EPI 390 Lecture 17Outline of Last 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 StudyOutline of Current Lecture I. Reasons to Study Drug UseII. Resources and Surveillancea. Drug Abuse Warning Network (DAWN)b. Monitoring the Future (MTF)c. National Survey on Drug Use and Health (NSDUH) III. Challenges Studying Substance UseIV. Managing Self-ReportV. Relating Drug Use to Binge DrinkingVI. Important Drug Use informationCurrent LectureI. Reasons to Study Drug Usea. Excessive use linked to chronic disease -- biological plausibility (…health concern) i. Alcohol may be connected to Liver cirrhosis ii. Tobacco may result in Cancer 1. [Dose-response relationship] b. Dependence and abuse are distressing in their own right (…personal, familial, psychological concern). c. Intoxication causing accidents, large costs in ER departments (…harm to self and others, $).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. Resources and Surveillancea. Drug Abuse Warning Network (DAWN)i. Surveillance system in the US collecting data on drug-related ER visits ii. Accidents, overdose, suicide attempts, panic (attacks), etc. iii. ER workers need not determine if the drug caused the visit—just that it was involved b. Monitoring the Future (MTF)i. Another surveillance system ii. Annual cross-sectional survey on drug use iii. Goal: Estimate the amount of drug use among high school students in theUS iv. Run by the University of Michigan v. Great estimates for prevalence. Harder to learn about incidence and risk factors – alone or in combination.c. National Survey on Drug Use and Health (NSDUH)i. Annual x-sectional survey on drug use in the US ii. Non-institutionalized persons 12+ 1. Households 2. College dorms 3. Homeless shelters iii. Computer-assisted interview (anonymity, etc.) iv. Survey team not affiliated with US government III. Challenges Studying Substance Usea. Self-report of sensitive information b. Participation (i.e., sample/subsample sizes) c. Attrition in longitudinal studies (e.g., dropouts) i. Note: These are limitation to most epidemiological studies -- however they are an even greater concern in studies of drug users IV. Managing Self-Reporta. Validation i. Studies such as the NSDUH will validate responses on drug use with biological data 1. i.e. A blood cotinine test for smoking a. Cannot be done on all individuals (too expensive) b. Instead, gather a sample of respondents and correlate their response with the drug test results i. Doesn’t solve the problem, but allows us to see how big of a problem self-report is (or isn’t) c. Computer assisted interview i. Less stigmatizing than a face to face interview d. Quality control questions i. Ask the same question different ways to test for consistencye. “Gating” systems i. Not asking every question to every individual ii. i.e. “Have you ever smoked a cigarette” if YES, ask “At what age did you first smoke a cigarette” if NO, skip cigarette module iii. Less burden on respondentV. Relating Drug Use to Binge Drinkinga. Substance abuse and mental health services admin Websitei. Binge drinking – quantitative definition. Current number of drinks to equal binge drinking for males ~22years: 5+ drinks, consumed in 1 hour. For women, it’s 4 drinks. This is a 12oz beer. ii. Need to stratify by gender/body size/type of alcohol/predisposition to alcoholism/health disorders (i.e. in liver)iii. Stratification variables/exposure variables: # of drinks vs. liver toxicity, by age, by gender. Morbidity/mortality?iv. Michigan alcohol surveillance brief: Who are the controls? Non-drinkers.1. What is the geography/location of Sample? Does it say it in the chart? a. The location is MI b/c he clicked on a MI link. VI. Important Drug Use informationa. There’s three major websites NSDA, SAMSA, NHAINS that you should know. Large, publicly accessible, retrospective data sets.b. Drugs of Abuse: In order for EMTs to treat individuals with symptoms from drug use, they need to know:i. Whether the drugs are stimulants or depressantsii. What the main abuse drugs are, etc. iii. Know the medical uses. iv. Don’t need to know psychological impacts,