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					Legal Drugs
Alcohol and Tobacco are drugs because:
Psychoactive
Recreational
Physical dependence
Alcohol
Large family of alcohol (methyl alcohol)
–Toxic
Ethyl alcohol – for drinking
–Product of fermentation
–Emerged spontaneously
–Probable discovery from fermented fruit
–10,000 years of beverage consumption
Acute Effects of Alcohol
Potency – measured by percent of pure alcohol
–Beer is 4%
–Wine is 10-13%
–Fortified wine products have alcohol added
•Legal limit of no more than 20%
•Sherry is fortified wine by adding Brandy
•Cisco is a wine cooler with 40% alcohol
–Hard liquor is produced by distilling the fermented juice to produce:
•Scotch, vodka, gin, rum, etc.
Acute Effects
Alcohol enters the blood and is thus transmitted to the brain
–BAC is the percent of alcohol in the blood
–.04 is the equivalent of 4grams of pure alcohol per liter of blood
–.10 is 10 grams per liter of blood
There is a relationship between BAC and behavior

Alcohol Effects of Behavior
Variations of dose-effect relationship
Size of drinker
Food/water content of stomach
Carbonation
Speed of drinking (shot of beer per minute for an hour?)
Tolerance (behavioral and physical)
Alcohol Effects of Mental Functions
Alcohol is a depressant
Slows down all organ functions in the body
–Especially the central nervous system
–Retards perception
–Impairs cognitive functioning
–Disorganizes the mental processing of information
Alcohol Effects of Motor Skills
Tolerance is a factor, but
Experienced drinkers tend to over-estimate their motor skill ability
–.02-.04 results is a 1.4% increase in fatal accident
–.05-.09 results in a 11% increase
–.10-.14 results in a 48% increase
–Over .15 results in a 385% increase

Alcohol Intake and BAC
Alcohol Oz. Beverage          BAC
½                      1 can, glass, shot .025

1                        2 cans, glass, shots .05

2                        4                   .10

3                        6                   .15

4                          8                 .20
Alcohol and Violence
By far the drug most related to violence
Causation effect is not known
Alcohol is the most widely used drug in existence
–Even without cause alcohol should be expected to be related to many
violent episodes (like coffee)
Alcohol and Violence (2)
Research confirms alcohols role as a contributing factor
Fear is reduced by alcohol
Subjects take risks more
Aggression increases, but only in people with a history of arguments, and
aggression (e.g. family)
Alcohol and Violence (3)
Summary Points:
Alcohol is correlated with wide range of violent acts
Alcohols effect of violent behavior is mediated by social context, setting,
and culture
Most   violence cannot be ascribed to alcohol and must be explained by
other factors
Alcohol is probably a causal factor in at least a portion of violent acts
Alcohol History
Native Americans who greeted Columbus brewed and drank beer
Early Americans (Puritans) brought large supplies of alcohol with them to
the New World
Two characteristics of early Americans’ drinking patterns:
–Frequency
–Quantity
History (2)
Per Capita Alcohol Consumption
All Americans’ 15 and older
–1790 = 5.8 gallons
–1830 = 7.1 gallons
•What is more, the proportion of alcohol consumed that was made up of
distilled spirits went from 40% in 1790 to 60% in 1830
Temperance Movement
Reacting to the increasing abuse of alcohol
Benjamin Rush wrote “An Inquiry into the Effects of Ardent Spirits on
the Human Mind and Body”
Challenged the conception that alcohol was all good
An advocate of moderation
The first to note that alcoholism progressed in stages and involved
addiction

The Temperance Movement
The American Temperance Society
Founded in 1826
Divided group between the proponents moderation and the proponents
abstinence
By 1830 the abstinence side carried the day
The 1.5 million members hit the streets converting drinkers
Alcohol consumption dropped dramatically

The Temperance Movement (2)
The movements strategy was to under cut the base of alcohol consumption
Local government and grass roots movements pressured to reduce the
number of taverns
Consumption   fell from 7.1 gallons per person in 1830 to about 2 gallons in
1900
By Prohibition the consumption rate had risen to 2.5 gallons per person
over age 15 (1920)
The Volstead Act: Ratified in 1919 in effect in 1920
Conflict between the “wets” and the “drys”
 Conflict between the status groups of:
Rural:
–Native born
–White collar
–Land owners
–Farmers
–Protestant
Urban:
–Immigrants
–Laborers
–Renters
–Catholic



Prohibition Impact
People switched from beer to liqueur
Increased volume of hard alcohol produced
Organized crime infrastructure for distribution and sale
–Most distribution done on small scale
Alcohol Consumption Today
2.3 gallons per person over age 14
One once alcohol per person per day
About 1/3 Americans are non-drinkers
–In 1939 58% define themselves as drinkers
–71% in 1976
–65% in 1996
–Plateau in the 1990’s

Influencing Factors
21 year old National drinking age
Drunk Driving Laws
Domestic Abuse Laws
Sentencing for Alcohol related crime
Drinkers and Non-Drinkers
Higher   the SES the greater the likelihood of drinking
–80% of college graduates
–58% non-college
–Similar for income comparison
Opposite stats for problem drinking
–½ as many college educated are problem drinkers and non-college educated
•Home trouble
•Heavy drinking
Drinkers and Non-Drinkers (2)
Sex has the strongest correlation on alcohol use than any other drug
Men consistently drink more than women
Daily drinkers: 17% female, 33% male
60% of men and 45% of women were drinkers
24% of men binge drink, but only 9% of women (5+ per occasion)
Drinkers and Non-Drinkers (3)
Age is also a factor in drinking patterns
21% of 12-17 year olds
61% of 18-25
63% of 26-34
53% of the over 35
Drinking peaks between 25-29 and declines gradually through middle age,
and rapidly into old age
Drinkers and Non-Drinkers (4)
Ethnicity as a factor in drinking patterns
Clear-cut differences in drinking remain between ethnic groups despite
generations of assimilation
–Catholics more than protestant
–Jews more likely to drink than other ethnic groups
–Irish drink more than other ethnic groups
Drink in past month:
–54% Whites
–42% Hispanic
–36% African-Americans
Binge Drink
–16% White
–16% Hispanic
–11% African-American
»No Statistical difference in heavy drinkers 4.4 – 6%
Alcoholism
No universally accept definition
Four common definitions in competition for dominance
–Quantity and frequency definition
–Psychological dependence definition
–Physical dependence definition
–Life problems definition
Quantity and Frequency Definition of Alcoholism
5 ounces per day
15 drinks per week
Drink everyday
Problems:
–Individual factors influence the effects based on quantity (age, weight, etc.)
–Binge drinkers don’t fit into the definition
•Yearly average may be low but, the pattern of drinking reveals excessive
amounts in short periods of time

Psychological Dependence Definition of Alcoholism
Experience psychological discomfort as a withdrawal symptom
Do you drink after a bad time?
Do your friends drink less than you?
Problems:
–Moderate drinkers could also answer yes to many of the questions
–Definition is very subjective
–Difference between habit and dependence?
Physical Dependence
Definition of Alcoholism
Clear physical withdrawal symptoms must be present
Shakes
Cramps
Problems:
–Too restrictive to be useful
–Problem drinkers are not included
Life-Problems
Definition of Alcoholism
Medical problems (e.g. liver)
Family problems (divorce, abuse)
Career problems (loss of job, no promotion)
Criminal Justice problems (arrests, convictions)
Problems:
–Sub-culture/ cultural definitions of problems
–Medical problems are not straight per dose outcomes (not all develop
cirrhosis of the liver)
Beyond the Definition Problem of Alcoholism
The most controversial debate in the field today
Can alcoholics learn to drink in a controlled, moderate, nondestructive
fashion?
–Disease proponents
•Can not learn to drink wisely
•Must avoid alcohol or relapse back to destructive patterns
–Reversible behavior disorder
•Can be taught to drink wisely and under control
•No disease foundation for alcoholism
Tobacco
The tobacco leaf contains about 1% nicotine among other psychoactive
properties
Can be:
–Smoked – the most efficient
–Chewed
–Snorted
Like other drugs, how the drug is used affects the consequence of usage
Nicotine
Nicotine is a poison
60 milligrams is a lethal dose
A cigar contains 100+ milligrams of nicotine
Kills by respiratory paralysis
Cigarette smoking
–Releases carbon monoxide
–Reduced oxygen to blood
–Shortness of breath
–Dizziness
–Chronic oxygen deficit damages heart and blood vessels
Nicotine and Addiction
Manufactures have denied the connection
Manufactures have repressed research that verified the connection
Today most pharmacologists agree and believe nicotine is the only
reinforcing chemical in tobacco
Nicotine and Addiction (2)
Six indicators of nicotine addiction:
Frequency 20-40 doses per day
Doses correlate with decreasing levels of nicotine in the body
Physical dependence patterns are replicated in laboratory (animal research)
Quitting produces a craving that lasts for years
People who do quit return to smoking as often as heroin addicts return to
heroin
Physical symptoms of withdrawal (headaches, irritability, heart
palpitations)
Nicotine and Death
Nonsmoker is more likely to live to 75 years than a smoker is to live to 65
One chemical in tobacco, benzopyrene, has been identified as the
carcinogenic chemical
430,000 Americans die per year
150,000 die from alcohol causes
Less than 25,000 from all other drugs
Tobacco History
Indigenous to North America
Prior to 1490’s the plant was unknown in Europe
Presented to Columbus and a crew member, Rodrigo returned to Portugal
with tobacco
He was jailed when people saw him smoke
The practice generated hostility and legislation to outlaw sales and use
Some laws even called for the death penalty
Tobacco History (2)
By the 1700’s tobacco was widely used
–Snorting powdered tobacco was popular
–Snuff
In the 1800’ the most popular method of using was chewing
Smoking did not become popular until the invention of the rolling machine
in 1881
Tobacco History (3)
Cigarette Consumption in the U.S.
Year               Billions            Per Capita
1900               2.5                 54
1935               134.4               1,564
1945               340.6               3,449
1963               523.9               4,345
1980               631.5               3,851
1990               524.0               2,926
1995               485.0               2,470
Tobacco Legislations
1964 the Surgeon General issued warnings about tobacco smoke
The  evidence about the negative effects of smoking have grown with each
passing year
Yet tobacco enjoys some immunity from legal control
Less control than:
–Children’s toys
–Automobiles

Legislative Barriers
Tobacco is a 45 billion dollar industry
Executives, employees, communities, stockholder and government all
profit from sales
Average agricultural produces yield $4000 per acre
Tobacco yields $200,000 per acre
Average tax is 50 cents a pack
33 cents per pack savings on Medicaid and Social Security payments
In 1996 the industry spent $600 million, employing 350 law firms to
protect the business
The Future of Tobacco Sales
90% of adult smokers began the habit before age 18
3,000 teenagers take up smoking everyday
1,000 will eventually die from tobacco-related illness
The CDC estimates that 5 million teenagers now smoking will die from
tobacco-related illness
Tobacco sales may decline in the U.S., but sales continue to rise overseas

Marijuana
Psychoactive agent in marijuana is delta-9-tetrahydrocannabinol
Wild marijuana has 1% THC
Average potency has 3-4% THC
Specially grown has 8% THC
Hashish has 8-14% THC
Hash oil has 50% THC
Marijuana
Marijuana is smoked or eaten
Smoking is the most popular route of administration
Admitting heated chemicals into the lungs has consequences that are not
found in the other route of administration
Like tobacco, Marijuana contains benzopyrene (carcinogenic)
Marijuana and Prolong Use
NO definitive consequences have been identified
Marijuana  tends to be used one-twentieth to one-one hundredth the
frequency of tobacco
On the other hand, marijuana smoke is held in the lungs for a longer period
of time
THC Half-Life
Marijuana contains 60 different cannabinoids
Only delta-9-tetrahydrocannabinol produces a buzz
The buzz comes from stimulation of the neurons in the cerebellum and
hypocampus
Delta-9 lasts about 3 hours in the body, but
11-hydroxy-tetrahydrocannabinoid called 11-OH_THC) and 11-nor-9-
carboxy-delta-9-tetrahydrocannabinoid (called 11-nor) are stored in fatty
cells and DO NOT generate a buzz at all

THC Half-Life (2)
Drug tests are measuring the presence of 11-OH-THC and 11-nor in the
body
THC remains in the blood for 19 hours
After a week 25% remains in the body’s fat tissues
Chronic users have THC in the body after 3 weeks of abstinence (figure 30
days for heavy users)
The slow degradation of THC is what causes a lack of withdrawal
symptoms from marijuana
Marijuana Trends
Like cigarette smoking marijuana smoking increased during the 1990’s
                   th
91’-97’ among 8 graders increased lifetime use from 10 to 23%
Annual use tripled from 6 to 18%
30 day use from 3 to 10%
Baby-boom echo explanation
Marijuana History
10,000 years of hemp use (unknown psychoactive use)
Marijuana as medicine has been found in ancient medical texts from
China, India, Persia, Greece and Rome
Marijuana was listed as a medicine in the U.S. until the introduction of the
Marijuana Tax Act of 1937
Marijuana History (2)
Used recreationally as early as 1900
Recreational use was probably introduced by Mexican laborers in the
Southwest
Spread  from the SW to New Orleans where African Americans began to
smoke pot
By 1920 Jazz musicians were smoking pot:
–Jossie Miles “Pipe Dream Blues”
–Duke Ellington “Hop Head”

Marijuana History (3)
White musicians also began to smoke pot by the 1930’s
In the 1950’s the beatnik movement (writers, poets, intellectuals) began
smoking pot
In the 1960’s college students began smoking pot
In the 1970’s smoking pot was part of the general social milieu
Marijuana History (4)
After prohibition the Federal Bureau of Narcotics and Dangerous Drugs
(FBNDD) needed new enemies to support the budget from years of fighting
the alcohol black market
Harry Ansliger was appointed head of the FBNDD by his Uncle Andrew

Mellon, Secretary of Treasury
Ansliger hated Jazz and especially Black Jazz musicians
He lobbied tirelessly for Criminalization of marijuana

Ansliger is widely reported to have stated many times of his dream of

arresting ALL Black Jazz musicians in one huge cross-country bust

Marijuana History (5)
Ansliger traveled the country giving speeches and writing articles about the
evils of marijuana
–“Marihuana: Assassin of Youth”
–“Marijuana-Sex Crazing Drug Menace”
–“Marijuana-The Weed of Madness”
In 1937 Congress passed the Marijuana Tax Act, which effectively
outlawed the growth, and use of marijuana
Acute Effects
Extremely superficial and few in number
–Reddening of eyes
–Increased heart rate
–Dryness of mouth
–Impaired motor coordination???? Research inconclusive
Not an effect
–Dilated pupil was thought to be true, but research by Weil showed no
dilation at all
–Increase in blood sugar level
Subjective Effects
Feelings of peacefulness
Relaxation
Heightened senses
Deep thinking
Laughter
Elongation of time
–Users overwhelming favorable
–Users enjoy the experience

Chronic Effects
Difficult to identify
–Marijuana only user?
–No third variables
Many harmful effects reported are now attributed to research design flaws
–Metal atrophy study done with mental patients
–Brain damage to monkeys, but gas masks were strapped to the face – so
bleeding in the brain was probably due to asphyxiation
Chronic Effects (2)
The only consistent finding is impaired functioning of the lungs
Chromosome damage (rarely)
Lower testosterone
Decreased birth weight
Studies involving long-term marijuana users do not show major clinical,
psychiatric, neurological, or social differences between users and non-users,
or between heavy and light users
Who Uses Marijuana?
Age
–Low use in early teens
–Increases in late teens
–Peaks in early 20’s
–Declines steadily after 30
More responsibilities equals lower smoking, and less responsibilities is
associated with more marijuana smoking
Who Uses Marijuana? (2)
Sex
–Males more than females
–Overall 36% of males and 27% of females
–Past year - 11% male, 7% female
–Past month – 6% male, 3% female
Males slightly more likely to use, but much more likely to be heavy users
Who Uses Marijuana? (3)
Peer Influence
–Why Peer influence and not peer pressure?
–Peer influence is a reciprocal relationship
–Peer pressure is a one-way relationship
Peddler myth
Isolated myth
Three ways friends influence marijuana use:
Role model
Defines the experience
Provides the drug
Who Uses Marijuana? (4)
Unconventionality
–The attitudes of users tends to be:
Liberal

Non-religious

Less traditional in sexual attitudes

Lifestyle dimension of user’s
–Tolerance for deviance
–Risk-taking
–Less authoritarian (more permissive)
Marijuana use correlates negatively with conventionality, traditionalism,
and conformity
Marijuana – Gateway Drug?
Two competing schools of thought on the gateway drug issue
–Internal Locus of Control
–External Locus of Control


Gateway Drug : Internal Locus of Control
Something inherent in smoking
Something intrinsic to marijuana
There is a causal mechanism that leads to more serious drug use
Frequent use leads to:
–Increased use to get the same high
BUT - Marijuana is an auto-titriculating drug

–Larger and larger amounts of marijuana
–Physical and psychological dependence
Gateway Drug: External Locus of Control
Progression takes place because of:
–Activities
–Friends
–Acquaintances
User’s make friends who have attitudes that are favorable toward drugs
The more a person uses marijuana, the more friends the person has that use
The more friends the more opportunity for marijuana use and other drugs
Amotivational Syndrome
User’s become apathetic
Ineffective at achieving conventional goals
Unable to carry out long range plans
Difficulty concentrating
Low achievement in school
Amotivational Syndrome (2)
Two assumptions must be accepted for there to be an amotivational
syndrome:
Marijuana user’s must be high a considerable portion of the time
Marijuana must have an effect on the user long after the user has stopped
smoking
Amotivational Syndrome (3)
Recent research does show:
–Lower grades in secondary school (not college)
–Miss more classes
–More drop outs
–Less likely to go to college
–Greater gap between ability measures and achievement measures
The more the individual uses the stronger the relationship
Amotivational Syndrome (4)
Marijuana users are also:
–More likely male
–More likely to live in divorced homes
–More likely to have parents who get drunk
–More likely to drink three or more times a week
–More likely to get drunk themselves
–More likely to be sexually active
Amotivational Syndrome (5)
The younger the subjects of amotivational research the stronger the
findings of amotivation
Marijuana   is one factor in a complex set of problems associated with
amotivation
Control for all other variables and the association disappears in adult
college students
From THE NATURAL MIND by Andrew Weil
When I was a freshman at Harvard, long before many people thought of

smoking marihuana, there was plenty of amotivation. It took such forms as
sleeping till dinner time and then playing Monopoly all night instead of
working and was indistinguishable from amotivation now associated with
heavy marihuana use. Heavy marihuana use is a convenient symptom for an
amotivated person to add to his list: it is fun, can be done with other people,
angers grownups, and so on. If it is not too late to find a rural college where
marihuana is still unknown, I would predict that the amotivated people there
would become the heavy marihuana smokers once the drug appeared on
campus. If marihuana were the cause of amotivation, one would expect that
amotivation could be cured by taking away the marihuana, but this is not the
case. Therefore, it makes more sense to see amotivation as a cause of heavy
marihuana smoking rather than the reverse.

Hallucinogens
Sometimes called psychedelics
Include:
LSD
Peyote
Mescaline
Psilocybin
MDMA
LSD
Best Known
Synthetic chemical in ergot fungus
The same fungus sometimes contaminates rye bread
The synthetic form was created in 1938 by Swiss chemist Albert Hofmann
Discovered serendipity by accidental inhalation
LSD (2)
Swallowed
Capsule
Tablet
Blotter Paper
An LSD trip lasts between 4 and 12 hours
“Flashbacks”
Natural Hallucinogens
Peyote
Contains mescaline
A cactus plant
Users ingest fresh or dried plant
Nausea is a frequent side-effect
Lasts 3 to 6 hours
Natural Hallucinogens (2)
Psilocybe mexicana
Contains psilocybin
A mushroom fungus
Users ingest dried “shroom”
Nausea sensations
Lasts 3 to 6 hours
MDMA

Developed around 1900 by Merck, Inc.
Firstreal use was in 1953 for Army
Later used to help couples in therapy
(3-4 methylenedioxymethamphetamine)
Subjective Effects
Eidetic Imagery
Synesthesia
Mixing of the senses
Seeing sounds
Smelling tones
Multilevel reality
See an object from many different angles at once


Subjective Effects (2)
Fluid reality
Solid object move
Subjective exaggeration
In numbers
In mood
In event
Timelessness
Time becomes irrelevant
Authentic hallucination
Whole scenes created out of nothing
Sensory  overload
Psychotic Episodes
Generation of temporary psychosis
Three schools of thought:
Any deviation from normal reality is a psychotic episode
A danger of creating mental illness

A recurrent psychotic episode can happen to any user

Hallucinogens are completely unpredictable
Individuals can have radically different experiences in the same setting

Experienced users can have bad trips

Psychotic reactions are socially based
Novel experiences are classified as insane

Loss of social mooring

As time passes fewer psychotic episodes are reported

Genetic Damage
Maiman Cohen in Science, 1967
Human blood cells in a culture of LSD
Chromosome breakage
Further, Cohen found one schizophrenic patient treated with LSD had
higher degree of chromosome damage
Findings of the uncontrolled studies became “facts” in the press
Genetic Damage (2)
Popular magazines published articles about how using LSD “even once”
would damage your children
Articles like “Acid Burned a Hole in My Genes”
Photographs of offspring with birth defects were used to show people what
could happen if they tried LSD

What are the fact on LSD and chromosomes?
Many factors can influence the outcome of chromosome and fetal studies
Controls, to exclude potential third variables are critical
Whether the subject took pure or contaminated LSD
How much LSD and at what dosage levels
Birth Defects
Effects in animals do not demonstrate effects in humans
Effects in vitro (cells in a solution) do not imply effects in vivo (living
being)
Chromosome breakage does not necessarily mean fetal damage
Birth defects occur in 4% of births
Irrespective of drug use
 A mother who has taken LSD and has a child with a birth defect is not
automatically evidence of LSD causation
Birth Defect Research
100 scientific researches
Subjects who ingested pure LSD showed no in vivo increases in
chromosome breakage
Subjects who ingested contaminated LSD (street purchase) had 3 times the
expected rate of chromosome breakage
Impurities are probably responsible for chromosome damage not LSD
itself
Birth Defect Research (2)
Researchers concluded that “There is no evidence of a malformed child
born to a woman who ingested pure LSD; there are six cases of
malformation associated with exposure to illicit LSD…. Given however, the
high frequency of… birth defects, the rare occurrence of malformed infants
born to women who used illicit LSD may be coincidental.”
In short, LSD does not appear to damage chromosomes
Patterns of Use
Beginning in 1963 with the dismissal of Timothy Leary from the faculty of
Harvard
The press has supported the public fear of hallucinogenic drugs
In 1967 there were 50 articles on the danger
By 1975 there were just 4 articles
As the press interest decreased the actual use rose
Patterns of Use (2)
Ever Used
Among college students
1967 just 1%
1971 18%
Among High School students
1975 7%
1985 4%
1990 5%
1997 8%




Patterns of Use (3)
Very few users can be classified as frequent, chronic, or compulsive
Low user loyalty
Not even remotely addictive
Physical
Psychological
Difficult to have a psychedelic drug “habit”
Hallucinogens and Dependence
Three reasons why hallucinogens do not produce dependence
Tolerance builds up rapidly
Faster than any other drug
A trip takes great effort and energy
You can’t just come back
Trips are inconsistent
The experience varies markedly from trip to trip


Stimulants: Amphetamine, Cocaine, and Crack
Amphetamine
–Benzedrine
–Dexedrine
–Methedrine
Street names
–Speed
–Ups
–Crank
–Meth
–Ice

Amphetamine
First synthesized in 1887
Marketed over the counter in 1932
–As a nasal decongestant
Used for the treatment of:
–Narcolepsy
–Depression
–Alcoholism
–Hyperactivity

Amphetamine (2)
Recreational use began in the 1940’s
Subjective and Objective Effects
–Heightened sense of competence
–Increased alertness
–Increased energy
–Stimulation of activity
–Feeling of euphoria
–Increased heart rate
–Inhibition of appetite
–Constriction of blood vessels
–Dry mouth
Legal and Illegal Instrumental Use
Beginning in the 50’s as “Diet Pill”
–Weight loss is temporary and modest
–Today the use is discredited
Truck drivers
Students’ studying all night
Athletes in games
Ordinary people to feel less depressed
Legal and Illegal Instrumental Use (2)
Recreational Multiple Drug Use
–Alcohol
–Marijuana
–Barbiturates
Used to enhance or counter other drugs
Less prevalent today
Compulsive Use
Speed Freaks
Injected IV
Full body orgasm – Jolt of electricity
Typical dose of speed is 2.5 to 10 milligrams
Speed Freak dose 500 to 1,000 milligrams
–Enough to kill the nonhabituated
Wakefulness for 2 to 5 days (a run)
METHAMPHETAMINE
Began in the 1980’s
Started in Hawaii and then to California
Manufactured by adding ephedrine
–A heart and central nervous system stimulant
Last a long time 12 hours +
Typically smoked
METHAMPHETAMINE TRENDS
Lifetime Use
–In 1990 the figure for H.S. seniors was 2.7%
–In 1997 the figure was 4.4
Current Use (past month)
–In 1990, .6%
–In 1997 the figure was .8%
The predicted nationwide epidemic has not occurred
Is Amphetamine Use Harmful?
Heavy use has dramatic effects
–Life
–Mind
–Body
Vasoconstrictor
–Elevated blood pressure
–Increased heart rate
–Increased heart effort to circulate blood
Is Amphetamine Use Harmful? (2)
Amphetamine psychosis
–High dose amphetamine use
–Paranoia
–Violent tendency
–Hallucinations
–Mood swings
Behavioral fixation
–Lint picking
–Counting seemingly infinite things
–Repetitive activity “punding” “getting hung up”
Is Amphetamine Use Addicting?
Physical Dependence
–Discontinuing use after a long period of use does produce withdrawal
symptoms
–Not even close to heroin or barbiturates
Symptoms include:
–Depression
–Lethargy
–Irritability
–Terror
Is Amphetamine Use Addicting?
Physical addiction
Not close to narcotics or depressants
No muscular spasms
No vomiting
In the classic sense no physical addiction
Strongly reinforcing
Behavioral dependence very similar to classic physical addiction
Cocaine
Effects almost identical to amphetamine
In laboratory trials subjects can not tell the difference
Cocaine effects last a relatively short period of time ½ to 1 hour
Cocaine effects are subtle “head” drug not a “body” drug like
amphetamine
Cocaine History
Dates back about 5000 years
Coca plant grows in the Andes Mountains
Plant contains 1-2% cocaine
Natives chew the leaves for energy
No harmful effects have ever been associated with the practice
Cocaine was extracted from the leaves in 1860
Cocaine History (2)
                                         th             th
Used in many popular drink in the 19 and early 20 century
Mariani’s Coca Wine
Coca Cola
The major reason for illegalizing cocaine is probably racism
–Southerners feared blacks became violent
–The drug crazed Negro
Route of Administration
Sniffed
Snorted
Smoked
–Freebase is dissolving cocaine by heating
–The result is pure cocaine
–Melting removes hydrochloride salt
–Vapors are then inhaled
IV injection
Route of Administration (2)
Sniffed or snorted takes about 3 minutes to pass the blood brain barrier
Smoked takes about 6-8 seconds
IV injection takes 12-15 seconds
Each route produces a very different high
Subjective and Objective Effects
Exhilaration
Euphoria
Sense of mastery
Increased energy
Aphrodisiac
–Only in small doses
–Large doses or frequent use inhibits sexuality
Cocaine Trends
Percent of H.S. senior in past year
–1987 10-13%
–1992 3%
–1997 6%
30 day use
–1987 4-6%
–1992 1%
–1997 2%
Cocaine Addiction
Not addictive in the classic sense
–No muscular spasms
–No vomiting
Psychological
–Depression
–Irritability
–Agitation

Cocaine Addiction (2)
Safety
–Relatively safe
–Moderate or light use produces no lasting physical or mental damage
–Pattern of use and relative safety is a product of cost
Behavioral dependency
–Results from frequent use
–Highly reinforcing
30-40% of users report some dysfunction
Crack
Emerged in 1985
Created by mixing cocaine with baking soda and heating
$50 of cocaine can become $150 of crack
Crack spreads because of this incentive
Crack Addiction
Use it once and you’re hooked
Only 30% of users become daily users
Hardly uncontrollable
However, far from innocuous
–Social consequences are high
–Same problems as cocaine only faster
Use trends are similar to cocaine

Psychotherapeutic Drugs
•Drugs Used for Medical or Psychiatric purposes
•Sedatives
•PCP and Ketamine
•Tranquilizers
•Antipsychotics
•Antidepressants
Sedatives
•General Depressants
–Retard signals in the central nervous system
–Slow down activity in many body organs
•Barbiturates
•Methaqualone

Sedatives (2)
•The first, Veronal was marketed in 1903
•2,500 different derivatives
•Classified by the length of their action
–Short-acting: Amytal and Seconal
–Long-acting: Phenobarbital and mephobarbital
Sedatives (3)
•Barbiturate effects are remarkably like alcohol
•Barbiturates do produce classic withdrawal symptoms
–Nausea
–Muscular twitching
–Anxiety
–Trembling

PCP and Ketamine
•PCP is phencyclidine
–Called angel dust or dust
•Closely related to Ketamine
–Called Special K
•Low doses produce
–Numbness
–Disorientation
•High doses produce
–Stupor
–Coma-like state
PCP and Ketamine (2)
•Never very popular street drugs
•Originally developed and approved for veterinarian use
•Not used on humans because of psychotic side effects
•Apparent connection to violent, bizarre behavior: not much different than
other drugs
•Media emphasis on violent behavior
Tranquilizers
•Valium
•Equanil
•Xanax
•Once a very popular treatment for anxiety and other minor psychological
disorders
•Use has declined sharply in recent years
Tranquilizers (2)
•The use has declined because:

•Cheaper generic brands have diluted the market
•Undesirable side effects
–Dependency
•Trends for use are mainly down, but slight increase in 1996

Antipsychotics
•Thorazine
•Stelazine
•Mellaril
•Used for major psychiatric ailments
–Psychosis
•Do not produce a high


Antipsychotics (2)
•Used primarily to reduce the number of in-patient mental hospital residents
•About 85% of state, local, and federal mental health patients are given
some form of antipsychotic drug
•The least expensive form of treatment today
•Side-effect can be debilitating
–Involuntary movement
–Shuffling walk
Antidepressants

•Used to treat mood or affect disorders
•Depression unipolar disorder
•Bipolar disorder is the alternating manic-depressive mood swing
•Prozac
•Tofranil
•Elavil


Antidepressants (2)
•Prozac introduced in 1987
•By 1996 it was the 7th best selling drug in America
•Prozac syndrome
–Violent
–Self destructive behavior
•Currently a debate in therapy

Heroin and Narcotics
The hardest drug
Heroin has defined the drug problem
Public perception of “Dangerous Drug”
Public connection to crime
Public stereotype of “junkie”
Narcotic Drugs
Opium
Grown in Southeast Asia
Used to produce the opiates
Opium
Morphine – an extract of opium
Heroin – an extract of morphine
Codeine

Narcotics
Four characteristics
Analgesic – reduce sensory feelings
Soporific – induce drowsiness, sleep
Physically addictive
Euphoria producing
   The danger comes from the fact that the ED and LD are close. Only 10-15
times the ED can kill the user.
Heroin and Narcotic Use Today
Fewer users than all other illegal drugs
In spite of the few users, heroin accounts for one in five of all emergency
room episodes
45% of all drug deaths
Other narcotics used recreationally:
Darvon
Percodan
Methadone
Dilaudid
Codeine
Demerol




Heroin Use Trends
  th   th       th
8 , 10 , and 12 graders
Lifetime use
1991 = 1%
1997 = 2%
Past Year
1991 = 1%
1997  = 1+%
Narcotics History
          th
In the 19 century sold as over the counter
Called “patent medicines”
Sold with no restrictions
Taken for medical reasons
Very large number of people took patent medicines (millions)
Users and addicts were respectable people
More likely to be female than male
Middle aged not young
White more than minority
Narcotics History (2)
1914 Harrison Act
Outlawed the sale of over the counter narcotics
Supreme Court decisions between 1919 and 1922
What was legitimate medical practice
Maintenance of addiction was outside the scope of medicine
Physicians were unwilling to risk treating addicts
Addicts and users became immoral criminals deserving of prison
Narcotics History (3)
The Harrison Act and the Supreme Court decisions had two major
consequences:
Created a subculture of addicts
Created a necessity for criminal activity
Controlled Opiate Use
A high proportion of opiate users
Chipping is using on a regular and occasional basis
Until recently chipping was thought to be impossible
Patterns and styles of drug use are not a simple function of the properties
of the drugs themselves
Norms of Use
Norms of the opiate subculture can function to control use in four ways:
Define moderate use and condemn compulsive use
Limit the social setting of use to safe practices
Norms identify unexpected effects and teach safe methods (wait to gauge
effects)
Norms compartmentalize use to protect and support non-drug related
obligations
Heroin Effects
The danger of heroin must be put in context
Death  is most often the result of conditions of illegality not toxicity
Potency and purity are not generally known
Asian heroin is 80% pure
On the way to USA half a dozen people step on the product
Dilute the product with quinine or milk sugar


Heroin Effects (2)
Street strength is 10 to 40% pure
Adulterants comprise most of a bag of heroin
Large variability causes unexpected overdoses
Hepatitis and tetanus from unsterilized needles
HIV is also transmitted by unsterilized needles


Heroin Effects (3)
Much of the effects are the result of the present social system surrounding
addiction
Narcotic dependence is extremely common among physicians
more than the general public
Yet physician rarely suffer the negative effects of addiction
Heroin Effects (4)
Four basic reasons for the difference:
Standard dose
Sterile needles
Nutritional compensation
Do not have to search for drugs or money

				
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