Drugs and Drug Policy book notes Introduction of 14 15 year olds in the US have already tried an illegal drug Half a million people are behind bars for dealing Half of all criminal violence and automobile fatalities are caused by drunkenness 1 in 12 adults suffer from a substance abuse disorder and 8 million children are living with an addicted parent Cigarette smoking kills more people than alcohol and all illegal drugs combined Now there are more psychoactive drugs than in ancient times and the availability of multiple drugs raises the possibility of drug combinations which can be more deadly than any drug alone The 19th century gave us both organic chemistry to produce refined products from plant materials including morphine and cocaine and potent synthetic molecules such as amphetamines and heroin and the hypodermic syringe as an especially efficient means of getting them to the brain Our current drug policies allow avoidable harm by their ineffectiveness and create needless suffering by their excesses Chapter 1 What is a drug hydration o A chemical that influences biological function other by providing nutrition or o Drugs can come from plants laboratories be benign or harmful depending or both depending on the dosage or can be traditional or novel o A psychoactive drug is a drug whose influence is in part on mental functions on mood perception cognition and behavior Penicillin is a drug but not a psychoactive drug o Abusable drug A drug whose mental effects are sufficiently pleasant or interesting or helpful that some people chose to take it for some reason other than to relieve a specific malady Antipsychotics are psychoactive but not abusable drugs o By this definition cannabis is not technically a drug it is plant material containing many different psychoactive drugs most notably THC and cannabidiol Why is drug use a problem o Often it isn t a problem since most people use drugs in reasonably controlled fashion and without much harm to themselves or others o Most drugs have the many occasional users fewer heavy users and fewer still who remain heavy users for years on end If adbusable psychoactives can be used safely where does the problem come in o They can be used safely doesn t mean that they will be used safely o They can cause three distinct types of problems psychological toxicity behavioral toxicity and addiction What does it mean for a drug to be toxic What is behavioral toxicity Is it the same as intoxication o The dose makes the poison o A standard measure of toxicity is the median lethal dose the quantity of some drug that will take to kill half of the people exposed to it Therapeutic index or ratio LD50 ED50 The higher the index the smaller the risk of therapeutic disaster o Mixing drugs and quantities increase risks of overdose form of toxicity o Sometimes it takes time for a substance to be toxic Tobacco can be profoundly toxic if chronically used o Not all toxic risks come from the drugs themselves i e other chemicals in smoking not nicotine causes cancer and the chronic health risks of heroin users come from sharing needles not from the heroin o Behavioral toxicity The way one acts under drugs i e foolish violent etc o A true intoxicant alcohol cannabis methamphetamine cocaine heroin can depending on dose generate a state of mind in which the ordinary constraints of prudence and conscience are so blunted as to enable extreme behavior atypical of the actions of the same person when not under the influence o By contrast drugs such as caffeine in coffee and nicotine in cigarettes or even small amounts of cocaine in coca tea or coca cola are psychoactive but not intoxicating o We could distinguish intoxicants from other drugs based on whether the drug induced state is a plausible explanation for the person s actions i e I was drunk is a valid excused I smoked a cigarette is not o Bad drug habit substance abuse or dependent disorder addiction when it reaches a more severe chronic form Bad habit A hard to break habit even after the problem is identified when the drug stars being consumed more often and in larger amounts Most people who try drugs never develop any substance abuse disorder o Trying without ever using consistently is by far the most common pattern for the most expensive illegal drugs o Most people who develop a bad habit recover fairly rapidly usually without professional help and with varying rates of residual damage only minorities don t What is addiction What is dependency o Two different kinds o Physical Dependency Defined by the presence of a withdrawal syndrome Withdrawal syndrome If a person experiences discomfort or other worse experiences once he stops taking the drug Can be sometimes fatal but managed with detoxification Alcohol and opiates can generate powerful physical dependency Cocaine s withdrawal symptoms are not as dramatic with the most important symptom being anhedonia inability to experience pleasure o Chemical Dependency The aggravated form of the substance abuse disorder Continued drug taking in the face of adverse consequences diminished voluntary control over the frequency and quantity of drug taking craving persistent intrusive thoughts about drug use that complicate efforts to abstain time spend using them and the crowding out of other activities Is addiction a disease Is it a chronic relapsing brain disorder o Since disease is an abnormal unwanted involuntary physical or mental condition then it is reasonable to label substance abuse disorders diseases o Someone with a problematic drug habit can choose from day to day whether to use the drug but can t choose from day to day not to have the habit or craving that help maintain it most people don t have such habits o The persistent craving even after years of abstinence can lead to relapse Does that mean that drug addicts are not personally responsible for their drug taking o No taking drugs is always voluntary not like the gag reflex o However for persistent drug cravers the decision to not use requires effort and induces suffering Is the risk of addiction limited to those with an addictive personality or those who are genetically predisposed o Genetic factors put some at risk than others however most problem drinkers don t have the relevant genetic markers and don t come from long lines of drunkards so the absence of identifiable risk factors does not imply the absence of a risk o People with certain psychological characteristics like poor impulse control and that are
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