Hello everyone and welcome back. In this section I would like to provide
you with a little bit of an overview of substance abuse and why it is
important. Let's begin by going to slide two.
As we can see, when we talk about psychoactive substances (or what we
call drugs),. drugs, as we know, influence many, many things within an
individual. They influence emotions, thinking patterns or thoughts, they
influence their behavior, and of course, they influence physiology. So, you
might ask, "So what? Who cares? It's my responsibility as the individual
using the drug."
Well, as we see in slide three, it’s not just the individual’s
responsibility. Substance abuse also influences society as well. Crime is
often driven by substance abuse. Domestic violence, especially alcohol use
and alcohol dependence, has a major, major impact on domestic violence. HIV
AIDS, /STD's/, Hepatitis are being primarily driven now by injection drug
use, and that is then spreading into the heterosexual population.
Educational quality has also been deteriorating. When you are on drugs
you can't think well, you can't understand information, and you can not
recall that information later in your life. The ultimate cost to society
from the use of substances is in the billions. Some of which I showed you in
the previous section. For example, insurance costs for driving while
intoxicated and killing somebody, plus judicial costs and corrections.
Millions and millions and billions of dollars are spent in the criminal
justice system and in the prison system just for substance abuse. Medical
costs covered by the taxpayers are also involved. If you get hurt while
using substances and you don't have a job or insurance or anything else, who
pays? You, (the public) do!
Substance abuse just does not relate to cocaine or methamphetamine or
some other illicit substances out there. Two of the substances out there
that we take cause many, many problems and shown in slide four. The first of
these is nicotine addiction, primarily through the smoking of cigarettes.
Nicotine addiction causes many, many problems. Especially, when one smokes
the substance into their system. Smoking kills thousands of people every
year. It also causes second-hand smoke which also kills and injures many,
many other individuals. It also causes your house to stink. The reason
people continue to smoke is because they are addicted. These people are
addicted to nicotine and there is no difference between the addiction they
have to nicotine and the addiction that they have to other substances. If
they try to quit they go through withdrawal, they have major problems with
relapse rates, etc. I will tell you that smoking is the hardest addition to
kick.
The other major substance that we also take that is legal is alcohol.
Alcohol, as we will see in the next major section is a very, very damaging
substance but it also causes lots and lots of problems. Thirty to forty
thousand people per year are killed because of alcohol related accidents. We
also have many individuals who get DUI's or DWI's. Domestic Violence is also
highly linked to alcohol ingestion as well as rape and other types of
violence.
So, if we know about all the damage from these drugs, why do we start to
use them in the first place? Well, as we can see on slide five, there is a
general progression of use. Who starts you using these substances? Well,
your friends usually start your use, and usually the person begins
reluctantly. When we do begin using, we begin to use these drugs
recreationally. Over time as you continue to use them you will build
tolerance. That is, you need more and more of the drug to get the same
effect. As this progression continues we begin to develop a substance abuse
problem. That is, we're using the substances more and more often. This
causes problems with yourself, with your family, or to society in general.
And as we continue to use these substances we move into substance
dependence. That is, you have to have the drug to function. You experience
withdrawal when you do not have it, etc. The classic examples are cigarettes
and coffee. How many of you out there who are cigarette users, when you wake
up in the morning you have to smoke a cigarette within the first twenty
minutes? Or, how many of you have to drink your coffee just to get yourself
going in the morning? These are substances that we use and are addicting.
Why do we use these substances? As you can see in slide six, we use them
because they make us feel good. They also relieve a lot of tension and
anxiety. They relieve stress. We also use these drugs (and start to use
these drugs) because of peer pressure. As we continue to use them over a
period of time, and we try to stop using them, it becomes painful from
withdrawal. So, they basically are used to relieve the pain. You also may
use substances to relieve the pain of some emotional thing that happened to
you. Thus, the pain relief can be physiological such as with morphine or
other types of opiates, or it can be psychological. Finally we also use
substances as part of religious experiences. This is especially true in some
of the Native American cultures.
Well, what are some factors for determining substance abuse? Well, as we
can see, cultural factors have a very, very important role in this. Society
basically pushes lots and lots of drugs on us. All you need to do is look at
the advertising out there for all sorts of different substances that we use,
both illegal and legal. There are also a lot of subgroup factors. That is,
if you are not using a particular substance in some particular group people
look upon you with suspect. That is, why are you here? The context where you
use the substance will also be very, very important. Go to a country club,
walk in the door, what is the first thing they ask you? "What can I get you
to drink?"
Pharmacological effects are also important. We need some compounds to
help us. However, the pharmacological effects we also use (and give to young
children) have the some kind of effects that we have with other major
illicit drugs such as, stimulants.
Now, there is a major text we use to differentiate between the different
levels of substance use. This is the DSM-IV. In the DSM-IV we identify three
major groups: Substance Intoxication, Substance Abuse, and Substance
Dependence. We're going to talk about this more as we talk about assessment,
but the major issue for substance dependence for us now is that is two
things need to happen. These are shown in slide nine.
For substance dependence or abuse you have to have tolerance. That is,
you need to have more and more of the drug to have the same effect. Second,
you have to have withdrawal. That is, you experience symptoms that are
opposite of the drugs that you had taken into your body. So, when you take a
stimulant and you are coming off the drug you experience lethargy, and when
you are taking depressants and you stop the drug you experience stimulation.
The classic example for depressants is alcohol.
One of the major issues that accompanies withdrawal is shown in slide
ten. Withdrawal is often cited as the major reason for continued use. It is
primarily important in relation to the issues from operant psychology, like
the use of negative reinforcement. The reason that you use these drugs is
number one, to escape negative symptoms. For example, if you are coming off
heroin and you are feeling really bad, you need to use the heroin again to
stop feeling those unpleasant symptoms. Another reason to continue to use it
is to avoid those unpleasant symptoms, that is, we don't want to experience
the withdrawals in the first place. So, as a result, the use continues.
A classic example is shown in slide eleven with the use of
methamphetamine. Specifically, when you begin using methamphetamine you feel
more alert, you feel stimulated, etc. As time continues and you begin to use
it more and more, often you experience withdrawals When you stop using it,
you feel lethargic, depressed, feel down, etc. You just can't seem to get
going, and you feel weird! That is, what used to be normal to you now is
weird. As a result, you use the drug again to feel normal.
Tolerance, as we see in slide twelve, is also very important. Basically,
what you need to do is understand that you need more and more of the same
drug to have the same effect. An example is alcohol. When early users (such
as youth) have one to two beers, man, you get a really good buzz. Middle
users need five or six beers. And for people who have been using over a
period of time you need ten, or twelve, or fifteen beers before you are
beginning to get a buzz. Of course the problem is that you have all sorts of
health related problems when you using the alcohol such as reaction time
problems, and, of course, you have withdrawal symptoms when you are not
using.
In slide thirteen, I want to talk a little bit about the dimensions of
drug use and abuse. Basically, it is based upon a continuum. You have
dependence on one end and non-users on the other end. That is the people who
are abstinent with recreational and experimental users in the middle. It
does not matter which drugs you are using, whether it be legal or illicit
drugs, the continuum basically works the same.
There are also different types of categories of different drugs and I
have listed several on slide fourteen. These can be legal or illegal. As you
see here we have stimulants, hallucinogens, depressants, opiates, analgesic
steroids, etc. So there are lots of different categories. There are also
some drug terms we use out there, as well. For example, There are the
gateway drugs. These are the drugs that presumably cause you to go on to
other drugs, and the classic example is marijuana. What people often do not
tell you is that other drugs often precede the use of marijuana, such as,
caffeine, nicotine, and other types of things. In addition, those gateway
drugs are also correlational to other drugs. So, you have to be a little
careful when you discuss that issue.
We also have over-the-counter drugs. Over-the-counter drugs are any kind
of drug that you can buy in a regular supermarket. And, of course we also
have, finally, designer or synthetic drugs. These are drugs that are
developed in the laboratory and then used for some particular types of
illness or other thing.
So, as you can see in slide sixteen, we have lots and lots of different
compounds. We also have lots and lots of different issues that drive
substance use and substance abuse. And, as I have shown you here a little
bit, the use is influenced by lots of different variables; and, also the
potential for abuse is influenced by lots of variables. As you get into this
course and we talk a little bit about issues, you will see the differences
of use and abuse and dependence are influenced by many, many things that are
out there.
Well, that concludes this section. In our next section we're going to
talk about some theories of substance abuse, and here we're going to show
you how those different types of research methods are very, very important
in evaluating the different theoretical modals that we have that describe
substance use and abuse. So until then, we hope you are having yourself a
great day and we look forward to talking with you soon.
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