THE MOST IMPORTANT TOXIC COMPOUNDS IN TOBACCO SMOKE
-Carbon Monoxide -Tar -Nicotine
-An odorless, colorless, tasteless toxic gas -Attaches itself to hemoglobin, preventing oxygen from being carried from the lungs to the rest of the body -Carbon monoxide in tobacco smoke produces a subtle but effective asphyxiation of the body.
-Quantity varies from 12 -16 mg per cigarette with 50% of tar contained in last third of cigarette -A sticky substance, adhering to cells in the lungs and airways leading to them -Alters the composition of cilia that normally sweep unwanted particles -Permits carcinogenic compounds to settle on pulmonary tissue
-A toxic, dependence-producing psychoactive drug, found exclusively in tobacco -Easily passes through the blood brain barrier and placental barrier in pregnant women in a few seconds -Stimulates CNS receptors sensitive to acetylcholine (called nicotinic receptors because they are sensitive to nicotine) -Releases adrenaline -Inhibits activity in the gastrointestional tract
-ingestion produces both tolerance effects and physical withdrawal symptoms. -withdrawal is the strong craving to return to tobacco use. Smokers typically adjust their smoking behavior to obtain a stable dose
Health Consequences of tobacco use
-An estimated 438,000 deaths in the United States each year are attributed to smoking related illnesses. -Smoking is responsible for approximately 30 percent of all cardiovascular diseases and CHD deaths -Cardiovascular disease – Arteriosclerosis, -Atherosclerosis, Coronary heart disease and stroke -Respiratory diseases (COPD) - Chronic bronchitis and Emphysema. 80-90 percent of all cases of COPD are due to cigarette smoking
Person’s life is shortened by XX minutes every time a cigarette is smoked
Cancer types caused by smoking
-Lung Cancer -Smoking also raises the risk of cancer of the larynx, mouth, lip, bladder, pancreas, kidney, and (in women) uterus.
SPECIAL HEALTH CONCERNS FOR WOMEN
-Dying from stroke due to brain hemorrhage -Dying from a heart attack -Additionally, there is a higher risk of low birth weight and physical defects in a newborn due to the mother’s smoking during pregnancy - Increase in risk is greater when women are also using birth-control pills.
Nonsmoking wives of husbands who smoke have a XX percent increased risk of lung cancer compared to women whose husbands do not smoke.
In an average room, ______ of the nicotine originating from cigarettes being smoked ends up in the atmosphere.
three fourths (75%)
FORMS OF SMOKELESS TOBACCO
Chewing tobacco: *Loose-leaf *Fine-cut *Plug *Twist Snuff
Regular use of smokeless tobacco can ___
increases risk of gum disease, loss of teeth, and oral cancer.
Signs of smokeless tobacco use
-Lumps in jaw or neck -Color changes inside lips -White patches in mouth -Leukoplakia on neck or lips -Red spots or sores (erythroplakia) on lips or gums -Repeated bleeding in the mouth -Difficulty in speaking or swallowing
About XX percent of smokers eventually succeed in quitting on a permanent basis.
Options available to smokers who want to quit:
-Social support groups (Smokers Anonymous and similar programs) -Counseling -Hypnosis -Acupuncture -Prescription medications
FIVE A’S: THE ROLE OF THE PHYSICIAN IN SMOKING CESSATION
-Ask about tobacco use -Advise to quit -Assess willingness to make a cessation attempt -Assist in cessation attempt -Arrange follow-up
FAMILIES OF XANTHINES
-Caffeine --- found in coffee, tea, and chocolate -Theobromine --- found in chocolate; about 1/10 as strong as caffeine and theophylline. -Theophylline --- small amounts found in tea; used as anti-asthma medication.
Xanthine levels of coffee
29-176 mg of caffeine (average 100 mg) per 5 ounce serving
Xanthine levels of tea
approximately 60 mg of caffeine, smaller amount of theophylline per 5 ounce serving
Xanthine levels of chocolate
approximately 6 mg of caffeine and 44 mg of theobromine per 1 ounce serving
Xanthine levels of softdrinks
approximately 34-55 mg of caffeine per 12 ounce serving
Xanthine levels of energy drinks
72-294 mg of caffeine per 12 ounce serving
Caffeine effects on the body
-Oral ingestion of caffeine is absorbed in about 30-60 minutes; CNS effects peak in about 2 hours. -Smokers eliminate caffeine 100% faster than nonsmokers. -Caffeine inhibits the effect of the inhibitory neurotransmitter adenosine. -Peripheral blood vessels are dilated, cerebral blood vessels in the head are constricted. -Caffeine dilates bronchial passageways. Theophylline has a stronger effect in this regard. Used in some anti-asthma meds.
Psychological effects of caffeine
Less drowsiness and fatigue More rapid and clearer flow of thought Improved auditory vigilance Improved visual reaction time Improved mood and reduced tension Increased capacity for muscular work Increased capacity for sustained intellectual effort Disrupted arithmetic skills Disrupted delicate muscular coordination and timing
Health issues associated with caffeine
-Cardiovascular effects -Osteoporosis and bone fractures -Breast disease -Effects during pregnancy and breastfeeding -Panic attacks
Cardiovascular and behavioral effects of caffeine show pronounced _______.
headache, impaired concentration, muscle aches, and irritability
Caffeine withdrawal effects
Toxic levels of caffeine (approximately 1,000 mg of caffeine equivalent to about 10 cups of caffeinated coffee) result in extreme nervousness and agitation, a condition called ____.
caffeinism (acute caffeine intoxication)
Lethal Dose of caffeine
5 to 10 times the level for acute caffeine intoxication
DRUGS THAT CALM US DOWN AND PRODUCE SLEEP
DRUGS THAT RELIEVE STRESS AND ANXIETY WITHOUT SEDATION
CATEGORIES OF BARBITURATES
Long-acting, Intermediate-acting, Short-acting, Ultra-short acting
Barbiturates that take effect in about one hour
Long-acting (phenobarbital, mephabarbital)
Barbiturates that take effect in about 30 minutes
Intermediate-acting (butalbarbital, amobarbital)
Barbiturates that take effect in about 15 minutes
Short-acting (pentobarbital, secobarbital)
Barbiturates that are usually used in surgical sedation – effects in 5-10 minutes
Ultra-short acting (pentothal)
Strong physical dependence Today seldom used for insomnia Produce upsetting nightmares and grogginess when withdrawn Used for epilepsy treatment Strong possibility of abuse Risk of lethal overdose - taking too much or in combination with alcohol.
CONTINUUM OF AROUSAL AS INDUCED BY CNS DEPRESSANTS
Normal>Relief from anxiety>Disinhibition>Sedation>Sleep>General anesthesia>Coma>Death
SIX TYPES OF ANXIETY DISORDERS
-Panic disorder -Obsessive-compulsive disorder -Post-traumatic stress disorder -Social anxiety disorder -Specific phobias -Generalized anxiety disorder
involves feelings of terror that strike suddenly and repeatedly with no warning
involves persistent and unwelcome thoughts or an urgent need to engage in a specific ritualistic behavior
involves frightening thoughts and memories of a previously experienced terrifying event
Post-traumatic stress disorder
involves an excessive level of anxiety and self-consciousness in everyday social situations
Social anxiety disorder
involves an intense fear of something that poses little or no actual danger.
involves excessive anxiety, worry, or tension, when little or nothing is occurring to provoke it.
Generalized anxiety disorder
Benzodiazepines produce their effects by binding to receptors in the brain that are sensitive to the ___
inhibitory neurotransmitter gamma aminobutyric acid (GABA).
-Relaxation and stress reduction -Relatively safe, unless combined with alcohol -Respiratory centers in the brain not affected -No reduction in the overall level of functioning in the body
ACUTE EFFECTS OF BENZODIAZEPINES
-can accumulate in the blood and cause confusion and loss of memory -Show tolerance effects with respect to sedative action but not with respect to their anxiety-producing action -Withdrawal symptoms are present but less severe than barbiturates -Show cross-tolerance and cross-dependence with alcohol and barbiturates
Chronic effects of Benzodiazepines
CLASSES OF BENZODIAZEPINES
-Long-acting drugs -Intermediate-acting drugs -Short-acting
Valium, Librium, Dalmane, Tranxene
Ativan, Klonopin, Restoril, ProSom
Versed, Halcion, Xanax
-ability to bind to a specific subtype of GABA receptors -Strong but transient effects -half-life of 2 hours -More useful as sedative than antianxiety -Good for trouble falling asleep
Zolpidem (Ambien) *Non-benzodiazepines
-Half-life of 6 hours -Helps people fall asleep and stay asleep
Eszopiclone (Lunesta) *Non-benzodiazepines
-Relieves anxiety without sedation -Long latency action -No tolerance, cross-tolerance, cross-dependence effects, or physical withdrawal signs
Buspirone (BuSpar) *Non-benzodiazepines
-Usually used for coronary heart disease and high blood pressure -Useful for anxiety–producing social events
Beta blockers (Tenormin, Lopressor, Inderal) *Non-benzodiazepines
SSRI’s useful in treatment of panic disorder, PTSD, and social anxiety disorder
Antidepressants (Zoloft, Paxil) *Non-benzodiazepines
-Benzodiazepine not available in U.S. -Induces disinhibition of behavior and subsequent memory lapse -Present day club drug -Possible use as a date rape drug
-First synthesized in 1960’s and available in health food stores -is an illicit drug of abuse -Produces euphoria and a lowering of inhibitions -can be easily slipped into alcohol without knowledge of drinker -High potential as a date-rape drug
-Mental disorders are caused by abnormal processes in the brain.
THE BIOMEDICAL MODEL OF MENTAL ILLNESS
-are “split off” or “broken off” from a firm sense of reality. Symptoms may include delusional thinking, hallucinations (usually auditory), dulled emotions, inappropriate verbal expressions, odd body postures (catatonia).
First-generation antipsychotic drugs
horazine, Haldol, Mellaril, Stelazine
Second-generation antipsychotic drug
Clozaril, Zyprexa, Risperdal
Third-generation antipsychotic drugs
Side effects of first generation antipsychotics
produce side effects that resemble Parkinson’s disease.
Side effects of second generation antipsychotics
Clorazil has possibility of producing agranulocytosis (lethal blood disorder).
Side effects of Third generation antipsychotics
modulates and stabilizes rather than just reducing levels of dopamine activity in the brain.
alters the level of stimulation of dopamine-sensitive receptors in the brain. Subtypes of dopamine-sensitive receptors are differentially affected
stabilize (modulate) the level of D2 receptors
Third-generation antipsychotic drugs
-Extremely depressed mood lasting at least 2 weeks -Cognitive symptoms – Feelings of worthlessness, indecisiveness, dysphoria -Disturbed physical functioning – changes in sleep patterns, appetite, energy level -Anhedonia – Loss of pleasure/interest in usual activities
Major Depressive Disorder
raise functioning levels of norepinephrine and serotonin by reducing the activity of monoamine oxidas
block reuptake of norepinephrine and serotonin at the synapse.
raise functioning levels of serotonin by blocking the reuptake of serotonin at the synapse.
First-generation antidepressant drugs
MAO-inhibitors (Nardil, Parnate), tricyclic drugs (Tofranil, Elavil)
Second-generation antidepressant drugs
SSRIs (Prozac, Celexa, Paxil, Zoloft)
Third-generation antidepressant drugs
Cymbalta, Remeron, Effexor
raise functioning levels of norepinephrine and serotonin by slowing down the reuptake of norepinephrine and serotonin similar to tricyclics; however, they are different in their chemical structure.
Third-generation antidepressant drugs
PRIORITIES OF THE WHITE HOUSE OFFICE OF NATIONAL DRUG CONTROL POLICY
Priority I --- Stopping drug use before it starts Priority II --- Healing America’s drug users Priority III --- Disrupting the market
PREVENTION APPROACHES THAT HAVE FAILED
-Reducing the availability of drugs -Punitive measures -Scare tactics and negative education -Objective information approaches -Magic bullets and promotional campaigns -Self-esteem enhancement and affective education
EFFECTIVE SCHOOL-BASED PREVENTION PROGRAMS
-Peer-refusal skills -Anxiety and stress reduction -Social skills and personal decision-making
COMPONENTS OF THE LIFE SKILLS TRAINING PROGRAM
Cognitive component Decision-making component Stress-reduction component Social skills component Self-directed behavior change component
provides info about short-term consequences of ATOD (Life Skills training program)
facilitates critical thinking and independent decision making (Life Skills training program)
helps develop ways to lessen anxiety in their lives (Life Skills training program)
teaches social assertiveness and specific techniques to say no (Life Skills training program)
Social skills component
fosters self-improvement and encourages a sense of personal control and self-esteem. (Life Skills training program)
Self-directed behavior change component
-Making it simple, keeping refusal direct and to the point -Having something else to do -Walking away -Avoiding the situation -Changing the subject -Hanging out with friends who aren’t ATOD users -Refusing to continue discussing it
COMPONENTS OF A COMMUNITY-BASED PREVENTION PROGRAM
-Alternative-behavior programming -Participation of multiple social institutions -Effective use of positive impactors -Effective use of the mass media -Sensitivity to the family dynamics of ATOD abuse
steer people away from high-risk situations that are associated with ATOD use.
religious institutions, media, family, community organizations.
Participation of multiple social institutions
positive use of role-models and promote range of anti-drug messages in press.
Effective use of positive impactors
commercials, web-sites, Partnership for a Drug-Free America
Effective use of the mass media
PARENTS AND GUARDIANS IN ATOD PREVENTION
-As role models -As educators or resources of information -As family policymakers and rule setters -As stimulators of enjoyable family activities -As consultants against peer pressure
TRIPLE-THREAT WORST-CASE SCENARIO FOR SUBSTANCE ABUSE
-High level of stress -Frequently bored -Having $25 dollars or more spending money per week
LEVELS OF INTERVENTION IN DRUG-ABUSE PREVENTION
Primary, Secondary, Tertiary
directed to those who have not had any or minimal experience with drugs
directed to those who already have had some experience with drugs
directed to those who seek treatment for drug abuse problems and the objective is for these individuals to stay drug free and avoid relapse.
Multidimensional Treatment Approach
-A biopsychosocial strategy for treatment includes biological, psychological, and social factors in drug abuse. -Increases the likelihood that treatment will be successful Drug abusers are frequently abusers of other drugs simultaneously -Many clients who are contending with drug abuse are also suffering from depression, anxiety, and other types of serious psychological disorders. -One out of five abusers of alcohol or other drugs have serious mental disorders
The concepts of rehabilitation (effort to reduce the chance the individual will behave in a similar way in future) and deterrence (effort to prevent future behavior by conveying the message that a punishment given to others for similar behavior would apply to them as well)
DRUG TREATMENT AND THE CRIMINAL JUSTICE SYSTEM
effort to reduce the chance the individual will behave in a similar way in future
effort to prevent future behavior by conveying the message that a punishment given to others for similar behavior would apply to them as well
Drug-Abuse Rehabilitation Goals
Goal #1 – decline in physical and psychological functioning must be reversed Goal #2 – use of all psychoactive substances must stop on a permanent basis. Goal #3 – life-style free of alcohol and other drugs must be rebuilt and maintained.
REHABILITATION AND THE FIVE STAGES OF CHANGE
-Pre-contemplation – wish to change but lack the serious intention to do so. -Contemplation – aware that a serious problem exists and are thinking about overcoming it, but haven’t made a serious commitment to action. -Preparation – considering taking action in the next 30 days and have unsuccessfully taken action over the past 12 months -Action – modify their behavior, their experiences, and their environment in an effort to overcome their problem. -Maintenance – continues for rest of ex-user’s life
Stages in the family reaction
denial, anger, bargaining, feeling, acceptance
takes on principal responsibilities of abuser’s life (Survival role coping mechanism)
FINDING THE BEST TREATMENT PROGRAM
Inpatient versus outpatient treatment Pharmacological versus psychotherapy or counseling Self-help groups versus individualized treatment Length of treatment program Aftercare in terms of half-way or recovery houses
model child outwardly, but inwardly unhappy (Survival role coping mechanism)
antisocial child to help divert attention (Survival role coping mechanism)
disconnected emotionally and physically from family (Survival role coping mechanism)
humorous and self-disparaging – results in low self-esteem and lack of maturity (Survival role coping mechanism)