SUBSTANCES SUBJECT TO DISORDERED USE LISTED IN THE DSM

Alcohol regulated by age and place of consumption (DEPRESSANT)

Nicotine regulated by age and place of consumption (STIMULANT)

Caffeine --not regulated (STIMULANT)

Benzodiazepines (anxiety) regulated by prescription (DEPRESSANT)

Barbiturates (anxiety and sleep) regulated by prescription (SEDATIVE)

Hypnotics (anxiety and sleep) regulated by prescription (SEDATIVE)

Amphetamines regulated by prescription (e.g., ADHD, obestiy) (STIMULANT)

Marijuana regulated by prescription in some jurisdictions of the US (UNCLASSIFIED)

Opium derivatives (e.g., morphine/codeine for pain/cough) regulated by prescription (SEDATIVE)

Inhalants (e.g., gasoline, glue, paint thinner, spray paint) and other volatile compounds containing esters/ketone/gycols)--not regulated (HALLUCINOGEN)

SUBSTANCES SUBJECT TO DISORDERED USE LISTED IN THE DSM CONTINUED

Marijuana (in most jurisdictions of the US) (UNCLASSIFIED)

Opium and derivatives (e.g., heroin) (SEDATIVE)

Cocaine (powder, base, crack) (STIMULANT)

LSD (i.e., d-lysergic acid diethylamide) (HALLUCINOGEN)

Mescaline/peyote (HALLUCINOGEN)

Psilocybin/mushrooms and related indole alkaloids such as DMT (HALLUCINOGEN)

Ecstasy/MDA/MDMA (methylenedioxymethamphetamine)

(STIMULANT&HALLUCINOGEN)

Amphetamines (e.g., speed, ice) (STIMULANT)

PCP (phencyclidine; angel dust; veterinary anesthetic)

PREVALENCE OF SUBSTANCE USE SURVEY 1997 (NIDA, 2003)

-prevalence of use of drugs on survey has not changed significantly since 1996

-Many more people try drugs than go on to become regular users

-Occasional users often called "chippers" or "recreational users"

- 36 percent of all Americans older than age 11 have tried at least one illicit drug during their lifetime

- 11 percent have used at least one illicit drug during the past year

-6 percent have used at least one illicit drug during the past month

-men have a higher rate of current illicit drug use than women (8.5 percent of men versus 4.5 percent of women)

- among 12- to 17-year-old drug users, there was little difference in the rate of drug use between adolescent males and females (9.2 percent for males versus 8.9 percent for females).

-among youths ages 12 to 13, 3.8 percent were current illicit drug users

-highest rates were found among young people ages 16 to 17 (19.2 percent) and ages 18 to 20 (17.3 percent).

- rates of use were lower in each successive age group, with only about 1 percent of people age 50 and older reporting current illicit use

PREVALENCE OF SUBSTANCE USE SURVEY 1997 (NIDA, 2003) CONTINUED

-33 percent of Americans age 12 or older have smoked marijuana at least once

-5.1 percent used marijuana during the past month; among 12 - 17 year olds use in past month increased from 9% to 11% between 1996 and 1997

-approximately 80 percent of current illicit drug users are marijuana or hashish users.

-71 percent of Americans reporting that they had smoked a cigarette at some time in their life

-30 percent reported having smoked a cigarette during the past month

-90% have drank during lifetime

-60% of males and 30% of females have been intoxicated at least once

-0.7 percent of the population age 12 and older, were current cocaine users

-Among persons 18 to 25 years old, cocaine use decreased from 2.0 percent in 1996 to 1.2 percent in 1997

PREVALENCE OF SUBSTANCE USE SURVEY 1997 (NIDA, 2003) CONTINUED

-heroin use decreased from 0.4 percent to 0.1 percent

-misuse of analgesics declined from 2.0 percent to 1.3 percent

- 2.5 percent of the population had tried methamphetamine at some time in their lives

-5.7 percent reported use of inhalants at least once in their lifetime

-0.4 percent were current users

DSM INCLUDES 4 TYPES OF SUBSTANCE-RELATED DISORDERS:

Substance Dependence

Substance Abuse

Substance Intoxication

Substance Withdrawal

3 or more of the following occurring within a 12 month period:

1. Tolerance

-need for increased amount of substance for desired effect

-diminished effect with continued use of same amount

2. Withdrawal

-substance-specific symptoms due to cessation/reduction of substance use

-substance-specific symptoms cause distress and/or impairment in functioning

3. Substance is taken in larger amounts or over a longer period than was intended

4. Persistent desire or unsuccessful effort to reduce/control substance use

5. A great deal of time is spent in obtaining, using, or recovering from the substance

6. Important social, occupational, or recreational activities are stopped/reduced

7. The substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that may be caused by the substance

1 or more of the following within a 12 month period:

1. Recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home

(e.g., miss work/school, neglect children)

2. Recurrent substance use in situations in which it is physically hazardous

(e.g. driving; operating machinery)

3. Recurrent substance-related legal problems

(e.g., arrests for disorderly conduct)

4. Continued substance use despite persistent or recurrent social/interpersonal problems caused or exacerbated by the effects of the substance

(e.g., arguments with spouse over intoxication)

All of the following once substance is consumed:

1. Development of a reversible substance-specific syndrome

2. Clinically significant maladaptive behavioral or psychological changes that are due to the effect of the substance upon the central nervous system

(e.g., belligerence, mood lability, cognitive impairment, impaired judgment)

3. Symptoms are not due to a general medical condition and are not accounted for by another mental disorder

All of the following after cessation or reduction of substance use:

1. Development of substance-specific syndrome

2. Substance-specific syndrome causes clinically significant distress or impairment in social or occupational functioning

3. Symptoms are not due to a general medical condition and are not accounted for by another mental disorder

PREVALENCE OF SUBSTANCE-RELATED DISORDERS (all types combined)

Alcohol: lifetime prevalence 20% men and 8% women (vs. 90% used)

Caffeine: unknown (% used also unknown)

Tobacco: 25 - 30% (vs. 71% used)

Marijuana: 4% (vs. 33 percent used)

Opiates: unknown (% used unknown)

Amphetamines: 2% lifetime (vs. 2.5% have used)

Cocaine: 0.2% (vs. 0.7% current users)

LSD & other hallucinogens: 0.3% (% used unknown)

Inhalants: unknown (% used unknown)

Nicotine: 20% (vs. 71% used)

Opiates: 0.7% (% used unknown; 0.1% have used heroin)

Sedative/hypnotic/anxiolytics: 1.1% (% used unknown)

TREATMENTS

-not all treatments have been studied (e.g., AA)

-no treatment has been shown to be effective in the long-term

-initial results of most treatments are positive, but recidivism rates are high

-in general, 30% - 40% remain substance-free one year after treatment

-treatments include:

-detoxification, sometimes in hospital

-drug treatments (antabuse for alcohol; methadone for heroin; nicotine for smokers)

-behavioral family/marital therapy to reinforce not using substance and complying to antabuse medications

-behavioral aversion therapy; covert sensitization

-behavioral contingency management of reinforcement of behaviors incompatible with substance use

-behavioral self-control training (use of self-monitoring, evaluation, and reinforcement)

-behavioral controlled drinking ; self-control, social skills to resist use, cognitive attribution of relapse

-GESTALT, which was used in the text's case study

-one of the most widely disseminated drug abuse prevention programs

-involves students in late primary and middle school

-includes values, decisions, self-concept, respect for the law, peer resistance training

-often conducted by police officers in 17 sessions @ 45 minutes per session

-sometimes includes drug awareness training for parents and teachers

-teacher gives supplemental lessons

-drug and alcohol identification and physical and behavioral effects

-social context of drug and alcohol abuse

-misuse of dependence on drugs and alcohol

-self-development

-interpersonal skills

-coping skills

-responsible decision-making

-zero tolerance for substance use

-longterm follow-up studies evaluate effectiveness

(Lyman et al., 1999, JCCP, 67, 590-593; Lyman & Milich, 2002, National Association of School Psychologists Communique, 31)

-reports prevalence of drug use among children:

61% of 12^th graders have smoked cigarettes

64% of 12^th graders have had at least one alcoholic drink

49% of 12^th graders have tried marijuana

29% of 12^th graders have tried other illegal drugs

-studied both short-term and long-term (10 year follow-up at age 20) effect of DARE administered to about 3500 children

-children randomly assigned to DARE versus drug education in health classes

-found no effect upon

-alcohol, tobacco, or other drug use

-ability to resist peer pressure

PLUS

-a NEGATIVE effect upon self-esteem!!! (iatrogenic)