4. Consequences for Society
Deaths
Emergency room visits
Drugs in the workplace and lost productivity
Broken homes, illnesses, shorter lives, etc.
Cost of maintaining habit
Cost of criminal behavior
Cost of treating patients
Fetal alcohol syndrome
Blood borne illnesses
5. Getting Information on Drug Use
Surveys
Hospital reports
Police reports
Can show trends over
time
What’s missing?
6. Extent of Drug Use
National Survey on Drug Use and Health (2010)
22.6 million Americans used illicit drugs
7 million used psychotherapeutic drugs non-medically
1.5 million were current cocaine users
28.8 million drove a car under the influence of alcohol
695,000 Ecstasy users, and 353,000 meth users
16.3% of pregnant women smoked cigarettes
2.5 million received substance abuse treatment for alcohol
69.6 million Americans smoked cigarettes
7. Have you used marijuana in the
last 30 days? ANONYMOUS
A. Yes
B. No
Yes
No
71%
29%
8.
9. Have you had 5 or more drinks in one sitting
in the last 30 days? ANONYMOUS
A. Yes
B. No
Yes
No
75%
25%
12. Have you used non-prescribed narcotics in
the last 30 days? ANONYMOUS
A. Yes
B. No
Yes
No
100%
0%
13.
14. Drug Abuse Warning Network
DAWN is a reporting system that
collects information on the number of
times drugs are implicated in both non-
lethal and lethal visits to emergency
rooms
Illicit drugs were responsible for the
most emergency room visits,
followed by pharmaceutical drugs
Data reflect acute drug problems,
not chronic drug use
15. DAWN gives information on:
A. The number of people
jailed for drug offenses
B. The number of times
drugs are implicated in
emergency room visits
C. The number of people
who admit drug use to
their doctors
Thenum
berofpeople
jail..
Thenum
beroftim
esdru..
Thenum
berofpeople
w
..
0% 0%
100%
16. Changing Attitudes
What made the
government change from
the laissez-faire attitude
of the 1800s to one of
control?
Toxicity
Dependence
Crime
17. Society’s perception of drugs:
Influenced by social and
psychological factors
Illegal drugs are condemned more
than legal drugs
18. What do you think about government
regulation of drug use?
A. The government
should be more
involved
B. The government
should be less
involved
C. Our government is
doing a good job
currently
Thegovernm
entshould
..
Thegovernm
entshould
b...
Ourgovernm
entisdoing..
100%
0%0%
19. Toxicity
Physical toxicity:
Danger to the body as a result of taking the drug
Behavioral toxicity:
Drug interferes with one’s ability to function
Acute toxicity:
Danger from a single experience with a drug
Chronic toxicity:
Danger posed by repeated exposure to the drug
20. Driving while drunk is an example
of:
A. Acute physical
toxicity
B. Chronic physical
toxicity
C. Acute behavioral
toxicity
D. Chronic
behavioral toxicity Acutephysicaltoxicity
Chronicphysicaltoxicity
Acutebehavioraltoxicity
Chronicbehavioraltoxicity
0%
25%
75%
0%
21. Cirrhosis of the liver is an example
of:
A. Acute physical
toxicity
B. Chronic physical
toxicity
C. Acute behavioral
toxicity
D. Chronic behavioral
toxicity
Acutephysicaltoxicity
Chronicphysicaltoxicity
Acutebehavioraltoxicity
Chronicbehavioraltoxicity
0%
25%
0%
75%
22. Patterns of Use
Experimental Use
Infrequent use motivated by curiosity
Social-Recreational Use
Taking drugs to share pleasurable experiences among
friends
Circumstantial-Situational Use
Short-term use to contend with immediate distress or
pressure
23. Patterns of Use
Intensified Use
Taking drugs on a steady basis to relieve a problem
Chronic Use
Indicates some extent of physical or psychological
dependence
Compulsive Use
Acquiring and consuming drugs is the main focus of life
24. Changing View on Dependence
Early medical model
True addiction involves physical dependence; key is
treatment of withdrawal symptoms
Positive reinforcement model
Drugs can reinforce behavior without physical
dependence
Psychological dependence is increasingly
viewed as the driving force behind repeated
drug use
This refutes the sometimes common belief that drugs
that aren’t as strongly physically addicting are less
dangerous
25. What do you think causes
“addiction”?
A. Genetics
B. Biology
C. Environment
(family/peer)
D. Weak personality
E. Properties of the
drug itself
Genetics
Biology
Environm
ent(fam
ily/peer)
W
eak
personality
Propertiesofthe
drugitself
25% 25%
50%
0%0%
26. Substance Use Disorder DSM-5
Substance use disorders span a wide variety of problems
arising from substance use, and cover 11 different criteria:
1. Taking the substance in larger amounts
or for longer than you meant to
2. Wanting to cut down or stop using the
substance but not managing to
3. Spending a lot of time getting, using, or
recovering from use of the substance
27. 4. Cravings and urges to use the
substance (psychological dependence)
5. Not managing to do what you should at
work, home or school, because of
substance use
6. Continuing to use, even when it causes
problems in relationships
7. Giving up important social, occupational
or recreational activities because of
substance use
28. 8. Using substances again and again,
even when it puts you in danger
9. Continuing to use, even when the
you know you have a physical or
psychological problem that could
have been caused or made worse by
the substance
10. Needing more of the substance to get
the effect you want (tolerance)
11. Development of withdrawal
symptoms, which can be relieved by
taking more of the substance.
(physical dependence)
29. Impacts of Drug Use
Family stability
Social behavior
Education and career
aspirations
Personal and social maturation
31. A correlate is:
A. A variable that
causes something
B. A thing you keep
horses in
C. A variable that is
associated with
something
A
variablethatcausess...
A
thingyou
keep
horsesin
A
variablethatisassocia...
3%
97%
0%
32. Family
Association between drug use and the likelihood that a
couple will separate or divorce
Women subjected to violence have higher rates of alcohol
dependence and other drug abuse problems
Family interventions into adolescent alcohol use reduce the
initiation and frequency of alcohol use
Marijuana use by young Black males is significantly reduced
when both parents are present
33. Family
Parental substance abuse is a
factor for 1/3 to 2/3 of all children
involved with the child welfare
system
Substance abuse is a factor in
many cases of child abuse and
domestic abuse
Alcohol use is associated with the
perpetration of sexual aggression,
especially toward boys **
34. Which of the following is not associated
with drug use in the family
A. Increased
violence
B. Higher divorce
rates
C. Low IQ
Increased
violence
Higherdivorcerates
Low
IQ
0%
100%
0%
35. Social Behavior
Drug users display more independence, rebelliousness,
acceptance of deviant behavior, and rejection of moral and
social norms than nonusers
Children of parents who use drugs are more likely to engage
in delinquent behaviors
Stimulants such as methamphetamines and cocaine are
associated with violence, while marijuana and heroin are
more likely to produce a passive response
36. Social Behavior
Alcohol is the drug involved with the most violent
incidents
The level of aggression associated with alcohol is
dose related
Binge drinking is associated with unsafe sex and
violence, and with nonconsensual sex
Most cases of dating violence occurred in the
South, and in many instances, involved alcohol **
37. Drug users show higher levels of
acceptance of deviant behavior
A. True
B. False
True
False
0%
100%
38. Alcohol is associated with
0%
0%
0%
0%
0% A. Higher level of violent incidents
B. Dating violence
C. Unsafe sex
D. Nonconsensual sex
E. All of the above
39. Education
There is a higher dropout rate from school for
those who used alcohol, illicit drugs, and cigarettes
There is a relationship between academic
performance and drug use
Drug use is assumed to be a predictor of welfare
dependency
Higher Education Act of 1965: College students
who are convicted of a drug offense are denied
federal financial aid
40. Do you feel that the regulations about
financial aid and drug convictions are fair?
67%
0%
33%
0% A. Yes
B. No
C. Sometimes
D. I’m undecided
41. Effects of drug use by pregnant
women
Women whose babies
test positive for drugs
such as cocaine are
subject to losing custody
of their children
Risks to the baby:
Low birth weight
Premature birth
Miscarriage
Birth defects
Difficulty bonding
Learning disabilities
43. Discussion
Write down 4 points that support your position (pro or con)
Write down the evidence for each point
44. Employment
Employed drug users have less stable job histories
than nonusers
Alcohol abusers earn significantly less money than
moderate drinkers and abstainers
Drug use is associated with higher accident rates
on the job and lower productivity
45. Drugs in the Workplace
Substance abuse in the workplace results in:
Lessened productivity
Increased accidents, absenteeism, and health care costs
Highest rates of drug use are food service workers and
construction workers – identifying drug problems in top-level
managers is more difficult
Employee Assistance Programs (EAPs) help workers deal
with problems that affect job performance, including alcohol
or drug problems
46. Drug Testing
In 2011, the federal government earmarked $283.1 million for
drug-related activities in schools
Random workplace drug testing has effectively identified
frequent users of illicit drugs
In many jurisdictions, physicians are required to report
women who use drugs during pregnancy or infants who test
positive for drug use by their mothers
47. Types of Drug Testing
Immunoassay is fast and less expensive than other
methods but may give false positive readings
Gas chromatography is more expensive and time-
consuming than other methods
Thin-layer chromatography is simple and inexpensive, but
requires expert interpretation
Gas chromatography/mass spectrometry is highly
sensitive, but is time-consuming and expensive
http://www.aa
fp.org/afp/201
0/0301/p635.
html
48. Problems with Drug Testing
False positive
A person tests positive for a drug even though no drug is present
in the person’s urine
False negative
A person tests negative even though drugs are present in the
person’s urine
49.
50. Legality of Drug Testing
Debated in two cases
before the U.S.
Supreme Court:
Skinner v. Railway
Labor Executive
Association
National Treasury
Employees Union v.
von Raab
In both cases, the
Supreme Court ruled
that the testing
program was justified http://www.nolo.com/legal-
encyclopedia/free-books/employee-
rights-book/chapter5-3.html
51. Crime: Drug Business
Drug trade is a big business with no signs of slowing down
Tactics for stopping drug flow into the US – military force,
reducing aid to drug-producing countries, and promoting crop
substitution – are ineffective
Results in thousands needing medical care for drug
overdoses, and has an economic impact on the criminal
justice system and environment
54. Crime: Drug Enforcement
• The narcotics trade is
tremendously profitable
• Even after billions of dollars
were spent on curbing drug
production, coca growth in
Colombia rose 27%
• Preventing drugs from
entering the United States or
reducing the amount of drugs
grown in the country is a
matter of demand, not supply
58. We all do things we know we shouldn’t do.
Why?
Characteristics of drugs can reinforce their
use
◦ Altered states of consciousness
Societal, community, and family factors play
an important role in whether an individual
tries a drug
Drug factors play an important role in
whether an individual continues to use a
drug
https://www.youe.com/w
atch?v=bWXR3AqZEO4tub
59. Experimentation:
◦ Especially among young people, curiosity is a
natural phenomenon that easily leads to
experimentation
Pleasure/Escape from Boredom:
◦ An individual who is bored will engage in
something pleasurable to relieve the boredom
◦ Drugs used to increase pleasure or reduce boredom
provide positive reinforcement
◦ Drugs taken to alleviate discomfort provide
negative reinforcement
60. Peer Influence:
◦ Many young people use drugs to gain peer
acceptance or approval
◦ Basic values, life goals, and aspirations still are
influenced more by parents
Spiritual Purposes:
◦ People have used drugs to communicate with
something or someone greater than themselves
◦ Psychoactive plants have roles in many religious
and spiritual practices
61. Self-Discovery:
◦ Drugs sometimes are used to fill a void in one’s life
Social Interaction:
◦ Drugs are used to facilitate interactions with others
◦ Certain social groups determine how a drug is used
Rebelliousness:
◦ Young people rebel against the conventions of
society, including warnings about drugs
https://www.youe.com/watch?v=bWXR3AqZEO4tub
62.
63. ◦ Community, parental,
and peer attitudes
and behaviors
◦ Antisocial/problem
behaviors
◦ Poor school
performance
◦ Perception that use is
prevalent
64. ◦ Involvement in religious activities
◦ Commitment to school,
involvement in extracurricular
activities
◦ Perceived risk
of drug use
◦ Parents as social
support
65.
66. U.S. Department of Health and Human
Services: Addiction is a “chronic, life-
threatening condition that has roots in
genetic susceptibility, social circumstance
and personal behavior”
No single theory adequately covers every
aspect of drug addiction – elements of
various theories provide insight into drug
addiction
67. Delayed behavioral or emotional development
may be a factor in substance abuse
Personality characteristics associated with drug
abuse:
◦ Low self-esteem
◦ Poor interpersonal skills
◦ Need for immediate gratification
◦ Defiant feelings toward authority
◦ Little tolerance for anxiety, frustration, and depression
◦ Impulsivity
◦ Risk taking
◦ Low regard for personal health
68. A. Impulsivity
B. Lack of
intelligence
C. Need for
immediate
gratification
D. Defiance
Im
pulsivity
Lack
ofintelligence
Need
forim
m
ediate
grati...
Defiance
0% 0%0%0%
69. Reinforcers are stimuli or events that increase the
likelihood of a particular behavior
Primary reinforcers reduce physiological needs or are
inherently pleasurable; examples are food, water, and
sex
Secondary reinforcers act as signals for the increased
probability of obtaining primary reinforcers; example:
money
Drugs can be primary or secondary reinforcers
70. A. Things that
reward us
B. Things that are
correlated with
drug use
C. Things that
make a behavior
more likely Thingsthatreward
us
Thingsthatare
correlate...
Thingsthatm
ake
a
beha...
0% 0%0%
71. Biological theory is a view of addiction
holding that it is based on genetics and
metabolic imbalances
Genetic theory: a person is predisposed to
drug addiction, including addiction to
alcohol, by hereditary influence
Metabolic imbalance: Narcotics help addicts
stabilize the metabolic deficiency caused by
absence of the drug
72. A. The biology of
the individual
B. Genetics
C. Metabolic
imbalances
D. All of the above
Thebiology
ofthe
indivi...
Genetics
M
etabolicim
balancesAlloftheabove
0% 0%0%0%
73.
74. Social theory is the hypothesis that drug use
is determined by cultural and social
influences
Rewards of drug use may be derived from
groups and others with whom we associate
Drug abuse may arise from antisocial
behavior
Social theory does not explain drug addiction
75. A. Attribute drug
use to cultural
and social
influences
B. Explain the
phenomenon of
addiction
C. Discount the
importance of
family influence
Attribute
druguseto
cu...
Explain
the
phenom
enon
..
Discountthe
im
portance
..
0% 0%0%
76. The impact of the media on drug use is hard
to determine
Many forms of
mass media feature
drugs:
◦ Movies
◦ Advertisements
◦ Billboards
◦ Television
◦ Music
◦ Celebrities
Notas do Editor
Deaths
Emergency room visits
Drugs in the workplace and lost productivity
Broken homes, illnesses, shorter lives, etc.
Cost of maintaining habit
Cost of criminal behavior
Cost of treating patients
Fetal alcohol syndrome
Others?
Survey questionnaires
Easy to use– inexpensive, efficient
Drawbacks
Bias in student population (e.g., dropouts not counted)
Potential inaccuracy of self-reports (among both users and non-users)
National Survey on Drug Use and Health
Face-to-face, computer-assisted interviews
68,000 individuals; carefully sampled households across the United States
Broken down into different age groups
Results published annually
Marijuana use among persons ages 12-25, by age group:1971-2006 (National Survey on Drug Use and Health)
In 2008 the percentage use for the age groups of 18-25 and 12-17 remained the same as they were in 2005; 16.5% and 6.7% respectively.
Finding similar patterns in two different studies, using different sampling techniques, is a stronger indication that these trends are real and reflect broad changes in American society over time
II. How Did We Get Here?
A. Have Things Really Changed?
1. Humans have used psychoactive drugs for thousands of years for therapeutic and recreational purposes.
2. Drug use has affected society in many areas: religion, law, government, economics, language, and education.
III. Drugs and Drug Use Today
A. Extent of Drug Use
1. Current information on drug use comes from several sources, including survey questionnaires done in junior highs, high schools, and colleges, but accurate statistics are hard to attain.
2. Self-reports may include a biased sample and be inaccurate or dishonest.
3. The Monitoring the Future Project follows nationwide trends over time in drug use among young people.
B. Trends in Drug Use
1. The perceived risk decreases as drug use increases; as drug use decreases the perceived risk increases.
2. The perceived availability of marijuana has changed little over time and, therefore, does not appear to explain differences in rates of use.
3. The National Survey on Drug Use and Health is a door-to-door survey estimating drug use in adolescents and adults in the United States.
4. Alcohol and cocaine use in 18- to 25-year-olds stays fairly consistent over time.
5. Drug use patterns seen in multiple surveys are most likely to be accurate.
6. Decreases or increases in drug use are not related to changes in government legislation, but are related to social trends.
Have Things Really Changed?
1. Humans have used psychoactive drugs for thousands of years for therapeutic and recreational purposes.
2. Drug use has affected society in many areas: religion, law, government, economics, language, and education.
Survey questionnaires
Easy to use– inexpensive, efficient
Drawbacks
Bias in student population (e.g., dropouts not counted)
Potential inaccuracy of self-reports (among both users and non-users)
National Survey on Drug Use and Health
Face-to-face, computer-assisted interviews
68,000 individuals; carefully sampled households across the United States
Broken down into different age groups
Results published annually
Marijuana use among persons ages 12-25, by age group:1971-2006 (National Survey on Drug Use and Health) https://nsduhweb.rti.org/respweb/homepage.cfm
In 2008 the percentage use for the age groups of 18-25 and 12-17 remained the same as they were in 2005; 16.5% and 6.7% respectively.
Finding similar patterns in two different studies, using different sampling techniques, is a stronger indication that these trends are real and reflect broad changes in American society over time
II. How Did We Get Here?
A. Have Things Really Changed?
1. Humans have used psychoactive drugs for thousands of years for therapeutic and recreational purposes.
2. Drug use has affected society in many areas: religion, law, government, economics, language, and education.
III. Drugs and Drug Use Today
A. Extent of Drug Use
1. Current information on drug use comes from several sources, including survey questionnaires done in junior highs, high schools, and colleges, but accurate statistics are hard to attain.
2. Self-reports may include a biased sample and be inaccurate or dishonest.
3. The Monitoring the Future Project follows nationwide trends over time in drug use among young people.
NSDUH http://www.samhsa.gov/data/sites/default/files/NSDUH-SR200-RecoveryMonth-2014/NSDUH-SR200-RecoveryMonth-2014.htm
An estimated 24.6 million individuals aged 12 or older were current illicit drug users in 2013, including 2.2 million adolescents aged 12 to 17. In 2013, 60.1 million individuals aged 12 or older were past month binge drinkers, including 1.6 million adolescents.
Of the estimated 22.7 million individuals aged 12 or older in 2013 who needed treatment for an illicit drug or alcohol use problem, 2.5 million received treatment at a specialty facility.
In 2013, about 1 in 10 adolescents (10.7 percent) had a major depressive episode (MDE) in the past year. Among adolescents with MDE, 38.1 percent received treatment or counseling for depression in the past year.
In 2013, nearly 1 in 5 adults aged 18 or older (18.5 percent) had a mental illness (i.e., "any mental illness," or AMI) in the past year; 4.2 percent had a serious mental illness (SMI); and 3.9 percent had serious thoughts of suicide in the past year.
In 2013, 1.4 percent of adolescents had co-occurring MDE and substance use disorder (SUD); 3.2 percent of adults had co-occurring AMI and SUD; and 1.0 percent of adults had co-occurring SMI and SUD.
http://www.monitoringthefuture.org/
Monitoring the Future is an ongoing study of the behaviors, attitudes, and values of American secondary school students, college students, and young adults. Each year, a total of approximately 50,000 8th, 10th and 12th grade students are surveyed (12th graders since 1975, and 8th and 10th graders since 1991). In addition, annual follow-up questionnaires are mailed to a sample of each graduating class for a number of years after their initial participation. The Monitoring the Future Study has been funded under a series of investigator-initiated competing research grants from theNational Institute on Drug Abuse, a part of the National Institutes of Health. MTF is conducted at the Survey Research Center in theInstitute for Social Research at theUniversity of Michigan.
EMBARGOED FOR RELEASE AT 12:01 A.M. ET, TUESDAY, DEC. 16, 2014 Note: Video explaining the results is available at http://youtu.be/9lpJO7j3k8U Use of alcohol, cigarettes, and a number of illicit drugs declines among U.S. teens ANN ARBOR—A national survey of students in U.S. middle schools and high schools shows some important improvements in levels of substance use. Both alcohol and cigarette use in 2014 are at their lowest points since the study began in 1975. Use of a number of illicit drugs also show declines this year. These findings come from the University of Michigan's Monitoring the Future study, which tracks trends in substance use among students in 8th, 10th and 12th grades. Each year the national study, now in its 40th year, surveys 40,000 to 50,000 students in about 400 secondary schools throughout the United States. ALCOHOL Alcohol use by the nation's teens continued its long-term decline in 2014. All three grades showed a decline in the proportion of students reporting any alcohol use in the 12 months prior to the survey; the three grades combined dropped from 43 percent to 41 percent, a statistically significant change. "Since the recent peak rate of 61 percent in 1997, there has been a fairly steady downward march in alcohol use among adolescents," said Lloyd Johnston, the study's principal investigator. "The proportion of teens reporting any alcohol use in the prior year has fallen by about a third." Of perhaps greater importance, the proportion of teens who report "binge drinking"—that is, consuming five or more drinks in a row at least once in the two weeks preceding the survey—fell significantly again this year to 12 percent for the three grades combined. This statistic is down from a recent high point of 22 percent in 1997. While this is an important improvement, say the investigators, still roughly one in five (19 percent) 12-graders report binge drinking at least once in the prior two weeks. Some 12th-graders drink even more heavily, reporting having 10 or more, or 15 or more, drinks in a row on at least one occasion in the prior two weeks. Since 2005 (the first year that this "extreme binge drinking" was measured), these measures also have declined, from 11 percent to 7 percent in 2014 for 10 or more drinks, and from 6 percent to 4 percent for 15 or more drinks. 2 Peer disapproval of binge drinking has been rising since 2000 among teens. Declines in availability may be another contributing factor to the drops in teen drinking. In recent years, there has been a fair decline in all three grades in the proportion saying that alcohol is easy for them to get. CIGARETTES Cigarette smoking also reached historical lows among teens in 2014 in all three grades. For the three grades combined, 28 percent reported any smoking in the prior month in 1997, the recent peak year, but that rate was down to 8 percent in 2014. "The importance of this major decline in smoking for the health and longevity of this generation of young people cannot be overstated," Johnston said. As with alcohol, there has been a substantial reduction in the proportion of students who say cigarettes are easy for them to get, and this decline continued into 2014. Increasing disapproval of smoking also has accompanied the decline in use, as well as an increased perception that smoking carries a "great risk" for the user. However, there were only modest further increases in these factors in 2014. ILLICIT DRUGS A number of measures of illicit drug use showed declines in use this year. The greatest decline was in students' use of synthetic marijuana—a particularly dangerous class of abusable substances. Synthetic marijuana (K-2, "Spice"), sold over the counter in many states—particularly in gas stations, convenience stores and head shops—has synthetic chemical components of marijuana sprayed onto shredded plant material that is then smoked. It is manufactured and sold in an unregulated system—often being imported from overseas—and it can be very potent and unpredictable in its effects. Side effects are many and are reported to be as severe as acute psychosis and heart attacks. "Most students still do not recognize synthetic marijuana as a dangerous class of drugs, although the proportion of 12th-graders reporting it as dangerous to use did rise significantly in 2014," Johnston said. "Efforts at the federal and state levels to close down the sale of these substances may be having an effect." The proportion of 12th-graders reporting use of synthetic marijuana in the prior 12 months has fallen by nearly half. It was 11 percent when first included in the survey in 2011 and was down to 6 percent in 2014. "Bath Salts," another class of synthetic drugs sold over-the-counter and of particular concern a few years ago, also have declined in use, with the percentages of students in all three grades now down to less than 1 percent. 3 "Fortunately, students have come to see these synthetic stimulants as more dangerous, which they are, and that appears to have limited their use," Johnston said. Substantial efforts to make them illegal probably have reduced their availability, but the availability of this drug is not measured in the study. Marijuana use, after five years of increasing among teens, actually declined slightly in 2014, with use in the prior 12 months declining from 26 percent to 24 percent for the three grades combined. "The belief that regular marijuana use harms the user, however, continues to fall among youth, so changes in this belief do not seem to explain the change in use this year, as it has done over most of the life of the study," Johnston said. Personal disapproval of use is also down some in 8th and 12th grades. Reported availability, on the other hand, is down significantly since 2013 in the two lower grades (and unchanged in 12th grade), which may help to explain the modest decline in use this year. Current daily or near-daily marijuana use—defined as use on 20 or more occasions in the prior 30 days—also declined some in 2014; nonetheless, it remains quite high. About one in every 17 high school seniors in 2014 (5.8 percent) is a current daily or near-daily marijuana user, which is down from 6.5 percent in 2013. An index of using any illicit drug other than marijuana in the prior 12 months declined by 1.9 percent (not a statistically significant change) to 15.9 percent in 12th grade; but in 8th and 10th grades the prevalence was virtually unchanged and stood at 6.4 percent and 11.2 percent, respectively. Ecstasy (MDMA) use showed a statistically significant decline in 2014. For the three grades combined use in the prior 12 months dropped from 2.8 percent in 2013 to 2.2 percent in 2014. In 2001, the peak year of use, the rate had reached 6 percent. Salvia, another drug used for its hallucinogenic properties, has fallen to quite low levels of use, and it continued to fall significantly in 2014. For example, it was used in the prior 12 months by 5.7 percent of the 12th-graders in 2009 but by less than 2 percent in 2014. Use of hallucinogens other than LSD, which for the most part involves the ingestion of hallucinogenic mushrooms (Psilocybin or "shrooms"), is continuing a longer-term decline. Availability of these drugs has been falling since 2001 and continued to decline in 2014. Any prescription drug misuse includes use of narcotics, sedatives, tranquilizers, and/or amphetamines without medical supervision. It has been of considerable public health concern in recent years, because most of these drugs showed a substantial increase in use in the 1990s, which then continued into the first decade of the 2000s, when many of the illegal drugs already were in decline. 4 Only 12th-graders report on their use of all of these drugs; they show a statistically significant decline between 2013 and 2014, from 16 percent to 14 percent, saying that they used one or more of these prescription drugs in the 12 months prior to the survey. The gradual turnaround began after 2005, when 17 percent indicated misuse of any of these drugs. "It's not as much progress as we might like to see, but at least the number of students using these dangerous prescription drugs is finally declining," Johnston said. Narcotic drugs other than heroin—among the most dangerous of the prescription drugs—have been declining in use by 12th-graders since 2009, when 9 percent indicated using them without medical supervision in the prior 12 months. Their use continued to drop significantly, from 7 percent in 2013 to 6 percent in 2014. Use of these drugs is reported only for 12th grade; students are reporting that these drugs are increasingly difficult to obtain. Use in the prior 12 months of the specific narcotic analgesic OxyContin also declined this year, significantly so in 8th grade. OxyContin use reached a recent peak among adolescents around 2009 and use has declined since then in all three grades. The 2014 reports of use in the past 12 months stand at 1.0 percent, 3.0 percent and 3.3 percent in grades 8, 10 and 12, respectively. Cough and cold medicines constitute a class of drugs available over-the-counter in most drug stores. These medicines usually contain the drug dextromethorphan which, when taken in large quantities, as teens sometimes do to get high, can be dangerous. Abuse of these drugs has been falling among teens since 2006 and declined significantly again in 2014, with annual prevalence declining from 4.0 percent to 3.2 percent for the three grades combined. Use of a number of the other illicit drugs remained essentially unchanged between 2013 and 2014, including some particularly dangerous ones like heroin, crack, methamphetamine and crystal methamphetamine. Other drugs for which use remained unchanged in 2014 include Ritalin and Adderall—both stimulants used in the treatment of ADHD—as well as LSD, inhalants, powder cocaine, tranquilizers, sedatives and anabolic steroids. However, most of these drugs are now well below their recent peak levels of use according to the investigators. "In sum, there is a lot of good news in this year's results, but the problems of teen substance use and abuse are still far from going away," Johnston said. "We see a cyclical pattern in the 40 years of observations made with this study. When things are much improved is when the country is most likely to take its eye off the ball, as happened in the early 1990s, and fail to deter the incoming generation of young people from using drugs, including new drugs that inevitably come along." Tables and figures associated with this release may be accessed at: http://monitoringthefuture.org/data/ data.html # # # # # Monitoring the Future has been funded under a series of competing, investigator-initiated research grants from the National Institute on Drug Abuse, one of the National Institutes of Health. The lead investigators, in addition to Lloyd Johnston, are Patrick O'Malley, Jerald 5 Bachman, John Schulenberg, and most recently Richard Miech—all research professors at the University of Michigan's Institute for Social Research. Surveys of nationally representative samples of American high school seniors were begun in 1975, making the class of 2014 the 40th such class surveyed. Surveys of 8th- and 10th-graders were added to the design in 1991, making the 2014 nationally representative samples the 24th such classes surveyed. The 2014 samples total 41,551 students located in 377 secondary schools. The samples are drawn separately at each grade level to be representative of students in that grade in public and private secondary schools across the coterminous United States. The findings summarized here will be published in January in a forthcoming volume: Johnston, L. D., O'Malley, P. M., Miech, R.A., Bachman, J. G., & Schulenberg, J. E. (2015). Monitoring the Future national results on adolescent drug use: Overview of key findings, 2014. Ann Arbor, Mich.: Institute for Social Research, the University of Michigan. The content presented here is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute on Drug Abuse or the National Institutes of Health. This year's findings on the use of e-cigarettes are presented in a separate companion news release: http://monitoringthefuture.org/press.html
http://www.icpsr.umich.edu/icpsrweb/SAMHDA/series/97
About Emergency Department Data / DAWN
History
The Drug Abuse Warning Network (DAWN) was established in 1972 by the Drug Enforcement Administration (DEA) to track emergency department (ED) visits caused by drug abuse in order to identify the drugs being abused, determine patterns in selected metropolitan areas and changing trends across the country, including the detection of new substances of abuse and new combinations. Initially focusing on metropolitan areas only, the system was later expanded to produce estimates for the U.S. and to capture deaths drug abuse-related deaths investigated by medical examiners/coroners in selected metropolitan areas. DAWN was transferred to the U.S. Department of Health and Human Services (DHHS) in 1980, where it was conducted by the National Institute on Drug Abuse (NIDA) within the National Institutes of Health (NIH). When NIDA assumed responsibility for DAWN, implementation of a sample of hospitals to produce representative estimates for the Nation and for selected metropolitan areas became a priority. In 1992, the Substance Abuse and Mental Health Services Administration (SAMHSA) took responsibility for DAWN and through 2011, the Center for Behavioral Health Statistics and Quality (CBHSQ, formerly the Office of Applied Studies) was responsible for DAWN operations and reporting. DAWN continued to produce estimates of drug abuse-related emergency department visits for the contiguous United States and 21 metropolitan areas through 2002. Because there were population shifts and changes in the hospital industry, DAWN implemented a sample redesign in 2003. Many other features of DAWN (e.g., redefining a DAWN visit to include all drug-related medical emergencies and not merely those involving misuse or abuse; the introduction of estimates that were representative of the Nation; changes in case-finding methodology etc.) were also introduced at that time. The medical examiner/coroner component of DAWN continued to collect data on drug-related deaths through 2010. Although the data were never nationally representative, by its final year in 2011, DAWN collected data from metropolitan areas in 37 States (with complete coverage of 13 States) and covered one-third of the U.S. population.
Methodology
DAWN's target population consists of all non-Federal, short-stay, general medical and surgical hospitals in the United States that have one or more EDs open 24 hours a day. The design consists of a stratified two-stage cluster sample of emergency department (ED) visits within hospitals. At the first stage, a stratified simple random sample without replacement of hospitals meeting the criteria for inclusion in the target population was drawn from the American Hospital Association’s 2001 Annual Survey Database of hospitals meeting the criteria for inclusion in the target population. This sample was supplemented with additional sample units in selected metropolitan areas to allow for separate estimates in those areas. The design initially called for review of all ED visits within the sampled hospitals and abstraction of all visits deemed substance-involved. Sampling at the second (visit) stage was implemented beginning in 2009 for hospitals with the largest numbers of total ED visits in order to meet resource constraints. In order to make population estimates, a set of final weights is applied to the visit observations. These weights are the product of the design weight for each hospital, factors to account for within-hospital monthly nonresponse and hospital-level nonresponse, and a ratio adjustment for observed versus frame total numbers of ED visits. More information may be found at www.samhsa.gov/data/sites/default/files/DAWN2k10/DAWN2k10/DAWN2k10-Methods-Report.htm
Future
The National Center for Health Statistics (NCHS) is currently implementing a redesign of its hospital data collection systems, including its Emergency Department (ED) component. This new endeavor, called the National Hospital Care Survey, combines the National Hospital Ambulatory Medical Care Survey (NHAMCS) and the National Hospital Discharge Survey (NHDS) collected by NCHS as well as DAWN collected by SAMHSA. The advantages include an improved response rate with a large, nationally representative sample of hospital EDs, reduction in cost, expanded information that will be collected (e.g., health insurance coverage information, diagnoses, treatment, and ability to track ED patients who have been admitted into the hospital through the ED). In addition, this new survey will collect robust and comprehensive data on mental health-related ED visits. Under the redesign, SAMHSA will receive data on drug-related visits as well as mental health related visits. Information on clinical history, patient conditions, procedures done, health insurance coverage, and more detailed disposition and provider information will also be available. Currently, NCHS is working to recruit hospitals with publishable data expected in 2016. Under this new data collection effort, SAMHSA will publish drug- and mental health-related visit data as SAMHSA’s Emergency Department Surveillance System or SEDSS.
Current Activities
Between 2011 and 2016, SAMHSA will continue to analyze and report using existing DAWN data. In addition, SAMHSA is investigating other data resources to report drug and mental health-related ED visits until such time when data from the NHCS is available.
http://www.samhsa.gov/data/emergency-department-data-dawn/about
Current laws trace back to two pieces of legislation from the early 1900s
Racist fears about deviant behavior, including drug misuse, played a role in the development of drug regulation
Laws were developed to regulate undesirable behaviors
Fraud in patent medicines that were sold directly to the public
False therapeutic claims
Habit-forming drug content
In the early 1900s, Collier’s magazine ran a series of articles attacking patent medicines—
“Great American Fraud”
Opium and the Chinese
U.S. was involved in international drug trade
Opium smoking brought to U.S. by Chinese workers
Laws passed against the importation, manufacture, and use of opium– racism involved?
Cocaine
Present in many patent medicines (and, yes, Coca-Cola!)
Viewed as a cause of increasing crime
Racist connections
Toxic = poisonous, deadly, or dangerous
What makes a drug toxic?
Amount used
How it is used
What the user did while on the drug
Specific toxicity for users who inject drugs
AIDS, HIV infection, and hepatitis B and C
Sharing needles passes infectious agents directly into the bloodstream
Some states, cities prohibit
needle purchase without Rx
Syringe exchange programs
Examples of acute toxicity
Behavioral: “Intoxication” that impairs the actions of drug users and increases the danger to themselves and others
Physiological: Overdose that causes the user to stop breathing
Examples of chronic toxicity
Behavioral
Personality and lifestyle changes
Effects on relationships with friends and family
Physiological
Heart disease
Lung cancer
Cirrhosis
Other health effects
What do “addicts” look like?
What drug do they take or what behavior do they engage in (alcohol, cigarettes, illicit drugs, food, sex, gambling, shopping, computer time)?
How much time do they spend on their habit?
How much of a drug do they take?
How do you decide on the definition of dependence?
Three basic processes
Tolerance
Physical dependence
Psychological dependence
Diminished effect on the body after repeated use of the same drug
The body develops ways to compensate for the chemical imbalance caused by the drug
Regular drug users may build up tolerance to the extent that their dosage would kill a novice user
Physical dependence is defined by the occurrence of a withdrawal syndrome
Tolerance typically precedes physical dependence
If drug use is stopped suddenly, withdrawal symptoms occur, ranging from mild to severe
Physical dependence means the body has adapted to the drug’s presence
Psychological or behavioral dependence
High frequency of drug use
Craving for the drug
Tendency to relapse after stopping use
Behavior is reinforced by the consequences
Over time, this becomes the biggest reason users report they continue to use
Early medical model = true addiction involves physical dependence; key is treatment of withdrawal symptoms
Positive reinforcement model = drugs can reinforce behavior without physical dependence
Psychological dependence is increasingly viewed as the driving force behind repeated drug use
This refutes the sometimes common belief that drugs that aren’t as strongly physically addicting are less dangerous
Some drugs are more likely than others to lead to dependence
Method of use, as well as other factors, influences risk of dependence
The “war on drugs” reflects the perspective that drugs are themselves evil
Is dependence due to biochemical or physiological actions in the brain?
Still no way to scan the brain and know if a person has/had developed dependence
Genetic physiological or biochemical markers have been sought as well, but none has proven reliable
No way to know if the drug or the drug use changes a person’s personality
Many other factors affect personality
Sensation-seeking = a personality characteristic statistically associated with early substance use and abuse
Alcohol dependence often exists within a dysfunctional family
Evidence suggests that dysfunctional relationships play a role in dependence, but they aren’t the only factor
Founders of AA characterized alcohol dependence as a disease
Others argue that dependence doesn’t have all the characteristics of a disease
There are ways to test and treat the effects of alcoholism but not the disease itself
There is some disagreement over how to define disease as well
Dependence is related to dysfunctions of:
Biology
Personality
Social interactions
Antecedent = a factor that occurs before an event such as the initiation of drug use
Still not labeled “causes”
Examples of antecedents
Aggressiveness
Conduct problems
Poor academic performance
Attachment to a drug-using peer group
Parental and community norms that support drug use
Alcohol and tobacco are sometimes considered gateways to the use of illicit drugs
Kandel & Faust’s 1975 study
Gateway substances are perhaps best thought of as early indicators of a basic pattern of deviant behavior resulting from a variety of risk factors
Correlate = a variable that is statistically related to another variable, such as drug use
IMPORTANT: Correlates are not causes
Socioeconomic status does not correlate well with drug use
Personality problems are poor predictors of drug use
IV. Correlates of Drug Use
A. What Factors Are Considered?
1. Surveyors look for common characteristics in those who use drugs, as compared with those who do not use drugs.
2. Study limitations can make it difficult to determine the effects of some factors.
B. Risk and Protective Factors
1. Risk factors are correlated with higher rates of drug use.
2. Risk factors for drug use include having friends who use drugs, engaging in fighting or stealing, perceiving that substance use is prevalent at school, knowing adults who use drugs, and having a positive attitude towards drugs.
3. The kids most likely to use marijuana frequently live in a rough neighborhood, have little parental monitoring, steal and get into fights, may not be involved in religious activities, and do poorly in school.
4. Protective factors are correlated with lower rates of drug use.
5. Protective factors for drug use include perceiving strong sanctions against drug use at school, having supportive parents, being committed to school, being involved in religious activities, and participating in two or more extracurricular activities.
6. Overall, studies of risk and protective factors suggest that adolescents who are more likely to smoke cigarettes, drink heavily, and smoke marijuana are also more likely to engage in other deviant behaviors, such as stealing, fighting, and early sexual behaviors.
C. Gender
1. Males are more likely to use alcohol, use tobacco, smoke marijuana, and use cocaine than are females.
D. Race
1. Stereotypes regarding drug use by different races may not be supported by findings from the National Survey on Drug Use and Health.
E. Level of Education
1. Those with more education (college degrees, compared with those who completed high school only) are much more likely to drink alcohol and somewhat less likely to use tobacco, marijuana, or cocaine.
F. Personality Variables
1. Evidence for correlations between traditional personality traits and drug use is somewhat weak and inconsistent.
2. Several studies focus on “impulsivity” as correlating with rates of substance use.
3. Personality factors may play a small role in whether someone decides to try alcohol or marijuana, but they may play a large role in whether drug use develops into a serious problem.
G. Genetics
1. Genetic studies are beginning to show clear association with substance-use disorders.
Having low-birthweight babies is a side effect of drug use by pregnant women.
How is drug use related to crime?
Intoxication causes behavior and personality change
Crimes may be committed while intoxicated
Drug use/possession is a crime
Crimes to fund cost of drug use
Society tries to protect itself through regulation
Current laws may not be part of a logical plan, ineffective or unrealistic
Drug use may change a person’s personality
People under the influence may commit crimes (e.g., many cases of homicide, domestic violence, etc.)
Crimes may be carried out to obtain money for drugs
Drug use is a crime
We want to protect society from the dangers of some types of drug use = legitimate social purpose
Some laws are not developed as part of a rationally devised plan and may not be realistic or effective
Current laws
These “Pot-Tarts,” seized by law enforcement in 2006, demonstrate the ingenuity of some illicit drug distributors. Upon raiding this facility, investigators found hundreds of marijuana-laced candies and soft drinks, including “Stoney Ranchers,” “Munchy Way,” “Rasta Reece’s,” and “Buddafingers.”
The benefit to farmers makes it hard to combat illegal drug production.
Figure 2.1 U.S. National Drug Control Budget—FY 2012 Funding Highlights
The federal government has steadily increased funding to interdict drugs.
Figure 2.4 Poll Responses to the Question: “Which of the Following Do You Feel Is the Single Best Way to Handle the War on Drugs?” (n = 4,730)
Motives for Drug Use
1. Personal and social variables such as identifying with a deviant subculture increase the likelihood of drug use.
2. Rebellious behavior can serve as a way to demand attention or to make a particular impression.
3. Drug use may be reinforced by the effects of the drug.
4. Drug users are often seeking an altered state of consciousness.
5. Societal, community, and family factors play an important role in determining whether a person tries a drug, but the individual’s experiences with a drug become more important with increasing use.
We all do things that we know, logically, we should not do
Eating too much
Driving too fast
Drinking too much
Identification with a deviant subculture is a key factor
Fads and cultural trends influence what drugs are used
Characteristics of drugs can reinforce their use
Altered states of consciousness
Societal, community, and family factors play an important role in whether an individual tries a drug
Drug factors play an important role in whether an individual continues to use a drug
Motives for Drug Use
1. Personal and social variables such as identifying with a deviant subculture increase the likelihood of drug use.
2. Rebellious behavior can serve as a way to demand attention or to make a particular impression.
3. Drug use may be reinforced by the effects of the drug.
4. Drug users are often seeking an altered state of consciousness.
5. Societal, community, and family factors play an important role in determining whether a person tries a drug, but the individual’s experiences with a drug become more important with increasing use.
Risk and Protective Factors
1. Risk factors are correlated with higher rates of drug use.
2. Risk factors for drug use include having friends who use drugs, engaging in fighting or stealing, perceiving that substance use is prevalent at school, knowing adults who use drugs, and having a positive attitude towards drugs.
3. The kids most likely to use marijuana frequently live in a rough neighborhood, have little parental monitoring, steal and get into fights, may not be involved in religious activities, and do poorly in school.
4. Protective factors are correlated with lower rates of drug use.
5. Protective factors for drug use include perceiving strong sanctions against drug use at school, having supportive parents, being committed to school, being involved in religious activities, and participating in two or more extracurricular activities.
6. Overall, studies of risk and protective factors suggest that adolescents who are more likely to smoke cigarettes, drink heavily, and smoke marijuana are also more likely to engage in other deviant behaviors, such as stealing, fighting, and early sexual behaviors.
What do “addicts” look like?
What drug do they take or what behavior do they engage in (alcohol, cigarettes, illicit drugs, food, sex, gambling, shopping, computer time)?
How much time do they spend on their habit?
How much of a drug do they take?
How do you decide on the definition of dependence?
Three basic processes
Tolerance
Physical dependence
Psychological dependence
Diminished effect on the body after repeated use of the same drug
The body develops ways to compensate for the chemical imbalance caused by the drug
Regular drug users may build up tolerance to the extent that their dosage would kill a novice user
Physical dependence is defined by the occurrence of a withdrawal syndrome
Tolerance typically precedes physical dependence
If drug use is stopped suddenly, withdrawal symptoms occur, ranging from mild to severe
Physical dependence means the body has adapted to the drug’s presence
Psychological or behavioral dependence
High frequency of drug use
Craving for the drug
Tendency to relapse after stopping use
Behavior is reinforced by the consequences
Over time, this becomes the biggest reason users report they continue to use
Early medical model = true addiction involves physical dependence; key is treatment of withdrawal symptoms
Positive reinforcement model = drugs can reinforce behavior without physical dependence
Psychological dependence is increasingly viewed as the driving force behind repeated drug use
This refutes the sometimes common belief that drugs that aren’t as strongly physically addicting are less dangerous
Some drugs are more likely than others to lead to dependence
Method of use, as well as other factors, influences risk of dependence
The “war on drugs” reflects the perspective that drugs are themselves evil
Is dependence due to biochemical or physiological actions in the brain?
Still no way to scan the brain and know if a person has/had developed dependence
Genetic physiological or biochemical markers have been sought as well, but none has proven reliable
No way to know if the drug or the drug use changes a person’s personality
Many other factors affect personality
Sensation-seeking = a personality characteristic statistically associated with early substance use and abuse
Alcohol dependence often exists within a dysfunctional family
Evidence suggests that dysfunctional relationships play a role in dependence, but they aren’t the only factor
Founders of AA characterized alcohol dependence as a disease
Others argue that dependence doesn’t have all the characteristics of a disease
There are ways to test and treat the effects of alcoholism but not the disease itself
There is some disagreement over how to define disease as well
Dependence is related to dysfunctions of:
Biology
Personality
Social interactions
Figure 3.4 A Medical College of Virginia study involving 949 female twin pairs found genetic factors to be more influential than environmental factors in smoking initiation and nicotine dependence. Likewise, a St. Louis
University study of 3,356 male twin pairs found genetic factors to be more influential for dependence on nicotine and alcohol.
An estimated $25 billion is spent on advertising tobacco, alcohol, and prescription drugs
One study of alcohol marketing worldwide showed that young people are influenced by marketing
Advertisements for cigarettes play on many themes, particularly independence
After cigarette ads were prohibited from television in 1971, the void was filled with advertisements for smokeless tobacco