Alcohol, Tobacco, and Other Drugs: A

Community Concern

Chapter 12

Introduction

• Use, misuse, and abuse of mind-altering substances predates recorded history

• Chronic alcohol and other drug abuse or dependence is regarded as destructive behavior in most cultures

• Affects individuals and the surrounding community

Consequences of Drug Abuse

Violence Associated with Drug and Alcohol Use

Scope of the Current Drug Problem

• More deaths, illnesses, and disabilities can be attributed to substance abuse than any other preventable health condition

• Economic costs include direct costs (health care, premature death, impaired productivity) and indirect costs (crime and law enforcement, courts, jails, social work)

• Those abusing are threats to themselves, their families, and their communities

Definitions

• Drug

• Psychoactive drugs

• Drug use

• Drug misuse

• Drug abuse

• Drug dependence

Factors that Contribute to Alcohol, Tobacco, and Other Drug Abuse

• Risk factors – factors that increase the probability of drug use

• Protective factors – factors that lower the probability of drug use

• Both can be genetic or environmental

Inherited Risk Factors

• Most research related to drug dependence and inherited risk is on alcoholism

• Research has shown genetic and biological markers may predispose someone to increased susceptibility to develop alcohol-related problems

Environmental Risk Factors

• Personal factors

• Home and family life

• School and peer groups

• Sociocultural environment

Types of Drugs Abused and Resulting Problems

• Legal drugs• Alcohol, nicotine, nonprescription (over-the-

counter) drugs, prescription drugs

• Illegal (illicit) drugs and controlled substances• Marijuana, narcotics, cocaine and crack

cocaine, hallucinogens, stimulants, depressants, club drugs and designer drugs, anabolic drugs, inhalants

Legal Drugs

• Can be legally bought and sold in the marketplace• Includes drugs that can be closely regulated,

likely regulated, and not regulated at all

Alcohol

• Number one drug problem in the United States

• Binge drinking

• Underage drinking

• Problem drinkers

• Alcoholism

• Blood alcohol concentration (BAC)

• FAS

Nicotine

• Psychoactive and addictive drug present in tobacco products

• Synar Amendment

• Environmental tobacco smoke (ETS) or secondhand smoke

Over the Counter Drugs (OTCs)

• Legal drugs other than alcohol and tobacco that can be purchased without a physician’s prescription

• Carefully regulated by the Food and Drug Administration (FDA)

• Most only provide symptomatic relief, not a cure

• Subject to misuse and abuse

Prescription Drugs

• Can be purchased only with a physician’s prescription because they have serious side effects for some people

• Regulated by the FDA

• Over 4,000 prescription drugs available

• Subject to misuse and abuse

• Risk of dependence

• Risk of unintentional overdose

Controlled Substances and Illicit Drugs

• Those regulated by the Controlled Substances Act of 1970

• Cannot be cultivated, manufactured, bought, sold, or used within the confines of the law

• Schedule I – high potential for abuse; no accepted medical uses

• Schedules II-V – have medical uses; scheduled based on potential for risk of dependence or abuse

• Drug Enforcement Agency (DEA) responsible for enforcing Controlled Substances Act

Marijuana

• Products derived from hemp plant

• Most abused illicit drug in the U.S.

• Acute effects – reduced concentration, slowed reaction time, impaired short term memory, impaired judgment

• Chronic effects – damage to the respiratory system (if smoked), amotivational syndrome

Narcotics

• Opium and its derivatives, morphine and heroin, come from an oriental poppy plant

• Narcotics numb the senses and reduce pain• High potential for abuse

• Opium poppies do not grow in U.S.; drug trafficking problems

• Heroin addiction leads to significant community health problems

Cocaine and Crack Cocaine

• Cocaine is the psychoactive ingredient in the leaves of the coca plant

• Powerful and addictive euphoriant/stimulant

• Purified forms – salt (white powder), dried paste (crack)

Hallucinogens

• Produce illusions, hallucinations, changes in perceptions

• Synesthesia – mixing of the senses

• Both naturally derived and synthetic

• LSD, mescaline, peyote, mushrooms

Stimulants

• Drugs that increase the activity of the central nervous system

• Amphetamines• Schedule II prescription drugs; widely abused

• Methamphetamines often made in clandestine labs

Depressants

• Slow down the central nervous system

• May lower anxiety and inhibitions

• Tolerance develops

• Strong physical dependence

• Alcohol, barbiturates, benzodiazapines

Club Drugs and Designer Drugs

• Illicit drugs, primarily synthetic, most commonly encountered at nightclubs and raves

• MDMA (ecstasy) most popular club drug

• Rohypnol – “date rape” drug

• Designer drugs – synthesized by amateur chemists in secret labs• Constantly change design to stay ahead of law

enforcement

Anabolic Drugs

• Protein-building drugs

• Anabolic/androgenic steroids, testosterone, human growth hormone

• Have some legitimate medical uses

• Sometimes abused by athletes and body builders

• Acute and chronic side effects

Inhalants

• Collection of psychoactive breathable chemicals

• Paint solvents, motor fuels, cleaners, glues, aerosol sprays

• Easy availability

• Low cost

• Often drug choice of young

• Acute and chronic effects

Prevention and Control of Drug Abuse

• Requires knowledge of:• Causes of drug-taking behavior

• Sources of illicit drugs

• Drug laws

• Treatment programs

• Community organizing skills

• Persistence, and cooperation of various individuals and agencies

Levels of Prevention

• Primary prevention aimed at those who have never used drugs

• Secondary prevention aimed at those who have used, but are not chronic abusers

• Tertiary prevention aimed at drug abuse treatment and aftercare, including relapse prevention

Elements of Prevention

• Education

• Treatment

• Public policy

• Law enforcement

• Education and treatment goals same:• Reduce demand for drugs

• Public policy and law enforcement goals same:• Reduce supply and availability of drugs

Governmental Drug Prevention and Control Agencies and Programs

• Include a multitude of federal, state, and local agencies

• Aim to reduce either the supply or demand for drugs

Federal Drug Control Spending

Federal Drug Control Spending

Federal Agencies and Programs

• Office of National Drug Control Policy

• Department of Health and Human Services

• Substance Abuse and Mental Health Services Administration (SAMSHA)

• National Institute on Drug Abuse

• Department of Homeland Security

• Department of Justice

• Bureau of Alcohol, Tobacco, Firearms, and Explosives (ATF)

State and Local Agencies and Programs

• State departments of health, education, mental health, justice, and law enforcement all address drug abuse prevention and control issues

• Some states have passed laws that conflict with federal laws

• Local communities have individuals, task forces, or agencies to prioritize problems and decide approaches for solving them

Nongovernmental Drug Prevention and Control Agencies and Programs

• Community-based drug education programs

• School-based drug education programs• DARE, student assistance programs, peer

counseling programs

• Workplace-based drug education programs• Employee assistance programs

• Voluntary health agencies

Discussion Questions

• How can risk factors for drug abuse be utilized to aide in drug abuse prevention?

• How should federal, state, and local funds be used to successfully deal with drug abuse problems?