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Chapter 6: Substance Abuse, Addiction, and Drugs of Abuse

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Introduction
This chapter provides a description of substance tolerance, abuse, dependence, and addiction. In addition, it covers the various drugs of abuse and their effects, as well as insights into the scope of the substance abuse problem among youth, implications for each of the most commonly abused drugs, and recent information on national trends regarding specific alcohol, tobacco, and other drug use among children and adolescents.


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"This nation has a massive and pervasive problem of drugs in our middle and high schools and we must muster a massive and pervasive response to provide a drug-free school environment for our children." (CASA, 2001).

Substance Abuse and Addiction

  • Defining tolerance

    • Tolerance is the body's accommodation to the presence of a drug so that the same dose results in a diminished effect over time.

    • Tolerance is an element of substance abuse, addiction, and dependence.

  • Defining substance abuse

    • Characteristics of substance abuse, as defined by the American Psychiatric Association (APA) (1994), include:

      • Recurrent use resulting in failure to fulfill major obligations at work, school, or home.

      • Recurrent use in situations in which it is physically hazardous.

      • Recurrent substance-related legal problems.

      • Continued use despite having persistent or recurrent social or interpersonal problems.

  • Defining addiction

    • Drug addiction is a chronic, relapsing illness that results in compulsive cravings and drug-seeking behaviors that continue despite negative consequences.

  • The foundations of addiction are genetic, psychological, and environmental.

  • The two variables that underlie the development of addiction are:

    • The amount of the drug taken.
    • The individual's inherent vulnerability to addiction.

  • Over time, for each individual, and to a different extent for each given substance, a threshold is reached such that use of substances permanently interferes with brain functioning. This process is often likened to flipping a switch.

  • Defining dependence

    • While drug addiction is characterized in part by psychological components, drug dependence is characterized only by a physiological adaptation of the body to the presence of a drug.

    • Because dependence is solely physiological, the withdrawal process is easier and can be managed by slowly decreasing dosages over time.

  • Adolescents' vulnerability to drug abuse and addiction

    • The same areas of the brain—those responsible for motivation and impulse control—that are affected by drug use are those that undergo rapid changes during adolescence.

    • Substance use affects these same developing regions of the brain, and addiction can occur more quickly and more permanently in youths than in older individuals.

    • By virtue of their neurobiological stage of development, adolescents appear to have a lower threshold for "flipping the switch" to addiction.



Drugs of Abuse

View Figure 1: Lifetime Use of Various Drugs in 2003
  • Central nervous system (CNS) depressants — alcohol, chloral hydrate, barbiturates, benzodiazepines, hypnotic sedatives, and other tranquilizers

    • Alcohol
      • Even low doses significantly impair the judgment and coordination required to drive a car safely.

      • Low to moderate doses of alcohol can increase the incidence of a variety of aggressive behaviors, including spousal and child abuse.

      • Moderate to high doses of alcohol cause marked impairments in higher mental functions, severely altering a person's ability to acquire and remember information; very high doses can cause respiratory depression and death.

      • Addictive potential

        • Chronic abuse of alcohol can lead to addiction (alcoholism).
        • Alcohol addiction can be characterized by increased tolerance, causing the abuser to drink greater amounts to achieve the desired effect.

      • Use among youth


    • Other Depressants

      • These drugs are sometimes referred to as sleeping pills, sedatives, hypnotics, minor tranquilizers, and antianxiety medications.

      • Depressants are used medically to relieve anxiety and promote sleep.

      • When they are abused or taken at high doses, many of these drugs can lead to unconsciousness and death.

      • The combination of depressants and alcohol can magnify the effects of these drugs.

      • Abuse of these drugs usually occurs as part of a pattern of multiple drug abuse.

      • Addictive potential

        • Two major groups of depressants have dominated the licit and illicit markets for nearly a century: first, barbiturates and now, benzodiazepines (tranquilizers).
        • Concern about the addiction potential of barbiturates and the ever-increasing numbers of fatalities associated with them has led to the development of alternative medications.

      • Use and impact among youth


  • Stimulants — nicotine (tobacco), cocaine, amphetamines/methamphetamine, methylphenidate (Ritalin), and other stimulants, such as diet pills

    • Tobacco

      • Cigarette smoke contains some 4,000 chemicals, several of which are known carcinogens.

      • Nicotine is the substance that reinforces and strengthens the desire to smoke.

      • Nicotine is both a transient stimulant and a sedative to the central nervous system.

      • Tar is the source of the majority of the toxic effects that result from smoking.

      • Alternative forms of tobacco include smokeless tobacco, kreteks, and bidis.

      • Addictive potential

        • Nicotine in tobacco products is an addictive drug comparable to heroin or morphine.
        • Withdrawal symptoms include changes in body temperature, heart rate, digestion, and muscle tone; irritability, anxiety, sleep disturbances, and nervousness; headaches, fatigue, and nausea; and cravings for tobacco.
        • Less than 20 percent of typical smokers succeed in stopping smoking on their first try.

      • Use among youth


    • Cocaine (Powder and Crack)

      • Cocaine is the most powerful drug within its class and one of the most potent drugs of abuse.

      • Most cocaine users in the United States "snort" the powdered drug through the nose; some dissolve it in water and inject it into a muscle or vein.

      • Small amounts of cocaine result in feelings of euphoria, energy, and mental alertness.

      • Other immediate effects include dilated pupils; elevated blood pressure, heart rate, respiratory rate, and body temperature; loss of appetite; and insomnia.

      • The use of cocaine can cause death by cardiac arrest or respiratory failure.

      • Crack causes the same effects as powder cocaine; it is a rapidly reacting form of cocaine that has been chemically altered so that it can be smoked.

      • Addictive potential

        • Cocaine can cause physical and psychological dependency, and tolerance develops rapidly.
        • Cocaine causes chemical changes in the brain that lead to intense cravings for more of the drug.
        • Recent research suggests that of those who use cocaine at least once, approximately 21 percent will eventually become addicted.
        • Crack produces the most dramatic cocaine "high" and is even more addictive than powder cocaine

      • Use among youth

        • Cocaine use is not common among youth; the average age of first use of cocaine is 20.
        • Non-Hispanic white and Hispanic youth are more likely to be current cocaine users or to have ever tried cocaine than African-American youth.

    • Amphetamines, methamphetamine

      • Amphetamines, methamphetamine, methylphenidate (Ritalin), and other stimulants can cause increased heart rate and respiration, elevated blood pressure, dilated pupils, and decreased appetite.

      • In addition, users may experience sweating, headache, blurred vision, dizziness, sleeplessness, and anxiety.

      • Extremely high doses can cause a rapid or irregular heartbeat, tremors, loss of coordination, and even physical collapse.

      • An amphetamine injection creates a sudden increase in blood pressure that can result in stroke, very high fever, or heart failure.

      • Ice is a slang term for a very pure form of methamphetamine that can be smoked.

      • Addictive potential

        • Amphetamines are generally considered to be addictive.

      • Use among youth


    • Ritalin

      • Ritalin is a drug indicated for the treatment of attention deficit/hyperactivity disorder (ADHD) that youths abuse for its pleasurable or attention-focusing effects.

      • Compared with cocaine, methamphetamine produces a much longer high (8-24 hours).

      • Addictive potential

        • Ritalin can be addictive if taken in high doses.

      • Use among youth

        • Ritalin was abused by 4 percent of high school seniors in 2002.

  • Cannabinoids (cannabis) — marijuana, tetrahydrocannabinol (THC), and hashish

    • Marijuana

      • Marijuana is a green or gray mixture of dried, shredded flowers and leaves of the hemp plant (Cannabis sativa).

      • It is by far the most-often-used illegal drug in the United States.

      • Long-term developmental effects of marijuana use by children and adolescents include apathy, loss of ambition and effectiveness, diminished ability to carry out long-term plans, difficulty in concentrating, and decline in school or work performance.

      • Marijuana's role as a "gateway" drug is also of major concern.

      • Chronic marijuana smokers are at risk for asthma and other lung disorders, including cancer.

      • Addictive potential

        • Research indicates that approximately 9 percent of marijuana users will become dependent on the drug.

      • Use among youth


  • Hallucinogens (psychedelics) — amphetamine variants (MDA, MDMA, Ecstasy), mescaline, peyote, LSD, phencyclidine and analogs, and other hallucinogens.

    • LSD

      • LSD is one of the most potent mind-altering chemicals.

      • LSD is odorless and colorless and is usually taken by mouth.

      • Users refer to their experience with LSD as a "trip" and to acute adverse reactions as a "bad trip."

      • Users may experience panic, confusion, suspicion, anxiety, and loss of control.

      • Some implications of LSD use are: users' experiences of severe, terrifying thoughts and feelings; fear of losing control; fear of insanity and death; and despair while using the drug.

      • Fatal accidents have occurred during states of LSD intoxication.

      • Addictive potential

        • Most users of LSD voluntarily decrease or stop its use over time.
        • LSD is not considered to be an addicting drug because it does not produce the compulsive drug-seeking behavior that cocaine, amphetamines, heroin, alcohol, and nicotine induce.

      • Use among youth

        • LSD use is less common among youth than other hallucinogens.
        • The percentage of high school seniors who reported using LSD in the past 30 days decreased between 2001 and 2002 from 2.3 to 0.7 percent.

    • MDMA/Ecstasy

      • MDMA, more commonly known as Ecstasy, is a so-called "designer drug" produced in clandestine laboratories.

      • It has both stimulant and hallucinogenic properties.

      • Physical symptoms of Ecstasy use include muscle tension, involuntary clenching of teeth, nausea, blurred vision, rapid eye movement, faintness, and chills or sweating.

      • It also increases heart rate and blood pressure—a particular risk for people with circulatory or heart disease.

      • Ecstasy is usually taken orally and is sometimes snorted; it is rarely injected.

      • Ecstasy has recently been found to cause brain damage, the reversibility of which is not yet known.

      • Likewise, Ecstasy causes users to become more impulsive, increasing their risk of engaging in other dangerous behaviors.

      • Addictive potential

        • Ecstasy is not considered to have a high potential for addiction.

      • Use among youth


    • Ketamine

      • Ketamine, also known as "Special K," "K," or "cat Valium," is a dissociative anesthetic that has effects similar to those of PCP (see below), only milder.

      • Users experience feelings of separation from their bodies or pleasant feelings of floating.

      • Bad ketamine experiences may include complete sensory detachment, likened by users to near-death experiences.

      • Ketamine has also been used as a "date-rape" drug.

      • Addictive potential

        • Ketamine does not have a high addictive potential.

      • Use among youth

        • In 2002, 2.6 percent of 12th graders, 2.2 percent of 10th graders, and 1.3 percent of 8th graders reported having used ketamine in the past year.
        • Use levels have remained largely unchanged since tracking began in 2000.

    • PCP

      • PCP is normally used in one of three ways: snorted, smoked, or eaten.

      • When smoked, PCP is often applied to a leafy material such as mint, parsley, oregano, or marijuana.

      • At moderate doses, PCP effects include distinct changes in body awareness similar to those associated with alcohol intoxication.

      • High doses of PCP can cause seizures, coma, and death (though death more often results from accidental injury or suicide during PCP intoxication).

      • PCP can cause effects that mimic the full range of symptoms of schizophrenia, such as delusions, paranoia, disordered thinking, a sensation of distance from one's environment, and catatonia.

      • Addictive potential

        • PCP does not have a high addictive potential.

      • Use among youth

        • PCP use is not common in adolescents.
        • In 2002, 1.1 percent of high school seniors reported use in the past year.

  • Narcotics (opiates) — codeine, heroin, morphine, hydrocodone (Vicodin), hydromorphone, oxycodone (OxyContin), methadone, fentanyl, and other narcotics.

    • Opiates, also referred to as narcotics, are derived from the opium poppy or are chemically similar synthetics.

    • They are a class of drugs used medically as pain relievers, anesthetics, and cough suppressants, as well as to control acute diarrhea.

    • They are taken orally, transdermally (skin patches), or injected.

    • As drugs of abuse, they are often smoked, sniffed, or self-administered by the more direct routes of subcutaneous ("skin popping") and intravenous ("mainlining") injection.

    • Narcotics produce a general sense of well-being by reducing tension, anxiety, and aggression.

    • Users may also experience constricted pupils; watery eyes; itching; inability to concentrate; apathy; lessened physical activity; dilation of the subcutaneous blood vessels, causing flushing of the face and neck; constipation; and respiratory depression.

    • An overdose may produce slow and shallow breathing, clammy skin, convulsions, coma, and possibly death.

    • Except in cases of acute intoxication, there is no loss of motor coordination or slurred speech as occurs with many depressants.

    • Heroin

      • Injection is the most practical and efficient way to administer low-purity heroin.

      • Recent studies indicate a shift from injecting heroin to snorting or smoking the drug because of increased purity and the misconception that these forms of use will not lead to addiction.

      • Heroin is a fast-acting drug, especially when injected or smoked.

      • The high from heroin is experienced as intense pleasure.

      • The effects disappear in a few hours.

      • Chronic users may develop collapsed veins, infections of the heart lining and valves, abscesses, cellulitis, and liver disease.

      • Addictive potential

        • Once individuals begin using heroin, they quickly develop a tolerance to the drug and need more and more to get the same effects.

      • Use among youth

        • Heroin use is relatively uncommon among youth.
        • In 2002, 1.7 percent of high school seniors reported ever having used heroin; only 0.5 percent reported use during the past 30 days.

    • Other narcotics

      • Sales and production of hydrocodone have increased significantly in recent years, as have diversion and illicit use.

      • This has likewise been the case for oxycodone, particularly OxyContin, a longer-lasting, timed-release version of the drug developed in 1995.

      • Potential for addiction

        • As is the case with all narcotics, tolerance develops rapidly, and dependence is likely.

      • Use among youth


  • Inhalants — organic solvents (gasoline, spray paint, hair spray, thinners), nitrites, and nitrous oxide (laughing gas).

    • Inhalants are common household and workplace substances that are sniffed or "huffed" (inhaled through the mouth) to give the user an immediate "head rush" or high.

    • They include a diverse group of chemicals found in consumer products such as aerosols, plastic cement, fingernail polish remover, lighter fluid, hairspray, insecticides, cleaning solvents, and sometimes anesthetics.

    • Inhalants produce a quick, temporary high and lightheadedness.

    • The high is sometimes compared to the sensation of being drunk and lasts from a few minutes to about three-quarters of an hour. It may be followed by aftereffects similar to those associated with an alcohol hangover—such as drowsiness, headache, or nausea—that last for 1 or 2 hours.

    • Deeply inhaling vapors or using large amounts over a short time may result in disorientation, violent behavior, unconsciousness, or death.

    • High concentrations of inhalants can cause suffocation by displacing the oxygen in the lungs or by depressing the central nervous system to the point where breathing stops.

    • Long-term use can cause weight loss, fatigue, electrolyte imbalance, and muscle fatigue.

    • The immediate negative effects of inhalants include nausea, sneezing, coughing, nosebleeds, fatigue, lack of coordination, and loss of appetite.

    • Addictive potential

      • Sustained use of inhalants leads to tolerance and, often, increased usage.
      • Physical withdrawal symptoms can begin within hours to a few days after discontinuation and include sweating, rapid pulse, hand tremors, insomnia, nausea, vomiting, physical agitation, anxiety, hallucinations, and grand mal seizures.

    • Use Among Youth

      • Because inhalants are readily available, inexpensive, and mistakenly believed by many youth to be safer than other drugs, they are especially popular among children and young adolescents; the peak initiation of use occurs in grades 6 to 9.
      • View Figure 14: Lifetime Prevalence of Inhalant Use

  • Steroids — anabolic (Anabolin, Methandriol).

    • Anabolic steroids are a group of powerful compounds closely related to the male sex hormone testosterone.

    • Taken in combination with a program of muscle-building exercise and diet, steroids can contribute to increases in body weight and muscular strength.

    • Steroid users are prone to more than 70 side effects ranging in severity from liver cancer to acne and including psychological as well as physical reactions.

    • The liver, cardiovascular, and reproductive systems are the most seriously affected by steroid use.

    • Psychological effects in both sexes include aggressive behavior known as "'roid rage" and depression.

    • Potential for addiction

      • Steroid use can be addictive; use often continues in spite of severe risks to physical and psychological health.
      • The most dangerous symptom of steroid withdrawal is depression, because it sometimes leads to suicide attempts.

    • Use among youth





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  Handbook Preface
Chapter 1: The Nature and Extent of Substance Abuse in the U.S.
Chapter 2: Foundations of Substance Abuse Prevention Curricula
Chapter 3: Needs Assessment and Curriculum Development
Chapter 4
Chapter 5
Chapter 6
Chapter 7: Curriculum Implementation
Practical Points


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