Class 1/2/14Freud and Substance use/abuse: Cocaineo 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 o Addicted to nicotine, smoked cigars for more than 30 years, got oral cancer 1923, which ultimately lead to death Morphine 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. Drug abuse: 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 year3 CATEGORIES: Depressantso Licit: Alcohol Illicit: Heroino RX: Morphine, codeine, methadone Stimulantso Licit: caffeine and nicotine Illicit: Cocaineo RX: Methylphenidate (Ritalin, concerta) Amphetamines (Adderall) Hallucinogenso Licit: Salvia Illicit: LSD, PCP, and Mescalineo RX: Ketamine (anesthetic)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 dextromethorphano Called “robo-tripping” or “skittling”o 2006 - nearly 1 million misused OTC medications. o 2009 – 6% of high school seniors took OTC medications. Major concerns:o Easy availabilityo Increased risk of brain damage, seizure, and death associated with high doses. Instrumental Use: A person is taking a drug with socially-approved goal in mind.o Licit: taking valium with prescription to relieve anxietyo Illicit: Taking morphine without prescription to relieve painRecreational 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.Drug toxicity: A drug’s harmful effects are referred to as toxicity Amount/quantity taken is the dose, typically measured in milligrams or 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 excessivelyo Psychoactive substances: alter moods, thought processes, or other psychological states. Heavy substance use induces changes in brain resulting in addictiono Addiction involves compulsive drug-seeking behavior and loss of control over drug use.Characteristics of individuals with diagnosis: DSM-5o 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. DSM-5 (since May 2013):o Differentiates disorders according to specific substance used, e.g. alcohol use disorder, heroin use disordero Disorders involve maladaptive pattern of recurrent use, extending over a period of at least 12 monthso Substance useo Causes notable impairment or distress o Continues despite social, occupational, psychological, or physical problemso With DSM
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