Chapter 16

Insider's Perspective

-Viewing a group or subculture from inside the group; seeing members as they perceive themselves. Drug users in agreement with other drug users or sympathizer

NCAA Banned Drug List (NCAA 2016)

1.Stimulants 2.Anabolic Agents 3.Alcohol and Beta Blockers (banned for rifle only) 4.Diuretics and Other Masking Agents 5.Street Drugs 6.Peptide Hormones and Analogues 7.Anti-estrogens 8.Beta-2 Agonists

HIV Symptoms (1 of 2)

An HIV-infected individual may not manifest symptoms of AIDS for as many as 10 to 12 years after the initial infection. Although the HIV- infected individual may experience no symptoms, he or she is highly contagious After an individual has become infected, he or she may have a brief flu-like illness usually within 6 to 12 weeks. It is not known what determines the length of the latency period, when symptoms are not present. The asymptomatic period eventually ends, however, and signs of immune disorder appear. Initial symptoms of this disease include night sweats, swollen lymph glands, fever, and/or headaches. Medications used to treat HIV infection (antiretroviral drugs) help many people with HIV to lower the levels of virus in their blood (viral load) to undetectable level

Athletes and Drug Abuse

Drug abuse has been reported since the Greeks started the Olympics in 776 BC. • " Doping" among world- class competitors is rampant. • Young athletes often receive exaggerated attention and prestige in almost every university, college, high school, and junior high school in the United States Besides risking their health, athletes who choose to dope should remember that they are role models. Seventy-three percent of youth want to be like a famous athlete; 53% of youth say it is common for famous athletes to use banned substances to get ahead

Subcultures of Special Populations

Drug use and/or abuse: -Athletes/mainly involved in sports -Women -Adolescents -College Students -HIV/AIDS •Promoters of Drug Use: The Entertainment Industry and the Intern

Nature and Extent of HIV/AIDS

Globally: More than 35 million people worldwide are living with HIV since the first cases were first reported in 1981 (CDC 2015b). In 2015, globally, 2 million people were newly infected with of HIV (CDC 2015b). Globally, 1.2 million die of AIDS each year (CDC 2015b). The number of people living with HIV included 2.6 million children younger than 15 years of age, 17.4 million women, and 36.9 million people living with HIV in 2014 (WHO 2015) In the United States: •Gay, bisexual, and other men who have sex with men (MSM), particularly young black/African American MSM, are most seriously affected by HIV. •By race, blacks/African Americans face the most severe burden of HIV. •The estimated incidence of HIV has remained stable overall in recent years, at about 50,000 new HIV infections per year (CDC 2015 Hispanics/Latinos represented 16% of the population but accounted for 21% of new HIV infections in 2010. Hispanics/Latinos accounted for 20% of people living with HIV infection in 2011. •Injection drug users represented 8% of new HIV infections in 2010 and 15% of those living with HIV in 2011 •Although males who have sex with males (MSM) represent about 4% of the male population in the United States, in 2010, MSM accounted for 78% of new HIV infections among males and 63% of all new infections. MSM accounted for 52% of all people living with HIV infection in 2009, the most recent year these data are available. •Blacks represent approximately 12% of the U.S. population but accounted for an estimated 44% of new HIV infections in 2010. They also accounted for 41% of people living with HIV infection in 2011 •The most common ways women get HIV (in order) are having sex with a man who has HIV and sharing injection drug works (e.g., needles, syringes) used by someone with HIV. •73% of pregnant women living with HIV had access to antiretroviral medicines to prevent transmission of HIV to their babies in 2014, and new HIV infections among children were reduced by 58% from 2000 to 2014 (CDC 2015

Drug Use by College Students

In 2014 (Johnston et al. 2015) •Most popular substance of use and abuse is alcohol (76.1% of college students). •38.6% of college students report use of illicit drugs. •20.8% report use of marijuana. •College students who frequently binge drink are more likely to smoke cigarettes and use illegal drugs as well. •A clear relationship exists between alcohol use and grade point average (GPA). (The more alcohol consumed, the lower the GPA.) Alcohol use by college students is associated with serious and acute problems such as alcoholism, poor academic performance, drinking and driving, and criminalistic behavior (e.g., driving while intoxicated, vandalism, violence). •Studies show that two major drinking patterns appear dominant among college students: (1) drinking related to impulsivity, disinhibition, and sensation-seeking and (2) drinking to manage negative emotional states, such as depression Young adults ages 18 to 25 are most likely to binge or drink heavily; 54% of the drinkers in this age group binge and about one in four are heavy drinkers. •Regarding recent surveys on annual drug patterns of full-time college students (Johnston et al. 2015) -76.1% had used alcohol -34.4% had used marijuana -22.6% had used cigarettes -38.6% had used any illicit drug -10.1% had used amphetamin

The Most Commonly Abused Steroids

Oral Steroids: - Anadrol (oxymetholone), Oxandrin (oxandrolone), Dianabol (methandrostenolone), and Winstrol (stanozolol) • Injectable Steroids: - Deca-Durabolin (nandrolone decanoate), Durabolin (nandrolone phenpropionate), Depo-Testosterone (testosterone cypionate), Equipoise (boldenone undecylenate), and Tetrahydrogestrinone (TH

Patterns of Anabolic Steroid Use by Athletes

Patterns of Anabolic Steroid Use by Athletes •Stacking: Use of several types of steroids at the same time. •Cycling: Use of different steroids taken singly but in sequence. • Plateauing: Developing tolerance to a particular steroid. •Pyramiding: Beginning steroid use with low doses moving to higher doses, then reducing the dosage at the end of the cycle. • Array:Use of other drugs while taking anabolic steroids to avoid possible side effects, such as taking diuretics,anti-acne, anti-estrogen

Steroid Usage in Professional Sports

Steroid Usage in Professional Sports •Usage patterns for anabolic steroids vary considerably according to athletes' motivation, level of competition, the type of sport, and the pressure for winning. • " Of the 26 sports included in the 2012 Games, the worst offender in terms of the rate of findings per sample (averaged across all eight years) is cycling, 3.71%." • "The second highest rate - 3.05% - was found among boxers. Badminton had the lowest rate of usage-indication findings per sample, at 0.87%." • "Footballers were the most tested athletes in terms of the total number of samples (30,398), followed by athletics (25,013), cycling (21,427), and aquatics (13,138)" (Burn-Murdoch 2012

Athletes and Drug Abuse (2 of 2

Studies have shown that athletes are not more likely than nonathletes to use drugs of abuse such as marijuana, alcohol, barbiturates, cocaine, and hallucinogens. However, • Athletes are much more likely than other subcultures of drug users to take drugs to enhance performance. These drugs include stimulants such as amphetamines, cocaine, and an array of drugs with presumed ergogenic effects, such as anabolic steroids

Outsider's Perspective

Viewing a group or subculture from outside the group and viewing the group and its members as an observer; looking "in." Nonusers viewing drug users

Drugs Used by Athletes

• Anabolic steroids consist of a group of natural and synthetic drugs that are chemically similar to cholesterol and related to the male hormone testosterone. • Naturally occurring male hormones, or androgens , are produced by the testes in males

Four Most Common Sources for Adolescents Obtaining Prescription Drugs (2009-2013)

•"Given for free by a friend or relative" (60.7%) •"Bought from a friend or relative" (39.2%) •"Bought from drug dealer/stranger" (20.6%) •"Took from friend/relative without asking" (16.1%) •"Bought prescription drugs on the Internet"(3.8%)

Subculture

•A subculture is defined as a special population or subgroup whose members share similar values and patterns of related behaviors that differ from the larger population. •Two types of forces affecting members of a drug-using subculture are: -Internal subcultural forces: Shared attitudes favorable of drug use, habitual, and/or addictive behavior -External subcultural forces: Law enforcement, availability of drug dealers, and concerns with being observed and/or caught using drugs

Consequences of Adolescent Drug Use

•Adolescent suicide •Sexual violence •Gangs

Drug Use in the Entertainment Industry

•Alcohol appeared in 93% of movies, 17% of songs; tobacco appeared in 89% of movies. •"About one-third of hit songs—including three- quarters of rap songs—have some form of explicit reference to drug, alcohol, or tobacco use . . ." (Yahoo! News 2008). •In movies depicting illicit drugs, marijuana appeared most frequently (51%); hallucinogens, heroin and other opiates, and miscellaneous others (each 12%); and crack cocaine (2

Women and Alcohol

•Alcohol is the drug most widely used and abused by women in the United States. -Women aged 12 and older: 47.5% used alcohol in the past month and 31.4% reported binge drinking (SAMHSA 2014). -Unlike men, women are less likely to develop severe alcohol dependence (only 25% of the alcoholics in the United States are female). •Women dependent on alcohol are judged more harshly than men dependent on alcoh

Major Reasons Cited by College Students for Using Alcohol*

•Breaks the ice (75.1%) •Enhances social activity (74.6%) •Gives people something to do (73.0%) •Gives people something to talk about (67.3%) •Allows people to have more fun (62.5%) •Peer bonding (62.4%) •Male bonding (60.6%) •Facilitates sex (53%) •Facilitates female bonding (51.2%) •Female bonding (52.9%) •Makes it easier to deal with stress (43.6%) * Sample survey of 53,622 total students with 36.8% male and 62.2% female college students and their use of alcohol and other drugs (SIUCC/Cor

How Do These Drugs Affect a Woman's Reproduction?

•Cocaine? A substantial threat to the fetus •Alcohol? Crosses the placenta and affects the fetus's development •Tobacco? Approximately 10% of women reported smoking during the last 3 months of pregnancy. (May be greater threat to the fetus than cocaine.) •Other drugs (marijuana, LSD, other depressant drugs)? Associated with abnormal fetal development when used during pregnan

Summary Findings: Drug Use and College Students from 2011 to 2014

•Drugs Declining in Use:cigarettes, crack, heroin, narcotics (other than heroin), and OxyContin •Drugs holding relatively steady: any illicit drug, alcohol, inhalants, marijuana, hallucinogens, amphetamines, LSD, Adderall, MDMA (Ecstasy),crystal methamphetamine (ice), Vicodin, tranquilizers, and cocaine •Drugs increasing in use: Any illicit drug; alcohol, Ritalin, and sedatives (barbiturate

Prevention and Treatment of Adolescent Drug Problems

•Encourage parental awareness of gangs. •Encourage alternative participation in organizations or groups (athletics, school activities, career development, or involvement in volunteering programs). •Help children to develop coping skills regarding frustration and stress. •Educate children about gang-related problems and help them understand that like drugs, gangs are the result of problems and are not the solutions to proble

College Students: Heavy Drinking Settings Include (Stewart 201

•Fraternity parties •Drinking in conjunction with athletic events •Drinking in residence halls •Drinking in off-campus housing areas with a high proportion of students •Drinking in bars adjacent to campu

Major Reasons for the Use/Abuse of Anabolic Steroids (1 of 2)

•Improve athletic performance •Increase muscle size or reduce body fat •Experienced physical or sexual abuse (e.g., female weightlifters who had been raped were found to be twice as likely to use anabolic steroids Adolescent steroid abusers often take risks such as drinking and driving, carrying a gun, driving a motorcycle without a helmet, and abusing other types of illicit drugs. • Muscle dysmorphia (also a key term in text) - a behavioral syndrome that causes individuals to have a distorted image of their bodies (i.e., perceiving themselves as looking small and weak, even when they may be large and muscular), may be a reason to use anabolic steroids

Past Year Adolescent Initiates of Prescription Drug Use

•In 2006 more than 2.1 million teens abused drugs. •In 2011 an average of 35% of 8th, 10th, and 12th graders used an illicit drug during their lifetime. •Every day, 2,000 teenagers (12-17) abuse a prescription pain reliever for the very first time (NIDA for Teens 2013). •Prescription and over-the-counter drugs are among the most commonly abused drugs by 12th graders, after alcohol, marijuana, synthetic marijuana (e.g., "Spice"), and tobacco (NIDA for Teens 2013). •Pain relievers like Vicodin and OxyContin are the prescription drugs most commonly abused by teens (NIDA 201 The prescription drugs most commonly abused by teens are painkillers, powerful narcotics prescribed to treat pain; depressants, such as sleeping pills or anti- anxiety drugs; and stimulants, mainly prescribed to treat attention-deficit hyperactivity disorder (ADHD). •Among teens who have abused painkillers, nearly one-fifth (18%) used them at least weekly in the past year

Drug Use by College Students Versus Same Aged Non college Group

•In 2014, college students (76.1%) were moderately higher in annual and 30-day use of alcohol than the noncollege group (74.5%). •College students had a higher prevalence of being drunk (42.6%) versus their aged peers not in college (34.1%). •Annual marijuana use was somewhat similar among college students and high school graduates of the same age who were not in college (34.4% vs. 39.7%). •More significant differences regarding cigarette usage, college students 22.6% versus 34.7% noncollege students

Effects of Anabolic Steroids (1 of 3)

•Increased strength •Increased lean body mass •Increased "bad" blood cholesterol •Increased risk of liver disorders •Psychological effects: irritability, outbursts of anger such as "road rage," mania, psychosis, and major depression •Psychological and physical dependence with continual use of high dose Withdrawal symptoms: cravings, fatigue, depression, restlessness, loss of appetite, insomnia, diminished sex drive, headaches •Alterations in reproductive systems and sex hormones: -Breast enlargement in males; breast reduction and hair growth in females -Infertility -Atrophy (shrinkage of the penis and testicles in males and enlargement of external genitalia in female Stunted growth in adolescents •Deepening of voice in females •Water retention •Change in skin and hair (severe acne, male pattern baldness, and increased body hair) •Persistent unpleasant breath odor •Swelling of feet and limb

Most Important Factors for Transmitting HIV/AIDS in the United States

•Intravenous drug use of heroin, cocaine, or both: most important factor for the spread of HIV/AIDS •Crack, cocaine, and methamphetamine: encourages high-risk sexual activiti

Youths and AIDS

•Male adolescents between the ages of 13 and 19 and young adult males (20-24 years of age) who were diagnosed with AIDS contracted the disease in the following ways (CDC 2013c): -Male-to-male sexual contact (91.8%) -Heterosexual contact (4%) -Male-to-male sexual contact and injection drug use (2.7%) -Injection drug use (IDU) (1.5% •Regarding race and ethnicity, this reported group was comprised of the following: -Males (62%) and females (64%) were black/African American -Males (19%) and females (18%) were Hispanic/Latino -Males (16%) and females (14%) were of white descent -Males (2%) and females (2%) were from multiple races (CDC 2013) •Three of the principal ways adolescents become infected with HIV are as follows: (1) high-risk sexual activity(unprotected sexual intercourse is reported by more than half of adolescents by the age of 17 years); (2) injection of substances of abuse; and (3) sex with multiple partners •African Americans were disproportionately affected by HIV infection, accounting for 55% of all HIV infections reported among persons aged 13 to 24. •"It is estimated that 50% of all new HIV infections are among young people (about 7,000 young people become infected every day), and that 30% of the 40 million people living with HIV/AIDS are in the 15-24 age group "(WorldHealth Organization [WHO], 2000-2004 Most 13- to 19-year-old females reported contracting HIV followed by AIDS through heterosexual contact (66%), injection drug use (19%), and other/not identified causes (15%). •Worldwide, sexual intercourse is by far the most common mode of HIV transmission HIV is spreading at alarming rates among younger urban gay males who are too young to recall the beginning of the AIDS epidemic two decades ago

Why Adolescents Use Drugs (1 of 3)

•Most adolescents who use substances of abuse during psychosocial development do not develop problematic drug dependence. •Adolescent users who have difficulty with drugs often lack coping skills, are from dysfunctional families, maintain poor self- images, and/or feel socially and emotional Parents who are most likely to foster drug-abusing children are: -Drug abusers themselves -Excessively rigid and condemning or range from intermittent extreme rigidity to extreme neglect -Overly demanding -Overly protective -Overwhelmed with their own personal conflicts -Unable to effectively communicate with their children Recent research indicates that the most important factor influencing drug use among adolescents is peer drug use. •Research also shows that there exists a correlation between strong family bonds and non-drug-using peer groups. •Use drugs to cope with boredom, unpleasant feelings, emotions, and stress or to relieve depression, reduce tension, and reduce alienation. Question for students: What other explanations could explain the major reason(s) why adolescents use dru

Drug Use Among Women with Comparisons to Men, 2015 (2 of 3)

•Most types of abused drugs by females (in descending order): -Alcohol, females 82.9% (males 83.1%) -Flavored alcoholic beverages, females 53.8% (males 53.0%) -Binge drinking (+5 or more drinks) in last two weeks, females 26.4% (males 42.9%) -Cigarettes, females 24.1% (males 31.1%) -Marijuana, females 27.8% (males 34.2%) -Any illicit drug other than marijuana, females 19.2% (males 23.6% Most types of abused drugs by females (in descending order) (continued): -Narcotics other than heroin, females 5.5% (males 7.4%) -Amphetamines, females 6.8% (males 8.8%) -Cocaine, females 3.6% (males 6.9%) -Hallucinogens, females, 2% (males 5.9%) -Hallucinogens other than LSD, females 1.7% (males 4.7%) Steroids, females 0.3% (males 1.1)% -Finally, epidemiological studies show that even though women are less likely to initiate drug use than men, they start earlier and are more susceptible to develop an addiction

Drug Use Among Women with Comparisons to Men, 2015 (1 of 3)

•Overall, females consistently use fewer licit and illicit drugs: 34.4% of females versus 39.8% of males use illicit drug

Current Major Treatments for HIV

•Protease inhibitors •Reverse transcriptase inhibitors:nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs) and non-nucleoside reversetranscriptase inhibitors (NNRTIs) •Highly active antiretroviral therapy (HAART) (medications that are also used to treat HIV/AIDS- infected individuals) •Integrase inhibitors: most recent medicatio

Patterns of Drug Use by 8th Graders

•Regarding recent surveys on lifetime drug use by 8th graders in 2014: -26.8% had used alcohol -13.5% had used cigarettes -10.8% had used inhalants -15.6% had used marijuana

Patterns of Drug Use in 12th Graders

•Regarding recent surveys on lifetime drug use by12th graders in 2014: -66.0% had used alcohol -34.4% had used cigarettes -6.5% had used inhalants -44.4% had used marijuana

Does Social Networking Motivate Drug Use?

•Research at The National Center on Addiction and Substance Abuse at Columbia University conducted a survey of 12- to 17-year-olds, they found that the vast majority (70%) of the teens surveyed used the sites and that 40% of all teens had "seen pictures on those sites of kids drinking or using drugs and that half of those teens were not yet teens—they were 13 years old or younger" (Reuters and Fox News Network 201 The top social media platforms for American teens are Facebook (71%), Instagram (52%), Snapchat (41%, and Twitter (33%). •"90% of teens are initially exposed to picture of their peers drink, using drugs or passing out on social media before the reach the age of 15 years old" (12 Keys Rehab 201 •"Teens who are exposed to these types of images are three times likelier to consume alcohol, and it's four times as likely that they'll use marijuana" (12 Keys Rehab 2016). • "These teens are able to access mind-altering substances, including prescription drugs, more readily than teens who don't use social media" (12 Keys Rehab 2016

Drugs Used by Athletes .1

•Stimulants (amphetamines and cocaine) •Clenbuterol •Erythropoietin (EPO) •Human growth factor (HGF) and human growth hormone (HGH) •Beta ß-adrenergic blockers •Gamma-hydroxybutyrat

Promoters of Drug Use: The Entertainment Industry and the Internet

•The Internet maintains a unique subculture of drug enthusiasts. •Numerous web sites are used by a growing number of drug users as forums for learning and exchanging the latest information and techniques about drug use (i.e., purchasing equipment for growing, chat rooms sharing information about the use of illicit drugs, news about drug "get togethers," such as parties, raves, festival locations where drugs are prevalent The Internet is a more recent source for marketing illicit drugs for anyone having access to computers, and this audience includes younger teens and adults. Legal suppliers appear to be fueling the trade by providing their products to unlicensed Internet pharmacies that then sell these legally restricted types of drugs (Join Together Online and BBC News 200 •The potential impact of acquiring illicit drugs from Internet sites was emphasized by a journalist warning that we should "Forget the drug dealer on the corner, teens are increasingly turning to the Internet to get high" (Fiore 2008

Adolescent Drug Use: Additional Recent Findings

•The percentage of adolescents aged 12 to 17 who were current alcohol users was 11.5% in 2014, totaling 2.9 million adolescents (CBHSQ 2015). •An estimated 1.3 million adolescents aged 12 to 17 had substance abuse disorders (SUDs) in 2014, which represents 5.0% of adolescents (CBHSQ 2015). •In 2014, slightly more than 2.3 million adolescents aged 12 to 17 in 2014 were current users of illicit drugs, which represents 9.4% of adolescents (CBHSQ 20 In 2014, 7.4% of adolescents aged 12 to 17 were current users of marijuana. This means that approximately 1.8million adolescents used marijuana in the past month (CBHSQ 2015). •Among adolescents aged 12 to 17 in 2014, 1.7 million used tobacco products in the past month, including 1.2 million current cigarette smokers. These 2014 numbers represent 7.0% of adolescents who were current tobacco users and 4.9% who were current cigarette smokers •In 2014, it was reported that the use of electronic cigarettes(e-cigarettes) was high among teens, with 9.5% of 8th graders, 14% of 10th graders, and 16.2% of 12th graders using e-cigarettes in the past month (Johnston et al.2016b). •Only 14.2 percent % of 12th graders viewed regular e-cigarette use as harmful. The nicotine in e-cigarettes is vaporized and inhaled (not smoked); however, the health impact of e-cigarette use is not yet clear, nor is it known(NIDA 2014a) Past-month marijuana use continues to exceed cigarette use among high school seniors. In 2015, 21.3% of high school seniors used marijuana in the past 30 days, compared with 11.4% who smoked cigarettes (Johnston et al. 201

Abuse of Anabolic Steroids by Athletes

•Under some conditions, androgen-like drugs can increase muscle mass and strength. •A more recent study from The American Journal of Sports Medicine reported that the number of anabolic steroid users in the United States is estimated at approximately 3 million people. •Males are much more likely to use steroids than females. •A 2015 Monitoring the Future Study found that only 1% of 8th graders, 1.2% of 10th graders, and 2.3% of 12th graders had used steroids (Johnston et al. 2016b) •Football players have the highest rate of steroid abuse and track athletes have one of the lowest (NCAA Research 201