria, and reductions in anxiety and tension. Alcohol may also reduce behavioral inhibitions. Alcohol can thus be reinforcing when it is used to combat depression (by producing euphoric feelings, even if short lived), to combat tension (by functioning as a tranquilizer), or to help people sidestep moral conflicts (for example, by dulling awareness of moral prohibitions).

Tolerance

Physical habituation to a drug such that with frequent use: 1) higher doses are needed to achieve the same effects, 2) the same amount of substance has a diminished effect.

nicotine prevalence

Prevalence is highest in Asia and South America. More than 1/3rd of U.S. high school seniors have smoked within the past month, at least half of this group on a regular basis. Of the more than 1,000 children and adolescents who begin smoking every day, 750 will die prematurely from a preventable, smoking-related disease. Prevalence of smoking remains high among Native Americans, blue-collar workers, and less educated individuals. Prevalence is lowest among college graduates and those over the age of 75. The age at which smoking begins is decreasing, especially among young women. Also, smoking prevalence has declined much less among women than among men. In general, lung cancer rates are lower among Asians than Whites or Latinos. Recent research has found that Chinese Americans metabolize less nicotine from cigarettes than either White or Latino smokers. This is consistent with the lower lung cancer rates.

Psychodynamic Approaches

Psychoanalysts view substance abuse and dependence as symptoms of conflicts rooted in childhood experiences. The therapist attempts to resolve the underlying conflicts, assuming that abusive behavior will then subside as the client seeks more mature forms of gratification. Although there are many successful psychodynamic case studies of people with substance abuse problems, there is a dearth of controlled and replicable research studies. The effectiveness of psychodynamic methods for treating substance abuse and dependence thus remains unsubstantiated.

Ethnicity and Alcohol Use and Abuse

Rates of alcohol use and alcoholism vary among American ethnic and racial groups. Some groups—Jews, Italians, Greeks, and Asians—have relatively low rates of alcoholism, largely as the result of tight social controls placed on excessive and underage drinking. Asian Americans, in general, drink less heavily than other population groups (Adelson, 2006).

barbituates

Sedative drugs which are depressants with high addictive potential About 1% of adult Americans develop a substance abuse or dependence disorder involving the use of barbiturates, sleep medication (hypnotics), or antianxiety agents at some point in their lives. Barbiturates such as amobarbital, pentobarbital, phenobarbital, and secobarbital are depressants, or sedatives First discovered in Germany more than 100 years ago, barbiturates were widely prescribed in the first half of the 20th century to fight anxiety and to help people sleep. Despite the development of the safer benzodiazepines, some physicians still prescribe barbiturates, especially for sleep problems. The drugs can cause many problems, not the least of which are abuse and dependence. Several thousand deaths a year are caused by accidental or suicidal barbiturate overdoses Usually taken in pill or capsule form, in low doses, they attach to the neuron receptors that receive GABA and "help" GABA to shut down those neurons. Just like with alcohol, barbiturates are broken down in the liver and in high doses, cause similar intoxication effects. At high doses, they also depress the reticular formation, the part of the brain that normally keeps people awake, thus causing the user to get sleepy. At too high a level, they can stop breathing, lower blood pressure, and lead to coma and death. Repeated use of barbiturates can quickly result in a pattern of abuse. Users spend much of the day intoxicated, irritable, and unable to do their work. Dependence can also result. The user may organize his or her life around the drug and needs increasing amounts of it to calm down or fall asleep. A great danger is that the lethal dose of the drug remains the same even while the body is building up a tolerance for its sedating effects. Once the prescribed dose stops reducing anxiety or inducing sleep, the user is all too likely to increase it without medical supervision and eventually may take a dose that proves fatal. Many users accidentally kill themselves by drinking alcohol while using barbiturates; the alcohol magnifies or potentiates the depressant effects of the barbiturates. This is also called a synergistic effect. Combined CNS depressants shut down breathing, heart rate, etc., leading to death Withdrawal symptoms include nausea, anxiety, sleep disturbances, and convulsions. While use steadily declined from 1975 to the early 1990s, the use of these drugs appears to be once again on the rise.

Self Control Strategies

Self-control training helps abusers develop skills they can use to change their abusive behavior. Behavior therapists focus on three components—the "ABCs"— of substance abuse: 1. The antecedent cues or stimuli (As) that prompt or trigger abuse. 2. The abusive behaviors (Bs) themselves. 3. The reinforcing or punishing consequences (Cs) that maintain or discourage abuse.

Social Skills Training (SST)

Social skills training helps people develop effective interpersonal responses. Assertiveness training, for example, may be used to train alcohol abusers to fend off social pressures to drink. Behavioral marital therapy seeks to improve marital communication and problem solving that may trigger abuse.

freud and cocaine

Surprisingly, in its early years, it was widely believed that cocaine posed few problems aside from intoxication. It was first used as a local anesthetic. While still a young neurologist, Sigmund Freud began using cocaine to combat his depression. He proclaimed, "Cocaine brings about an exhilaration and lasting euphoria...an increase in self-control and...more vitality and capacity for work...in other words, you are simply normal" (Freud, 1885). Freud lost his enthusiasm for cocaine after nursing a physician friend to whom he had recommended the drug through a night-long psychotic state brought on by cocaine

Psychological Effects of Alcohol

The effects of alcohol or other drugs vary from person to person. By and large they reflect the interaction of: -The physiological effects of the substances. -Our interpretations of those effects.

types of amphetamines

The first amphetamine, Benzedrine, was synthesized in 1927. Almost as soon as it became available as an inhalant to relieve stuffy noses, the public discovered its stimulating effects. Physicians thereafter prescribed it and the other amphetamines were soon synthesized to control mild depression and appetite. WWII soldiers used it to ward off fatigue. Today, amphetamine-related drugs (e.g., Adderall; methylphenidate or Ritalin is chemically related to amphetamine) are often used to treat hyperactive children. These drugs, including Benzedrine, Dexedrine, and Methedrine, produce their effects by causing the release of norepinephrine and dopamine and blocking the reuptake of these neurotransmitters.

crack

The hardened, smokable form of cocaine that may be more than 75% pure.

marijuana stats

The marijuana available in the U.S. today can be more than 10x as powerful than that used in the1970s. The THC content is as high as 10-15% compared to 1-5% in the late 1960s. Marijuana use among teens and young adults increased 2008-2010 (SAMSA). Legalization of marijuana in some states has led to increased use.

Marijuana Use Among College Students

The number of college students using marijuana in the past 12 months nationwide was 38% in 2015. 1 in every 22 collegiates have "toked up" at least 20 times in the past month. The increase in use may be attributable to several factors such as the rise of "medical marijuana", legalization of recreational use of marijuana in states including California, as well as the increased concentration of THC in marijuana due to agricultural technology.

Detoxification

The process of ridding the system of alcohol or other drugs under supervised conditions. Detoxification is often more safely carried out in a hospital setting. In the case of addiction to alcohol or barbiturates, hospitalization allows medical personnel to monitor and treat potentially dangerous withdrawal symptoms such as convulsions.

Relapse-Prevention Training

The word relapse derives from Latin roots meaning "to slide back." This training is designed to help substance abusers to identify high-risk situations and learn effective coping skills for handling these situations (Witkiewicz & Marlatt, 2004). Relapse-prevention training also focuses on preventing lapses from turning into full-blown relapse.

Benzodiazepines

These anti-anxiety drugs developed in the 1950s are the most popular sedative-hypnotic drugs available. Xanax and Valium are just two of the dozens of these compounds in clinical use. In the U.S., sedatives are manufactured in vast quantities - enough, it is estimated, to supply each man, woman, and child with 50 pills per year. Many are shipped legally to Mexico and then brought back into the U.S. and trafficked illegally. Many polydrug abusers choose a sedative as one of their drugs, sometimes to come down from a stimulant or to reduce withdrawal effects. they calm people by binding to receptors that receive GABA and by increasing GABA activity at those receptors. Unlike the barbiturates, however, these drugs relieve anxiety without making people as drowsy. Because they are less likely to slow a person's breathing, they are less likely to cause death in the event of an overdose.

Behavioral Approaches

These approaches to treating substance abuse and dependence focus on modifying abusive and dependent behavior patterns. According to behaviorally oriented therapists the key question is whether abusers can learn to change their behavior when they are faced with temptation

Sedatives-hypnotic drugs

These drugs produce feelings of relaxation and drowsiness. At low dosages, they have a calming or sedative effect. At higher dosages, they are sleep inducers or hypnotics. There are two primary subtypes -barbiturates -benzodiazepines.

Other: Under tongue; inserted anally; inserted vaginally; eyedrops

Time is variable, but longer than 20 seconds.

Overview of drugs

U.S. - drug (loving) culture •Risk factors: Being male; family history of drug addiction •Dependence rates vary by substance

ecstacy (MDMA)

a designer drug, a chemical knockoff similar in chemical structure to amphetamine. It produces mild euphoria and hallucinations and has become especially popular on college campuses and in clubs and "raves" in many cities. Ecstasy can produce adverse psychological effects, including depression, anxiety, insomnia, and even paranoia and psychosis.

cocaine

a natural stimulant extracted from the leaves of the coca plant—the plant from which the soft drink obtained its name - found in South America. It is the most powerful natural stimulant known. The drug was first separated from the plant in 1865. Coca-Cola was originally described as a "brain tonic and intellectual beverage," in part because of its cocaine content Processed cocaine is an odorless, white, fluffy powder. For recreational use, it is often snorted so that it is absorbed through the mucous membrane of the nose. It can also be swallowed Some users prefer the more powerful effects of injecting cocaine intravenously or smoking it in a pipe or cigarette. Some mix heroin and cocaine and inject the combined drugs; this is known as a "speedball". The late comedian, John Belushi, died after injecting this drug combination. When purified by this chemical process, the cocaine base - or freebase - produces very powerful effects. It is absorbed rapidly into the lungs and carried to the brain in a few seconds, where it induces an intense two-minute high, followed by restlessness and discomfort. "Ice" and "crank" are the free-base counterparts of cocaine and crack, respectively. (Crack is a powerful, ready-to-smoke, free-base form of cocaine.) In the early 1960s, an estimated 10,000 persons in the U.S. had tried cocaine. Today, more than 21 million people have tried it, and 1.8 million - most of them teenagers or young adults - are using it currently. In the past, cocaine's use and impact were limited by the drug's high cost. Moreover, cocaine was usually snorted, a less efficient route of administration than either injection or smoking. Since 1984, the availability of newer, more powerful, and sometimes cheaper forms of cocaine, such as crack, has produced an enormous increase of abuse or dependence. Many people now ingest cocaine by free-basing. Millions of people now use crack, a powerful form of free-base cocaine that has been boiled down into crystalline balls. It is smoked with a special pipe and makes a crackling sound as it is inhaled (hence the name). Aside from the harmful effects on behavior, the drug poses serious physical dangers. During the first hour after taking cocaine, a user's risk of heart attack increases nearly 24 times. Cocaine is a vasoconstrictor, causing the blood vessels to narrow. As users take larger and larger doses of the purer forms of cocaine now available, they are at greater risk of dying from an overdose, often from a heart attack. The greatest danger of cocaine use is an overdose. Excessive doses have a strong effect on the respiratory center of the brain, at first stimulating it and then depressing it, to the point where breathing may stop. For some people, this strain on the heart causes a brain seizure that brings breathing or heart functioning to a sudden stop. Cocaine use can create major, even fatal, heart problems. The heart beats rapidly and irregularly under the drug's influence and at the same time must work harder to pump blood through the vessels that have narrowed as a result of cocaine's effects. Cocaine also increases a person's risk for stroke and causes cognitive impairments, such as difficulty paying attention and remembering. Given its strong vasoconstricting properties, cocaine poses special dangers in pregnancy, for the blood supply to the developing fetus may be compromised. Pregnant women who use cocaine run the risk of having a miscarriage and of having children with abnormalities in immune functioning, attention and learning, thyroid size, and dopamine and serotonin activity in the brain.

LSD (lysergic acid diethylamide)

a synthetic hallucinogenic drug. In addition to the vivid parade of colors and visual distortions produced by LSD, users have claimed it "expands consciousness" and opens new worlds—as if they were looking into some reality beyond the usual reality. Sometimes they believe they have achieved great insights during the LSD "trip," but when it wears off they usually cannot follow through or even summon up these discoveries.

free-basing

a technique for ingesting cocaine in which the pure cocaine basic alkaloid is chemically separated from the processed cocaine (e.g., "freed" by heating it with ether), vaporized by heat from a flame, and inhaled with a pipe. -The freebasing process is hazardous as ether is highly flammable. -The late comedian Richard Pryor brought public attention to the dangerousness of freebasing after he nearly died when the ether he was using (while freebasing) ignited and led to severe burns of his head and upper torso.

delirium tremens (DTs)

alcohol withdrawal delirium, which usually occurs in someone who has been drinking heavily for a number of years when the level of alcohol in the blood drops suddenly. The person has tremors and hallucinations that are primarily visual but may be tactile as well.

street names for cocaine

angel, blow, candy, cane, Dr. White, go powder, happy dust, icicles, joy flakes, lady, nose candy, rails, reindeer dust, rock candy, snort, snow, stardust, toot, uptown, white stuff, and wings.

inhalants

are volatile substances that produce chemical vapors that can be inhaled to induce a psychoactive, or mind-altering, effect. (NIDA, 2012). Depending on the inhalant, they can have effects similar to stimulants, depressants, and hallucinogens. -volatile solvents -aerosols -gases -nitrites

Korsakoff's syndrome

characterized by glaring confusion, disorientation, and memory loss for recent events

Stimulants (uppers)

cocaine, amphetamine, and nicotine, act on the brain and sympathetic nervous system (SNS) to increase alertness and motor activity. Stimulants increase the activity of the central nervous system, which enhances states of alertness and can produce feelings of pleasure or even euphoric highs. The effects vary with the particular drug

disulfiram (brand name Antabuse)

discourages alcohol consumption because the combination of the two produces a violent response consisting of nausea, headache, heart palpitations, and vomiting. In some extreme cases, combining disulfiram and alcohol can produce such a dramatic drop in blood pressure that the individual goes into shock or even dies. Although disulfiram has been used widely in alcoholism treatment, its effectiveness is limited because many patients who want to continue drinking simply stop using the drug

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