I. Drug Use and Abuse

A. Drugs are nonfood chemicals that alter the way a person thinks, feels, functions, or


B. Psychoactive drugs have mood-altering or mind-altering effects.

C. Drugs can have medicinal value, but they can have serious negative effects on the health

and well–being of individuals when used improperly

II. Drug Use, Misuse, and Abuse

A. Medications are drugs that have beneficial uses. Foods are not considered drugs, but many foods contain substances such as caffeine that affect the body. Furthermore, when

some vitamins and minerals are consumed in large doses, they have drug like activity in

the body.

B. Drug misuse is the temporary and improper use of a legal drug. 1. Sharing prescription medications is a common form of drug misuse. 2. Refer students for typical drug misuse behaviors.

C. Drug abuse is the intentional improper or nonmedical use of a drug. 1. The use negatively affects the health and well-being of the user, his or her

family, or society.

2. Psychoactive drugs are more likely to be abused than other drugs because of their effects on the mind.

D. The government classifies many commonly abused psychoactive drugs into five drug schedules according to their potential for abuse, medical usefulness, and safety.

E. Schedule I drugs—heroin and LSD, for example— have the most stringent control status. They are commonly abused, have little medicinal value and lack accepted safety

for use. Schedule II, III, IV, and V drugs are available by prescription.

F. Alcohol and nicotine are not scheduled drugs, but the widespread abuse of these substances is responsible for disabling and killing more people than the combined use of

all controlled drugs.

III. Psychoactive Drugs: Effects on the Mind and Body

A. How Psychoactive Drugs Affect the Brain 1. Psychoactive drugs interact with nerve cells in the brain, altering the activity

of chemical transmitters that carry messages from one nerve to another.

2. Psychoactive drugs affect levels of these chemicals in certain parts of the brain, particularly areas of the brain that influence perceptions, thought

processes, feeling, and behaviors.

3. Many commonly abused drugs affect reward centers where they have a positive influence on mood and alertness.

4. Thus, psychoactive drugs often produce euphoria (a “high”) when used.

B. What Happens to Drugs in the Body? 1. After entering the bloodstream, psychoactive drugs eventually reach the brain

where they produce their characteristic effects.

2. Small amounts may be eliminated in urine, feces, or exhaled breath, but the remainder must be metabolized (broken down) into less harmful products and

then eliminated. This process is called detoxification, which usually occurs in

the liver.

3. Some drugs are stored in body fat for weeks and detoxified slowly over time. 4. Intoxication occurs when a drug reaches poisonous levels in the body. 5. An overdose occurs when the body is unable to eliminate excessive amounts

of a drug rapidly.

6. Drug overdoses can be extremely dangerous situations. 7. Polyabuse is abusing more than one drug at a time. 8. When different drugs that have similar effects are combined, the effects of

each drug can be amplified. This amplification is called synergism, which can

be deadly. A common example of synergism is the serious and even life-

threatening effects of combining depressants such as alcohol and barbiturates.

9. Combining depressants can result in severely depressed respiration, resulting in coma or death.

10. Drug interactions can occur with legal or over-the-counter drugs (non- prescription drugs).

a. For example, taking Tylenol with alcohol can cause liver failure and death.

IV. Illicit Drug Use in the United States

A. The Prevalence of Illegal Drug Use 1. In 2012, estimated 23.9 million Americans (9.2% of the population aged 12

and over) were current illicit drug users in that year, meaning they had used an

illicit drug in the month prior to the interview.

2. Fewer Americans use illicit drugs, today, than in the 1970s. 3. Certain segments of the population are more likely to use illicit drugs than


4. Being male, unemployment, and lower education levels are associated with increased drug use risk.

5. In 2012, 36.4% of college students used marijuana at least once during the year, up from 27.7% in 1992.

6. LSD use among college students decreased to 1.9% of students, down from 1994, when about 5% of college students reported LSD use.

B. Why Do People Use Psychoactive Drugs? 1. Ask students why they think people use these drugs.

2. People use drugs for various reasons, such as to relieve boredom, satisfy curiosity, escape problems and stress release.

C. Patterns of Psychoactive Drug Use 1. Drug experimentation and illicit use peaks between the ages of 18 and 20. 2. Most young people who use drugs begin by smoking cigarettes and then drink

alcohol. Marijuana is often the next drug for experimentation in this age


3. In 2012, about 11%, 28% and 36% of 8th, 10th, and 12th grade students reported marijuana use, respectively.

4. Alcohol, nicotine, marijuana, and inhalants often are referred to as gateway drugs because teens use these substances before moving on to other

psychoactive drugs.

5. After using alcohol and nicotine, teenagers are likely to use marijuana next and then any combination of stimulants, depressants, or hallucinogens.

6. Not all drug use follows this stepping stone pattern, however. Some teens do not try other psychoactive drugs after using alcohol or marijuana.

V. Drug Dependence

A. Recreational drug use is usually for pleasure, relaxation, or feeling comfortable in social settings.

B. Drug dependence or addiction occurs when the user develops a habitual pattern of taking the drug that results in a compulsive need that is physical and psychological.

C. Dependent persons are unable to avoid using drugs, and their preoccupation with them interferes with their managing the responsibilities of family and work.

D. Physiological and Psychological Dependence 1. When people take certain psychoactive drugs repeatedly over an extended

period, their bodies make various physiological adjustments to function as

normally as possible.

2. As a result, these people display characteristic signs and symptoms of physical dependence or physical addiction.

3. Tolerance is the ability to endure larger amounts of certain psychoactive drugs while the adverse effects decrease. The usual dose of a drug no longer

produces the desired effects.

4. Withdrawal is a temporary physical and psychological state that occurs when certain drugs are discontinued. Signs and symptoms of withdrawal may

include shaking (tremors), anxiety, and pain.

5. Psychological dependence occurs when a person needs to use a drug regularly to relieve boredom, anxiety, or stress. Psychological dependence can result in

powerful cravings for drugs, and motivates drug-seeking behavior. Not

everyone who uses drugs becomes dependent on them.

E. Risk Factors for Drug Dependency

1. Addiction is the result of complex interactions among biological, personal, social, and environmental factors.

2. Certain conditions in the home—such as parental drug abuse, ineffective parenting, or mental illness—are probably the most crucial risk factors for

children becoming drug abusers.

3. Protective factors, such as strong family and school ties, parental monitoring of behavior with clear rules of conduct, and academic success, reduce the

potential for drug use among youth.

VI. Stimulants

A. Stimulants relieve fatigue, suppress appetite, and improve mood. 1. These drugs enhance chemical activity in parts of the brain that influence

emotions, attention, sleep, and learning.

2. Additionally stimulants increase blood pressure levels and heart rates.

B. Amphetamines and Methamphetamines 1. Synthetic stimulants are amphetamines, methamphetamines, and


2. Amphetamines increase energy and alertness, lessen the need for sleep, produce euphoria, and suppress appetite.

3. Methamphetamines (speed) are more potent forms of amphetamines that have few medically approved uses.

4. Overdoses of methamphetamines can be deadly by resulting in cardiovascular collapse or strokes.

5. Crystal Meth is an extremely potent and addictive drug, crystal meth can produce violent behavior and damage the liver, kidneys, and lungs as well as

the physical appearance

C. Party Drugs 1. Amphetamines and methamphetamines are two drugs in a group called “party


2. It includes alcohol, GHB, GBL, Rohypnol, LSD, ketamine, and Ecstasy. 3. Adolescents, teenagers, and young adults use these drugs at all-night parties

and in other social situations to reduce anxiety, induce euphoria, or build


4. However, these drugs can have long-lasting negative effects on the brain.

D. Ritalin and Other Medically Useful Stimulants 1. Ritalin is prescribed for people with attention disorders, but it is abused

among high school and college students.

2. The stimulant Adderall is more recently used for the treatment of ADHD and is also abused by those who do not need it for medical reasons.

3. Stimulants also are prescribed to treat narcolepsy, but their use to suppress appetite is controversial.

4. Adderall has been used as an “academic enhancer;” however, there is no evidence to suggest Adderall use, by those who do not have an ADHD

diagnosis, improves academic performance.

E. Cocaine 1. Cocaine is a powerful stimulant derived from the leaves of the coca bush. 2. Crack is a rock crystal form of cocaine. 3. It has some medical uses, particularly as an anesthetic. 4. Cocaine is highly addictive and can cause serious health problems including

damage to the nasal passages, lungs and respiratory tract, cardiovascular

problems, and water.

F. Caffeine 1. Worldwide, caffeine is the most commonly used psychoactive substance. 2. Caffeine is a stimulant that causes limited dependence. 3. The average American consumes about 200 mg of caffeine daily—the

equivalent of about two cups of coffee or five cola beverages.

4. caffeine intake improves alertness and reaction time, lifts the mood, helps the body burn fat, blunts pain, and helps relive headache pain.

5. Withdrawal from caffeine causes headaches, tiredness, irritability, and depression.

6. caffeine can disturb sleep and provoke migraine headaches in those prone to them. Consuming 200mg or more per day may increase the risk of


7. Caffeinism occurs on high doses more than 600ml/day. Symptoms include nervousness, trembling, irritation of the stomach lining, insomnia, increased

urine production, diarrhea, sweating, and rapid heart rate.

8. Typical patterns of moderate caffeine consumption are not harmful to healthy people.

VII. Depressants

A. Depressants slow the activity of the central nervous system, producing sedative (calming) and hypnotic (trance-like) effects as well as drowsiness.

1. Alcohol, barbiturates, and minor tranquilizers are depressants. 2. Although some depressants have medical value, they are often misused and


3. Depressants slow heart and respiratory rates, increasing the risk of death when overdoses are taken.

4. Tolerance and dependency occur with regular use. 5. Withdrawal can be deadly.

B. Sedatives and Tranquilizers 1. These depressants are sometimes prescribed to treat insomnia or mild anxiety. 2. However, safer therapies are available. 3. In 2012, 2.1 million Americans abused tranquilizers; 270,000 abuses


C. Rohypnol 1. It often is referred to as a “date-rape drug” because it produces sedation as

well as memory loss concerning the events that occurred while one is under

the drug’s influence.

D. GHB and GBL 1. Gamma hydroxybutyrate, also known as GHB, was formerly sold in health

food stores as a dietary supplement to induce sleep and build muscle.

2. OTC sales were banned by the FDA in 1990, and GHB became a Schedule I drug in 2000 because of its dangerous side effects including seizures and


3. Gamma butyrolactone, also known as GBL, is a drug that the body converts to GHB. It was labeled as a dietary supplement to help build muscles, improve

physical performance, enhance sex, reduce stress, and induce sleep.

4. GBL-related products have been associated with reports of at least 55 adverse health effects, including one death.

5. It is not an approved FDA drug, and all but one manufacturer have recalled it.

VIII. Opiates

A. Opiates include opium, the dried sap of the opium poppy, and drugs such as codeine, morphine, heroin, and Percodan, which are derived from opium.

1. Synthetic opiates include Darvon and Demerol. 2. These compounds are medically used as sedatives, analgesics (which alleviate

pain), and narcotics (alter the perception of pain and induce euphoria and


3. Opiates also are used to treat severe diarrhea and severe coughing. 4. Opiates are highly addictive. Excessive doses depress the CNS, slowing

respiration and reducing mental functioning.

5. People who share needles when injecting heroin increase their risk of becoming infected with bacterial and viral infections, including hepatitis and


B. Opium and Heroin 1. Drugs dealers chemically convert opium to heroin after it enters this country. 2. Heroin is often adulterated before it is sold illegally, which increases the risk

of people taking overdoses.

3. Worldwide, heroin is one of the most widely abused illegal drugs. 4. In 2012, only 0.6% and 0.41% reported use of heroin in 2012, respectively.

C. OxyContin and Vicodin 1. OxyContin is a medication prescribed for moderate to severe chronic pain. 2. Abuse of the drug is popular among high school students. 3. It is very dangerous when combined with other drugs, such as alcohol. 4. Vicodin also is prescribed to reduce pain.

5. Its abuse is higher than OxyContin abuse, especially among high school students and young adults.

6. The rate of illicit Vicodin and OxyContin use steadily declined from 2009 to 2012.

IX. Marijuana

A. Marijuana is the most widely used illicit drug in the United States. 1. THC is the psychoactive substance in marijuana. 2. Marijuana alters normal perceptions and thought processes. 3. When people smoke marijuana or hashish, THC enters the brain rapidly. THC

alters muscular coordination and normal thought processes such as mental

concentration, problem solving, time perception, and short–term memory.

4. Like alcohol, marijuana use can have serious consequences for drivers. 5. After alcohol, marijuana is the most common drug found in blood of fatally

injured drivers.

6. Smoking marijuana and hashish can damage the respiratory tract and may increase the risk of lung infections and lung cancer.

7. Marijuana use has negative effects on reproductive functioning. 8. The drug rarely produces physical dependence when taken infrequently and in

low doses. It can, however, cause psychological dependence.

9. Marinol, a synthetic form of THC, can ease the side effects of nausea and vomiting that accompanies chemotherapy, wasting syndrome in AIDS

patients, muscle spasms in multiple sclerosis patients, and for the treatment of

migraine headaches and seizures.

10. Marijuana has been approved for medical use in 20 states and the District of Columbia.

11. In June 2005 the U.S. Supreme Court ruled that federal authorities may prosecute patients whose physicians prescribe marijuana for their medical use,

and that state laws do not protect users from the federal ban on the drug.

12. Marijuana use is legal for non-medical use in Colorado and Washington.

X. Hallucinogens

A. These drugs produce hallucinations, abnormal and unreal sensations. They can also

produce frightening psychological responses, including anxiety and depression and the

feeling of losing control over your mind.

1. Common physical side effects include elevated blood pressure, dilated pupils, and increased body temperature.

2. While psychological dependence is possible, physical addiction and withdrawal do not occur.

B. LSD (Lysergic acid diethylamide)

1. “Acid” is an extremely potent drug with effects that may last up to 12 hours. 2. Some people have psychotic reactions such as paranoid delusions from using

the drug.

3. Flashbacks also are possible but generally subside over time.

C. Mescaline

1. Peyote, or mescaline, is derived from a small cactus that grows in Mexico and Texas. It is a hallucinogen.

2. Users eat peyote and have hallucinations that last 1 to 2 hours. 3. Street sources of mescaline are often adulterated with LSD.

D. Psilocybin

1. Certain types of mushrooms contain psilocybin, a chemical that produces effects that are similar to but not as intense or long-lasting as those of LSD.

2. Unpleasant mood swings and uncontrollable arm and leg movements may result from psilocybin ingestion.

3. Users may die after ingesting poisonous varieties of wild mushrooms mistaken for those containing psilocybin.

E. PCP (Phencyclidine)

1. PCP, also known as angel dust or rocket fuel, is difficult to classify because it produces a variety of effects that are hallucinogenic, depressant, stimulant, or

anesthetic effects depending on the dose in which it is taken.

2. Its psychoactive effects can last up to 6 hours. 3. High doses can cause severe toxic reactions that may be deadly.

F. Ketamine 1. Ketamine is an analog to PCP. 2. An analog is a drug that is similar to another drug and may or may not

produce similar responses.

3. It has limited use as a human and veterinary anesthetic. 4. Snorting the drug produces dreamlike effects, but the drug can produce

serious side effects such as high blood pressure and rapid pulse rate.

5. Ketamine may be injected by groups of people, increasing the risk of spreading infectious diseases.

6. In high doses or when combined with other drugs, fatal reactions can occur.

XI. Inhalants

A. Inhalants are gases that are breathed in and produce euphoria, dizziness, confusion, and drowsiness.

B. They are taken to induce mood changes.

C. They can be sniffed (such as from a container or an aerosol can), inhaled out of a bag (a practice called “bagging”), or, using a rag soaked with an inhalant (known as


D. Teenagers often are unaware of the dangers of inhalants.

E. Negative health effects include brain damage, irregular heartbeat, anemia, liver damage, kidney failure, coma, and death.

F. Use among college students is relatively low.

G. Refer students to list of common products that contain toxic inhalants.

XII. Designer Drugs: Drugs with Mixed Effects

H. By making chemical alterations to an existing controlled drug, one can make a new drug that is not classified as a controlled substance.

I. After the Drug Enforcement Administration determines that a designer drug has the potential to be abused, they can classify it as a controlled substance.

J. Designer drugs often are more toxic than the drugs from which they are derived.

K. Refer students to list of some commonly used designer drugs.

L. Ecstasy 1. Ecstasy is an illegal designer drug that is chemically similar to mescaline and


2. Users report that Ecstasy improves their self-esteem and increases their desire to have intimate contacts with other people.

3. The drug may produce panic and anxiety, hallucinations, tremors, rapid heart rate, loss of coordination, and psychotic behavior

4. Since the 1980s, several people have died after taking it.

M. K2 1. K2 is a drug that is made in the laboratory and works in the brain much like

the THC of marijuana.

2. Although nicknamed “fake weed,” this drug is not marijuana and is much more potent and dangerous than marijuana.

3. Side effects can be life-threatening.

N. Bath Salts 1. The name is only a disguise for a cocaine-like, life-threatening drug that raises

the blood pressure and heart rate, increases the risk of heart attack and stroke,

and can cause hallucinations, delusions, and paranoia—possibly long-term.

2. Marketed under names like Zoom 2, Vanilla Sky, and Ocean Wave, reports of this drug began in 2010, and by 2011 legislation was underway to make “bath

salts” a controlled substance.

3. Initial research indicates the rate of bath salts us is low among high school students.

XIII. Over-the-Counter Drugs

A. The FDA regulates the production and marketing of prescription and nonprescription medications.

B. To be sold in this country, an over-the-counter (OTC) drug must be safe and effective when people follow the product information that comes with it.

C. Manufacturers must evaluate the safety and effectiveness of the active ingredients in these products.

D. Herbal products that are sold as food supplements in health food stores are not regulated by the FDA.

E. Misuse and abuse of OTC medicines is common.

F. Look-Alike Drugs 1. Some manufacturers produce caffeine-containing pills that look like

prescription medications.

2. Unsuspecting people may purchase look-alike drugs that are sold as amphetamines on the street.

F. Weight Loss Aids

1. Refer students to The Consumer Health Box in Chapter 10 for a description of the potential harmful effects of these products and the drugs they contain.

G. Ephedrine/Ephedra

1. Ephedrine and pseudoephedrine are found in various OTC preparations such as weight loss aids and cold remedies, and they act as a stimulant, appetite

suppressant, concentration aid, and decongestant.

2. These drugs acts as stimulants and are misused as such can produce high blood pressure, sleeplessness, irregular and rapid heart beat, and, in high

doses, can evoke psychotic symptoms.

3. In 2004, the FDA banned the sale of dietary supplements that contain ephedrine because of its dangerous side effects.

4. The Chinese herb ma huang is a natural source of ephedrine and is used in traditional Asian medicine in the United States.

XIV. Drug Treatment and Prevention

A. Treating Drug Dependency 1. Many drug-dependent individuals require medical supervision in special

clinical settings to manage withdrawal signs and symptoms safely.

2. The goal of drug treatment is to reduce the likelihood that abusers will return to their previous drug use behaviors.

3. Three major forms of long-term drug abuse treatment are: methadone maintenance, outpatient drug-free programs, and residential therapeutic


a) Methadone maintenance programs: Use methadone to treat addiction to opiates. Methadone helps ease withdrawal symptoms and reduce

cravings for opiates. This form of treatment is controversial.

b) Outpatient dug-free programs: Provide medical care and a wide variety of counseling and psychotherapy approaches while they continue to

live with their families and work in their communities.

c) Residential Therapeutic communities: For drug abusers that require detoxification. TCs provide controlled environments where users can

live for several months where they receive medical care and


4. In many communities, one can find self-help groups such as Alcoholics Anonymous (see Chapter 8) that are useful adjuncts to professional outpatient

drug treatment.

5. For people who lack health insurance, the high of medical care is a barrier to obtaining such treatment.

6. Most drug treatment programs that last less than 90 days have limited long- term effectiveness. Length of time in treatment is the best predictor of positive

post-treatment outcomes.

7. Relapse is a more likely if the patient has severe mental illness or polyabuse, and they return to communities where drugs are readily available.

8. Recovering addicts are more likely to abstain if they are married or in stable relationships, supported by their families, and employed.

B. Anti-Drug Vaccines 1. An anti-drug vaccine works by stimulating the immune system to develop

antibodies against a particular drug, such as an anti-cocaine vaccine or an anti-

morphine vaccine. These antibodies attach to the drug in the bloodstream,

making the molecules of the drug too large to pass through the membranous

blood-brain barrier. The user does not feel the effects of the drug and therefore

has no reason to use it.

C. Preventing Drug Misuse and Abuse 1. Efforts to reduce the supply of illicit drugs have proven ineffective. 2. Educational programs that promote drug-free lifestyles, especially among

children and young adults, may help reduce the prevalence of drug abuse.

3. Successful drug prevention programs: a. Enhance protective factors and reverse or reduce known risk factors. b. Use interactive methods such as peer discussion groups. c. Target all forms of drug use. d. Teach resistance skills. e. Increase social skills and assertiveness. f. Reinforce attitudes against drug use.

4. Drug education programs that involve parents, media, and the community are more successful than programs that limit educational activities to classrooms.

XV. Across the Life Span: Drugs

A. Pregnant drug users are at risk of miscarriage, ectopic (tubal) pregnancy, and stillbirth.

B. Babies born to mothers who used cocaine, opiates, amphetamines, and marijuana regularly during pregnancy are more likely to be premature and smaller than babies

who were not exposed to these substances before birth.

C. Pregnant women should consult their physicians before using any drugs during pregnancy.

D. Children from low socioeconomic backgrounds are at risk of having developmental problems for a variety of reasons, including their mothers’ lack of prenatal care.

E. High-risk characteristics for drug use among teenagers include gender, family income, parents’ drug use, latchkey status, and peer drug use.

F. Teens who stay in school, attend classes regularly, make good grades, and get along well with their peers generally avoid using drugs.

G. Resilient children accept responsibility, adapt to change, manage stress, solve problems, and are achievement– and success–oriented. Resilient young people have

the ability to remain psychologically, socially, and spiritually healthy even though

their families are dysfunctional or not supportive.

H. Abuse of illicit drugs is not a widespread problem among elderly.

I. However, many elderly people have a higher risk of becoming intoxicated from their prescribed medications because their bodies do not detoxify and eliminate such

substances as effectively as younger ones, and they often take a variety of

medications that may interact negatively.

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