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Focus on
PHARMACOLOGY
ESSENTIALS FOR HEALTH PROFESSIONALS
CHAPTER
11
Substance Abuse
Introduction
• Substance abuse is a major issue in
today’s society.
• The most commonly abused substances
include: alcohol, prescription and OTC
medications, and illegal drugs.
• The most common addiction is to
nicotine, found in tobacco products.
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
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Substance Abuse
• A substance abuse problem exists
when 3 of the following occur:
– Failure to fulfill obligations
– Hazardous behavior
– Recurrent related legal problems
– Continued use despite social or
interpersonal problems
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Substance Dependence
• A person is substance dependent if
any 3 of the following exist:
– Tolerance
– Withdrawal
– Increasing consumption
– Desire to quit
– Excessive time spent on abuse
– Fewer social activities
– Continued use while understanding the
effects
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Addiction
• Addiction is defined as progressive,
chronic use of a substance that causes
the user to continue to use it despite
serious health and social consequences.
• The additive effect is any combination
of substances that may be lethal.
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Addictive Drugs
• Cannabinoids – marijuana, hashish
• Depressants – barbiturates,
benzodiazepines
• Dissociative anesthetics – ketamine,
PCP
• Hallucinogens – LSD, mescaline
• Opioids – morphine, codeine
• Others – anabolic steroids,
dextromethorphan
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Polysubstance Abuse
• Polysubstance abuse is the use of
two or more substances of abuse.
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Most Abused Drugs
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Marijuana – 5.8 percent of Americans
Sedatives –2.8 percent
Opioids – 2.1 percent
Cocaine – 0.8 percent
Hallucinogens – 0.4 percent
Methamphetamine – 0.2 percent
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
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Early Substance Abuse
• The earlier in life that substance abuse
begins, the higher the chance for longterm effects.
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CNS Depressants
• CNS depressants cause relaxation or
sedation.
• Except for alcohol, they are controlled
due to their abuse potential.
• Examples of CNS depressants are
included in the following slides.
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Barbiturates and Non-barbiturate
Sedative-Hypnotics
• These agents are known as sedatives
(hypnotics).
• They are used for sleep disorders and
certain forms of epilepsy.
• They may cause physical or
psychological dependence as well as
tolerance.
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Benzodiazepines
• These agents have widely replaced
barbiturates.
• They are usually used to treat anxiety,
but also for muscle relaxation and
prevention of seizures.
• Withdrawal is not as severe as from
barbiturates or alcohol.
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Opioids
• These agents are derived from unripe
poppy seeds.
• Parenteral forms cause a euphoric rush,
intense sedation, an abnormally slow
body functions.
• Overdose is potentially fatal, and
withdrawal is extremely unpleasant.
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Cannabinoids
• These agents are obtained from the
hemp plant.
• They are usually smoked to obtain their
effects.
• The most psychoactive agent they
contain is delta-9-tetrahydrocannibol
(THC).
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Marijuana
• Marijuana is regularly referred to as:
– Pot, weed, grass, reefer, or dope
• Daily use increases risk of lung cancer
since it is inhaled more deeply than
tobacco products.
• It has recently been approved for
restricted sale in some states for
certain conditions, but is still a
Schedule I drug.
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Hallucinogens
• These agents produce “dreamlike”
effects.
• They are all Schedule I drugs with no
approved medical use.
• The prototype drug is lysergic acid
diethylamide (LSD).
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LSD
• Common effects include hallucinations,
visions, afterimages, and religious
revelations.
• Terrifying, negative experiences may
also occur, with effects lasting up to 12
hours.
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LSD
• Flashbacks may occur, in which the
user experiences the drug’s effects at a
later date without recurrent use of the
drug.
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Other Related Drugs
• Various forms of methamphetamines,
including “Ecstasy”
• Ketamine
• Mescaline
• PCP
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CNS Stimulants
• Legally available by prescriptions
• Used to treat narcolepsy, attention
deficit hyperactivity disorder, and
obesity
• They improve mental and physical
performance, but overdosage may
cause seizures and cardiac arrest.
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Amphetamines
• Though amphetamines cause shortterm alertness, long-term effects
outweigh their benefits.
• Illegally produced amphetamines are
popular drugs of abuse
(methamphetamine).
• Common terms include: “meth,” “ice,”
and “cat”.
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Methylphenidate
• This drug, sold as “Ritalin,” is a CNS
stimulant used for children with ADHD.
• It helps children to relax and focus,
while having the opposite effect in
adults.
• It is a Schedule II drug that is
commonly inhaled, injected, or mixed
with heroin (a form known as a
speedball).
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Cocaine
• Cocaine is obtained from the leaves of
the South American coca plant.
• A Schedule II drug with limited use, it
is illegally used by inhaling, injecting,
or smoking.
• It has rapid, intense effects, but may
cause serious nasal problems,
convulsions, dysrhythmias, stroke, and
death from respiratory arrest.
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Caffeine
• Caffeine is obtained from many different
plants, and is commonly used in coffee,
tea, soda, chocolate, and ice cream.
• It causes increased alertness and
insomnia.
• Repeated use causes tolerance and
dependence, but approved use includes
being added to OTC pain relievers.
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Effects of Substance Abuse
• Anxiety and depression often lead to
substance abuse.
• Substance abuse often leads to:
– Imprisonment
– Unemployment
– Cognitive dysfunction
– Family problems
– Financial loss
– Poor decisions
– Potentially hazardous sexual relationships
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Risk Factors
• Risk factors for drug abuse include:
– Absent or problem parents
– Substance-abusing peers or parents
– Permissive parents
– Poor parental discipline
– Access to prescriptions
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Additional Risk Factors
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Student absenteeism
Aggressive behavior
Poor social skills
Poor academic performance
Early drug use
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Treatment
• When treating addiction,
detoxification must first take place.
• This is the period of getting over
physical withdrawal symptoms.
• Psychological treatment involves
motivational therapy, such as Alcoholics
Anonymous (AA) or Narcotics
Anonymous (NA).
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Allihays / Dreamstime
Figure 11-1
Alcoholics Anonymous is one of the most popular treatment programs
available for substance abusers.
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Therapies
• Often, therapies include interactions
with the user, peers, and families.
• Psychotherapy, drug counseling, and
urine testing may be required.
• Pharmacological treatments may be
indicated for certain addictions
(example: methadone, which is used
for heroin addictions).
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
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Cigarette Smoking
• The single largest preventable cause of
death and illness in the United States is
smoking (mostly due to lung cancer).
• Tobacco dependence is its continued
consumption despite significant
physical, economic, or social side
effects.
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
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Cigarette Smoking
• Smoking-related cancers often occur
when the smoker is in his or her 30s,
and often lead to death
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
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Smailhodz / Shutterstock
Figure 11-2
Smoking is the single-largest preventable cause of death and illness in the
United States.
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Nicotine
• Nicotine is highly addictive and
carcinogenic, affecting most body
systems.
• It accelerates heart rate, increases
blood pressure, and may result in
abnormal muscular contractions.
• Withdrawal causes anxiety, insomnia,
headaches, and gastrointestinal
disturbances.
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
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Effects of Smoking
• Family incidence of cancer means the
smoker has a much more likely chance
of neoplasms.
• Heart disease is greatly increased.
• Chronic lung diseases will shorten life.
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Effects of Smoking
• Lower back pain is greatly increased.
• Smoking repels many potential
relationships.
• It causes premature aging and
wrinkling.
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Smoking Cessation Techniques
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Clinics
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Hypnotherapy
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Progressive filters •
Bupropion
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Varenicline
Employer-offered
financial incentives
Drug counseling
Acupuncture
Literature
Nicotine replacement
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Alcoholism
• Long-term abuse causes devastating
effects.
• Alcohol causes:
– Relaxation or sedation
– Memory impairment
– Loss of coordination
– Decreased inhibition
– Reduced judgment
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Alcohol Metabolism
• Alcohol is metabolized at the rate of
about one serving per hour.
• This means:
– 12 ounces of beer
– 5 ounces of wine
– 1.5 ounces of “hard liquor”
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Effects of Alcoholism
• More than 85,000 Americans die every
year due to alcohol use and related
behaviors.
• Withdrawal is severe, including
delirium tremens (DTs), which
includes confusion, agitation, panic,
“crawling skin,” and paranoia.
• Cirrhosis of the liver is debilitating and
potentially fatal.
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
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Treatment of Alcoholism
• Acute withdrawal is treated with
benzodiazepines and antiseizure
medications.
• Behavioral counseling, self-help groups,
and drugs such as disulfiram may all be
beneficial.
• Additional treatments include
acamprosate calcium and naltrexone.
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini