Chapter 12: Alcohol, Tobacco, and Other Drugs: A Community Concern

Treatment

- (for drug abuse and dependence) care that removes the physical emotional and environmental conditions that have contributed to drug abuse and or dependence - Aims to reduce the demand for drugs and save money. -Money is saved on enforcement, medical costs, and lost productivity - Treatment may be residential (inpatient) or nonresidential (outpatient) - Behavioral health care: limits inpatient care to 28 days after they can continue to an outpatient basis. Aftercare (continuing care provided to the recovering former drug abuser) involves peer group or self-help support group meetings like the AA or NA. - Treatment for drug dependence is an important component of a community's comprehensive drug abuse prevention and control strategy.

Voluntary Health Agencies

- Drug prevention and control program are carried out at the local level. Teachers, community health education, social workers, law enforcement officer, and volunteers carry out drug abuse prevention programs. - Some programs seek to educate or provide knowledge, seek to change beliefs or attitudes about alcohol or other drug use, and others seek to alter behavior. - Founded to prevent or control the social and personal consequences of alcohol, tobacco, and other drug abuse. - Ex. Mothers Against Drunk Driving, Students Against Destructive Decisions, AA, NA, ACS. They are active locally, statewide, and nationally. - Community leaders: encourage parents, school officials, members of law enforcement, businesses, social groups, community health workers, and the media to work together to reduce the abuse of drugs. - Need to have citizen support and vigilance to reduce the threat of alcohol and drugs.

Designer Drugs

- Drug synthesized illegally that is similar to, but structurally different from known controlled substances. - Term to describe drugs synthesized by amateur chemists. - Chemists constantly change their design of their drugs to stay one step ahead of law enforcement. - Ex. MDMA, synthetic narcotics, and dissociative anesthetics such as PCP (angel dust) and ketamine.

Introduction

- Drug taking is an experimental or social, a temporary departure from a natural, nondrugged physical and mental state. Misguided attempt to self-medicate or to cope with physical problems (depression loneliness guilt low self esteem) - Drug taking ceases to be a matter of conscious choice, these people have become chronic drug abusers or drug dependent. - Little benefit to their communities and detract from their communities.

State and Local Agencies and Programs

- Drug war in the US must be fought on the local level (homes, neighborhoods, and schools). State support comes from law enforcement, expertise in education and mental health.

illicit (illegal) drugs

- Drugs that cannot be legally manufactures, distributed, or sold, and that usually lack recognized medicinal value. Drugs that have been placed under Schedule I of the Controlled Substances Act of 1970. Over 150 drugs. - Drugs that do have medical uses are placed in Schedule II to V of the Act depending upon their potential for abuse and risk of causing dependence - Schedule II drugs: opium derivatives (morphine fentanyl oxycodone and methadone), stimulants amphetamine and meth and certain depressants. - Schedule III drugs: have medical uses and exhibit a lower risk of potential abuse than Schedule II. Contain less concentrated forms of Schedule II drugs and steroids. - Schedule IV: contains drugs that are less potential for abuse than Schedule III drugs. Includes milder stimulants and depressants. - Schedule V: Drugs that dilute concentrations of opium or opiates used in such medicines as cough syrups. - Drug Enforcement Administration (DEA)

Stimulants

- Drugs that increases activity level in the CNS - Amphetamines, dexies, meth, ice, Ritalin, cat. These drugs cause the release fo high levels of dopamine which stimulates the brain cells. - Tolerance builds up quickly so abusers must escalate their doses rapidly. - Chronic abusers can develop tremors and confusion, aggressiveness, and paranoia. Long term effect include memory loss and permanent brain damage

Hallucinogens

- Drugs that produce profound distortions of the senses - Effects are due to synesthesia - Include both naturally derived drugs and synthetic drugs. - Physical dependence does not occur but tolerance does. Overdose deaths are rare but unpleasant experiences occur (like loss of vision) - No legal sources for these drugs

risk and protective factors

- Either genetic (inherited) or environmental. - Inherited traits can increase one's risk of developing dependence on alcohol and susceptibility to other drugs. - Environmental risk factors (home and family life, school and peers, ad society and culture) has been identified.

Elements of Prevention

- Elements that play a role in drug abuse prevention and control: education, treatment, public policy, and enforcement Education and treatment is to reduce the demand of drugs Public policy and enforcement is to rescue the supply and availability of drugs in the community.

Inherited Risk Factors

- Evidence for heritability of risk for alcoholism (studies reviewed by Tabakoff and Hoffman and in the Tenth Special Report to the US Congress on Alcohol and Health from the Secretary of Health and Human Services. - Two types of alcoholism: Type 1 (milieu-limited) and Type 2 (male limited) alcoholism. - Research is supported by using biological and genetic markers in animal models. Some markers predispose an individual biochemically to increase the susceptibility to developing alcohol problem (others can be protective in nature). ex. genes can code for enzymes that inhibit the normal metabolism of alcohol could cause one to respond positively or negatively to the effects of alcohol - Genes can influence smoking.

US Department of Homeland Security

- Formed because of the terrorist attacks on the WTC and Pentagon. - Received the third largest portion of funding from that National Drug Control Budget ($4.1 billion). - Deals with the protection of terrorist attacks more than the prevention and control of drug trafficking - Receiving funds are the Immigration and Custom Enforcement, Customs and Border Protection, Counternarcotics Enforcement, and the US Coast Guard. - Immigration and Customs helps to precent immigration of criminals. Customs and Border works to protect borders of external threats. Coast Guard helps to interdict illegal drug trafficking in coastal waters.

Substance Abuse and Mental Health Services Administration (SAMHSA)

- Four centers: Center for Substance Abuse pRevention (CSAP), Center for Substance Abuse Treatment (CSAT), Center for Mental Health Services (CMHS), and the Center for Behavioral Health Statistics and Quality (CBHSQ).

Prescription Drugs

- Have serious side effects so they can only be purchased only with a physician's written instruction (prescription). Prescription drugs are regulated by the FDA. Written prescription connotes that the prescribed drugs are being taken by the patient under the prescribing physician's supervision. - Includes the patient's name, the amount to be dispensed, and the dosage. - 47.4% of people in the US are using at least one prescription drug during the past month. - Misuse can be those cited for OTC drugs and giving certain prescription drug to another. - Stimulants (amphetamines), depressants (Valium), and prescription option pain relievers have a higher potential for abuse than others. - Greater risk for developing dependence or taking an overdose from these drugs because they are strong. - The abuse and misuse of opioid pain relievers has risen to epidemic proportions. From 2000 and 2014, the rate of overdose deaths (involving opioids, heroin and prescription opioid pain relievers increased 200%. More than 165000 overdose deaths involving prescription opioids occurred and overdose deaths involving opioids quadrupled. - 2014 the leading causes of death for ages 1-44 was unintentional injuries and for 25 to 64 unintentional poisoning was the leading cause of unintentional injuries. - Increase in overdoses involving prescription opioids influenced by: Opioids are potent pain relievers and their potency makes them highly addictive. And when mixed with illicit drugs they can be lethal. They are increasingly available. The primary factor contributing to overdoses is an increase in prescription for opioid pain relievers. Prescription opioid misuse and abuse can lead to dependency. Use of prescription opioids is a risk factor for heroin use - Prescription drug abuse put strains on emergency departments: visits increased 128% and accounts for 28% of all related drug emergency department visits. - Prescription drug abuse can lead to development of drug resistant strains of pathogens (reinfecting the body with drug resistant organisms). When the strain is transmitted to another the antibiotic treatment fails. If drug misuse continues, then bacteria becomes resistant to multiple drugs. ex. Multi-drug resistant TB (MDR-TB) and CA-MRSA infections (bacterial infections that are resistant to some antibiotics.

Local Agencies

- Includes the mayors' offices, police and sheriffs' departments, school corporations, health departments, family services offices, mental health services, prosecutor's offices, juvenile justice system, judges and courts, drug task forces. - Some have community drug task force or coordinating council that includes both government officials and representatives of nongovernmental agencies. Task is to prioritize problems faced by the community and decide on appraises to solving them. Goals is develop a coordinated and effective efforts to resolve the issue.

State Agencies

- Includes the offices of the governor, state departments of health, education mental health, justice, and law enforcement. - Visit stage governments homepage and search the terms "drug abuse prevention agencies or programs". - Provides actual services, or stats, or other information, expertise or serve as conduit for federal funding aimed at local governments. - State government is to promote, protect, and maintain the health and welfare of its citizens. Each state has their own laws regulating the sale of tobacco, alcohol, and prescription drugs. Each state issue licenses and passes laws and sets of penalties. - State can pass laws that a conflict with federal laws. Half of states have legalized marijuana for medical purposes. US Department of Justice said that it relies heavily on states to enforce their own marijuana laws.

Tobacco Use Health Consequences

- Increased risk for heart disease, lung cancer, chronic obstructive lung disease, stroke, emphysema, and other conditions. - Smoking tests in 480,000 premature deaths and 5.1 million years of potential life lost (number is expected to rise to $300 billion per year). Tobacco smoking is estimated at more than $300 billion per year. More than half of this total ($156 million) is due to lost of productivity, and the remainder is in health care cost. Health care costs attributed to smoking (43%) are paid with government funds, including Medicaid and Medicare. - Problem of uneven state tobacco laws remedied by the Sonar Amendment.

National Institute on Drug Abuse (NIDA)

- Largest institution in the world devoted to drug abuse research. - Efforts are aimed to understand the causes and consequences of drug abuse and evaluating prevention and treatment programs. - Divisions: Division of Clinical Neuroscience and Behavioral Research, Division of Basic Neuroscience and Behavioral Research, Division of Epidemiology, Prevention Research, Pharmacotherapies and Medical Consequences of Drug Abuse. - Conduct research and public articles on the causes, prevention, and treatment of tobacco, alcohol, and other drug abuse.

Factors that Contribute to Alcohol, Tobacco, and other Drug Abuse

- Lies with the individual because it is a matter of choice. Individuals are differentially at risk for engaging in drug taking behaviors.

Types of Drugs Abused and Resulting Problems

- Many classification systems of drugs. Problems with classification because all drugs have multiple effects and because the legal status of a drug can depend on its formulation, strength, and the age of the user. - Legal (licit drugs): alcohol, nicotine, and nonprescription and prescription drugs. - Illegal (illicit drugs): stimulants, depressants, narcotics, hallucinogens, marijuana, and other drugs.

Scope of the Current drug Problem in the US

- More deaths, illnesses, and disabilities can be attributed to the abuse of alcohol, tobacco, and any other drugs than to any other preventable health condition. - One-fourth of 2.5 million deaths each year are due to alcohol, tobacco, or illicit drug use. - 2011, 2.4 million emergency department visits were due to drug use and misuse. Substance abuse is more than $700 billion per year (include direct and indirect costs) - $742 billion annual drug bill: $249 billion for the cost of alcohol abuse and alcoholism, $193 billion for drug abuse, and smoking is $300 billion. - Federal, state, and local governments spend $467.7 billion from substance abuse and addiction: $238.3 billion be federal, %135.8 billion be state, and $93.8 billion be local governments. Accounts for 10.7% of their entire $4.4 trillion budgets. - Abuse of alcohol and other drugs is one of the US most expensive community and publi health problems.

Education drug abuse education

- Provides information about drugs and the dangers of drug abuse, changing attitudes and beliefs about drugs, providing skills necessary to abstain from drugs, and ultimately changing drug abuse behaviors. - Education is a primary prevention that can be school or community based. People must visibly support the program. ex. School-based drug prevention programs: Project ALERT, LifeSkills Training (LST), and Class Action ex. Community-based: American Cancer Society's Great American Smoke-out, Race Against Drugs (nationwide), Reality Check Campaign (to boost awareness about marijuana).

OJP

- Provides leadership to federal, state, local, and tribal justice systems by disseminating knowledge and practices and providing grants for the implementation of these crime-fighting strategies. - Works with the justice community to identify crime-related challenges and to provide information, training, coordination, and innovative strategies and approaches for addressing these challenges.

School-Based Drug Education Programs

- Strong, comprehensive school health education program (that occupies a permanent and prominent place in the school curriculum) is the best defense against all health problems. But schools lack these programs. - Ex. Drug Abuse Resistance Education program (DARE). Goal is to change attitude and beliefs about drugs. Successful in changing children's images on the police. No real success in reducing actual drug use. - Ex. Project ALERT. Reduced students' current marijuana use by 60% reduced alcohol use by 24% and reduce students pro drug use attitudes and beliefs. - Student assistance programs (SAPs). - Peer counseling programs

Monitoring the Future

- Surveys drug use among high school and college students that is carried out annually since 1975. In 1992, use of all drugs reached their lowest level. Since 1992, the use levels for any illicit drug have fluctuated. 8, 10, 12th graders the prevalence of the use of any illicit drug use peaked in 1999 at 55% and declined to 47% in 2009. Since 2009, the use has remained stable between 47% and 50%. Marijuana accounts for more than half of the figure. - Drug use levels peaked in the mid to late 1990s and early 2000s. Drugs like cocaine is at their lowest reported levels. - College students reported lower levels of usage of all illicit drugs Thant high school seniors.

Law Enforcement

- The application of federal, state, and local laws to arrest, jail, bring to trial, and sentence those who break drug laws or break laws because of drug use - Control drug use, control crime (related to drug use ad drug trafficking- the buying manufacturing or transporting of illegal drugs), prevent the establishment of crime organizations, and protect neighborhoods - Concerned with limiting supply of drugs in the community be interrupting the source, transit, and distribution of drugs.

Bureau of Alcohol, Tobacco, Firearms, and Explosives (ATF)

- The federal agency in the US Department of Justice that regulates alcohol and tobacco.

Public Policy

- The guiding principles and courses of action pursued by governments to solve practical problems affecting society - Ex, passing drunk driving laws or zoning ordinances that limit the number of bars or the type and amount of advertisements for legal drugs. Restrictions of smoking, setting the BAC to 0.08%. Taxes. - Should guide the budget discussion (how much community should spend).

Cocaine and Crack Cocaine

- The psychoactive ingredient in the leaves of coca plant, which then is refined and makes a powerful stimulant/euphoriant - It is a stimulant - In its more purified dorms as a salt or dried pasts (crack) cocaine is a powerful stimulant/euphoriant and very addictive. - Cocaine use among high school seniors peaked in 1982 with 13.1% reported use. IT decreased in 1992 but doubled in 1999. In 2015 the prevalence was the lowest at 2.5%. In 2014, 4.5 million Americans age 12 and older used cocaine and 1.5 million used cocaine in the past month.

Abusing alcohol and other drugs as serious health outcomes

- Threat to themselves and families because they are at risk for physical, mental, and financial ruin. Habitual drug users can develop psychological or physical dependence on the drug. If the drug is illegal, it can constitute to. criminal activity and carry added risks for arrest and incarceration. - Threat to the community because they have greater health care needs, suffer more injuries, and are less productive than this who do not. Can loss economic opportunity and productivity to social and economic destruction. Those who abuse drugs = more violent acts that results in economic loss, injury, and death.

1986 US Surgeon General's report on the effects of Environmental tobacco smoke or second hand smoke

- Tobacco smoke in the ambient air - Adults and children who inhale tobacco smoke of others (passive smoking) are also at increased risk for cardiac and respiratory illness.

Other Federal Agencies

- US Department of Staes, Defense, Veterans Affair, and Education are involved in drug abuse prevention and control. - US State Department had drug summits that tires to reduce the production and shipment of illicit drugs into the country, Defense Department helps foreign allies to control cultivation of illegal drug crops and production of illegal drugs. Veteran Affairs helps with the treatment of drug-related health problems of veterans. - Department of Education launched drug free schools and communities programs in 1980s. Aimed schools to adopt no drug use policies and to provide message to communities and schools not to condone or approve of alcohol and drug use by minors. Budget is $50.2 million.

amotivational syndrome

- a pattern of behavior characterized by apathy, loss of effectiveness, and a more passive, introverted personality - a chronic apathy toward maturation and the achievement of the developmental tasks listed previously (independent living, setting and achieving goals, and developing an adult self-identity)

Inhalants

- breathable substances that produce mind-altering effects - collection of psychoactive breathable chemicals - paint solvents, motor fuels, clearers, glues, aerosol sprays, cosmetics, and other types of vapor. - easy access and low cost they are drug of choice for the young - Primary effect is depression. Might feel a reduction of anxieties and inhibitions, making the user feel high. - Continued use can lead to hallucinations and lost of consciousness. Toxic to kidneys, liver, and nervous system. - Use of inhalants can result from boredom and peer pressure and represents a maladaptation to these conditions.

direct costs and indirect costs

- direct costs: health care expenditures, premature death, and impaired productivity - indirect costs: costs of crime and law enforcement, courts, jails, ad social work

Peer counseling programs

- school-based programs in which students discuss alcohol and other drug-related problems with peers - talk about mutual problems and receive support and learn coping skills from peers

Depressants

- slow down the central nervous system (depress the CNS) - Drugs that slow the CNS activity (like alcohol barbiturates and benzodiazepines) - Among the first effects of taking these drugs are the lowering of anxiety and loss of inhibitions. - Effects produce the feeling of high - As one continues to use these drugs, tolerance develops and the users experiences the need for greater doses to feel the same effects that previous doses provided. - Strong physical dependence develops so that absences results in clinical illness

sociocultural environment

- social ecology: the study of the effects of the physical and social environment upon the individual - Drug taking can stem from neighborhoods or society. Example: living in the inner city with crime, physical decay, and threats to personal safety could set to motion changes in values and behaviors (related to drug use or alcohol) - Federal, sate, and local drug prevention education program,s, law enforcement successes, and treatment availability can improve social environment and reduce prevalence of drug abuse. - Can increase taxes on certain products and develop zoning ordinances that limit the number of bars and liquor stores in certain neighborhoods can be effective.

Drug Use

A nonevaluative term referring to drug-taking behavior in general; any drug-taking behavior (regardless of whether the behavior is appropriate)

Drug (chemical) dependence

A psychological and sometimes physical state characterized by a craving for a drug. Occurs when a user feels that a particular drug is needed for normal functioning.

Psychological dependence

A psychological state characterized by an overwhelming desire to continue use of a drug. The user experiences a strong emotional or psychological desire to continue use of drug even though clinical signs of physical illness may not appear.

Definitions: Drugs

A substance other than food or vitamins that when taking in small quantities alters one's physical, mental, or emotional state.

abuse of illicit drugs vs abuse of alcohol and tobacco products

Abuse of alcohol and tobacco products are more of a serious challenges to American's health. - Rate of smoking and alcohol consumption has declined since 8, 10, and 12 since 1992, but use still remains high.

cocaine use

Cocaine use from 8th, 10th, and 12th graders peaked in 1999 at 4.5%, and declined to 1.6% in 2015.

Controlled Substances and Illicit (Illegal) Drugs controlled substances

Drugs regulated by the Comprehensive Drug Abuse Control Act of 1970, including all illegal drugs and prescription drugs that are subject to abuse and can produce dependence.

Psychoactive Drugs

Drugs that alter sensory perceptions, mood, thought processes, or behavior.

Legal Drugs

Drugs that are legally bought and sold in the marketplaces. Includes those that are closely regulated (morphine), lightly regulated (alcohol and tobacco), and still others that are not regulated (caffeine).

risk factors

Factors that increase the probability of drug use. People with a high number of risk factors are said to be vulnerable to drug abuse or dependence.

protective factors

Factors that lower the probability of drug use. More protective risk factors are said to be resistant to drug abuse.

Drug Enforcement Agency (DEA)

Investigates and assists in the prosecution of drug traffickers and their accomplices in the US and abroad and seizes the drugs and assets. Employs more than 5,000 special agents and support personal.

FBI

Investigates multinational organized crime networks that control the illegal drug market.

problem drinker

One for whom alcohol consumption results in a medical, social, or other type of problem. People who begin to experience personal, interpersonal, legal, or financial problems because of their alcohol consumption.

tolerance

Physiological and enzymatic adjustments that occur in response to the chronic presence of drugs, which are reflected in the need for ever-increasing doses

2015 National Drug Control Strategy

Priority areas: - prevent drug use in communities - seeking early intervention in health care - integrating treatment and support recovery - breaking cycle of drug use, crime, and incarceration - disrupting drug trafficking and production - strengthening international partnerships - improve information systems to address drug use and consequences Goals: - Curtail illicit drug consumption - Improve public health and public safety by reducing. the consequences of drug abuse

ENDS

Liquid contains nicotine and other ingredients is heated into an aerosol that his inhaled by the user.

Controlled Substance Act of 1970 (Comprehensive Drug Abuse Control Act of 1970)

The central piece of federal drug legislation that regulates illegal drugs and legal drugs that have a high potential for abuse.

Physical dependence

The discontinuation of drug use results in clinical illness. (usually both phyla and psychological dependence is present at the same time).

Office of National Drug Control Policy

The headquarters of America's drug control effort, located in the executive branch of the US government, headed by a director appointed by the president. Nation's anti-drug efforts are headed up the White House ONDCP. They report the nation's drug control strategy and budget.

Alcoholism

a disease characterized by impaired control over drinking, preoccupation with drinking, and continued use of alcohol despite adverse consequences - Two characteristics: physical dependence on alcohol and loss of control over one's drinking

club drugs

a general term for those illicit drugs, primarily synthetic, that are most commonly encountered at night clubs and "raves"

physical dependence

a physiological state in which discontinued drug use results in clinical illness

employee assistance program (EAP)

a workplace drug program designed to assist employees whose work performance is suffering because of a personal problem such as alcohol or other drug problems

methaqualone

an illicit depressant drug

binge drinking

consuming five or more drinks on a single occasion for males and four or more drinks for females - Rate of binge drinking in college students: 31.4% IN 2011, 30.3% IN 2013, 33.7% IN 2014, to 30.4% in 2015.

Barbiturates

depressant drugs based on the structure of barbituric acid

stimulant

drug that increases activity in the central nervous system

synesthesia

impairment of mind characterized by a sensation that senses are mixed

Benzodiazepines

non barbiturate drug

Methamphetamine

the amphetamine most widely abused

poly drug use

the concurrent use of multiple drugs

Drug Enforcement Administration (DEA)

the federal government's lead agency with the primary responsibility for enforcing the nation's drug laws, including the Controlled Substances Act of 1970 - Under the Department of Justice and has the responsibility of enforcing the provisions of the Controlled Substances Act. - Job is to interdict the trafficking, manufacturing, distribution, and sales of the substances under Schedule I. Sources are from illegal grows and manufactures. Schedule 2 to 5 are from the streets and illegal production.

Drug Abuse

Use of a drug when it is detrimental to one's health or well-being. Occurs when one takes prescription or nonprescription drug for a purpose over than that for which it is medically approved. ex. taking prescription diet pill for the effects Abuse of legal drugs occurs when one is aware that continued use is detrimental to one's health. Illicit drug use is considered drug abuse because there are no approved medical uses for illicit drugs. The use of alcohol and nicotine by those under the legal age is considered drug abuse.

marijuana and ecstasy use

Use remains below peak levels, but it is well above the lowest levels reported during the past decade. Marijuana use among grades 8, 10, 12 peaked to 1997 at 30.1% hit its lowest of 21.4% in 2007 and increased to 23.7% in 2015. Peaked in 1997 at 17.9% and hit lowest level 12.4% in 2007, and increased to 14% in 2015.

Levels of Prevention

- Drug abuse prevention activités can be primary, secondary, or tertiary.

Environmental Risk Factors

- Both social and psychological. - Personal factors, home and family life, school and peer groups, and other components of the social and cultural environment

Over the Counter Drugs

- (nonprescription drugs) drugs (except tobacco and alcohol) that can be legally purchased without a physician's prescription - Includes: Aspirin, Tylenol, ibuprofen, cough and cold remedies, emetics, laxatives, mouthwashes, vitamins and others. Sold to those who self-diagnose and self-medicate their own illness. - US Food and Drug Administration ensure the safety and effectiveness of these products when they are being used according to their label instructions. No one supervises the sell or use of these substances. - Example of drug misuse is following the dosage directions or using the drugs after their expiration date. Example of drug abuse is using laxatives to lose weight or avoid gaining weight. - Common drugs that are abused: appetite suppressants, stimulants, and nasal sprays. - Common cold OTC products that contain pseudoephedrine have been the target to make meth. Lead to stricter regulation by the FDA in 2006 the Combat Methamphetamine Epidemic Act of 2005 was signed into law in 2006 which limited the sale of pseudoephedrine products and to place them not in the front of the store. - OTC drugs provides symptomatic relief. Danger of OTC drug misuse and abuse is that symptoms that should be brought to the attention of a physician is unreported. And those who abuse these drugs may become dependent (unable to live normally without them). OTC may establish a pattern of dependency that predisposes the abuser to developing dependent relationships with prescription drugs or illicit drugs.

Affordable Care Act

- 2010 - Bars insurance companies from establishing eligibility rules based on pre-existing conditions (like history of addiction and substance abuse treatment). - Defines health benefits that must be covered, which include services and treatment for substance use disorders. - Improves substance abuse treatment options for many people.

Violence associated with the use of alcohol and other drugs

- 27% of violent crimes - Up to 70% deaths associated with water recreation - 43% rape victimization against women - 39% rape and sexual assault victimization - 38% Traffic fatalities - 24% M and 17% F suicide - 27.7% of assault

Amphetamines

- A group of synthetic drugs that act as stimulants. - Schedule II prescription drugs that have been widely abused for many years. Increased regulatory efforts in 1970s contributed to the rise in cocaine trade. - When cocaine abuse decline in 1980s there was a resurgence of amphetamine abuse (primarily meth) known as crystal, crank, speed, go fast, or just meth. - Production and use were in the southwestern states. By 1995, production and abuse has spread to the Midwest and 1999 meth abuse had become the fastest growing drug threat in the US. The popularity of amphetamines has declined. In 2015about 6.2% used amphetamine the past year. - Meth use among high schoolers declined from 4.1% in 1999 to 0.6% in 2015. In 2014 0.5% of high schoolers or 1.4 million were current meth users. - Decline from 2002 and 2006 - Methylphenidate is a schedule 2 drug used to treat ADHD.

Rohypnol (flunitrazepam)

- A powerful depressant in the Benzdiazapine group that has achieved notoriety as a "date-rape' drug because its toxic and sedative affects when combined with alcohol can last up to 8 hours. - Predatory drug - Exhibits all characteristics of depressants and its a legal prescription drug in more than 50 countries. In the US it is illegal (Schedule I) drug because it is more dangerous and less medically useful. - Controlled Substances Analogue Act of 1986 was enacted to reduce the flow of designer drugs into the market and make it easier to prosecute those manufacturing and distributing these drugs. Controlled Substance Act of 1970 did not list designer drugs as illegal.

Fetal alcohol spectrum disorder (FASD)

- A range of disorders caused by prenatal exposure to alcohol. FASD refers to conditions such as fetal alcohol syndrome (FAS), fetal alcohol effects (FAE), alcohol related neurodevelopment disorders (ARND) and alcohol related birth defects (ARBD). - FASD rates can vary from 0.3 cases of FASD per 1,00 live births to 9.0 cases per 1,000 live births. FASD costs society thousands of dollars over a diagnosed person's lifetime. - The lifetime costs for one individual with FASD is $2 million. For FAS cases alone the annual costs to the US is over $4 billion

Alcohol

- Alcohol is the number one problem drug in the US by any standard of measurement (number of those who abuse it, number of injuries and injury deaths it causes, amount of money spent, social and economic costs to society). - Beer is the form of alcohol involved in most heavy episodic drinking. Drunk by high students and college students through binge drinking. - Community health concern is underage drinking (drinking by those younger than 21). Lead to reckless driving, risky sexual behaviors that can lead to disease transmission and unintentional pregnancies, commission of violent and dangerous acts. - $22.5 billion or 17.5% of all money is spent on alcohol, can be accounted for underage drinking. - Alcohol industries depend on underage drinkers because: the amount of alcohol consumed by them and the fact that many pathological underage drinkers will become adult drinkers ($25.8 billion or 20.1% of the consumer expenditure for alcohol). - In 2015 63% high school seniors drank at least once in their lifetime, 58.2% in the past year, and 35.3% in the past 30 days. 7.1% of high school students met the criteria for alcohol abuse or dependence. 26% of all underage drinkers abused alcohol compared to the 9.6% of adults. During the past 30 days for college students 57.2% of underaged college students consumed alcohol, 30.4% reported binge drinking. - Alcohol use is reinforcing: Lowers anxieties and produces mild euphoria. For 7% people alcohol use becomes a problem because they become problem drinkers or alcohol dependent. Alcoholism. - Alcohol abuse and alcohlism = $249 billion. $774.69 for every citizen. Binge drinking accounts for 3/4. 72% of this cost is due to the lost of productivity, 11% is from health care costs, and 9.4% from criminal justice costs. Health care cost for alcoholics is about twice compare to non. - Alcohol and other drugs are contributing factors to unintentional injuries and injury deaths. Risk of motor vehicle crash increases with alcohol consumption and BAC. Young drivers are at risk because inexperienced drivers and inexperienced drinkers (19% of 16 to 20 years old who were involved in a fatal car crash had alcohol in their blood). - Healthy People 2020 objectives - Alcohol increases one's risk for other types of unintentional injures (like drowning, falls, fires, and burns). Association between unintentional injuries and the abuse of other drugs are less documented. - Alcohol can contribute to intentional violence in the community. Alcohol consumption is associated with child abuse, rape, and other sexual assaults, homicides, assault, suicides, and spouse and partner abuse. Among college students aged 18 to 24, alcohol has been associated with sexual assault, assault, suicide, vandalism, and property damage. About 97,000 (or 2%) of students aged 18-24 have experienced sexual assault by another college student who was drinking. - Fetal alcohol spectrum disorder is another community health problem resulting from drinking.

Synthetic marijuana

- Category of drugs that are chemically produced and have properties similar to THC (the psychoactive ingredient found in marijuana) - K2, Spice (sold in small pockets of plant arterial that are laced with synthetic THC-like compounds) - Deceptively marketed as safe legal alternative to marijuana. - Adolescent use of synthetic marijuana declined from 8% in 2012 to 4.2% in 2015. Attitudes about the perceived harmfulness of synthetic marijuana pose a risk; about 1/3 of 10th graders perceived occasional use as harmful - Potential for abuse and other adverse health effects. Can be effects similar to marijuana. Can be rapid heart rate, increased blood pressure, hallucinations, agitation, and vomiting. - 2011 five chemicals that were used to produce synthetic marijuana were placed into Schedule I of the CSA. - Obama in 2012 signed the Synthetic Drug Abuse Prevention Act of 2012 (SDAPA) which places specific known classes of cannabimimetic agents (chemicals used to produce synthetic marijuana) into Schedule 1 of CSA. Expanded the list of temporarily scheduled chemicals. Since 2011, all 50 states have banned synthetic marijuana. - 2012 DEA stuttered Project Synergy which was an international effort to target and take down synthetic drug traffickers. In 2013 the effort resulted in more than 227 arrests and the seizure of 1252 kilo of synthetic marijuana. - Hard to determine what is synthetic marijuana and manufactures are discovering and using new classes of cannabimimetic agents that are not banned by the federal or state laws

Community Based Drug Education Programs

- Child care facilities, public housing, religious institutions, business, and health care facilities. - Features to include: comprehensive strategy, indirect approach to drug abuse prevention, goal of empowering youth, participatory approach, culturally sensitive orientation, and high structured activities. - Need cultural sensitive programs for reaching minorities in the community. Substance Department of Health and Human Services has data about successful programs. - Example: Across Ages. School and commit based drug prevention for youth 9 to 13 years that seeks to strengthen the bonds between adults and youth and provide opportunities for positive community involvement. Pairing older adult mentors with young adolescents (youth making transition to middle school). Employs mentoring, community service, social competence training, and family activities to build youths' sense of personal responsibility for self and community. Success in decrease of substance, tobacco, and alcohol use, increase in problem solving ability, increase school attendance, decrease suspensions, improve attitude towards adults, and towards school and future.

Club Drugs and Designer Drugs

- Club Drugs: MDMA, ketamine, GHB, GBL, Rohypnol, LSD, PCP, methamphetamine, and other. These drugs are illegal which means there is no guarantee of their safety or their identity. - Can cause brain damage. Most popular of the club drugs is "Molly/MDMA/Ecstasy". Annual use of MDMA for 8th 10th and 12th graders peaked at 6% in 2001 and in 2015 levels declined to 2.4%. - Club drugs, rohypnol, designer drugs

Narcotics: Opium, Morphine, Heroin, and Others

- Comes from the oriental poppy plant Papaver Somniferum. - Narcotics are drugs derived from or chemically related to opium that reduce pain and induce stupor, such as morphine. They numb the senses and reduce pain and they have a high potential for abuse. - Most widely abused in heroin (a derivative of morphine). In 2014, 914,000 (0.3%) reported use in the past year. In 2011, 620,000 reported use in the past year. Increase was because of the opioid epidemic. Heroin is like opioids but they are more cheaper. In 2015 about 0.5% of high students used heroin once. - Heroin arrives from Southwest Asia, Southeast Asia, Mexico, and South America. Most enters across the southwestern border and most comes from South America. Proportion of heroin seizures in which heroin originated from Mexico has grown. - Heroin is the number on illicit narcotic of abuse and the third leading cause of drug-related emergency department visits after cocaine and marijuana. Heroin has been overtaken y other synthetic opioids as the leading cause of narcotic-induced overdose drug deaths. Substances account to more than 28,000 overdose deaths in the US in 2014. - Narcotics produce euphoria, analgesia, and drowsiness. They reduce anxiety and pain without affecting motor activity that was alcohol and barbiturates do. Body can make physiological adjustments to the presence of the drug. Tolerance means that larger doses are needed to achieve the same effects as the initial dose. - Tolerance develops rapidly to the euphoric effects, the depressing effects on respiration may continue to increase with dose level, increasing the risk of a fatal overdose. As the cost of a dug habit becomes higher, the abuser usually attempts to quit. - Go through withdrawal which is hard because they are physical dependent on the drug. - Community is effected because of the loss of productivity and addicts must obtain money illegal to purchase the drugs. This can increase the epidemics of STD and blood-borne diseases that can cause HIV and Hep. 2015 Indiana experienced an outbreak of HIV that was associated with the use of heroin that was taken intravenously. Addicts can increase the availably of the frug for first time users. Burden on the criminal justice system.

Nongovernmental Drug Prevention and Control Agencies and Programs

- Community and school based programs, workplace programs, and voluntary agencies.

Anabolic Drugs

- Compound, structurally similar to the male hormone testosterone, that increases protein synthesis and thus muscle building - Protein building drugs. Included: anabolic/androgenic steroids (AS), testosterone, and human growth hormone (HGH). - Legitimate medical uses like rebuilding of muscles after starvation or disease and treatment of dwarfism. - Abused by athletes and. body builders to increase muscle mass. strength, and endurance. - Side effects for Males: Acne, gynecomastia (development of breasts), baldness, reduced fertility, and reduction in testicular size. Side Effects for Females: masculinizing, male physique, body hair, failure to ovulate (menstrual problems), and deepening the voice. - Long term abuse: psychological dependence - Because in the late 1980s boys and young men from high school and college were taking anabolic steroids, these drugs were placed in Schedule III of Controlled Substances Act in 1990. - Steroid abuse levels off since 1990s

Healthy People 2020 Objectives for alcohol

- Decrease the rate of alcohol impaired driving (0.08 or greater BAC) fatalities from 0.4 to 0.38 per 100 million miles traveled. - Public policy changes: raising the min legal drinking age, strengthening and enforcing state listen revocation laws, and lowering the BAC tolerance from 0.10% to 0.08%, stricter law enforcement, and better education for those cited for driving while intoxicated. - President Clinton signed the bill that made 0.08 BAC the national standard. End of 2004 all states signed the bill. - National Transportation Safety Board released new recommendations to states to reduce the legal BAC limit of 0.8 to 0.05.

Governmental Drug Prevention and Control Agencies and Programs

- Different federal, states and local agencies - Aimed to reduce the supply of or demand for drugs

Marijuana

- Most abused illicit drug in the US. Dried plant parts of the hemp plant, Cannabis sativa. - Its illegal and therefore brings the users to contact with illegal activities. Act of smoking is detrimental to one's health. And marijuana occurs in conjunction with drinking alcohol and the use of other drugs. And the adolescent who uses marijuana is delaying the accomplishment of developmental tasks (like adult self identify, achieving independence, and developing interpersonal skills) - Polydrug use can be more serious than single drug use. - 2015 about 44.7% of high school seniors reported having smoked marijuana. 21.3% reported smoking in the past 30 days. - The perceived risk of use is one of the factors that seems to contribute to the level of use. And the student's attitudes is disapproval rates (declined). Goal for healthy people 2020 is to increase the promotions of adolescents who disapprove of trying marijuana (10% improvement). - Acute health effects: Reduce concentration, slowed reaction time, impaired short term memory, and impaired judgement. 2011 marijuana used alone or with one or more other drugs was involved in 455,668 emergency department visits. - Chronic effects: Damage to the respiratory system by the smoke (amotivational syndrome). Physiological and psychological withdrawal symptoms can lead to continued drug use. - 2003 and 2013 admission to treatment programs for marijuana abuse averaged around 326,000 per year. Admission due to marijuana was second to admission due to opiates and alcohol. - 2013 marijuana was reported as the primary frug of abuse for 17% of those age 12 and older who enter drug treatment programs. - Those who smoked marijuana are more likely to use other addictive drugs.

Federal Agencies and Program

- Office of National Drug Control Policy - 2015 National Drug Control Strategy - 56.1% of the National Drug Control Budget was aimed at reducing the supply of drugs, 43.9% was to reduce the demand for drugs. Lae enforcement receives about 35% of budget, treatment got 39%, 14% was spent on interdiction, and 6% in interval support, and 5% on prevention. - National Drug Control Strategy budget for 2016 was 27.6 billion. The US Department of Health and Human Services (National Institute on Drug Abuse and Substance Abuse and Mental Health Services) was scheduled to receive the largest portion of funds in 2016, then the US Department of Justice, and the US Department of Homeland Security and the reminder is spread to the Department of Defense, State, Education, Veterans, Treasury, Labor, Transportation, Interior, Agriculture, and the Office of National Drug Control Policy.

social and peer groups

- Peers can influence one's expectations of the effects of a drug. - Actual drug use by peers influences attitudes and choices by adolescent. - Studies shown that support of drinking by peers is the single most important factor in adolescent's choice to drink. - Magic elixir: alcohol can enhance social and physical pleasure, sexual performance and responsiveness, power and aggression and social competence.

personal factors

- Personalty traits (impulsiveness depressive stress personality disturbances). - Difficult to determine the degree to which these factors are inherited or the product of family environment. ex. stress can be a inherited characteristic or learned behavior

Prevention and Control of Drug Abuse

- Prevention and control requires knowledge of the causes of drug-taking behavior, sources of illicit drugs, drug laws, and treatment programs, and community organizing skills, persistence, and cooperation among vast array of concerned individuals and officials and unofficial agencies. - From community health, drug abuse is a chronic condition so they are chronic disease prevention activities.

primary prevention

- Programs that are aimed at those who have never used drugs, and their goal is to prevent or forestall the initiation of drug use - Drug education programs that stress primary prevention of drug and alcohol use are the most successful for children at elementary school age. - Any activity that reduces the likelihood of primary drug use is considered primary prevention. Anything that forestalls primary drug use. ex. raising tax or price of alcohol, arresting a neighbor drug pusher, destroy cocaine crop

secondary prevention

- Programs that are aimed at those who have started alcohol or other drug use but who have not become chronic abusers and have nit suffered major physical and mental impairment. - Alcohol and drug abuse education that stresses secondary prevention are successful for high school and college students. Presented in educational , workplace, or community settings.

tertiary prevention

- Programs that are designed to provide drug abuse treatment and aftercare and relapse programs. Designed for adults. - Clients that turn themselves in or court order.

ATF

- Protect communities from illegal diversion of alcohol and tobacco products. Partners with communities, industries, enforcement, and public safety agencies to safeguard the public through information sharing, training, research, and use of tech.

Nicotine

- Psychoactive and additive drug present in tobacco products (cigarettes, e-cig, cigars, smokeless tobacco and pipe tobacco). - 66 million Americans ages 12 or older or 25.2% of persons in that age group used a tobacco product in the past 30 days. 16% of adults aged 18 and older are current smokers. Tobacco use has steadily declined since 1997. Tobacco use begins in adolescence. 88% of adult smokers being smoking by the 18 and 99% begin smoking at 26. - Electronic cigarettes are categorized as electronic nicotine delivery system (ENDS). Highest use of all tobacco products among high school students. Between 2011 and 2015 e-cigarette use rose from 1.5% to 16%. Factors that affected the increase: perceived risk and product appeal. In 2015 17% of students viewed smoking as risky compared to the 52,9% that perceived smoking one to five cigarettes as risky. In 2013 and 2014, four in five youths who were current users cited the availability of appealing flavors as the main reason for trying e-cigarettes. Tobacco industry tripled its expenditure on e-cigarette advertising from $6.4 million to $18.3 million between 2011 and 2012. - Tobacco use is the single most preventable cause of disease, disability, and death in the US. - environmental tobacco smoke (ETS: secondhand smoke) - 2006 an agreement was reached between RJ Reynolds Tobacco Company and the Attorneys General of 40 states to end the sale of these items (fruit candy and liquor flavored cigarettes). In 2009 Obama signed the Family Smoking Prevention and Tobacco Control Act into law that gave the US Food and Drug Administration oversight over tobacco products. - Reduce smoking rates is to increase the taxes on cigarettes (increasing the financial cost of smoking). Cigarettes are taxed at the federal level, state level, and in some jurisdiction at the county or city level. In 2009 it was $1.01 per pack and in 2016 it was 1.61 -- Chicago had the highest combined state and local tax at $6.16 and New York had the second highest state and local cigarette tax at $5.85. Missouri had the lowest start tax at $0.17 and Virginia had the second lowest at $0.30. In 2016, New York was the highest in the nation at $10.45. InMay 2016, the US Food and Drug extended its authority to regulate tobacco products to ENDS.

Workplace-Based Drug Education Programs

- Reagan signed the Executive Order 12564 proclaiming a Drug-Free Federal Workplace. - Rationale: The desire and need for the well-being of employees, the loss of productivity caused by drug use, the illegal profits of organized crime, illegality of the behavior itself, the undermining of public confidence, and the role of the federal government as the largest employer in the nation to set a standard for other employees to follow in these matters. - Drug abusers are a personal health problem and law enforcement problem. And a behavior that affects safety and productivity of others. - Substance abusers: are less productive, miss more work, injure themselves, file more workers' compensation claims - Five facets: (1) formal written substance abuse policy that reflects the employer's commitment to a drug-free workplace (2) employee drug education and awareness program (3) supervisor training program (4) employee assistance program (EAP) (5) drug testing program - Prevalence of workplace drug use has declined significantly because of the workplace drug abuse and prevention programs that include drug testing. - 2014 about 4.7% of drug tests were positive.

US Department of Health and Human Services

- Receives the largest portion of the federal budget, more than $9.5 billion in 2015. Money is spent on drug prevention education, treatment programs, and research into the causes and physiology of drug abuse. Most is spent to reduce the demand for drug. - HHS plan is to do research, create,etn, and educational activities. - Misuse and abuse of tobacco, alcohol, and drugs are addressed as lifestyle problems. HHS recognizes that drug misuse and abuse are inherited, environmental, social and economics causes. - Solution involves the application of the three levels of prevention an recognizes the importance of incorporating the three primary prevention strategies: education regulation and automatic protection - HHS published health status, risk reduction, and service and protection objectives on the use of tobacco, alcohol, and other drugs in Healthy People 2020 - Lead agency in the HHS is SAMHSA - National Institute on Drug Abuse and the Food and Drug Administration are agencies that deal with the problems of drugs and alcohol. - National Institute on Drug Abuse (NIDA) - US Food and Drug Administration (FDA) in charged with ensuring the safety and efficacy of all prescription and non prescription drugs. Dictates how drugs should reach the market and how they must be labeled, packaged, and sold. FDA is more concerned with drug misuse than abuse.

Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA)

- Requires health insurers and group health plans to provide the same level of benefits for mental and substance use treatment and services that they do for medical/surgical care.

home and family life

- Research does that not all family associated risk is genetic in origin. - Family structure, family dynamics, quality of parenting, and family problems can contribute to drug experimentation. Family turmoil can cause the initiation of alcohol and drug use. Alcohol and drug use is a symptom of personal and family problems (not the cause). - Failure of parents to provide an environment conducive to the development of interpersonal skills (communication skills) can result in the lost of self-esteem and increase in delinquency, nonconformity, and sociopathic behaviors (all personal risk factors oof alcohol and drug abuse) - Family attitudes toward alcohol and drug use influence adolescents; belies and expectations about the effects of drugs. Age of first use of alcohol, tobacco, and illicit drugs is correlated to later developments of alcohol and drug problems (especially is use begin at 15).

Student assistance programs (SAPs)

- School-based drug education programs to assist students who have alcohol or other drug problems - Aimed at identifying and intervening in cases of drug problems

US Department of Justice

- Second largest portion of federal spending for drug control (7.5 billion in 2015). - Addresses the supply of the drug trade most directly by identifying, arresting, and prosecuting those who break drug laws. Protect the welfare of society by incarcerating offenders, bettering other from becoming involved in the drug trade, and provides a clear picture to all of the cost of drug trade and abuse. - Contributes indirectly to reducing the demand of drugs. - Budget is large because it has enforcement responsibilities and maintains prisons and prisoners. Employs people who manage the penal system, marshals, attorneys, and judges, Largest portion goes to Bureau of Prisons. DOJ operates treatment, education, and rehabilitation programs in these prisons. - Within the DOI: Drug Enforcement Agency (DEA), Federal Bureau of Investigation (FBI), the Office of Justice Programs (OJP) and the Bureau of Alcohol, Tobacco, Firearms, and Explosives (ATF)

US Environmental Protection Agency (EPA) released the report Respiratory Health Effect of Passive Smoking: Lung Cancer and Other Disorders

- Stated that ETS is a human class A carcinogen (the same class that contains asbestos) and that is responsible for 42,000 deaths annually among non smoking Americans. Associated with 150,000 to 300,000 cases of lower respiratory infections (bronchitis and pneumonia) in infants and children up to 18 months - EPA found that ETS aggravates asthma in children and is a risk factors for new cases of childhood asthma.

US Food and Drug Administration (FDA)

A federal agency in the US Department of Health and Human Services charged with ensuring the saftey and efficacy of all prescription and nonprescription drugs.

Synar Amendment

A federal law that requires states to set the minimum legal age for purchasing tobacco products at 18 years and requires states to enforce this law. New York and California to enact legations that increase 18 to 21.

National Council on Alcoholism and Drug Dependence and the American Society of Addiction Medicine

Alcoholism is a chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestation. Disease is progressive and fatal. Characterized of impaired control over drinking, preoccupation with alcohol, use of alcohol. Symptoms may be chronic or periodic.

generational forgetting

Means that drug prevention is never finished. Drug prevention must be permanent part of our culture. We must track our children about the dangers of experimental drug use in the same way we teach them too look both ways before they cross the street.

Drug Free Federal Workplace

Required federal employees to refrain from using illegal drugs, and required agency heads to develop plans for achieving drug-free workplaces for employees. Set up drug testing programs and procedures and employee assistance programs that includes provisions for rehabilitation. By the mid 1990s programs were in more that 80% of American companies.

Drug Misuse

The inappropriate use of legally purchased prescription or nonprescription drugs. ex. stopping taking your antibiotics OR take 4 Aspirins

Family Smoking Prevention and Tobacco Control Act

The law banned deceptive marketing practices by the tobacco industry, specifically the use of the words "light" "low" or mild on cigarette packaging. The tobacco industry spends billions of dollars each year on advertising and promotions to sell its products. In 2011, it was $8.37 billion.

Blood Alcohol Concentration (BAC)

The percentage of alcohol in the blood. - BAC with 0.02 and 0.049 is estimated to be 2.75 times higher to get in a fatal crash for males. For BAC 0.05 and 0.079 etc... 323 - In 1994, 38% of all persons killed in traffic fatalities had a BAC of 0.01 or greater, the figure decreased to 34% in 2014.