Substance Abuse test 2

Drugs affect the activity of neurotransmitters

- Synthesis/storage stimulated or inhibited -Release blocked/enhanced -Receptors blocked or activated (diffusion out of the synaptic cleft. Enzymatic degradation. Reuptake by presynaptic cells)

Adaptations constitute the biological bases for

- Tolerance: Decreased response to a set dose of a drug in response to repeated use of that drug. Reverse Tolerance (enhance response to a given drug dose) and Cross-tolerance (development of tolerance to one drug causes tolerance to related drugs) - Dependence: Physiological & psychological changes or adaptations that occur in response to the frequent administration of a drug. Cross dependence (withdrawal symptoms due to dependence on drug can be relieved by other drug). - Withdrawal: Unpleasant physical and/or psychological symptoms resulting from the absence of a drug in the body - Sensitization

1830: Peak drinking period in U.S.

- Use in colonial America. - Triangle trade (Yankees traded rum for slaves, then slaves for molasses in west indies, then back to New England to make rum) - Colonial taverns were key "institutions" promoting alcohol consumption

Benzodiazepine use

- Use of these drugs to relieve acute stress or insomnia can be beneficial - Due to side effects and problems associated with long-term use, they should be prescribed at the lowest dose and for the shortest time possible - Non-drug intervention such as psychotherapy should always be considered either in addition to, or in lieu, drug therapy alone

Blood Alcohol Concentration (BAC):

-Almost all (95%) of consumed alcohol is inactivated by liver metabolism. -Liver metabolizes alcohol at a slow and constant rate, unaffected by the amount of alcohol ingested. ("zero order" kinetics. Saturation of enzyme capacity. 0.5 oz of pure alcohol or 1.0 oz of liquor per hour).

The Abuse of Hormones (Anabolic Steroids)

-Androgens (testosterone, DHEA): Stimulate growth of muscle of muscle mass. Increase body weight. -Anabolic steroids: are structurally related to the sex hormone testosterone. Sometimes abused by athletes and body builders to improve strength and physical appearance. Controlled as schedule III substances.

How serious is Alcohol Consumption

-Approx. 51.8% (133.4 million) Americans are past-month alcohol drinkers (aka current drinkers) -Approx 22.6% (58.3 million) Americans binge drink and 6.2% (15.9 million) report heavy drinking

Three major reasons why women are more sensitive to the effects of alcohol:

1. Body size 2. Women absorb alcohol sooner 3. Women possess less of the metabolizing enzymes that biotransforms alcohol

GABA is the most common inhibitory neurotransmitter in the brian (CNS):

1. Limbic system (alter mood) 2. RAS (cause drowsiness) 3. Motor Cortex (relax Muscles)

Craving

A compulsion to drink alcohol even during inappropriate times (i.e: work/driving).

PTSD

A psychiatric syndrome in which an individual who has been exposed to a traumatic event or situation experiences psychological stress that may manifest itself in a wide range of symptoms, including: Re-experiencing the trauma, numbing of general responsiveness or hyper-arousal

Co-Dependency (co-alcoholism)

A relationship pattern in which addicted or non-addicted family members identify with the alcoholic/addict and deny the existence of alcohol consumption as a problem

Types of Alcoholics:

1. Young Adults: 31.5% of U.S. alcoholics. Young adult drinkers without major problems regarding drinking 2. Young Antisocial: 21% of U.S. alcoholics. Mid 20s, has early onset of regular drinking and alcohol problems. Comes from heavy alcohol use family 3. Functional: 19.5% of U.S. alcoholics. Middle aged, with 50% from families with multigenerational alcoholism. 4. Chronic Severe: 9% of U.S. alcoholics. Mostly middle aged, high rates of antisocial personality disorder and criminality.

Temperance movement

1830-1850

Figure 8.04

45% of distribution of the cost of alcohol abuse is abusers and households.

Alcohol hepatitis

Chronic inflammation. Reversible if drinking stops.

Enabling

Denial, or the making up of excuses for the excessive drinking problems of the alcoholic, thus allowing or "enabling" the addiction to persist

Margin of Safety

The range in dose between the amount of drug necessary to cause the intended (recreational or therapeutic) effect and a toxic unintended effect. -The greater the MOS, the less likely that serious adverse side effects will occur. -Drugs with narrow MOS have very high rates of serious adverse side effects in populations who abuse them -Prescription vs. Over the Counter.

The American Psychiatric Association considers..

dependence on CNS depressants a psychiatric disorder.

Detoxification

elimination of a toxic substance, such as a drug, and its effects from the body.

Hepatotoxic effect

enlarged, "fatty" liver. Reversible if drinking stops.

Tolerance

need to increase usage to achieve the desired effect or "buzz" from alcohol.

People most likely to abuse CNS depressant include individual who...

use drug to relieve continual stress, paradoxically feel euphoria and stimulation from depressants, use depressants to counteract the unpleasant effects of the other drugs of abuse, combine depressants with alcohol or heroin to potentiate their effects.

Social Lubricant

what a social psychologist refers to the perception of alcohol. Alcohol lowers inhibitions, promotes sociability

Benzodiazepine side effects:

- Rebound in REM sleep & insomnia (prolonged use of hypnotic doses) - Paradoxical effects (nightmares/anxiety/restlessness) - Bizarre, inhibited behaviors (extreme agitation/ hostility, paranoia, rage)

Benzodiazepines (valium-type)

- Short-acting treat insomnia (hypnotics) - Long-acting provide prolonged relaxation and relief from persistent anxiety (sedatives) - When used alone, death from overdose is rare - Classified as schedule IV drugs - Medical use: relief from stress and anxiety, treats neurosis, etc. - Selective CNS depression

Central Nervous System

- Brain and Spinal Cord and Integration center. -The CNS receives information from the PNS, evaluates the information, then regulates muscle and organ activity via the PNS - Reticular activating system (receives input from all the sensory systems and cerebral cortex) -Basal Ganglia (Controls motor activity) -Limbic System (Network of linked brain regions) -The Cerebral Cortex (Helps interpret, process and respond to information) -The Hypothalamus (Major link between the nervous and endocrine systems)

Benzodiazepine abuse

- For most, effects are not reinforcing (rewarding) - Should be cautiously prescribed to patients with a history of substance abuse - Not especially addicting - "date rape" drug - Alcoholics do find the effects of benzodiazepines rewarding

Symptoms of Alcohol withdrawal

- Hyper-excited nervous system - Muscle tremors, nausea, anxiety - Delirium tremens (Most serious withdrawal symptom)(hallucinations, delirium, rapid HR, fever, seizures)

Benzodiazepine tolerance / dependence/ withdrawal

- Occurs with frequent/chronic/prolonged use - Effects usually not as severe as most other CNS depressants.

Common reasons for CNS depressant abuse

- Opioid narcotic users: supplement drug supplies, offset tolerance to opioids (cross tolerance), relieve opioid withdrawal symptoms (cross dependence) - Alcoholics: offset tolerance to alcohol, relieve alcohol withdrawal symptoms, and achieve intoxication without "smell" of alcohol.

Prohibition era (1920-1933)

- Ratification of the 18th amendment (1919) to the U.S. constitution (outlawing alcohol use) - Alcohol was outlawed in January 1920 - Speakeasies and bootlegging grew - Patent Medicines flourished - 1933, the 21st amendment repealed prohibition.

Negative Impact of Alcohol

-100,00 deaths associated with alcohol each year (2,000 college students) -More than 2% of night-time drivers have a blood alcohol that exceeds legal amounts (0.08%) -Moderate/long-term alcohol use contributes to mouth, GI tract, liver and breast cancer. -Chronic alcohol use can lead to dependence - Alcohol use is the 2nd leading drug related cause of premature death in US (tobacco #1)

Effects of Alcohol in the Brain

-Alcohol is a CNS depressant -Work in the CNS by binding and activating GABA receptors: GABA agonist, intensifies the inhibitory effects of GABA, neuronal activity is further diminished.

Alcohol as a Drug

-Alcohol is a psychoactive drug and a CNS depressant (alcohol suppresses CNS activity at all doses) -Approx. two million treatment for drug abuse, 64% are treated for alcoholism.

Fetal Alcohol Syndrome:

-Alcohol is a teratogen -Damage is dose related -A safe lower level of alcohol consumption has not been established for pregnant women.

Alcohol and the Family

-Alcohol is considered a family disease. -25% of American children are exposed to an alcoholic before the age of 18.

Dose-Response:

-All effects, both desired and unwanted, are related to the dose or amount of a drug administered. -Factors that affect the way an individual responds to a drug: Dose, Tolerance, and potency. -A dose-response curve illustrates the correlation between the amount of a drug administered (dose) and its effects (response) on an individual user.

Treatment of alcoholism

-Breaking denial as a psychological defense -Relapsing syndrome: return to use after quitting. Easy to relapse without a radical shift in lifestyle -Alcohol rehabilitation and medical ramifications: treatment modality. Treatment of co-occuring disorders. -Ongoing support.

The Effects of CNS Depressants

-CNS depressants reduce CNS activity and diminish the brains level of awareness -"High" due to dis-inhibitory effects on the brain. -Short-acting depressants are more likely to be abused (rapid onset, intense effects) -Depressant drugs include (alcohol, antihistamines, barbiturates, benzodiazepine and opioid narcotics)

Drug Receptors

-Chemical messengers from glands and neurons exert their effects by interacting with special protein regions in membranes called receptors. -Receptors only interact with molecules that have specific configuration.

What is required to deal with alcohol related social problems

-Education -Prevention -Treatment

Barbiturates

-Important historical role as sedative-hypnotic agents -General depression of most neuronal activity -Narrow margin of safety and abuse liability, they were mostly replaced by benzodiazepines "Schedule" varies by preparation: II, III & IV High Abuse potential Severe tolerance and physical dependence

Physical Effects of Alcohol

-Influences almost every organ system in the body after entering the bloodstream. -The effects of alcohol on the human body are dependent on the blood alcohol content (BAC)

Short-Term Effects of Alcohol

-Low to Moderate doses: Disinhibiton, social setting and mental state can determine the individual response (euphoric/friendly/talkative)(aggressive/angry/hostile), Interference with motor activity, reflexes and coordination. -Moderate doses: Slightly increase HR. slightly dilates blood vessels in arms, legs, and skin. Moderately lowers BP. Stimulates appetite, increase in urine output (antidiuretic hormone). -Higher doses: Socialsetting has little influence on effects. Severe CNS depression and impairment in motor activity. Difficulty walking, talking, thinking. Induces drowsiness and causes sleep. Induces a hangover when drinking stops. -Larger amounts consumed rapidly: Severe depression of the brain stem and motor control areas of the brain. Lethal alcohol level between 0.4%-0.6% by volume in the blod (cardiovascular and/or respiratory failure).

Alcohol Metabolism:

-Metabolizing enzyme, alcohol dehydrogenase, is made in the liver: -Ethanol>(alcohol dehydrogenase)> Acetaldehyde> (aldehyde Dehydrogenase)>Acetate

Pharmacokinetic Factors

-Method of administration (oral ingestion, inhalation, injection) -Manner and rate of Absorption -Manner and rate of distribution (solubility and molecular size) -Manner and rate of activation -Manner and rate of Biotransformation (changing the chemical properties/pharmacological properties of drug by metabolism) -Manner and rate of elimination

Moderate to excessive drinking during pregnancy can result in

-Spontaneous abortion -Damage to fetus: Fetal Alcohol Syndrome (FAS)

Potency:

-The amount of drug necessary to cause an effect. -The smaller the dose required to achieve an effect, the greater its potency.

Toxicity:

-The capacity of a drug to do damage or cause adverse effects in the body. -A potent drug will likely have much more serious adverse effects in an ill person (HOMEOSTASIS DISTURBED) than in a healthy person who can adjust to tolerate its toxicity. -Drugs with high potency are often toxic even at low does. Particularly dangerous when these drugs are abused.

Alcohol Withdrawal

-Well-nourished/mostly healthy alcoholics can usually go through withdrawal safely in an outpatient setting. -Ill alcoholics require medical supervision to detox -Benzodiazepines/barbiturates can lessen or alleviate alcohol withdrawal symptoms.

Difference in alcohol metabolism between genders and races

-men are larger than women -alcohol is mostly water soluble (males have higher tolerance bc higher body water content. Females have lower tolerance bc higher body fat content.) -Males have more alcohol

"wet" vs. "dry" culture

1. "Wet" cultures: Alcohol is integrated into daily life activities. Abstinence rates are low. 2. "Dry" cultures: Alcohol consumption is not as common during everyday activities. Abstinence is more common. When drinking does occur, more likely to result in intoxication.

Agonist vs. antagonist:

1. Agonist: Substances or drugs that activate receptors. 2. Antagonist: Substances or drugs that attach to receptors and prevent them from being activated.

Four reasons why many people view alcohol as a non-drug

1. Alcohol is legal 2. Alcohol is widely available/easy to obtain 3. Long history/acceptance of alcohol use 4. Advertising and media promote drinking as normal/ acceptable

Adaptive processes chart.

1. First drug experience 2. (a) Rewarding (b)unrewarding 3. (a) frequent use (b) stop use 4. (a)body, brain, adaptation 5. (a) dependence (b) Tolerance 6. (aa) psychological (ab) physical (b) increase drug dose to maintain effect. 7. (aa) Abstinence causes craving and emotional discomfort. (ab) abstinence causes withdrawal and rebound.

Four Common Types of Alcohol

1. Methanol (poisonous): methyl or wood alcohol. Small amounts>Blindness/larger amounts> death. 2. Isopropyl alcohol (poisonous): rubbing alcohol 3. Ethylene Glycol (poisonous): Used in antifreeze 4. Ethanol (beverage alcohol): grain alcohol. Alcohol content expressed as a % by volume.

Anandamide (Common Neurotransmitter)

1. Neurotransmitter- Anandamide. 2. Type of effect- Inhibitory. 3. CNS change- relaxation/Increase sense of well being. 4. Drug of abuse- Tetrahydrocannabinol

Drug Dependence (physical and psychological)

1. Physical: Withdrawal and rebound 2. Psychological Dependence: Craving

Set vs. Setting

1. Set: an individual's expectation of the specific effect a drug will have on them. 2. Setting: The physical and/or social environment where drugs (including alcohol) are consumed.

Types of CNS Depressants

Barbiturates and Benzodiazepines

Adaptive Processes

Drugs interfere with the normal workings of the body (disrupt homeostasis)

Potentiative (synergistic) effects

Effect of a drug is enhanced by another drug or substance.

Kidney is most important to..

Eliminate drugs from body

Asian Glow

Flushing due to buildup of toxic acetaldehyde is observed I approx. 1/3 of Asian populations

Acute drug response (Time-response factor)

Immediate or short-term effects experienced after taking a single dose of a drug.

Very impaired or loss of control

Inability to limit drinking once begun.

Chronic drug response (Time response factor)

Long-term effects experienced after taking a drug over an extended period of time.

Liver is the major organ that..

Metabolizes drugs in body

Drug Interactions

Occur when the presence of one drug alters the action of another drug (can be misdiagnosed as symptoms of disease. Highly problematic is substance-abusing pop. Etc.)

Antagonistic (Inhibitory) effects

One drug cancels or blocks effects of another.

BAC produced depends on

Presence of food in the stomach, rate of alcohol consumption, drinkers body composition, concentration of alcohol.

Cirrhosis

Scarring and fibrosis. Irreversible.

Additive effects

Summation of effect of drugs taken concurrently.

Acute alcohol withdrawal syndrome

Symptoms that occur when an alcohol-dependent individual does not maintain his/her usual blood alcohol concentration

Delirium Tremens

The most severe, even life-threatening, form of alcohol withdrawal, involving hallucinations, delirium and fever

Physical dependence

Withdrawal symptoms when attempting to abstain (i.e: nausea, sweating, anxiety)

Women and Alcohol

Women possess greater sensitivity to alcohol, have a greater likelihood of addiction, and develop alcohol-related health problems sooner than men

Fermentation

process of making alcohol. Sugar, eater, yeast and heat. Distillation concentrates alcohol

Cumulative effect

the buildup of drug concentration in the body due to multiple doses taken within short intervals.

Plateau Effect

the maximum effect a drug can have regardless of dose.

Threshold Dose

the minimum amount of a drug necessary to have an effect

Depressants are typically classified according to the specific effect they have on the body and different effects with dosage

•Sedatives: cause mild depression and relaxation. Anxiolytic drugs relieve anxiety. LOW DOSE (relieve anxiety and promote relaxation) •Hypnotics: induce drowsiness & encourage sleep. Amnesiac effects refer to memory loss. HIGH DOSE (cause drowsiness and promote sleep) •Anesthetics: induce a deep state of CNS depression resulting in unconsciousness. EVEN HIGHER DOSE (induced anesthesia. Used for patient management during surgery)