EPI 390 Lecture 16Outline of Last Lecture I. Explanatory Models: Culture and Global HealthII. Types of Explanatory ModelsIII. Understanding Culture in Public HealthIV. Benefits of Understanding Explanatory ModelsV. Sectors of Healthcare in GhanaVI. The Ghanaian Explanatory ModelVII. Factors that Impact Receiving HealthcareOutline of Current Lecture I. Prevention in Michigan (video)II. Overview of Drug Dependencea. Useful Database WebsitesIII. Relevant DefinitionsIV. The Idea of “Addiction”V. Defining an “Illicit Drug”VI. Diagnostic and Statistical Manual of Mental Disorders (DSM)a. Substance Abuseb. Substance DependenceVII. Drug use vs. Drug abuseVIII. Drug Abuse vs. Dependence Case StudyCurrent LectureI. Prevention in Michigan (video)a. MI has successfully developed and sustained a strong system for collecting/using data by collaborating across multiple data systems.i. The data is necessary to inform any strategic planning process. It needs tocover substance abuse trends, incidence, prevalence, and morbidity/mortality. This information helps define whom you should be working with and the program you should implement, based on your target population1. This is all based on epidemiology. These notes represent a detailed interpretation of the professor’s lecture. GradeBuddy is best used as a supplement to your own notes, not as a substitute.ii. The data systems they primarily use are those for education, community health, public health, and mental health.iii. They’ve also created collaborative relationships across departments, i.e. with the Department of Highway Safety Planning in the MI Police. The MI police have employed PhD epidemiologists. This is the only squad in the country that has this. iv. The department of public health, the department of education, the department of state police, and various coalitions, service providers, mental health administrators and substance abuse prevention administrators all help provide information to the SEOW.II. Overview of Drug Dependencea. How do you collect data on drug abuse? i. Drug use: neutral term. (Versus drug abuse or drug dependency)ii. A state bordering CO or WA is going to be the next one to legalize marijuana because officials already have a problem with people crossing the border.b. Useful Database Websitesi. The NIH is a collection of institutes. One for cancer, one for bone health, and the institute addressing drug abuse is NIDA – the national institute of drug abuse.ii. The NIDA branch of epidemiology is where you go if you want a job in the field. It’s where you want to start, because it compiles all recent developments.1. Things you should be able to navigate:a. The director’s page (can get weekly emails updating you in developments. Same with Medscape)b. Heroin – likely b/c of the issue in the twin citiesc. NIDA TV (specifically videos)d. Link between drug epidemiology and forensic science (be able to triangulate back to forensic section)e. NIDA at Work video: (from website)f. Effects on drunk driving, on mothers in breast feeding, marijuana use. Volunteers to participate in marijuana studies. Brain imaging, physiological/subjective effects, cognitive functions, concentrations in various different matrices (in hair, saliva, etc.) after acute use or chronic useIII. Relevant Definitionsa. Drug: any substance, natural or artificial, other than food, which by its chemical nature alters structure or function in the living organism. i. Some ambiguity with alcohol b. Illicit drug: A drug that is unlawful to possess or use.i. Unlawful use of prescription drugs c. Drug misuse: The use of prescribed drugs in greater amounts than, or for purposes other than, those prescribed by a physician or dentist. i. Paints, glues, solvents d. Drug abuse: The use of a substance in a manner, amounts, or situations such thatthe drug use causes problems or greatly increases the chances of problems occurring. i. Social, legal, occupational, psychological or physical e. Drug dependence: a state in which the individual uses the drug so frequently andconsistently that it appears that it would be difficult for the person to get along without using the drug. i. Physiological dependenceIV. The Idea of “Addiction”a. Not a formally used term b. Social stigma c. Does not refer to a specific condition d. Avoid using this term in research settingsV. Defining an “Illicit Drug”a. Cocaine leaf grows well in Lima, Peru. Marijuana grows well in California. Most illegal drugs are modifications on substances found in nature.i. Machu Pichu – gives cocaine leaves to tourists. Coca leaves have a chemical reaction that seems to help with hypoxia from the altitude. It’s also an anesthetic.ii. Coca Cola. The drug effects are addictive; for most people it’s probably the sugar that is addictive.b. Moral: Coca leaf itself is not an illegal drug. It is the altered, adulterated form that is.c. Is alcohol a drug? It has been altered via fermentation. “Where does yeast come from? A yeast tree? A yeast bush? You drink it and you don’t know what it is?? It’s a fungus. But where does it come from?”i. Based on the textbook definition, there’s no good evidence to argue for or against alcohol as a drug. The illegality of alcohol to some individuals does not change the argument of alcohol as a drug. That’s because there is no ethics/morality included in the definition.1. Illegality vs. unethical use of substances/drugsd. Illicit drugs – does have to meet a legal definition. The substance is unlawful; you cannot possess or use it. i. Prescription drugs – if you take a drug that is a legitimate prescription for someone else, your use of it is illegal. Even if it’s a medicine you also take.1. Don’t argue ethicality. Just look at legality.VI. Diagnostic and Statistical Manual of Mental Disorders (DSM)a. Diagnostic and Statistical Manual of Mental Disorders – the Dictionary for mentaldisorders (including drug abuse and dependence). b. Published by American Psychiatric Association-APA i. International Classification of Disease (ICD) used abroad. ii. Current edition: DSM IV-TR iii. DSM V expected in Spring of 2013 c. Substance Abusei. A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by one (or more) of the following, occurring within a 12-month period: 1. Recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home 2. Recurrent