Two Categories of ProblemsChanges in U.S. Drug LawsDrug-Related ToxicityDrug Abuse Warning Network (DAWN)Blood-Borne DiseasesProblematic Drug UseSubstance DependenceTolerancePhysical DependencePsychological DependenceChanging Views of DependenceDSM-IV-TR: Substance Use DisordersDSM-IV-TR: Substance AbuseDSM-IV-TR: Substance DependenceIs Dependence Cause by the Substance?Is Dependence Biological?Is Dependence Biological?Is there an Addictive Personality?Is Dependence a Family Disorder?Is Dependence a Disease?Does Drug Use Cause Crime?Why We Try to Regulate DrugsDrug Use as a Social Problem Two Categories of ProblemsProblems related to taking the drug Problems related to drug use as deviant behavior- risk of developing drug dependence- risk of overdose- arrests, fines, jailing- expenses associated with drug prevention and treatmentChanges in U.S. Drug Laws- U.S. changed from a laissez-faire attitude (1800s) to one of tight drug restrictions- Three main concerns1. Toxicity -dangerous chemicals?2. Dependence -habit-forming compounds?3. Crime-drug users become dangerous?Drug-Related Toxicity- Toxic: poisonous, deadly, or dangerous Physiological versus Behavioral toxicity Acute versus Chronic toxicityToxicity Physiological BehavioralAcute - Heroin overdose (the user stops breathing)- “Drunk driving”- Intoxication that dangerously impairs behavioral functioning Chronic - Heart disease- Lung cancer- Cirrhosis- Deleterious lifestyle changes- Strain on interpersonal relationshipsDrug Abuse Warning Network (DAWN)- A system for collecting data on drug-related emergency room visits and deaths Data collected at some U.S. metropolitan hospitals- DAWN collects data on: Illicit drugs Misuse of legal prescription and OTC drugs- Does not determine whether drugs caused the death or ER visitER Visits Death1. Alcohol-in-combination2. Cocaine3. Prescription Opioids4. Marijuana5. Benzodiazepines1. Prescription Opioids2. Alcohol-in-combination3. Benzodiazepines4. Cocaine5. Methadone- Does DAWN tell us how dangerous a drug is? Data are simply number of mentions in total ER visits/deaths- What DAWN does not tell us: Relative danger of a drugo How many problems as a proportion of total drug users? Cause of ER visit or deatho Drugs are mentioned in every case regardless of the cause of the accidentBlood-Borne Diseases- Specific toxicity for users who inject drugs Not due to the action of drug itself Sharing needles passes infectious agents directly into bloodstreamo AIDS, HIV infection, and hepatitis B and C- Syringe exchange programs Example of harm reduction Funded by some local governments Lowers rate of infectionProblematic Drug Use- What is the definition of “addiction”? Often difficult to define- Does it matter: What drug is ingested? How much time is spent on drug-taking? How much drug is ingested?- When does drug use go from “recreational” to “problematic”?Substance Dependence- Three basic processes that may occur with repeated drug use Tolerance Physical dependence Psychological dependence- These processes can be defined and studied by researchers interested in understanding drug dependenceTolerance- Diminished effect of the drug after repeated use Individual may need to use more of the drug to experience the desired effects- The body develops ways to compensate for the chemical imbalance caused by the drugPhysical Dependence- Physical dependence is defined by the occurrence of a withdrawal syndrome If drug use is stopped suddenly, withdrawal symptoms occur, ranging from mild to severe- Tolerance typically precedes physical dependence- Physical dependence means the body has adapted to the presence of the drug- Often characterized by: High frequency of drug use Craving for the drug Tendency to relapse after stopping usePsychological Dependence- Behavioral psychology contextualizes psychological (or behavioral) dependence as: Drug-taking is reinforced by consequences (the drug effects) Research evidence:o Laboratory animals will lever-press for injections of many drugs of abuseChanging Views of Dependence- Early medical models (before 1960) True addiction involves physical dependence Key is treatment of withdrawal symptoms But what about drugs with no clear withdrawal symptoms?- Positive reinforcement model (1960s) Drugs can reinforce behavior without physical dependence Psychological dependence – based on reinforcement – is increasingly viewed as the driving force behind repeated drug useDSM-IV-TR: Substance Use Disorders- Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) Developed by the American Psychiatric Association Provides diagnostic criteria and definitions for multiple disorders Focuses on complex behavioral definitions- DSM-IV-TR substance use disorders: Substance Abuse Substance DependenceDSM-IV-TR: Substance Abuse- 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 home2. Recurrent substance use in situations in which it is physically hazardous3. Recurrent substance-related legal problems4. Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substanceDSM-IV-TR: Substance Dependence- 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. Tolerance2. Withdrawal3. 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 use5. A great deal of time is spent in obtaining the substance6. Important social, occupational, or recreational activities are given up or reduced because of substance use7. Substance use continues despite knowledge of having a persistent or recurrent problem that iscaused or exacerbated by the substance- Note that Tolerance and Withdrawal do not have to be present for this diagnosisIs Dependence Cause by the Substance?- Some drugs are more likely than others to lead to dependence Heroin or crack cocaine for example- But method of use – or route of