Substance Use as a Social Problem PDF

Substance Use as a Social Problem SEPTEMBER 11 T H , 2024 Announcements Bonus point opportunity: Sex & Gender-based Analysis+ (SGBA+) in Substance Use Research https://www.eventbrite.com/e/sex-gender-based-an alysis-sgba-in-substance-use-research-tickets-1004 713092907?aff=oddtdtcreator...

Substance Use as a Social Problem SEPTEMBER 11 T H , 2024 Announcements Bonus point opportunity: Sex & Gender-based Analysis+ (SGBA+) in Substance Use Research https://www.eventbrite.com/e/sex-gender-based-an alysis-sgba-in-substance-use-research-tickets-1004 713092907?aff=oddtdtcreator Date: October 8th, 2024 Time: 2:00-3:30pm ADT Location: Online Substance use in the media this week “And let me say that the United States Congress, including some of the most conservative members of the United States Senate, came up with a border security bill which I supported. And that bill would have put 1,500 more border agents on the border to help those folks who are working there right now over time trying to do their job. It would have allowed us to stem the flow of fentanyl coming into the United States. I know there are so many families watching tonight who have been personally affected by the surge of fentanyl in our country. That bill would have put more resources to allow us to prosecute transnational criminal organizations for trafficking in guns, drugs and human beings.” Substance use in the media this week “They allowed criminals. Many, many, millions of criminals. They allowed terrorists. They allowed common street criminals. They allowed people to come in, drug dealers, to come into our country, and they're now in the United States. And told by their countries like Venezuela don't ever come back or we're going to kill you. Do you know that crime in Venezuela and crime in countries all over the world is way down? You know why? Because they've taken their criminals off the street and they've given them to her to put into our country. “ Themes Supply reduction – stopping import of fentanyl Enforcement strategy – increased border presence and prosecution of drug trafficking War on Drugs framing – blaming the drug and suppliers, not focusing on the things that might lead someone to take drugs (more on this next week!) Using War on Drugs framing to justify anti-immigration policy Agenda for toda Drugs as a social problem, including: Risk factors Protective factors Social norms Stigma What factors contribute to or influence drug use? Correlates of drug use Source: Statistics Canada and American Addiction Cente Risk factors  Gender Level of education Some factors include… Social support Genetics  Correlated with lower rates of drug use Protectiv e factors Protective factors include: Being involved in Perceiving strong school and Supportive family sanctions against extracurricular and friends (social drug use (social activities safety net) exclusion) (education, income, early life) Activity 1: Consider the “whirlpools of risk” What factors might act as weights or a life jacket? Domain Risk Factors Protective Factors Individual/Personality Sensation seeking Positive upbringing? Parents, Morals? Career Family/Peers Abusive home, Supportive home parental status Community/ Rough neighbourhood, Protective, supportive, Environmental availability no availability Societal Racial, availability Safer country, laws Textbook pg. 18 “…the statistical analysis found both direct and indirect support for the hypothesized association between Euphoria and perspectives on the issue of drugs—feelings toward those who use or are addicted to drugs, the causes of drug addiction, support for harm reduction strategies, and beliefs about the effectiveness of drug treatment and education.”  “Overall, Redditors’ impressions were that the show is a realistic portrayal of SUDs, and they found the main character to be relatable. They also pointed out the character portrayed multiple negative character traits. Although many Redditors believed the show was realistic, others felt it glorified substance use. ” “man, the portrayal of opiate addiction is inaccurate as fuck. There’s no way Rue would have just gotten clean two separate times without going on subs [opioid substitutes]…” “If you think addiction is glamorous then you haven’t seen addiction.” In summary… There are a range of overlapping factors that can work together to increase or decrease someone’s drug use Much like the SDOH, social factors may be the most impactful and the hardest to address! Delivering education alcohol is relatively easy But if that alone worked, none of us would ever over- drink… Addressing housing, income, social exclusion, social norms, early childhood experiences….more complicated! What factors determine when drug use is a problem? Social norms about drug use Social norms around alcohol use  What are some of the social norms regarding the use of various drugs? Activity 2: Why do you think there are Social norms different social norms regarding different drugs? How difficult do you think these social norms are to change? We know that there are protective and risk factors that will influence someone’s initiation of and experience with drug use. We also know that there are social norms surrounding drug use, impacting what we might see as problematic. So when is drug use a “problem”? Vs. Vs Vs Vs  Problems directly related to taking the drug such as an overdose or injuries Social problems related to taking a drug such as being arrested or Drug Use as causing an accident (drinking and a Social driving) Problem Factors that influenced the creating of drug law/policies (more about how policies were developed will be covered next week) Toxicity Dependence Crime Factor 1: Toxicity Toxic: poisonous, deadly, or dangerous Toxicity: refers to the effects of drugs that interfere with normal functioning in such a way as to produce dangerous or potentially dangerous consequences ◦ E.g. Alcohol poisoning- suppresses respiration What makes it toxic? ◦ Amount used ◦ How it was used ◦ What the user did while using the drug ◦ Acute (short-term/single dose) and chronic toxicity (long-term effects from repeated use)  Tolerance Diminished effect on the body after repeated use of the same drug; same dose but lesser effect The body develops ways to compensate for the chemical imbalance caused by the drug Regular drug users may build up tolerance to the extent Factor 2: that their dosage would kill a nontolerant individual Dependence Physical dependence Defined by the occurrence of a withdrawal syndrome Tolerance typically precedes physical dependence If drug use is stopped suddenly, withdrawal symptoms occur, ranging from mild to severe Physical dependence means the individual has come to depend on the substance to function normally Psychological or behavioural dependence High frequency of drug use Emotional desire/craving for the drug to elicit positive effect Tendency to relapse after stopping use Reinforcement- a procedure in which a behavioural event is followed by a consequence event, such that the behaviour is then more likely to be repeated. ◦ A consequence is any change (good or bad) following a behavior that makes the behavior more or less likely to happen. ◦ Over time, this becomes the biggest reason users report they continue to use Table 2.1: Examples of Four Types of Drug-Induced Toxicity Acute (immediate) Behavioural “Intoxication” from alcohol, marijuana, or other drugs that impair behaviour and increase danger to the individual. Physiological Overdose of heroin or alcohol causing the user to stop breathing. Chronic (long-term) Personality changes reported to occur in alcoholics and suspected by some to occur in marijuana users (amotivational syndrome). Behavioural The long-term use of marijuana has been associated with increased risk of addiction, and harm to person’s memory, concentration, intelligence, and decision-making ability. Heart disease, lung cancer, and other effects related to smoking; liver Physiological damage and multiple organ cancers resulting from chronic alcohol exposure. The long-term effects of smoking marijuana have been associated with risks for bronchitis and lung infections. Which is more important? The theory that psychological dependence is more important than physical dependence has increasingly become accepted as the driving force behind repeated drug use. The DSM-V provides complex behavioral definitions for substance-related disorders. Substance-related disorders are divided into two groups: Substance Use Disorders and Substance-induced Disorders. ◦The DSM-V provides diagnostic criteria for Substance Use Disorder. ◦See textbook Chapter 2 DSM-5: Diagnostic criteria for SUD 1.Taking the substance in larger amounts or for longer than you're meant to 2.Wanting to cut down or stop using the substance but not managing to 3.Spending a lot of time getting, using, or recovering from use of the substance 4.Cravings and urges to use the substance 5.Not managing to do what you should at work, home, or school because of substance use 6.Continuing to use, even when it causes problems in relationships DSM-5: Diagnostic criteria for SUD cont’d 7. Giving up important social, occupational, or recreational activities because of substance use 8. Using substances again and again, even when it puts you in danger 9. Continuing to use, even when you know you have a physical or psychological problem that could have been caused or made worse by the substance 10. Needing more of the substance to get the effect you want (tolerance) 11. Development of withdrawal symptoms, which can be relieved by taking more of the substance Contemporary debates in substance dependence Is dependence caused by the substance? Is dependence biological? Is there an “addictive personality”? Is dependence a family disorder? Is dependence a disease?  Some drugs are more likely to result in dependence than others are and method of use influences risk of dependence (injections vs smoking). Is The dependence potential of psychoactive dependence drugs may be categorized from “very low” to “very high.” caused by The concept of a “war on drugs” reflects the the perspective that drugs that cause substance? dependence possess both personality and motives – evil motives. Placing all the blame on the drug itself ignores the potential beneficial uses of the drug and fails to account for why dependence does not develop in most users. Table 2.3: Dependence Potential of Psychoactive Drugs Very high Heroin (IV) Crack cocaine High Morphine (injected) Opium (smoked) Moderate/high Cocaine powder (snorted) Tobacco cigarettes PCP (smoked) Moderate Diazepam (Valium) Alcohol Amphetamines (oral) Moderate/low Caffeine MDMA* (ecstasy) Marijuana Low Ketamine (see Chapter 14) Very low LSD† Mescaline Psilocybin * MDMA, methylenedioxymethamphetamine † LSD, lysergic acid diethylamide Source: Gable, R.S. Toward a Comparative Overview of Dependence Potential and Acute Toxicity of Psychoactive Substances Used Nonmedically. American Journal of Drug and Alcohol Abuse 19 (1993), pp. 263–81. Taylor and Francis publishers. Is dependence biological? Possibility that all compulsive behaviours might have some common physiological or biochemical action in the brain (dopamine) that increases risk of being dependent However, no genetic, physiological, or biochemical marker has been found that strongly predicts dependence. Ongoing research in the field of pharmacogenetics may soon lead to the identification of such markers.  Is there an “addictive personality”? Many factors affect personality The personality trait “sensation seeking” has been associated with greater risk for abuse of stimulants. ◦ Tend to a greater “high” and greater “liking” of a substance in laboratory Researchers are also studying complex relationships between impulsivity, the tendency to act quickly without as much regard to long term consequences, and drug use. All of these factors are complex Other viewpoints Family disorder? Evidence suggests that dysfunctional relationships play a role in the development of dependence, but such relationships are not the sole factor. Disease? Some characterize addiction as a disease Others argue that substance dependence doesn’t have all the characteristics of a disease ◦ Cannot take a blood test or x-ray to “prove” its existence ◦ Perhaps “like” a disease but not it “is” a disease ◦ Disease conceptualization may help de-stigmatize Factor 3: Crime Laws may be enacted based on certain beliefs about the connection between drug use and crime. Belief that drug use may change an individual’s personality in a lasting way, turning the individual into a “criminal type.” There is little evidence to support this claim with most illicit drugs. However….alcohol is associated with assault and sexual assault Crimes may be carried out for the purpose of obtaining money to purchase drugs. Illicit drug use is a crime. ◦ More than 100,000 police-related drug offences are reported every year in Canada However… Think about the social determinants of health – drug use is only one factor why someone may be charged with committing a crime (poverty) Some individuals commit a crime because they have no social supports (long wait times for treatment or no treatment in their community) Other factors? Stigma & substance use  What is stigma? Stigma is defined as the experience of being “deeply discredited” or marked as a result of one’s “undesired differentness.” For example, less likely to be offered help than those with a mental or physical illness Are there different stigmas/stereotypes for different substances? Types of stigma: Individual Institutional Self-stigma Stigma by association  What are some terms/names used to describe someone with dependences? Things What are some attitudes/perception to of people struggling with dependence issues? conside Do you think certain populations r face increased stigma/discrimination regarding substance use? For example, are certain populations “judged” more harshly? Key Elements of Drug-Related Stigma 3. 1. Blame 2. Regard/treat and moral Criminalizati as abnormal judgment on or unhealthy 5. Fear and 4. Patronize isolate Seeing beyond the substance Stigma: Seeing beyond substance Have you ever witnessed or experience stigma concerning PWUD? Thinking about the situation, what are some strategies that could have helped you and/or the person experiencing the stigma? Examples can include stigma you witnessed in a news story you’ve read/watched, a friend or family member’s situation, the way PWUS were depicted by someone else, or a personal experience.  What can we do to reduce stigma? 1. Use “people-first” language (e.g. Person who use substances) 2. Use language that reflect the medical nature of substance use disorders and treatment (e.g. substance use disorder) 3. Avoid slang (e.g. junkie) 4. Identify people how they want to be identified 5. Others? Source: North Bay Parry Sound Health District Education Campaign Shaming the sick: Substance use and stigma Next week Topic: Drug Policy in Canada and beyond Reading: Textbook Chapter 3 Recommended readings provide examples of drug policy in Portugal & BC Guest lecture (virtual): Cayley Russell Canadian Research Initiative in Substance Misuse Qualitative evaluation of BC’s decriminalization policy Your first discussion post will be based on