WHY PEOPLE USE SUBSTANCES

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WHY PEOPLE USE SUBSTANCES

• Semi-medicinal uses
• alcohol to intoxicate a weary mind
• belladonna to calm an angry intestine or to
  poison an adversary
• opium to overcome worry and strain.
• the relief of pain, in particular, is an age-old
  aim of humankind
• various narcotic and sleep-producing agents were
  probably used by primitive people.

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WHY PEOPLE USE SUBSTANCES

• Consciousness changing uses
• expand their vision
• enhance their appreciation of their world
• change their mood
• alter their inner existence
• stupefy their awareness

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Some Important Historical Instances

• Genesis (920)Noah planted a vineyard, "and he
  drank of the wine, and became drunk, and lay
  uncovered in his tent." Alcohol has been used by
  many cultures and has been worshipped as a god
• Homer tells how some of Odysseus' crew succumbed
  to forgetfulness in the land of the Lotus-eaters
  Opium has also been used extensively, at least
  since the time of ancient Greece
• the ancient Vedic philosophers of India spoke of
  soma, a mysterious and probably mythical plant

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HISTORY OF ALCOHOL

• Fermentation--any sugar-containing mishmash, left
  exposed in a warm atmosphere, yeasts converting
  sugar to alcohol and carbon dioxide
• Alcoholic beverages probably discovered
  accidentally
• early man presumably liked the effects, and
  proceeded to purposeful production regular
  cultivation of the vine and other suitable crops
• Few preliterate people did not learn to convert
  some of the fruit of the earth into alcohol

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Primitive Society Motivations for Alcohol Use

• important nutritional value
• best medicine available for some illnesses and
  especially in relieving pain
• facilitated religious ecstasy and communion with
  mystical powers
• enabled periodic social festivity, personal
  jollification, mediator of popular recreation
• helped reduce anxiety, tension, and fears
  connected with concerns over subsistence, safety,
  warfare, etc.

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Primitive Society Motivations for Alcohol Use
(contd)

• calm anger or tranquillize hostility and reduce
  suspicion, making possible peaceful associations
  and commercial or ceremonial relations
• in individuals with extraordinary
  responsibilities, helped to assuage the personal
  anxieties
• formalized public binge, permissive loosener of
  interpersonal aggressions, which otherwise the
  mores of the cohesive small society necessarily
  forbade

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earliest civilizations manufactured sold
alcoholic beverages

• oldest known code of laws, Hammurabi of Babylonia
  (c. 1770 BC), regulated drinking houses
• Sumerian physician-pharmacists prescribed beer
  (c. 2100 BC)
• Egyptian doctors (c. 1500 BC) included beer or
  wine in 15 percent of their prescriptions
• Semitic cuneiform literature of the northern
  Canaanites contains abundant references to the
  ubiquitous religious and household uses

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Turning Water Into Wine

• Water probably the original fluid used as
  offering in worship rites
• alcoholic beverages displaced water due to its
  capacity to help priest/participants reach a
  desired state of ecstasy
• This ectasy naturally attributed to supernatural
  spirits and gods
• The red wine eventually perceived as symbolizing
  the blood of life, ultimately passed into the
  Christian Eucharist
• Egyptian Mesopotamian civilizations drinking
  and drunkenness became common practice, often
  troublesome to government and accompanied by
  acute and chronic illnesses

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Drunkenness

• The Roman philosopher Seneca classified it as a
  form of insanity
• alcoholism appears first in the classical essay
  "Alcoholismus Chronicus" (1849) by the Swedish
  physician Magnus Huss
• rapidly became a medical term for the condition
  of habitual inebriety conceived as a disease
• the bearer of the disease was called an alcoholic
  or alcoholist (e.g., Italian alcoolisto, French
  alcoolique, German Alkoholiker, Spanish
  alcohólico, Swedish alkoholist)

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Alcohol control in modern societies

• lack of consensus around many issues of right and
  wrong or proper and improper behavior
• drinking, since the latter part of the 18th
  century, has been a focus of disagreement
• In US, the late 18th-century temperance movement
  became 19th century anti-alcohol movement that
  culminated 20th century Prohibition (1919-1933)
• Currently crazy quilt of local regulations

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U.S. Regulations vary across municipalities

• total prohibition
• prohibition only of distilled spirits and strong
  wines
• liquor sold only by the bottle, not by the drink
• liquor sold only in airplane bottles
• drinks may be served only together with food, in
  others only without food
• Etc.

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HISTORY OF DRUG CONTROL

• first major national efforts by Chinese in the
  19th century
• commerce in poppy (opium) and coca leaf (cocaine)
  organized basis during the 1700sEnglish East
  India Company was engaged in the profitable
  export of opium from India to China
• monopoly of the China trade was eventually
  abolished in 1839-42
• the Opium War between the Chinese and the British
  followed

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U.S. Drug Control

• the nation most preoccupied with drug control
• largely the "Americanized" countries have made
  narcotics regulation a matter of public policy
• principal U.S. legislation has been
• Harrison Narcotics Act of 1914
• Opium Poppy Control Act of 1942
• Narcotic Drug Control Act of 1956
• Drug Abuse Control Amendment of 1965

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Opium Cocaine Addiction in U.S.

• 1800s opiates and cocaine were mostly unregulated
  drugs
• 1890s the Sears Roebuck catalogue offered a
  syringe and a small amount of cocaine for 1.50
• 1886, Coca-Cola was named after its two key
  ingredients -- coca leaves and kola nuts. by
  1904 it was as little as 1/400th of a grain per
  once of Coca-Cola syrup by 1929, Coke became
  cocaine-free
• estimated that one US. citizen of 400 was an
  addict of opium in 1914 user were mostly white
  or Chinese.
• "Of all the nations of the world,the United
  States consumes most habit-forming drugs per
  capita. Opium, the most pernicious drug known to
  humanity, is surrounded, in this country, with
  far fewer safeguards than any other nation in
  Europe fences it with." (Dr. Hamilton Wright,
  United States first Opium Commissioner, New York
  Times, 1911)

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Early U.S. Drug Regulations and Racism

• JAMA (1900) editorial Negroes in the South are
  reported as being addicted to a new form of
  vice--that of 'cocaine sniffing' or the 'coke
  habit'.
• newspapers claimed cocaine caused blacks to rape
  white women and was improving their pistol
  marksmanship
• Chinese immigrants blamed for importing the
  opium-smoking habit
• 1903 Committee on the Acquirement of the Drug
  Habit concluded, "If the Chinaman cannot get
  along without his dope we can get along without
  him".
• Dr. Hamilton Wright stated
• "Cocaine is often the direct incentive to the
  crime of rape by the Negroes of the South and
  other sections of the country
• "One of the most unfortunate phases of smoking
  opium in this country is the large number of
  women who have become involved and were living as
  common law wives or cohabitating with Chinese in
  the Chinatowns of our various cities".

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Continuum of substance involvement
Abuse/Dependence
Treatment
Secondary Intervention
Hazardous Use
Secondary Prevention
Users
No Use
Prevention
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Treatment Models of Addiction

• MODEL PROBLEM ORIGIN TREATMENT ACTION
• MORAL Individual Willpower
• TEMPERANCE The substance Ban the substance
• SPIRITUAL Individual Turn life over to higher
  power
• DISPOSITIONAL/DISEASE Individual, w/o
  blame Medical treatment
• EDUCATIONAL Deficient knowledge Educate
• CHARACTEROLOGICAL Personality abnormalities Charac
  ter restructuring
• CONDITIONING Learned behavior Relearn
  behaviors
• SOCIAL LEARNING Social pressures/examples Relearn
  behaviors alter interactions
• COGNITIVE Thoughts and expectancies Challenge
  and restructure cognitions
• SOCIOCULTURAL Societal controls Decrease/regulate
  availability/desirability
• SYSTEMS Family Alter family patterns
• BIOLOGICAL Genes Counsel the susceptible
• PUBLIC HEALTH Agent/host/risk factors Harm
  reduction

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Stepped Care

• used in situations where the same condition
• can have a wide degree of manifestations
• may vary in severity from person to person
• the level and degree of medical intervention may
  be increased incrementally, "step by step
• used with "spectrum disorders" for which one
  standard solution would not cover all patients
  needs

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Continuum of Care

• Inpatient
• day hospital
• intensive outpatient
• standard outpatient
• brief treatment
• mailed feedback
• medication (addiction and/or psychotropic)