I. Do you have a substance abuse problem?

II. Rates and expenses incurred

    - 15.3 million people in US have alcohol abuse problems

    - 5.2 million have drug abuse problems

    - 25% of population has at least a history of substance abuse
 

    - 1995: $177 billion spent on substance abuse

    - 100,000 deaths/year associated with alcohol abuse

    - cigarette smoking causes death in at least 400,00 people/year
 

    - 1995: over 17,000 people killed in alcohol related traffic accidents in the US

    - major cause of death among teenagers in US = drunk driving

    - DWI arrest rates highest among 18-29 y.o.

    - more than half of drunk drivers killed are under 30 y.o.
 

    - if you are convicted of DWI you will pay a fine, lose your license, and possibly go to jail

    - legal BAC level is < .10 and .05 - .09 for DWAI

    - slightly lower penalties for DWAI

    - Zero tolerance law - drivers under 21 with any alc in blood pay $125 and 6mo lic susp

    - proposal in NYC - impound car if suspected of DWI

    - DWI vehicular homicide = felony
 

III. Substances

    1. Types:
alcohol, amphetamines (speed, diet pills), caffeine, cannabis (marijuana), cocaine (also crack), hallucinogens (LSD, mescaline, Ecstasy), inhalants (glue, paint, gasoline), nicotine, opiods (morphine, heroin, codeine), phencyclidine (PCP), sedatives/hypnotics/anxiolytics (barbiturates, Quaaludes, Valium)
    (slide: Drugs and their effects)
 
 
 

    2. Estimates of rates of use
 
 
 

VI. Substance Dependence
 

    Symptoms (3 or more)

        - tolerance
 

        - withdrawal
 

        - substance taken in larger amounts or over longer time than intended
 

        - persistent desire or unsuccessful efforts to cut down or control use
 

        - great deal of time spent in obtaining, using, or recovering from the substance
 

        - important activities are given up
 

        - use is continued despite knowledge of problem that is exacerbated by substance
 
 

V. Substance Abuse

    Symptoms (one or more)

        - recurrent use resulting in failure to fulfill major role obligations
 

        - recurrent use in situations in which it is physically hazardous
 

        - recurrent substance-related legal problems
 

        - continued use despite persistent or recurrent social or interpersonal problems caused by effects of substance
 
 

VI. Models of substance abuse
 

    1. Personality based models

        - moral model
 
 

        - "addictive personality"
 
 

        - anitsocial/impulse control problems
 
 
 

    2. Disease models

        - stage theory
 
 

        - biological/genetic causes
 
 
 
 
 

    3. Psychological models

        - learning model
 
 
 
 

        - cognitive model
 
 
 
 

        - social learning
 
 
 
 
 

    4. Relation between substance problems and other mental disorders
 
 
 
 

    5. Other models

        - culture
 

        - diathesis-stress
 
 

        - multiple risk factors
 
 
 

VII. Risk factors for use and possibly abuse/dependence

    1. lower SES
 

    2. family disruption and low bonding with family
 

    3. availability of drugs
 

    4. family alcohol and drug use
 

    5. poor and inconsistent family management
 

    6. peer rejection in early grades
 

    7. associating with substance-using peers
 

    8. early and persistent problem behaviors
 

    9. academic failure
 

    10. low degree of commitment to school
 

    11. alienation and rebelliousness
 

    12. anxiety
 

    13. depression and low self-esteem
 

    14. antisocial personality, impulsivity
 

    15. physical or sexual abuse
 

    16. stressful life events
 

    17. positive expectations about substances
 

    18. genetics
 
 

VIII. Course of disorder
 

    Depends on substance, but in general...
 

        1. may be a chronic, progressive, degenerative disease with tragic severe, outcomes
 

        2. experimentation does not lead to lifelong addiction or adverse consequences
 

        3. people who use substances frequently are typically multiple substance users
 

        4. most adult substance abusers began abuse in adolescence
 

        5. most adolescents who try drugs do not progress to severe abuse
 

        6. some people show remission, especially late in life
 

        7. relapse is frequent
 

        8. no good estimates of number of people who recover
 

IX. Treatment
 

    1. Prevention