Chapter 2                               Drug Use as a Social                                    Problem© 2011 McGraw-Hill ...
Costs of Drug Use to Society                       Deaths                       Emergency room visits                  ...
Changing Attitudes          What made the government change           from the laissez-faire attitude of the           18...
Toxicity            Toxic = poisonous, deadly, or dangerous          What makes a drug toxic?                    Amount ...
Toxicity          Physiological toxicity vs. behavioral           toxicity          Acute effects vs. chronic effects   ...
Drug-Related Toxicity         Examples of acute toxicity          Behavioral: “Intoxication” that impairs the           a...
Drug-Related Toxicity         Examples of chronic toxicity          Behavioral                    Personality and lifest...
Drug Abuse Warning Network          A system for collecting data on drug-           related deaths and emergency room vis...
Drug Abuse Warning Network          Alcohol is reported only           in combination with           other drugs         ...
Drug Abuse Warning Network                                     Toxicity Data         ER Visits                            ...
Drug Abuse Warning Network          What it tells us about how dangerous a           drug is                    Simply g...
Blood-Borne Diseases                Specific toxicity for users who inject drugs                AIDS, HIV infection, and...
Substance Dependence          What do “addicts” look like?          What drug do they take or what behavior do they     ...
Substance Dependence          Three basic           processes                    Tolerance                    Physical ...
Tolerance          Diminished effect on the body after           repeated use of the same drug          The body develop...
Physical Dependence          Physical dependence is defined by the           occurrence of a withdrawal syndrome         ...
Psychological Dependence          Psychological or           behavioral dependence                         High frequenc...
Changing Views of                                                          Dependence          Early medical model = true...
Substance Abuse and                                      Dependence: DSM-IV-TR          APA diagnostic criteria for abuse...
Substance Dependence:                                             DSM-IV-TR          A maladaptive pattern of substance u...
Substance Abuse:                                                          DSM-IV-TR          A maladaptive pattern of sub...
Is Dependence                        Caused by the Substance?          Some drugs are more likely           than others t...
Is Dependence Biological?          Is dependence due to biochemical or           physiological actions in the brain?     ...
Is There an “Addictive                                          Personality”?          No way to know if the drug or the ...
Is Dependence a Family                                      Disorder?          Alcohol dependence           often exists ...
Is Substance Dependence a                             Disease?          Founders of AA characterized alcohol           de...
Biopsychosocial Perspective          Dependence is related to           dysfunctions of:                         Biology...
Drugs and Crime     Drug use may change a      person’s personality     People under the      influence may commit      ...
Drugs and Crime                 Crimes may be                  carried out to obtain                  money for drugs    ...
Why We Regulate Drugs          We want to protect society from the           dangers of some types of drug use =         ...
Chapter 2                                  Drug Use as a Social Problem© 2011 McGraw-Hill Higher Education. All rights res...
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  • Image sources: Brand X Pictures (Image Ch02_01SocialProblem) Creatas/PunchStock (Image Ch02_14Syringe)
  • Image sources: C. Sherburne/PhotoLink/Getty Images (Image Ch02_02AcuteBehavior); CDC/ Dr. Edwin P. Ewing, Jr. (Image Ch02_03ChronicPhysiological)
  • Image source: Getty Images (Image Ch02_04EmergencyRoom)
  • Image source: Dynamic Graphics/JupiterImages (Ch02_05DrugAlcoholCombo)
  • Image source: Dynamic Graphics/JupiterImages
  • Image source: © Creatas/PunchStock (Image Ch02_06Syringe)
  • Image source: Ryan McVay/Getty Images (Image Ch02_07ToleranceWithdrawal)
  • Image source: The McGraw-Hill Companies, Inc./Gary He, photographer (Image Ch02_08CravingReinforcement)
  • Image source: The McGraw-Hill Companies, Inc./Jill Braaten, photographer (Image Ch02_09SoloDrinker)
  • Image source: Jack Star/PhotoLink/Getty Images (Image Ch02_10DysfunctionalFamily)
  • Credit Text: Getty Images/Doug Menuez (Image Ch02_11BiopsychosocialApproach)
  • Image source: © Mikael Karlsson (Image Ch02_12DrugsCrimeArrest)
  • Image source: Brand X Pictures (Image Ch02_13DrugSale)
  • Hart13 ppt ch02

    1. 1. Chapter 2 Drug Use as a Social Problem© 2011 McGraw-Hill Higher Education. All rights reserved.
    2. 2. Costs of Drug Use to Society  Deaths  Emergency room visits  Drugs in the workplace and lost productivity  Broken homes, illnesses, shorter lives, etc.  Cost of maintaining habit  Cost of criminal behavior  Cost of treating patients  Fetal alcohol syndrome  Others?© 2011 McGraw-Hill Higher Education. All rights reserved.
    3. 3. Changing Attitudes  What made the government change from the laissez-faire attitude of the 1800s to one of control?  Toxicity  Dependence  Crime© 2011 McGraw-Hill Higher Education. All rights reserved.
    4. 4. Toxicity Toxic = poisonous, deadly, or dangerous  What makes a drug toxic?  Amount used  How it is used  What the user did while on the drug© 2011 McGraw-Hill Higher Education. All rights reserved.
    5. 5. Toxicity  Physiological toxicity vs. behavioral toxicity  Acute effects vs. chronic effects Acute behavioral toxicity (drunk driving) Chronic physiological toxicity (cirrhosis)© 2011 McGraw-Hill Higher Education. All rights reserved.
    6. 6. Drug-Related Toxicity Examples of acute toxicity  Behavioral: “Intoxication” that impairs the actions of drug users and increases the danger to themselves and others  Physiological: Overdose that causes the user to stop breathing© 2011 McGraw-Hill Higher Education. All rights reserved.
    7. 7. Drug-Related Toxicity Examples of chronic toxicity  Behavioral  Personality and lifestyle changes  Effects on relationships with friends and family  Physiological  Heart disease  Lung cancer  Cirrhosis  Other health effects© 2011 McGraw-Hill Higher Education. All rights reserved.
    8. 8. Drug Abuse Warning Network  A system for collecting data on drug- related deaths and emergency room visits at some U.S. metropolitan hospitals  DAWN collects data on improper use of legal prescription and over- the-counter drugs as well as illicit drugs© 2011 McGraw-Hill Higher Education. All rights reserved.
    9. 9. Drug Abuse Warning Network  Alcohol is reported only in combination with other drugs  Drug-alcohol and drug- drug combinations are very common© 2011 McGraw-Hill Higher Education. All rights reserved.
    10. 10. Drug Abuse Warning Network Toxicity Data ER Visits Deaths 1. Cocaine 1. Prescription Opioids 2. Alcohol-in- (not heroin) combination 2. Cocaine 3. Marijuana 3. Alcohol-in- 4. Prescription Opioids combination 5. Benzodiazepines 4. Benzodiazepines 5. Methadone© 2011 McGraw-Hill Higher Education. All rights reserved.
    11. 11. Drug Abuse Warning Network  What it tells us about how dangerous a drug is  Simply gives us total deaths/ER visits  What it does not tell us about how dangerous a drug is  Consider relative danger vs. total impact of the drug  Number of users vs. number of reported problems© 2011 McGraw-Hill Higher Education. All rights reserved.
    12. 12. Blood-Borne Diseases  Specific toxicity for users who inject drugs  AIDS, HIV infection, and hepatitis B and C  Sharing needles passes infectious agents directly into the bloodstream  Some states, cities prohibit needle purchase without Rx  Syringe exchange programs© 2011 McGraw-Hill Higher Education. All rights reserved.
    13. 13. Substance Dependence  What do “addicts” look like?  What drug do they take or what behavior do they engage in (alcohol, cigarettes, illicit drugs, food, sex, gambling, shopping, computer time)?  How much time do they spend on their habit?  How much of a drug do they take?  How do you decide on the definition of dependence?© 2011 McGraw-Hill Higher Education. All rights reserved.
    14. 14. Substance Dependence  Three basic processes  Tolerance  Physical dependence  Psychological dependence© 2011 McGraw-Hill Higher Education. All rights reserved.
    15. 15. Tolerance  Diminished effect on the body after repeated use of the same drug  The body develops ways to compensate for the chemical imbalance caused by the drug  Regular drug users may build up tolerance to the extent that their dosage would kill a novice user© 2011 McGraw-Hill Higher Education. All rights reserved.
    16. 16. Physical Dependence  Physical dependence is defined by the occurrence of a withdrawal syndrome  Tolerance typically precedes physical dependence  If drug use is stopped suddenly, withdrawal symptoms occur, ranging from mild to severe  Physical dependence means the body has adapted to the drug’s presence© 2011 McGraw-Hill Higher Education. All rights reserved.
    17. 17. Psychological Dependence  Psychological or behavioral dependence  High frequency of drug use  Craving for the drug  Tendency to relapse after stopping use  Behavior is reinforced by the consequences  Over time, this becomes the biggest reason users report they continue to use© 2011 McGraw-Hill Higher Education. All rights reserved.
    18. 18. Changing Views of Dependence  Early medical model = true addiction involves physical dependence; key is treatment of withdrawal symptoms  Positive reinforcement model = drugs can reinforce behavior without physical dependence  Psychological dependence is increasingly viewed as the driving force behind repeated drug use  This refutes the sometimes common belief that drugs that aren’t as strongly physically addicting are less dangerous© 2011 McGraw-Hill Higher Education. All rights reserved.
    19. 19. Substance Abuse and Dependence: DSM-IV-TR  APA diagnostic criteria for abuse and dependence (page 36)  Complex behavioral definitions  Dependence can occur with or without physiological dependence (i.e., withdrawal)© 2011 McGraw-Hill Higher Education. All rights reserved.
    20. 20. Substance Dependence: DSM-IV-TR  A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring at any time in the same 12-month period: 1. Tolerance 2. Withdrawal 3. Substance often taken in larger amounts or over a period longer than intended 4. Persistent desire or unsuccessful efforts to cut down or control substance use 5. A great deal of time is spent in obtaining the substance 6. Important social, occupational, or recreational activities are given up or reduced because of substance use 7. Substance use continues despite knowledge of having a persistent or recurrent problem that is caused or exacerbated by the substance© 2011 McGraw-Hill Higher Education. All rights reserved.
    21. 21. Substance Abuse: DSM-IV-TR  A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by one or more of the following occurring at any time in the same 12-month period: 1. Recurrent substance use resulting in failure to fulfill major role obligations at work, school, or home 2. Recurrent substance use in situations in which it is physically hazardous 3. Recurrent substance-related legal problems 4. Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance© 2011 McGraw-Hill Higher Education. All rights reserved.
    22. 22. Is Dependence Caused by the Substance?  Some drugs are more likely than others to lead to dependence  Method of use, as well as other factors, influences risk of dependence  The “war on drugs” reflects . the perspective that drugs are themselves evil© 2011 McGraw-Hill Higher Education. All rights reserved.
    23. 23. Is Dependence Biological?  Is dependence due to biochemical or physiological actions in the brain?  Still no way to scan the brain and know if a person has/had developed dependence  Genetic physiological or biochemical markers have been sought as well, but none has proven reliable© 2011 McGraw-Hill Higher Education. All rights reserved.
    24. 24. Is There an “Addictive Personality”?  No way to know if the drug or the drug use changes a person’s personality  Many other factors affect personality  Sensation-seeking = a personality characteristic statistically associated with early substance use and abuse© 2011 McGraw-Hill Higher Education. All rights reserved.
    25. 25. Is Dependence a Family Disorder?  Alcohol dependence often exists within a dysfunctional family  Evidence suggests that dysfunctional relationships play a role in dependence, but they aren’t the only factor© 2011 McGraw-Hill Higher Education. All rights reserved.
    26. 26. Is Substance Dependence a Disease?  Founders of AA characterized alcohol dependence as a disease  Others argue that dependence doesn’t have all the characteristics of a disease  There are ways to test and treat the effects of alcoholism but not the disease itself  There is some disagreement over how to define disease as well© 2011 McGraw-Hill Higher Education. All rights reserved.
    27. 27. Biopsychosocial Perspective  Dependence is related to dysfunctions of:  Biology  Personality  Social interactions© 2011 McGraw-Hill Higher Education. All rights reserved.
    28. 28. Drugs and Crime  Drug use may change a person’s personality  People under the influence may commit crimes (e.g., many cases of homicide, domestic violence, etc.)© 2011 McGraw-Hill Higher Education. All rights reserved.
    29. 29. Drugs and Crime  Crimes may be carried out to obtain money for drugs  Drug use is a crime© 2011 McGraw-Hill Higher Education. All rights reserved.
    30. 30. Why We Regulate Drugs  We want to protect society from the dangers of some types of drug use = legitimate social purpose  Some laws are not developed as part of a rationally devised plan and may not be realistic or effective  Current laws© 2011 McGraw-Hill Higher Education. All rights reserved.
    31. 31. Chapter 2 Drug Use as a Social Problem© 2011 McGraw-Hill Higher Education. All rights reserved.
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