Alcohol Drugs & Society Chapters 5-7

Bath Salts come in appealing containers and usually contain the statement

"not for human consumption".

El Chapo was ranked as one of the world's most powerful people from 2009 to 2011. After two escapes from jail, he was captured again in

2016.

National Council on Alcoholism and Drug Dependency

: A disease in which there is impaired control over drinking, preoccupation with alcohol, continued use of alcohol in the face of adverse consequences, and distorted thinking.

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A dangerous designer drug derived from meperidine (Demerol), MPTP is a synthetic derivative of morphine that produces powerful results. Although meperidine has only one-sixth the analgesic potency of morphine, it is highly toxic. It is prescribed to manage severe pain and is available in liquid or pill form. Toxicity is marked by muscle twitching and convulsions. According to government statistics, 782 people were treated in emergency rooms because of meperidine in 2008. MPTP causes a Parkinson's-like condition that results in paralysis to the brain and nervous system. Symptoms of this condition can be improved, but not cured, through traditional treatment for Parkinson's disease. Another analog derived from meperidine is MPPP. MPPP has the potential to be extremely toxic and leads to the synthesis of MPTP within the body. This was discussed earlier in this section.

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A lesser known designer drug is BZP. It was first synthesized in 1944 as an antiparasitic agent. The effects of BZP are similar to amphetamine effects, but it is 10 to 20 times less potent than amphetamines.Due to the amphetamine-like effects, BZP caught the attention of drug abusers. BZP is often mixed with 1-[3(trifluoro-methyl)phenyl]piperazine (TFMPP), which produces effects similar to MDMA (ecstasy) This drug is promoted at raves as a substitute for MDMA. The drug first gained popularity in New Zealand, with a reported 44% of college students having used it From 1999 to 2008, it was a legal drug in New Zealand and was marketed as a legal party pill. Due to the legal nature, users felt it was a safe drug because it was sanctioned by the government. Users also reported the drug was easily accessible and socially acceptable. Furthermore, due to the legal status of the drug, users felt comfortable using higher doses due to the perceived inferior strength of the drug. In 2008, New Zealand changed the legal status of the drug to criminalize its use. The prohibition of BZP in New Zealand resulted in reduced use among young adults. In a survey conducted after the prohibition of the drug, the majority of respondents felt that the drug was harder to obtain and was more expensive compared to prices before prohibition, thus usage of BZP decreased. There have been no recorded deaths from the sole usage of BZP, but when combined with other drugs (i.e., MDMA and alcohol), the potential for death and hospitalization increase. Ingestion of BZP has been found to produce dissociative states, psychosis, precipitation of mania in schizophrenia, and organ failure. In the United States, BZP was temporarily labeled as a schedule I drug in 2002 and permanently labeled as a schedule I drug in 2004.

American Society of Addiction Medicine:

A primary, chronic disease with genetic, psychological, and environmental factors influencing its development and manifestations. The disease is often progressive and fatal. It is characterized by continuous or periodic impaired control over drinking, preoccupation with alcohol, use of alcohol despite adverse consequences, and distortions in thinking, most notably denial.

Gender

Abstinence, overall, is increasing for men and women. Rates of abstention for both sexes increase as people age but as education and family income go up, abstinence rates go down. Because more women are seeking treatment, one could surmise that drinking problems among women are increasing. This may be misleading because the stigma of women having drinking problems is diminishing and therefore many women who previously shunned treatment out of fear of being stigmatized are now getting help. However, men have higher rates of alcohol use compared to women. They are more likely to engage in excessive drinking behavior and drink more frequently. Gender roles in America may contribute to this gender disparity regarding alcohol consumption. For example, men may be more likely to drink because it demonstrates masculinity and facilitates aggression. Furthermore, American culture may be more accepting of excessive drinking by men but less accepting of the same behaviors by women. Some also stipulate that women are more likely to successfully quit drinking due to their generally lower levels of drinking (i.e., less alcohol per drinking episode). In regard to women's drinking patterns, the demographic subgroups that stand out include women who are unemployed, looking for work, or employed part-time outside the home. Drinking problems are more prevalent among women who are divorced, separated, or not married but living with a partner. Women in their 20s to early 30s as well as women with husbands or partners who drink heavily are at greater risk for becoming problem drinkers. For many women, heavy drinking started after a health problem such as depression or reproductive difficulties. Women who suffer from depression have higher rates of alcohol consumption.

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Alcohol accounts for 10% of all deaths in the United States each year, and the life expectancy of an alcoholic is reduced by 15 years. It affects every organ in the body. Two important factors that determine how alcohol affects the body are frequency of use and quantity consumed. The type of alcohol consumed does not matter. In a study of male and female adolescents, beer, wine, and distilled spirits produced equally damaging physical impairment. The definition of moderate drinking for men is no more than two alcoholic drinks per day, and for women, it is no more than one alcoholic drink per day. Light drinking would be less than this amount. There is no standard definition of heavy drinking, although a commonly accepted number for binge drinking is consumption of five or more drinks at one sitting for men and four or more drinks at one sitting for women.

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Alcohol can devastate friends, families, neighbors, and others with whom the drinker is involved. The media regularly report family violence, criminal activities, suicides, accidents, and automobile fatalities attributed to alcohol. Violent behavior is dose-related in that the more one drinks, the more likely one is to become violent. Moreover, intoxicated males are more likely than nonintoxicated males to find that using force to obtain sex is acceptable. Alcohol is the most widely used substance in the United States with an estimated 1 in 12 adults suffering from alcohol abuse or dependence. Additionally, more than 7 million children are living in a household where one parent is abusing alcohol. Moreover, alcoholism is the third leading lifestyle-related cause of death in the United States, and is responsible for an average of 30 years of potential life lost for each death. In a separate study of emergency room patients, it was found that drinking doubles the risk of injury.

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Alcohol has been implicated in violent behavior, suicide, criminal activity, automobile accidents, premature death and disability, and loss of productivity in industry. Next, we will explore underage drinking, caffeinated alcohol, alcoholism, and symptoms associated with alcohol withdrawal.

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Alcohol is a central nervous system depressant. Beverage alcohol, or ethyl alcohol, should not be confused with methyl alcohol, or wood alcohol. Methyl alcohol is extremely toxic and may lead to blindness and death. By using certain yeasts, the carbon, hydrogen, and oxygen of sugar and water are transformed into ethyl alcohol and carbon dioxide. This process, called fermentation, yields beverages that are about 14% alcohol. The percentage of alcohol in a beverage can be increased by distillation, a procedure in which a solution containing alcohol is boiled. Alcohol has a lower boiling temperature than other liquids. Therefore, during the heating process, alcohol separates from the solution in the form of steam. The steam is captured in a cooling tube and turns back into a liquid. This distilled liquid contains a higher alcohol content. To brew beer, sprouted barley is added to cereal grains such as corn, wheat, or rye to change the carbohydrates in the grains into sugar, while yeast changes the sugar into alcohol. The alcohol content of beer is about 5%, and beer advertised as having fewer calories also has alcohol but a smaller percentage. Fruit juices, particularly those with high sugar content, are used to make wine. The alcohol content of wine ranges from 8 to 14% generally. Wine coolers, a mixture of wine with various carbonated beverages, first introduced in the early 1980s, are about 4% alcohol by volume. Adding alcohol to slightly sweetened wines produces fortified wines such as sherry and port. These have higher alcohol content. In the United States, labels on bottles of distilled alcohol, such as rum, gin, and whiskey, indicate the proof of the contents. The amount of alcohol is determined by dividing the proof in half. Thus, a bottle that is 80 proof is 40% alcohol

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Alcohol is a problem on college campus; with more college students engaging in problematic alcohol consumption compared to their non college attending peers. Three-fourths of college students who were sexually assaulted reported being under the influence of alcohol during the assault. One study found 30% of students have claimed to experience a sexual assault while attending college. While the consumption of alcohol does not cause assault, it is associated with higher rates of sexual assault.

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Alcohol is the most widely used drug among American youth. In terms of premature death, disease, injury, property damage, motor vehicle crashes, alcohol-related crime and productivity, the economic cost of underage drinking amounts to $27 billion.n By the age of 15, 33% of teens reported to having at least one drink while among 18-year-olds, almost 60% report having at least one drink. Reasons stated among youths regarding underage drinking include seeking new challenges, peer pressure, increased desire for independence, and stress. More than 4,300 deaths among youth are attributed to underage drinking. This includes 1,580 deaths from motor vehicle crashes, 1,269 from homicides, 245 from alcohol poisoning, and 492 from suicides. High school students who engaged in binge drinking 10 or more times were six times more likely to drink and drive. Another concern is that there is a significant relationship between drinking before age 13 and suicide attempts, especially among youths with a history of depression. Youth who start drinking before the age of 15 are four times more likely to meet the criteria for alcohol dependence at some point in their lives.

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Alcohol is transformed in the liver into acetaldehyde and then to acetate, water, and carbon dioxide. It is eliminated from the body through urine, exhalation, and sweat. Alcohol leaves the body at a rate of approximately three-fourths ounce per hour. An ounce of distilled spirits, a bottle of beer, and a glass of wine all have about the same amount of alcohol. Thus beer and wine are capable of producing the same intoxicating effects as hard liquor.Males and females absorb alcohol at different rates. Because the average male body is larger and contains more water than the average female, males are less likely to feel the effects from the same amount of alcohol. Another difference is that men have more gastric alcohol dehydrogenase activity, enabling them to metabolize alcohol more quickly than women. Hence, there is a greater buildup of alcohol in women, as alcohol leaves their bodies more slowly. A woman herself does not always absorb alcohol at the same rate. In the premenstrual phase of her cycle, a woman absorbs alcohol more quickly than at other times. Thus she will feel the effects of alcohol faster. Also, women who take birth control pills absorb alcohol more quickly than women who do not. The concentration of alcohol in the blood is referred to as blood alcohol concentration (BAC) or blood alcohol level (BAL). The effect of alcohol on a person correlates with the percentage of alcohol in the person's bloodstream

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Alcoholism has many definitions, none of which is universally accepted. Some consider it to be a disease. The disease concept gained popularity with the decline of the temperance movement and the failure of the movement to prohibit alcohol. The notion that alcoholism is a disease identifies the individual as having some kind of personal defect rather than placing the blame on failed social policies. The idea that alcoholism is a progressive disease that follows a series of stages was promoted by E. M. Jellinek. His ideas have been dismissed because most alcoholics do not follow consistent patterns. The 1994 revision of the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV) discarded the term alcoholism in favor of alcohol abuse and alcohol dependence. Alcohol abuse refers to continued drinking despite recurring social, interpersonal, and legal problems. Alcohol dependence is predicated on the presence or absence of tolerance and withdrawal. According to the US Department of Health and Human Services, alcohol dependence is "a disease that is characterized by abnormal alcohol-seeking behavior that leads to impaired control over drinking. Increasingly, mental health experts are viewing alcohol abuse on a continuum with a range of treatments. Whether alcoholism is considered a disease is important. As a society, we are not likely to hold people at fault for having a disease. Thus, if alcoholism is a disease, drunkenness can be used as a legal defense. Also, if alcoholics run afoul of the law, they receive treatment rather than punishment. Alcoholism affects 1 out of every 10 Americans.

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Also called ecstasy, molly (nickname for molecular), E, XTC, and Adam, MDMA (3,4-methylenedioxy-methamphetamine) is a hallucinogen with amphetamine-like properties.MDMA has been called a "psychedelic amphetamine."First developed in 1914, MDMA is akin to the hallucinogen MDA. Intended originally as an appetite suppressant, it received little attention until it resurfaced in the 1960s. LSD and MDMA were available at the same time. LSD, however, did not evoke nausea and vomiting as MDMA did. After being promoted by illicit manufacturers, MDMA became more popular by the mid-1970s. In the 1970s, psychotherapists gave MDMA to their clients to reduce anxiety and facilitate communication. By 1985, production had grown to about 500,000 doses.

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Also, 20% of people with a mood or anxiety disorder had a concurrent substance abuse disorder. The most common disorders associated with alcohol abuse are posttraumatic stress disorder and major depression. Mood disorders and anxiety also play a role in heavy alcohol consumption with one study finding sexual minority groups having higher rates of anxiety and mood disorders, which is related to higher rates of heavy alcohol use. There is research demonstrating that people who lack impulse control have higher rates of alcoholism. For many women, there is a strong relationship between violent behavior and alcohol dependence. Alcohol problems during adolescence and adulthood have been linked to antisocial behavior in childhood. The relationship between alcohol and depression also occurs among adolescents. However, parents can serve as a protective factor for children with mood disorders by being present in their children's lives and monitoring their children's behavior. One study found that higher rates of alcohol use among children who experienced depression could be offset by increased levels of parental monitoring. Because alcohol produces mild euphoria and reduces anxiety, its use is reinforcing. However, individuals with social anxiety engage in more hazardous drinking when in a party situation. People's expectations about alcohol have been shown to be predictors of alcohol dependence. Alcohol abusers anticipate the effects of alcohol to be positive. Likewise, if using alcohol is viewed as helpful in coping with negative moods, the potential for abuse is higher. The adolescents at greatest risk for developing alcohol-related problems think alcohol is socially enhancing. College students who expect positive outcomes from drinking alcohol likewise are heavier drinkers. Abuse is more common among people who believe that alcohol enhances their social and physical enjoyment, potency, aggression, sexual performance and responsiveness, and social competence. However, individuals who expected alcohol to increase their sexual risk-taking behavior did engage in more sexual risk-taking behaviors. Alcohol is linked to sexual behavior. One study of college students found that 32% drank alcohol prior to having unprotected vaginal sex. One-third of high school students report they are sexually active and one-fourth of these students used alcohol or another drug before their last sexual intercourse. Another study of 18- to 25-year-olds noted that alcohol dependence is associated with a greater number of sexual partners—ten or more partners. Despite anecdotes about how alcohol makes people appear more attractive, alcohol use does affect one's perception about the appearance of others. Many adolescents expect alcohol to have a disinhibiting effect and, consequently, engage in risk-taking sexual behavior. Alcohol consumption has been linked with risky sexual behaviors.

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An estimated 15 to 30% of all nursing home patients are admitted because of permanent alcohol-induced brain damage. Alcohol acts on the cerebrum, affecting judgment, reasoning, and inhibitions. It stimulates the release of serotonin, which could account for the disinhibiting effect of alcohol. Alcohol acting on the cerebral cortex affects motor activity and moods change quickly. Alcohol stimulates the release of dopamine, accounting for feelings of pleasure or euphoria. The senses are impaired when alcohol affects the cerebellum. Many alcoholics experience memory loss and difficulty with problem-solving and decision-making. At some level of consumption of alcohol, the medulla is sedated to the point that respiration could stop. Alcohol produces brain damage that can be seen using computer tomography imaging. These images look for brain shrinking, which is a way of identifying brain damage. Both alcoholic men and women experience significant brain shrinking because of alcohol consumption, but what is most concerning is alcoholic women who drank for about half the amount of time as men showed similar signs of shrinkage. This suggests the woman's brain is more vulnerable to alcohol compared to a man's brain. Although drinking small amounts of alcohol daily does not affect memory adversely, occasional large amounts could harm memory. Alcohol use disorders have been associated with a decrease in working memory and episodic memory.Working memory is the brain's way of manipulating short-term information and is associated with decision-making and behavior. Episodic memory is the feeling one gets from remembering a past event. It is more than just a factual set of events, but includes an emotional memory of the event. A study of teenagers in the United Kingdom found that those who used excessive amounts of alcohol suffered from memory problems. Similarly, US middle-school students experienced memory loss after drinking. Alcohol-induced amnesia usually lasts a short time. Some people appear conscious and even function when they drink, but later, they have no memory of what transpired. This condition, referred to as an alcohol-induced blackout, may be an early indication of alcoholism. Finally, prenatal exposure of the fetus to alcohol possibly affects its attention and memory for the long term even with no more than one drink per day. One condition resulting from chronic alcohol abuse is Wernicke-Korsakoff syndrome, which occurs in about 20% of chronic alcohol users. This syndrome develops because alcohol impedes the body's ability to utilize thiamine, one of the B vitamins. Brain lesions form on the brain, which are caused by high demands of already depleted vitamin B1 (thiamine) stores. If discovered and treated early, some of the symptoms associated with this syndrome are reversible, but if not treated early on, it may lead to death. The person with this disorder is able to remember events or facts learned early in life but unable to recall recent events or facts. Other characteristics of this disease are disorientation, nerve damage, poor coordination, and rapid horizontal eye movement.

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Another muscle builder that has caught the attention of the public, primarily because it was used by homerun king Mark McGwire, is androstenedione. The Major League Baseball Players Association did not forbid players from using androstenedione at that time, even though the NCAA, the NFL, and the International Olympic Committee had banned it. Known as "andro," androstenedione, like creatine, is classified as a nutritional supplement, although it is no longer sold legally. Androstenedione is a precursor molecule that is just one metabolic step away from testosterone. Its producers claim that androstenedione causes users to generate more testosterone for a few hours after a workout. Androstenedione can be converted into the female sex hormone estrogen as well. In 1999, a randomized controlled trial was conducted to determine if oral androstenedione improved performance in healthy adult athletes. Results from this study showed there were no significant differences between those who took oral andostenedione and those who did not in terms of overall body composition, muscle strength, and muscle fiber analysis. The effects of androstenedione are similar to those of anabolic steroids. For example, males may experience testicular atrophy, impotence, and breast enlargement. Women who take androstenedione may have increased facial hair, become bald, have deepened voices, and experience abnormal menstrual cycles. Women may also have an increased risk of breast and endometrial cancer. In January 2010, the FDA recalled androstenedione because of its potential side effects.

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Children of alcoholics are more likely to suffer from depression, anxiety, suicidal ideation, substance abuse, and/or interpersonal difficulties. Attention deficit hyperactivity disorder (ADHD) is 2.5 to 3 times more likely to occur in children whose mothers have an alcohol use disorder. It is not unusual for children of alcoholics to lie, suppress feelings, and withdraw from close relationships. Moreover, they may demonstrate anger toward the nondrinking parent for not providing support and protection. The harmful effects of parental alcohol abuse do not end with childhood. Adult children of alcoholics (ACOAs) find it hard to receive and give love. They devalue themselves, are easily depressed, develop inordinate feelings of responsibility, fear abandonment, handle authority poorly, and feel guilt when asserting themselves. To avoid feelings of failure and self-deprecation, they have a great need to be in control. Children often go to great lengths to hide a parent's drinking problem. Secrecy and denial are key elements of a family with an alcohol problem. However, children of alcoholics will open up if they perceive the listener to be supportive and trustworthy. ACOAs should recognize the following four points: The family affected by alcoholism is not a normal family. Responsibility and blame for an alcoholic family do not rest with them. Growing up in an alcoholic household, although extremely painful, can be a learning experience. ACOAs have to acquire skills to form healthy relationships. Individuals can find support from the group Adult Children of Alcoholics, which operates similarly to Alcoholics Anonymous. Despite the difficulties, growing up in an alcoholic household does not doom a child to an unhappy, unfulfilling adulthood. Many children are resilient and transcend the frightful situations in which they find themselves. Although the ACOA movement is beneficial to many people, it does have its detractors. One criticism is that, although ACOA meetings foster support and fellowship, they may also foster feelings of victimhood. This allows some adult children to blame their alcoholic parents for many of the problems they have. Healthy children in healthy families also grow up with conflict and disappointment, and conflict and disappointment during the formative years do not necessarily lead to problems during adulthood. Some studies have found that ACOAs have no more psychological problems than those who are not raised in an alcoholic household. It has been noted that ACOAs do not have higher rates of substance abuse, defensiveness, or codependency. One study found that adolescent sons of alcoholic fathers had strong senses of identity. This may be due to these adolescents maturing at a faster rate than peers

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Chronic alcohol consumption increases the risk for cancer in many organs, including the liver. Because the liver is the main site of metabolism of alcohol, heavy alcohol use can have devastating effects on that organ. The three main conditions associated with overuse of alcohol are fatty liver, alcohol hepatitis, and cirrhosis. If one already has hepatitis C, then alcohol will exacerbate the condition, resulting in a shorter lifespan. The mean age of death for women with hepatitis C who drink heavily is reduced from 61.0 years to 49.1 years. The comparable reduction for males is from 55.1 to 50.0 years. Cirrhosis is irreversible, even if alcohol use stops. Some signs of fatty liver are evident in 90 to 100% of heavy drinkers, whereas 10 to 35% develop alcohol hepatitis, and 10 to 20% develop cirrhosis. Fatty liver can develop within a few days of heavy drinking. Symptoms of alcohol hepatitis include jaundice (a yellowish skin color), fatigue, low-grade fever, reduced appetite, dark urine, and occasional vomiting and nausea. Cirrhosis of the liver, a deadly condition in which liver cells are destroyed, occurs in about 10% of long-term heavy drinkers. Deaths from chronic liver disease and cirrhosis have been declining in the United States; in 1970, 17.8 deaths from cirrhosis was reported compared to 12.0 deaths per 100,000 in 2014. Nevertheless, liver cirrhosis remains the 12th leading cause of death in the United States. Women are more susceptible than men to alcohol-related liver damage despite their lower levels of consumption. Also, women show symptoms of liver disease after shorter time spans of alcohol use. The elderly have seen an increase in alcohol-related liver diseases. Moreover, their prognosis is especially poor. The cirrhosis mortality rate of Hispanics is much greater that Whites and non-Hispanic Blacks. White males and females have lower rates of cirrhosis than non-White males and females. Alcoholic liver disease. Fatty liver, Fibrosis, Hepatitis, Cirrhosis of the liver. illustration. Any kind of alcohol can cause liver damage.

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Cocaine use by collegiate and professional athletes is well documented and is the most frequently detected stimulant found among drug tests of athletes. Cocaine impairs performance requiring hand-eye coordination and concentration. Most athletes use cocaine for social reasons, not to improve performance. Amphetamines have been used in sports to reduce fatigue and sustain intense exercise. There were reports of amphetamine use in the 1952 and 1956 Olympic Games. By the 1960 Olympics, amphetamine use was rampant. On the first day of competition, a Danish cyclist died and three others collapsed from amphetamine use. This tragedy provided the impetus for drug testing of athletes. In the 1996 Olympics, five athletes tested positive for a banned stimulant. In 1968, the International Olympic Committee required athletes to submit to drug testing or face disqualification. The US Olympic Committee publishes a list of drugs that result in disqualification. The list includes not only illegal drugs but prescribed and over-the-counter drugs as well. Concerns over performance-enhancing drugs rose in the United States when professional football players reportedly used amphetamines during competition. The NFL officially banned these drugs in 1971. Although steroids were not seen as a problem at that time, the perception in the NFL has changed and steroids are now banned. In 1995, the US Supreme Court ruled that high schools have the right to drug test athletes, that the interest of the school outweighs the privacy issues of its students. Also, in preparation for the 2002 Winter Olympics in Salt Lake City, the federal government allocated $3.3 million to support the antidoping program.

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College students drink more alcohol compared to their noncollege-attending peers. To illustrate this point, one study found approximately 32% of college students meet the criteria for alcohol abuse and 6% meet the criteria for alcohol dependence. The number of arrests on college campuses for alcohol and other drugs has increased dramatically in the last few years. This increase may reflect stricter enforcement policies by college administrators. In a survey of 343 colleges in the United States, 61% responded that they enforced alcohol policies. Many colleges have responded by creating policies that ban alcohol altogether, with approximately 34% of US colleges and universities having a ban on alcohol.However, whether a college campus is considered a "wet" or "dry" campus has little impact on problematic drinking behaviors, although some evidence has shown there is a decrease in alcohol dependence on "dry" campuses. US colleges are not alone in addressing alcohol use by students. At one Australian university, almost one-half of students drank to harmful or hazardous levels. In Germany, it was reported that 80% of university students drank heavily and that 20% displayed problem drinking.

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College students who are fraternity and sorority members have significantly higher alcohol consumption rates than students who are not affiliated with fraternities and sororities. Among fraternity members, 75% drink heavily compared to nonfraternity peers. Sixty-two percent of sorority members drink heavily compared to 41% of nonsorority peers. Binge drinking is more common in households with an annual income above $75,000 than among households with incomes below $75,000., Adolescents who are victims of bullying are more likely to drink as a coping mechanism.

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Concern regarding designer drugs began in 1982, when George Carillo, a 42-year-old man, was brought into the Santa Clara Valley Medical Center. He was described as a mannequin because he was unable to move; his body was twisted and drool came out of his mouth. The neurologist at the hospital diagnosed him with Parkinson's, which is highly unusual given the age of the patient; Parkinson's rarely affects people under the age of 50 and to the extent of the symptoms the patient was displaying, it would have suggested an advanced stage of the disease by at least 10 years. Doctors were puzzled by this case even more when the patient led them to his girlfriend who also had symptoms of the disease. A little later, two brothers, both in their 20s were hospitalized with similar symptoms. These cases had doctors confused until they discovered they had all used a synthetic (and legal) version of heroin type drug.

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Creatine is a naturally occurring amino acid. An over-the-counter substance that has gained in popularity is the amino acid creatine monohydrate, referred to as a nutritional supplement. A number of professional athletes, coaches, and fitness researchers promote its use, although the physiological mechanisms by which it works are not well understood. Creatine is believed to increase water content in muscles, adding to their size and possibly their ability to function. It produces a modest increase in strength. Another study of women between the ages of 58 and 71 who took creatine found that they had significant increases in muscle power and strength without experiencing adverse side effects. A similar study was conducted in 2015 with comparable results. Postexercise creatine supplementation increased lean tissue mass and increased upper and lower body strength compared with resistance training alone in healthy adults between 50 and 71 years of age.Creatine is one of the most popular nutritional supplements that is taken to improve athletic performance. Some studies show that creatine is effective for improving an athlete's performance. One study of competitive female swimmers found that swimmers propelled themselves more quickly when using creatine, even though their body weight and body composition were unaffected.Footnote Other studies of creatine's effects show that one's sprinting ability in hot, humid conditions significantly improvedFootnote and that anaerobic running capacity is increased for men.On the other hand, creatine supplementation has not been proven to help cardiac patients with physical performance or other health-related measures. One disadvantage is that creatine reduces one's range of movement.Should its use be banned from the athletic competition? Among Major League Baseball teams, eight disapproved of creatine use, seven took no position, and once approved it. In the National Basketball Association (NBA), two teams disapproved, eleven took no position, and eight approved. In the NFL, eight teams disapproved, four took no position, and five approved. A higher percentage of football players are believed to use creatine than athletes in other sports. Creatine is considered a nutritional supplement. The FDA does not test it for safety.

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Depressants such as barbiturates, benzodiazepines (minor tranquilizers), and alcohol are not perceived as ergogenic drugs, though they have been used to improve performance. Benzodiazepines and barbiturates reduce tremors, a quality important to hand steadiness.Footnote Weight throwers improved their performance, whereas swimmers were significantly impaired after taking a certain barbiturate. Benzodiazepines impair psychomotor performance, although this becomes less so as tolerance develops. Benzodiazepines hinder driving ability, further demonstrating that these drugs harm performance. Alcohol significantly reduces psychomotor skills. Some endurance athletes drink beer before competitions because they think it provides carbohydrates for energy. Calories from beer, however, are converted to heat and are not available as energy. Moreover, alcohol results in significant loss of fluid. Alcohol also reduces aerobic capacity, and reaction time, fine and complex motor coordination, balance and steadiness, visual tracking, and information processing are impaired.

Current research shows that MDMA may affect the brain, although there is much controversy regarding the validity of the research demonstrating brain damage. Most users do not believe that they are harmed by using ecstasy. MDMA has been shown to increase three brain chemicals:

Dopamine—causes a surge in euphoria and increased energy/activity, Norepinephrine—increases heart rate and blood pressure, Serotonin—affects mood, appetite, sleep and other functions (also triggers sexual arousal)

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Dr. Benjamin Rush, a signer of the Declaration of Independence, was one of the first people to identify alcoholism as a disease. Before Rush, most people saw excessive drinking as a lack of will.Rush advocated that physicians become abstinent in order to enhance their profession. In his 1784 publication, An Inquiry into the Effects of Ardent Spirits upon the Human Body and Mind, Rush described the harmful effects of alcohol.Unfortunately, at the time, his ideas regarding alcohol were not well received, but they did help lead to the temperance movement that followed shortly thereafter.

synthetic drugs

Drugs that are synthesized by chemicals to mimic illicit drugs

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Fentanyl is the generic name for Sublimaze®, Actiq®, and Duragesic®, a synthetic narcotic developed for its anesthetic properties. It is typically used to help manage pain after surgery and is estimated to be 50 to 100 times more potent than morphine. It is also used to help manage chronic pain for patients who are dependent on and tolerant of opioids. When used in its prescription and legal form, it is administered by injection, transdermal patch, or by lozenges. The euphoria that fentanyl produces is briefer than the high from heroin. In many instances, fentanyl is combined with other drugs, especially heroin. If one is unaware that fentanyl is mixed into other drugs, there is greater potential for an adverse reaction. The potential for rapid addiction is strong. In California, an estimated 20% of people already dependent on opiates use a powerful derivative of fentanyl nicknamed China white. In 2008, more than 20,179 people went to emergency rooms because of fentanyl. The vast majority of fatal overdoses from fentanyl occurred among males. People who use fentanyl illegally take it as a powder, spiked on blotter paper, mixed with or substituted for heroin, or as tablets. Fentanyl depresses the respiratory system, decreases the heart rate and blood pressure, and causes constipation. It can be fatal. Death is so swift that needles have been found in people who apparently died while injecting themselves. Whether death is attributable to the drug or to its contaminants is unclear.

6-6g

Fetal alcohol spectrum disorders (FASD) is a general term describing the various effects that occur as a result of women who drink alcohol while pregnant. These effects can be behavioral, physical, and/or mental (see Figure 6.4). In addition, they can produce learning disabilities. The leading known cause of mental retardation is FASD. Unfortunately, diagnosing FASD is difficult because the physical markers for in-utero alcohol use are not apparent. The facial deformities do not always appear.Alcohol traverses the placenta and interferes with fetal development. The fetus is especially vulnerable during the first trimester of pregnancy. Unfortunately, many women drink alcohol before realizing they are pregnant as most women do not know they are pregnancy until they are four to six weeks into the pregnancy. Three in four women who want to get pregnant as soon as possible report drinking alcohol; thus women are advised to abstain from alcohol while trying to get pregnant. The Centers for Disease Control estimates more than 3 million women are at risk of exposing their baby to alcohol, and there are no safe limits for alcohol use during pregnancy. Yet an estimated 1 in 10 pregnant women consume alcohol while pregnant, with the highest rates among women aged 35 to 44 years old, college graduates, and unmarried women. In addition to a smaller brain at birth, children with FASD are marked by head and facial anomalies such as a small head, flat cheeks, and thin lips, as well as retarded growth, central nervous system problems, and malformations of many major organs in the body. As these children get older, they exhibit behavioral problems including hyperactivity, short attention span, poor impulse control, and poor coordination. An Australian study found that women who drank more than one drink per day or who engaged in binge drinking had children with learning, attention, and intellectual problems. Children of mothers who used alcohol while pregnant were studied over a period of 25 years. After 25 years, there was a higher likelihood of attention, arithmetic, spatial-visual memory, and IQ deficits as well as increased alcohol problems and psychiatric disorders. The Niaaa's Four Criteria for Defining Fetal Alcohol Syndrome: Maternal drinking during pregnancy A characteristic pattern of facial deformities Growth retardation Brain damage, which often is manifested by intellectual difficulties or behavioral problems with FASD also suffer from eye-related problems, although they are not the only people who have eye-related problems from alcohol. Chronic alcoholism is associated with a significantly increased risk of cataracts, color vision deficiencies, and problems with the cornea. Also, there may be a link between prenatal alcohol exposure and iron-deficiency anemia in infancy. The prenatal effects of alcohol may be exacerbated by iron deficiency. FASD is irreversible but preventable.Since 1989, the US Surgeon General's office has required that all alcoholic beverages bear a label warning pregnant women of the hazards of drinking. Unlike labels on cigarette packages, these labels are not uniform and are difficult to see. Nevertheless, after the labels were introduced, drinking by pregnant women decreased, although most women who reduced their alcohol consumption were low-risk drinkers. About 5% of pregnant women who drink alcohol also use other drugs. Some drugs like cocaine are especially harmful to the developing fetus, but it is difficult to know the interactive effects of many drugs with alcohol. A study by the Alan Guttmacher Institute found that half of the doctors it surveyed believe that occasional alcohol use during pregnancy will not increase the risk of adverse outcomes, despite the fact that since the early 1980s the federal government has advised women to refrain from consuming alcohol during pregnancy. What is the incidence of FASD? On a worldwide basis, it is estimated that 0.97 per 1,000 live births have fetal alcohol syndrome, although it is commonly believed that the rate is much higher.Healthcare costs for each affected baby is $2,842, but follow-up care would increase that amount significantly. In the United States, FASD rates are considerably higher among Native Americans than among the general population. To quantify exactly how much alcohol the mother has to drink to cause FASD would be difficult. Some women consume two drinks daily and produce children with FASD, whereas other mothers can drink the same amount and not have babies with FASD. Some neurobehavioral problems have appeared with as few as seven drinks per week. A woman who consumes four to six drinks per day has a one-third chance of bearing a child with FASD. One thing is clear, though: The more a pregnant woman drinks, the more likely it is that FASD will develop.

5-2b

Human growth hormones (HGH)—which are naturally produced in the body and stimulate protein synthesis—and erythropoietin (EPO) are other drugs used to enhance performance. HGH were first isolated in the 1950s, although it was not until the 1980s that they were used as a doping agent.One study of young male bodybuilders found that 12% used HGH.Starting in 2011, the National Football League (NFL) initiated game-day testing for HGH.

6-2

In 2014, a little more than half of all Americans reported to having consumed alcohol. Alcohol use varies greatly, with negative consequences increasing as patterns of alcohol use increase.

6-8

In the 1800s, a common view of alcoholism was that it was a matter of personal choice. Today, theories explaining the causes of alcoholism range from heredity to sociocultural reasons to differences in biochemistry to personality differences to interpersonal factors. No single theory provides a definitive explanation. A family history of alcoholism is strongly linked to children's alcoholism. According to the Ninth Special Report to the US Congress on Alcohol and Health in 1997, "a positive family history for alcoholism is one of the most consistent and powerful predictors of a person's risk for developing the disease." Regardless of the cause for alcoholism, it has been shown that drinking at an early age is associated with later alcoholism. One study found that among alcoholics, 47% had problems with alcohol by age 21. In the following sections, we will examine various theories that seek to explain factors contributing to alcoholism.

6-1b

In the early 1800s, a movement to curb the escalating rate of alcohol use and abuse swept through the United States. At this point in time, America was feeling the toll that the Revolutionary War had on society. Many families lost husbands and sons, who were the breadwinners and sole providers. Compounded by high inflation rates and large-scale immigration, the country experienced high levels of poverty and violence. Many people felt hopeless during this time in history and perhaps tried to deal with these feelings by consuming alcohol. Men and women drank alcohol from morning until night, with some historians referring to this age as the "Alcoholic Republic."Footnote Public intoxication and binge drinking was at the highest peak, and people recognized the larger problems emanating from uncontrolled alcohol use. Alcohol was seen as a major cause of crime and violence; for example, men who drank too much would steal and beat their wives. These observations led to the temperance movement, the initial purpose of which was to modify alcohol use, not to eliminate it. In essence, alcohol consumption in moderation was acceptable but habitual drunkenness was viewed as sinful. Dr. Rush did not condemn alcohol, but he was critical of uncontrolled drinking. He argued that alcohol, especially hard alcohol, interfered with the ability to earn a living and with family life. He believed that alcoholism was both a progressive disease culminating in addiction and a gradual form of suicide.

One study of college students reported that 8% had used the drug. In another study done on substance- and alcohol-dependent inpatients, it was discovered that almost 45% of them were considered synthetic cannabinoid users.

In this study, synthetic cannabinoid use was more common among younger people, males, and among those who had fewer years of education.

Studies suggest that athletes who use performance-enhancing drugs are more likely to use other illicit substances. In a study conducted on male college athletes, it was discovered that athletes who use a performance-enhancing substance report higher prevalence rates of heavy drinking, cigarette use, marijuana, narcotic, and dietary supplemental use.

Is education the answer? As mentioned earlier in this section, the NCAA is investigating the use of substance abuse education to deter drug use among student athletes. Germany introduced the National Doping Prevention Plan to reduce doping by student athletes. The theory behind this program was if student athletes were educated on doping and banned substances, use rates would decline. However, in a study 4 years after the initiation of this program there were no significant changes in doping and banned substance behaviors among athletes who participated in the program. Although knowledge about doping and banned behaviors increased slightly among participants, behaviors did not follow these trends.

6-8c

Likewise, students will limit their drinking if they perceive that other students drink very little. In an international survey of college students in 21 developed and developing countries, the highest rates of drinking were in Belgium, Colombia, Ireland, Poland (men), and England (women). Religious groups such as Muslims and Mormons advocate abstinence. The greater one's religious commitment, the less likely one is to drink heavily and the more likely one will abstain. When alcohol is used ritualistically (in religious ceremonies or for special occasions) or is consumed for social reasons, heavy drinking is minimal. In contrast, another study found religiosity and religious affiliation do not protect against the development of an alcohol use disorder. These researchers suggest spiritual experiences have a protective factor against developing an alcohol use disorder and may help play a role in treatment of alcohol use disorders. Prayer and mindful meditation, components of spiritual health, provide protective factors against alcohol use disorder and may help those in treatment. Alcoholism rates are higher if alcohol is used for personal reasons such as relaxing or coping with problems. The European Union (EU) is monitoring binge drinking among teenagers because binge drinking increased from 47 to 57% in Ireland and from 37 to 50% in Norway during the last decade. In a study of adolescent drinking in 30 European countries, it was found that alcohol consumption and violence were less common in Mediterranean countries than other European countries. Also, rates of suicide and heavy drinking among adolescents are higher in northern Europe than in southern Europe. Southern Europeans have higher rates of alcohol consumption but lower rates of alcoholism. In Russia, meanwhile, where excessive alcohol use is a cultural norm, the rate of suicide is high. The mere fact that alcohol is available or restricted is not a factor in rates of alcoholism. Forbidding children from drinking small amounts of alcohol does not affect whether they ultimately become alcoholics. Attitudes toward alcohol, reasons for its use, and demonstrating how it can be consumed responsibly are more important in whether children drink abusively. The Cultural Considerations given here shows the age by which one can drink alcohol.

6-9d

Many studies show a relationship between alcohol abuse and intimate partner violence with alcohol use being the strongest predictors for intimate partner violence. Among males and females, violence is likely to be greater on drinking days compared to nondrinking days. Many studies indicate a relationship between alcohol dependence and physical abuse. As the amount and frequency of alcohol use escalate, so does the probability of violence. Conversely, a reduction in intoxication reduces victimization. Numerous studies show a consistent relationship between alcohol use and dating violence. In one study, one-fourth of youth who went to the emergency room for injuries related to dating violence were under the influence of alcohol. In two-thirds of all homicides, the victim, assailant, or both had been drinking. In an exploratory student among young adults who had perpetrated dating violence, they were asked to describe their feelings on alcohol and if it contributed to dating violence. Many of these perpetrators felt alcohol escalated minor conflict and exacerbated feelings of irritation and anger.Footnote Moreover, women who are victims of violence or other traumatic events have higher rates of alcohol dependence. Alcohol also is related to child abuse, though studies linking the two do not account for variables such as socioeconomic status. In one study, individuals who were abused as children reported higher levels of monthly drinking frequency and problematic drinking behaviors. Additionally, children who were physically abused had higher rates of alcohol use disorder compared to nonabused children. A connection has been identified between women who physically abuse children and alcohol abuse or dependency. Yet, cross-cultural studies show that alcohol does not have to lead to aggressive behavior. One could speculate that alcohol is used as an excuse for this behavior. In other words, the relationship between aggression and alcohol use may depend on the culture where alcohol is consumed. A relationship exists between alcohol use and intimate partner violence.

6-6e

Moderate alcohol consumption has been associated with reduced inflammation and improved response to vaccination.Footnote Other studies show moderate alcohol use reduces immunity.Footnote Chronic alcoholics are considered immune compromised hosts and are more prone to infections such as pneumonia and peritonitis.Footnote Alcohol interferes with the movement of white blood cells, which is important in fighting infections. A type of white blood cells, T lymphocytes, which help to resist infections, are notably deficient in alcoholics with severe liver disease. Alcohol dependence reduces immunity to HIV. One study found that women with HIV tend to drink more alcohol, exacerbating their deterioration. In contrast, a study conducted in 2016 showed drinking patterns among HIV-infected persons to be less compared to the general population. They attribute this to increased awareness of the detrimental effect alcohol has on the antiretroviral drugs used to treat HIV. There is an association between heavy alcohol users and the risk of HIV transmission. Heavy alcohol drinkers are more likely to engage in unsafe sexual behavior, have more sexual partners, and share syringes for other drug use, all of which are risk factors for HIV infection. A study of American and Australian homeless youth found that they were more prone to developing HIV because they were more likely to engage in high-risk behaviors, especially Australian youths. Animal studies demonstrate that HIV infection passes more readily from mother to fetus when drugs such as alcohol are abused.

6-2a

Most people who drink today are social drinkers. Also called "low-risk" drinking, these drinking patterns do not lead to long-term health or social problems, although they may experience immediate risks such as accidents. Social drinkers are able to abstain from alcohol at will.

creatine monohydrate

Natural substance used to increase strength and short-term speed. One benefit of creatine—in a roundabout way—is that it may prevent some people from using anabolic steroids. Another benefit, according to an Australian study, is that creatine may boost brain power in vegetarians.A small study of ten people indicated that creatine may help relieve depression.Moreover, creatine may help the elderly with cognitive functioning.Because creatine is a nutritional supplement and not a drug, the FDA does not scrutinize it for safety. In essence, no regulations are in place regarding its sale and use. Nonetheless, many people perceive creatine as a safe alternative to steroids. Reported side effects of creatine include muscle cramping, dehydration, water retention, and kidney problems. Other side effects are gastrointestinal distress, nausea, and seizures. Three college wrestlers who died in 1997 were believed to be taking creatine, although the relationship between creatine and their deaths could have been coincidental.

6-10a summary:

No drug is used more extensively or serves as many functions as alcohol. It played an integral role in the early history of the United States, when it was viewed positively because it contained nutrients and because other beverages were often unsanitary. The rum trade was instrumental to the economic prosperity of the United States. Concern over immoderate drinking and alcohol's role in the breakdown of the family eventually led to the temperance movement and to politically active groups such as the Women's Christian Temperance Union (WCTU), the Anti-Saloon League, and the National Prohibition Party. National prohibition of alcohol, the 18th Amendment, went into effect in 1920. At first it reduced alcohol-related illnesses and deaths. But the law was difficult to enforce, illegal alcohol posed hazards, and there was widespread contempt for the law. In 1933, prohibition was repealed by the 21st Amendment. Most people who drink alcohol are social drinkers. Drinking behavior varies according to geography, sex, race, and age. Generally, men drink more alcohol than women; some ethnic groups, such as Asian Americans, drink less than other groups, and older people consume less alcohol than younger people. Among college students, about 40% engage in binge drinking on a regular basis. Alcohol is absorbed primarily in the small intestine. Food in the stomach, carbon dioxide in the beverage, emotional state, and body size affect the rate of absorption. The liver is responsible for metabolizing alcohol. The body metabolizes alcohol at a rate of three-fourths ounce per hour. Alcohol affects every organ in the body. It affects the brain by altering inhibitions, judgment, coordination, and memory. Alcohol acts on the liver by causing fatty liver, hepatitis, and cirrhosis of the liver. The esophagus and existing peptic ulcers become inflamed from alcohol consumption. Alcohol adversely affects the heart muscle, contributing to poor circulation, raises blood pressure, and increases the risk of stroke. Alcoholics are more prone to infections. Alcohol is associated with cancer of the pharynx, esophagus, larynx, and liver. Women who drink while pregnant can deliver children with fetal alcohol spectrum disorders (FASD), a condition characterized by mental retardation and other physical anomalies. Alcoholics use alcohol chronically and are unable to control their drinking. They differ from problem drinkers, who consume alcohol infrequently or occasionally but encounter emotional, social, financial, or interpersonal problems when they drink. Alcoholism has been shown to run in families. Studies dealing with twins and alcoholism indicate a possible relationship. Drinking patterns are affected greatly by cultural practices. Cultures that accept drunkenness, allow alcohol to be used for personal reasons, and find intoxication amusing have higher rates of alcoholism. Everybody in society pays for the problems associated with alcohol. On college campuses, arrests for alcohol offenses increased greatly in the late 1990s. A significant amount of money goes toward treating people with alcohol-related illnesses. Half of all fatalities from automobile accidents are linked to alcohol. Alcohol use is high among those who die from accidents and suicides, and it is connected to family violence. Many children growing up in households in which one or both parents are alcoholics are left with emotional scars. Most people who drink do so without harm to themselves or others. Yet, too many people have suffered from their own use of alcohol or from the drinking of someone else.

6-1d

None of these occurred. In fact, a decline was seen among theaters and entertainment industries, while many restaurants failed because they no longer gained a profit from liquor sales.Footnote In addition, many people lost their jobs due to the closing of distilleries, saloons, and all alcohol-related trades (i.e., barrel makers, truckers, etc.).Footnote

6-2d

One factor affecting the extent of alcohol consumption is cost. As costs increase, consumption levels decrease. This can be achieved through raising excise taxes on alcohol. These tax increases are used to reduce harm by reducing excessive alcohol consumption while raising revenue received from these taxes. In a study reviewing the effects of alcohol cost and other factors, researchers determined a decrease in overall consumption, decreased alcohol motor vehicle crashes, and a decrease in alcohol-related violence.

6-7b

One popular brand, Four Loko, was believed to be responsible for numerous hospitalizations due to alcohol intoxication. Young adults who combine alcohol with energy drinks experience more alcohol-related harm compared to other drinkers. Combining energy drinks with alcohol has been shown to offset fatigue, which may increase the urge to continue drinking. Additionally, some believe combining energy drinks with alcohol reverses the impaired effects of alcohol, but this is not the case. In a study comparing the driving ability of alcohol-impaired individuals and alcohol combined with energy drinks-impaired individuals, it was shown the addition of energy of caffeinated drinks does not improve driving ability or attention/reaction time. It has been shown that caffeinated alcohol adversely affects visual-spatial ability as well as cognitive functioning. Essentially, caffeinated alcohol enables an individual to be awake longer and so he or she is able to drink more. Hence, these drinks result in greater intoxication. In 2010, the US Food and Drug Administration banned adding caffeine to alcohol. Not everyone supports the ban on caffeine being added to alcohol. There are many examples in which caffeine is mixed with alcohol, such as rum and Coke, Irish coffee, and Red Bull and vodka. According to Jacob Sullum, editor of Reason magazine, the proposed ban on Four Loko resulted from only two studies. He maintains that the conclusions drawn from those studies are questionable.

6-8a

One way to determine whether alcoholism is genetic is by studying identical twins. Four decades ago, a researcher found that if one identical twin was alcoholic, the chance of the other twin being alcoholic was 71%. It is estimated that the heritability of alcoholism fall between 50 and 80%, suggesting a genetic risk for alcoholism. The odds of fraternal twins both being alcoholic was 32%. More recent twin studies found that the heritability of alcoholism for males was 50%. The heritability for female twins was nil. However, women tend to become addicted to alcohol more quickly than men. In a study looking at young adolescence and young adults, a specific gene (GABRA2) has been linked with an increase in drunkenness, with a greater impact on females compared to males. This may explain the gender difference on the impact of alcoholism and also suggests that drinking alcohol during this developmental stage in life produces a greater risk for having problems with alcoholism later in life. These studies suggest that genetics could well be a predisposing factor. Twins, however, are socially closer than nontwin siblings and therefore their relationship might lead to imitative behavior. However, Danish twins born to an alcoholic parent but adopted by the age of six weeks to nonalcoholic parents had a higher rate of alcoholism than adopted children born to nonalcoholic parents. Other studies corroborate that children born to alcoholic parents but adopted during infancy and reared by others were at greater risk for alcoholism. Using adoption studies to determine the possible presence of a genetic link to alcoholism has been criticized on the grounds that adoption agencies are biased in how they decide where to place children, and that there is no standard definition of alcoholism. According to the NIAAA, between 50 and 60% of alcoholism vulnerability has a genetic basis. Recent studies suggest that many genes may play a role in the development of alcoholism, but one of the difficulties is identifying these specific genes. The National Institute on Alcohol Abuse and Alcoholism has funded the Collaborative Studies on Genetics of Alcohol study since 1989 with the hopes of being able to identify specific genes that play a role in alcoholism. To date, many studies have been done to identify specific genes not only to identify genes that influence the risk of alcoholism, but also to help inform treatment decisions regarding the treatment of alcoholism. It is speculated that some neurotransmitters such as serotonin or gamma-aminobutyric acid may be linked to alcoholism. The genetic predisposition to alcoholism may involve a lack of physiological sensitivity to the effects of alcohol, which can lead to heavy drinking. It is speculated that environmental factors affect the impact of genetics, especially at critical times in one's development. Twins who were maltreated are more likely to become alcoholic. This suggests that genetics and environment both play a role in the development of alcoholism. Finally, even if genetics is a factor, environmental conditions such as marriage have an ameliorating effect. And, even though the rate of alcoholism among children of alcoholics is higher, most children of alcoholics do not become alcoholics. Practically speaking, children of alcoholics should be mindful of the greater risk but understand that they are not consigned to a life of alcoholism if one or both parents are alcoholics.

MDPV is the most common synthetic cathinone to be found in people who are admitted to the emergency department after taking bath salts. Symptoms associated with bath salts are:

Paranoia—extreme and unreasonable distrust of others, Hallucinations—experiencing sensations and images that seem real but are not, Increased sociability, Increased sex drive, Panic attacks, Excited delirium—extreme agitation and violence behavior.

American Psychiatric Association:

Patients whose alcohol intake is great enough to damage their physical health, or their personal or social functioning, or when it has become a prerequisite to normal functioning.

5-2

Performance-Enhancing Drugs

5-2a

Prior to their use in athletics, anabolic steroids were used by German soldiers during World War II to increase their muscle strength and aggressiveness. Reports of steroid use by male and female Soviet athletes appeared in 1954. Shortly thereafter, US weightlifters began taking steroids, followed by football players and swimmers. Anabolic steroids belong to the compound anabolic-androgenic steroids. Anabolic refers to muscle building and androgenic refers to increased male sex characteristics. Anabolic steroids are synthetic substances related to the male sex hormones. They mimic the action of testosterone. Steroids are only legally available through a prescription. They are believed to add bulk and strength if they are taken by motivated people who train intensively and follow a proper diet. Taking testosterone during puberty augments muscle mass and strength, but steroid use later in adolescence stunts growth. Users experience a stimulant-like high and feelings of aggressiveness, which may account for higher intensity while training and competing. Studies on their effects are conducted retrospectively, and factors such as diet, dosage, type of steroid, and level of training make it hard to answer the question conclusively.

6-2b

Problem drinkers engage in risky drinking activity, but can modify their behavior when faced with negative consequences due to their drinking behavior. Problem drinkers sometimes engage in heavy drinking, but are not physically dependent on alcohol and will not experience withdrawal symptoms when abstaining from alcohol. Problem drinkers may engage in binge drinking behavior, which is consuming four drinks for women and five drinks for men in a short time period (2 hours). Most people who binge drink are not alcohol dependent. This is the most common type of excessive drinking with almost 25% of Americans over the age of 12 engaging in this type of behavior. A person can abuse alcohol and not be an alcoholic. Problem drinkers do not necessarily drink daily or even frequently.

One study found, through a self-reported questionnaire, a positive correlation between MDMA use and anxiety and psychoticism.

Psychoticism is a person who is highly aggressive and exhibits interpersonal hostility. Similarly, another study was done to determine if ecstasy users differed in self-reported rates of depression and anxiety compared to nonecstasy users.

Loopholes

Recall, the 19th amendment did not make it illegal to consume alcohol; it was allowed for religious and medical purposes. Pharmacists were allowed to dispense alcohol for a variety of medical problems (influenza, anxiety, etc.); thus the number of registered pharmacists grew during the era of prohibition. In New York, this amount tripled during the prohibition era. As you can imagine, the number of people suffering from these ailments also increased, as more people went to their local pharmacists for prescription alcohol. More people attended church to gain access to wine. Additionally, there was an increase in self-professed rabbis as they would then have legal access to wine. With an increase in religion, one would think crime rates would drop due to the improvement of moral character among US citizens, but this was not the case.

synthetic cannabinoids

Related to chemicals found in the marijuana plant

In 2002, a 20-year-old, Asian American woman was brought to the emergency room at Harbor-UCLA Medical Center after having taken multiple tablets of ecstasy (3,4-methylenedioxymethamphetamine [MDMA]) and large quantities of water while dancing and drinking excessively during a party the night before.

She died from hyponatremia: water overdose

American Medical Association:

Significant impairment that is directly associated with persistent and excessive use of alcohol. Impairment may involve physiological, psychological, or social dysfunction.

Male college athletes report higher rates of performance enhancing drugs compared to non-athlete male college students. Contrary to what one would expect, the use of performance enhancing drugs increased during the off season for male athletes.

Similarly, use of social drugs (i.e., tobacco, marijuana, cocaine) were higher during the off season for both male and female athletes. This is true even through athletes are subject to drug testing during the academic year; not just in-season.

6-6d

Specifically, light-to-moderate users have lower risk of coronary artery disease, ischemic stroke, and heart failure. It has also been shown that women who drink moderately are less likely to become overweight, although the opposite is true for men. Furthermore, in a study among postmenopausal women, it was shown that light-to-moderate drinking may be a protective factor against weight gain and obesity, with wine showing the strongest predictor. Specifically, light-to-moderate users have lower risk of coronary artery disease, ischemic stroke, and heart failure. It has also been shown that women who drink moderately are less likely to become overweight, although the opposite is true for men. Furthermore, in a study among postmenopausal women, it was shown that light-to-moderate drinking may be a protective factor against weight gain and obesity, with wine showing the strongest predictor.

6-9c

Suicide is among the top 20 leading causes of death in the world.Footnote Alcohol and drug abuse are one of the major risk factors associated with suicide.Footnote In a meta-analysis of the current literature regarding alcohol use disorder and suicide, it was concluded that alcohol use disorder was associated with suicidal ideation, suicide attempts, and completed suicides.Among soldiers in the army who commit suicide, which increased throughout the first decade of 2000, 19% involved alcohol.Footnote An estimated 32% of veterans who attempted suicide were diagnosed with alcohol abuse or disorder.Footnote Adolescents who attempt suicide often suffer from depression and are likely to have initiated alcohol consumption prior to age 13.

5-1a

Synthetic cathinone are related to a stimulant in the khat plant. The khat is a shrub in East African & southern Arabia. The people in these regions chew the leaves of this plant for its mild stimulant effects. The synthetic version of these stimulants has been shown to produce effects that are much stronger than the natural version. Synthetic cathinones are referred to as "new psychoactive substances," which are generally unregulated and are intended to mimic the effects of illicit drugs.These products are sold in small packages and are often labeled "not for human consumption" online or at drug paraphernalia stores. They may also be labeled as "plant food," "jewelry cleaner," or "phonescreen cleaner" and may be advertised under a number of names such as: Flakka, Bloom, Cloud Nine, Lunar Wave, Vanilla Sky, White Lightning, Scarface.

5-2d

Tetrahydrogestrinone (THG) is a synthetic steroid that athletes are taking to improve athletic performance. THG is made by modifying another anabolic steroid. It is alleged that THG was designed and manufactured by a California company known as Bay Area Laboratory Cooperative (BALCO). BALCO's owner, Victor Conte, claims that THG is not a steroid but a nutritional supplement. Numerous athletes, such as baseball players Jason Giambi and Barry Bonds, football player Bill Romanowski, and track and field athletes including Marion Jones, are suspected of having used THG. The FDA has not approved THG for use. The FDA has warned individuals not to use THG because the drug has not undergone scientific scrutiny. Despite the lack of testing for THG, the FDA speculates that THG may cause some of the same side effects as steroids. Don Catlin, who heads a drug testing laboratory at the University of California in Los Angeles, fears that other designer drugs that can evade detection may be developed. When THG was first developed, the belief was that it could not be detected by conventional drug testing procedures because it deteriorates quickly. However, with improved drug testing, it can now be detected. Nonetheless, it is difficult for testing to keep up with the changes in the variety of drugs that may be produced. Despite the stance of the US Anti-Doping Agency (USADA), many athletes taking performance-enhancing drugs do not view themselves as cheaters. Rather, they consider the use of these drugs as a means of getting the edge over their competitors. Though it is not known how extensively THG is used, its consumption is thought to be widespread. Moreover, the public expects to see athletes who are bigger, stronger, and faster. The era of the 250-pound professional lineman is over. Every 2 years when the Olympic Games are held, fans watch to see if world records are broken. Fans get excited when the homerun record is broken. Interestingly, the NBA and the National Hockey League (NHL) have not banned THG.

6-9b

The BAL of moped drivers has been found to be higher than that of automobile and motorcycle drivers. Moreover, the mortality rate following moped crashes is higher than automobile and motorcycle crashes. Furthermore, in 2014, 30% of all motorcycle accidents resulting in a fatality involved the driver having a BAL of 0.08 percent or higher. In general, alcohol use is overrepresented among people coming into emergency rooms. One study reported that 38% of women and 48% of men admitted into emergency rooms tested positive for psychoactive drugs, with alcohol the most prevalent. In terms of fire-related fatalities, victims were more likely to have higher BAC levels than survivors of drug-related fires. According to the US Coast Guard, there were 137 fatalities and 302 injuries emanating from alcohol-related boating accidents in 2014. Alcohol use is the contributing factors in fatal boating accidents resulting in 21% of fatalities from boating accidents.One study found that over 9% of workers were hung over while at work. The International Labor Office estimates that over 30% of all workplace accidents are a result of alcohol consumption. Furthermore, one study found that one-third of all workplaces deaths can be attributed to alcohol use at work. The professions with the highest rate of heavy alcohol users are food service workers (17.4%) followed by construction workers (15.1%).Footnote

6-7d

The first 5 days of withdrawal are the most severe, although withdrawal symptoms can last for weeks. The craving for alcohol is one obvious symptom of withdrawal. Other characteristics of alcohol withdrawal are the following:Delirium tremens (DTs): A potentially fatal withdrawal symptom marked by delusions, confusion, and disorientation. The person might feel bugs crawling on the skin. The initial phase of DTs lasts from one day to one week. DTs cannot be cured, and medical supervision is necessary. It is estimated that between 3 and 5% of patients who are hospitalized for alcohol withdrawal experience DTs, with 1 to 4% of these patients dying. During withdrawal, a sedative sometimes is administered to ease the discomfort. Extreme arousal: Characterized by anxiety, irritability, absence of hunger, and inability to get to sleep. This state of arousal is actually a rebound effect, as an alcoholic is typically depressed. Auditory and visual hallucinations: Visions and imaginary perceptions occur in about one-fourth of alcoholics during withdrawal. Physiological symptoms: Include elevated temperature and blood pressure, fast pulse, dilation of pupils, and increased perspiration (may last for two or three days), increased sensitivity to sounds and touch, and grand mal seizures. Cognitive symptoms: Impaired concentration, memory, and judgment. Alcohol withdrawal is broken down into stages. Stage 1: Anxiety, insomnia, nausea, and abdominal pain. Begins 8 hours after the last drink. Stage 2: High blood pressure, increased body temperature, unusual heart rate, and confusion. Begins 24 to 72 hours after the last drink. Stage 3: Hallucinations, fever, seizures, and agitation. Beings 72+ hours after the last drink.

6-9a

The leading cause of death among youth ages 15 to 20 is motor vehicle crashes. Yet, 57% of 16- to 20-year-olds drove a vehicle when they thought that they were over the legal limit.Footnote The age group with the highest rate of drunk-driving fatal crashes is 21 to 24. This age group accounts for 35% of all fatal crashes in which the BAC is 0.08 or higher. Among the 3,306 pedestrian fatalities in 2009, 48% of either drivers or pedestrians had a BAC of 0.08 or higher. In 2015, alcohol-impaired driving fatalities increased by 3.2% compared to 2014.Footnote Alcohol-impaired driving accounts for almost 30% of all vehicle fatalities in the United States. In 2015, over 10,000 people died as a result of alcohol-related motor vehicle accidents in the United States (see Table 6.5). Drivers with a BAC of 0.08 or higher are eight times more likely to have a prior "driving while impaired" conviction than drivers with no alcohol. However, it has been found that revoking a driver's license immediately has more impact than waiting until there is a conviction. One strategy that effectively reduces drinking and driving is the implementation of ignition interlocks. These are devices that use breath analysis to prevent drunk drivers from being able to start their car. Before starting the car, a driver must breath into a device that measures the driver's alcohol level. If the level is higher than the programmed amount, the vehicle will not start. A recent study concluded a reduction of 15% in alcohol-related vehicle deaths in states that use ignition interlocks.Responsible beverage service laws are requirements or incentives for retail alcohol establishments (i.e., bars, liquor stores) to participate in reducing alcohol-related problems. These establishments participate in training programs aimed at reducing underage alcohol sales and serving already intoxicated customers. Recognizing that having patrons who get into automobile accidents is bad for business, some bar owners have agreed to give out vouchers for taxis to their patrons. To avoid driving after drinking too much, 28% of individuals used a designated driver and 13% called a cab or a ride. However, some studies have found these programs are not effective. A recent study found no association between responsible beverage laws and self-reported binge drinking or alcohol-impaired driving. The message against drinking and driving has reached to many 16- to 20-year-old drivers. It is estimated that raising the drinking age to 21 has reduced fatalities involving 18- to 20-year-old drivers by 13% and has saved an estimated 19,121 lives since 1975. Gender is an important variable. Males are five times more likely to be involved in fatal car crashes. Alcohol slows down reaction time, and the addition of caffeine to alcoholic beverages does not improve driving performance. Alcohol affects the driver in the following ways: A driver who is under the influence of alcohol processes information more slowly than one who is not. Alcohol-impaired drivers are more likely to look to the center of their visual field and not use their peripheral vision. Alcohol-impaired drivers are less able to attend to multiple sources of information. People who drink moderately (0.05 BAC) underestimate hazards when they drive. In 1998, the US Senate debated whether there should be a national 0.08 BAC standard for drunk driving. Senator Paul Wellstone of Minnesota argued in favor of a 0.08 standard, citing that it would reduce alcohol-related fatalities by 5 to 8%. Senator Jack Reed of Rhode Island concurred, noting that states with a 0.08 standard had 16% fewer fatal automobile deaths. Senator Frank Lautenberg of New Jersey supported the 0.08 standard, claiming that countries such as Canada, Ireland, Great Britain, and Germany have successfully implemented such restrictions. Rick Berman of the American Beverage Institute maintained that the evidence suggesting that a BAC of 0.08 lowers the fatal automobile rate is inconclusive. Not all US senators believe that a national 0.08 standard is appropriate. In 1998, Senators Trent Lott of Mississippi, Don Nickles of Oklahoma, and Craig Thomas of WyomingFootnote agreed that the issue of drunk driving has to be addressed, but that the federal government should not intervene in the states' right to decide. They asserted that the federal government should not usurp the responsibilities of individual states.

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The relationship between alcohol and cancer is complex because the effects vary by quantity and cancer site. The US Department of Health and Human Services released the 14th report on carcinogens, which lists alcoholic beverage consumption as a known carcinogen. Thus the more alcohol a person consumes in a lifetime, the higher the risk of developing alcohol-related cancer. It is estimated that 3.5% of all cancer deaths in the United States are alcohol related. Considerable research links alcohol abuse and certain forms of cancer, especially cancers of the nasopharynx, esophagus, larynx, and liver. A European study of more than 500,000 people found that the risk of colon cancer was 26% higher for those people who had more than two alcoholic drinks per day. A Dutch study indicated that colorectal cancer was related to heavy alcohol use but not to light use. In another study that included 750,000 people, on the other hand, those who drank four to seven glasses of red wine per week were only 52% as likely to be diagnosed with prostate cancer. Similarly, individuals who drank two or more glasses of wine per week had a 40% reduction in developing kidney cancer. There is a relationship between alcohol consumption and breast cancer. It is estimated that the relative risk for breast cancer increases 7% for every drink per day. Additionally, women who consume two to five drinks per day have 1.5 times the risk of breast cancer. It is estimated that 4% of newly diagnosed cases of breast cancer among women in the United States can be attributed to chronic alcohol use. Consuming four or more drinks increases the likelihood of oral and pharyngeal cancer five-fold. The same amount of alcohol results in a 30% greater risk for pancreatic cancer. Although alcohol abuse can cause high rates of esophageal cancer even among nonsmokers, alcohol and smoking combined produce a much higher rate, suggesting a synergistic effect. Beer consumption is related to cancers of the lower gastrointestinal tract. This could be attributable to congeners—the nonalcoholic ingredients such as flavoring agents or other residual substances—rather than alcohol itself.

Many individuals use sports supplements to enhance their performance or appearance. In Canada, over $1 billion is spent annually on sports supplements.

They can be purchased in gas stations as well as grocery and drugstores and over the Internet. Concerns regarding the use of sports supplements include their lack of regulation and absence of research into their long-term effects.

In a study done on patients receiving treatment services for synthetic cannabinoids, the most common reason for difficulty in stopping drug use was the presence of withdrawal symptoms.

This study found the most commonly reported symptoms being anxiety, mood swings, nausea, and loss of appetite with the onset occurring within 1 to 2 hours after the last use. In addition to the presence of withdrawal symptoms, negative outcomes are associated with synthetic cannabinoid use including: Severe agitation and anxiety, Fast, racing heartbeat and higher blood pressure, Nausea and vomiting, Muscle spasms, seizures, and tremors, Intense hallucinations and psychotic episodes, Suicidal and other harmful thoughts and/or actions

Sexual Orientation

Those who identify as sexual minorities may experience higher rates of alcohol use. Lesbian women have more than three times greater odds of lifetime alcohol use disorders compared to heterosexual women. On the other hand, one study found that men who identified as being a sexual minority had significantly lower rates of alcohol use disorders compared to heterosexual men. However, another study found an increased risk of alcohol dependence among homosexual men, although there was only a slight increase in risk. While there are increased risks of alcohol use among sexual minorities, it may have more to do with other characteristics of being in a marginalized subgroup. For example, homosexual persons are more likely to be single and never married, both relationship categories associated with increased risk of alcohol-related problems. Additionally, having children in the household is considered a protective factor against alcohol-related problems, with same-sex couples reporting to having fewer households with children in them. Perhaps the greatest impact on sexual minorities is "minority stress." These are stresses placed on minority populations that are quite different from the stresses placed on nonstigmatized populations. They are chronic, socially based, and include experiences of prejudice, discrimination, and internalized homophobia. These influences and stressors may be the greatest factors in risk of alcohol-related problems.

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When alcohol is consumed on a regular basis, the esophagus and existing peptic ulcers are subject to inflammation. Irritation of the esophagus is marked by chest pain and pain while swallowing. Alcohol abusers have higher rates of esophageal cancer and gastric carcinomas. Because a high proportion of alcohol abusers also smoke, it is difficult to delineate how much damage is attributable to alcohol use and how much is due to smoking. When alcohol is taken with aspirin, the inner lining of the stomach is especially prone to damage. Internal bleeding is especially common when alcohol and aspirin are taken together. Heavy alcohol use is implicated in an increased risk of tooth decay, gum disease, and loss of teeth. Heavy use has been shown to damage the salivary glands and interfere with saliva secretion. Alcoholics may also suffer from inflammation of the tongue and mouth, although it is unclear whether this effect is from the alcohol itself, or from poor nutrition, which is often a symptom of heavy alcohol use. Heavy alcohol use is implicated in acute pancreatitis, a potentially fatal condition marked by severe abdominal pain, nausea, occasional diarrhea, tachycardia, vomiting, and fever. The pancreas secretes insulin and regulates blood sugar levels. More than three-fourths of chronic pancreatitis cases are related to heavy alcohol consumption. It is believed that alcohol abuse is the major cause of chronic pancreatitis. Development of alcoholic pancreatitis occurs, typically, after 10 to 15 years of heavy drinking. Alcoholics often incur malnutrition because alcohol interferes with the body's ability to utilize nutrients and also causes diarrhea, which leaches nutrients out of the body. Additionally, people who consume large amounts of alcohol often replace calories from food with alcohol. At least 80% of patients with alcohol-related liver disease have protein energy malnutrition and vitamin deficiency. Alcohol alters how the body metabolizes proteins, carbohydrates, lipids (fats), and minerals. Also, alcoholics tend to have poor eating habits and, as a result, often become anemic. Nutritional inadequacies are linked to liver disease, certain forms of cancer, pancreatic disease, and fetal alcohol syndrome in newborns. In young and middle-aged men, chronic alcohol use has been associated with the bone disorder osteoporosis.

Neighborhood

Where one lives can influence alcohol consumption patterns. Living in a more advantaged and educated urban neighborhood has been associated with greater alcohol consumption rates among young adults. Those who live in rural areas are more likely to abstain from alcohol but consume more alcohol per occasion.

Ethnicity

Whites typically begin drinking at an earlier age than Blacks and Hispanics. Moreover, Whites progress to alcohol dependence at a faster rate than Blacks and Hispanics. In addition, African American youth are less likely than White or Latino adolescents to drink any alcohol, engage in excessive alcohol use, or develop an alcohol use disorder. Furthermore, African American youth start drinking later and their drinking is less likely to persist throughout adolescence. Alcohol-related mortality is greater for Black and Hispanic men than for White and Asian American men. Black men possibly have more alcohol-related problems than White men because of their higher unemployment rate, discrimination, poor living conditions, and inadequate health care, rather than alcohol use per se. Among individuals seeking alcohol treatment, Blacks and Hispanics are less likely to seek help than Whites. Any discussion of drinking patterns among Hispanics is complicated by their cultural diversity. Among the numerous Hispanic groups are Mexicans, Puerto Ricans, and Cubans. In contrast to men and women of Puerto Rican or Cuban origin, Mexican American men and women are more likely to either abstain from alcohol or to drink heavily. Also, Mexican American men and women have more alcohol-related problems than the other two groups. Drinking patterns seem to be affected by acculturation. The more acculturated a person becomes, the more he or she follows the drinking patterns of the adopted population. One study of Caucasian and Asian students found that Asian students were better able to resist social pressure to drink alcohol than Caucasian students. Many Asians have a mutant gene that causes the alcohol-flush reaction when they drink alcohol. Because of this genetic mutation, the liver is less able to metabolize alcohol. Symptoms of the alcohol-flush reaction include facial flushing, heart palpitations, dizziness, and nausea. Consequently, alcohol use and problems are less prevalent among Asian Americans than among all other major racial and ethnic groups in the United States. Similarly, generalizing about drinking patterns of American Indians is unwise because of tribal diversity. Some tribes have a high incidence of alcohol abuse, and others are primarily abstinent. The research is not consistent. One national study found that Native American adolescents drank more than Hispanics and Blacks but less than Whites. A study of Native American youths in Montana showed that Native American youth began drinking at an earlier age and more heavily than White youths. Because of stress due to perceived discrimination, it was found that 20% of Native American youths begin drinking by age 11 to 12 and that these young people are at greater risk for becoming problem drinkers. Examining deaths caused by alcohol is one way to assess the extent of alcohol-related problems among American Indians and Alaska Natives. Rates of suicides, accidents, homicides, and especially cirrhosis of the liver—conditions influenced by alcohol—are higher among American Indians and Alaska Natives than the general population. In the last 40 years, the rate of suicide among Native Americans has increased significantly. Native Americans have the highest rates of alcohol-related deaths of all ethnicities in the United States. The high incidence of accidents and homicides is attributed to binge drinking, which is characteristic of some tribes. It is speculated that American Indians experience a flushing response similar to the flushing reaction in Asians but that it is milder and less unpleasant than the Asian flushing response. This flushing reaction has little effect on drinking frequency or amount.

Perhaps one of the largest economic consequences of prohibition was the loss of revenue for local governments and the federal government. Before prohibition, many states relied on liquor taxes to fund their budget. For example, in New York, almost 75% of the state's revenue came from liquor taxes. Once prohibition came into effect,

all of that revenue was lost. Loss of liquor revenue also cost the federal government, with some estimates ranging as high as $11 billion. Additionally, the federal government had to put forth extra money to enforce prohibition, with estimates as high as 300 million dollars.

As early as the 3rd century b.c., Greek athletes ate mushrooms to enhance their performance. In the 1800s, athletes took alcohol, opium, nitroglycerin, and strychnine to improve their performance. American Thomas Hicks won the 1904 Olympic Games marathon after reportedly taking strychnine and brandy, and he was not disqualified. In the 1940s, some athletes and bodybuilders took

anabolic steroids to increase their muscle mass and intensify their training regimen.

It is currently legal to use for children and adults with growth hormone deficiency

and for adults with short bowel syndrome and muscle-wasting disease associated with HIV/AIDS

designer drugs

are Synthetic substances that are chemically similar to existing drugs.

This last study showed students who do not live with parents, who earn at least $50 a week (not by a job), and who go out more than four times a week are more at risk for using bath salts. Additionally, people who use bath salts report higher lifetime use of alcohol and marijuana. They are also ten times more likely to use hard drugs such as

cocaine, LSD, crack, and heroin.

At one time anabolic steroids were not

considered addictive. However, based on guidelines from the US Sentencing Commission, steroids are now considered addictive.Footnote Studies have shown that animals will self-administer steroids when given the chance, and people continue their use despite experiencing negative effects.Footnote Users who quit anabolic steroid use report withdrawal symptoms that include mood swings, fatigue, and loss of appetite. Depression has also been associated with the discontinued use of steroids.

The most preferred drug is marijuana regardless of whether the sport is

contact or noncontact. In 2009-2010, the number of National Collegiate Athletic Association (NCAA) athletes who tested positive for marijuana was 71, a threefold increase from the previous year. Early in 2015, the NCAA recommended a change in their drug testing policy to exclude recreational drugs from the list of substances being tested for. Proponents for this amendment argue that because these drugs do not impact performance, they should not be tested. Additionally, drug testing among student athletes has not served as a deterrent for drug use, and some wonder the purpose of testing. Lastly, student athletes who test positive for these drugs are more likely to drop out of the sport and out of school. Rather than use testing to deter drug use, the committee recommends education along with interventions and behavioral management programs to address drug use among athletes.The proposal to eliminate street drugs from drug testing was rejected by both the Division II and Division III Management Councils. The focus still remains on the creation and implementation of drug education programs to deter drug use among student athletes.

Designer and synthetic drugs were initially

difficult to regulate. Once a molecular compound was identified as being illegal, drug producers would change the formula slightly making it legal again. To address this issue, Congress passed the Analog Act.

The effects of bath salts, which can be smoked, swallowed, snorted, injected, or inhaled, have been compared to those of

ecstasy. Bath salts became increasingly popular in Western Europe in 2009 and 2010 before emerging in the United States. The drug has since been made illegal in 28 states, although it can be purchased in convenience stores and head shops. In the first six months of 2011, poison control centers in the United States received 3,470 calls regarding bath salts. Bath salts react similarly in the brain to stimulants such as cocaine.

Performance-enhancing drugs, also known as

ergogenic aids, are used to gain a competitive advantage.

The use of caffeine

extends beyond professional and college athletes. A number of young people are consuming sports and energy drinks. These drinks are high in caffeine and calories. One effect is weight gain

The media are replete with stories of drug use by athletes during the Olympic Games. Track and field stars such as Marion Jones have blemished careers due to drug use. The Major League Baseball Players Association attracted much adverse attention due to its scandal with performance-enhancing drugs. Because athletes are seen as role models, their fall from grace touches a chord; moreover, drug use by athletes is antithetical to the idea that athletes represent a

healthy lifestyle.

The pop star Prince died in April 2016 from an overdose of fentanyl. In an investigation into his death, pills containing the drug fentanyl were discovered in his home. These pills were incorrectly labeled as

hydrocodone, a narcotic drug used to help manage pain. Fentanyl is a favorite for Mexican cartels and has risen in popularity due to the lucrative nature of the drug and the relative ease in manufacturing it.In fall 2015, Mexico discovered 27 kilograms of fentanyl on a landing strip in Sinaloa, which is equal to almost one ton of heroin.The raid also uncovered almost 20,000 tablets of fentanyl made to look like oxycodone. The men arrested in the raid were members of the drug cartel led by Joaquin Guzman Loera (AKA El Chapo)

The drug bath salts are not related to the one for use

in the bathtub.

Performance enhancing drugs have been since the third century as a way to

increase physical performance in competitions.

if a person changes one thing about a drug's compound, the drug can become

legal again. To respond to this problem, in 1986, the US Congress passed legislation curbing the manufacture of these analogs in the Federal Analog Act. Under this act, if a chemical is structurally similar to a drug prohibited by the Controlled Substance Act, the chemical is prohibited. These chemicals are classified as Schedule I drugs. Despite these efforts, the business of designer drugs, according to the Drug Enforcement Administration (DEA), exceeds a billion dollars a year.

Synthetic cathinone products marketed as "bath salts" should not be confused with products such as Epsom salts that people use during bathing. These bathing products have no

mind-altering ingredients.

there persists a notion that synthetic cannabinoids are safe because they resemble the

natural form of marijuana.

When fentanyl is used clinically, side effects include

nausea, dizziness, delirium, decreased blood pressure, vomiting, blurred vision, and possible cardiac and respiratory arrest. Its anesthetic effects last 1 to 2 hours, although the effects on respiration last longer. Unfortunately, some patients given a fentanyl patch for moderate pain have used the patch to commit suicide.

The effects of MDMA can last from 3 to 6 hours with many users taking a second dose once the first one's effects begin to fade. The side effects of MDMA include

nausea, sleeplessness, loss of appetite, depression, headache, hangover, jaw clenching, teeth grinding, muscle cramping, blurred vision, and panic. Additionally, some users report symptoms that can last up to a week following moderate use of the drug that include:Irritability, Impulsiveness and aggression, Depression, Sleep problems, Decreased appetite, Decreased interest in and pleasure from sex.

A serious immediate effect is heatstroke because MDMA can trigger convulsions or seizures and widespread blood clotting followed by collapse and coma. Death can result from MDMA use as well. The physical complications that have been reported include tachycardia, arrhythmias, hypertension, metabolic acidosis, cerebral hemorrhages, convulsions, coma, vomiting, and diarrhea. MDMA use has been associated with

overheating, which, although has been seen in nonclub type environments, may be exacerbated in the club environment. Club environments play high-frequency techno music that encourages intense movement via dancing. This may lead to an even higher rise in body temperature along with excessive sweating, which may in turn lead to excessive fluid intake among MDMA users and result in the occurrence of lethal hyponatremia. This condition, known as a fatal water overdose, arises from too much water being taken in. The blood cannot accommodate the higher water levels and as a result releases water to the cells that begin to expand resulting in brain edema or brain swelling, which can lead to death. This is especially dangerous when neurons (brain cells) begin to expand because there is not enough room in the brain to accommodate the swelling.

People turn to performance-enhancing drugs to improve

physical appearance

The impact of performance-enhancing drugs is evident in baseball. The Major League Baseball Players Association initiated drug testing in 2003. In each season from 1999 to 2001, at least 40 players hit 30 home runs. In 2010, only 18 players hit 30 or more home runs. In 2000, 5,693 home runs were hit (a record number). In 2010, there were 4,613 home runs, nearly a 20% decline. In 2002, former National League Most Valuable Player, Ken Caminiti, believed at least half of all Major League Baseball players were using anabolic steroids. When random mandatory testing was first initiated in 2003, between 5 to 7% of players tested

positive for performance-enhancing substances. It is widely believed that this number greatly underestimates those who were using the drug as players were told when they would be tested and certain drugs (human growth hormones) were not detectable in tests.

Despite concerns regarding its effects, ecstasy does not appear to adversely affect performance on cognitive tests. The US Food and Drug Administration (FDA) has approved studies to determine whether MDMA relieves physical pain and psychological trauma in patients dying of cancer, with chronic pain, and with arthritis. In addition, there is research into whether MDMA is effective for treating

posttraumatic stress disorder.bThere is evidence that some women who used MDMA during pregnancy had babies with higher rates of congenital abnormalities

Regular MDMA use has been associated with

psychiatric problems such as anxiety, depression, and psychoses.

Blood doping is illegal. They are used to give an athlete an extra boost of red blood cells during competition. A typical person's percentage of

red blood cells is around 45% while blood doping can raise that to over 50%. While blood doping is illegal, high altitude training is not. Training at high altitudes can also increase the percentage of red blood cells in the body giving the athlete an advantage.

Ecstasy pills come in many creative designs. These simple designs make the user feel the product they are taking is

safe.

Today, MDMA is popular in many dance clubs, and is associated with the rave

scene

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synthetic cannabinoids because they are related to chemicals found in marijuana plants. They are synthetic chemicals that can be sprayed on dried plants so they can be smoked in a similar fashion to marijuana or sold as liquids to be vaporized and inhaled (much like an e-cigarette).These substances mimic the effects of marijuana without the risk of the user testing positive for marijuana. These drugs come under a variety of names including K2, Spice, Summit, Solar Flare, Yucatan Fire, and Genie.

In 2016 through September 30, US poison control centers received 2,075 reports of exposure to

synthetic cannabinoids.

Anabolic steroids can be

taken orally or intramuscular injections. There are also some topical doses that can be applied and absorbed through the skin. It is estimated that doses used to improve performance are 10 to 20 times higher than doses prescribed by a physician. Some athletes use different techniques in their anabolic steroid use to avoid the harmful effects of steroids. These include: Cycling—taking doses for a period of time, stopping for a time, and then restarting, Stacking—combining two or more different types of steroids, Pyramiding—slowing increasing the dose or frequency of abuse, reaching a peak amount, and then gradually tapering off

6-1c

the 18th amendment was ratified in 1919 and went into effect on January 16, 1920. The 18th amendment to the US Constitution prohibited the sale, transportation, and manufacturing of alcohol. The Volstead Act (also known as the National Prohibition Act) was created to help carry out the intentions of the 18th amendment. The Volstead Act specifically defined "intoxicating liquors," the language used in the 18th amendment. Enforcing prohibition proved to be a difficult task and tended to be strictly enforced in rural areas and small towns where many supported prohibition efforts, compared to larger more urban populations. Consumption of alcohol was not illegal and alcohol could be obtained legally for religious purposes and via medical prescriptions. Another problem with the enforcement of prohibition was the year delay between the passage and enactment of the law. Thus many individuals were able to stock up on their supply of alcohol during the year preceding enforcement. While prohibition experienced some successes such as lower rates of alcohol use in the beginning, lower rates of death from alcohol-related deaths, and better work production (less work absenteeism, less worksite alcohol-related accidents, etc.), the problems resulting from prohibition proved to be greater than anticipated.

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the previous drinking behaviors, alcoholics cannot control their drinking behaviors in spite of the negative consequences experienced as a result of alcohol. Considered to be alcohol dependent, alcoholics will experience withdrawal symptoms when abstaining from alcohol.

A strong motivation for many people to use drugs is the desire to enhance performance. Society's emphasis on competition could push people into taking drugs to gain an athletic or academic advantage. Likewise, because of the emphasis on sex appeal, some individuals look to drugs to enhance

their sexual performance and experience. The effects of drugs, especially anabolic steroids, on performance will be examined here.

The Olympic Games have been marred by doping cases. In the summer 2016 Olympics at Rio, Russia was almost banned from competing in the games. In July 2016, the World Anti-Doping Agency conducted an independent investigation on Russia's Ministry of Sport and Federal Security Service which resulted in findings that suggest the Ministry operated as state-wide system to initiate a state-wide doping system and cover the results of positive drug testing samples. By the end of July 2016, the World Anti-Doping Agency decided they will allow Russian athletes if they are able to prove they have not been doping before the Olympic games. It is important to note that athletes from other countries did not have to submit to

these guidelines. Moving forward, Russia submitted 389 athletes for consideration and in the beginning of August 2016, 278 of them were eligible to compete in the games.

Anabolic steroids do have medical benefits

when prescribed by physicians. Anabolic steroids were first developed in the late 1930s to treat hypogonadism, a condition in which the testes fail to produce enough testosterone.They are still given to people who have some types of impotence and to AIDS patients to treat the body wasting often associated with that disease.

now mandated by the State of New York that

women may not be refused alcohol at bars or other establishments that serve alcohol. These rights fall under the New York City Commission on Human Rights and 'prohibits unlawful discrimination in employment, public accommodations, and housing on the basis of pregnant or perceived pregnancy".