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Addiction Week 1 Summary

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Summary of the literature for Week 1 - course Addiction

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  • 8 september 2021
  • 74
  • 2021/2022
  • Samenvatting
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galinajimberry
Week 1: Introduction & Vulnerability: Environment and
Genetics


Historical and Cultural Perspectives on
Substance Use and Substance Use Disorders

PSYCHOACTIVE SUBSTANCE USE – HISTORY, PATTERNS, AND CULTURAL
VARIATION

Patterns of Substance Use

People engage in a variety of patterns of psychoactive substance use – which vary according
to:

(1) The type of substance
(2) The route of drug administration
(3) The frequency and quantity of use

Substance use is distinct from (1) problem use and (2) substance use disorders (SUDs)

- An understanding of patterns of substance use – provides a foundation for
understanding the compulsive and pathological substance use behaviors – that
characterize many of those with SUDs

Drug Classifications

Variety of natural – and synthetic – substances are psychoactive – in that they:

(1) Produce subjective feelings of intoxication – and/or reward
(2) Are self-administered
(3) Produce cognitive and behavioral changes in the user

No two drugs are identical – but many exert similar (1) physiological and (2) psychological
actions

There is no single – or ‘correct’ – classification system for psychoactive drugs – they can be
grouped based on:

(1) Their molecular structure

, (2) Clinical use
(3) Subjective effects
(4) Actions on neurotransmission
(5) Effects on the autonomic NS
(6) Effects on the CNS

Four General Classes of Drugs

Described are four very general classes of drugs – subject to abuse potential – including

- (1) narcotics, (2) general depressants, (3) stimulants, and (4) hallucinogens

The DSM-IV describes eleven drug classes in addition to an “other” category – including
alcohol, caffeine, amphetamines, cocaine, inhalants, nicotine, opiates, etc.

- This “other” category is important – because the number and types sof drugs is
NOT static

The Psychoactive Effects of Drugs

Drugs exert their psychoactive effects primarily in the central nervous system (CNS)

- But there are many different routes of administration – by which they are ingested

Routes of Administration

Some substances are primarily ingested via one particular route of administration – e.g.,
drinking alcohol

Many other substances – have multiple common routes of administration

(1) These can correspond with levels of substance involvement
- E.g., heroin can be snorted or injected – the latter route being associated with
greater potential for – and severity of – addiction

Different routes of administration – may involve different chemical preparations of a
substance

- E.g., smoking cocaine vs smoking crack

Routes vary with regard to – the speed of drug absorption into the brain

, - Which appears to be associated degree of (1) subjective high and (2) potential for
addiction

The fastest absorption – into brain tissues – occurs via the lungs

- Whereas absorption is relatively slow – for substances that are absorbed into the
bloodstream from the stomach and small intestine

Route of drug administration – may have social meaning

Example:

- Many of those who snort cocaine – have negative opinions on smoking crack
- Upper-class opium smokers’ use not considered a large social problem – but
lower-class opium smokers were

Substance Users

Substance users – differ in terms of the topography of use – which includes the dimensions of
(1) frequency and (2) quantity

Frequency of Use

The frequency of use of a substance – can range from one lifetime use – to use that occurs
daily or multiple times a day

- The frequency level – that is considered problematic by professionals – and the
public – varies according to (1) culture and (2) the substance in question

In Western societies – the daily use of small to moderate amounts of alcohol is NOT seen as
problematic

- Whereas many in these same cultures – would see monthly cocaine – or any
heroin – use as problematic and dangerous

Quantity of Use

The quantity – refers to the amount of a substance that is used during a (1) use episode or (2)
during a day in which use occurred

Quantity can be more easily measured for some drugs than for others:

, (1) Alcohol consumption – can be assessed using a measurable unit called a “standard
drink”
- The definition of this unit – varies by country and across research study
- The definition of this unit – requires knowledge of the alcohol content of various
beverages
(2) Psychoactive prescription drugs – are produced under laboratory standards of purity
and strength
- Quantity can be accurately measured
(3) Cocaine and marijuana – vary widely in their concentration and purity
- Making the number of puffs, joints, lines, etc. – a much cruder measure of actual
drug quantity

The quantity levels – at which substance use is considered problematic:

- Varies by culture
- Depends on the perceived risk of harm – of the drug in question

Overall

Reports of frequency and quantity – are often combined – to provide overall estimates of
substance use

- Such as the number of standard drinks – consumed in a week or a month

Patterns of use – are vary important above and beyond overall “Q/F” estimates

- E.g., consuming one drink per day has very different consequences than
consuming seven drinks once per week

Simultaneous Polydrug Use (SPU)

Many persons use two – or more – psychoactive substances in combination – i.e., at the same
time or in temporal proximity

- A phenomenon known as simultaneous polydrug use (SPU)

Some drug combinations – are known to produce novel psychoactive metabolites – that may
produce different effects than their precursor drugs

Example: The production of the metabolite cocaethylene – from combined alcohol and
cocaine use

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