All psychoactive drugs of abuse alter feelings, thoughts, and behavior. They directly affect the brain or the central nervous system (CNS). The specific actions of these drugs are highly complex. Feelings are altered when the drugs affect neurotransmitters and intercellular communications that seek a balance between excitatory and inhibitory functions. Every organism is driven toward establishing a balance between these two systems that is called homeostasis.
Specific drug action depends on the route of administration, the dose, the presence or absence of other drugs, and the clinical state of the individual. In general, psychoactive drugs can be classified by their primary action on the CNS (Hardman, Limbird, Molinoff, Ruddon, & Gilman, 1996).
PRESCRIPTION DRUGS
Several indicators suggest that prescription drug abuse is on the rise in the United States. According to the 1999 National Household Survey on Drug Abuse, in 1998, an estimated 1.6 million Americans used prescription pain relievers nonmedically for the first time. This represents a significant increase since the 1980s, when there were generally fewer than 500,000 first-time users per year. From 1990 to 1998, the number of new users of pain relievers increased by 181 per-cent; the number of individuals who initiated tranquilizer use increased by 132 percent; the number of new sedative users increased by 90 percent; and the number of people initiating stimulant use increased by 165 percent. In 1999, an estimated 4 million people, almost 2 percent of the population aged 12 and older, were currently (use in past month) using certain prescription drugs nonmedically: pain relievers (2.6 million users), sedatives and tranquilizers
(1.3 million users), and stimulants (0.9 million users).
Approximately 4 Million Americans reported current use of prescription drugs for nonmedical purposes in 1999. (Source: Office of Applied Studies, Substance Abuse and Mental Health Services Administration. National Household Survey on Drug Abuse, 1999.)
An estimated 9 million people aged 12 and older used prescription drugs for nonmedical reasons in 1999; more than a quarter of that number reported using prescription drugs nonmedically for the first time in the previous year.
According to a recent national survey of primary care physicians and patients regarding substance abuse, 46.6 percent of physicians find it difficult to discuss prescription drug abuse with their patients. Prescription drug abuse is not a new problem, but one that deserves renewed attention.
Prescription drug abuse affects many Americans. Some trends of concern can be seen among older adults, adolescents, and women. In addition, health care professionals, including physicians, nurses, pharmacists, dentists, anesthesiologists, and veterinarians are at increased risk of prescription drug abuse because of ease of access, as well as their ability to self-prescribe drugs. In spite of this increased risk, recent surveys and research in the early 1990s indicate that health care providers probably suffer
Although many prescription drugs can be abused or misused, there are three classes of prescription drugs that are most commonly abused: Opioids, which are most often prescribed to treat pain; CNS depressants, which are used to treat anxiety and sleep disorders; Stimulants, which are
prescribed to treat the sleep disorder narcolepsy, attention-deficit hyper-activity disorder (ADHD), and obesity.
Opioids
Opioids are commonly prescribed because of their effective analgesic, or pain-relieving, properties. Medications that fall within this class, sometimes referred to as narcotics, include morphine, codeine, and related drugs. Morphine, for example, is often used before or after surgery to alleviate severe pain. Codeine, because it is less efficacious than morphine, is used for milder pain, as well as meperidine (Demerol), which is used less often because of its side effects. In addition to their pain-relieving properties, some of these drugs, for example, codeine and diphenoxylate (Lomotil), can be used to relieve coughs and diarrhea.
Other examples of opioids that can be prescribed to alleviate pain include oxycodone (OxyContin), propoxyphene (Darvon), hydrocodone (Vicodin), and hydromorphone (Dilaudid), Most people who take prescription medications take them responsibly; however, the nonmedical use or abuse of prescription drugs remains a serious public health concern. Prescription drugs like opioids, central nervous system (CNS) depressants, and stimulants, when abused, can alter the brain’s activity and lead to dependence and addiction.
Opioids act by attaching to specific proteins called opioid receptors, which are found in the brain, spinal cord, and gastrointestinal tract. When
these drugs attach to certain opioid receptors, they can block the transmission of pain messages to the brain. In addition, opioids can produce drowsiness, cause constipation, and, depending upon the amount of drug taken, depress respiration. Opioid drugs also can cause euphoria by stimulating the brain regions that affect what we perceive as pleasure.
Chronic use of opioids can result in tolerance for the drugs, which means that users must take higher doses to achieve the same initial effects. Long-term use also can lead to physical dependence and addiction. The body adapts to the presence of the drug, and withdrawal symptoms occur if use is reduced or stopped. Symptoms of withdrawal include restlessness, muscle and bone pain, insomnia, diarrhea, vomiting, cold flashes with goose bumps (“cold turkey”), and involuntary leg movements. Finally, taking a large single dose of an opioid could cause severe respiratory depression that can lead to death. Many studies have shown, however, that properly managed medical use of opioid analgesic drugs is safe and
rarely causes clinical addiction, defined as compulsive, often uncontrollable use of drugs.
Opioids should not be used with other substances that depress the central
nervous system, such as alcohol, antihistamines, barbiturates, benzodiazepines, or general anesthetics, as such a combination increases
the risk of life-threatening respiratory depression.
Nicotine (Cigarette Smoking)
Tobacco use remains the leading preventable cause of death in the United States, causing more than 440,000 deaths each year and resulting in an annual cost of more than $75 billion in direct medical costs. Nationally, smoking results in more than 5.6 million years of potential life lost each year.
Approximately 80% of adult smokers started smoking before the age of 18. Every day, nearly 4,000 young people under the age of 18 try their first cigarette.
More than 6.4 million children living today will die prematurely because of a decision they will make as adolescents — the decision to smoke cigarettes.
About 62 million people in the United States ages 12 and older, or 29 percent of the population, are current cigarette smokers, according to the 1996 National Household Survey on Drug Abuse. This makes nicotine, the addictive component of tobacco, one of the most heavily used addictive drugs in the United States.
Effects of Nicotine
When a person inhales cigarette smoke, the nicotine in the smoke is rapidly absorbed into the blood and starts affecting the brain within 7 seconds. In the brain, nicotine activates the same reward system as do other drugs of abuse such as cocaine or amphetamine, although to a lesser degree. Nicotine's action on this reward system is believed to be responsible for drug-induced feelings of pleasure and, over time, addiction. Nicotine also has the effect of increasing alertness and enhancing mental performance. In the cardiovascular system, nicotine increases heart rate and blood pressure and restricts blood flow to the heart muscle. The drug stimulates the release of the hormone epinephrine, which further stimulates the nervous system and is responsible for part of the "kick" from nicotine. It also promotes the release of the hormone beta-endorphin, which inhibits pain.
People addicted to nicotine experience withdrawal when they stop smoking. This withdrawal involves symptoms such as anger, anxiety, depressed mood, difficulty concentrating, increased appetite, and craving for nicotine. Most of these symptoms subside within 3 to 4 weeks, except for the craving and hunger, which may persist for months.
Health Effects of Tobacco Products
Besides nicotine, cigarette smoke contains more than 4,000 substances, many of which may cause cancer or damage the lungs. Cigarette smoking is associated with coronary heart disease, stroke, ulcers, and an increased incidence of respiratory infections.
Smoking is the major cause of lung cancer and is also associated with cancers of the larynx, esophagus, bladder, kidney, pancreas, stomach, and uterine cervix. Smoking is also the major cause of chronic bronchitis and emphysema.
Women who smoke cigarettes have earlier menopause. Pregnant women who smoke run an increased risk of having stillborn or premature infants or infants with low birthweight. Children of women who smoked while pregnant have an increased risk for developing conduct disorders.
Cigar and pipe smokers and users of chewing tobacco and snuff can also become addicted to nicotine. Although cigar and pipe smokers have lower death rates than cigarette smokers do, they are still susceptible to cancers of the oral cavity, larynx, and esophagus. Users of chewing tobacco and snuff have an elevated risk for oral cancer.
CNS Depressants and Stimulants
The CNS depressants depress excitable nervous tissue at all levels of the brain and nervous system. The CNS depressants include all sleeping medications, anti-anxiety drugs (also called minor tranquilizers), opium derivatives, cannabis, and inhalants (Hardman et aI., 1996; Schuckit, 1984).
The CNS stimulants achieve their effect either by the stimulation of nervous tissue through blocking the actions of inhibitory cells or releasing transmitter substances from the cells or by the direct action of the drugs themselves. These drugs include all of the amphetamines and cocaine. Nicotine and caffeine also stimulate nervous tissue, but to a much lesser degree (Hardman et al., 1996; Schuckit, 1984).From Chemical Dependency Counseling: A Practical Guide 2nd Edition Robert R Perkinson page 211-212 We hghly recommend you purchase tis manual for your library at Amazon.com
Note: Be sure to take notes. Some test questions will come from this video.
As a Christ Centered Addiction Specialist, you will be able to help your counselees go way beyond just getting clean and sober.
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