Motivation and Drug use

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Motivation and Drug use
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IS DRUG USE A PROBLEM?egMarijuana?Other
drugs?
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OK thenDrug Abuse?
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Problem How to define

• Drug addiction? Is once enough? A repetitive
  behavior pattern associated with increase risk of
  disease or social problems (Marlatt, 1988)..often
  characterized by immediate gratification and high
  relapse ratesbut is this the same as abuse?
• Drug abuse-how to define?

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Drug Abuse

• The self-administration of any drug in a manner
  that deviates from the approved medical or social
  patterns within a given culture (Jaffe).
• Drug Dependence- a condition in which an
  individual requires a drug to function normally.
  A distinction is often made between Physical
  dependence and Psychological dependence.

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Physical Dependence

• An adaptive state produced by repeated use of a
  drug which manifests itself by intense
  physiological disturbances (withdrawal syndrome)
  when use of the drug is halted (abstinence).
• Withdrawal syndrome- a constellation of symptoms
  that occur when an individual stops using the
  drug to which dependence has developed. Symptoms
  typically in reverse direction of the effects
  caused by the drug.

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Psychological dependence

• A condition characterized by intense drive or
  cravings for a drug.

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Perhaps motivations for drug use can be estimated
by the degree to which drug abuse is a problem.
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Problem How to measure(Reactivity and return
rate issues)
How big is the problem?
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Illicit drug use reported by state
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Accuracy of surveys?
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• B.3.1 Screening and Interview Response Rate
  Patterns
• In 2004, respondents continued to receive a 30
  incentive in an effort to improve response rates
  over years prior to 2002. Of the 142,612 eligible
  households sampled for the 2004 NSDUH, 130,130
  were successfully screened for a weighted
  screening response rate of 90.9 percent
  (Table B.2). In these screened households, a
  total of 81,973 sample persons were selected, and
  completed interviews were obtained from 67,760 of
  these sample persons, for a weighted interview
  response rate of 77.0 percent (Table B.3). A
  total of 9,362 (15.2 percent) sample persons were
  classified as refusals or parental refusals,
  2,918 (3.9 percent) were not available or never
  at home, and 1,933 (3.9 percent) did not
  participate for various other reasons, such as
  physical or mental incompetence or language
  barrier (see Table B.3, which also shows the
  distribution of the selected sample by interview
  code and age group). Among demographic subgroups,
  the weighted interview response rate was highest
  among 12 to 17 year olds (88.6 percent), females
  (78.5 percent), blacks (81.9 percent), in
  nonmetropolitan areas (79.2 percent), and among
  persons residing in the South (78.7 percent)
  (Table B.4).
• The overall weighted response rate, defined as
  the product of the weighted screening response
  rate and weighted interview response rate, was
  70.0 percent in 2004. Nonresponse bias can be
  expressed as the product of the nonresponse rate
  (1-R) and the difference between the
  characteristic of interest between respondents
  and nonrespondents in the population (Pr - Pnr).
  Thus, assuming the quantity (Pr - Pnr) is fixed
  over time, the improvement in response rates in
  2002 through 2004 over prior years will result in
  estimates with lower nonresponse bias.

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And How the questions are askedeg
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VS. selected age ranges by month
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Or special populations?
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Different Ethnic groups?
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• So maybe marijuana use is not so overwhelming?

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But Alcohol is a drug
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And Tobacco!
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And..
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And of course there are many other psychoactive
drugs we are not considering here

• Heroin
• LSD
• Crack
• MDMA
• Etc

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Overdoses? DAWN
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Heroin overdose
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Not just our problem
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COSTS of DRUGS in SOCIETY?
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And money is being lost
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Incarceration costs- not including lost
productivity for families
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And Psychological WORRY?
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Psychological Impacts?
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Drugs and Violence
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So Lets War on Drugs!
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More money (lost?)
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it does cost lots of money
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The WAR on Drugs
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People are being incarcerated
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And sent up for treatment
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But is it working?
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Cocaine production is not down
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Prices are relatively stable
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Costs of the War on Drugs
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Effectiveness of War?
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AND CONCERNS/COSTS in the home and Work place
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It does create its own economy
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Should we use drug testing at work?
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Maybe its necessary
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What if tests are too sensitive??
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Watch out here they come!
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Is the War aimed in the right directions?
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DRUG TESTS BRING WORRIES OF ACCURACYApril 16,
1998 "I go to extraordinary lengths before I
call a positive."Dr. DavidBerg, Medical review
officer said.The water-cooler talk is true
Poppy seeds can produce a positive test for
heroin, and cold medicine can suggest
methamphetamine.
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The wild eyed claim that a third of all people
accused of drug use will be innocent is not so
ridiculous after all. Figure 4 shows that the
proportion of spurious results among people
identified as drug users is surprisingly
sensitive to test accuracy. An accuracy of 99 is
marginal at best. However the biggest surprise is
the fact that the proportion of spurious results
among people failing drug tests approaches 100
as the proportion of drug users in the general
population approaches zero. Drug testing in a
drug free population amounts to a witch hunt.
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SO ?

• Whatever your perspective on drug use and abuse,
  its difficult to argue that drug use is in no way
  problematic.
• Especially when considering the harmful effects
  of drug addiction/Abuse to the individual and to
  society.

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For the Sake of Argument

• Lets say there is significant drug use and/abuse
  in our society.

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What are the causes of drug Use and Addiction?

• A difficult question.
• MORAL MODEL-character
• MEDICAL MODEL-disease
• LEARNING MODEL-reinforcement
• ENLIGHTENMENT MODE-multifactorial

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??

• Genetics
• Environment
• Concordance rates in identical twins separated at
  birthdoes not completely rule out environmental
  factors.

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• Whatever the original causes,
• 2 additional factors are necessary before drug
  addiction will occur..

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• Availability prohibition?
• Trying it.-turning on.
• But what then leads to dependence?

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Commonalities in Drug Addiction

• Taking the drug
• Decreased initial drug effect (tolerance)
• Cravings
• (psychologicalbut obvious physical dependence is
  not a common denominator.
• Dose stabilization
• Periods of abstinence

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And unfortunately..RELAPSE
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Is treatment effective?
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Other contributing factors to drug
dependence/abuse

• Type of drug
• Route of administration

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Consider heroin vs. an oral opiate drug
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Structure of heroindiacetylmorphine
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Factors influencing drug effectsSystems that the
drug affects..opioid receptors in the brain
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And receptor subtypes affected
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How drugs can affect the nervous system
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Direct vs Indirect actions
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Agonism and antagonism
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Competitive vs non-competitive drug actions
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Reuptake
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Direct receptor agonism
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Direct receptor antagonism
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Indirect agonism ACHE inhibitors
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Drugs can affect synthesisegL-DOPA
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Drug addiction and the brain?
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Animal Models of drug reward and dependence

• James Olds and Intra-cranial Self-administration
• Place preference
• 2 lever choice
• Progressive ratio
• Conflict tests

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REWARD SYSTEMS OF THE BRAIN?
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ICSS and brain reward centers?

• LH
• MFB
• VTA-Accumbens
• DA agonist and antagonist effects

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From ICSS to ICDSA
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Brain ccts of drug rewardIntra-cranial drug
infusion
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Microdialysis techniques
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ICCS increases DA release in Nucleus Accumbens
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Drugs increase DA release in accumbens
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What about ICSS in Humans
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Special Issue-MJ

• Quotes
• On September 12, 2002, the Drug Enforcement
  Administration, the White House Office of
  National Drug Control Policy, and the Surgeon
  General, in response to the expanding world
  dialog concerning the legalization of marijuana
  (including our main ally Great Britain, our
  neighbor Canada and some of our own states),
  jointly launched a campaign to "dispel the myths
  about marijuana, and teach parents and children
  the REAL facts surrounding this drug."
• This initiative will cost the American taxpayers
  billions of dollars spent by these agencies on
  commercials, advertisements and policies that
  they themselves admit are totally ineffective and
  fail to achieve their objective (which is the
  decrease in marijuana use among adolescents).
  According to the Office of National Drug Control
  Policy, "Marijuana use has doubled among teens in
  the last decade."

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• ONDCP says, "NO drug matches the threat posed by
  marijuana."ONDCP is currently spending hundreds
  of millions of dollars on commercials solely
  targeting marijuana use with themes taken
  straight out of the script of the film "Reefer
  Madness". They have written an open letter to
  American prosecutors urging them to prosecute
  marijuana cases more severely, and to work with
  local authorities and law makers to help enact
  tougher marijuana legislation. And they have
  written an open letter to parents filled with
  lies and scare tactics, such as marijuana causes
  reckless and criminal activity, pregnancy,
  problems with learning and comprehension,
  psychosis and mental illness. These same "facts",
  however, do not stop our government from
  sanctioning the manufacture and sale of alcohol.

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• The Surgeon general says, "Marijuana has three to
  five times the carcinogens as tobacco."Yet
  Federal Bureau of Mortality statistics state that
  no deaths have ever been caused by marijuana,
  while hundreds of thousands of deaths are caused
  by tobacco every single year! Now shouldn't
  marijuana be killing three to five times the
  people that tobacco kills annually? Also, the
  average tobacco user smokes four to eight times
  the number of cigarettes versus the number of
  joints the average marijuana smoker consumes.
  Now, according to them, this would equal up to
  266 more damaging carcinogens than marijuana,
  yet this is totally legal.

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• The DEA and ONDCP both say, "Marijuana is an
  addictive drug. In 1999 over 200,000 people
  entered treatment centers for help."This is
  however not voluntary admissions, as they would
  like for us to think, but the number of people
  out of over 700,000 arrests for marijuana use,
  who were forced by the court system to enter
  substance abuse treatment programs as part of
  their sentences. Also, this number includes the
  people who were forced to enter treatment
  programs to remain employed after failing a urine
  test.

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• The DEA and ONDCP say, "More children are
  addicted to marijuana than alcohol and all
  illicit drugs combined."The lie here is again
  the word "addicted". "More children USE marijuana
  than alcohol and other illicit drugs". This is a
  result of marijuana being more prevalent than
  these drugs in today's schools, and not that it
  is more addicting. A recent study showed that
  children say that marijuana is easier to get than
  tobacco and alcohol. This says two things first,
  that if marijuana were legal, with the
  restrictions that are placed on tobacco and
  alcohol, it would be harder for children to
  obtain, and second, that the war on marijuana is
  not working!

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• The real truth about marijuana's addictiveness
  can be found on the webpage of UNIMED
  Pharmaceuticals, the manufacturer and distributor
  of Marinol(a FDA approved synthetic version of
  the active ingredient in marijuana)."In 1999,
  the U.S. Drug Enforcement Administration(DEA),
  based in part from a concurring recommendation
  from the U.S. Department of health and Human
  Services, reclassified Marinol(dronabinol)
  Capsules from a Schedule II substance to Schedule
  III. This action was taken after thorough review
  of the abuse potential of Marinol, which found
  that the drug has lower abuse potential than
  drugs or substances in Schedules I and II. The
  DEA also found little evidence of actual Marinol
  abuse, despite increased number of prescriptions
  issued."

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• Now consider this, Marinol is 95 pure THC.
  Meanwhile, the most potent marijuana, even at the
  exaggerated potency levels that the
  prohibitionists claim, is only a third of this.
  In reality the average marijuana being smoked in
  America is less than 10 THC.

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• ONDCP and the DEA say, "87,000 annual emergency
  room visits are people seeking treatment for
  marijuana related traumas."What they're not
  telling you is that hospitals do drug testing,
  and whether you're pregnant, or you experience
  any emergency that requires a blood or urine
  test, at the hospital's discretion, you could be
  drug tested. A positive marijuana result ends up
  being a marijuana related emergency room
  statistic regardless of the injury or
  circumstances.

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• The DEA and ONDCP say, "Marijuana affects a
  child's learning abilities, and that a child with
  a "D", or lower, average grade score is four
  times more likely to smoke marijuana than a child
  with an "A" average."Now what are they saying
  here? That a dumb child is more likely to smoke
  pot, or that a kid who smokes pot will more than
  likely become dumb? And what formula did they use
  to calculate the percentage? "D"4X, "C"3X,
  "B"2X ? Based on this a student with an "A"
  average will be just as likely to smoke marijuana
  as any other "A" student who already does.

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• ONDCP and the DEA say, "Marijuana not only
  affects the user but others as well because as
  many car crashes are caused by marijuana as are
  caused by alcohol."Yet FBI and state police
  statistics state that up to 50 of all highway
  accidents and fatalities are alcohol related. Now
  this would mean that the other 50 are marijuana
  related, leaving these two causes as the only
  factors contributing to accidents on our nation's
  roads. In Virginia, in both state police and DMV
  highway reports, marijuana is not even listed as
  a cause of crashes or accidents. In spite of
  this, right now, the federal government is
  proposing a "zero tolerance" drugged driving law
  which targets marijuana users.

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• An officer can administer a roadside drug
  test(pulse and/or blood pressure check, saliva,
  blood or urine samples), and ANY positive result
  results in an immediate DUI (whether you've
  recently smoked any amount of marijuana or within
  days or weeks). Meanwhile, UNIMED Pharmaceuticals
  has this to say about Marinol and driving
  "Patients receiving treatment with Marinol should
  be specifically warned not to drive, operate
  machinery, or engage in any hazardous activity
  until it is established that they are able to
  tolerate the drug and to perform such tasks
  safely." The DEA has changed this statistic
  from 50 to 40 to 1 out of 3 reckless drivers
  "who were tested for drugs" tested positive for
  marijuana. Now, even if all reckless drivers not
  under the influence of alcohol were tested for
  drugs then, according to their claims, this would
  amount to 16 at the highest. In reality, the
  actual percentage would be negligible when
  compaired to alcohol!

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• The DEA and ONDCP say, "Marijuana is a major
  factor in crime."Based on a survey of a small
  select group of prisoners they claim that 40 of
  all arrestees tested positive for marijuana. But
  what select group, and from where? Why not a
  study of every prisoner from every local, state
  and federal prison? The U.S. Justice Department
  already has the crime reports and past histories
  of every prisoner, past and present. And they
  already drug test in every jail and prison
  throughout the country. What are the real numbers
  based on the entire penal system? (Then again,
  with over 730,000 annual arrests for marijuana
  use, far more than 1/3 of all total arrests,
  maybe 40 of all arrestees did test positive for
  marijuana.) Of course, as long as marijuana
  remains illegal, this statement will always be
  true based solely on the fact that the possession
  and consumption of marijuana is a criminal act.

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• ONDCP and the DEA say, "Marijuana will always be
  a dangerous drug because it inevitably leads its
  users to harder more dangerous drugs."I will use
  their own statistics to expose this lie. John
  Walters, ONDCP director, says, "Marijuana use
  among teenagers has doubled over the last
  decade." But Asa Hutchinson, director of the DEA,
  says, "Cocaine use has dropped 75 over the last
  15 years and that other illicit drug use has been
  cut by 50." Now if marijuana use has doubled and
  marijuana leads to harder drugs shouldn't we be
  seeing an increase in harder drug use and not a
  50 decrease? Also, based on Mr. Hutchinson's
  statistics, we should expect to see a complete
  elimination of cocaine use in America after the
  next five years. (75 in 15 years/ 5 years 25)
  In May, 2002, ONDCP stated that marijuana use
  had tripled in recent years. In September, 2002,
  marijuana use had doubled over the last decade.
  In November, 2002, ONDCP said marijuana use had
  declined by 50 since 9-11, proving, they said,
  "that teenagers were acknowledging the connection
  between drugs and terrorism". In spite of this
  ONDCP is cancelling their "drugsterrorism" ads
  because it was found that they are totally
  ineffective, and may actually incite pro-drug
  attitudes among teenagers.

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• The DEA and ONDCP both say that "medical
  marijuana and/or industrial hemp are nothing more
  than camouflaged attempts to legalize a dangerous
  drug." Right now they are attempting to ban all
  products containing hemp, hemp seed and hemp seed
  oil, while they themselves currently both grow
  and import hemp, not only for industrial
  purposes, but for medicinal use also! And they
  are waging a compassionless war on both the sick
  and dying who use marijuana, and the care-givers
  who supply it, while endorsing synthetic
  marijuana (Marinol) for these same people! This
  is all the federal government's camouflaged
  attempts to keep marijuana illegal, in all forms
  and at all costs, and to quash these legitimate
  industries with lies and the long arm of the law!
  The U.S., by the way, is the only industrialized
  nation that doesn't allow legitimate hemp
  cultivation, and one of the very few that
  prohibit medical cannabis.

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• The DEA and ONDCP say, "Not only the illicit drug
  trade, but also the casual use of marijuana,
  directly supports domestic and international
  terrorism."Although they are cancelling their
  T.V. terrorism ads the Federal government is
  still emphasizing this theme. They have appointed
  Asa Hutchinson, DEA director, as the Under
  Secretary of Borders and Transportation in the
  Department of Homeland Security. And DHS has
  already created a new Anti-Narcotics department
  with a former CIA operative as its "Czar". This
  is all a deceptive maneuver to coerce support for
  the failing 90 year old War on Drugs by playing
  on the fears and emotions of a post 9-11 America!
  If we are going to start blaming the casual user
  because somewhere down the trafficking line blood
  might have been spilled, then everyone take all
  the money out of your wallets and purses and
  throw it away because somewhere down the line
  blood was spilled for that dollar bill. The
  violence and terrorism involved in the drug trade
  is created, not because of the psychoactive
  properties of the drugs themselves, but because
  of the enormous wealth generated by illegal
  drugs, which is created through the illicit black
  market, which is created by the prohibitive laws
  of the War On Drugs. If I could grow marijuana
  in my home, as I can grow tobacco, make wine and
  brew beer, for my own personal use within my
  home, as I can enjoy a pipe, or a glass of wine,
  liquor or beer, how would that aid domestic or
  international terrorism?

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• The DEA and ONDCP say, "Not only the illicit drug
  trade, but also the casual use of marijuana,
  directly supports domestic and international
  terrorism."Although they are cancelling their
  T.V. terrorism ads the Federal government is
  still emphasizing this theme. They have appointed
  Asa Hutchinson, DEA director, as the Under
  Secretary of Borders and Transportation in the
  Department of Homeland Security. And DHS has
  already created a new Anti-Narcotics department
  with a former CIA operative as its "Czar". This
  is all a deceptive maneuver to coerce support for
  the failing 90 year old War on Drugs by playing
  on the fears and emotions of a post 9-11 America!
  If we are going to start blaming the casual user
  because somewhere down the trafficking line blood
  might have been spilled, then everyone take all
  the money out of your wallets and purses and
  throw it away because somewhere down the line
  blood was spilled for that dollar bill. The
  violence and terrorism involved in the drug trade
  is created, not because of the psychoactive
  properties of the drugs themselves, but because
  of the enormous wealth generated by illegal
  drugs, which is created through the illicit black
  market, which is created by the prohibitive laws
  of the War On Drugs. If I could grow marijuana
  in my home, as I can grow tobacco, make wine and
  brew beer, for my own personal use within my
  home, as I can enjoy a pipe, or a glass of wine,
  liquor or beer, how would that aid domestic or
  international terrorism?

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