Just How Severe is the Problem?Substance use-low to moderate use of a substance that does not impair functioningSubstance intoxication – acute effects of substance useSubstance abuse disorder- 2 separate diagnosisAlcohol abuse – do you use alcohol obsessively, and have a lot of experiencesDrunk driving, putting your self into danger,Alcohol dependence – need for the substance, withdrawal, high tolerance, avoid recovering from the substanceDSM just linked them together to make SADCaffeine is the most widely used and socially accepted drug? –FactDeath by cigarettes, cigars, pipes, and smokeless tobacco – factCaffeine is a stimulantAnxiety can be a side affectBenefits at very low levelsCan’t meet for an abuse disorder with caffeine but can have intoxication and withdrawalCan cause death in extreme casesCaffeine intoxicationYou can only meet for this disorder if it causes distress or impairmentCertain amount of caffeine will help you focus but to much will put you over the top and impair your functioningCaffeine withdrawalHim stopping getting headaches and took Excedrin then realized he was just replacing the caffeine with another type of caffeine so stopped taking it and started getting flu like symptomsNicotineEnters your blood stream really quickly (especially smoking)ImmediateCultural aspectsStimulant and a sedative – initial high you getWorks on the adrenal glands – initial affectLonger – more nicotine in the blood stream and produces a calming affectAffect moodIncreases serotoninIncreases blood pressure, heart rate, some people use it as an appetite suppressant – used to lose weight20% of people smoke right nowlittle more in men and women, no difference in SES, race, ethnicityMore restrictive nowDon’t know why it’s so much harder to quitAsk smokers about 70% want to quit, about 50% has tried, only 2.3% succeedWhen you quit nicotine – have to do it on your own, other things causes burning bridges in your life, it doesn’t cause huge impact on your life in very negative wayFirst cigarette in the morning is the hardest to get ride of because you have the withdrawal over nightComplications with pregnancy – low birth rate, pre-matureSame criteria for all use disorders (tobacco, alcohol, caffeine, marijuana etc.) except -TobaccoCan not have tobacco intoxicationIt’s not as severe in changing your behavior in a significant wayBut can have withdrawalAlcoholActually considered a depressant –central nervous symptom depressantGABA – stops other neurotransmitters from working – shuts down serotonin, decreases brain activityWhy you have slower reaction timesThings become out of focusBalance is off, slurred speech, dizzy, all brain related, poor judgment – cognitively your brain is not as efficientSecond most common psychoactive substance (next to caffeine)Depends on your tolerance, size, ingest in foodScary part – people who become dependent on alcohol tend to report that they don’t feel the affects of alcohol as much so drink moreTake greater riskMen drink more but women are more susceptible for negative health riskWomen may have more enzymes that don’t break down as easilyAsians – almost like a poison to them and they get sick easilyAlcohol cirrhosis – of the liver, detoxifies your blood, can’t filter it as well over time, scare tissue developsSome people need liver transplantsWernike-Korsakoff syndrome – thiamineConfusion, amnesia, confabulation (filling in the details of a story you don’t remember with made up material)Never recover if they stop drinking80% have to do into living system because they get confused and can’t functionFetal alcohol syndrome (FAS)Can have major effects on themLower birth rateOlder – have a lot of learning disorders, impulse control disordersPoor eye, hand coordinationAlcohol intoxicationThese start to happen around blood alcohol of about .1, bigger ones happen at about .2 (.02-.06 is the good feeling of it with very little impairment at that level)Same for all use disorders exceptAlcohol use disorderTake in larger amounts – have to have 0 or you go all the wayCan’t have one cause then ill have 20Tried to cut down and can’t cut downLots of timeCraving, urgesDon’t go to work, spend time with familyOne will continue use despite health problems or psychological problemsEven though my liver functioning is getting bad I continue to do itContinued use despite interpersonal problemsContinued use despite physical health or psychological problemsUse in situations where it will be dangerousAny 2 of these in a 12 month periodAlcohol withdrawalDeliria- high blood pressure, fever, DT’sIllicit Drugs – MarijuanaLeaves can be used but normally flower of the plant, some people use stem of the plantIncreased appetiteHumor- things are funnierMore relaxedSlows perception of timeIncreased visual and auditory senses (fishbowl affect), some experience dullCannabinoid receptors – respond in the pleasure parts of the brain, responds to THCMost highly and often used illicit substanceMore common in men then in womenMore chemically engineered, most potent – more THC – some are stronger than others, different high feel in themAble to enhance them, stronger dosesHelp manage weightMarijuana IntoxicationSlow tongue, social withdrawal, some very social, blood shot eyes, munchies, increased heart rate,Rare but can have hallucinationsEuphoria, tranquility, calming affectMarijuana WithdrawalRestless, abdominal health issues, depressed, anxiety,Withdrawal might increase risk/aggression between relationshipsResearch Hot Topic: Medical Uses of MarijuanaCalifornia – caught with it in your pocket - $100 fine18 states exempt laws for patientshas its benefits but also has its downfalls (side affects)Illicit Drugs. . . CNS StimulantsDopamine – being the big oneProduce euphoria, energy, sexual pleasure, power, positive reinforcesAmphetaminesEcstasyCrystal methamphetamineRisk – blood pressure, risk of heart attackUse for asthma, ADHA in kids (opposite affect in kids – brings them into focus)Functional Impairment and EpidemiologyParanoid, become aggressiveTolerance develops rapidly which can increase addictionWithdrawalDepression, irritability – what is the opposite of the drugIllicit Drugs. . . CocaineDerived from leaves of coca plant – produced numbing feelingPowder, liquid mixed with water, rock form – immediate high and super strong, tends to last longerUse to be in cokeUsed more by males,Acts on