The document discusses changing attitudes towards substance use and regulation from the 1800s to present. It covers factors like toxicity, dependence, and crime that influenced more controlling policies. Toxicity can refer to both acute and chronic physiological and behavioral effects. Dependence involves tolerance, withdrawal, and psychological preoccupation. Data on drug-related emergency visits and deaths provides some information on dangers but does not capture relative risk or consider number of users. Laws aim to reduce costs to society from dangers of certain drug use, but not all policies have been rationally conceived or effective at achieving this.

1. Chapter 2
Social Issues: Substances, Addiction and Related Disorders

2. Changing AttitudesChanging Attitudes
 What made the government change from the laissez-faireWhat made the government change from the laissez-faire
attitude of the 1800s to one of control?attitude of the 1800s to one of control?
 ToxicityToxicity
 Dependence (in relation to substance use)Dependence (in relation to substance use)
 CrimeCrime

3. 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
Physiological toxicity & behavioral toxicity
Acute effects & chronic effects

4. 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
Examples of chronic toxicity
• Behavioral: Personality and lifestyle changes; effects on relationships
• Physiological: Lung cancer, cirrhosis, heart disease & other health effects

5. Toxicity & DAWN
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
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
Alcohol is reported only in combination with other drugs
Drug-alcohol and drug-drug combinations are very
common

6. Toxicity & 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

7. The Concept of Dependence
In relation to substance use, substance-related and addictive disorders
dependence has recently undergone extensive review
Text: Three basic processes
Tolerance
Need for increased amount
Diminished effect with continued use
Physical dependence - withdrawal symptoms/syndrome
Psychological dependence
Mental preoccupation
Interference
Different views on dependence

8. Drugs & Crime: Why We Regulate Drugs
We want to protect society from the dangers of some types of drug use
What are the real costs to a society?
Some laws are not developed as part of a rationally devised plan and may not be
realistic or effective
Based on 4 ideas of drugs and crime:
1. Drug use changes personality; creates “criminal type”
2. People under the influence may commit crimes (e.g., many cases of
homicide, domestic violence, etc.)
3. Crimes may be carried out to obtain money for drugs
4. Drug use is a crime