EPI 390 Lecture 18Outline of Last 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 informationOutline of Current Lecture I. Review of DSMII. An in depth look at William Halsteada. His accomplishmentsb. Halstead’s AddictionIII. Review of Reasons to Study Drug UseIV. Resources and SurveillanceCurrent LectureI. Review of DSMa. MTF – one of the databases you can use. Used more often than DSMb. Diagnostic and Statistical Manual of Mental Disorders – the Dictionary for mentaldisorders (including drug abuse and dependence). c. 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 d. 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 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.2. Recurrent substance use in situations in which it is physically hazardous 3. Recurrent substance-related legal problems 4. Continued substance use despite having persistent or recurrent social or interpersonal problems caused by, or exacerbated by, theeffects of the substancee. Substance Dependencei. A maladaptive pattern of substance use, leading to clinically significant impairment or distress, manifested by 3 (or more) of the following, occurring at any time in the same 12-month period: 1. Tolerance, as defined by either of the following: a. A need for markedly increased amounts of the substance to achieve intoxication or the desired effect (outcome). b. Markedly diminished effect with continued use of the same amount of the substance. 2. Withdrawal, as manifested by either of the following: a. The characteristic withdrawal syndrome for the substance (refer to Criteria A and B of the criteria sets for withdrawal from the specific substances). b. The same (or a closely related) substance is taken to relieve or avoid withdrawal symptoms.3. The substance is often taken in larger amounts or over a longer period than was intended. 4. There is a persistent desire or unsuccessful efforts to cut down or control substance use.5. A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects. 6. Important social, occupational, or recreational activities are given up or reduced because of substance use. 7. The substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance.f. OCD and PTSD are now their own sections in the DSM because they’ve become such a broad range of disorders.II. An in depth look at William Halsteada. William Halstead – surgeon, realized that surgeons might be infecting patients during operations. Halstead was a cocaine user; the cocaine was originally used as an anesthetic.b. Are drugs bad? No. They’re naturally occurring substances. It’s the use of them that can be incorrect. Halstead’s use of cocaine is an example of this.c. His accomplishmentsi. Blood transfusion to sister – first record of blood transfusion in emergency situation. Could easily have made things worse, but in this instance, it allegedly saved sister from dying of shock after hemorrhaging during pregnancyii. Did gallbladder surgery on mother in kitchen – anesthetized her with ether, sterilized hands and tools in carbolic acid. First instance of gallbladder surgery1. Anesthesia and sterile technique made some afflictions easily treated and increased survival (correction of hernias – piece of intestine pierces lining, gallbladder, appendix surgery)a. Sterile technique wasn’t enough – needed aseptic technique (this prevented infection from occurring, insteadof sterile technique, which killed an infection that was already there)b. Commissioned sterile operating theatre (in New York) for own use. iii. Recognized the surgeon’s hands were the main culprit in spreading infection – used many sterile techniques. Developed rubber gloves after his surgical assistant/nurse developed an allergy to the caustic solution used for sterility.1. Nurses adopted it regularly; surgeons didn’t adopt it for another 6 yearsiv. He was a baby maker. Most surgeons can trace lineage back to Halstead.v. People never went to the doctor unless there was an emergency; no one had regular check ups. vi. Halstead developed breast cancer treatment. 1. Women wouldn’t find out they had cancer until a tennis ball sized tumour was felt. This was usually too late and they died. 2. However, they began to realize if you removed the tumour, surrounding tissue, and underlying muscles, there was less incidence of local reoccurrence. a. (Halstead got over 50% cure; most others had ~0%). Also removed nearby lymph nodes.vii. John Hopkin’s was the first university with research labs. Began research influencing and advancing clinical medicined. Halstead’s Addictioni. Freud had read about cocaine, which allowed german troops to stay awake and fight for days. Noticed numbness anywhere the drug touched. Used it as topical treatment for eye diseases.1. Began to use it to numb eye for surgery; this method was published. a. Halstead read the publication and began injecting his students to see how it numbed the body – the idea was to use it as local anesthesia, blocking nerve ends that could be done before surgery. b. He offered it to dentists for use as well.2. Side effect: a. Addiction - many of his students died or dropped out. b. He would test on himself first, and became addicted. He had built up tolerance, so needed to use more, and would talk gibberish. i. His family did an intervention and brought him in for treatment but cocaine addiction was fairly unknown and so treated him with morphine, getting him addicted to morphine.c. He never fully got his life back under control – continued to use cocaine recreationally –