Module 8: Substance Abuse and Addictions

Content

This Module contains 5 Lessons:
  • Lesson 1: Drugs
  • Lesson 2: Alcohol
  • Lesson 3: Tobacco
  • Lesson 4: Misuse of Prescription Drugs
  • Lesson 5: Drug Abuse and Addiction

Objectives:

Students will be able to:
  • understand a set of fundamentals about neurobiology and how drugs of abuse change the brain
  • recognize that drug addiction is a treatable, chronic brain disease
  • experience the process of scientific inquiry and develop an enhanced understanding of the nature and methods of science
  • appreciate the role of science in society and the relationship between basic science and human health. understand that drug abuse initially is a voluntary behavior
  • to define drug addiction as the continued compulsive drug abuse despite known adverse health or social consequences
  • understand that drug abuse and addiction are associated with long-term physical and functional changes in the brain
  • recognize that addiction is influenced by biological factors (for example, genetics and age) and by the social and behavioral context of drug use.

Lesson 1: Drugs

Drugs

Source: Drug Abuse, National Institute on Drug Abuse via Medline Plus, http://www.nlm.nih.gov/medlineplus/drugabuse.html
Drug abuse is a serious public health problem that affects almost every community and family in some way. Each year drug abuse results in around 40 million serious illnesses or injuries among people in the United States. Abused drugs include:
  • Club drugs
  • Amphetamines
  • Anabolic steroids
  • Cocaine
  • Heroin
  • Inhalants
  • Marijuana
  • Prescription drugs
Drug abuse also plays a role in many major social problems, such as drugged driving, violence, stress and child abuse. Drug abuse can lead to homelessness, crime and missed work or problems with keeping a job. There are different types of treatment for drug abuse. But the best is to prevent drug abuse in the first place.


Learning Activity 1.1: Watch this video about the Long Term Effects of Drugs on the Brain.
  • Explain how drug addiction is a brain disease.
  • What are three reasons that make finding answers to the health impact of drug addiction difficult to do?


Club Drugs

Source: Club Drugs, NLM, NIH, http://www.nlm.nih.gov/medlineplus/clubdrugs.html
The term club drug refers to a wide variety of dangerous drugs. These drugs are often used by young adults at all-night dance parties, dance clubs and bars. They include
  • Methylenedioxymethamphetamine (MDMA), also known as Ecstasy XTC, X, Adam, Clarity and Lover's Speed
  • Gamma-hydroxybutyrate (GHB), also known as Grievous Bodily Harm, G, Liquid Ecstasy and Georgia Home Boy
  • Ketamine, also known as Special K, K, Vitamin K, Cat Valium
  • Rohypnol, also known as Roofies, Rophies, Roche, Forget-me Pill
  • Methamphetamine, also known as Speed, Ice, Chalk, Meth, Crystal, Crank, Fire, Glass
  • Lysergic Acid Diethylamide (LSD), also known as or Acid, Boomers, Yellow Sunshines
Club drugs have become more common in recent years. Sometimes people use them to commit sexual assaults. Club drugs can cause serious health problems and sometimes death. They are even more dangerous if you use them with alcohol.

Why Type of Drugs are Club Drugs?

Source: Ketamine, http://www.drugabuse.gov/publications/infofacts/club-drugs-ghb-ketamine-rohypnol
Club drugs are a pharmacologically heterogeneous group of psychoactive drugs that tend to be abused by teens and young adults at bars, nightclubs, concerts, and parties. Gamma hydroxybutyrate (GHB), Rohypnol, ketamine, as well as MDMA (ecstasy) and methamphetamine are some of the drugs included in this group.
  • GHB (Xyrem) is a central nervous system (CNS) depressant that was approved by the Food and Drug Administration (FDA) in 2002 for use in the treatment of narcolepsy (a sleep disorder). This approval came with severe restrictions, including its use only for the treatment of narcolepsy, and the requirement for a patient registry monitored by the FDA. GHB is also a metabolite of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA). It exists naturally in the brain, but at much lower concentrations than those found when GHB is abused.
  • Rohypnol (flunitrazepam) use began gaining popularity in the United States in the early 1990s. It is a benzodiazepine (chemically similar to sedative-hypnotic drugs such as Valium or Xanax), but it is not approved for medical use in this country, and its importation is banned.
  • Ketamine is a dissociative anesthetic, mostly used in veterinary practice.

How Are Club Drugs Abused?

  • GHB and Rohypnol are available in odorless, colorless, and tasteless forms that are frequently combined with alcohol and other beverages. Both drugs have been used to commit sexual assaults (also known as “date rape,” “drug rape,” “acquaintance rape,” or “drug-assisted” assault) due to their ability to sedate and incapacitate unsuspecting victims, preventing them from resisting sexual assault.
  • GHB is usually ingested orally, either in liquid or powder form, while Rohypnol is typically taken orally in pill form. Recent reports, however, have shown that Rohypnol is being ground up and snorted.
  • Both GHB and Rohypnol are also abused for their intoxicating effects, similar to other CNS depressants.
  • GHB also has anabolic effects (it stimulates protein synthesis) and has been used by bodybuilders to aid in fat reduction and muscle building.
  • Ketamine is usually snorted or injected intramuscularly.

How Do Club Drugs Affect the Brain?

  • At high doses, GHB’s sedative effects may result in sleep, coma, or death.
  • Rohypnol can produce anterograde amnesia, in which individuals may not remember events they experienced while under the influence of the drug.
  • Ketamine is a dissociative anesthetic, so called because it distorts perceptions of sight and sound and produces feelings of detachment from the environment and self. Low-dose intoxication results in impaired attention, learning ability, and memory. At higher doses, ketamine can cause dreamlike states and hallucinations; and at higher doses still, ketamine can cause delirium and amnesia.

Addictive Potential

  • Repeated use of GHB may lead to withdrawal effects, including insomnia, anxiety, tremors, and sweating. Severe withdrawal reactions have been reported among patients presenting from an overdose of GHB or related compounds, especially if other drugs or alcohol are involved.
  • Like other benzodiazepines, chronic use of Rohypnol can produce tolerance, physical dependence, and addiction.
  • There have been reports of people binging on ketamine, a behavior that is similar to that seen in some cocaine- or amphetamine-dependent individuals. Ketamine users can develop signs of tolerance and cravings for the drug.

What Other Adverse Effects Do Club Drugs Have on Health?

Uncertainties about the sources, chemicals, and possible contaminants used to manufacture many club drugs make it extremely difficult to determine toxicity and associated medical consequences. Nonetheless, we do know that:
  • Coma and seizures can occur following use of GHB. Combined use with other drugs such as alcohol can result in nausea and breathing difficulties. GHB has been involved in poisonings, overdoses, date rapes, and deaths.
  • Rohypnol may be lethal when mixed with alcohol and/or other CNS depressants.
  • Ketamine, in high doses, can cause impaired motor function, high blood pressure, and potentially fatal respiratory problems.

Methamphetamine

Source: Methaphetamine, NIH: National Institute on Drug Abuse, http://www.nlm.nih.gov/medlineplus/methamphetamine.html
Methamphetamine is a very addictive stimulant drug. It can be smoked, injected, inhaled or taken by mouth. It has many street names, such as speed, meth, and chalk. Methamphetamine hydrochloride, the crystal form inhaled by smoking, is referred to as ice, crystal, glass and tina.
Methamphetamine affects the brain and can create feelings of pleasure, increase energy and elevate mood. Abusers may become addicted quickly, needing higher doses more often. Adverse health effects include irregular heartbeat, increased blood pressure and a variety of psychological problems. Long-term effects may include severe mental disorders, memory loss and severe dental problems.

What Type of Drug is Methamphetamine?

Source: Methamphetamine, http://www.drugabuse.gov/publications/infofacts/methamphetamine
Methamphetamine is a central nervous system stimulant drug that is similar in structure to amphetamine. Due to its high potential for abuse, methamphetamine is classified as a Schedule II drug and is available only through a prescription that cannot be refilled. Although methamphetamine can be prescribed by a doctor, its medical uses are limited, and the doses that are prescribed are much lower than those typically abused. Most of the methamphetamine abused in this country comes from foreign or domestic superlabs, although it can also be made in small, illegal laboratories, where its production endangers the people in the labs, neighbors, and the environment.

How Is Methamphetamine Abused?

Methamphetamine is a white, odorless, bitter-tasting crystalline powder that easily dissolves in water or alcohol and is taken orally, intranasally (snorting the powder), by needle injection, or by smoking.

How Does Methamphetamine Affect the Brain?

Methamphetamine increases the release and blocks the reuptake of the brain chemical (or neurotransmitter) dopamine, leading to high levels of the chemical in the brain—a common mechanism of action for most drugs of abuse. Dopamine is involved in reward, motivation, the experience of pleasure, and motor function. Methamphetamine’s ability to release dopamine rapidly in reward regions of the brain produces the intense euphoria, or “rush,” that many users feel after snorting, smoking, or injecting the drug.
Chronic methamphetamine abuse significantly changes how the brain functions. Noninvasive human brain imaging studies have shown alterations in the activity of the dopamine system that are associated with reduced motor skills and impaired verbal learning. Recent studies in chronic methamphetamine abusers have also revealed severe structural and functional changes in areas of the brain associated with emotion and memory, which may account for many of the emotional and cognitive problems observed in chronic methamphetamine abusers.
Repeated methamphetamine abuse can also lead to addiction—a chronic, relapsing disease characterized by compulsive drug seeking and use, which is accompanied by chemical and molecular changes in the brain. Some of these changes persist long after methamphetamine abuse is stopped. Reversal of some of the changes, however, may be observed after sustained periods of abstinence (e.g., more than 1 year).

What Other Adverse Effects Does Methamphetamine Have on Health?

Taking even small amounts of methamphetamine can result in many of the same physical effects as those of other stimulants, such as cocaine or amphetamines, including increased wakefulness, increased physical activity, decreased appetite, increased respiration, rapid heart rate, irregular heartbeat, increased blood pressure, and hyperthermia.
Long-term methamphetamine abuse has many negative health consequences, including extreme weight loss, severe dental problems (“meth mouth”), anxiety, confusion, insomnia, mood disturbances, and violent behavior. Chronic methamphetamine abusers can also display a number of psychotic features, including paranoia, visual and auditory hallucinations, and delusions (for example, the sensation of insects crawling under the skin).
Transmission of HIV and hepatitis B and C can be consequences of methamphetamine abuse. The intoxicating effects of methamphetamine, regardless of how it is taken, can also alter judgment and inhibition and can lead people to engage in unsafe behaviors, including risky sexual behavior. Among abusers who inject the drug, HIV/AIDS and other infectious diseases can be spread through contaminated needles, syringes, and other injection equipment that is used by more than one person. Methamphetamine abuse may also worsen the progression of HIV/AIDS and its consequences. Studies of methamphetamine abusers who are HIV-positive indicate that HIV causes greater neuronal injury and cognitive impairment for individuals in this group compared with HIV-positive people who do not use the drug.

Anabolic Steroids

Source: Anabolic Steroids, http://www.drugabuse.gov/publications/infofacts/steroids-anabolic-androgenic
Anabolic-androgenic steroids (AAS) are synthetically produced variants of the naturally occurring male sex hormone testosterone. “Anabolic” refers to muscle-building, and “androgenic” refers to increased male sexual characteristics. “Steroids” refers to the class of drugs. These drugs can be legally prescribed to treat conditions resulting from steroid hormone deficiency, such as delayed puberty, as well as diseases that result in loss of lean muscle mass, such as cancer and AIDS.

How Are AAS Abused?

Some people, both athletes and non-athletes, abuse AAS in an attempt to enhance performance and/or improve physical appearance. AAS are taken orally or injected, typically in cycles rather than continuously. “Cycling” refers to a pattern of use in which steroids are taken for periods of weeks or months, after which use is stopped for a period of time and then restarted. In addition, users often combine several different types of steroids in an attempt to maximize their effectiveness, a practice referred to as “stacking.”

How Do AAS Affect the Brain?

The acute effects of AAS in the brain are substantially different from those of other drugs of abuse. The most important difference is that AAS are not euphorigenic, meaning they do not trigger rapid increases in the neurotransmitter dopamine, which is responsible for the “high” that often drives substance abuse behaviors. However, long-term use of AAS can eventually have an impact on some of the same brain pathways and chemicals—such as dopamine, serotonin, and opioid systems—that are affected by other drugs of abuse. Considering the combined effect of their complex direct and indirect actions, it is not surprising that AAS can affect mood and behavior in significant ways.

AAS and Mental Health

Preclinical, clinical, and anecdotal reports suggest that steroids may contribute to psychiatric dysfunction. Research shows that abuse of anabolic steroids may lead to aggression and other adverse effects. For example, although many users report feeling good about themselves while on anabolic steroids, extreme mood swings can also occur, including manic-like symptoms that could lead to violence. Researchers have also observed that users may suffer from paranoid jealousy, extreme irritability, delusions, and impaired judgment stemming from feelings of invincibility.

Addictive Potential

Animal studies have shown that AAS are reinforcing—that is, animals will self-administer AAS when given the opportunity, just as they do with other addictive drugs. This property is more difficult to demonstrate in humans, but the potential for AAS abusers to become addicted is consistent with their continued abuse despite physical problems and negative effects on social relations. Also, steroid abusers typically spend large amounts of time and money obtaining the drug: this is another indication of addiction. Individuals who abuse steroids can experience withdrawal symptoms when they stop taking AAS—these include mood swings, fatigue, restlessness, loss of appetite, insomnia, reduced sex drive, and steroid cravings, all of which may contribute to continued abuse. One of the most dangerous withdrawal symptoms is depression— when persistent, it can sometimes lead to suicide attempts.
Research also indicates that some users might turn to other drugs to alleviate some of the negative effects of AAS. For example, a study of 227 men admitted in 1999 to a private treatment center for dependence on heroin or other opioids found that 9.3 percent had abused AAS before trying any other illicit drug. Of these, 86 percent first used opioids to counteract insomnia and irritability resulting from the steroids.

What Other Adverse Effects Do AAS Have on Health?

Steroid abuse can lead to serious, even irreversible health problems. Some of the most dangerous among these include liver damage; jaundice (yellowish pigmentation of skin, tissues, and body fluids); fluid retention; high blood pressure; increases in LDL (“bad” cholesterol); and decreases in HDL (“good” cholesterol). Other reported effects include renal failure, severe acne, and trembling. In addition, there are some gender- and age-specific adverse effects:
  • For men—shrinking of the testicles, reduced sperm count, infertility, baldness, development of breasts, increased risk for prostate cancer
  • For women—growth of facial hair, male-pattern baldness, changes in or cessation of the menstrual cycle, enlargement of the clitoris, deepened voice
  • For adolescents—stunted growth due to premature skeletal maturation and accelerated puberty changes; risk of not reaching expected height if AAS is taken before the typical adolescent growth spurt
In addition, people who inject AAS run the added risk of contracting or transmitting HIV/AIDS or hepatitis, which causes serious damage to the liver.


Learning Activity 1.2: Watch this video titled: Psychoactive Drugs and take the ungraded quiz.
  • What factors impact the influence of a drug?
  • What can tolerance of a drug cause?


Cocaine

Source: Cocaine, NIH: National Institute on Drug Abuse via MedlinePlus, http://www.nlm.nih.gov/medlineplus/cocaine.html
Cocaine is a powerful drug that stimulates the brain. People who use it can form a strong addiction. They may have to use more and more of the drug to get high. It's sold on the street as a fine, white powder. There are two forms of cocaine: hydrochloride salt and freebase. The salt dissolves in water. People can take it in a vein or in the nose. The freebase form can be smoked. Crack is the street name of a smokable form of cocaine.
No matter how cocaine is taken, it is dangerous. Some of the most common serious problems include
  • Heart problems, including heart attacks
  • Respiratory effects, including respiratory failure
  • Nervous system problems, including strokes
  • Digestive problems
Any of these can be fatal. Using cocaine with alcohol is a common cause of drug-related death.

What Type of Drug is Cocaine?

Source: Cocaine, http://www.drugabuse.gov/publications/infofacts/cocaine
Cocaine is a powerfully addictive stimulant drug. The powdered hydrochloride salt form of cocaine can be snorted or dissolved in water and then injected. Crack is the street name given to the form of cocaine that has been processed to make a rock crystal, which, when heated, produces vapors that are smoked. The term “crack” refers to the crackling sound produced by the rock as it is heated.

How Is Cocaine Abused?

Three routes of administration are commonly used for cocaine: snorting, injecting, and smoking. Snorting is the process of inhaling cocaine powder through the nose, where it is absorbed into the bloodstream through the nasal tissues. Injecting is the use of a needle to insert the drug directly into the bloodstream. Smoking involves inhaling cocaine vapor or smoke into the lungs, where absorption into the bloodstream is as rapid as it is by injection. All three methods of cocaine abuse can lead to addiction and other severe health problems, including increasing the risk of contracting HIV/AIDS and other infectious diseases.
The intensity and duration of cocaine’s effects—which include increased energy, reduced fatigue, and mental alertness—depend on the route of drug administration. The faster cocaine is absorbed into the bloodstream and delivered to the brain, the more intense the high. Injecting or smoking cocaine produces a quicker, stronger high than snorting. On the other hand, faster absorption usually means shorter duration of action: the high from snorting cocaine may last 15 to 30 minutes, but the high from smoking may last only 5 to 10 minutes. In order to sustain the high, a cocaine abuser has to administer the drug again. For this reason, cocaine is sometimes abused in binges—taken repeatedly within a relatively short period of time, at increasingly higher doses.

How Does Cocaine Affect the Brain?

Cocaine is a strong central nervous system stimulant that increases levels of dopamine, a brain chemical (or neurotransmitter) associated with pleasure and movement, in the brain’s reward circuit. Certain brain cells, or neurons, use dopamine to communicate. Normally, dopamine is released by a neuron in response to a pleasurable signal (e.g., the smell of good food), and then recycled back into the cell that released it, thus shutting off the signal between neurons.
Cocaine acts by preventing the dopamine from being recycled, causing excessive amounts of the neurotransmitter to build up, amplifying the message to and response of the receiving neuron, and ultimately disrupting normal communication. It is this excess of dopamine that is responsible for cocaine’s euphoric effects. With repeated use, cocaine can cause long-term changes in the brain’s reward system and in other brain systems as well, which may eventually lead to addiction. With repeated use, tolerance to the cocaine high also often develops. Many cocaine abusers report that they seek but fail to achieve as much pleasure as they did from their first exposure. Some users will increase their dose in an attempt to intensify and prolong the euphoria, but this can also increase the risk of adverse psychological or physiological effects.

What Adverse Effects Does Cocaine Have on Health?

Abusing cocaine has a variety of adverse effects on the body. For example, cocaine constricts blood vessels, dilates pupils, and increases body temperature, heart rate, and blood pressure. It can also cause headaches and gastrointestinal complications such as abdominal pain and nausea. Because cocaine tends to decrease appetite, chronic users can become malnourished as well.
Different methods of taking cocaine can produce different adverse effects. Regular intranasal use (snorting) of cocaine, for example, can lead to loss of the sense of smell; nosebleeds; problems with swallowing; hoarseness; and a chronically runny nose. Ingesting cocaine can cause severe bowel gangrene as a result of reduced blood flow. Injecting cocaine can bring about severe allergic reactions and increased risk for contracting HIV/AIDS and other blood-borne diseases. Binge-patterned cocaine use may lead to irritability, restlessness, and anxiety. Cocaine abusers can also experience severe paranoia—a temporary state of full-blown paranoid psychosis—in which they lose touch with reality and experience auditory hallucinations.
Regardless of the route or frequency of use, cocaine abusers can experience acute cardiovascular or cerebrovascular emergencies, such as a heart attack or stroke, which may cause sudden death. Cocaine-related deaths are often a result of cardiac arrest or seizure followed by respiratory arrest.


Learning Activity 1.3: Watch these video to find out about:
What is one thing you learned from these videos that you didn't know before?

Heroin

Source: Heroin, NLM, NIH, http://www.nlm.nih.gov/medlineplus/heroin.html
Heroin is a drug made from morphine, a natural substance in the seedpod of the Asian poppy plant. Heroin usually appears as a white or brown powder. Heroin can be injected, smoked or snorted. Heroin abuse is a serious problem in the United States. Major health problems from heroin include miscarriages, heart infections and death from overdose. People who inject the drug also risk infectious diseases, including HIV/AIDS and hepatitis.
Regular use of heroin can lead to tolerance. This means users need more and more drug to have the same effect. At higher doses over time, the body becomes dependent on heroin. If dependent users stop heroin, they have withdrawal symptoms. These symptoms include restlessness, muscle and bone pain, diarrhea, vomiting and cold flashes.
Heroin is an opiate drug that is synthesized from morphine, a naturally occurring substance extracted from the seed pod of the Asian opium poppy plant. Heroin usually appears as a white or brown powder or as a black sticky substance, known as “black tar heroin.”

How Is Heroin Abused?

Heroin can be injected, snorted/sniffed, or smoked—routes of administration that rapidly deliver the drug to the brain. Injecting is the use of a needle to administer the drug directly into the bloodstream. Snorting is the process of inhaling heroin powder through the nose, where it is absorbed into the bloodstream through the nasal tissues. Smoking involves inhaling heroin smoke into the lungs. All three methods of administering heroin can lead to addiction and other severe health problems.

How Does Heroin Affect the Brain?

Heroin enters the brain, where it is converted to morphine and binds to receptors known as opioid receptors. These receptors are located in many areas of the brain (and in the body), especially those involved in the perception of pain and in reward. Opioid receptors are also located in the brain stem—important for automatic processes critical for life, such as breathing (respiration), blood pressure, and arousal. Heroin overdoses frequently involve a suppression of respiration.
After an intravenous injection of heroin, users report feeling a surge of euphoria (“rush”) accompanied by dry mouth, a warm flushing of the skin, heaviness of the extremities, and clouded mental functioning. Following this initial euphoria, the user goes “on the nod,” an alternately wakeful and drowsy state. Users who do not inject the drug may not experience the initial rush, but other effects are the same.
With regular heroin use, tolerance develops, in which the user’s physiological (and psychological) response to the drug decreases, and more heroin is needed to achieve the same intensity of effect. Heroin users are at high risk for addiction—it is estimated that about 23 percent of individuals who use heroin become dependent on it.

What Other Adverse Effects Does Heroin Have on Health?

Heroin abuse is associated with serious health conditions, including fatal overdose, spontaneous abortion, and—particularly in users who inject the drug—infectious diseases, including HIV/AIDS and hepatitis. Chronic users may develop collapsed veins, infection of the heart lining and valves, abscesses, and liver or kidney disease. Pulmonary complications, including various types of pneumonia, may result from the poor health of the abuser as well as from heroin’s depressing effects on respiration. In addition to the effects of the drug itself, street heroin often contains toxic contaminants or additives that can clog blood vessels leading to the lungs, liver, kidneys, or brain, causing permanent damage to vital organs.
Chronic use of heroin leads to physical dependence, a state in which the body has adapted to the presence of the drug. If a dependent user reduces or stops use of the drug abruptly, he or she may experience severe symptoms of withdrawal. These symptoms—which can begin as early as a few hours after the last drug administration—can include restlessness, muscle and bone pain, insomnia, diarrhea and vomiting, cold flashes with goose bumps (“cold turkey”), and kicking movements (“kicking the habit”). Users also experience severe craving for the drug during withdrawal, which can precipitate continued abuse and/or relapse.
Major withdrawal symptoms peak between 48 and 72 hours after the last dose of the drug and typically subside after about 1 week. Some individuals, however, may show persistent withdrawal symptoms for months. Although heroin withdrawal is considered less dangerous than alcohol or barbiturate withdrawal, sudden withdrawal by heavily dependent users who are in poor health is occasionally fatal. In addition, heroin craving can persist years after drug cessation, particularly upon exposure to triggers such as stress or people, places, and things associated with drug use.
Heroin abuse during pregnancy, together with related factors like poor nutrition and inadequate prenatal care, has been associated with adverse consequences including low birthweight, an important risk factor for later developmental delay. If the mother is regularly abusing the drug, the infant may be born physically dependent on heroin and could suffer from serious medical complications requiring hospitalization.


Learning Activity 1.4:
Watch the video interviews about Ruth and her struggle with heroin.
  • How well would you deal with drug addiction in your life?


Marijuana

Source: Marijuana,http://www.drugabuse.gov/infofacts/marijuana.html

Marijuana is the most commonly abused illicit drug in the United States. It is a dry, shredded green and brown mix of flowers, stems, seeds, and leaves derived from the hemp plant Cannabis sativa. The main active chemical in marijuana is delta-9-tetrahydrocannabinol, or THC for short.

How is Marijuana Abused?

Marijuana is usually smoked as a cigarette (joint) or in a pipe. It is also smoked in blunts, which are cigars that have been emptied of tobacco and refilled with a mixture of marijuana and tobacco. This mode of delivery combines marijuana's active ingredients with nicotine and other harmful chemicals. Marijuana can also be mixed in food or brewed as a tea. As a more concentrated, resinous form, it is called hashish; and as a sticky black liquid, hash oil. Marijuana smoke has a pungent and distinctive, usually sweet-and-sour odor.

How Does Marijuana Affect the Brain?

Scientists have learned a great deal about how THC acts in the brain to produce its many effects. When someone smokes marijuana, THC rapidly passes from the lungs into the bloodstream, which carries the chemical to the brain and other organs throughout the body.
THC acts upon specific sites in the brain, called cannabinoid receptors, kicking off a series of cellular reactions that ultimately lead to the "high" that users experience when they smoke marijuana. Some brain areas have many cannabinoid receptors; others have few or none. The highest density of cannabinoid receptors are found in parts of the brain that influence pleasure, memory, thinking, concentrating, sensory and time perception, and coordinated movement.
Not surprisingly, marijuana intoxication can cause distorted perceptions, impaired coordination, difficulty with thinking and problem solving, and problems with learning and memory. Research has shown that, in chronic users, marijuana's adverse impact on learning and memory can last for days or weeks after the acute effects of the drug wear off. As a result, someone who smokes marijuana every day may be functioning at a suboptimal intellectual level all of the time.
Research into the effects of long-term cannabis use on the structure of the brain has yielded inconsistent results. It may be that the effects are too subtle for reliable detection by current techniques. A similar challenge arises in studies of the effects of chronic marijuana use on brain function. Brain imaging studies in chronic users tend to show some consistent alterations, but their connection to impaired cognitive functioning is far from clear. This uncertainty may stem from confounding factors such as other drug use, residual drug effects, or withdrawal symptoms in long-term chronic users.

What Other Adverse Effect Does Marijuana Have on Health?

Effects on the Heart
Marijuana increases heart rate by 20-100 percent shortly after smoking; this effect can last up to 3 hours. In one study, it was estimated that marijuana users have a 4.8-fold increase in the risk of heart attack in the first hour after smoking the drug. This may be due to increased heart rate as well as the effects of marijuana on heart rhythms, causing palpitations and arrhythmias. This risk may be greater in aging populations or in those with cardiac vulnerabilities.
Effects on the Lungs
Numerous studies have shown marijuana smoke to contain carcinogens and to be an irritant to the lungs. In fact, marijuana smoke contains 50-70 percent more carcinogenic hydrocarbons than tobacco smoke. Marijuana users usually inhale more deeply and hold their breath longer than tobacco smokers do, which further increase the lungs' exposure to carcinogenic smoke. Marijuana smokers show dysregulated growth of epithelial cells in their lung tissue, which could lead to cancer; however, a recent case-controlled study found no positive associations between marijuana use and lung, upper respiratory, or upper digestive tract cancers. Thus, the link between marijuana smoking and these cancers remains unsubstantiated at this time.
Nonetheless, marijuana smokers can have many of the same respiratory problems as tobacco smokers, such as daily cough and phlegm production, more frequent acute chest illness, and a heightened risk of lung infections. A study of 450 individuals found that people who smoke marijuana frequently but do not smoke tobacco have more health problems and miss more days of work than nonsmokers. Many of the extra sick days among the marijuana smokers in the study were for respiratory illnesses.

How Widespread is Marijuana Abuse?

Source: National Survey on Drug Use and Health (NSDUH)
According to the National Survey on Drug Use and Health, in 2009, 16.7 million Americans aged 12 or older used marijuana at least once in the month prior to being surveyed, an increase over the rates reported in all years between 2002 and 2008. There was also a significant increase among youth aged 12-17, with current use up from 6.7 percent in 2008 to 7.3 percent in 2009, although this rate is lower than what was reported in 2002 (8.2 percent). Past-month use also increased among those 18-25, from 16.5 percent in 2008 to 18.1 percent in 2009.

Is Marijuana Medicine?

The potential medicinal properties of marijuana have been the subject of substantive research and heated debate. Scientists have confirmed that the cannabis plant contains active ingredients with therapeutic potential for relieving pain, controlling nausea, stimulating appetite, and decreasing ocular pressure. Cannabinoid-based medications include synthetic compounds, such as dronabinol (Marinol®) and nabilone (Cesamet®), which are FDA approved, and a new, chemically pure mixture of plant-derived THC and cannabidiol called Sativex®, formulated as a mouth spray and approved in Canada and parts of Europe for the relief of cancer-associated pain and spasticity and neuropathic pain in multiple sclerosis.
Scientists continue to investigate the medicinal properties of THC and other cannabinoids to better evaluate and harness their ability to help patients suffering from a broad range of conditions, while avoiding the adverse effects of smoked marijuana.

Lesson 2: Alcohol

Alcohol Abuse

Source: Alcohol Abuse, NIH: National Institute on Alcohol Abuse and Alcoholism via Medline, http://www.nlm.nih.gov/medlineplus/alcohol.html

If you are like many Americans, you drink alcohol at least occasionally. For many people, moderate drinking is probably safe. It may even have health benefits, including reducing your risk of certain heart problems. Moderate drinking is one drink a day for women or anyone over 65, and two drinks a day for men under 65.
Some people should not drink at all, including alcoholics, children, pregnant women, people on certain medicines and people with some medical conditions.
Anything more than moderate drinking can be risky. Binge drinking - drinking five or more drinks at one time - can damage your health and increase your risk for accidents, injuries and assault. Years of heavy drinking can lead to liver disease, heart disease, cancer and pancreatitis. It can also cause problems at home, at work and with friends.

Quick Quiz

Source: College Health, CDC, http://www.cdc.gov/Features/CollegeHealth/
  1. How many drinks for males within a short period of time is considered binge drinking? How many drinks for females within a short period of time is considered binge drinking?
  2. True or false: Binge drinking is a risk factor for sexual assault, especially among young women in college settings. Each year, about 1 in 20 college women are sexually assaulted. Binge drinking also increases the chances of car crashes, violence against others, unintended pregnancies, and the spread of HIV and sexually transmitted diseases.
  3. What is the most commonly used and abused substance among youth in the United States, more than tobacco and illicit drugs?
  4. True or false: Teens and young adults who do not get enough sleep are at risk for automobile crashes, poor grades and performance in school, depressed moods, and problems with peer and adult relationships.

Quick Quiz Answers: 1) males-5 or more within a short period of time, females- 4 or more within a short period of time; 2) true; 3) Alcohol; 4) true

Beyond Hangovers

Source: Beyond Hangovers, NIAAA, NIH, http://pubs.niaaa.nih.gov/publications/Hangovers/beyondHangovers.htm

A brightly colored cosmopolitan is the drink of choice for the glamorous characters in Sex and the City. James Bond depends on his famous martini—shaken, not stirred—to unwind with after confounding a villain. And what wedding concludes without a champagne toast?
Alcohol is part of our culture—it helps us celebrate and socialize, and it enhances our religious ceremonies. But drinking too much—on a single occasion or over time—can have serious consequences for our health. Most Americans recognize that drinking too much can lead to accidents and dependence. But that’s only part of the story. In addition to these serious problems, alcohol abuse can damage organs, weaken the immune system, and contribute to cancers. Plus, much like smoking, alcohol affects different people differently. Genes, environment, and even diet can play a role in whether you develop an alcohol-related disease.
On the flip side, some people actually may benefit from drinking alcohol in small quantities. Sound complicated? It sure can be. To stay healthy, and to decide what role alcohol should play in your life, you need accurate, up-to-date information. This brochure is designed to offer you guidance based on the latest research on alcohol’s effect on your health.

Moderate and Binge Drinking

Source: Moderate & Binge Drinking, National Institute on Alcohol Abuse and Alcoholism, NIAAA, NIH

Moderate or “low-risk” drinking
Research shows that people who drink moderately may be less likely to experience an alcohol use disorder (AUD). These drinking levels, which differ for men and women, are:
For men:
  • No more than 4 drinks on any single day AND no more than 14 drinks per week
For women:
  • No more than 3 drinks on any single day AND no more than 7 drinks per week
To stay low risk for AUDs, you must keep within both the single-day and weekly limits.
Even within these limits, you can have problems if you drink too quickly or have other health issues. To keep your risk for problems low, make sure you:
  • Drink slowly
  • Eat enough while drinking
Certain people should avoid alcohol completely, including those who:
  • Plan to drive a vehicle or operate machinery
  • Take medications that interact with alcohol
  • Have a medical condition that alcohol can aggravate
  • Are pregnant or trying to become pregnant

Heavy or “at-risk” drinking
For healthy adults in general, heavy drinking means consuming more than the single-day or the weekly amounts listed above. About 1 in 4 people who drink above these levels already has alcohol dependence or alcohol abuse problems.

Binge drinking
Binge drinking means drinking so much within about 2 hours that blood alcohol concentration (BAC) levels reach 0.08g/dL. For women, this usually occurs after about 4 drinks, and for men, after about 5.
Drinking this way can pose health and safety risks, including car crashes and injuries. Over the long term, binge drinking can damage the liver and other organs.


Learning Activity 2.1: Find out about alcohol content in drinks, calories in alcoholic drinks, and the cost of drinking.
  1. Use the Cocktail Content Calculatorto find out how strong your mixed drink or cocktail is.
    1. Do you know how many “standard drinks” are in an alcoholic beverage? Use the Drink Size Calculator to find out.
    2. Find out how many calories are in your alcoholic beverage of choice using the Alcohol Calorie Calculator.
    3. How much do you spend on alcohol. Use the Alcohol Spending Calculator to find out.


A Little Goes a Long Way: Know the Amounts

Source: Beyond Hangovers, NIAAA, NIH, http://pubs.niaaa.nih.gov/publications/Hangovers/beyondHangovers.htm

Knowing how much alcohol constitutes a “standard” drink can help you determine how much you are drinking and understand the risks. One standard drink contains about 0.6 fluid ounces or 14 grams of pure alcohol. In more familiar terms, the following amounts constitute one standard drink:
  • 12 fluid ounces of beer (about 5% alcohol)
  • 8 to 9 fluid ounces of malt liquor (about 7% alcohol)
  • 5 fluid ounces of table wine (about 12% alcohol)
  • 1.5 fluid ounces of hard liquor (about 40% alcohol)
You’re chatting with friends at a party and a waitress comes around with glasses of champagne. You drink one, then another, maybe even a few more. Before you realize it, you are laughing more loudly than usual and swaying as you walk. By the end of the evening, you are too slow to move out of the way of a waiter with a dessert tray and have trouble speaking clearly. The next morning, you wake up feeling dizzy and your head hurts. You may have a hard time remembering everything you did the night before.
These reactions illustrate how quickly and dramatically alcohol affects the brain. The brain is an intricate maze of connections that keeps our physical and psychological processes running smoothly. Disruption of any of these connections can affect how the brain works. Alcohol also can have longer-lasting consequences for the brain—changing the way it looks and works and resulting in a range of problems.
Most people do not realize how extensively alcohol can affect the brain. But recognizing these potential consequences will help you make better decisions about what amount of alcohol is appropriate for you.

What happens inside the brain?

The brain’s structure is complex. It includes multiple systems that interact to support all of your body’s functions—from thinking to breathing to moving.
These multiple brain systems communicate with each other through about a trillion tiny nerve cells called neurons. Neurons in the brain translate information into electrical and chemical signals the brain can understand. They also send messages from the brain to the rest of the body.
Chemicals called neurotransmitters carry messages between the neurons. Neurotransmitters can be very powerful. Depending on the type and the amount of neurotransmitter, these chemicals can either intensify or minimize your body’s responses, your feelings, and your mood. The brain works to balance the neurotransmitters that speed things up with the ones that slow things down to keep your body operating at the right pace.
Alcohol can slow the pace of communication between neurotransmitters in the brain.

Fetal Alcohol Syndrome

Alcohol can affect the brain at any stage of development—even before birth. Fetal alcohol spectrum disorders are the full range of physical, learning, and behavioral problems, and other birth defects that result from prenatal alcohol exposure. The most serious of these disorders, fetal alcohol syndrome (FAS), is characterized by abnormal facial features and is usually associated with severe reductions in brain function and overall growth. FAS is the leading preventable birth defect associated with mental and behavioral impairment in the United States today.
The brains of children with FAS are smaller than normal and contain fewer cells, including neurons. These deficiencies result in life-long learning and behavioral problems. Current research is investigating whether the brain function of children and adults with FAS can be improved with complex rehabilitative training, dietary supplements, or medications.

Alcohol and Heart Disease

Americans know how prevalent heart disease is—about 1 in 12 of us suffer from it. What we don’t always recognize are the connections heart disease shares with alcohol. On the one hand, researchers have known for centuries that excessive alcohol consumption can damage the heart. Drinking a lot over a long period of time or drinking too much on a single occasion can put your heart—and your life—at risk. On the other hand, researchers now understand that drinking moderate amounts of alcohol can protect the hearts of some people from the risks of coronary artery disease.
Deciding how much, if any, alcohol is right for you can be complicated. To make the best decision for yourself, you need to know the facts and then consult your physician.

Know the Benefits

Research shows that healthy people who drink moderate amounts of alcohol may have a lower risk of developing coronary heart disease than nondrinkers. Moderate drinking is usually defined as no more than two drinks in a given day for men and one drink per day for women who are not pregnant or trying to conceive.
A variety of factors, including diet, genetics, high blood pressure, and age, can cause fat to build up in your arteries, resulting in coronary heart disease. An excess of fat narrows the coronary arteries, which are the blood vessels that supply blood directly to the heart. Clogged arteries reduce blood supply to the heart muscle, and make it easier for blood clots to form. Blood clots can lead to both heart attacks and strokes.
According to recent studies, drinking moderately can protect your heart from these conditions. Moderate drinking helps inhibit and reduce the build-up of fat in the arteries. It can raise the levels of HDL—or “good” cholesterol—in the blood, which wards off heart disease. It can help guard against heart attack and stroke by preventing blood clots from forming and by dissolving blood clots that do develop. Drinking moderately also may help keep blood pressure levels in check.
These benefits may not apply to people with existing medical conditions, or who regularly take certain medications. In addition, researchers discourage people from beginning to drink just for the health benefits. Rather, you can use this research to help you spark a conversation with your medical professional about the best path for you.

Cancer Risk

Genetics, environment, and lifestyle habits can all heighten your risk of getting cancer. We can’t do anything to change our genes, and we often can’t do much to change our environment. But lifestyle habits are a different story.
Drinking too much alcohol is one lifestyle habit that can increase your risk of developing certain cancers. This does not mean that anyone who drinks too much will develop cancer. But numerous studies do show the more you drink, the more you increase your chances of developing certain types of cancer.
For example, a group of Italy-based scientists reviewed more than 200 studies examining alcohol’s impact on cancer risk. The collective results of these studies clearly demonstrate that the more you drink, the higher your risk for developing a variety of cancers. The National Cancer Institute identifies alcohol as a risk factor for the following types of cancer:
  • Mouth
  • Esophagus
  • Pharynx
  • Larynx
  • Liver
  • Breast
At least 7 out of 10 people with mouth cancer drink heavily. Drinking five or more drinks per day can also increase your risk of developing other types of cancers, including colon or rectal cancer. In fact, summary estimates from the recent World Cancer Research Fund report indicate that women who drink five standard alcohol drinks each day have about 1.2 times the risk of developing colon or rectal cancer than women who do not drink at all.
People who drink are also more likely to smoke, and the combination increases the risk significantly. Smoking alone is a known risk factor for some cancers. But smoking and drinking together intensifies the cancer-causing properties of each substance. The overall effect poses an even greater risk.
The risk of throat and mouth cancers is especially high because alcohol and tobacco both come in direct contact with those areas. Overall, people who drink and smoke are 15 times more likely to develop cancers of the mouth and throat than nondrinkers and nonsmokers. In addition, recent studies estimate that alcohol and tobacco together are responsible for:
  • 80 percent of throat and mouth cancer in men
  • 65 percent of throat and mouth cancer in women
  • 80 percent of esophageal squamous cell carcinoma, a type of esophagus cancer
  • 25 to 30 percent of all liver cancers


Learning Activity 2.2:

Find out what it takes to cut down or quit drinking alcohol at Rethinking Drinking, Alcohol and Your Health.
  • What are your reasons for and against making a change?
  • What are small changes that can make a big difference?
See where you stand -
  • Check your drinking pattern
  • See if you have signs of a problem
Decide whether & how to change
  • Weigh your reasons for and against making a change
  • Plan a change
Choose tips for cutting back or quitting
  • Track what you drink
  • Keep track with drinking tracker cards
Stay in control
  • Handle urges to drink (module)
  • Build skills in refusing drinks (module)


Lesson 3: Tobacco

Tobacco

Source: A Report of the Surgeon General: How Tobacco Smoke Causes Disease, The Biology and Behavioral Basis for Smoking-Attributable Disease Fact Sheet 2010, http://www.surgeongeneral.gov/library/tobaccosmoke/factsheet.html More Information
The 30th tobacco-related Surgeon General’s report issued since 1964 describes in detail the specific pathways by which tobacco smoke damages the human body. The scientific evidence supports the following conclusions:

There is no safe level of exposure to tobacco smoke.

  • Any exposure to tobacco smoke – even an occasional cigarette or exposure to secondhand smoke – is harmful.
  • You don’t have to be a heavy smoker or a long-time smoker to get a smoking-related disease or have a heart attack or asthma attack that is triggered by tobacco smoke.
  • Low levels of smoke exposure, including exposures to secondhand tobacco smoke, lead to a rapid and sharp increase in dysfunction and inflammation of the lining of the blood vessels, which are implicated in heart attacks and stroke.
  • Cigarette smoke contains more than 7,000 chemicals and compounds. Hundreds are toxic and at least 69 cause cancer. Tobacco smoke itself is a known human carcinogen.
  • Chemicals in tobacco smoke interfere with the functioning of fallopian tubes, increasing risk for adverse pregnancy outcomes such as ectopic pregnancy, miscarriage, and low birth weight. They also damage the DNA in sperm which might reduce fertility and harm fetal development.

Damage from tobacco smoke is immediate.

  • The chemicals in tobacco smoke reach your lungs quickly every time you inhale. Your blood then carries the toxicants to every organ in your body.
  • The chemicals and toxicants in tobacco smoke damage DNA, which can lead to cancer. Nearly one-third of all cancer deaths every year are directly linked to smoking. Smoking causes about 85% of lung cancers in the U.S.
  • Exposure to tobacco smoke quickly damages blood vessels throughout the body and makes blood more likely to clot. This damage can cause heart attacks, strokes, and even sudden death.
  • The chemicals in tobacco smoke inflame the delicate lining of the lungs and can cause permanent damage that reduces the ability of the lungs to exchange air efficiently and leads to chronic obstructive pulmonary disease (COPD), which includes emphysema and chronic bronchitis.

Smoking longer means more damage.

  • Both the risk and the severity of many diseases caused by smoking are directly related to how long the smoker has smoked and the number of cigarettes smoked per day.
  • Chemicals in tobacco smoke cause inflammation and cell damage, and can weaken the immune system. The body makes white blood cells to respond to injuries, infections, and cancers. White blood cell counts stay high while smoking continues, meaning the body is constantly fighting against the damage caused by smoking which can lead to disease in almost any part of the body.
  • Smoking can cause cancer and weaken your body’s ability to fight cancer. With any cancer – even those not related to tobacco use – smoking can decrease the benefits of chemotherapy and other cancer treatments. Exposure to tobacco smoke can help tumors grow.
  • The chemicals in tobacco smoke complicate the regulation of blood sugar levels, exacerbating the health issues resulting from diabetes. Smokers with diabetes have a higher risk of heart and kidney disease, amputation, eye disease causing blindness, nerve damage and poor circulation.

Cigarettes are designed for addiction.

  • The design and contents of tobacco products make them more attractive and addictive than ever before. Cigarettes today deliver nicotine more quickly from the lungs to the heart and brain.
  • The powerful addicting elements of tobacco products affect multiple types of nicotine receptors in the brain.
  • Evidence suggests that psychosocial, biologic, and genetic factors may also play a role in nicotine addiction.

There is no safe cigarette.

  • The evidence indicates that changing cigarette designs over the last five decades, including filtered, low-tar, and “light” variations, have NOT reduced overall disease risk among smokers and may have hindered prevention and cessation efforts.
  • The overall health of the public could be harmed if the introduction of novel tobacco products encourages tobacco use among people who would otherwise be unlikely to use a tobacco product or delays cessation among persons who would otherwise quit using tobacco altogether.
The only proven strategy for reducing the risk of tobacco-related disease and death is to never smoke, and if you do smoke to quit.
  • Quitting at any age and at any time is beneficial. It's never too late to quit, but the sooner the better.
  • Quitting gives your body a chance to heal the damage caused by smoking.
  • When smokers quit, the risk for a heart attack drops sharply after just 1 year; stroke risk can fall to about the same as a nonsmoker’s after 2-5 years; risks for cancer of the mouth, throat, esophagus, and bladder are cut in half after 5 years; and the risk for dying of lung cancer drops by half after 10 years.
  • Smokers often make several attempts before they are able to quit, but new strategies for cessation, including nicotine replacement and non-nicotine medications, can make it easier.
The evidence indicates that changing cigarette designs over the last five decades, including filtered, low-tar, and “light” variations, have NOT reduced overall disease risk among smokers and may have hindered prevention and cessation efforts.
The overall health of the public could be harmed if the introduction of novel tobacco products encourages tobacco use among people who would otherwise be unlikely to use a tobacco product or delays cessation among persons who would otherwise quit using tobacco altogether.

Learning Activity 3.1: Watch this video - A Tale of Two Smokers.
Follow two people as they attempt to lead healthier lives, and learn how the choices you make depend on what choices are available. (Unnatural Causes Interactivity)
  • If you were told you had to quit smoking and lose 20 lbs., how easy would it be for you?

Quitting

The only proven strategy for reducing the risk of tobacco-related disease and death is to never smoke, and if you do smoke to quit.
Quitting at any age and at any time is beneficial. It's never too late to quit, but the sooner the better. Quitting gives your body a chance to heal the damage caused by smoking. When smokers quit, the risk for a heart attack drops sharply after just 1 year; stroke risk can fall to about the same as a nonsmoker’s after 2-5 years; risks for cancer of the mouth, throat, esophagus, and bladder are cut in half after 5 years; and the risk for dying of lung cancer drops by half after 10 years. Smokers often make several attempts before they are able to quit, but new strategies for cessation, including nicotine replacement and non-nicotine medications, can make it easier.
Tobacco smoke is a toxic mix of more than 7,000 chemicals. Many are poisons. When these chemicals get deep into your body’s tissues, they cause damage. Your body must fight to heal the damage each time you smoke. Over time, the damage can lead to disease.
The chemicals in tobacco smoke reach your lungs quickly when you inhale. What this new report shows is that these same poisonous chemicals reach every organ in your body. They go quickly from your lungs into your blood. Then the blood flows through your arteries. It carries the chemicals to tissues in all parts of your body. Your lungs, blood vessels, and other delicate tissues become inflamed and damaged when you smoke.

Smoking Keeps Your Body under Attack

If you spilled drain cleaner on your skin, it would hurt and become inflamed. If you did this many times a day, your skin would not have a chance to heal. It would stay red, irritated, and inflamed. The organs in your body also have a lining of cells similar to skin. Chemicals in tobacco smoke cause inflammation and damage to these cells. When you keep smoking, the damage cannot heal.
Smoking makes your immune system work overtime. Your body makes white blood cells to respond to injuries, infections, and even cancers. Blood tests show that your whiteblood cell numbers stay high when you smoke. High numbers mean that your body is constantly fighting against the damage caused by tobacco smoke. This constant stress disrupts how your body works. New research shows that stress can lead to disease in almost any part of your body.

Damage is Immediate.

The poisons in smoke pose a danger right away. Sudden blood clots, heart attacks, and strokes can be triggered by tobacco smoke. Poisons in tobacco smoke disrupt the way your body heals itself. Even smoking a cigarette now and then is enough to hurt you. Sitting in a smoky bar raises your odds of a heart attack.
The more years you smoke, the more you hurt your body. Scientists now know that your disease risk surges even higher after you have smoked for about 20 years. But research shows that if you quit by age 30, your health could become almost as good as a nonsmoker’s. At any age, the sooner you quit, the sooner your body can begin to heal.

Nicotine is powerfully addictive.

Addiction to nicotine changes the chemical balance in your brain. Addiction keeps people smoking even when they want to quit. Breaking addiction is harder for some people than others. Many people need more than one try in order to quit.
Scientists now know more about why the brain craves nicotine. Like heroin or cocaine, nicotine changes the way your brain works and causes you to crave more and more nicotine. These powerful cravings make it hard for you to think about anything else. Smoking can cause both physical and mental addiction.

Cigarettes are designed for addiction.

Cigarette makers have long known that nicotine addiction helps sell their products. Cigarettes today deliver more nicotine and deliver it quicker than ever before. The additives and chemicals that tobacco companies put in cigarettes may have helped make them.
You might have thought that “filtered,” “low-tar,” or “light” cigarettes were less dangerous than others. But research shows that these cigarettes are every bit as addictive and are no safer than other cigarettes. Misleading labels are no longer allowed.
Many teens who try cigarettes don’t know how easy it is to become addicted. Nicotine addiction is so powerful that every day about 1,000 teens become daily smokers. Why is this important? Because most current smokers became addicted as teenagers.

You can beat addiction to tobacco.

Smokers who quit go through withdrawal. The first days are the most uncomfortable. The physical symptoms of nicotine addiction end about 3 weeks after you quit smoking. But you may still have an urge to smoke when you wake up, drink coffee, or are out with friends. It takes longer to break these patterns. But you can beat it.


Learning Activity 3.2: Watch this video - Get Tobacco Out of Movies
Youth are being targeted by the big tobacco industry through Hollywood movies. This video was created by the Sudbury & District Health Unit's Youth Program Advisors to raise public awareness of this issue.
  • What movies and TV shows do you think glorify smoking?

True/False Quiz about Smoking and Cigarettes

Source: Myths about Smoking and Cigarettes, CDC, http://www.cdc.gov/tobacco/data_statistics/sgr/2010/myths/pdfs/myths.pdf
Smoking is just a choice.
The first time? Yes. After just a few cigarettes? No. Addiction to nicotine can happen quickly. It changes the chemical balance in your brain. Smoking may seem like it’s just a choice or a habit. In fact, most people who use tobacco are addicted. Breaking nicotine addiction is harder for some people than others. Quitting can take several tries. But don’t give up. If you need help to quit, ask your doctor about nicotine replacement, medicines, or coaching.
Filters make cigarettes safer.
Filters do not protect you. They are designed to make smoke particles smaller. That makes nicotine easier to absorb. This increases addiction. Cigarettes have been engineered to speed up nicotine’s path to your brain. Their design feeds addiction. Light or low-tar cigarettes may sound less dangerous. They aren’t. These misleading labels are no longer allowed. No cigarette is safe. Tobacco smoke contains more than 7,000 chemicals. At least 250 are toxic.
An occasional cigarette is no big deal.
Smoking doesn’t just cause diseases for heavy smokers or longtime smokers. The 2010 Surgeon General’s Report shows how breathing tobacco smoke can cause immediate harm. Tobacco smoke can trigger sudden heart attacks and death, even in nonsmokers. Each cigarette you smoke hurts your lungs, your blood vessels, and cells throughout your body. Smoking a few cigarettes a week can cause a heart attack. Cutting back is not enough to protect you. You have to quit entirely.
It’s too late to quit—the damage is already done.
It’s true that the longer you use tobacco, the more you hurt your body. But at any age, the sooner you quit, the sooner your health can improve. The 2010 Surgeon General’s Report shows how using tobacco causes disease almost everywhere in your body. Within 20 minutes after quitting, your body starts to heal. After 2 to 5 years, your risk for stroke is similar to that of a nonsmoker. In 10 years, your lung cancer risk is cut in half.
Secondhand smoke may bother people, but it isn’t dangerous.
Tens of thousands of nonsmokers die every year from breathing others’ secondhand smoke. Breathing the chemicals in tobacco smoke changes your blood’s chemistry almost immediately. Deadly clots can form and block arteries to your heart or brain. When you smoke at work, home, or at a restaurant, everyone there breathes poisons. If you smoke in your car, rolling down a window does not protect your passengers. It is not healthy to breathe any amount of tobacco smoke.
The little bit of smoke that my kids get doesn’t hurt them.
Don’t smoke or let others smoke around your children. They can get bronchitis, pneumonia, and ear infections from smoke. Even if you only smoke by an open window, some of the smoke stays in your house and poisons the air your children breathe. Children with asthma can have a serious, even deadly, asthma attack from breathing secondhand smoke. The best way to protect children is to quit smoking. If you or someone else in your household are not ready to quit, be sure to make your home and car 100% smoke-free.

Learning Activity 3.3: Watch this video about addiction of tobacco
  • What are the main points?

Lesson 4: Misuse of Prescription Drugs

Misuse of Prescription Drugs

Source: Misuse of Prescription Drugs, NLM, NIH,http://www.nlm.nih.gov/medlineplus/prescriptiondrugabuse.html

Prescription Drugs

Most people take medicines only for the reasons their doctors prescribe them. But an estimated 20 percent of people in the United States have used prescription drugs for nonmedical reasons. This is prescription drug abuse. It is a serious and growing problem.
Abusing some prescription drugs can lead to addiction. You can develop an addiction to:
  • Narcotic painkillers
  • Sedatives and tranquilizers
  • Stimulants
Experts don't know exactly why this type of drug abuse is increasing. The availability of drugs is probably one reason. Doctors are prescribing more drugs for more health problems than ever before. Online pharmacies make it easy to get prescription drugs without a prescription, even for youngsters.

Learning Activity 4.1: How to Identify Unknown Pills
Pillbox was developed to aid in the identification of unknown solid dosage pharmaceuticals. The system combines high-resolution images of tablets and capsules with appearance information (imprint, shape, color, etc.) to enable users to visually search for and identify an unknown solid dosage pharmaceutical.

This system is designed for use by emergency physicians, first responders, other health care providers, Poison Control Center staff, and concerned citizens.

The system enables users to identify solid dosage forms based on physical criteria: imprint (characters or number printed on a medication), shape, color, size, and scoring. Users are shown thumbnail images of possible matches. These images are continually updated as the user enters additional information.
  • Visit the Pillbox to check the pills in your family medicine cabinet.
  • Find any surprises?


Learning Activity 4.2: Clean out your medicine cabinet.

Commonly Abused Prescription Drugs

Source: Commonly Abused Prescription Drugs, http://www.drugabuse.gov/drugs-abuse/commonly-abused-drugs/commonly-abused-prescription-drugs-chart

Medications can be effective when they are used properly, but some can be addictive and dangerous when abused. Some prescribed medications that - when used in ways or by people other than prescribed - have the potential for adverse medical consequences, including addiction.
In 2010, approximately 16 million Americans reported using a prescription drug for nonmedical reasons in the past year; 7 million in the past month.
After marijuana, prescription and over-the-counter medications account for most of the commonly abused drugs.

What types of prescription drugs are abused?

Three types of drugs are abused most often:
  • Opioids—prescribed for pain relief
  • CNS depressants—barbiturates and benzodiazepines prescribed for anxiety or sleep problems (often referred to as sedatives or tranquilizers)
  • Stimulants—prescribed for attention-deficit hyperactivity disorder (ADHD), the sleep disorder narcolepsy, or obesity.

How can you help prevent prescription drug abuse?

  • Ask your doctor or pharmacist about your medication, especially if you are unsure about its effects.
  • Keep your doctor informed about all medications you are taking, including over-the-counter medications.
  • Read the information your pharmacist provides before starting to take medications.
  • Take your medication(s) as prescribed.
  • Keep all prescription medications secured at all times and properly dispose of any unused medications.

Prescription Drug Advertising

Your healthcare provider is the best source of information about the right medicines for you.
The Food and Drug Administration (FDA) protects public health by assuring the safety, effectiveness, and security of a wide range of products, including human prescription drugs. We also advance public health by helping people get the accurate, science-based information they need to use medicines appropriately and improve their health. Prescription drug advertisements can provide useful information for consumers to work with their health care providers to make wise decisions about treatment.

FDA Authority Over Advertising

Source: FDA, http://www.fda.gov/Drugs/ResourcesForYou/Consumers/PrescriptionDrugAdvertising/ucm071964.htm
The FDA serves the public health and welfare in many ways. One way is overseeing the approval and marketing of prescription drugs. It's authority is based on a number of federal laws, including the Federal Food, Drug, and Cosmetic Act. Among other areas, this law specifically addresses prescription drug advertising. This law requires that advertisements for prescription drugs be accurate and not misleading.
Direct-to-consumer (DTC) advertising is a relatively new area of prescription drug promotion. No federal law has ever banned DTC advertising. Until the mid-1980s, drug companies gave information about prescription drugs only to doctors and pharmacists. When these professionals thought it appropriate, they gave that information to their patients. However, during the 1980s, some drug companies started to give the general public more direct access to this information through DTC ads.
The law requires that product claim ads give a "fair balance" of information about drug risks as compared with information about drug benefits. This means that the content and presentation of a drug's most important risks must be reasonably similar to the content and presentation of its benefits.
This does not mean that equal space must be given to risks and benefits in print ads, or equal time to risks and benefits in broadcast ads. The amount of time or space needed to present risk information will depend on the drug's risks and the way that both the benefits and risks are presented.
Think about the following questions when you see an ad for a prescription drug. Also, think about asking these questions when you talk to your doctor or pharmacist about a drug.
  • What condition does this drug treat?
  • Why do I think that I might have this condition?
  • If I have the condition, am I part of the population the drug is approved to treat?
  • Should I take this drug if I have a certain condition?
  • Should I take this drug if I am taking certain other drugs?
  • Which of the drug's possible side effects am I concerned about?
  • How will this drug affect other drugs I am taking?
  • Will foods, beverages (alcoholic or non-alcoholic), vitamins, or other supplements affect how this drug works?
  • Are there other drugs that treat my condition?
  • Is there a less costly drug I could use to treat my condition?
  • What else can I do to help deal with my condition? For example, should I exercise or change my diet?
  • Do other drugs for my condition have different side effects?
  • How can I learn more about this condition and this drug?

Harmful Interactions: Mixing Alcohol with Medicines

Source: Harmful Interactions: Mixing Alcohol with Medicines, National Institute on Alcohol Abuse and Alcoholism, NIH, http://pubs.niaaa.nih.gov/publications/Medicine/medicine.htm

You’ve probably seen this warning on medicines you’ve taken. The danger is real. Mixing alcohol with certain medications can cause nausea and vomiting, headaches, drowsiness, fainting, or loss of coordination.

It also can put you at risk for internal bleeding, heart problems, and difficulties in breathing. In addition to these dangers, alcohol can make a medication less effective or even useless, or it may make the medication harmful or toxic to your body.

Some medicines that you might never have suspected can react with alcohol, including many medications which can be purchased “over-the-counter”—that is, without a prescription. Even some herbal remedies can have harmful effects when combined with alcohol.

See the NIH publication Harmful Interactions: Mixing Alcohol with Medicines for a list of medications that can cause harm when taken with alcohol and description of the effects that can result. The list gives the brand name by which each medicine is commonly known (for example, Benadryl®) and its generic name or active ingredient (in Benadryl®, this is diphenhydramine). The list presented here does not include all the medicines that may interact harmfully with alcohol. Most important, the list does not include all the ingredients in every medication.

Medications are safe and effective when used appropriately. Your pharmacist or other health care provider can help you determine which medications interact harmfully with alcohol.

Did You Know…

Mixing alcohol and medicines can be harmful. Alcohol, like some medicines, can make you sleepy, drowsy, or lightheaded. Drinking alcohol while taking medicines can intensify these effects. You may have trouble concentrating or performing mechanical skills. Small amounts of alcohol can make it dangerous to drive, and when you mix alcohol with certain medicines you put yourself at even greater risk. Combining alcohol with some medicines can lead to falls and serious injuries, especially among older people.

Medicines may have many ingredients

Some medications—including many popular painkillers and cough, cold, and allergy remedies—contain more than one ingredient that can react with alcohol. Read the label on the medication bottle to find out exactly what ingredients a medicine contains. Ask your pharmacist if you have any questions about how alcohol might interact with a drug you are taking.

Some medicines contain alcohol

Certain medicines contain up to 10 percent alcohol. Cough syrup and laxatives may have some of the highest alcohol concentrations.

Alcohol affects women differently

Women, in general, have a higher risk for problems than men. When a woman drinks, the alcohol in her bloodstream typically reaches a higher level than a man’s even if both are drinking the same amount. This is because women’s bodies generally have less water than men’s bodies. Because alcohol mixes with body water, a given amount of alcohol is more concentrated in a woman’s body than in a man’s. As a result, women are more susceptible to alcohol-related damage to organs such as the liver.

Older people face greater risk

Older people are at particularly high risk for harmful alcohol– medication interactions. Aging slows the body’s ability to break down alcohol, so alcohol remains in a person’s system longer. Older people also are more likely to take a medication that interacts with alcohol—in fact, they often need to take more than one of these medications.

Timing is important

Alcohol and medicines can interact harmfully even if they are not taken at the same time.

Remember…

Mixing alcohol and medicines puts you at risk for dangerous reactions. Protect yourself by avoiding alcohol if you are taking a medication and don’t know its effect. To learn more about a medicine and whether it will interact with alcohol, talk to your pharmacist or other health care provider.

Lesson 5: Drugs, Abuse and Addiction

Drugs, Abuse and Addiction

Source: Understanding Drug Abuse and Addition, http://www.drugabuse.gov/publications/infofacts/understanding-drug-abuse-addiction
Many people do not understand why or how other people become addicted to drugs. It can be wrongfully assumed that drug abusers lack moral principles or willpower and that they could stop using drugs simply by choosing to change their behavior. In reality, drug addiction is a complex disease, and quitting takes more than good intentions. In fact, because drugs change the brain in ways that foster compulsive drug abuse, quitting is difficult, even for those who are ready to do so. Through scientific advances, we know more about how drugs work in the brain than ever, and we also know that drug addiction can be successfully treated to help people stop abusing drugs and lead productive lives.
Drug abuse and addiction have negative consequences for individuals and for society. Estimates of the total overall costs of substance abuse in the United States, including productivity and health- and crime-related costs, exceed $600 billion annually. This includes approximately $181 billion for illicit drugs, $193 billion for tobacco, and $235 billion for alcohol. As staggering as these numbers are, they do not fully describe the breadth of destructive public health and safety implications of drug abuse and addiction, such as family disintegration, loss of employment, failure in school, domestic violence, and child abuse.

Optional Learning Activity: Read this short article titled: Breaking Bad Habits, Why It's So Hard to Change from NIH News in Health.
Wise Choices
  • Avoid tempting situations. If you always stop for a donut on your way to work, try a different route. Keep fatty foods, cigarettes, alcohol and other tempting items out of your home.
  • Replace unhealthy behaviors with healthy ones. Try exercise, a favorite hobby or spending time with family.
  • Prepare mentally. If you can’t avoid a tempting situation, prepare yourself in advance. Think about how you want to handle it and mentally practice what you plan.
  • Enlist support. Ask friends, family and co-workers to support your efforts to change.
  • Reward yourself for small steps. Give yourself a healthy treat when you’ve achieved a small goal or milestone.
Have you ever tried any of these strategies to break a bad habit?

What Is Drug Addiction?

Addiction is a chronic, often relapsing brain disease that causes compulsive drug seeking and use, despite harmful consequences to the addicted individual and to those around him or her. Although the initial decision to take drugs is voluntary for most people, the brain changes that occur over time challenge a person’s self control and ability to resist intense impulses urging them to take drugs.
Fortunately, treatments are available to help people counter addiction’s powerful disruptive effects. Research shows that combining addiction treatment medications with behavioral therapy is the best way to ensure success for most patients. Treatment approaches that are tailored to each patient’s drug abuse patterns and any co-occurring medical, psychiatric, and social problems can lead to sustained recovery and a life without drug abuse.
Similar to other chronic, relapsing diseases, such as diabetes, asthma, or heart disease, drug addiction can be managed successfully. And as with other chronic diseases, it is not uncommon for a person to relapse and begin abusing drugs again. Relapse, however, does not signal treatment failure—rather, it indicates that treatment should be reinstated, adjusted, or that an alternative treatment is needed to help the individual regain control and recover.

What Happens to Your Brain When You Take Drugs?

Drugs contain chemicals that tap into the brain’s communication system and disrupt the way nerve cells normally send, receive, and process information. There are at least two ways that drugs cause this disruption: (1) by imitating the brain’s natural chemical messengers and (2) by overstimulating the “reward circuit” of the brain.
Some drugs (e.g., marijuana and heroin) have a similar structure to chemical messengers called neurotransmitters, which are naturally produced by the brain. This similarity allows the drugs to “fool” the brain’s receptors and activate nerve cells to send abnormal messages.
Other drugs, such as cocaine or methamphetamine, can cause the nerve cells to release abnormally large amounts of natural neurotransmitters (mainly dopamine) or to prevent the normal recycling of these brain chemicals, which is needed to shut off the signaling between neurons. The result is a brain awash in dopamine, a neurotransmitter present in brain regions that control movement, emotion, motivation, and feelings of pleasure. The overstimulation of this reward system, which normally responds to natural behaviors linked to survival (eating, spending time with loved ones, etc.), produces euphoric effects in response to psychoactive drugs. This reaction sets in motion a reinforcing pattern that “teaches” people to repeat the rewarding behavior of abusing drugs.
As a person continues to abuse drugs, the brain adapts to the overwhelming surges in dopamine by producing less dopamine or by reducing the number of dopamine receptors in the reward circuit. The result is a lessening of dopamine’s impact on the reward circuit, which reduces the abuser’s ability to enjoy the drugs, as well as the events in life that previously brought pleasure. This decrease compels the addicted person to keep abusing drugs in an attempt to bring the dopamine function back to normal, except now larger amounts of the drug are required to achieve the same dopamine high—an effect known as tolerance.
Long-term abuse causes changes in other brain chemical systems and circuits as well. Glutamate is a neurotransmitter that influences the reward circuit and the ability to learn. When the optimal concentration of glutamate is altered by drug abuse, the brain attempts to compensate, which can impair cognitive function. Brain imaging studies of drug-addicted individuals show changes in areas of the brain that are critical to judgment, decisionmaking, learning and memory, and behavior control. Together, these changes can drive an abuser to seek out and take drugs compulsively despite adverse, even devastating consequences—that is the nature of addiction.

Why Do Some People Become Addicted While Others Do Not?

No single factor can predict whether a person will become addicted to drugs. Risk for addiction is influenced by a combination of factors that include individual biology, social environment, and age or stage of development. The more risk factors an individual has, the greater the chance that taking drugs can lead to addiction.
For example:
Biology. The genes that people are born with––in combination with environmental influences––account for about half of their addiction vulnerability. Additionally, gender, ethnicity, and the presence of other mental disorders may influence risk for drug abuse and addiction.
Environment. A person’s environment includes many different influences, from family and friends to socioeconomic status and quality of life in general. Factors such as peer pressure, physical and sexual abuse, stress, and quality of parenting can greatly influence the occurrence of drug abuse and the escalation to addiction in a person’s life.
Development. Genetic and environmental factors interact with critical developmental stages in a person’s life to affect addiction vulnerability. Although taking drugs at any age can lead to addiction, the earlier that drug use begins, the more likely it will progress to more serious abuse, which poses a special challenge to adolescents. Because their brains are still developing in the areas that govern decisionmaking, judgment, and self-control, adolescents may be especially prone to risk-taking behaviors, including trying drugs of abuse.

Prevention Is the Key

Drug addiction is a preventable disease. Results from NIDA-funded research have shown that prevention programs involving families, schools, communities, and the media are effective in reducing drug abuse. Although many events and cultural factors affect drug abuse trends, when youths perceive drug abuse as harmful, they reduce their drug taking. Thus, education and outreach are key in helping youth and the general public understand the risks of drug abuse. Teachers, parents, medical and public health professionals must keep sending the message that drug addiction can be prevented if one never abuses drugs.

Learning Activity 5.1: Watch this 2 minute video titled Anyone Can Become Addicted to Drugs.

What Is Addiction?

Source: The Essence of Drug Addiction by Nora Volkow, M.D., Director, National Institute on Drug Abuse, http://science.education.nih.gov/supplements/nih2/Addiction/guide/essence.htm
More than three decades of research supported by the National Institute on Drug Abuse (NIDA) has proven that addiction is a complex brain disease characterized by compulsive, at times uncontrollable, drug craving, seeking, and use that persist despite potentially devastating consequences. Addiction is also a developmental disease; that is, it usually starts in adolescence or even childhood and can last a lifetime if untreated. Disagreements about the nature of addiction remain: namely, whether it reflects voluntary or involuntary behavior and whether it should be punished or treated as a health issue. Even though the first time a person takes a drug, it is often by choice—to achieve a pleasurable sensation or desired emotional state—we now know from a large body of research that this ability to choose can be affected by drugs. And when addiction takes hold in the brain, it disrupts a person’s ability to exert control over behavior— reflecting the compulsive nature of this disease.

The human brain is an extraordinarily complex and fine-tuned communications network made up of billions of cells that govern our thoughts, emotions, perceptions, and drives. Our brains reward certain behaviors such as eating or procreating—registering these as pleasurable activities that we want to repeat. Drug addiction taps into these vital mechanisms geared for our survival. And although not a life necessity, to an addicted person, drugs become life itself, driving the compulsive use of drugs—even in the face of dire life consequences—that is the essence of addiction.

How Does Addiction Take Hold in the Brain?


The rewarding effects of drugs of abuse come from large and rapid upsurges in dopamine, a neurochemical critical to stimulating feelings of pleasure and to motivating behavior. The rapid dopamine “rush” from drugs of abuse mimics but greatly exceeds in intensity and duration the feelings that occur in response to such pleasurable stimuli as the sight or smell of food, for example. Repeated exposure to large, drug-induced dopamine surges has the insidious consequence of ultimately blunting the response of the dopamine system to everyday stimuli. Thus the drug disturbs a person’s normal hierarchy of needs and desires and substitutes new priorities concerned with procuring and using the drug.

Drug abuse also disrupts the brain circuits involved in memory and control over behavior. Memories of the drug experience can trigger craving as can exposure to people, places, or things associated with former drug use. Stress is also a powerful trigger for craving. Control over behavior is compromised because the affected frontal brain regions are what a person needs to exert inhibitory control over desires and emotions.

That is why addiction is a brain disease. As a person’s reward circuitry becomes increasingly dulled and desensitized by drugs, nothing else can compete with them—food, family, and friends lose their relative value, while the ability to curb the need to seek and use drugs evaporates. Ironically and cruelly, eventually even the drug loses its ability to reward, but the compromised brain leads addicted people to pursue it, anyway; the memory of the drug has become more powerful than the drug itself.

When does drug abuse become drug addiction? It rarely happens with the first use of a drug. Drug abuse and drug addiction can be thought of as points along a continuum. Any use of a mind-altering drug or the inappropriate use of medication (either prescription or over-the-counter drugs) is drug abuse, but the point when drug abuse becomes drug addiction is less clear. Different people may reach the point of addiction at different stages. Scientists continue to investigate the factors that contribute to the transition to drug addiction.

Drug addiction is defined as the continued compulsive use of drugs despite adverse health or social consequences. Drug-addicted people have lost control of their drug use. Individuals who are addicted to drugs often become isolated from family or friends, have difficulty at work or school, may commit crimes, and become involved with the criminal justice system. For a person addicted to drugs, continuing to take them becomes the primary focus in life.

Certain drugs, including opioids and alcohol, cause strong physical reactions in the body when drug use stops. When a person addicted to heroin stops taking heroin, he or she can experience a variety of symptoms ranging from watery eyes and a runny nose to irritability and loss of appetite and then diarrhea, shivering, sweating, abdominal cramps, increased sensitivity to pain, and sleep problems. In general, withdrawal from heroin makes people feel miserable. Withdrawal from alcohol can cause serious effects such as seizures and even death. Withdrawal from other drugs, such as cocaine and amphetamines, does not lead to strong physical reactions, but it may make the person feel depressed or lethargic. For most drugs, physical withdrawal symptoms can usually be controlled effectively with medications. Even though withdrawal from some drugs does not cause the person abusing them to have physical reactions, stopping drug use is difficult because of the changes the drugs have caused in the brain. Once the drugs stop, the person will have cravings, or intense desire for the drugs. Craving arises from the brain’s need to maintain a state of homeostasis that now relies on the presence of the drug. A person may experience cravings at any stage of drug abuse or addiction, even early in the experimentation phase of drug abuse. Cravings have a physical basis in the brain. Using PET imaging, scientists have shown that just seeing images of drug paraphernalia can stimulate the amygdala (part of the brain involved in emotional memory) in an addicted person.

Drugs of addiction do not merely cause short-term changes in an individual’s cognitive skill and behavior. A drug “high” lasts a short time, ranging from less than an hour to 12 hours, depending on the drug, dose, and route of administration. The changes in the brain that result from continued drug use, however, can last a long time. Scientists believe that some of these changes disappear when drug use stops; some disappear within a short time after drug use stops, and other changes are potentially permanent.

One of the first changes in the brain that may occur in response to repeated drug abuse is tolerance. Tolerance develops when a person needs increasing doses of a drug to achieve the same high or “rush” that previously resulted from a lower dose of the drug. Two primary mechanisms underlie the development of tolerance. First, the body may become more efficient at metabolizing the drug, thereby reducing the amount that enters the brain. Second, the cells of the body and brain may become more resistant to the effect of the drug. For example, after continued cocaine use, neurons decrease the number of dopamine receptors, which results in decreasing cocaine’s stimulatory effect. Opioids, on the other hand, do not cause a change in the number of receptors. Instead the opioid receptors become less efficient in activating associated cellular processes, thus reducing the effects of the opioids.

In addition to the functional and anatomical changes in the brain, drug abuse puts people at higher risk for other health problems. For example, inhalant abuse can lead to disruption of heart rhythms, and snorting cocaine can lead to ulcerations in the mucous membranes of the nose. In addition, injection drug users (IDUs) are at higher risk of contracting HIV through the sharing of potentially contaminated needles. Similarly, hepatitis B and hepatitis C are much more common among drug addicts than the general population. Tuberculosis is another concern. Drug abuse and addiction also are contributing factors in motor vehicle accidents.

Learning Activity 5.2: Environmental, Behavioral, and Social Influences on Drug Abuse and Addiction
Go through Lessons 3 & 4 on The Brain: Understanding Neurobiology website.

Optional: Drug Abuse and Addiction as Challenging Public Health Problem

Drug Abuse and Addiction: One of America's Most Challenging Public Health Problems



Contemporary Health Issues

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