Uppers Downers & All Arounders

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Uppers Downers All Arounders

• Chapter 2, Part II

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Physiological Responses to Drugs

• Determines how drugs affect people and why it is
  difficult to control their levels of use.
• They include
• Tolerance to Drug
• Tissue Dependence
• Psychological Dependence Reward-reinforcing
  action of drugs
• Withdrawal

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Tolerance

• Results from the bodys attempt to eliminate a
  drug that it treats as a toxin
• With continued drug use the body tries to
  neutralize the toxic effects by
• Requiring larger amounts of the drugs to achieve
  the original effects
• Degree of effects depend on the
• Amount used
• Duration of use
• Frequency of use
• Individuals chemistry
• State of mind

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Kinds of Tolerance

• Dispositional Tolerance
• Speeds up the metabolism to handle the drug in
  order to eliminate it
• Example Increases the amount of cytocells and
  mitochondria in the liver to neutralize the
  drug.. So it will take more of the drug to
  achieve the same level of intoxication

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Kinds of Tolerance

• Pharmacodynamic Tolerance
• Results from the desensitization of nerve cells
  to the action of the drug
• Ex. The nerve cells become less sensitive and
  begin producing an antidote or antagonist to the
  drug, ie. The brain will generate more opiod
  receptor sites.

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Kinds of Tolerance

• Behavioral Tolerance
• Brain adjustments that affect behavior
• Someone who is high may make himself appear sober
  when threatened, then revert back to the high
  state
• Reverse Tolerance
• Person has greater sensitivity to the drug, after
  prolong use, and the bodys ability to metabolize
  the drug decreases.
• Ex. A person who has drunk a 12-pack of beer
  daily for ten years, may find themselves drinking
  3-4 beers to achieve the effect due to tissue
  damage of the liver and kidneys.
• Also, the person may stay drunk longer as the
  liver is no longer metabolizing the alcohol and
  the alcohol just continues to circulate in the
  body until it is eliminated.

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Kinds of Tolerance

• Acute Tolerance
• The bodys immediate resistance to the effects of
  the drug
• Ex. The brain and the body adapts instantly to
  the drug, as with tobacco
• Select Tolerance
• The body will develop a tolerance to some effects
  of the drug, but not to other effects resulting
  in potentially fatal side-effects in high doses
  of the drug.
• Ex The body may not feel the euphoric effect,
  but the organs of the body may react adversely to
  the drug respiratory function of the lungs and
  continue damage to the liver

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Kinds of Tolerance

• Inverse Tolerance (Kindling)
• Person becomes more sensitive to the drug as the
  brain chemistry changes
• After months of using marijuana or cocaine with
  minimal effect, the drug user may get an intense
  effect/reaction
• Greater risk for heart attack or stroke

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• Tolerance develops rapidly to amphetamines. As
  the body adapts to the toxin, the liver, brain,
  and other tissues become better able to handle
  greater amounts. One dose of amphetamine on day 1
  can increase to 30 doses on day 100 to achieve
  the same effect. Tolerance usually develops with
  higher-dose chronic use. Low-dose infrequent use
  induces only minimal tolerance. (p.58)

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Tissue Dependence

• Biological adaptation of the body to the drug
  such that the body comes to depend on the drug to
  stay in balance.
• The tissues and organs of the body come to depend
  on the drug to stay functional
• Ex. Alcoholic will need a drink to ward off the
  shakes
• Heroin addict will need a fix to stop body aches,
  headaches

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Psychological Dependence the Reward-reinforcing
Action of the Drugs

• Results from the action of the drugs on the brain
  chemistry
• Pleasurable effects induce user to continual use
• Recognized as an important factor that
  contributes to addiction
• Altered states of distorted perceptions of
  pleasurable feelings prompt users to avoid lifes
  problems

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Withdrawal

• Marked by unpleasant effects that follow the
  cessation of drug use as the body attempts to
  restore its chemical balance
• Withdrawal can be so severe that the user will
  continue to use drugs to avoid withdrawal
  symptoms
• Kinds of Withdrawal
• Non-purposive Withdrawal
• Purposive
• Protracted Withdrawal

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Kinds of Withdrawal

• Non-purposive
• Series of unpleasant or even life-threatening
  physiological effects that accompanies cessation
  of use by an addict
• Example Sweating, headaches, vomitting,
  diarrhea, body aches, tremors,
• Purposive
• Emotional expectation of physical effects
• Manipulative counterfeiting in an effort to
  obtain more drugs, money or sympathy

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Kinds of Withdrawal

• Protracted withdrawal (environmental triggers and
  cues)
• Flashback or recurrence of addiction withdrawal
  symptoms that trigger heavy craving for a drug
  long after detoxification
• Cravings can be triggered by a sensation
  associated with prior use and can be strong
  enough to cause relapse
• PAWS (Post Acute Withdrawal Syndrome)

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OPIOD EFFECTS VS WITHDRAWAL SYMPTOMS
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Basic Pharmacology

• Metabolism Excretion
• Metabolism is the ability of the body to process,
  use and inactivate drugs or food
• Chief organ of metabolism is the liver
• Metabolism rates vary depending on the age,
  gender, race, heredity, general health, emotional
  state, presence of other drugs, weight, tolerance
  and exaggerated or allergic reactions
• Excretion is the process of elimination of those
  substances from the body
• Chief organs of excretion are the kidneys via the
  Urethra
• Other pathways of excretion is the sweat glands,
  lungs

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The liver is most responsible for metabolizing,
detoxi-fying, and eliminating drugs. The
drug-laden blood enters through the portal vein,
is processed by various enzymes, and then sent
via the hepatic vein to the heart where it is
then pumped to the rest of the body. If the
alcohol and another depressant drug are taken
together, they compete for the same enzymes so
the liver allows the other to enter the
circulatory system at full strength.
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Desired Effects vs Side Effects

• Desired Effects include
• Satisfying curiosity, getting high,
  self-medicating, gaining self confidence,
  increased energy, relieving pain, controlling
  anxiety, peer pressure, social confidence,
  boredom, altering consciousness, coping with
  isolation, competion, seeking oblivion
• Side Effects (Biopsychosocial)
• Mild to moderate to fatal effects
• Polydrug Use
• Combination of more than one drug
• May use another drug to replace the unavailable
  one
• Get a different feeling
• Enhance effects
• Counteract effects
• Cross addiction

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LEVELS OF USE
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LEVELS OF USE

• Abstinence
• Not using drugs, except accidentally
• With true abstinence, drug craving cannot develop
  not matter how high hereditary and environmental
  predisposition factors are
• Experimentation
• Infrequent use of a drug to satisfy curiosity
• Only few exposures, no pattern of use develops
• Problematic consequences can occur if user is
  pregnant, driving, has physical or mental
  illness, has an alergic reaction or has legal
  problems

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LEVELS OF USE

• Social/recreational Use
• Use has irregular pattern with small impact on
  persons life
• Same consequences of use can occur as with
  experimentation
• Habituation
• Regular pattern of use and loss of some control
  over a drug with minimal harmful consequences
• Drug Abuse
• Continues to use despite negative consequences,
  including health, school, work, emotional
  well-being and drug use continues on a regular
  basis.

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LEVELS OF USE

• Addiction/Dependency
• Difference between abuse and Addiction is the
  Compulsion to use
• Uses drug in larger amounts or for longer periods
  of time
• Unsuccessfully tries to cut down or control use
• Spends a great amount of time in activities to
  obtain drugs or recover from use
• Gives up or reduces important social,
  occupational or recreational activities because
  of use
• Continues use despite knowledge that drug use
  is causing physical or psychological problems

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Theories of Addiction

• DSM IV-TR divides substance related disorders
  into substance use and substance induced
  disorders
• Substance use disorders are divided into abuse
  and dependency
• Substance-induced disorders include conditions
  that are caused by specific substances,
  intoxication, withdrawal, delirium, etc.
• Theories of Addiction focus on the environment,
  the host (user) and agent (drug itself) and the
  interactions between them

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Theories of Addiction

• The Disease Model AKA Medical Model
• Addiction is a chronic, progressive, relapsing,
  incurable and potentially fatal disease
• Triggered by drug use that reacts to biochemical
  and neurological irregularities.
• Sees heredity as more important than
  environmental influences in moving a person to
  addiction
• Addiction is characterized by impulsive use, loss
  of control, repeated attempts at abstinence,
  continuation of use despite negative
  consequences, and complications resulting from
  abuse

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Theories of Addiction

• The Behavioral/Environmental Model
• Sees addiction as environmental and developmental
  influences as the main causes leading a person to
  addiction.
• Stress, anger and peer pressure are some stress
  factors
• Academic Model
• Sees addiction as occurring when body adapts to
  the toxic effects of drugs.
• Given enough drugs over time, a person will
  become addicted
• The process is characterized by tissue
  dependence, withdrawal syndrome, and psychic
  dependence

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Theories of Addiction

• Diathesis-Stress Theory of Addiction
• Result of genetic and environmental factors such
  as stress
• People with a pre-disposition or vulnerability to
  develop drug addiction is caused by
• genetic and environment factors combined with an
• availability of drugs and
• practice of certain behaviors.
• When a person is stressed or challenged by the
  use of drugs or behaviors, then the brain changes
  to the point where return to normal use or
  behavior is difficult

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Heredity, Environment Use of Psychoactive Drugs

• Heredity
• Many traits are passed on through generations
• Heredity susceptibility to avoid, use or abuse
  drugs varies from person to person, depending on
  the brain structure and neurochemical composition
  
• Twin Studies
• 34 with one parent, 400 2 parents, 900 with
  grandparents
• Alcoholic-Associated Genes
• DRD A1 Allele gene found in 70 of chronic
  alcoholics
• DRD4 gene with excessive dopamine prevents
  dependence from developing

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Heredity, Environment Use of Psychoactive Drugs

• Environmental factors include
• Physical/sexual/emotional abuse
• Stress
• Nutrition
• Living conditions
• Family relationships
• Health care
• School quality
• Peer pressure
• Economic factor

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Heredity, Environment Use of Psychoactive Drugs

• Psychoactive Drugs
• Move people further along the compulsion curve
• Depends on strength of drug
• Amount
• Frequency and
• Duration of use
• Long Term or heavy use may take a person with low
  susceptibility 10 years of heavy drinking to
  become an alcoholic
• A person with high susceptibility can take just 1
  year to become an alcoholic

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SPECT stands for single photon emission
computerized tomography, a method for imaging the
activity of the brain. It shows areas of activity
and inactivity. The holes in the brain are
actually areas that are inactivated by the use of
a drug or the practice of some behavior.
Abstinence will restore much but not all of the
brain function. The more chronic the use, the
less restoration of activity. Methamphetamine is
more toxic than heroin or cocaine.
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Alcohol is a protoplasmic poison, so much of the
inactivation in the brain of a chronic alcoholic
can be long lasting. Heroin is less toxic to
brain cells, so abstinence will restore more
brain function