1. Psychoactive Drugs

2. Hip and cool?

3. Faces of Meth
Before After (3 years later)

4. Faces of Meth
Before After (17 months later)

5. Faces of Meth
Before After (3 months later)

6. DSM Abuse/Dependence Categories
5.1 Alcohol-Related Disorders
5.2 Amphetamine (Or Amphetamine-Like) Related Disorders
5.3 Caffeine-Related Disorders
5.4 Cannabis-Related Disorders
5.5 Cocaine-Related Disorders
5.6 Hallucinogen-Related Disorders
5.7 Inhalant-Related Disorders
5.8 Nicotine-Related Disorders
5.9 Opioid-Related Disorders
5.10 Phencyclidine (Or Phencyclidine-Like)-Related Disorders
5.11 Sedative-, Hypnotic-, or Anxiolytic-Related Disorders
5.12 Polysubstance-Related Disorder
5.13 Other (or Unknown) Substance-Related Disorder

7. Substance-related disorder
Abuse of, or dependence on, a mood- or behavior-altering drug
Substance: Anything that is ingested in order to produce a high, alter one's senses, or otherwise affect functioning
Characterized by
Excessive use of habit forming substances
The use of a substance for a reason other than which it was intended or in a manner or in quantities other than directed
Two general groups:
Substance abuse
Use interferes with social or occupational functioning
Abuse may progress to dependence
Substance dependence
Compulsive abuse behavior
Shows tolerance and withdrawal

8. DSM-IV definition: Substance abuse
A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by one or more of the following in a 12-month period:
failure to fulfill major role obligations at work, school, home
e.g., repeated absences or poor work performance related to substance use; substance-related absences, suspensions, or expulsions from school; neglect of children or household
use in situations in which it is physically hazardous
e.g., driving an automobile or operating a machine
substance-related legal problems
e.g., arrests for substance-related disorderly conduct
persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance
e.g., arguments with spouse or children, physical fights

9. DSM-IV definition: Substance dependence (continued)
Tolerance: a need for markedly increased amounts of the substance to achieve intoxication or desired effect
Withdrawal: Physiological and psychological symptoms associated with reduction in heavy substance use> Usually exhibits 2 or more of the following symptoms:
Sweating or rapid pulse Nausea or vomiting
Increased hand tremor Physical agitation
Insomnia Anxiety
Transient visual, tactile, or auditory hallucinations or illusions
Grand mal seizures

10. DSM-IV definition: Substance dependence
The substance is often taken in larger amounts or over a longer period than was intended
There is a persistent desire or unsuccessful efforts to cut down or control substance use
A great deal of time is spent in activities to obtain, use, or recover from effects of the substance
Important social, occupational or recreational activities are given up or reduced
Continued use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance
e.g., illness, marital conflict, job problems

11. How Alcohol Works: Getting in
About 20 percent of alcohol is absorbed in your stomach
The remaining 80 percent is absorbed in your small intestine
How quickly depends on
the percent of the alcohol in the drink
vodka is absorbed faster than beer because vodka has a higher alcohol percentage
how much you've just eaten
a full stomach will slow down alcohol absorption

12. How Alcohol Works: Getting out
Where it goes: Kidneys, Lungs, Liver, Brain
Kidneys and lungs remove about 10% of the alcohol
which is why a breathalyzer test can be used to measure a person's blood alcohol level)
Liver breaks down 90% of the alcohol into acetic acid
Blood alcohol concentration (BAC)
The proportion of alcohol in your blood
Goes up when the body is taking in alcohol faster than it can release it
One ounce of alcohol will increase the average person's BAC roughly 0.03%
BAC and the number of drinks consumed are not always accurate indicators of the level of impairment
There is much variation according to genetics, body weight, gender, and body fat percentage
Tolerance to alcohol varies from one person to another because of the above factors and from adaptation to chronic alcohol use

13. How Alcohol Works: In your brain
Alcohol alters amounts of neurotransmitters
Causes sluggish movements and slurred speech by
Increasing the effects of the inhibitory neurotransmitter GABA
Inhibiting the excitatory neurotransmitter glutamate
Creates a feeling of pleasure by
Increasing the amount of the dopamine in the brain's reward center

14. How Alcohol Works: In your brain
Alcohol affects multiple areas of the brain
In the Cortex it affects our thought processes
depresses behavioral inhibitions, causing less inhibition
slows down the processing of information from the senses
interferes with thought processes, making it difficult to think clearly
In the Cerebellum it affects our kinesthetic senses
interferes with the integration of information from movement and balance sensory organs, resulting in staggering
In the Hypothalamus and pituitary it influences our emotional state
Depresses nerve centers that control sexual arousal and performance
Sexual urges may increase, but sexual performance will decreases
In the Medulla it affects our vital life functions
Induces sleepiness, slows breathing, and lowers body temperature

15. Stages of Alcohol Intoxication
Euphoria (BAC = 0.03 to 0.12 percent)
Become more self-confident, attention span shortens, flushed, judgment reduced, trouble with fine movements
Excitement (BAC = 0.09 to 0.25 percent)
Become sleepy, have trouble understanding or remembering things, uncoordinated balance and body movements
Confusion (BAC = 0.18 to 0.30 percent)
Become confused and emotional, dizzy and may stagger, slurred speech
Stupor (BAC = 0.25 to 0.4 percent)
Can barely move, stand or walk, may vomit, may lapse in and out of consciousness
Coma (BAC = 0.35 to 0.50 percent)
They are unconscious, lower-than-normal body temperature, breathing is slower and more shallow, heart rate may slow
Death (BAC more than 0.50 percent)
The person usually stops breathing and dies

16. Substance-related disorders
People with substance-related disorders also commonly suffer from other psychological disorders, a condition known as comorbidity
Substance abusers also likely to have:
disruptive disorders (conduct or oppositional defiant disorder, impulse-control disorders)
mood disorders (e.g., depression, dysthymia)
anxiety disorders (e.g., PTSD; social phobia)

17. Prevention
Substance abuse and dependence tend to develop rapidly following first use
suggesting that a slim window of opportunity exists to prevent substance disorders once drug use has begun
Conclusions of a study by
Reebye, P, Moretti, MM, and Lessard, JC (1995) Conduct disorder and substance use disorder: comorbidity in a clinical sample of preadolescents and adolescents. Canadian Journal of Psychiatry, 40(6):

18. Neural Basis of Drug Cravings
Mesolimbic Dopamine Pathway
= System of neurons connecting
Ventral Tegmental Area (VTA)
Activated by activities that produce pleasure
Also involved in security motivation, avoidance, and fear-conditioning, Seeking food and companionship and avoiding physical and psychological discomfort and intoxication
Nucleus accumbens (Nac)
Key structure of the brain responsible for reward, motivation, and addiction
Prefrontal cortex
Regulates overall motivational salience and determines the intensity of behavioral responding

19. Mesolimbic Pathway and Addictive Behavior
Almost every drug abused by humans has been shown to increase dopamine levels in the Mesolimbic Pathway
Mesolimbic Pathway and Psychotic Behavior
Abnormally high dopamine levels in the mesolimbic pathway are strongly linked to psychosis and schizophrenia
Responsible for psychotic affects of addictive drugs
Mesolimbic Pathway and Creative Drive
Moderate levels of dopamine in the mesolimbic pathway increases general arousal and goal directed behaviors and decreases latent inhibition; all three effects increase the creative drive of idea generation
Flaherty, A.W, (2005). "Frontotemporal and dopaminergic control of idea generation and creative drive". Journal of Comparative Neurology 493 (1):

20. Neural Basis of Drug Cravings
Sustained dopamine release
promotes drug-seeking behavior
causes pathophysiological synapse changes along the Mesolimbic Pathway, the prefrontal cortex, and nucleus accumbens (brain damage)
Hyperresponsive to stimuli predicting drug availability
Reduced capacity to regulate neurotransmission
Sources:
Phillips, et al. (2003). Nature, 422,
The Neural Basis of Addiction: A Pathology of Motivation and Choice. Peter W. Kalivas, Ph.D. and Nora D. Volkow, M.D. Am J Psychiatry 162: , August 2005.

21. Can Drugs Cause Brain Damage?
Drugs that have been associated with brain damage or cognitive impairments:
Amphetamines
MDMA (“ecstasy”): Serotonin neurons
Methamphetamine: Dopamine neurons
Cocaine:
Blocks cerebral blood flow
Phencyclidine (PCP or “angel dust”):
Blocks NMDA receptors
Drugs that have NOT been associated with long-lasting brain damage
LSD
Marijuana
Opiates

22. Psychoactive Drug
A chemical substance that acts primarily upon the CNS where it alters brain function, resulting in temporary changes in perception, mood, consciousness, and behavior
Most psychoactive drugs exert their effects by influencing chemical reactions at synapses
Agonist
Substance that ENHANCES the function of a synapse
Cause excessive release of a neurotransmitter
Block re-uptake off a neurotransmitter
Antagonist
Substance that BLOCKS the function of a synapse

23. An Acetylcholine Synapse: Example of Drug Action
Whole eggs, liver, beef steak, and soy are among foods naturally rich in choline
Black widow and cobra venom & ACh: Paralysis
Botulinum toxin & ACh: denervation and local paralysis
Nicotine & ACh: An increase in conductance of the ion(s) for which that channel is selective
Nerve agents
Pesticides
muscle relaxant, poison

24. Psychoactive drug classification
One can classify a drug by it’s most pronounced behavioral or psychoactive effect
Sedative Hypnotics and Anti-anxiety Agents
Antipsychotic Agents
Antidepressants
Mood Stabilizers
Narcotic Analgesics
Psychomotor Stimulants
Psychedelics and Hallucinogens

25. Psychoactive drugs: Anti-anxiety Agents and Sedative Hypnotics
Central nervous system depressants
They bind to GABA (inhibitory neurotransmitter) receptors and increase its effect
The GABAA Receptor Has Two Sites:
Sedative-Hypnotic Site: Alcohol and barbituates
Antianxiety Site: Benzodiazepines

26. Psychoactive drugs: Anti-anxiety Agents and Sedative Hypnotics (continued)
Barbituates
Produce sedation and sleep (e.g., Phenobarbital, alcohol)
Can also produce general anesthesia, coma, and death
Used as an anesthetic
Other uses: Replaced by benzodiazepines, which have less potential for abuse and danger of lethal overdose
Benzodiazepines
Minor tranquilizers
Antianxiety agents
Drugs that reduce anxiety (e.g., Valium, Xanax)
Used to treat anxiety, insomnia, agitation, seizures, muscle spasms, and alcohol withdrawal

27. Psychoactive drugs: Anti-anxiety Agents and Sedative Hypnotics (continued)
Allopregnanolone
Natural hormone (a neurosteroid) produced by pineal gland
Reduces anxiety and creates calm at times of stress (conflicting evidence)
Higher levels in women than in men
Thought to make women more sensitive to alcohol than men
Associated with premenstrual symptoms

28. Psychoactive drugs: Antipsychotic Agents
Major Tranquilizers (Neuroleptic)
Drugs used to treat psychosis - a loss of contact with reality (hallucinations, delusions, disorganized thinking)
Examples: schizophrenia, mania, and delusional disorder
Blocks the D2 dopamine receptor
The normal effect of dopamine release is reduced
Mechanism of therapeutic action is still not understood
Immediate effect of reducing motor activity
After short period of use, there is a reduction in the symptoms of schizophrenia
Negative side effect: Dyskinesia (impaired control of movement)

29. Psychoactive drugs: Examples of Antipsychotic Agents
Zyprexa - acute manic episodes and maintenance of bipolar disorder
Solian - positive (high dose) and negative (low dose) symptoms of schizophrenia
Seroquel - bipolar disorder, schizophrenia, and chronic insomnia (low dose)

30. Dopamine Hypothesis of Schizophrenia
Proposal that schizophrenia symptoms are due to excess activity of the neurotransmitter dopamine
Evidence
Antipsychotic drugs block D2 receptors
Amphetamine promotes release of dopamine and can also produce symptoms similar to schizophrenia
But there is still no conclusive evidence of dopamine-related differences in the brains of schizophrenic patients

31. Psychoactive drugs: Antidepressants
Although antidepressants affect synapses very quickly, their antidepressive actions take weeks to develop
About 30% and 50% of patients with depression fail to respond to antidepressants, suggesting that other neurotransmitters are likely involved
Antidepressant drugs tend to lose efficacy over the course of treatment
Therapeutic effects of antidepressants typically do not continue once the course of medication ends
Most antidepressants are known to produce tolerance
They are not addictive, but can produce psychological withdrawl
Virtually all major antidepressant drugs suppress REM sleep
a common side effect of most antidepressants is an increase in vivid dreams

32. Classes of Antidepressants
Monoamine Oxidase (MAO) Inhibitors
Block the enzyme MAO from degrading neurotransmitters such as dopamine, norepinephrine, and serotonin
Tricyclic Antidepressants
First-generation antidepressants with a chemical structure characterized by three rings that block serotonin, dopamine, and norepinephrine reuptake transporter proteins
Second-Generation Antidepressants
Action is similar to first-generation antidepressants, but is more selective in its action on the serotonin reuptake transporter proteins; also called atypical antidepressants
Selective Serotonin Reuptake Inhibitors (SSRIs)
Block the reuptake of serotonin into the presynaptic terminal

33. Psychoactive drugs: Second-Generation Antidepressants
Action is similar to older (tricyclic) antidepressants, but with fewer side effects
Paroxetine (e.g. Paxil, Seroxat, Aropax) is a selective serotonin reuptake inhibitor (SSRI)
Used to treat the symptoms of depression, obsessive-compulsive disorder, post-traumatic stress disorder, panic disorder, generalized anxiety disorder, social phobia/social anxiety disorder, and premenstrual dysphoric disorder
Bupropion (e.g. Wellbutrin, Zyban) is a norepinephrine and dopamine reuptake inhibitor (NRDI)
Also used for smoking cessation, seasonal affective disorder, and Attention Deficit Disorder
Side effects: Nausea, diarrhea, headaches, sexual (loss of libido, failure to attain an erection or reach orgasm, Bupropions may increase libido slightly

34. The most commonly prescribed antidepressants
In the US in 2005:
Sertraline (e.g. Zoloft, Lustral, Apo-Sertral, Asentra, Gladem, Serlift, Stimuloton)
Escitalopram (e.g. Lexapro, Cipralex)
Fluoxetine (e.g. Prozac, Sarafem, Fluctin, Fontex, Prodep, Fludep, Lovan)
Venlafaxine (e.g. Effexor XR, Efexor)
Citalopram (e.g. Celexa, Cipramil, Talohexane)
Paroxetine (e.g. Paxil, Seroxat, Aropax)
Trazodone (e.g. Desyrel, Trazolan)
Amitriptyline (e.g. Elavil)
Bupropion (e.g. Wellbutrin, Zyban)
The most commonly prescribed antidepressant in Germany is reported to be concentrated extracts of hypericum perforatum (St John's Wort)

35. Psychoactive Drugs: Narcotic Analgesics
Drugs with sleep-inducing (narcotic) and pain-relieving (analgesic) properties
General effects of narcotic analgesics
sedation, slowed reflexes, raspy speech, sluggish "rubber-like" movements, slowed breathing, cold skin, and possible vomiting

36. Psychoactive Drugs: Narcotic Analgesics - Opiates
Many of these drugs are derived from opium, an extract of the seeds of the opium poppy plant
Opiates are potentially addictive
Continued use of narcotic analgesics will build a tolerance
Pure opioids (from the plant)
Codeine: ingredient of cough medicines and pain relievers
Morphine: powerful pain reliever
Synthetic opioid
Methadone

37. Psychoactive Drugs: Morphine
Acts directly on the synapses of the nucleus accumbens to relieve pain
Morphine binds very strongly to the mu-opioid receptors
Causes higher incidence of euphoria and dependence (addiction) as compared to most other opioids
Morphine has recently been found to be endogenously produced by humans
made by cells in the heart, pancreas and brain

38. Psychoactive Drugs: Narcotic Analgesics
Nalorphine and Naxolone
Blocks the effects of morphine
useful in reversing the effects of narcotic overdoses
Heroin
An opiate drug synthesized from morphine
More fat soluble and penetrates the BBB faster than morphine, therefore it produces very rapid pain relief
Once in the brain, heroin is rapidly metabolizes back into morphine
the morphine molecule binds with opioid receptors and produces the subjective effects of the heroin high

39. Psychoactive Drugs: Endorphins
Peptide hormone that acts as a neurotransmitter and may be associated with feelings of pain or pleasure
produced by the pituitary gland and hypothalamus
resemble opiates in their abilities to produce analgesia and a sense of well-being
Endorphins are released during stress, such as during long, continuous workouts, when the level of intensity is between moderate and high, and breathing is difficult
Do endorphins cause the runner's high? …. not likely
changes in mood state occur when people exercise on opioid antagonists (e.g., Nalorphine)
high appears to come from completing a challenge rather than as a result of exertion

40. Psychoactive Drugs: Behavioral Stimulants
Stimulates the sympathetic nervous system to increase motor behavior and elevate a person’s mood and level of alertness by increasing synaptic activity of the monoamine neurotransmitters:
dopamine (primarily), norepinephrine and serotonin
Physical effects: Overall agitation, prevents sleep, reduces appetite, speeds up breathing and heart rate and widens the pupils

41. Psychoactive Drugs: Behavioral Stimulants
Low to moderate doses
Induce wakefulness, increase activity, decrease appetite
Produce feelings of euphoria, well-being and self-confidence
Stereotypic behaviors - brief, repetitive actions (e.g., arranging of objects, grooming, and persistent repetition of words)
High doses
Produce a psychosis (vivid hallucinations and paranoid ideation)
Often indistinguishable from paranoid schizophrenia
Can cause periods to become irregular or even stop in women
Emotional effects:
At first - feel more energetic, cheerful and confident
Come down - feel sad, helpless, hopeless, nervous, angry, violent
Regular users – psychotic symptoms (e.g., delusions, hallucinations, & paranoia) that can develop into paranoid psychosis

42. Psychoactive Drugs: Behavioral Stimulants
Cocaine
Obtained from the leaves of the coca plant
Addictive
Derivates such as Novocaine are used as local anesthetics
Dopamine agonist: blocks the reuptake of dopamine
Amphetamine
Initially an asthma treatment
Study aid
Improvement of alertness and productivity
Weight-loss aid

43. Psychoactive Drugs: Behavioral Stimulants
Caffeine
Inhibits the enzyme the normally breaks down the second messenger cyclic AMP
Increase in cAMP leads to an increase in glucose production within cells, which makes more energy available and allows for higher rates of cellular activity
Results in increased activity of dopamine (causes stimulating effects) and serotonin (to a lesser extent - causing positive changes in mood)
Nicotine
A cholinergic agonist -- it acts by stimulating nicotinic acetylcholine receptors
Low dose stimulation of the central nervous system is followed by depression at high doses
Chronic use of nicotine leads tolerance and dependence

44. Psychoactive Drugs: Speed - Methamphetamine - Amphetamines
Toxic effects on the brain
A single high dose of meth has been shown to damage nerve terminals in the dopamine-containing regions of the brain
As much as 50% of the dopamine-producing cells in the brain can be damaged after prolonged exposure to relatively low levels of speed
Serotonin-containing nerve cells may be damaged even more extensively
Messes with every aspect of mood, emotion, sleep and appetite

45. Long-term Use of Methamphetamine

46. Longterm Use of Methamphetamine Meth-Mites
Users develop obsessive itching and picking of the skin, creating red, irritated, blotchy, and sometimes bloody sores

47. Psychoactive Drugs: Psychedelic Drugs
Alter sensory perception and cognitive processes
Range from seemingly non-toxic to extremely toxic
Do NOT cause hallucinations
Hallucinations are perceptions that have no basis in reality, but that appear entirely realistic
”Hallucinations" induced by psychedelic drugs are more accurately described as a modification of regular perception
the subject is usually quite aware of the illusory and personal nature of their perceptions

48. Psychedelic Drugs: Four main types
Acetylcholine psychedelics
Norepinephrine psychedelics (e.g., mescaline)
Tetrahydrocannabinol (THC): active ingredient in marijuana
Serotonin psychedelics (e.g., lysergic acid diethylamide)

49. Psychedelic Drugs - Acetylcholine psychedelics
Examples: PCP, angel dust, crystal, dust, embalming fluid, DOA, surfer; street K, special K
Distort perception of sight and sound and produces feelings of detachment (dissociation)
Some effects include
agitation, euphoria, disinhibition, rigidity, unable to speak, unresponsive to pain, including unpredictable violent reactions to environmental stimuli, Schizophrenia-like psychotic states; Flashbacks
Effects are directly caused by the toxicity to one's body

50. Psychedelic Drugs - Norepinephrine psychedelics
Examples: mescaline, DOM (also as STP), TMA, MDA, MDMA (ecstasy),MMDA, DMA, and drugs from nutmeg (myristin and elemicin)
Mental Effects
Sensation and perception impairment, loss of a sense of time, disorganization of thought and psychotic reactions.
Physical Effects
Speed up the heartbeat and increase the blood pressure, dilates pupils, increases blood sugar level, raise body temperature, cause heavy perspiration and nausea.
Large doses, mescaline lowers the blood glucose.

51. Psychedelic Drugs - Tetrahydrocannabinol
Active ingredient in marijuana
Low to medium use:
Relaxation, reduced coordination and blood pressure, disruption in attention, an altered sense of time and space.
High use can cause:
Depression, hallucinations, delusions, impaired memory, disorientation, cancer.
Unclear if it becomes addictive or causes long-term mental abnormalities
Lung cancer is high risk of regular use because there is a high level of tar and other chemicals.

52. Psychedelic Drugs - Serotonin psychedelics
Examples: LSD, Dimethyltryptamine (DMT), Psilocybin (mushrooms that belong to the genera Psilocybe, Panaeolus, andConocybe), psilocin, bufotenine Ololiuqui (morning glory seeds) Harmine
Alter mood and perception, paranoid ideation, depression, undesirable hallucinations, and/or a confusional state resembling a drug-induced dementia.
Persistent flashbacks occur weeks/months after last drug use
Psychedelics can precipitate serious depressions, paranoid behavior, or prolonged psychotic episodes.

53. Drugs, Experience, Context, and Genes Tolerance
How do we develop a tolerance to drugs such as alcohol?
Metabolic Tolerance
Changes in efficiency or capacity to metabolize ethanol resulting in a decrease in the BAC following a given dose of alcohol
Number of enzymes needed to break down alcohol may increase
Cellular (Functional) Tolerance
Activities of brain cells may adjust to minimize the effect of alcohol
Characterized by a decrease in pharmacologic or physiologic responsiveness upon alcohol exposure
Hypothesized to be mediated by neuroadaptative changes in the CNS
Learned Tolerance
People can learn to cope with effects of alcohol and therefore may not appear to be drunk

54. Drugs, Experience, Context, and Genes Why Doesn’t Everyone Abuse Drugs?
Genetics?
Despite some evidence of a genetic contribution, no gene or set of genes related to alcoholism have been found
Any satisfactory explanation of drug abuse will require genetic and learning components
Personality Traits?
Unusual risk-taking may be trait common to drug abusers
Low Frustration and Tolerance - impatient
Anxiety
Grandiosity - to hide feelings of low self-worth
Perfectionism - an idealist
Justification
Isolation and deep insecurity - loners
Exaggerates unpleasant interpersonal relationships
Impulsiveness
Defiance - a feeling that one does not fit into society
Dependence on other persons

56. Factors that influence drug responsiveness
Age:
Older individuals are more sensitive to drugs
Less effective barriers and less effective at eliminating drugs
Body Size:
Smaller individuals are more sensitive to drugs
Fewer body fluids to dilute drugs
Sex
Females are more sensitive to drugs
Smaller than men on average
Homones may also play a role