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Drugs and The Brain – Understanding Addiction

  • Drugs come from plants either as by-products of them or developed chemically.
  • In the US, $150 billion is spent on legal pharmaceutical drugs.
  • All pharmaceutical drugs have at least three names.
    • chemical name of a drug is the organic chemistry chemical description of the molecule.  Most will never know or understand this name of a drug they are taking.
    • generic name of a drug is the official name of the drug.  It is still a detailed chemical name but much simpler.
    • brand name is for a specific formulation and manufacturer.
  • The big difference between the generic name and the brand name is that a generic name is public domain while a brand name is trademarked by the company that developed the drug.  The developing company gets to name the drug but it must be FDA approved.
  • One drug can be a painkiller, a controlled substance, a schedule II substance or just morphine.
  • Categories of psychoactive drugs are:
    • stimulants
    • hallucinogens
    • marijuana
    • depressants
    • opioids
    • psychotherapeutics
    • nicotine.
  • All drugs have defining characteristics.
  • The Physician’s Desk Reference has color photographs of most legally manufactured drugs; it also includes information like dose and potency.
  • The placebo effect is usually thought of in terms of a sugar or fake pill.
  • Many drugs effects are influenced by the users experiences, mood, how tired they are, in addition to other substances in the system, such as food to other drugs.
  • Dose-response refers to the correlation between the response and the quantity of drug administered.
    • The response may vary due to factors such as tolerance.
    • With a dose-response curve we hope to be able to answer a verity of questions; from what is an effective dose or a lethal dose.
  • Toxicity, in early animal studies, is measured in how many animals die as a result of taking the drug.  After more studies, the therapeutic index is set as LD50 / ED50.
  • The margin of safety is the difference between doses necessary for an intended effect and toxic unintended effects.
  • Potency refers to the amount of drug necessary to cause an effect, while toxicity is the capacity of a drug to upset or destroy normal body functions.
  • The forms and methods of taking drugs greatly effect how the drugs will interact with the users system.
    • Oral ingestion is the simplest way the drugs enter the body, but also the most complicated way to enter the bloodstream. Oral ingestion must make it through the acid in the stomach while avoiding neutralization by food and drink.  When the drug gets past the stomach it still has to go through the liver, as well as other organs.
    • Inhalation is when the drug is smoked or “huffed”.  Nicotine, marijuana, crack are most effective when delivered this way.   It is also rapidly absorbed due to all the capillaries in the lungs consequently moving quickly into the blood.  This is the fastest way to get psychoactive drugs into the system.
    • Injection put the drug into the system as well.
      • Intravenous injection puts the drugs right in the vein, so the onset of the effect of the drug is fast.  You can so put a high concentration of drugs in because it does not have to pass through a membrane.
      • Intramuscular injection puts the drug into the muscle and subcutaneous goes just under the skin.
    • Topical application is not used as often because many drugs are not absorbed effectively through the skin.
  • After drug administration, the body eliminates the drug through metabolism and excretion.
  • The drug will either leave the system or be changed so much that it will no longer have an effect on the body.
  • Prodrugs have been developed to start working only after they have been altered by the body.
  • The body has adaptive processes such as tolerance and dependence to protect against potential harm.
  • With drug disposition tolerance the more the drug is used the faster the metabolism or excretion.
  • Behavioral tolerance (conditioned tolerance) is when the behavior of the user changes even if the bio-chemical reaction in the body does not. There is strong evidence that tolerance effects are maximized when the drug-taking behavior occurs consistently in the same surroundings or under the same circumstances.

Today’s Society &

Drug USe

  • Drug use is taking an aspirin for a headache, or a single dose of cough syrup for a cough or a hit of acid.
  • How the drug is taken has an effect on how the body reacts.
  • How much and how often are points that make the difference between normal use and abuse.
  • Four principles of psychoactive drugs:
  1. Drugs are not bad or good; they are not evil, they are a substance. By itself a drug cannot do anything until it enters a body. Some drugs help the body function when taken correctly but can cause harm when misused or abused.
  2. Every drug has multiple effects. No part of the body works independently from the rest; all systems are connected. When a drug is taken it affects all parts of the body it passes through.
  3. Both size and the quality of the drug affect the effects of the drug. The better the quality, or the larger the dose the larger the response or the more severe the response.
  4. The effects of a drug depend on the person. Not only personality, but age, race, weight… all  of them influence how the body takes in and responds to the drug.
  • History tells us that humans have used, misused and abused some plants or substances for as long as humans have been around.
  • Four pharmacological revolutions
  1. 19th century – vaccines. This is the first time drugs were used to help stop the number one killers at the time: communicable diseases. For the first time there were drugs that were powerful and have selective beneficial effects. This helped people have faith in medicine stopping illness.
  2. WWII – antibiotics. Not only did they help cure diseases but also helped prevent infection. This got us to the point that we are now; we expect to take something to fix everything.
  3. 1950’s – anti-psychotic drugs. This was the first time that drugs were used to treat psychotic disorders. This changed the way people saw and treated mental illness. We have new drugs that effect how we think, our emotions, and perceptions.
  4. Oral contraception – now we have control of our body through chemicals. Some drugs are not meant to treat anything but to control and change the way the body was meant to work.

  • Then there were many social changes in the US: The Beatles, civil rights, Vietnam, LSD, etc. Drugs became more common and accepted.
  • In 1971 Nixon declared the first “War on drugs”; yet during this time the legal drinking age was lowered and penalties for having marijuana were eased.
  • In the 80’s tolerance lessened. The legal drinking age was raised to 21 again and penalties were stiffened on all drugs, including marijuana.
  • Perception of the risk – when the perception of the risk is low the use is high and vice versa. This differs from perception of availability.
  • Longitudinal studies are one way we have looked for antecedents of drug use.
  • Evidence tells us not to do things but we do them anyways; from eating too much, driving too fast,drinking too much, texting while driving, and driving while intoxicated
  • Cultural trends influence what drugs are being used.

Alcohol – Understanding Addiction

  • Mead, made from honey dates back to about 8000 BC.  Beer and wine followed close behind.
  • Fermentation is the basis to all alcohol.  Depending on what fruits, grains and yeast is used gives you different types of alcohol fewer than 15 percent concentration; above 15% distillation in needed.
  •  In the US large scale distillation started at the end of the 18th century.
  •  It was more profitable to ship a barrel of whiskey than it was to ship 100 bails of corn.
  • The percent of alcohol content is indicated by proof in the United States.  The percent alcohol is half the proof = 90 proof whiskey is 45 percent alcohol.
  • Beer is about 4 percent alcohol.  It is made by adding barley malt to other grains.  Then hops are added with the yeast.  From there, different techniques give the variety of tastes of beer.
  • In the US Anheuser-Busch , Coors, and Miller make up a majority of beer sales.  Imported and independent (microbreweries) beers are growing in popularity.
  • Wine is one of the oldest alcoholic beverages that is still drunk today.
  • There are two main types of American wine, generics and Varietals.  Generic is made to taste like a region in Europe.  Varietal is made from a specific type of grape.  There are more Varietal wines and they are normally more expensive the Generic wine.
  • Other wines add sugar, brandy or are fortified making sherry, port, Madeira or Muscatel.
  • Distilled spirits were first known to Europeans as fermented malted barley.   Whiskey made in the US began to grow in popularly in 1789.  Today many commercial distilleries produce 95 percent pure alcohol.  The proof influences the taste and other properties of liquor.
  • In the 1700’s most Americans drank more alcoholic beverages than water because water was not always clean.
  •  Alcoholic drinks were seen as good while drunkenness was seen as bad. The problem was the “weak” person not the alcohol.
  • Things soon changed and alcohol became “evil” and demonized.  In 1784 Dr. Benjamin Rush documented the problems of heavy drinking such as jaundice, delirium, and seizures.
  • Today these are all proven disadvantages of long term heavy drinking.  Dr. Rush was the first to call theaddiction to alcohol a disease.  Other doctors saw the same symptoms in others, which led to thetemperance movement.
  •  In the temperance movement, people were to use beer and wine in moderation and no distilled spirits at all.  Soon beer became a problem as well and the temperance movement started to include abstaining from all alcohol beverages, including beer and wine.
  • In 1851 Maine became the first state to have a prohibition law.  13 states fallowed but by 1868 9 states had rescind them.  After that many states and counties became “wet” or “dry”.
  • Then on January 16th, 1920, one year after the 36th state ratified the law, the 18th Amendment was national law.  This made the sale, manufacture and transport of intoxicating liquors illegal.
  • As a result organized crime became profitable and speakeasies and bathtub gin became common words.
  • Another effect was that alcohol consumption went down and deaths from alcohol went down.
  • On February 20th, 1933 the 18th Amendment was repealed by the 21st Amendment.  One of the main reasons was tax revenue the government was missing and the beginning of the great depression.
  •  By the end of the “noble experiment” alcohol dependence and alcohol-related deaths were lower then before Prohibition.
  • Some state and local governments remained completely dry or allowed just the sell of beer and wine.  This is still true today.
  • The age at which someone can drink was 18 or 21, depending on the state, until 1988 when all states had to have a minimum age of 21 or lose federal transportation money.
  • Today the federal government gets 1% or $8.5 billion of all taxes collected from alcohol tax.  Then the states tax collect $4 billion each year in taxes from alcohol.   With all of these taxes added up, more than half the cost of the average bottle comes from taxes.
  • Ethnic and social factors lead to differences in patterns of use.  The Irish are associated with drinking hard liquor while the French are associated with wine.  Russian and Irish are associated with heavy drinking and drinking problems from hard liquor while Germany is associated with beer.  In reality the Czechs are the world’s leaders in beer and the French have the highest rate of alcohol dependence, suicide and death from cirrhosis of the liver.
  • About one-third of adults in the United States said they abstain from alcohol.
  • Half the alcohol that is consumed in the US is done by 10% of the drinkers.  Aspects that effect if and how much someone drinks is race, gender, religion, urban vs rural, and education level.
  • College students are still associated with heavy drinking.  They are more likely to binge drink than drink every day.
  • Many schools have banned alcohol at school related activities and have stiffer penalties for groups that break school rules.  This has not changed how many college aged drinkers drink.
  • The absorption of alcohol in the body is not only dependent on the type of alcohol but the gender, their weight, what they ate and how often they work out among other things.
  • When alcohol is taken in, it is distributed throughout the body in the blood in addition to other body fluids.
  •  Until the alcohol is metabolized it remains in the body.  Only about 2% escapes the body in its original form.
  • The enzyme alcohol dehydrogenase converts alcohol to acetaldehyde and that gets converted to acetic acid.  Until that happens nothing will “sober”  a person up; not coffee, exercise, a pill or a sports drink.
  • Some people have a higher amount of the enzyme than others. Heavy drinkers will start to have higher levels of this enzyme because the liver will adjust.
  • Until the 19th century alcohol was used as an anesthetic because of it’s affect on the CNS.
  • It had many disadvantages in comparison to nitrous oxide and ether so it was not used once there was an alternative.
  •  Alcohol enhances the inhibitory effects of GABA as well as effects on other neurons in the brain.  Even at low levels there are adverse effects on behavior; euphoria sets in, there is a reduction in anxieties, inhibitions go away and simple behaviors become hard.
  • While a heavy drinker’s blood-alcohol-concentration (BAC) will continue to go up, the behavioral effects will not be provoked as fast as in a novice drinker.
  •  In the early 1980’s attention was given to driving while drunk.  Dose has a large effect on the ability to drive safely.  With a  BAC of .08 a driver is three times more likely to be involved in a crash than those who have not had anything to drink.  If the driver has little experience with driving in the first place, it is up to five times than a sober adult with training.  The risk goes up from there, if the BAC goes up.  Drinking and driving is still a problem today.
  • No other psychoactive drug has been linked to sexual behavior as alcohol has. Shakespeare knew how alcohol affects sex drive and sexual performances.  Today alcohol is linked to risky sexual behavior.  This is an example of how alcohol affects the brain and decreases inhibitions.  Many times we are willing to have unprotected sex while we are under the influence of alcohol, something that we would not normally do; and even just have sex with someone we would not normally do it.
  • Alcohol is also associated with many sexual assaults.  Alcohol impairs information processing so that the user concentrates on the action and not the outcome.
  • Blackout can affect the user of alcohol as well.
  • There is a correlation between alcohol and homicides. About 50% of all the murders are accounted with alcohol.
  •  Even suicide is associated with drinking; with 1/3 of all suicides involving alcohol.
  • Dilation of the peripheral blood vessel make a user of alcohol feels warm when in reality their body temperature is going down.
  •  Fluid balance becomes a problem as the brain decreases the output of antidiuretic hormone ADH.  The diuretic effect is what makes a user increase in urine flow and can lower blood pressure in others.
  • Hormonal balance becomes a problem because with each dose of alcohol the adrenal corticosteroid are released and testosterone is suppressed.
  • Behavior toxicity comes from the belief that you can do something on alcohol when in reality you cannot, such as operating heavy equipment, swimming, or driving.
  • Acute toxicity can come from drinking too much in one sitting.
  • There is not a cure for the “hangover”.  Other counties call it different things but a hangover is the effect on the body after high or very fast intake of alcohol.  Rest and time is what it will take to feel better.
  • You can treat some of the symptoms of a hangover but the only cure is not to over indulge in any alcohol.
  • Chronic toxicity comes from repeated damage to organs that are directly or indirectly affected by the intake of alcohol.   From the brain (Wernicke-Korsakoff syndrome) the heart (heart disease) and the liver (cirrhosis) many areas of the body are effected by heavy drinking.  Cancer and immune deficiency are related to many parts of the body affected by alcohol as well as the increased likelihood of getting other diseases.
  • When a pregnant woman drinks, she not only puts herself at risk but the baby as well.  Fetal alcohol syndrome and fetal alcohol effect impair the baby before and after birth.
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