Class 1 2 14 Freud and Substance use abuse Cocaine o Freud believed cocaine could cure close friend Dr Ernst von Fleischl Marxow of morphine addiction o Further research convinced Freud that cocaine could not just cure drug and alcohol addiction and abuse but also ease other ailments including depression anxiety and aches and pains o Freud used cocaine recreationally and to self medicate assorted ailments Stopped after 12 years Nicotine Morphine o Addicted to nicotine smoked cigars for more than 30 years got oral cancer 1923 which ultimately lead to death o During cancer treatment morphine against pain Died of morphine overdose injected by his physician Assisted suicide Psychoactive drugs Affects the nervous system May alter consciousness and awareness influence how we sense and perceive things and modify our moods feelings emotions and thoughts Both legal coffee alcohol tobacco prescriptions and illegal marijuana heroin cocaine LSD Misuse o When a prescription or over the counter OTC drug is used inappropriately In 2010 approximately 16 million Americans reported using a prescription drug for nonmedical reasons in the past year approx 5 of pop o Drug taking behavior where primary motivation is recreational o Most recent national statistics show that almost 20 million Americans spend over 64 billion on illegal drugs each year Drug abuse 3 CATEGORIES Depressants Stimulants o Licit Alcohol o RX Morphine codeine methadone Illicit Heroin o Licit caffeine and nicotine o RX Methylphenidate Ritalin concerta Amphetamines Adderall Illicit Cocaine Hallucinogens o Licit Salvia o RX Ketamine anesthetic Illicit LSD PCP and Mescaline Recent concerns Nonmedical use of nonprescription cough and cold medications Club drugs e g Bath salts High caffeinated energy drinks particularly if consumed with alcohol Fatal overdoses from heroin and other opiates have increased in Norfolk County in the last few years In Norfolk county heroin is responsible for more deaths than homicides There were about 40 fatal overdoses in 2011 then in 2012 more than 50 and in 2013 fatalities are projected to reach the 60s Reported overdoses in Brockton doubled in June said Erik Johnson general manager for American Medical Response for Eastern Massachusetts In a typical month Brockton registers 17 overdoses The city saw 35 in June Cause unknown higher purity suspected Wave of fatal heroin overdoses in 2013 in MA higher purity suspected Over the Counter cough and cold medications used to get high o Cough suppressant dextromethorphan o Called robo tripping or skittling o 2006 nearly 1 million misused OTC medications o 2009 6 of high school seniors took OTC medications o Easy availability o Increased risk of brain damage seizure and death associated with Major concerns high doses Instrumental Use A person is taking a drug with socially approved goal in mind o Licit taking valium with prescription to relieve anxiety o Illicit Taking morphine without prescription to relieve pain Recreational Use A person is taking the drug for the sole purpose of experiencing its psychoactive properties to get high Drug use can be characterized by these two categories A drug s harmful effects are referred to as toxicity Amount quantity taken is the dose typically measured in milligrams or Drug toxicity micrograms The DAWN reports Drug Abuse Warning Network DAWN statistics which reflect drug related lethal and nonlethal emergencies in major metropolitan hospitals in the United States offer another measure of acute drug toxicity In general DAWN statistics show that cocaine and narcotic drugs are both highly toxic and that many emergencies involve drugs being taken in combination with alcohol Heroin or cocaine cause most drug related deaths caused by acute toxicity There are also recent concerns about the increasing number of emergencies associated with club drugs and opiate based pain relief medications Addiction Compulsive drug use despite harmful consequences characterized by the inability to stop using a drug strong desire to relapse after rehab failure to meet work social or family obligations sometimes depending on the drug tolerance and withdrawal Mainly psychological aspect Dependence Physical aspect When body adapts to the substance develops tolerance and occurrence of withdrawal symptoms when drug use stops Physical dependence can happen with chronic use including prescription drugs even if taken as instructed Often accompanies addiction o Tolerance after repeated use the original dose no longer produces the desired effect thus requiring increasingly larger doses to get the same effects o Withdrawal painful physical and psychological symptoms that occur after a drug dependent person stops using the drug The main chemical messenger involved in the brain s reward mechanism is the neurotransmitter DOPAMINE o Each time the person uses a substance they feel good which makes them want to use the substance again Over time changes in the brain occur e g less dopamine is produced which lessens the pleasurable effects of the substance and larger amounts are needed to get the same feeling o Tolerance effects can be quite dangerous because experienced drug users often end up taking potentially lethal dose levels Or after rehab if relapse start with last used levels Substance Use Disorders Arise when psychoactive substances are used excessively o Psychoactive substances alter moods thought processes or other psychological states Heavy substance use induces changes in brain resulting in addiction o Addiction involves compulsive drug seeking behavior and loss of control over drug use DSM 5 since May 2013 Characteristics of individuals with diagnosis DSM 5 o Inability to control substance use despite harmful effects o Craving for and preoccupation with obtaining and using substance o Development of tolerance o Withdrawal symptoms o Differentiates disorders according to specific substance used e g alcohol use disorder heroin use disorder o Disorders involve maladaptive pattern of recurrent use extending over a period of at least 12 months o Substance use o Causes notable impairment or distress o Continues despite social occupational psychological or physical problems o With DSM 5 no longer distinction Dependence and Abuse Substance abuse is used more than drug use in terms of describing it because there is often confusion in the public mind about what is defined as a drug and what is not MAJOR COSTS OF DRUG USE AND ABUSE 1 Lost workplace productivity
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