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Week 2 drug use and addiction

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Another resource from uneOpen – the first open online site to offer credit towards a university degree. Enrol now at https://www.uneopen.com/

Another resource from uneOpen – the first open online site to offer credit towards a university degree. Enrol now at https://www.uneopen.com/

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  • 1. Week 2: Drug use andaddiction (full lecturescript)
  • 2. What we understand as a ‘drug’ is flawed – it is a social construct – and by that Imean, what we understand as a ‘drug’ is subject to our social and cultural beliefs.In other words, how we define a ‘drug’ is determined by our society and ourculture.What we view as a drug also influences who we see as ‘drug users’ and how werespond to drug use in our society. This is not an objective activity. Drugs is ahighly subjective topic, both in definition of it and reaction to it. For example, howmany of you would feel offended if you were called a ‘drug user’ and yet many ofyou would regularly drink coffee, coke cola, caffeine drinks like Red Bull andMother, some of you may even smoke cigarettes, and probably many of you drinkalcohol. At some point in your life you have invariably taken both prescription andover the counter medication without ever consider yourself as taking drugs. Andyet, you possibly still have quite strong reactions and firm views about society’s‘drug problem’ and what should be done about ‘drug users’. Many sociallyaccepted activities in Australian society rely or promote drug use (remember tobroaden understanding of what constitutes a drug).Cocaine was once an ingredient in Coca-Cola – and as long as the companycontinues to use coca leaves then molecules of cocaine will remain in this drink(Clinard and Meier 2008, 213)
  • 3. • How do we define drugs? - is it a psychological or physical altering substance?• Why are some drugs stigmatised and others not (heroin v caffeine)• Is it the use of the product itself or the activity associated with the product that makes it problematic?ie, crime more likely associated with products deemed drugs because they are harder to obtain as the act ofprohibition/criminalisation pushes a product onto the black market thus inflating its value. In contrast, thereis often no or minimal crime associated with so called legal drugs (with exception of many activitiesassociated with young people).• What about alcohol? How does it fit in the picture of drug use and social harm?• “The word drugs covers a range of substances from aspirin and antacid pills to alcohol; hallucinogenic drugssuch as marijuana; stimulants like caffeine, nicotine, and cocaine; mind-altering drugs; mood modifiers; andpsychoactive narcotics like heroin that profoundly affect the central nervous system, influencingmood, behaviour, and perception through action on the brain” (Clinard and Meier 2008, 206)• According to Clinard and Meier “a drug refers to a substance with a chemical basis” (2008, 206) – but thisdefinition encompasses an extremely wide range of substances, many of which are not associated withdeviancy so there must be some other criteria that, combined with this definition, makes some substances‘drugs’ and others not.• Goode argues a drug is a drug simply because society says it is (2004, 58 cited in Clinard and Meier2008, 207)• “To judge deviance, one must identify the norms that govern use of a particular drug and the situations inwhich they allow or prescribe its use” (Clinard and Meier 2008, 209)• There is therefore a general ambivalence in most western societies about drug use because many commondrugs are not recognised as drugs, some societies even legalise what we generally think of as illicit drugs(ie, Amsterdam).
  • 4. Addiction is strongly associated with drugs, and means users need higherand higher doses to get the same effects as the body builds a tolerance tothe toxic effects of the drug.Addiction occurs through regular dosage rather than level of drug. Thatis, addiction occurs by regularly using rather than intermittent use of highlevels. Addicts need daily dose of drugs to operate relatively normally andwithdrawal occurs between 10-12 hrs after a missed or withdrawn dose.Methadone is used as a substitute to drugs like heroin and morphine, bit isitself highly addictive. The difference between methadone and the otherdrugs it is intended to replace is that users only need one daily dose whereaswith heroin they may need up to 3 in order to operate normally.It is generally thought marijuana is addictive, however research does notsupport this assertion. It is also thought that marijuana acts as a ‘gateway’drug leading users on to harder drugs. Once again however, researchevidence does not support this theory.
  • 5. This slide shows some common drugs and the percentage of users ofthe known population of addicts in the US. It shows marijuana is themost widely used drug followed by pain killers.
  • 6. AddictionThe textbook refers to addiction as “physical dependence” (Clinard and Meier 2008, 222).Schaef defines addiction “as any process over which we are powerless” (1987 cited in Clinard and Meier 2008, 222)This definition of addiction as powerlessness is popular among organisations claiming to help addicts beat addictions, such asAlcoholics Anonymous and Narcotics Anonymous as a crucial step in their treatment programs is often the recognition by the addictthat they have no control over their addiction.But these definitions are unhelpful as they capture many behaviours we do not generally associate with addiction, such as obsessivecompulsive disordersClinard and Meier (2008, 223) adopt a definition of addiction as the use of a substance that causes physiological consequences fromits withdrawal and “those substances are physically dependence producing”. Thus, an addict is someone who uses dependenceproducing substances and experiences distress when not using this substance. By this definition, a user of substances who fails toexperience distress when not using is not considered an addict.Wikipedia has the most comprehensive definition of addiction.“Addiction is the continued use of a mood altering substance or behavior despite adverse dependency consequences, or aneurological impairment leading to such behaviors.Addictions can include, but are not limited to, drug abuse, exercise abuse, sexual activity and gambling. Classic hallmarks of addictioninclude: impaired control over substances/behavior, preoccupation with substance/behavior, continued use despiteconsequences, and denial. … Physiological dependence occurs when the body has to adjust to the substance by incorporating thesubstance into its normal functioning. This state creates the conditions of tolerance and withdrawal. Tolerance is the process bywhich the body continually adapts to the substance and requires increasingly larger amounts to achieve the original effects.Withdrawal refers to physical and psychological symptoms experienced when reducing or discontinuing a substance that the body hasbecome dependent on. Symptoms of withdrawal generally include but are not limited to anxiety, irritability, intense cravings for thesubstance, nausea, hallucinations, headaches, cold sweats, and tremors.”http://en.wikipedia.org/wiki/Addiction
  • 7. In the addiction discourse, the professional terminology istolerance, dependence and abstinence syndromeTolerance refers to the amount of drug an individual must use in orderto achieve their desired effect. The more frequent use of a druggenerally requires a higher dose as the body develops a tolerance to adrug’s affects over time.Dependence refers to the need or desire to use a drug. A greaterdependency will produce a more distressing craving or overwhelmingdesire to use a drug.Abstinence syndrome refers to the physical effects of withdrawal fromregular drug use. Withdrawal syndrome is the term most often used torefer to adults experiencing the negative physical effects of drugwithdrawal. Whereas, abstinence syndrome is more widely used torefer to the physical effects of drug withdrawal on newborn babies.
  • 8. Addiction is not merely associated with illicit drugs. Nicotine is a legalsubstance renowned for its highly addictive properties. Quit Victoriadefine nicotine as a drug of addiction and argue that one in twolifetime smokers will die from a disease caused by their smoking. QuitVictoria argues, in 2004-05 there were a total of 14,901 deathsattributable to tobacco use. {http://quit.org.au/resource-centre/fact-sheets/deaths-from-smoking}.
  • 9. Not all addiction is considered socially deviant. The following table providesa continuum of social acceptability of addictive behaviour.“The table shows some examples of common addictive behaviors, whichillustrate the continuum from socially deviant to socially problematic tosocially acceptable behaviors in mainstream Western cultures. These are notmeant to be rigid categorizations, but simply examples of how behaviorstend to be perceived -- for example, illegal activities such as underagedrinking are classed as "deviant," whereas in reality, this is quite commonand often accepted by youth and adults. Some behaviors have shiftedposition in recent decades, for example, smoking cigarettes is sociallyproblematic, but not yet socially deviant, while it was socially acceptablethirty years ago.” {About.com/addictionshttp://addictions.about.com/od/howaddictionhappens/a/deviant_behavior.htm}.
  • 10. • There are different types of users: recreational, habitual (not all regular drug users are dependent drug users), anddependent• Addiction doesn’t simply occur because someone uses an addictive substance. Addiction is much more complicated andresearchers believe it is partly a social process. In other words, a user often needs to be exposed to an addict society inorder to become an addict. This group socialisation appears to be an important factor determining whether someonebecomes an addict or simply a habitual, regular, or recreational user. Usually people are introduced to drugs byfriends, family, workmates, classmates, team mates etc.• After introduction to a drug, a user needs to develop a motivation to continue using. Some motivations are identified as:pain relief; to fit in; to please others; to produce euphoria; for kicks; to overcome reluctance to do something else(ie, strippers and prostitutes often use drugs before working); to relief pressure of stress (often profession related); to helpwith concentration; to assist performance (ie, students, sports people); some other reason• Drug use is high among some subcultures – street cultures, surf cultures, in the US ghetto cultures (less so inAustralia), nightclub cultures, body building etc• All of which reinforce the notion group culture is a necessary precondition for addiction.• Maintaining a drug habit can be an all-consuming existence: finding money to buy drugs, scoring drugs, gettinghigh, repeating the process• Contrary to general belief, addicts do not use in order to withdraw from social engagement, as addict subculture is acrucial factor in sustaining addicts and plays an important role in their socialisation. In other words, an addict may not beengaging in conventional society, but they are often heavily involved in their own sub or street culture. Successful druguse cannot be sustained and developed without the sub/street cultures along which drug networks are maintained and anew user must successfully negotiate their local drug community in order to become a regular, and subsequently, addicteduser. Unsuccessful attempts to infiltrate this culture would create a serious impediment to developing a drug habit as theuser would find accessing and purchasing drugs extremely difficult.
  • 11. • The opiate cycle of addiction is understood as:• Experimentation or initiation – usually in the company of peers; most users do notcontinue with opiate use, but some do.• Escalation – pattern of frequent use develops leading up to daily use, physicaladdiction, and increasing intolerance.• Maintenance – stable regular use. Generally user can function normally keeping up withgeneral home/work responsibilities• Dysfunction – negative effects of continued use start to arise such ascriminalisation/incarceration/treatment. Addict may make attempts to quit, but oftenfails (70-90% of addicts relapse).• Recovery – addict needs to develop a successful attitude to quit drugs (they have to wantto get off drugs), often goes hand in hand with major life changes such as changing peergroups or getting out of relationships etc. (Strangely, research has found, many addictsdo successfully kick their habit after many years of use and often without treatmentsuggesting attitude is the key variable in successful withdrawal from drug use).• Ex-addict – acquisition of a new social identity, that of the ex-addict, no longeridentifying as an addict. (Clinard and Meier 2008, 229)
  • 12. Responding to drug use and addictionThere are two control responses – control the substances and controlthe behaviour of those involved with drugsStrategies for controlling substances are restricting imports anddecriminalisation (decriminalisation deflates value of drugs andremoves incentive for criminals to engage in these activities)Strategies for controlling individuals involved in drugs are applyingcriminal sanctions, diverting users into treatment programs, operatingself-help programs to encourage people to stop using drugs, andeducation programs to stop people trying and forming drug habits inthe first place.
  • 13. CriminalisationTwo perspectives dominate public policy strategies – legalist models v health and welfaremodelsCountries using legalist models adopt tough on drugs measures such as harsh criminalsanctions like imprisonment, though sentencing measures, and often three strikes policiesand often refer to a ‘war on drugs’ or ‘get tough on drugs’ policies (ie, US, Indonesia etc).Laws are generally designed around prohibitions on theimporting, manufacture, selling, using and possession of certain drugs. Most crimeassociated with addicts is property crime as users steal goods to sell to fund their habit.More serious crime is generally associated with those involved in theimporting, manufactue, and selling of drugs.Health and welfare models offer an alternative view of drug use and see users as peoplewith problems and not as criminals. The health and welfare model reduces associatedcrime, deflates price of drugs, controls associated health risks, as governments become thedrug supplier.Although many proponents of the health and welfare model advocate decriminalisation ofminor drugs like marijuana, they do not do so for harder drugs such as heroin or cocaineinstead preferring medical administration of the drug under strict conditions with medicaladministration of heroin only available for confirmed addicts and not recreational or casualusers. The UK and many western European counties adopt this model.
  • 14. Abolitionists (those who want to see the legalisation of drugs) argue people shouldbe free to live their lives as they see fit even if that means practicing self-destructive behaviours. They also argue criminalising some drugs ignores themajor social problems caused by other substances such as alcohol and cigarettes.Prohibitionists (those who advocate the criminalisation of drugs) argue comparingthe costs of legal and illegal substances is flawed. This is because, although deathrates from alcohol and cigarette use is very high, these substances are freelyavailable and widely used. Drug use in comparison is more controlled as not aswidely used therefore, although the drug death rate is much lower thanalcohol/tobacco death rates, if drugs were freely available the rate of death wouldincrease significantly. That is, the control of these drugs is the primary reason thedrug death rate is relatively low.Australia has a mix of legal and health and welfare models with the legalistic modeldominating with criminal sanctions applying to drug use. However the health andwelfare model is evident in the use of drug courts and drug diversion programs.Some states in the US are now decriminalising marijuana and many others allow itslegal use as a medical treatment for pain relief.
  • 15. “Since 1985 harm minimisation has been adopted by Australian Governments as the national framework for addressing therange of issues related to alcohol and other drugs in Australia. The National Drug Strategy 2004 - 2009 adopts a harmminimisation approach to the use of illicit drugs and the misuse of licit drugs. There are three aspects used when addressingalcohol and other drug use through a harm minimisation approach:reducing the supply of drugsreducing the demand for drugsreducing the harm from drugs.”“Harm minimisation acknowledges that some people in societies will use alcohol and other drugs and therefore incorporatespolicies which aim to prevent or reduce drug related harms. ... As of March 2009 at least 84 countries worldwide supportedor allowed a harm reduction approach to drug policy (International Harm Reduction Association, 2008).Harm reduction is defined as “policies, programmes and practices that aim to reduce the harms associated with the use ofpsychoactive drugs in people unable or unwilling to stop. The defining features are the focus on the prevention ofharm, rather than on the prevention of drug use itself, and the focus on people who continue to use drugs” (TheInternational Harm Reduction Association, 2009).“An example of a harm reduction approach is Needle and Syringe Programs. These programs have been implementedeffectively in Australia for over 20 years, and provide sterile injecting equipment to injecting drug users to reduce the sharingof needles and prevent the spread of HIV, Hepatitis C and other blood borne viruses.”“The effectiveness of these programs has been evaluated in Australia. The evaluation found that approximately 32,000 newHIV infections and 97,000 new Hepatitis C infections had been prevented during the decade 2000-2009 as a direct result ofthe Needle and Syringe Programs. In addition, the programs resulted in health care cost savings of over four dollars for everyone dollar spent.” {http://nceta.flinders.edu.au/society/harm-minimisation/ Return on Investment 2: Evaluating the cost-effectiveness of needle and syringe programs in Australia 2009}.
  • 16. TreatmentTreatment programs generally aim to eliminate an addict’s addictionand thus stop them from using drugs – to get them to a state ofabstinence.In Australia, treatment is used as an alternative to incarceration, oftenwith the condition that if an addict does not complete the programthey serve unfinished time in prison. Most treatment programs usemethadone is a heroin substitute as a mechanism for slow withdrawalfrom this highly addictive drug. These programs often have a highrelapse rate as addicts must change their attitudes and behaviours inorder to successfully become drug-free (remember successfulwithdrawal requires serious lifestyle changes that can only becommitted to via a major change in attitude towards drug use).
  • 17. PreventionThere are two main aspects to prevention methods – media and education.The use of media to inform and scare would be users into avoiding drugs is astrategy used from time to time, often when there is a policy initiative beingundertaken regarding a certain drug (you should all remember the mediacampaigns of the last couple of years over ecstasy and the scare tactics used likeshowing drug labs in dirty bathrooms and toilets and the toxic chemicalsmanufacturers often use).The main form of prevention method used is education. Most schools have drugeducation programs designed to inform students about the hazards of drug usewith the aim being to discourage any experimentation or use of drugs.Drug education programs can also be implemented into specific industries thathave the potential for high use (such as escort and brothel workers), seriousconsequences for those that might use drugs while working (such as mine and oilworkers, truck drivers), or those where their jobs provide them access to drugs(such as law enforcement, medical and dental professions etc).
  • 18. “Like most problems in deviant behaviour, prevention of drug use is notan easy task. The practice of taking drugs to achieve physical effectshas become well ingrained in society, and only an extremely fine lineseparates legal drug therapies from illegal drug use in many respectsand social situations” (Clinard and Meier 2008, 251)
  • 19. Questions from textWho determines whether a substance is to be defined as a drug in Australia? (discussion about the role of community generally viewing the use of a particular substance as undesirable, thenmove through the processes of lobbying governments for change, and the final role of legislation).What are some of the ways substances defined as ‘drugs’ are controlled in Australia? (ie, criminalisation, regulation, controlled use (via treatment programs etc)).What is ‘the war on drugs’ and has it been a successful campaign? Why/why not? (ie, criminalisation pushes drug use underground, increases value of illegal drugs, more crime associatedwith illegal drugs, regulation controls drug use (makes it boring), takes away the huge profits for criminals engaged in cultivation and selling (government becomes the dealer), can also discussthe difference between the criminal model and the health & welfare model of drug control, also need to mention the high financial and social costs of this policy as costs lots of money andpeople to police drugs, clogs up criminal justice system, makes criminals of users etc).Clinard and Meier argue “public concern over drugs varies in faddish cycles” – can you identify when there has been public hysteria about particular substances and when other substanceshave lost their ‘allure’? (ie, popular use of opiates/cannabis pre-1940s (government gave troops cannabis cigarettes during WWII), general ambivalence about alcohol, increasing concern inlast 10 yrs over youth’s use of alcohol, growing intolerance with tobacco and smokers etc, general ambivalence about over-medication of children via Ritalin, over-use and/or abuse ofprescription drugs, non-recognition of more damaging substances like adult use of alcohol).Why is drug use seen as a social problem? (discussion about the costs of drug use to society – crime (local, national, international), economic costs (loss of productivity of individual andeconomic losses to society), social costs (underproductive and dependent citizens – poor citizenship); and for the individual – health risks (HIV/AIDS, hepatitis, death from overdose, risks fromunknown substances mixed with some drugs, paranoid psychosis, organ failure), crime risk (incarceration, committing crimes to fund habit, being a victim of crime), social risks (losingjob, family, becoming homeless, losing relationships etc)).Certain types of drugs more commonly associated with different groups in society such as: (class discussion on this issue):ecstasy – young people, especially those who frequent nightclubs & ravesheroin – generally associated with street addicts, ie, those most often seen as homeless, unemployed, low socio-economic individualscocaine – often associated with middle, upper and professional classesmethamphetamine –cannabis – surf cultures, hippie cultures, young people generally,What about professions? Clinard and Meier state medical professions have high rates of functioning users, what other professions would be susceptible to high rates of drug use? And why?(any occupation that places high demands on individuals via long hours, shift work, need for high concentration levels, high risk occupations, ie, truck drivers, doctors, medical students, policeofficers, mine workers, professional sports persons (Lance Armstrong, AFL players), regular shift workers, musicians, escorts and prostitution industry, … - remember too, that many of theseindustries employ drug testing mechanisms to control and limit drug use in the profession which should be an indication that the industry does or has had a problem in the past).
  • 20. Weblinkshttp://nceta.flinders.edu.au/ National Centre for Education and Training on Addictionhttp://ncpic.org.au/ National Cannabis Prevention and Information Centrehttp://ndarc.med.unsw.edu.au/ National Drug & Alcohol Research Centrehttp://ndri.curtin.edu.au/ National Drug Research Institutehttp://www.ndlerf.gov.au/ National Drug Law Enforcement Research Fundwww.turningpoint.org.au/ has interesting research on drugs policy in Australia including costs of policing drugs, policies ondrugs, and timeline for drugs policieshttp://australia.gov.au/topics/health-and-safety/drug-and-alcohol-use Australian government links to resources for drugs and alcoholhttp://www.unodc.org/unodc/en/illicit-drugs/definitions/index.html United Nations Office on Drugs and Crime – can access UN pdf‘Get the Facts about Drugs’ from this site which is an easy to read brief document outlining some back facts are common drugsincluding what each one is and the effects each has on users, including risks.http://www.radar.org.au/completed.aspx Register of Australian Drug and Alcohol Research sets out current and completed drug andalcohol studies in Australia.http://addictions.about.com/od/howaddictionhappens/a/deviant_behavior.htm Addictive behaviors - from socially acceptable todeviant behaviorhttp://www.legislation.nsw.gov.au/xref/inforce/?xref=Type%3Dact%20AND%20Year%3D1985%20AND%20no%3D226&nohits=y DrugMisuse and Trafficking Act 1985 NSW – look up definitions of drugs in Part 1 section 3 of the act
  • 21. AIC websiteTrends and Issues:Amphetamine users and crime in Western Australia, 1999-2009How much crime is drug or alcohol related? Self-reported attributions of police detaineesMeasuring drug use patterns in Queensland through wastewater analysisResearch in Practice:Drug use among police detainees: a comparative analysis of DUMA and the US Arrestee Drug Abuse Monitoring programIncrease in use of methamphetaminePharmaceutical drug use among police detaineesNSW Bureau of Crime Research and StatisticsTrends in possession and use of narcotics and cocaine http://www.bocsar.nsw.gov.au/lawlink/bocsar/ll_bocsar.nsf/vwFiles/bb52.pdf/$file/bb52.pdfThe impact of the Australian heroin shortage on robbery in NSW http://www.bocsar.nsw.gov.au/lawlink/bocsar/ll_bocsar.nsf/vwFiles/BB26.pdf/$file/BB26.pdfThe effectiveness of methadone maintenance treatment in controlling crime: An aggregate-level analysishttp://www.bocsar.nsw.gov.au/lawlink/bocsar/ll_bocsar.nsf/vwFiles/BB24.pdf/$file/BB24.pdfThe criminal history profile of methadone clients: a research note http://www.bocsar.nsw.gov.au/lawlink/bocsar/ll_bocsar.nsf/vwFiles/BB21.pdf/$file/BB21.pdfThe NSW Drug Court a re-evaluation of its effectiveness http://www.bocsar.nsw.gov.au/lawlink/bocsar/ll_bocsar.nsf/vwFiles/CJB121.pdf/$file/CJB121.pdfThe impact of heroin dependence on long-term robbery trends http://www.bocsar.nsw.gov.au/lawlink/bocsar/ll_bocsar.nsf/vwFiles/CJB79.pdf/$file/CJB79.pdf#target=_blankDoes prohibition deter cannabis use? http://www.bocsar.nsw.gov.au/lawlink/bocsar/ll_bocsar.nsf/vwFiles/CJB58.pdf/$file/CJB58.pdf#target=_blankHeroin harm minimisation Do we really have to choose between law enforcement and treatment?http://www.bocsar.nsw.gov.au/lawlink/bocsar/ll_bocsar.nsf/vwFiles/CJB46.pdf/$file/CJB46.pdf#target=_blank