This document provides an overview of addictions and risky behaviors. It discusses gambling addiction and factors associated with problem gambling. It also addresses drug use on college campuses, including reasons why students do and do not use drugs. The document outlines understanding of drugs and their effects, routes of drug administration, and differences in drug experiences between genders. It discusses caffeine and various medications, including prescription drug abuse on campus. The document defines substance use disorders and withdrawal. It also examines common drugs of abuse such as cannabis, synthetic drugs, and stimulants; and provides details on their effects and risks.

1. Chapter 11 –Addictions
11
Addictions
LectureOutline
I. Risky Behaviors
A. Overview
1. The vast majority of college students do not engage in addictive
behaviors.
2. However, some do and the reasons why are complex.
B. Addictive Behaviors and the Dimensions of Health
1. Substance abuse and other self-destructive behaviors, such as gambling
and compulsive eating, can affect every dimension of health.
a. Physical health
b. Psychological health
c. Spiritual health
d. Social health
e. Intellectual health
f. Environmental health
II. Gambling
A. Introduction
1. Problem gambling has become more common among American adults
than alcohol dependence.
2. Men, who are twice as likely to be frequent gamblers as women, reach
their highest gambling rates in their late teens.
3. Researchers identified key indicators associated with “pathological”
gambling:
a. Gambling more than once a month.
b. Gambling more than two hours a month.
c. Wagering more than 10 percent of monthly income.
d. A combination of parental gambling problems, gambling frequency,
and psychological distress.
B. Gambling on Campus

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1. College students who gamble do so for fun or excitement, to socialize, win
money, or “just have something to do”—similar reasons why adults
gamble.
2. Problem gambling refers to all individuals with gambling-related
problems, including mild or occasional ones.
C. Risk Factors for Problem Gambling:
1. Male sex
2. Gambling at an early age (as young as 8)
3. A big win earlier in one’s gambling career
4. Consistently chasing losses
5. Gambling alone
6. Feeling depressed before gambling
7. Feeling excited or aroused during gambling
8. Behaving irrationally during gambling
9. Poor grades at school
10. Engaging in other addictive behaviors
11. Lower socioeconomic class
12. Parents with a gambling or addiction problem
13. A history of delinquency or stealing money to fund gambling
14. Skipping class to go gambling
III. Drug Use on Campus
A. Introduction
1. More than six in ten college students have never used marijuana or other
illegal drugs.
2. Yet substance abuse remains a serious health risk for the minority of
undergraduates who do use drugs.
3. Marijuana remains the most widely used illicit drug on campus.
4. About 2 percent of college students report that they have misused
prescription opioids at least once in the past, while 7 percent did so in the
last year.
a. Characteristics of illicit drug users:
i. Most in the late teens and early 20s
ii. Most likely to be male
iii. Most likely to be white
iv. Lower GPA
v. More likely to be sexually active
vi. Less likely to report strong religious values
vii. More likely to not be or have never been married
viii. Less likely to report good physical or mental health

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ix. More likely than nonusers to misuse prescription drugs
b. Characteristics of users of prescription drug for nonmedical reasons:
i. Equally likely to be male or female.
ii. More likely to be white.
iii. Lower GPA.
iv. Less likely to report good physical or mental health.
v. More likely to report knowing a member of the faculty or
administration.
B. Why Students Don’t Use Drugs:
1. Spirituality and religion.
2. Academic engagement.
3. Perceived harmfulness.
4. Athletics.
C. Why Students Use Drugs:
1. Genetics and family history.
2. Parental attitudes and behavior.
3. Substance use in high school.
4. Social norms.
5. Positive expectations.
6. Mental health problems.
7. Social influences.
8. Alcohol use.
9. Race/ethnicity.
10. Sexual identity.
IV. Understanding Drugs and Their Effects
A. Introduction
1. A drug is a chemical substance that affects the way you feel and function.
2. Drug abuse is a pattern of substance use resulting in negative
consequences or impairment.
3. Drug dependence is a pattern of continuing substance use despite
cognitive, behavioral, and physical symptoms.
4. Drug misuse is taking a drug for a purpose or by a person other than that
for which it was intended or not taking the recommended doses.
5. Drug diversion is the transfer of a medication from the individual to
whom it was prescribed to another person.
6. Risks are involved with all forms of drug use.
a. Medications, caffeine, alcohol and tobacco all have potentially life-
threatening problems.
B. Routes of Administration

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1. Orally
a. The most common way of taking a drug, by swallowing a tablet,
capsule, or liquid.
b. It may not have an effect for 30 minutes or more.
2. Inhalation
a. Drugs entering the body through the lungs by inhaling smoke, gasses,
aerosol sprays, or fumes from solvents or other compounds which
evaporate quickly.
b. Huffing is placing inhalants in a plastic bag, putting it over the mouth
and nose, and taking deep breaths.
i. Huffing can have fatal consequences.
3. Intravenous
a. Injection gets the drug into the bloodstream immediately.
4. Intramuscular
a. Injection gets drug into bloodstream moderately fast.
5. Subcutaneous
a. Injection gets drug into bloodstream more slowly (about 10 minutes).
C. Dosage and Toxicity
1. Increasing dose intensifies the effect produced by smaller doses.
2. Toxicity: dosage level at which a drug becomes poisonous to the body,
causing either temporary or permanent damage.
D. Individual Differences
1. Often drugs intensify the emotional state a person is in.
2. Personality and psychological attitude also play a role in drug effects.
a. User’s mind-set – his or her expectations or preconceptions about
using the drug – affects the experience.
E. Gender and Drugs
1. Men encounter more opportunities to use drugs
2. Both genders display equal opportunity to use drugs for the first time
3. Men and women are equally likely to become addicted to cocaine, heroin,
hallucinogens, tobacco and inhalants.
4. Women are more likely to become addicted to sedatives and drugs to treat
anxiety or insomnia.
5. Men are more likely to abuse alcohol and marijuana
6. Female cocaine users are more vulnerable to poor nutrition, depression,
and physical abuse.
V. Caffeine and Its Effects
A. Overview
1. Most widely used psychoactive (mind-affecting) drug in the world.

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2. Caffeine is a stimulant.
3. Drinking up to six cups a day of caffeinated or decaffeinated coffee will
not shorten your lifespan and may convey health benefits, including a
lower risk of type 2 diabetes, cardiovascular and other diseases.
4. You can overdose on caffeine and develop symptoms such as restlessness,
nervousness, excitement, insomnia, flushed face, increased urination,
digestive complaints, and muscle twitching.
5. Withdrawal can cause headaches and other neurological symptoms.
6. High-energy Caffeinated Beverages
a. Men between 18 and 34 consume the most
b. Teens that drink them are 2 to 3 times more likely to use alcohol,
drugs, and cigarettes.
7. Caffeine Intoxication
a. Based on 5 or more of the following symptoms: restless, nervousness,
excitement, insomnia, flushed face, increased urination, digestive
disturbances, muscle twitching, rambling though or speech, rapid or
irregular heart rate, periods of inexhaustibility, and agitation.
VI. Medications
A. Introduction
1. As many as half of all patients take the wrong medications, in the wrong
doses, at the wrong times, or in the wrong ways.
2. Every year, these errors lead to an estimated 125,000 deaths and more
than 8.5 billion in hospital costs.
B. Over-the-Counter Drugs
1. Many widely used OTC drugs pose unsuspected hazards.
2. OTC medications can be used improperly, often simply because of a lack
of education.
3. Those most often misused:
a. Nasal sprays
b. Laxatives
c. Eye drops
d. Sleep aids
e. Cough syrup
f. Pain killers
C. Prescription Drugs
1. The most widely used prescription drugs are pain medications, sedative
or anxiety medications, sleeping medications, and stimulant medications.
2. Nonadherence

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a. Many prescription medications are not taken the way they should be;
millions simply aren’t taken at all.
3. Physical Side Effects
a. Serious complications include heart failure, heart attack seizures,
kidney and liver failure, severe blood disorders, birth defects,
blindness, memory problems, and allergic reactions.
b. Overdoses of opioid painkillers now cause more deaths than heroin
and cocaine combined.
4. Psychological Side Effects
a. Can cause changed in the way people think, feel, and behave.
b. Doctors may not even mention potential mental and emotional
problems.
5. Drug Interactions
a. Drugs can interact in a variety of ways.
b. What you eat or drink can impair or completely wipe out the
effectiveness of drugs or lead to unexpected effects on the body.
6. Generic Drugs
a. The generic name is the chemical name for a drug.
b. Same active ingredient and cost 20–85% less than brand names.
c. Fillers and binders that may affect the drugs absorption may be
different.
d. Ask physician if generic vs. brand name matters.
7. Buying Drugs Online
a. The dangers of unregulated distribution of medications have alarmed
government agencies and medical groups.
b. American Medical Association has declared it unethical for physicians
to write prescriptions for people they haven’t met.
c. Consumers have to be wary.
i. Some drugs need to be monitored.
ii. Quality control is an issue.
iii. Counterfeit drugs are increasingly sold on line.
VII. Prescription Drug Abuse on Campus
A. Introduction
1. As many as one in five college students misuses or abuses a prescription
medication every year. Only marijuana use is more widespread on
campus.
B. Prescription Stimulants
1. The most widely abused prescription drugs are stimulant medications
such as Ritalin.

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2. Most think that they help their focus, concentration, and to study longer,
but they actually have lower GPAs.
C. Prescription Painkillers
1. Abuse of painkillers like OxyContin, Vicodin, is widespread on campus.
2. Like other addictions, this “habit” is a treatable brain disease.
VIII. Substance Use Disorders
A. Introduction
1. Addiction is the compulsive use of a substance, loss of control, negative
consequences, and denial.
B. Dependence
1. Psychological dependence feeling a strong craving for a drug because it
produces pleasurable feelings or relieves stress and anxiety.
2. Physical dependence occurs when a person develops tolerance to the
effects of a drug and needs larger and larger doses to achieve intoxication
or another desired effect.
3. People with substance dependence disorder may use a drug to avoid or
relieve withdrawal symptoms, or they may consume larger amounts of a
drug or use it over a longer period than they’d originally intended.
C. Abuse
1. Psychoactive substance abuse disorder is then a person continues to use
drugs despite their awareness of persistent or repeated social,
occupational, psychological, or physical problems related to drug use, or
they use drugs in dangerous ways or situations.
D. Intoxication and Withdrawal
1. Intoxication refers to maladaptive behavioral, psychological, and
physiologic changes that occur as a result of substance use.
2. Withdrawal is the development of symptoms that cause significant
psychological and physical distress when an individual reduces or stops
drug use.
E. Polyabuse
1. Using several drugs.
F. Coexisting Conditions
1. Many individuals with substance abuse disorders also have another
psychiatric disorder, such as depression.
G. Causes of Drug Dependence and Abuse
1. The Biology of Dependence
a. Addictive drugs have such a powerful impact on dopamine and its
receptors that they change the pathways within the brain’s pleasure
center.

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b. Dopamine, is a brain chemical associated with feelings of satisfaction
and euphoria.
2. The Psychology of Vulnerability
a. Scientists do not believe there is an addictive personality, but certain
individuals are at greater risk of drug dependence because of
psychological factors, including difficulty controlling impulses, a lack
of values that might constrain drug use, low self-esteem, feelings of
powerlessness, and depression.
IX. Common Drugs of Abuse
A. Cannabinoids
1. Marijuana and hashish are the most widely used illegal drugs.
2. Some 12 million Americans use cannabis.
3. How Users Feel
a. In low to moderate doses, marijuana typically creates a mild sense of
euphoria, a sense of slowed time, a dreamy sort of self-absorption, and
some impairment in thinking and communicating.
b. The immediate physical effects of marijuana include increased pulse
rate, bloodshot eyes, dry mouth and throat, slowed reaction times,
impaired motor skills, increased appetites, and diminished short-term
memory.
4. Risks
a. Brain
i. Long-term marijuana use causes significant brain abnormalities,
including shrinkage of key structures involved in memory,
learning, and emotion that can lead to memory loss, difficulty
learning new information, and psychotic symptoms.
ii. Short-term effects include problems with memory and learning;
distorted perceptions; difficulty thinking and problem solving; loss
of coordination; increased anxiety; and panic attacks.
b. Lungs
i. Smoking cannabis may cause similar effects to smoking tobacco.
c. Heart
i. Increased risk of heart attack and sudden death
d. Pregnancy
i. Babies born to mothers who use marijuana during pregnancy are
smaller and more likely to develop health problems than those
born to mothers who did not use the drug.
5. Withdrawal
a. Compulsive, often uncontrollable craving for the drug.

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b. Stopping after long-term use can produce marijuana withdrawal
syndrome.
i. Insomnia, restlessness, loss of appetite, and irritability.
B. Synthetic Designer Drugs
1. The National Institute on Drug Abuse identifies a variety of drugs –
alcohol, LDS, MDMA, GHB, GBL, ketamine, fentanyl, Rohypnol, and
nitrites – as club drugs.
2. First became popular among teen and young adults at nightclubs, bars, or
night-long dances often held in warehouses.
a. Ecstasy
i. Also known as MDMA, E, XTC, X, hug, beans, love drug.
ii. Although it can be smoked, inhaled, or injected, it is almost always
taken as a pill.
iii. How Users Feel
(a) Belongs to a family of drugs called enactogens, which literally
means “touching within.”
(b) As a mood elevator, it produces a relaxed, euphoric state but
does not produce hallucinations.
iv. Risks
(a) Psychological difficulties (confusion, depression, sleep
problems, drug craving, severe anxiety, and paranoia) and
physical symptoms (muscle tension, involuntary teeth
clenching, nausea, blurred vision, rapid eye movement,
faintness, chills, sweating, and increases in heart rate and blood
pressure).
b. GHB and GBL
i. Gamma hydroxybutyrate - Once sold in health-food stores for its
muscle building and alleged fat burning properties, it was banned
because of its effects on the brain and nervous system.
ii. Gamma butyrolactone – Acts as a stimulant and has been used as a
“date rape drug.”
c. Nitrites
i. They are used recreationally for a high feeling, a slowed sense of
time, a carefree sense of well-being, and intensified sexual
experiences.
C. “Synthetic,” “Herbal,” and “Legal” drugs.
1. New, unregulated psychoactive substances are emerging so quickly that
researchers describe their proliferation as “unprecedented in the annals of
drug abuse.”
2. Despite warnings, many buyers perceive them as safe.

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3. Some are highly toxic industrial chemicals with potentially life-
threatening adverse effects.
a. Herbal or Synthetic Marijuana
b. Khat (Kat, Catha, Chat, Abyssinian Tea)
c. Synthetic Stimulants
d. Herbal Ecstasy
e. Salvia
D. Stimulants
1. Increase activity in some portion of the brain or spinal cord.
2. Amphetamine
a. Trigger the release of epinephrine (adrenaline), which stimulates the
central nervous system.
i. How Users Feel
(a) Amphetamines produce a state of hyper-alertness and energy.
ii. Risks
(a) Amphetamine intoxication may cause feelings of grandiosity,
increased heart rate, less frequent effects such as speeding up or
slowing down of muscular movement, and in high doses, a
rapid or irregular heartbeat.
iii. Withdrawal
(a) When the immediate effects of amphetamines wear off, users
experience a crash and become shaky, irritable, anxious, and
depressed.
3. Methamphetamine
a. An addictive stimulant that is less expensive and possibly more
addictive than cocaine or heroin, and has become American’s leading
drug problem.
i. How Users Feel
(a) Methamphetamine causes the release of large amounts of
dopamine, which causes a sensation of euphoria, increased
self-esteem, and alertness.
ii. Risks
(a) Increased heart rate, blood pressure, wakefulness and physical
activity, depressed appetite, and elevated body temperature.
Other effects on the central nervous system include irritability,
insomnia, confusion, tremors, convulsions, anxiety, paranoia,
and aggressiveness.
(b) Meth users engage in more sex, more carelessly.

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iii. The Toll on Society
(a) Law enforcement officials consider meth their biggest drug
problem.
iv. Withdrawal
(a) Meth addiction is difficult to treat.
4. Cocaine
a. Cocaine, (also called coke, snow, lady), is a white crystalline powder
extracted from the leaves of the South American coca plant.
i. Various forms:
(a) Freebase
(b) Crack
ii. How Users Feel
(a) A powerful stimulant to the central nervous system, cocaine
targets several chemical sites in the brain, producing feelings of
soaring well-being and boundless energy.
iii. Risks
(a) Cocaine dependence is an easy habit to acquire.
(b) The physical effects of acute cocaine intoxication include
dilated pupils, elevated or lowered blood pressure,
perspiration or chills, nausea or vomiting, speeding up or
slowing down of physical activity, muscular weakness,
impaired breathing, chest pain, and impaired movements or
muscle tone.
(c) Cocaine use can cause blood vessels in the brain to clamp shut
and can trigger a stroke, bleeding in the brain, and potentially
fatal brain seizures.
(d) Cocaine can damage the liver and cause lung damage in
freebasers.
(e) The combination of alcohol and cocaine is particularly lethal.
iv. Withdrawal
(a) When addicted individuals stop using cocaine, they often
become depressed.
(b) Other symptoms of cocaine withdrawal include fatigue, vivid
and disturbing dreams, excessive or too little sleep, irritability,
increased appetite, and physical slowing down or speeding up.

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E. Depressants
1. Depress the central nervous system, reduce activity, and induce
relaxation, drowsiness, or sleep.
2. Benzodiazepines and Barbiturates
a. These depressants are the sedative-hypnotics, also known as anxiolytic
or antianxiety drugs.
b. Rohypnol, also called roofies, rophie, roche, or the forget-me pill, is
one of the benzodiazepines that has been of particular concern because
of its abuse in date-rape.
i. How Users Feel
(a) Low doses of these drugs may reduce or relieve tension, but
increasing doses can cause a loosening of sexual or aggressive
inhibitions.
ii. Risks
(a) All sedative-hypnotic drugs can produce physical and
psychological dependence within two to four weeks.
(b) Intoxication with these drugs can produce changes in mood
and behavior.
(c) Taken in combination with alcohol, these drugs have a
synergistic effect that can be dangerous or even lethal.
iii. Withdrawal
(a) Withdrawal from sedative-hypnotic drugs may range from
relatively mild discomfort to a severe syndrome with grand
mal seizures, depending on the degree of dependence.
3. Opioids
a. The opioids include opium and its derivatives (morphine, codeine, and
heroin) and synthetic drugs that have similar sleep-inducing and pain-
relieving properties.
b. Synthetic opioids include meperidine (Demerol), Methadone, and
Propoxyphene (Darvon).
i. How Users Feel
(a) All opioids relax the user.
ii. Risks
(a) Addiction is common. All regular users of opioids rapidly
develop drug dependence, which can lead to lethargy, weight
loss, loss of sex drive, and the continual effort to avoid
withdrawal symptoms through repeated drug administration.
iii. Withdrawal
(a) The intensity of opioid withdrawal depends on the degree of
addiction.

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F. Hallucinogens
1. Hallucinogens produce vivid and unusual changes in thought, feeling,
and perception.
2. Do not produce dependence in the same way as cocaine or heroine.
a. LSD and peyote are common hallucinogens.
G. Dissociative Drugs
1. Initially developed as general anesthetics for surgery, these drugs distort
perceptions of sight and sound and produce feeling of dissociation or
detachment from the environment or self.
2. Ketamine:
a. Is an anesthetic used by veterinarians.
b. It has become common in club scenes and has been used as a date rape
drug.
c. It can be addictive and cause long-term memory loss.
3. PCP
a. Is an illicit drug manufactured as a tablet, capsule, liquid, spray, or
crystallike white powder than can be swallowed, smoked, sniffed, or
injected.
b. Its effects are utterly unpredictable.
c. It may trigger violent behavior or irreversible psychosis the first time it
is used, or the twentieth time, or never.
X. Inhalants
A. Inhalants or deleriants are chemicals that produce vapors with psychoactive
effects.
1. The most commonly abused inhalants are solvents, aerosols, model-
airplane glue, cleaning fluids, and petroleum products like kerosene and
butane.
2. At lower doses, users may feel slightly stimulated; at higher doses, they
may feel less inhibited.
3. Regular use of inhalants leads to tolerance, and the effects are
unpredictable.
XI. Treating Substance Dependence and Abuse
1. The most difficult step is for users to admit they are addicted.
2. Treatment can take place in an outpatient setting, a residential facility, or a
hospital.
3. Personal treatment plans may consist of individual psychotherapy,
marital and family therapy, medication, and behavior therapy.

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B. Principles of Drug Addiction Treatment
1. Principles that characterize effective drug abuse treatment include:
a. Addiction is a complex but treatable disease that affects brain function
and behavior.
b. No single treatment is appropriate for everyone.
c. Treatment needs to be readily available.
d. Effective treatment attends to multiple needs of the individual.
e. Remaining in treatment for an adequate time is critical.
f. Counseling and other behavioral therapies are the most commonly
used forms of drug abuse treatment.
g. Medications are an important element of treatment.
h. Many drug-addicted individual also have other mental disorders.
i. Medically assisted detoxification is only the first stage of addiction
treatment and by itself does little to change the long-term drug abuse.
j. Treatment does not need to be voluntary to be effective.
k. Drug use during treatment must be monitored continuously, as lapses
during treatment do occur.
C. 12-Step Programs
1. As many as 200 different recovery programs are based on the spiritual 12-
step program.
2. The basic precept is that members have been powerless when it comes to
controlling their addictive behavior on their own.
3. To get the most out of a 12-step program:
a. Try out different groups.
b. Once you find a comfortable group, go back several times before
making a final decision to continue.
c. Keep an open mind.
d. Accept whatever feels right to you and ignore the rest.
D. Relapse prevention
1. When relapses do occur, they should be viewed as neither a mark of
defeat nor evidence or moral weakness.
2. The key is learning to avoid obvious cues and associations that can set-off
intense cravings.
3. Therapists emphasize that every lapse does not have to lead to a full-
blown relapse.

15. Chapter 11 –Addictions
Keywords
addiction
amphetamine
barbiturates
benzodiazepines
cannabinoids
cathinone
club drugs
cocaine
designer drugs
dopamine
drug
drug abuse
drug dependence
drug diversion
drug misuse
Ecstasy (MDMA)
gambling disorder
generic
hallucinogen
hashish
inhalants
intoxication
intramuscular
intravenous
LSD (lysergic acid diethylamide)
marijuana
opioids
over-the-counter (OTC) drugs
PCP (phencyclidine)
physical dependence
polyabuse
psychoactive
psychological dependence
salvia
stimulant
subcutaneous
toxicity
12 Step program
withdrawal