Download Chapter Sixteen: Using Drugs Responsibly

Chapter 16
Using Drugs Responsibly
Learning Objectives
1. Explain the difference between a drug and a medicine.
2. Explain the concept of a drug receptor and its relation to drug side effects.
3. Describe the logic of a double-blind drug effectiveness study.
4. Define lifestyle drugs.
5. Give examples of the overuse of legal drugs in American society and the influences of drug
advertising on drug use.
6. Explain the FDA’s drug approval process.
7. Define addiction, physical dependence, habituation, tolerance, and withdrawal.
8. Describe the different effects of the major classes of psychoactive drugs (stimulants,
depressants, marijuana, hallucinogens, PCP, and inhalants).
9. Describe the health hazards of using anabolic steroids.
Key Terms
Addiction (363)
Amphetamines (367)
Caffeine (368)
Club drugs (369)
Cocaine (366)
Contraindication (356)
Direct-to-consumer advertising (DTCA) (360)
Dose (357)
Double-blind (357)
Drug (345)
Drug abuse (362)
Drug hypersensitivity (356)
Ecstasy (MDMA) (369)
Gamma hydroxybutyrate (GHB) (369)
Habituation (366)
Hallucinogens (372)
Hashish (371)
Hypnotics (370)
Inhalants (373)
Ketamine (370)
Lifestyle drugs (359)
LSD (372)
Marijuana (371)
Medicine (354)
Opiates (370)
Over-the-counter (OTC) drugs (358)
Phencyclidine (PCP) (372)
Physical dependence (363)
Psychoactive (358)
Psychological dependence (366)
Receptor (355)
Rohypnol (370)
Sedatives (370)
Side effects (356)
Stimulants (366)
Teratogen (356)
Tolerance (363)
Tranquilizers (370)
Withdrawal symptoms (366)
Chapter Summary
Drugs are chemical substances that can be of great benefit in maintaining health and in treating
disease. Drugs are prescribed to cure disease, to suppress or modify distressing symptoms, and to
prevent illness or undesired conditions. However, all drugs have side effects that may be
uncomfortable or harmful. Many drugs mimic natural body substances and interact with cellular
receptor sites, thereby altering physiology.
Far too many drugs are used by people to cope with symptoms and conditions that could be dealt
with by safer, more effective means. Drug companies encourage the use of drugs for economic
reasons. Doctors prescribe drugs excessively because patients expect it.
Each person should weigh the risks and benefits of taking any drug. Reducing the kinds and
amounts of drugs that are taken should be an important health goal. Such drugs include not only
prescription medicine, over-the-counter medications, and illegal drugs, but also such commonly
ingested substances as caffeine, nicotine, and alcohol.
All recreational drugs contain psychoactive substances that affect moods, perceptions, and
thoughts. Humans have always sought ways to change states of consciousness. No one really
understands why people seek and use psychoactive drugs. For some, these drugs increase
pleasurable sensations and feelings; for others, they mask negative and depressed mood states. In
many cultures, the use of psychoactive drugs is an integral part of spiritual practices.
Marijuana is the most commonly used recreational drug in the United States and has been
smoked and eaten by people all over the world for thousands of years. The use of cocaine has
increased dramatically in the United States in recent years. Both substances can create
psychological habituation. Some people’s lives are disrupted or destroyed because all of their
energy and resources are devoted to obtaining the recreational drug they crave.
Hallucinogenic drugs, such as LSD and mescaline, are the most potent psychoactive drugs
known. Hallucinogens alter perceptions, moods, thoughts, and feelings. Many dangerous
substances, e.g., inhalants, phencyclidine (PCP), and opiates, are also used as recreational drugs.
Other than alcohol, nicotine, caffeine, and some forms of amphetamines, most commonly used
recreational drugs are illegal, and using or selling these drugs is a crime. Society has always
regulated the use of drugs and will probably continue to do so in the future.
Lecture Outline
What Is a Drug?
•
A drug is a chemical in a medicine that alters the structure or function of some of the
body’s biological processes.
•
Alteration can be to start, stop, speed up, or slow down a process.
•
A medicine is a drug (or combination of drugs) that is used to prevent illness, cure
disease, aid healing, or suppress symptoms.
•
Drugs are classified according to the particular biological process they affect rather than
by their chemical properties.
•
Drug Laws
– Drugs are categorized into the following five groups:
•
Prescription drugs—chemicals so potent that only a doctor can permit
their use
•
Over-the-counter drugs—chemicals that are not so potent so that
consumers can obtain them directly from stores
•
Dietary supplements—plant extracts or vitamins act as drugs and can be
obtained from stores
•
Addictive drugs—tobacco and alcohol, taken by choice
•
•
Illegal drugs—considered so dangerous that they are outlawed
How Drugs Work
– Many drugs act by interacting with specific cells in the body that carry receptors,
which are proteins on the surface or inside a cell to which a drug or natural
substance can bind and affect cell function.
– When a drug binds to a receptor, it affects the biological processes of cells or
organs.
•
Pharmacogenetics
– A major assumption in the prescribing of drugs is that everyone’s body uses a
drug in the same way.
– The science of pharmacogenetics is to ID many of the genes that affect drug
responses and adverse effects.
– The hope is that drugs will one day be able to be tailored to a patient’s specific
biology to produce optimum benefit and minimal risk.
•
Unintended Harmful Effects of Drugs
– Even though a drug may be intended to have a single effect, it often does not
because it binds to different kinds of receptors on different cells.
– Unintended drug actions are called side effects.
– Some side effects include allergic reactions called drug hypersensitivity.
– Contraindication—a medical reason for not taking a drug
•
Routes of Drug Administration
– Drugs can be taken:
•
By mouth
•
By inhalation
•
By injection into the muscle or bloodstream
•
By implant under the skin
•
Through the skin
•
Through mucous membranes of the eyes, nose, vagina, and anus
– Drugs remain active in the body for a relatively short time, often only a few
hours.
•
Effectiveness of Drugs
– The dose of a drug is the amount that is administered or taken.
– Effectiveness of a particular dose of a drug is influenced by:
•
Person’s body size
•
How rapidly the drug breaks down and is eliminated
•
The presence of other drugs or food in the body
•
The person’s mental state
•
Person’s expectations of the drug’s efficacy
– Tested by doing a double-blind study
•
Those receiving a drug and those administering the drug don’t know who
is receiving the drug and who is receiving a placebo.
The Overmedicating of Americans
•
Americans consume huge amounts of drugs every year, both prescription and
nonprescription.
•
Psychoactive drugs
– More than 25% of legal drugs sold in America
– Alter thoughts, feelings, and sensations
– Psychoactive drugs include:
•
•
Tranquilizers
•
Sleeping pills
•
Mood modifiers
•
For example, alcohol, tobacco, caffeine
Lifestyle Drugs
– Lifestyle drugs are sold to basically healthy middle-class Americans.
– Lifestyle drugs are used in the place of making healthy choices such as eating a
diet of vegetables and fruit and staying active.
– Psychotropic drugs—useful for treating specific diseases but not intended to mask
problems caused by stress or relieve anxieties of daily living
– Some are used to target normal changes that occur with aging, hair loss, reduced
sexual drive, and sagging or wrinkled skin.
– Weight loss or appetite suppressant drugs
•
Drug Company Advertising
– Pharmaceutical companies market to doctors by “courting” them for business.
– In the United States, pharmaceutical companies are also allowed to advertise
directly to consumers through television and print media.
The FDA and You
•
A number of tests are run on groups of volunteers to test a drug’s effectiveness.
•
Drugs are also watched for side effects.
•
Only after trials are done does the FDA give approval for sale.
Drug Misuse, Abuse, and Addiction
•
Using any drug to the point where health is adversely affected or the ability to function in
society is impaired can be defined as drug abuse.
•
Drug abuse refers to the person taking the drug being personally or socially impaired.
•
A drug is being abused if the user cannot control taking it and the drug is being used
continually to mask anxiety, combat stress, or seek pleasure.
•
Addiction
– Progressive, chronic condition characterized by:
•
Compulsion—overwhelming preoccupation desire, or drive to use a
psychoactive drug
•
Loss of control—inability to control use of a drug or loss of control over
one’s behavior because of taking a drug
•
Continued drug use despite adverse consequences—tendency not to stop
using a drug in the face of arrest, job loss, family breakdown, and health
problems
•
Distortions in normal thinking—not admitting that problems are the result
of drug taking (denial)
•
Physical Dependence
– Physical changes take place so that continued taking of the drug is necessary.
•
Alcohol
–
•
Caffeine
•
Tolerance
An adaptation of the body to a drug so that larger doses are necessary to produce
the same effect
•
Withdrawal
– A consequence of physical dependence that occurs when the body adapts to the
absence of a drug on which it has become physically dependent
– In general, withdrawal from nervous system depressants leads to:
•
Anxiety
•
Irritability
•
Susceptibility to seizures
– Withdrawal from stimulants can produce:
•
•
Sleepiness
•
Depression
•
Loss of consciousness
Psychological Dependence
– When repeated use of a drug causes an intense craving for the drug
– May lead to compulsive drug-seeking behavior that is injurious to relationships,
jobs, and families
Stimulants
•
Substances that increase the activity of the central nervous system and are referred to as
“uppers.”
•
Common stimulants include cocaine, amphetamines, and caffeine.
•
Main effects include:
– Increased mental arousal and physical energy
– A state of euphoria
•
Long-term use causes physical and psychological dependence.
•
Cocaine
– Stimulant obtained from the coca shrub
– Induces euphoria, sense of power, and clarity of thought, increased physical vigor,
and increased heart rate and blood pressure
– Continued use can result in:
•
Loss of appetite and weight loss
•
Malnutrition
•
Sleep disturbance
•
Altered thought and mood patterns
– Frequent cocaine sniffing can damage the nasal septum
– Routes of administration:
•
Sniffing (“snorting”) it as a white powder
•
Injecting it directly into the bloodstream
•
Smoking it in the form of “free base” or “crack”
– Produces tolerance, physical dependence, and withdrawal
– Potential for psychological dependence with cocaine is very high.
– Can consume an individual’s entire life
•
Amphetamines
– Manufactured chemicals that stimulate the central nervous system
– Most common are:
•
Dextroamphetamine
•
Methamphetamine
•
Dextromethamphetamine
•
“Ice” is a dangerous form that is smoked.
– Produce a hallucinogenic effect that lasts for hours
– Usually taken orally, but can be injected
– Can be prescribed by physicians, but have little medical use
– Produce feelings of euphoria, increased energy, greater self-confidence, increased
ability to concentrate, increased motor and speech activity, perceived
improvement in physical performance
– Excessive use can cause:
•
Caffeine
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Headaches
•
Irritability
•
Dizziness
•
Insomnia
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Panic and confusion
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Delirium
•
Crash
•
Tolerance
•
Mild physical dependence
– Natural substance found in a variety of plants used in making coffee, tea,
chocolate, and soft drinks
– Produces decreased drowsiness and fatigue, faster and clearer flow of thought,
increased capacity for sustained performance, nervousness, tremors, insomnia,
and inability to perform complex tasks
– Psychological dependence can result from chronic use and tolerance can gradually
develop.
– Mild withdrawal symptoms can occur when caffeine use is ceased, including:
•
Headache
•
Irritability
•
Restlessness
•
Lethargy
Club Drugs
•
Consist of several psychoactive chemicals that are often used at social events
•
These include:
– Ecstasy
– GHB
– Ketamine
– Rohypnol
•
Ecstasy
– Methylenedioxymethamphetamine—an amphetamine that has become popular in
recent years
– Also called “Ecstasy,” “Adam,” “XTC,” “Clarity,” “Essence,” MDMA, or MDM
– Users experience hallucinogenic effects and euphoria
– Stimulates the release of serotonin, producing a high that can last hours
– Risks:
•
Confusion, depression, sleep problems, drug craving, severe anxiety and
paranoia during and after taking the drug
•
Muscle tension, involuntary teeth clenching, nausea, blurred vision, rapid
eye movement, faintness, chills, or sweating
•
•
Increases heart rate and blood pressure
•
Long-term damage to serotonin-producing nerve cells in brain
•
Liver damage with long-term use.
GHB
– Gamma hydroxybutyrate
– Also called “G” or “Liquid Ecstasy”
– Causes sedation, increased sexual interest, relaxation, short-term amnesia
– Very dangerous to mix with alcohol
– Large doses can cause users to become comatose and stop breathing
•
Ketamine
– Is a dissociative psychedelic used medically as a veterinary and human
anaesthetic
– Also called “K,” “Special K,” or “Cat Tranquilizer”
– Causes hallucinations, bizarre behavior, psychosis
•
Rohypnol
– Flunitrazepam is a benzodiazepine used as a sleep medication favored for its short
duration
– Also called “Ruffies” or “Roofies”
– Reduces anxiety, inhibition, and muscular tension
– Has received a lot of attention as a “date rape drug”
Depressants
•
Reduce the level of arousal, motor activity, and awareness of environment
•
Increase drowsiness and sedation
•
Produce mild state of euphoria, reduction in inhibitions, feeling of relaxation
•
May impair mood, speech, and motor coordination
•
Carry the potential for:
– Physical and psychological dependence
– Tolerance
– Withdrawal symptoms
•
If two or more depressants are taken at the same time, they produce an effect much
stronger than either drug produces when taken alone (synergistic effect).
•
Sedative and Hypnotic Drugs
– By prescription only
– Sedatives promote mental calmness and reduce anxiety
– Hypnotics promote sleep or drowsiness
– Most common sedative-hypnotic drugs are called benzodiazepines, popularly
known as tranquilizers
– Barbiturates
•
Barbiturates are sedative-hypnotic drugs that include barbituric acid and
its derivatives; these drugs include amobarbital, pentobarbital,
phenobarbital, secobarbital, Tuinal, Rohypnol, and GHB.
•
Opiates
– Opiates are a group of chemically related drugs derived from the opium poppy;
depress the central nervous system (CNS).
– Cause physical dependence, habituation, tolerance, and serious withdrawal
symptoms.
– Can be fatal because of respiratory failure.
– Morphine and heroin are derivatives of opium; they block nerve transmission in
the CNS, suppressing mental and physiological functions.
Marijuana
•
Forms:
– Hashish—sticky resin of the Cannabis sativa plant
– Ganja—dried tops of female plants
– Bhang—contains smaller amounts of THC
– Sinsemilla—potent form of marijuana
•
Active ingredient is THC
•
Low doses of THC produce:
– Euphoria, sense of relaxation
– Sometimes altered perception of time and space
•
THC consumption can invoke:
– Confusion
– Anxiety
– Hallucinations
– Paranoia
•
Research indicates that marijuana contains carcinogens.
•
Many states have legalized use for medical purposes, such as:
– Nausea caused by chemotherapy
– Anorexia as a result of cancer
– AIDS
– Chronic pain
– Migraines
Hallucinogens
•
Derived from as many as 100 kinds of plants and from chemical synthesis in the lab
•
Alter perception, thought, mood, sensation, and experience
•
Most often ingested orally
•
Produce tolerance but do not create physical dependence or symptoms of withdrawal;
there is a danger of psychological dependence
Phencyclidine (PCP)
•
AKA “Angel Dust”
•
PCP was originally used as an animal anesthetic; it is no longer legal and is used now
only as an illegal recreational drug.
•
The effects of PCP vary, depending on the dose and route of administration; it can be:
– A stimulant
– A depressant
– A hallucinogen
Inhalants
•
Depressants of the CNS
•
Intended effect: Loss of inhibition
•
Unintended effects:
– Dizziness
– Amnesia
– Inability to concentrate
– Confusion
– Impaired judgment
– Hallucinations
– Acute psychosis
•
Chemical substances that vaporize rapidly and when inhaled produce various kinds of
depressant effects similar to alcohol
•
Model airplane glue, nail polish remover, paint thinner, gasoline, aerosols, amyl nitrite,
and chloroform
•
Do not produce tolerance or withdrawal, nor do they induce physical dependence
•
Can damage the kidneys, liver, and lungs
Anabolic Steroids
•
Synthetic derivatives of the male hormone testosterone
•
Taken orally or injected
•
Produce increased lean muscle mass, strength, and ability to train longer and harder
•
Side effects include liver tumors, jaundice, fluid retention, high blood pressure, severe
acne, and trembling
Reducing Drug Use
•
People are overmedicated and overly dependent on drugs.
•
The healthiest approach is to be as free of drugs as possible.
•
Wellness is not achieved by taking drugs.
•
All drugs can be dangerous, and illegal recreational drugs are especially dangerous.
Using Drugs Responsibly
•
What is your opinion on the amount of drugs we tend to use in the United States? Is it
appropriate or not?
•
How do you respond to the prospect of taking a drug for a medical condition? Are you
ever critical of what the doctor recommends?
•
Is it bad to have caffeine on a daily basis? Why or why not?
•
What does or would motivate you to avoid recreational drugs?
Study Guide and Self-Assessment Workbook
16.1 Being Knowledgeable About Drugs
16.2 Medicines I Take
16.3 Nonessential Drugs I Consume
16.4 Drugs in Media and Advertising
Additional Resources
American Council for Drug Education
164 West 74th Street
New York, NY 10023
(800) 488-DRUG
www.acde.org
National Center on Addiction and Substance Abuse
Columbia University
152 West 57th Street, 12th Floor
New York, NY 10019-3310
(212) 841-5200
www.casacolumbia.org
National Institute on Drug Abuse (NIDA)
5600 Fishers Lane, Room 10A-39
Rockville, MD 20857
(301) 443-6245
Helpline: (800) 662-HELP
www.nida.nih.gov