Chapter 12 Abuse of Alcohol and Other Drugs

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Chapter 12Abuse of Alcohol andOther Drugs
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Scope of the Problem

• 246 -414 billion annual economic loss
• Direct cost - Treatment, mortality, productivity
• Indirect cost - Law enforcement, courts, prison
  system, case managers, insurance rates
• Annual prevalence of illicit drug use among youth
  
• Marijuana 1 illicit drug used by 21.6 of high
  school seniors

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Risks of Abusing Alcohol /Other Drugs

• Self
• Family
• Community

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Risks to SELF of Drug Abuse

• Absenteeism and poor performance at school or
  work
• Loss of productivity revenue
• Underachievement at school or work
• Lower average SAT scores
• Scholastic failure/interruption
• Loss of employment and economic opportunity
• Risk of adulterated drugs
• Adverse drug reactions or bad trips
• Psychosis
• Suicide
• Risk in infectious disease
• Risk of chronic or degenerative diseases
• Increased risk of accidents
• Risk of arrest and incarceration

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Risks to FAMILY of Drug Abuse

• Marital instability/family problems
• Domestic violence and child abuse or neglect
• Increase in number of broken homes
• Defaults on mortgages, loans, and increase in
  bankruptcies
• Injury to fetus or newborn baby

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Risks to COMMUNITY of Drug Abuse

• Increase in public welfare load
• Epidemics of STDs
• Unnecessary burden on health care system
• Unnecessary deaths economic losses
• Criminal activity
• Increased cost of insurance and security
• Increased cost for police, courts, prisons

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Up to 50 Spousal abuse
20-35 Suicides
50 Traffic fatalities
62 Assaults
Alcohol other drugs
49 Murders
52 Rapes
68 Manslaughter Charges
38 Child abuse
69 Drownings
Health Concerns Associated with Alcohol Use
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Definitions

• Drug
• substance other than food or vitamins that when
  taken in small quantities, alters ones physical,
  mental, or emotional state
• Psychoactive drug
• alters perception, mood, thought processes, or
  behavior
• Drug misuse
• inappropriate use of prescription or
  nonprescription drugs

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Definitions

• Drug abuse
• taking of a drug for non-medically approved
  purposes
• continued use of a legal drug with the knowledge
  that it is hazardous to ones health (cigarette
  smoking)
• Drug dependence
• Psychological - characterized by the strong
  desire to continue the use of a drug
• Physical - state in which discontinued drug use
  (withdrawal) results in physical illness
• Alcoholism lthttp//www.aarecovery.com/alcoholism.h
  tmlgt

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Factors that Contribute to Substance Abuse

• Inherited risk factors
• evidence of some types of alcoholism
• Children of alcoholics - 4x higher risk of
  alcoholism
• Risk higher for children of alcoholic father also
  indicated
• Actual gene unidentified - DRD2 gene is a
  candidate
• Enzymes may inhibit normal metabolism of alcohol

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Environmental risk factors

• Personal
• Personality, mood, susceptibility to stress and
  depression/anxiety, social and communication
  skills
• Home family
• Family dynamics, problems, negative events,
  attitudes, expectations, skills developed
• School peer group factors
• Peer pressure and support
• Sociocultural aspects of ones environment
• Cost and Availability, advertisement, employment
  levels, threats to safety, unempowered, future
  appears hopeless, short term goals, quality of
  law enforcement and education

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Types of Legal Drugs Abused

• Alcohol
• 1 drug problem in America - WHY?
• 80 of high school seniors tried alcohol once
  (NIDA, 1999), 33reported being drunk in past 30
  days, and 31 binge drinking in past 2 weeks
• 40 of college students report having 5 or more
  drinks in a row at least once in the past 2 years
• Problem drinkers
• use results in personal, financial, social or
  legal problems
• 10 of those who drink

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Types of Legal Drugs Abused

• Nicotine
• use occurs in the form of cigarette, cigar, pipe
  smoking, chewing tobacco and snuff
• 34.6 of high school seniors smoked cigarettes
  within last 30 days (1999)
• 23.1 smoked daily (1999)
• 430,700 deaths each year
• 138 billion economic cost (1/2 for health care
  costs)
• environmental (ETS) or second hand smoke
• EPA - ETS is a human class A carcinogen
• Lung Cancer, Respiratory infections, Asthma

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Types of Legal Drugs Abused

• Over-the-counter (OTC) drugs
• can be purchased without a doctors prescription
• misuse is very common
• most provide symptomatic relief, not a cure
• Prescription drugs
• requires a physicians written instructions
• usually stronger than over-the-counter drugs
• greater risk of abuse, e.g., OxyContin
  (painkiller)

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Types of Illicit Drugs Abused

• Marijuana
• most abused illicit drug
• 23.1 HS Seniors smoked in past 30 days(1999)
• 1997 - 32.3 annual usage in college students
• both acute and chronic effects- cognitive,
  emotional, social, developmental
• use higher among students who participate in
  other high risk activities, e.g., binge drinking,
  smoking, multiple sex partners
• factors associated with marijuana use
• more time at parties and socializing with friends
• less time studying and poorer academic
  performance
• perceiving religion and community service as
  unimportant
• larger, commuter, or coed schools - more use

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Types of Illicit Drugs Abused

• Opium, morphine, heroin
• Narcotics numb the senses and reduce pain
• 500,000 to 1 million heroin addicts
• produce tolerance and physical dependence
• injection users are at high risk for becoming
  infected with HIV
• Synthetic Narcotics demerol, darvon, percodan,
  and oxycontin (painkillers)

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Types of Illicit Drugs Abused

• Cocaine
• potent stimulant
• 1.7 million Americans used in last 30 days
• Hallucinogens
• LSD
• Mescaline
• Psilocybin

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Types of Illicit Drugs Abused

• Designer or Club Drugs
• Rohypnol (date rape drug)
• MDMA (ecstasy) and related compounds
• PCP (angel dust) and related chemicals
• Stimulants
• Amphetamines
• Methamphetamine (crystal crank speed
  meth)
• Methcathinone (cat)
• Methylphenidate (Ritalin)

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Types of Illicit Drugs Abused

• Depressants
• Barbiturates
• Benzodiazepines
• Methaqualone
• Anabolic drugs
• Inhalants

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Prevention Control of Drug Abuse

• Primary (Children and Adolescents)
• are aimed at those who have never used drugs,
  their goal is to prevent or forestall the
  initiation of drug use.
• i.e., raising the price of alcohol, increasing
  cigarette taxes, arresting a neighborhood drug
  pusher, destroy crops
• Institutionalize drug prevention - each new
  generation
• Secondary (Late Childhood and Adolescents)
• seek to reach those who have begun drug use but
  are not chronic drug abusers
• Tertiary (Adolescents and Adults)
• designed to provide treatment for abuse
  aftercare

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Elements of Prevention

• REDUCE DEMAND
• Education - increase knowledge and skills
• Treatment- reduce physical, emotional, and
  environmental conditions leading to abuse
• Residential and Outpatient
• 1.00 for treatment saves 7.00 in medical and
  crime
• REDUCE SUPPLY
• Law Enforcement - ID, Arrest, Trial, Sentencing
• Control use, related crime, crime orgs., and
  protect neigborhoods
• Limit Source, Transit, and Distribution
• Public Policy - Laws and Funding
• Smoking bans, zoning ordinances, advertising
  limits

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Official Agencies Programs

• White House Office of National Drug Control
  Policy
• Director John P. Walters - 2001
• Five Goals
• 1. Educate youth to reject illegal drugs
• 2. Reduce drug-related crime and increase safety
• 3. Reduce health and social costs of illegal
  use
• 4. Shield air, land, and sea borders from drugs
• 5. Break foreign and domestic drug sources of
  supply
• 19.2 Billion dollars budgeted for 2002

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Other Federal Agencies

• Department of Justice (DOJ)
• Reduce Supply
• law enforcement prisons, other aspects of
  justice system
• Largest budget 8.23 Billion
• Drug Enforcement Agency (DEA)
• lead governmental agency on investigation and
  prosecution of drug traffickers
• FBI
• Immigration Naturalization Service

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Official Agencies Programs

• Department of Health Human Services
• Reduce Demand
• 2.87 Billion in 2001
• Prevention education, treatment, and research
• Department of Treasury
• Reduce Supply
• 1.69 Billion
• U.S. Customs Service
• Internal Revenue Service (IRS)
• Bureau of Alcohol, Tobacco and Firearms (ATF)

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Official Agencies Programs

• HHS - agencies
• Substance Abuse and Mental Health Services
  Administration (SAMSHA)
• National Institute of Drug Abuse (NIDA)
• lead federal research agency
• Food and Drug Administration (FDA)
• federal regulatory agency for legal drugs

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Official Agencies Programs

• State government
• influence the outcome of drug wars through
  advocacy, administrative aid and legislation
• Regional coordination offices
• provide a link between state and local efforts
• Local agencies programs
• Local coordinating councils
• Community-based drug education programs
• School-based drug education programs
• DARE

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Worksite Based Programs

• Drug Free Federal Workplace - Exec. Order 1986
• Concern with Safety and Productivity of workers
• Drug Free Workplace - Private Sector programs
• Written formal policy
• Drug Education and Awareness programs
• Supervisor Training
• Employee Assistance Programs
• Drug Testing - began in 1987

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Voluntary Agencies Programs

• Mothers Against Drunk Drivers
• Students Against Drunk Drivers
• Alcoholics Anonymous
• Narcotics Anonymous
• American Cancer Society

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Chapter 12
Abuse Of Alcohol And Other Drugs