Copyright (c) Pearson Education 2010 Drugs, Behavior, and Modern Society SIXTH EDITION Charles F. Levinthal Chapter 2 Drug-taking Behavior: The Personal and Social Concerns This multimedia product and its contents are protected under copyright law. The following are prohibited by law: any public performance or display, including transmission of any image over a network; any public performance or display, including transmission of any image over a network; preparation of any derivative work, including the extraction, in whole or in part, of any images; preparation of any derivative work, including the extraction, in whole or in part, of any images; any rental, lease, or lending of the program any rental, lease, or lending of the program

Copyright (c) Pearson Education 2010 JUDGING DRUG TOXICITY THROUGH ED AND LD MEASURES Effective dose (ED): The minimal dose of a particular drug necessary to produce the intended drug effect in a given percentage of the population Effective dose (ED): The minimal dose of a particular drug necessary to produce the intended drug effect in a given percentage of the population Lethal dose (LD): The minimal dose of a particular drug capable of producing death in a given percentage of the population Lethal dose (LD): The minimal dose of a particular drug capable of producing death in a given percentage of the population

Copyright (c) Pearson Education 2010 EXAMPLES OF LD AND ED MEASURES ED The dose that produces the intended drug effect in 50 percent of the population under study ED The dose that produces the intended drug effect in 50 percent of the population under study ED The dose producing the intended drug effect in 100 percent of the population ED The dose producing the intended drug effect in 100 percent of the population LD The dose producing death in 50 percent of the population under study LD The dose producing death in 50 percent of the population under study LD The dose producing death in 100 percent of the population LD The dose producing death in 100 percent of the population

Copyright (c) Pearson Education 2010 ED-RESPONSE AND LD-RESPONSE CURVES (b) THAT WOULD PRESENT SERIOUS TOXICITY PROBLEMS

Copyright (c) Pearson Education 2010 WHICH DRUG WOULD BE THE LEAST TOXIC?

Copyright (c) Pearson Education 2010 TWO MEASURES OF DRUG SAFETY Therapeutic index: The ratio of LD50 to ED50. If LD50 is 100 and ED50 is 20, then the therapeutic index is 5. Therapeutic index: The ratio of LD50 to ED50. If LD50 is 100 and ED50 is 20, then the therapeutic index is 5. Margin of safety: The ratio of LD1 to ED99. If the LD1 is 100 and ED99 is 20, then the margin of safety is 5. Margin of safety: The ratio of LD1 to ED99. If the LD1 is 100 and ED99 is 20, then the margin of safety is 5. The higher the ratios, the safer the drug. The higher the ratios, the safer the drug. However, a drug with a margin of safety of 5 is safer than a drug with an equivalent therapeutic index. The margin of safety is the more conservative measure in the direction of safety. However, a drug with a margin of safety of 5 is safer than a drug with an equivalent therapeutic index. The margin of safety is the more conservative measure in the direction of safety.

Copyright (c) Pearson Education 2010 DAWN The Drug Abuse Warning Network (DAWN) program reports the number of drug-related emergency department (ED) visits in major metropolitan hospitals in the United States. The Drug Abuse Warning Network (DAWN) program reports the number of drug-related emergency department (ED) visits in major metropolitan hospitals in the United States. Drug-related ED visits can be due to a wide range of personal circumstances. Drug-related ED visits can be due to a wide range of personal circumstances.

Copyright (c) Pearson Education 2010 TWO TYPES OF DRUG TOXICITY Chronic toxicity: The physical or psychological harm a drug might cause over a long period of time. Chronic toxicity: The physical or psychological harm a drug might cause over a long period of time. Acute toxicity: The physical or psychological harm a drug might cause to the user immediately or soon after the drug is ingested into the body. Acute toxicity: The physical or psychological harm a drug might cause to the user immediately or soon after the drug is ingested into the body.

Copyright (c) Pearson Education 2010 EXAMPLES OF ACUTE TOXICITY Accidental lethal overdose of heroin Accidental lethal overdose of heroin Behavioral dangers from being “high” Behavioral dangers from being “high” Dangerous combinations of several drugs Dangerous combinations of several drugs Dangerous combination of alcohol with any drug Dangerous combination of alcohol with any drug Overmedication of precription or OTC drugs Overmedication of precription or OTC drugs

Copyright (c) Pearson Education 2010 DISTRIBUTION OF DRUG-RELATED ED VISITS IN 2006 BY TYPE OF DRUG INVOLVEMENT

Copyright (c) Pearson Education 2010 RELATIVE FREQUENCY OF DRUGS IN ALCOHOL-IN-COMBINATION ED CASES IN 2006

Copyright (c) Pearson Education 2010 EXAMPLES OF CHRONIC TOXICITY Liver disease due to chronic alcoholic consumption Liver disease due to chronic alcoholic consumption Lung cancer due to chronic tobacco smoking Lung cancer due to chronic tobacco smoking Cardiovascular disease due to chronic tobacco smoking Cardiovascular disease due to chronic tobacco smoking Pulmonary disease due to chronic tobacco smoking Pulmonary disease due to chronic tobacco smoking

Copyright (c) Pearson Education 2010 U.S. DEATHS PER YEAR FROM TOBACCO, ALCOHOL, AND ILLICIT DRUG USE

Copyright (c) Pearson Education 2010 DRUG TOLERANCE DEFINED Tolerance is the capacity of a specific dose of a drug to have a gradually diminished effect on the user as the drug is taken repeatedly. Tolerance is the capacity of a specific dose of a drug to have a gradually diminished effect on the user as the drug is taken repeatedly. Tolerance requires that a higher dose of a drug to be taken to produce an equivalent effect. Tolerance requires that a higher dose of a drug to be taken to produce an equivalent effect. Behavioral tolerance is a form of tolerance that occurs when a drug is used in the same surroundings or under the same circumstances. Also called conditioned tolerance. Behavioral tolerance is a form of tolerance that occurs when a drug is used in the same surroundings or under the same circumstances. Also called conditioned tolerance.

Copyright (c) Pearson Education 2010 MODELS OF DRUG DEPENDENCE Physical dependence is based on the idea that the drug abuser continues to take a drug to avoid the consequences of physical withdrawal symptoms. Physical dependence is based on the idea that the drug abuser continues to take a drug to avoid the consequences of physical withdrawal symptoms. Psychological dependence is based on the idea that the drug abuser is motivated by a strong craving for the pleasurable effects of the drug. Psychological dependence is based on the idea that the drug abuser is motivated by a strong craving for the pleasurable effects of the drug.

Copyright (c) Pearson Education 2010 PSYCHOLOGICAL DEPENDENCE: A SIMPLIFIED ILLUSTRATION OF HOW DRUGS ARE SELF-ADMINISTERED IN RATS

Copyright (c) Pearson Education 2010 SUBSTANCE DEPENDENCE DSM-IV-TR CRITERIA At least 3 out of the following must apply within the past year: Tolerance Tolerance Withdrawal Withdrawal Unintentional overuse Unintentional overuse Persistent desire or efforts to control drug use Persistent desire or efforts to control drug use Preoccupation with the drug Preoccupation with the drug The reduction or abandonment of important social, occupational, or recreational activities in order to engage in drug use The reduction or abandonment of important social, occupational, or recreational activities in order to engage in drug use Continued drug use despite major drug-related problems Continued drug use despite major drug-related problems Symptoms must have persisted for more than a month or occurred repeatedly over a longer period of time.

Copyright (c) Pearson Education 2010 SUBSTANCE ABUSE DSM-IV-TR CRITERIA At least one of the following must apply within the past year: Recurrent drug use resulting in a failure to fulfill major obligations at work, school, or home Recurrent drug use resulting in a failure to fulfill major obligations at work, school, or home Recurrent drug use in situations in which use is physically hazardous Recurrent drug use in situations in which use is physically hazardous Recurrent drug-related legal problems, such as arrest for disorderly conduct or drug-related behavior Recurrent drug-related legal problems, such as arrest for disorderly conduct or drug-related behavior Continued drug use despite the knowledge of persistent social, occupational, psychological, or physical problems that would be caused or made more difficult by the use of the drug Continued drug use despite the knowledge of persistent social, occupational, psychological, or physical problems that would be caused or made more difficult by the use of the drug Note: The person must have never met the criteria for substance dependence for this particular drug.

Copyright (c) Pearson Education 2010 DSM-IV-TR CRITERIA FOR SUBSTANCE DEPENDENCE AND ABUSE