Chapter 10: Substance use and addictive disorders

It has been estimated that the cost of substance misuse is _____ each year in the US alone.

$740 billion

What is methamphetamine?

*A kind of amphetamine (nicknamed "crank") that has surged in popularity over the past decade* - Available in the form of crystals ("ice", "crystal meth"), and is smoked by users - Most made in "stovetop laboratories" > typically operate for a few days in a remote area and then move on to a new—safer—location > increased 8-fold in number, production, and confiscations this century

What is delirium tremens? What does it consist of?

*A particularly dramatic alcohol withdrawal reaction experienced by a small percentage of people* - It consists of terrifying visual hallucinations that begin within 3 days after they stop or reduce alcohol intake. > small, frightening animals chasing or crawling on them; objects dancing in front of their eyes - Usually runs its course after 2 to 3 days (just like other withdrawal symptoms) - Extreme cases: > seizures, lose consciousness, stroke, or death > preventable w/ medical treatment

What are the dangers of LSD?

*Although people do not usually develop tolerance to LSD or have withdrawal symptoms when they stop taking it, the drug poses dangers for both one-time and long-term users* 1) It is likely to produce enormous perceptual, emotional, and behavioral reactions; these may be extremely unpleasant > could injure oneself 2) Possible long-term effects > some users eventually develop psychosis or a mood or anxiety disorder > flashbacks (even after LSD has left the body) can occur days or months after last LSD experience

Which group of drugs is generally safer: barbiturates or benzodiazepines?

*Benzodiazepines* are generally safer and less likely to lead to intoxication, tolerance effects, and withdrawal reactions. - For the first half of the twentieth century barbiturates were the most widely prescribed sedative-hypnotic drugs, now benzodiazepines are usually prescribed instead *these are sedative-hypnotic drugs*

What does LSD do?

*LSD (lysergic acid diethylamide)*: Within 2 hours of being swallowed, LSD brings on a state of hallucinogen intoxication, sometimes called hallucinosis, marked by a general strengthening of perceptions, particularly visual perceptions, along with psychological changes and physical symptoms - Hallucinosis may cause: > hearing sounds more clearly, visual distortions or hallucinations, tingling or numbness of limbs, or confusing sensations of hot and cold > synesthesia: the crossing of different senses - LSD can also induce: > strong emotions > perception of time slowing dramatically > resurfacing of long forgotten memories - Physical symptoms include: > sweating, palpitations, blurred vision, tremors, and poor coordination

Why have more and more marijuana users developed cannabis use disorder over the past three decades?

*Mainly because marijuana has changed* - marijuana widely available in the United States today is at least four times more powerful than that used in the early 1970s - average THC content of today's marijuana is 8 percent, compared with 2 percent in the late 1960s - now grown in places with a hot, dry climate, which increases the THC content

What is stimulant use disorder?

*Regular use of either cocaine or amphetamines may lead to stimulant use disorder* - The stimulant comes to dominate the person's life, and the person may remain under the drug's effects much of each day and function poorly in social relationships and at work.

High enough doses of benzodiazepines can cause intoxication and lead to _____

*Sedative-hypnotic use disorder* - a pattern marked by craving for the drugs, tolerance effects, and withdrawal reactions - when benzodiazepines were first discovered, they seemed so safe and effective that physicians prescribed them generously

What are stimulants?

*Stimulants are substances that increase the activity of the central nervous system, resulting in increased blood pressure and heart rate, more alertness, and sped-up behavior and thinking* - cocaine and amphetamines - caffeine - nicotine

What are amphetamines?

*They are stimulant drugs that are manufactured in the laboratory* - Common examples: amphetamine (Benzedrine), dextroamphetamine (Dexedrine), and methamphetamine (Methedrine)

What does a person experience after smoking marijuana?

*When smoked, cannabis produces a mixture of hallucinogenic, depressant, and stimulant effects* 1) *At low doses*: - the smoker typically has feelings of joy and relaxation and may become either quiet or talkative - some 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 - time seems to slow down, and distances and sizes seem greater than they actually are - physical changes: > red eyes, fast heartbeat, higher blood pressure, higher appetite, dry mouth, and dizziness > some people fall asleep 2) *In high doses*: - odd visual experiences, changes in body image, and hallucinations - may become confused or impulsive - some worry that other people are trying to hurt them

Describe the two kinds of synergistic effects

*synergistic effect = the combined impact of multiple drugs* 1) *When two or more drugs have similar actions* - alcohol, benzodiazepines, barbiturates, and opioids—all depressants—may severely depress the central nervous system when mixed > extreme intoxication, coma, and even death 2) *When two or more drugs have opposite or antagonistic actions* - stimulant drugs, for example, interfere with the liver's usual disposal of barbiturates and alcohol > people who combine barbiturates or alcohol with cocaine or amphetamines may build up toxic, even lethal, levels of the depressant drugs in their systems

Each year _____ people are admitted to hospitals with a multiple-drug emergency, and _____ of them die.

*tens of thousands* of people; *several thousand* of them die

Provide examples of how opium has been used.

- *Drugs derived from opium* such as heroin, morphine, and codeine; and similar synthetic (laboratory-blended) drugs *known collectively as narcotics* - Used to be used in the *treatment of medical disorders* because of its ability to reduce both physical and emotional pain

What areas of the brain are impacted by alcohol consumption? What symptoms occur?

- Depresses areas of the brain responsible for judgement and inhibition - Slows down additional areas in the central nervous system, impacting speech, judgement, and memory. They may become emotionally sensitive or aggressive. - Motor functions are impacted, slowing reaction times and causing clumsiness. - Hearing and vision (especially peripheral) are dulled.

What are the nutritional consequences of long-term excessive drinking?

- Makes ppl feel full so they don't desire food - Has no nutritional value - Malnourished, weak, & prone to disease - Vitamin and mineral deficiencies > B1 deficiency can lead to Korsakoff's syndrome (extreme confusion, memory loss, & other neurological symptoms; they may make up for memory losses by confabulating)

In what ways does long-term excessive drinking effect a person's heart and immune system?

- May damage the heart - May lower immune system's ability to fight off cancer, bacterial infections, and AIDS

What forms are amphetamines taken in?

- Most often taken in pill or capsule form - Some people inject the drugs intravenously or smoke them for a quicker, more powerful effect

What are the dangers of opioid use?

- Overdose > closes down respiratory center in the brain, almost paralyzing breathing and often causing death > death particularly likely during sleep

What are the dangers of marijuana?

- occasionally causes panic reactions similar to the ones caused by hallucinogens, and some smokers may fear they are losing their minds > typically ends in 2 to 6 hours along with other effects - marijuana can interfere with the performance of complex sensorimotor tasks and with cognitive functioning >>> has caused many automobile accidents > 4 percent of adults have driven while under the influence of marijuana at least once during the past year - serious disadvantage at school or work > people on a marijuana high often fail to remember information, especially anything that has been recently learned, no matter how hard they try to concentrate - possible long term health problems: > lung disease, reduces lung capacity, lower sperm count and higher ovulation abnormality

Although the prevalence of crack use has declined over the past two decades, around _____% of all people over the age of 11 (almost ____ individuals) have used it within the past year

0.3% of all people over the age of 11; almost 1 million individuals

Over a one-year period, _____% of all adults in the United States display this disorder

0.4%

1) In a given year, 0.1 percent of all people over the age of 11 years display stimulant use disorder that is centered on cocaine, and 2) 0.3 percent display stimulant use disorder centered on amphetamines

1) 0.1% of all people over 11 2) 0.3% of all people over 11

1) Surveys suggest that more than _____% of adults in the United States, a total of _____ million people, display an opioid use disorder within a given year. 2) Most of these persons (80 percent) are addicted to _____ 3) Around 20 percent of those with opioid use disorder are addicted to _____

1) 1%; 2.6 million 2) pain-reliever opioids, prescription drugs such as oxycodone. 3) heroin.

1) Currently, approximately _____ people in the United States die from pain reliever overdoses each year, 2) _____ from heroin overdoses, 3) and _____ from overdoses of other opioids 4) These numbers represent ____ of all drug overdose deaths.

1) 20,000 people 2) 15,000 people 3) 8,000 people 4) two-thirds of all drug overdose deaths

1) Around _____ of all Americans over the age of 11 regularly smoke tobacco— 2) a total of _____ million people 3) Similarly, _____ of the world population over 11 smoke regularly— 4) a total of _____ billion people

1) 24% of all Americans over age 11 2) 63 million people 3) 20% of the world population over 11 4) 1.1 billion people

Who consumes methamphetamine?

1) About as likely to be used by women as men. Around 40 percent of current users are women 2) Popular today among a wide range of people, from biker gangs to rural Americans to urban gay communities 3) Has gained wide use as a "club drug"

1) Almost _____% of all people over the age of 11 in the United States have used methamphetamine at least once 2) Around _____% currently have methamphetamine use disorder

1) Almost 6% of all people over 11 2) Around 0.3% currently have methamphetamine use disorder

How does cocaine work?

1) At first cocaine stimulates the higher centers of the central nervous system - excited/energetic/talkative/euphoric 2) As more is taken, it stimulates other centers of the central nervous system - faster pulse/high blood pressure/faster and deeper breathing/further arousal and wakeness *Cocaine produces these effects largely by increasing supplies of the neurotransmitter dopamine at key neurons throughout the brain* - Excessive amounts of dopamine travel to receiving neurons throughout the central nervous system and overstimulate them - Cocaine appears to also increase the activity of the neurotransmitters norepinephrine and serotonin in some areas of the brain

What was the initial purpose of amphetamines, and how has its use changed?

1) First produced in the 1930s to help treat asthma 2) Soon became popular among: - people trying to lose weight - athletes seeking an extra burst of energy - soldiers, truck drivers, and pilots trying to stay awake - students studying for exams through the night *Physicians now know the drugs are far too dangerous to be used so casually, and they prescribe them much less freely*

1) The most powerful form of cannabis is _____ 2) The weaker ones include _____

1) Hashish 2) Marijuana > mixture derived from buds, crushed leaves, and flowering tops

What experiences must a person have to receive a diagnosis of substance use disorder?

1) Individual displays a maladaptive pattern of substance use leading to significant impairment or distress 2) Presence of at least 2 of the following substance-produced symptoms within a 1-year period: - Substance is often taken in larger amounts - Unsuccessful efforts to reduce or control substance use - Much time spent trying to obtain, use, or recover from effects of substance - Failure to fulfill major role obligations - Continued use despite persistent interpersonal problems - Reduction of important activities - Continued use in dangerous situations - Continued use despite worsening of physical or psychological problems - Craving for substance - Tolerance effects - Withdrawal reactions

What factors moderate the concentration of alcohol in a person's blood?

1) Larger body size is a buffer 2) Men have more of the stomach enzyme alcohol dehydrogenase than women do.

How does methamphetamine work?

1) Like other kinds of amphetamines, methamphetamine increases activity of the neurotransmitters dopamine, serotonin, and norepinephrine - increased arousal, attention, and related effects 2) It can have serious negative effects on a user's physical, mental, and social life. - damages nerve endings, a problem called neurotoxicity users focus more on methamphetamine's immediate positive impact, including perceptions by many that it makes them feel hypersexual and uninhibited

1) More than _____% of all people in the United States have used LSD or another hallucinogen at some point in their lives 2) Around _____%, or _____ people, are currently using them

1) More than *15%* of all people in the US 2) Around *0.5%*, or *1.2 million* people

What factors contributed to the emergence of the current opioid epidemic?

1) Painkiller prescriptions 2) Increase in potency at the same time as increase in use 3) Increased availability of heroine 4) Since 2011, the increased affordability, availability, and potency of opioid drugs have produced a still greater demand for opioids

How does LSD work?

1) Primarily by binding to some of the neurons that normally receive the neurotransmitter serotonin, changing the neurotransmitter's activity at those sites - These neurons ordinarily help the brain send visual information and control emotions

Describe the differences in effect based on blood-alcohol concentration for: 1) 0.06% 2) 0.09% 3) 0.55%

1) Usually relaxed and comfortable 2) Intoxicated 3) Death is likely - most ppl lose consciousness before reaching 0.55%

What is the current prevalence of alcoholism for: 1. non-Hispanic white Americans 2. Hispanic Americans 3. Black Americans 4. Native Americans 5. Asian Americans

1. 6.1% 2. 6.4% 3. 4.9% 4. 9.7% (particularly men) 5. 3.2%

What are the withdrawal symptoms of heroine?

1. At first: the withdrawal symptoms are anxiety, restlessness, sweating, and rapid breathing 2. Later they include severe twitching, aches, fever, vomiting, diarrhea, loss of appetite, high blood pressure, and weight loss of up to 15 pounds (due to loss of bodily fluids). *These symptoms usually peak by the third day, gradually subside, and disappear by the eighth day*

Describe the experience a person has after consuming cocaine

1. Cocaine brings on a euphoric rush of well-being and confidence. Given a high enough dose, this rush can be almost orgasmic, like the one produced by heroin. 2. As the stimulant effects of cocaine subside, the user goes through a depression-like letdown, popularly called crashing, a pattern that may also include headaches, dizziness, and fainting - those who take a particularly high dose may sink into a stupor, deep sleep, or, in some cases, coma

What categories do the substances people misuse fall into?

1. Depressants 2. Stimulants 3. Hallucinogens 4. Cannabis

What are the dangers of cocaine?

1. Harmful effects on behavior, cognition, and emotion 2. Physical dangers - annual number of cocaine-related emergency room incidents has multiplied more than 125 times since 1982 3. Overdose - strong effect on the respiratory center of the brain - can also create major, even fatal, heart irregularities or brain seizures (bring breathing or heart function to a stop)

For *mixed drugs* answer each statement with "slow", "moderate" or "high" 1. Potential Intoxication 2. Addiction Potential 3. Risk of Organ Damage or Death 4. Risk of Severe Social or Economic Consequences 5. Risk of Severe or Long-Lasting Mental & Behavioral Change

1. High 2. High 3. High 4. High 5. High

For *opioids* answer each statement with "slow", "moderate" or "high" 1. Potential Intoxication 2. Addiction Potential 3. Risk of Organ Damage or Death 4. Risk of Severe Social or Economic Consequences 5. Risk of Severe or Long-Lasting Mental & Behavioral Change

1. High 2. High 3. Moderate 4. High 5. Low to moderate

For *stimulants (cocaine, amphetamines)* answer each statement with "slow", "moderate" or "high" 1. Potential Intoxication 2. Addiction Potential 3. Risk of Organ Damage or Death 4. Risk of Severe Social or Economic Consequences 5. Risk of Severe or Long-Lasting Mental & Behavioral Change

1. High 2. High 3. Moderate 4. Low to moderate 5. Moderate to high

For *cannabis* answer each statement with "slow", "moderate" or "high" 1. Potential Intoxication 2. Addiction Potential 3. Risk of Organ Damage or Death 4. Risk of Severe Social or Economic Consequences 5. Risk of Severe or Long-Lasting Mental & Behavioral Change

1. High 2. Low to moderate 3. Low 4. Low to moderate 5. Low

For *alcohol* answer each statement with "slow", "moderate" or "high" 1. Potential Intoxication 2. Addiction Potential 3. Risk of Organ Damage or Death 4. Risk of Severe Social or Economic Consequences 5. Risk of Severe or Long-Lasting Mental & Behavioral Change

1. High 2. Moderate 3. High 4. High 5. High

In what ways are amphetamines similar to cocaine?

1. Increase energy and alertness and reduce appetite when taken in small doses 2. Produce a rush, intoxication, and psychosis in high doses 3. Cause an emotional letdown as they leave the body 4. Stimulate the central nervous system by increasing the release of the neurotransmitters dopamine, norepinephrine, and serotonin throughout the brain *although the actions of amphetamines differ somewhat from those of cocaine*

For *sedative-hypnotics*: *barbiturates ; benzodiazepines* answer each statement with "slow", "moderate" or "high" 1. Potential Intoxication 2. Addiction Potential 3. Risk of Organ Damage or Death 4. Risk of Severe Social or Economic Consequences 5. Risk of Severe or Long-Lasting Mental & Behavioral Change

1. Moderate ; moderate 2. Moderate to high ; moderate 3. Moderate to high ; low 4. Moderate to high ; low 5. Low ; low

High doses of the drug produce cocaine intoxication—what are the symptoms?

1. Poor muscle coordination 2. Grandiosity 3. Bad judgment 4. Anger 5. Aggression 6. Compulsive behavior 8. Anxiety 9. Confusion 10. Some people have: - hallucinations, delusions, or both, a condition called *cocaine-induced psychosis*

The disorder also plays a role in more than _____ of all suicides, homicides, assaults, rapes, and accidental deaths, including _____% of all fatal automobile accidents in the United States

1/3 29%

More than _____% of children live with a parent with alcohol problems.

10%

Around _____% of all adults have driven while intoxicated at least once in the past year. How does this compare to previous statistics?

10% A significant drop since 2002 when 14 percent of adults had driven in an intoxicated state

How long do the effects of cannabis usually last?

2 to 6 hours - changes in mood may continue longer

What is the average rate at which alcohol is metabolized by the liver into carbon dioxide and water, which can be exhaled and excreted?

25% of an ounce per hour *Different people's livers work at different speeds*

What percentage of people over the age of 11 binge drink each month in the US? What gender identity increases the likelihood of this practice?

25% of people Men outnumber women 2:1

_____% of college students binge drink at least once a month. Provide some examples of negative consequences to this.

38% of college students 1. Alcohol-related arrests account for 83 percent of all campus arrests. 2. More than half of all sexual assaults on college campuses involve the heavy consumption of alcohol. 3. Alcohol is a factor in at least 25 percent of academic problems and 28 percent of all instances of dropping out of college. 4. Approximately 700,000 students each year are physically or emotionally traumatized or assaulted by a student drinker. 5. Half of college students say "drinking to get drunk" is an important reason for drinking. 6. Binge drinking often has a lingering effect on mood, memory, brain functioning, and heart functioning. 7. Binge drinking is tied to 4,300 deaths among college-age persons every year. 8. The number of female binge drinkers among college students has increased 31 percent over the past decade. *These findings have led some educators to describe binge drinking as "the number one public health hazard" for full-time college students*

There has been a _____ percent increase in the number of deaths caused by opioid overdoses in the past decade

400%

Surveys indicate that over a one-year period, _____% of all people over 11 years of age in the United States display alcohol use disorder, known in popular terms as alcoholism. For teenagers specifically, the rate is 2.5% Is gender a predictor of alcoholism?

5.9% 2.5% Yes, *Men with this disorder outnumber women by 2 to 1*

According to some studies, the mortality rate of persons with untreated opioid use disorder is _____ times the rate of other persons

63

In any given year, _____% of all teens and adults in the US, around _____ million people, have a substance use disorder. _____ have the highest rate of substance use disorders in the US (_____%), while _____ have the lowest (_____%). _____, _____, and _____ have rates between _____ and _____%. Only _____% of all those with substance use disorders receive treatment from a mental health professional.

7.8%, 21 million people Native Americans, 11.6%, Asian Americans, 3.8% Non-Hispanic white Americans, Hispanic Americans, and African Americans, between 7 and 8.2% Only 18%

According to surveys, _____% of pregnant Americans have drunk alcohol during the past month and _____% of pregnant people have had binge drinking episodes.

9.3% 4.6%

What is a speedball?

A mixture of cocaine and heroine

Define "binge drinking episode"

A person drinking five or more drinks on a single occasion.

What is freebasing?

A technique in which the pure cocaine basic alkaloid is chemically separated, or "freed," from processed cocaine, vaporized by heat from a flame, and inhaled through a pipe

_____ of prescriptions are written annually for benzodiazepines.

Altogether, 130 million

Clinical theorists have developed sociocultural, psychological, and biological explanations for why people develop substance use disorders. Among these, _____ has gained broad support.

Among these, *no single explanation* has gained broad support Like so many other disorders, excessive and chronic drug use is increasingly viewed as the result of *a combination of these factors*

Describe the experience a person has after the injection of an opioid.

An injection quickly 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 drug user feels relaxed, happy, and unconcerned about food, sex, or other bodily needs. - also causes nausea, narrowing of the pupils ("pinpoint pupils"), and constipation

What is cirrhosis?

An irreversible condition in which the liver becomes scarred and dysfunctional - Caused by long term, excessive drinking - Accounts for more than 38,000 deaths per year

Around _____ people, _____% of all teenagers and adults in the United States, have displayed cannabis use disorder within the past year

Around *4 million* people, *1.5%* of all teenagers and adults in the US

As many as _____% of those who use one illegal drug are also using another to some extent

As many as *90%*

As many as half of _____ have a deficiency of alcohol dehydrogenase.

Asian Americans - this can cause a very negative reaction to even modest alcohol intake - helps to prevent extended use

How does the rate of binge drinking in substance-free dorms compare to forms without this quality?

Binge drinking rates seem to be half compared to those who live in a fraternity or sorority house

How do opioids work?

By depressing the central nervous system, particularly the centers that help control emotion - the drugs attach to brain receptor sites that ordinarily receive endorphins—neurotransmitters that help relieve pain and reduce emotional tension -When neurons at these receptor sites receive opioids, they produce pleasurable and calming feelings just as they would do if they were receiving endorphins - Bodily reactions that can also be brought about by releases of endorphins in the brain > reducing pain and tension, opioids cause nausea, narrowing of the pupils ("pinpoint pupils"), and constipation

_____ is the most powerful natural stimulant now known

Cocaine

How do drinking rates differ between college students who do and do not identify as athletes?

College athletes are more likely to drink, drink heavily, and binge drink than college students who are not athletes

What painkiller is most commonly linked to overdose deaths?

Fentanyl

What is "GABA"? How is it impacted by the consumption of alcohol?

GABA is a neurotransmitter that carries an inhibitory message when received by certain neurons When alcohol binds to receptors on those certain neurons, it helps GABA to shut down the neurons, thus relaxing the drinker

How do benzodiazepines work?

Like alcohol and barbiturates, they calm people by binding to receptors on the neurons that receive GABA and by increasing GABA's activity at those neurons - relieve anxiety without making people as drowsy as other kinds of sedative-hypnotics - less likely to slow a person's breathing, so they are less likely to cause death in the event of an overdose

More than 22 million people over the age of 11 (8.3 percent of the population) currently smoke marijuana at least monthly

More than *22 million* people over the age of 11 (*8.3%* of the population)

What is a substance use disorder?

Patterns of maladaptive behaviors and reactions brought about by the repeated use of substances. - come to crave a particular substance and use it excessively

Why is each of the cannabis drugs found in various strengths?

Potency of a cannabis drug is greatly affected by: 1. the climate in which the plant is grown 2. the way it was prepared 3. the manner and duration of its storage

What are hallucinogens?

Substances that cause powerful changes in sensory perception, from strengthening a person's normal perceptions to inducing illusions and hallucinations - the trips may be exciting or frightening, depending on how a person's mind interacts with the drugs - *Also called psychedelic drugs, the hallucinogens include:* > LSD > mescaline > psilocybin > MDMA (ecstasy) - Many come from plants or animals, some are produced in laboratories

What are depressants?

Substances that slow the activity of the central nervous system - alcohol - sedative-hypnotic drugs - opioids

What is substance intoxication?

The cluster of temporary changes in behavior, emotion, or thought that occur shortly after consuming a substance, and are considered undesirable.

Define "cannabis intoxication"

The overall "high"

Describe the rate of opioid dependence from the 1980's to now

The rate of opioid dependence dropped considerably during the 1980s, rose in the early 1990s, fell in the late 1990s, and now is high once again. Currently, many clinicians are referring to it as an epidemic

What tricks can help a person sober up after drinking alcohol?

There are no tricks that have been shown to work The only way to sober up is by metabolizing the alcohol over time

Why is overdose more likely if a person starts heroine or pain reliever use after taking a long break from it?

They often make the fatal mistake of taking the same dose they had built up to before

Why do people consume methamphetamine?

Users focus more on immediate positive impact, including: - perceptions by many that it makes them feel hypersexual and uninhibited

How long do LSD symptoms last?

While the person is awake and alert, usually for about 6 hours

Describe the withdraw symptoms experienced by a person diagnosed with alcohol use disorder.

Within hours their hands, tongue, and eyelids begin to shake; they feel weak and nauseated; they sweat and vomit; their heart beats rapidly; and their blood pressure rises. They may also become anxious, depressed, unable to sleep, or irritable. *A small percentage of people with alcohol use disorder go through a particularly dramatic withdrawal reaction called delirium tremens (the DTs).*

What is crack?

a powerful form of freebase 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 - sold in small quantities at a fairly low cost - contributed to epidemic in 1980s mostly ppl with low SES

It has been estimated that in the overall population, around _____ babies is born with this syndrome.

around 1 of every 1,000 babies - 67 of every 1,000 babies of pregnant people who are problem drinkers - 80 to 200 such births per 1,000 heavy-drinking pregnant people

What are sedative-hypnotic drugs (also called anxiolytic, meaning "anxiety-reducing", drugs)?

e drugs produce feelings of relaxation and drowsiness - Calming or sedative effect at low doses - Sleep inducers or hypnotics at higher doses

Many regular users also develop a tolerance for marijuana. What withdrawal symptoms might these people experience?

may feel restless and irritable and have flulike symptoms when they stop smoking

How many people in the US die each year from too high a blood alcohol level?

more than 1,000 people per year

After taking heroin repeatedly for just a few weeks, users may develop _____

opioid use disorder