Chapter 7 in Health: The Basics - Addictive Behaviors, Licit and Illicit

7Addictive Behaviors,
Licit and Illicit Drugs
USE, MISUSE, AND ABUSE
How can I recognize the signs of addiction in a loved one or even myself?
Is my roommate’s obsessive gambling an addiction?
Should I be concerned about the safety of prescription drugs?
Are there any negative long-term effects from marijuana use?
OBJECTIVES
■ Identify the signs of addiction and discuss types of addictions, including
compulsive behaviors such as gambling and shopping.
■ Discuss the six categories of drugs and their routes of administration.
■ Compare choices in prescription and over-the-counter drugs, and
understand how to use them safely and how hazardous drug interactions
can occur.
■ Profile illicit drug use in the United States, including who uses illicit
drugs, financial impact, and impact on college campuses and the
workplace.
■ Discuss the use and abuse of controlled substances, including cocaine,
amphetamines, marijuana, opiates, hallucinogens, designer drugs,
ISBN: 0-558-34154-3
inhalants, and steroids.
Health: The Basics, Eighth Edition, by Rebecca J. Donatelle. Published by Benjamin Cummings. Copyright © 2009 by Pearson Education, Inc.

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It isn’t difficult these days to find high-profile toms that occurs when the addicted person abruptly stops
cases of compulsive and destructive behavior.
using the drug.
Stories of celebrities and politicians struggling
2. Continued use of the substance despite knowledge of the
with addictions to alcohol, drugs, and sex are
harm it causes oneself and others (deterioration in work
splashed in the headlines and profiled on
performance, relationships, and social interaction).
television news programs. But millions of
“everyday” people throughout the world are
3. Unsuccessful efforts to cut down or cease using the drug,
including relapse, the tendency to return to the addictive
staging their own battles with addiction as well. Addictions
behavior after a period of abstinence.
can be perplexing, because many potentially addictive activi-
ties may actually enhance the lives of those who engage in
4. Tolerance or an acquired reaction to a drug in which
them moderately. In addition to alcohol and drugs, commonly
continued intake of the same dose has diminished effects.
recognized objects of addiction include gambling, shopping,
In response to tolerance, drug users must increase the
and borrowing money.
dose to achieve the desired effect.
Until recently, health professionals were unwilling to diag-
nose an addiction until medical symptoms appeared in the
Defining Addiction
patient. Now we know that although withdrawal, pathological
behavior, relapse, and tolerance are valid indicators of addic-
Addiction is continued involvement with a substance or
tion, they do not characterize all addictive behavior.
activity despite ongoing negative consequences. Addictive
behaviors initially provide a sense of pleasure or stability
that is beyond the addict’s power to achieve in other ways.
Eventually, the addicted person needs to be involved in the
Signs of Addiction
behavior to feel normal.
Studies show that all animals share the
How can I
In this chapter, addiction is used interchangeably
same basic pleasure and reward circuits
recognize the
with physiological addiction. However, physiological
in the brain that turn on when they
signs of
dependence, the adaptive state that occurs with regular
engage in something pleasurable. We all
addiction in a
addictive behavior and results in withdrawal symptoms, is
loved one or
engage in potentially addictive behaviors
only one indicator of addiction. Psychological dynamics play
even myself?
to some extent because some are essential
an important role, which explains why behaviors not related
to our survival and are highly reinforcing,
to the use of chemicals—gambling, for example—may also
such as eating, drinking, and sex. At some point along the
be addictive. A person who possesses a strong desire to con-
continuum, however, some individuals are not able to engage
tinue engaging in a particular activity is said to have devel-
in these behaviors moderately, and they become addicted.
oped a psychological dependence. In fact, psychological and
Addictions are characterized by four common symptoms:
physiological dependence are so intertwined that it is not
(1) compulsion, or excessive preoccupation with the behavior
really possible to separate the two. For every psychological
state, there is a corresponding physiological state. In other
words, everything you feel is tied to a chemical process
occurring in your body.1 Thus, addictions once thought to be
addiction Continued involvement with a substance or
entirely psychological in nature are now understood to have
activity despite ongoing negative consequences.
physiological components.
To be addictive, a substance or behavior must have the
physiological dependence The adaptive state that occurs
potential to produce a positive mood change. Chemicals are
with regular addictive behavior and results in withdrawal
responsible for the most profound addictions, not only
symptoms.
because they produce dramatic mood changes, but also be-
withdrawal A series of temporary physical and
cause they cause cellular changes to which the body adapts
biopsychosocial symptoms that occur when an addict
so well that it eventually requires the chemical to function nor-
abruptly abstains from an addictive chemical or behavior.
mally. Yet other behaviors, such as gambling, spending money,
relapse The tendency to return to an addictive behavior
working, and sex, also create changes at the cellular level
after a period of abstinence.
along with positive mood changes. Although the mechanism is
not well understood, all forms of addiction probably reflect
tolerance Phenomenon in which progressively larger doses
dysfunction of certain biochemical systems in the brain.2
of a drug or more intense involvement in a behavior are
Traditionally, diagnosis of an addiction was limited to
needed to produce the desired effects.
drug addiction and was based on four criteria as defined by
compulsion Preoccupation with a behavior and an
the American Psychological Association:
overwhelming need to perform it.
1. Use for the purpose of relieving withdrawal symptoms—
a series of temporary physical and psychological symp-
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CHAPTER 7
Addictive Behaviors, Licit and Illicit Drugs
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Health: The Basics, Eighth Edition, by Rebecca J. Donatelle. Published by Benjamin Cummings. Copyright © 2009 by Pearson Education, Inc.

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Compulsive or Pathological
Gambling
Gambling is a form of recreation and entertainment for
millions of Americans. Most people who gamble do so
casually and moderately to experience the excitement of
anticipating a win.
However, over 3 million Americans
Is my
are compulsive, or pathological,
roommate’s
gamblers (addicted to gambling), and
obsessive
15 million more are considered to be
gambling an
at risk for developing a gambling
addiction?
addiction.3 The American Psychiatric
Association (APA) recognizes pathologi-
cal gambling as a mental disorder and lists ten characteristic
As a result of the growing popularity of poker games, betting on
behaviors, including preoccupation with gambling, unsuc-
sports events, and online gambling, college students have a problem
gambling rate two or three times that of the general population.
cessful efforts to cut back or quit, using gambling to escape
problems, and lying to family members to conceal the extent
of involvement with gambling.
Gamblers and drug addicts describe many similar
and an overwhelming need to perform it; (2) loss of control,
cravings and highs. A recent study supports what many
or the inability to predict reliably whether any isolated
experts believe to be true: that compulsive gambling is like
occurrence of the behavior will be healthy or damaging;
drug addiction. Compulsive gamblers in this study were
(3) negative consequences, such as physical damage, legal
found to have decreased blood flow to a key section of the
trouble, financial problems, academic failure, or family
brain’s reward system. Much as with people who abuse
dissolution, which do not occur with healthy involvement in
drugs, it is thought that compulsive gamblers compensate
any behavior; and (4) denial, the inability to perceive that the
for this deficiency in their brain’s reward system by overdo-
behavior is self-destructive. These four components are
ing it and getting hooked.4 Most compulsive gamblers state
present in all addictions, whether chemical or behavioral.
that they seek excitement even more than money. They
place increasingly larger bets to obtain the desired level of
Addictive Behaviors
excitement.
Who is at risk for getting hooked to the rush of gambling?
Men are more likely to have gambling problems than women
Clearly, tobacco, alcohol, and other drugs are addictive, and
are. Gambling prevalence is also higher among lower-income
addictions to these drugs create multiple problems for ad-
individuals, those who are divorced, African Americans, older
dicted individuals as well as their families and society. Later
adults, and individuals residing within 50 miles of a casino.
in this chapter, and in other chapters in this book, we will dis-
Residents in southern states, where opportunities to gamble
cuss specific substance-related addictions. But first, we will
have increased significantly over the past 20 years, also have
examine two behaviors known to be addictive because they
higher gambling rates.5
are mood-altering: compulsive gambling and shopping.
Gambling among college students appears to be on the
rise across the nation. In a 2005 telephone poll conducted
by University of Pennsylvania’s Annenburg Public Policy
Center, 15.5 percent of college students reported gambling
loss of control Inability to predict reliably whether a
once a week, up from 8.3 percent in 2002, an 87 percent
particular instance of involvement with an addictive
increase. Men dominated the gambling scene, with 26 percent
substance or behavior will be healthy or damaging.
reporting gambling each week, whereas 5.5 percent of
women reported gambling weekly.6
negative consequences Physical damage, legal trouble,
What accounts for this trend? College students have easier
financial ruin, academic failure, family dissolution, and other
access to gambling opportunities than ever before with the
severe problems associated with addiction.
advent of online gambling, a growing number of casinos,
denial Inability to perceive or accurately interpret the self-
scratch tickets, lotteries, and sports betting networks. In
destructive effects of an addictive behavior.
particular, the largest boost has come from the increasing
compulsive (pathological) gambler A person addicted
popularity of poker. Access to poker on the Internet and tele-
ISBN: 0-558-34154-3
to gambling.
vised poker tournaments have revived the game, causing
188 PART THREE Avoiding Risks from Harmful Habits
Health: The Basics, Eighth Edition, by Rebecca J. Donatelle. Published by Benjamin Cummings. Copyright © 2009 by Pearson Education, Inc.

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many young people to spend an unhealthy amount of time
people incur overwhelming debt through a combination of
and money participating in online poker tournaments.
hardship and ignorance about financial management, com-
On campus, it is more common for men to gamble than
pulsive debtors incur debt primarily as a result of buying or
women. Other characteristics associated with gambling
gambling behaviors in which they have engaged to relieve
among college students include spending more time watching
painful feelings.
TV, using computers for nonacademic purposes, spending
less time studying, earning lower grades, participating in
intercollegiate athletics, and engaging in heavy, episodic
How Addiction Affects
drinking and using illicit drugs in the past year.7
Whereas casual gamblers can stop anytime they wish and
Family and Friends
are capable of seeing the necessity to do so, compulsive
gamblers are unable to control the urge to gamble even in
The family and friends of an addicted person also suffer
the face of devastating consequences: high debt, legal prob-
many negative consequences. Often they struggle with
lems, and the loss of everything meaningful, including
codependence, a self-defeating relationship pattern in which
homes, families, jobs, health, and even their lives. Gambling
a person is “addicted to the addict.” It is the primary outcome
can also have a detrimental affect on health: cardiovas-
of dysfunctional relationships or families.
cular problems affect 38 percent of compulsive gamblers,
Codependence is not accurately defined by isolated inci-
and their suicide rate is 20 times higher than that of the
dents, but rather by a pattern of behavior. Codependents find
general population.
it hard to set healthy boundaries and often live in the chaotic,
crisis-oriented mode that naturally occurs around addicts.
Compulsive Shopping
They assume responsibility for meeting others’ needs to the
point that they subordinate or even cease being aware of their
and Borrowing
own needs. They may be unable to perceive their needs
because they have repeatedly been taught that their needs are
Although compulsive spending has been a pervasive problem
inappropriate or less important than someone else’s. Their
in the United States for some time, a more insidious form of
behavior goes far beyond performing kind services for another
the addiction lurks in the new “plastic generation.” Credit
person. Codependents feel less than human if they fail to
card companies entice you with fantasies of having it all,
respond to the needs of someone else, even when their help
right now—whether or not you can afford it.
was not requested. Although the term codependent is used less
The credit card companies seem to be succeeding. There
frequently today, treatment professionals still recognize the
are 400 million MasterCards and Visas out there. Add to that
importance of helping addicts see how their behavior affects
cable shopping stations, catalog shopping, and shopping over
those around them and of working with family and friends to
the Internet, and the opportunity to overspend is greater
establish healthier relationships and boundaries.
than ever before. The resulting debt from all this spending
Family and friends can play an important role in getting
is phenomenal. After bankruptcies, formerly a last resort,
an addict to seek treatment. They are most helpful when
reached a record high in 2005, new laws came into effect in
they refuse to be enablers. Enablers are people who
2006 reducing the number of bankruptcy filings by 70 percent
knowingly or unknowingly protect addicts from the natural
to 618,000 for 2006. But consumer debt remains high, and it
consequences of their behavior. If they don’t have to deal
is expected that the number of bankruptcies filed will soon
with the consequences, addicts cannot see the self-
increase again.8 On average, compulsive spenders are
destructive nature of their behavior and will therefore con-
$23,000 in debt, usually in the form of credit card debt or
tinue it. Codependents are the primary enablers of their
mortgages against their homes.9
addicted loved ones, although anyone who has contact with
Although most people can manage debt with careful
an addict can be an enabler and thus contribute (perhaps
planning, some spend money to meet emotional needs they
powerfully) to continuation of the addictive behavior.
can’t fulfill elsewhere. Anxiety, self-doubt, and anger all
Enablers are generally unaware that their behavior has this
lead to spending as a way of coping with daily stressors.
effect. In fact, enabling is rarely conscious and certainly
College students may be particularly vulnerable to spending
not intentional.
problems because advertisers and credit card companies heav-
ily target them.
Compulsive gambling and shopping can frequently lead
to compulsive borrowing to help support the addiction. Irre-
codependence A self-defeating relationship pattern in
sponsible investments and purchases lead to debts that the
which a person is “addicted to the addict.”
addict tries to repay by borrowing more. Compulsive debtors
enablers People who knowingly or unknowingly protect
borrow money repeatedly from family, friends, or institu-
addicts from the natural consequences of their behavior.
tions in spite of the problems this causes. Whereas most
ISBN: 0-558-34154-3
CHAPTER 7
Addictive Behaviors, Licit and Illicit Drugs
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Health: The Basics, Eighth Edition, by Rebecca J. Donatelle. Published by Benjamin Cummings. Copyright © 2009 by Pearson Education, Inc.

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Drugs being
swallowed/smoked
Once in bloodstream,
Drugs being
chemicals attach to
injected
receptor sites in
various parts of the body.
Steps in Drug Breakdown
1. Drug is introduced.
2. Drug circulates in bloodstream.
3. Drug attaches to specific
receptor sites.
4. Liver breaks down drugs
circulating in bloodstream.
5. Drugs at receptor sites
dissipate.
6. Lungs, bowels, skin, and
kidneys excrete chemicals
metabolized by the liver.
FIGURE 7.1 How the Body Metabolizes Drugs
?what do youTHINK? Although overall use of drugs in the United States has
fallen by 50 percent in the last 20 years, the past 10 years
Why do we tend to protect others from the natural
have shown an increase in the use of certain drugs by adoles-
consequences of their destructive behaviors? ■ Have
cents.11 It is important to understand how drugs work and
you ever confronted someone you were concerned
why people use them. Humans appear to have a need to alter
about? If so, was the confrontation successful?
their consciousness, or mental state. We like to feel good or
■ What tips would you give someone who wants to
escape the normal. Consciousness can be altered in many
confront a loved one about an addiction?
ways: children spinning until they become dizzy and adults
enjoying the rush of thrilling extreme sports are examples.
To change our awareness, many of us listen to music, sky-
Drug Dynamics
dive, ski, read, daydream, meditate, pray, or have sexual
relations. Others turn to drugs to alter consciousness.
Drugs work because they physically resemble the chemi-
Drug misuse and abuse are problems of staggering proportions
cals produced naturally within the body (Figure 7.1). Most
in our society. Each year, drug and alcohol abuse contributes to
bodily processes result from chemical reactions or from
the destruction of families and jobs and to the deaths of more
changes in electrical charge. Because drugs possess an elec-
than 120,000 Americans. Drug abuse costs taxpayers more
trical charge and chemical structure similar to those of chemi-
than $294 billion in preventable health care costs, extra law
cals that occur naturally in the body, they can affect physical
enforcement, vehicle crashes, crime, and lost productivity.10
functions in many different ways. For example, many
It’s impossible to put a dollar amount on the pain, suffering,
painkillers resemble the endorphins (meaning “morphine
and dysfunction that drugs cause in our everyday lives.
within”) that are manufactured in the body.
A current explanation of how drugs work is the receptor site
ISBN: 0-558-34154-3
theory, which states that drugs bind to specific receptor sites in
receptor sites Specialized locations on cell membranes to
the body. These sites are locations on the membranes of some
which drugs can attach themselves.
cells to which, because of their size, shape, electrical charge,
190 PART THREE Avoiding Risks from Harmful Habits
Health: The Basics, Eighth Edition, by Rebecca J. Donatelle. Published by Benjamin Cummings. Copyright © 2009 by Pearson Education, Inc.

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and chemical properties, drugs can attach themselves. Most
benign items such as perfumes, cosmetics, household
drugs attach to multiple receptor sites on cells located through-
cleansers, paints, glues, inks, dyes, gardening chemicals,
out the body in places such as the heart and circulatory system,
pesticides, and industrial by-products.
the lungs, liver, kidneys, brain, and gonads (testicles or ovaries).
>
Routes of Administration
try it NOW!
of Drugs
Achieve a drug-free and “natural high.” Many people
Route of administration refers to the way in which a given
become addicted to drugs because of the positive, short-
drug is taken into the body. The most common methods include
term effects they can exert on mood. Right now, you can
oral ingestion (by mouth), inhalation (administration of drugs
take a walk in a beautiful and sense-stimulating location,
through the mouth or nostrils via sniffing or smoking), and
lose yourself in a favorite song, or visit an amusement
injection into the muscles (intramuscular) bloodstream (intra-
park and ride the roller coaster to satisfy a craving for
venous), or just under the skin (subcutaneous). Intravenous
injection, which involves the insertion of a hypodermic syringe
an endorphin rush or simply to lift your spirits.
directly into a vein, is the most common method of injection
Types of Drugs
for drug misusers because the drug’s effect is felt rapidly. It is
also the most dangerous method of administration because of
the risk of contracting HIV and/or hepatitis B and damage to
Scientists divide drugs into six categories: prescription, over-
blood vessels. Drugs can also be absorbed through the skin or
the-counter, recreational, herbal, illicit, and commercial
tissue linings (inunction)—the nicotine patch is a common
drugs. These classifications are based primarily on drug
example of a drug that is administered in this manner—or
action, although some are based on the source of the chemical
in question. Each category includes some drugs that stimulate
body functions and some that depress body functions. Each
psychoactive drugs Drugs that have the potential to alter
category also includes psychoactive drugs, which have the
mood or behavior.
potential to alter a person’s mood or behavior.
prescription drugs Medications that can be obtained only
■ Prescription drugs can be obtained only with the written
with the written prescription of a licensed physician.
prescription of a licensed physician or other health care
provider with prescription rights. More than 10,000 types
over-the-counter (OTC) drugs Medications that can be
of prescription drugs are sold in the United States, at an
purchased without a physician’s prescription.
annual cost of over $200 billion to consumers.12
recreational drugs Drugs that contain chemicals that help
■ Over-the-counter (OTC) drugs can be purchased without
people relax or socialize; most, but not all, drugs in this
a prescription. Each year, Americans spend more than
category are legal.
$20 billion on OTC products, and the market is increasing
herbal preparations Substances of plant origin that are
at the rate of 20 percent annually. More than 300,000 OTC
believed to have medicinal properties.
products are available, and an estimated three out of four
people routinely self-medicate with them.
illicit (illegal) drugs Drugs whose use, possession,
■ Recreational drugs belong to a somewhat vague category
cultivation, manufacture, and/or sale are against the law
whose boundaries depend on how the term recreation is
because they generally are recognized as harmful.
defined. Generally, these drugs contain chemicals used to
commercial preparations Commonly used chemical
help people relax or socialize. Most of them are legally
substances including cosmetics, household cleaning products,
sanctioned even though they are psychoactive. Alcohol,
and industrial by-products.
tobacco, coffee, tea, and chocolate products are usually
route of administration The manner in which a drug is
included in this category.
taken into the body.
■ Herbal preparations form another vague category.
Included among these approximately 750 substances are
oral ingestion Intake of drugs through the mouth and into
herbal teas and other products of botanical (plant) origin
the digestive tract.
that are believed to have medicinal properties. (See
inhalation The introduction of drugs through the nostrils
Chapter 17 for more on herbal preparations.)
or mouth and into the lung.
■ Illicit (illegal) drugs are the most notorious type of drug.
injection The introduction of drugs into the body via a
Although laws governing their use, possession, cultivation,
hypodermic needle.
manufacture, and sale differ from state to state, illicit
drugs generally are recognized as harmful. All of them are
intravenous injection The introduction of drugs directly
psychoactive.
into a vein.
■ Commercial preparations are the most universally used
inunction The introduction of drugs by absorption
yet least commonly recognized chemical substances. More
through the skin.
than 1,000 of these substances exist, including seemingly
ISBN: 0-558-34154-3
CHAPTER 7
Addictive Behaviors, Licit and Illicit Drugs
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Health: The Basics, Eighth Edition, by Rebecca J. Donatelle. Published by Benjamin Cummings. Copyright © 2009 by Pearson Education, Inc.

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through the vagina or anus in the form of suppositories. Sup-
Today, consumers have a variety of resources available to
positories are typically mixed with a waxy medium that melts
them for determining risks of various prescription medicines
at body temperature so the drug can be released into the blood-
and can make educated decisions about whether or not to take
stream. However the drug enters the system, most drugs remain
a certain drug. One of the best resources is the U.S. Food and
active in the body for several hours.
Drug Administration (FDA) Center for Drug Evaluation and
Research website (www.fda.gov/cder). This special consumer
section of the FDA provides current information on risks and
Using, Misusing,
benefits of prescription drugs. Being knowledgeable about
what you are taking or thinking about taking is a sound
and Abusing Drugs
strategy to ensure safety. (See the Consumer Health box
for more on prescription drug safety issues.)
Although drug abuse usually is referred to in connection with
illicit psychoactive drugs, many people abuse and misuse
Types of Prescription Drugs
prescription and OTC medications. Drug misuse involves
the use of a drug for a purpose for which it was not intended.
Antibiotics are drugs used to fight bacterial infection. Bacter-
For example, taking a friend’s high-powered prescription
ial infections continue to be among the most common serious
painkiller for your headache is a misuse of that drug. This is
diseases throughout the world, but the vast majority can be
not too far removed from drug abuse, the excessive use of
cured with antibiotics. There are close to 100 different antibi-
any drug, and may result in serious harm.
otics, which may be dispensed by intramuscular injection or
The misuse and abuse of any drug may lead to addiction.
in tablet or capsule form. Some, called broad-spectrum
Both risks and benefits are involved in the use of any chemi-
antibiotics, are designed to control disease caused by a
cal substance. Intelligent decision making requires a clear-
number of bacterial species. These medications may also kill
headed evaluation of these risks and benefits.
off helpful bacteria in the body, thus triggering secondary
infections. For example, some vaginal infections are related
to long-term use of antibiotics. It is important to follow your
?what do youTHINK? health care provider’s directions when taking antibiotics and
to use them only when you have a bacterial infection. The
What are some situations in which students misuse
misuse of antibiotics has led to a dangerous increase in drug-
drugs? ■ Other than alcohol, which drugs
resistant bacteria in recent years.
(prescription or OTC) do students tend to abuse
Central nervous system depressants are sedative or hyp-
while they are in college?
notic medications commonly used to treat anxiety. The two
main types of drugs in this group are benzodiazepines (such
Prescription Drugs
as Valium, Ativan, and Xanax), and barbiturates (including
Amytal and Seconal). The benzodiazepines are the most
widely used drug in this category, most commonly prescribed
Even though prescription drugs are administered under med-
for tension, muscular strain, sleep problems, anxiety, panic
ical supervision, the wise consumer still takes precautions.
attacks, and alcohol withdrawal. They differ widely in their
Hazards and complications arising from the use of prescrip-
mechanism of action, absorption rate, and metabolism, but all
tion drugs are common.
produce similar intoxication and withdrawal symptoms. Ben-
zodiazepine sleeping pills have largely replaced barbiturates,
which were used medically in the past for relieving tension
suppositories Mixtures of drugs and a waxy medium
and inducing relaxation and sleep.
designed to melt at body temperature that are inserted into
All sedative or hypnotic drugs can produce physical and
the anus or vagina.
psychological dependence in several weeks. A complication
drug misuse The use of a drug for a purpose for which it
specific to sedatives is cross-tolerance, which occurs when
was not intended.
users develop tolerance for one sedative or become dependent
on it and develop tolerance for others as well. Withdrawal
drug abuse Excessive use of a drug.
from sedative or hypnotic drugs may range from mild
antibiotics Prescription drugs designed to fight bacterial
discomfort to severe symptoms, depending on the degree of
infection.
dependence. A major public health issue is whether or not
central nervous system depressants Sedative or
persons using benzodiazepines have an increased risk of
hypnotic medications commonly used to treat anxiety.
cognitive decline and dementia. Ongoing research is investi-
gating this possible link.13
benzodiazepines Central nervous system depressants that
Antidepressants are medications typically used to treat
ISBN: 0-558-34154-3
relieve anxiety, relax the body, and induce sleep.
major depression, although occasionally they are used for
antidepressants Prescription drugs used to treat clinically
other forms of depression that resist conventional therapy.
diagnosed depression.
There are several groups of antidepressant medications
192 PART THREE Avoiding Risks from Harmful Habits
Health: The Basics, Eighth Edition, by Rebecca J. Donatelle. Published by Benjamin Cummings. Copyright © 2009 by Pearson Education, Inc.

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CONSUMER health
IMPROVING THE SAFETY OF PRESCRIPTION AND OVER-THE-COUNTER DRUGS
In 1993, the Food and Drug Admin- with it, including heart attack and stroke, assistance in prioritizing and further eval-
istration (FDA) changed its policies
and an increased risk for a potentially fatal
uating potential adverse health concerns.
to speed the approval process of
skin reaction. Lotronex, a drug for treating
■
Healthcare Professional Information
new drugs. These changes were
irritable bowel syndrome, was pulled
Sheets. These information sheets for
made for humanitarian reasons, in
from the market after being linked to
health care professionals contain the
response to activists seeking rapid approval
five deaths, the removal of one patient’s
most important new information for
of experimental drugs that offered at least
colon, and other bowel complications.
safe use, including known and potential
a ray of hope to AIDS patients who other-
In response to these events and others,
safety issues based on reports of
wise faced certain death. The “accelerated
the Food and Drug Administration has
adverse events, new information that
development/review” process was seen as
launched a new drug safety initiative. It
may affect prescribing of the drug, and
a way to offer drugs that might be a signifi-
established the Drug Safety Oversight
its approved indications and benefits.
cant improvement over existing treatments
Board to oversee safety issues, consult
■
Patient Information Sheets. These are
or that could benefit people with life-
with medical experts and consumer
one-page information sheets for
threatening illnesses for which no treat-
groups, and provide new information on
patients in a consumer-friendly format
ment currently exists.
medication risks and benefits to con-
for all products on Drug Watch. Infor-
Hundreds of new
sumers and health care providers. The FDA
mation includes new safety informa-
Should I be
drugs have been
has also developed new and improved
tion as well as basic information about
concerned
approved since then.
communication channels to the general
how to use the drug.
about the
Of that number, a
public on drug safety information.
safety of
handful have been
New communication channels include
prescription
withdrawn after
the following:
Sources: U.S. Food and Drug Administration,
drugs?
reports of deaths
“The FDA Speeds Medical Treatment for Serious
■
The Drug Watch Web Page. This page
Diseases,” March-April 2006, www.fda.gov/cder;
and severe side effects. Two examples are
includes emerging information, for
U.S. Food and Drug Administration, “Accelerated
the prescription drugs Bextra and
both previously and newly approved
Development Review,” 2006. www.fda.gov/
Lotronex. Bextra, a drug widely used for
drugs, about possible serious side effects
cder/handbook; U.S. Department of Health and
treating arthritis pain, was taken off the
Human Services, “News Release: Reforms Will
or other safety risks and how risks can
market after a large-scale study revealed a
Improve Oversight and Openness at FDA,”
be avoided. The agency will enhance
February 15, 2005, www.fda.gov/cder/
series of cardiovascular risks associated
access to this information and call for
drugsafety.htm.
approved for use in the United States. Prozac, Zoloft, and
way the drug is absorbed, potentially causing discomfort or
Paxil are well-known examples. Over the past decade,
even allergic reactions in some users. Always note any reac-
the use of antidepressant drugs in the United States has
tions you have to medications, and tell your doctor about them.
increased by 48 percent overall, and by 124 percent in
children.14
Over-the-Counter Drugs
Generic Drugs
Over-the-counter (OTC) drugs are nonprescription substances
used in the course of self-diagnosis and self-medication.
Generic drugs, medications sold under a chemical name
More than one-third of the time, people treat their routine
rather than under a brand name, have gained popularity in
health problems with OTC medications. In fact, American
recent years. They contain the same active ingredients as
consumers spend billions of dollars yearly on OTC prepara-
brand-name drugs but are less expensive. If your doctor pre-
tions for relief of everything from runny noses to ingrown
scribes a drug, always ask whether a generic equivalent exists
toenails. There are 40,000 OTC drugs and more than
and whether it would be safe and effective for you to try. Not
300,000 brand names for them.
all drugs are available as generics.
Be aware, though, that there is some controversy about
the effectiveness of generic drugs because substitutions
generic drugs Medications marketed by chemical name
sometimes are made in minor ingredients that can affect the
rather than brand name.
ISBN: 0-558-34154-3
CHAPTER 7
Addictive Behaviors, Licit and Illicit Drugs
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Health: The Basics, Eighth Edition, by Rebecca J. Donatelle. Published by Benjamin Cummings. Copyright © 2009 by Pearson Education, Inc.

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HEALTH headlines
“PHARMING” PARTIES: THE NEW DRUG ABUSE VENUE
Several teens are sitting at the ■ 225 percent for sedatives such as the dangers. “My friend told me to save
kitchen table listening to one
Nembutal and Seconal
the painkillers for when I’m drinking or
describe how she obtained
Unfortunately, prescription drugs are
getting high,” says a 17-year-old with a
OxyContin from the medicine
often easier to obtain than illegal ones.
chuckle. She doesn’t think of herself as an
chest at home. “It was left over,” she says,
Some teenagers and college students come
addict, but she recognizes the signs of
“from my sister’s wisdom teeth surgery.”
by them legitimately (such as those who
addiction among her friends: “I know a lot
Says another, “I’ll give you some of this
have a prescription for an amphetamine-
of people who live by pills. Pills can dictate
Ritalin for some of that painkiller.”
based prescription medication) but trade
your life—I have seen it.” Painkillers such as
This is not an ordinary party—it’s a
them for others, such as painkillers, that
OxyContin, Percocet, Percodan, Vicodin,
pharming party, a get-together arranged
hold more appeal because of their potent
and others are highly addictive if taken for
so young adults can barter for their favorite
high. Others order from shady Internet phar-
prolonged periods of time. OxyContin, in
prescription drugs. Pharming parties repre-
macies where prescriptions are not always
particular, can be a very addictive and
sent a growing trend among teenaged
required. Some students may fake or exag-
dangerous narcotic when abused. Users
drug abusers and college students. Accord-
gerate symptoms to persuade physicians to
may take the pill orally, snort it, or dissolve
ing to a report by the National Center on
write prescriptions.
it in a solution they can inject. The “rush”
Addiction and Substance Abuse (CASA)
Studies also find that many who are
is similar to that of heroin. Chronic use can
at Columbia University, the use of illegal
abusing prescription medications are also
also result in increasing tolerance, and
substances such as cocaine, heroin, and
abusing illegal drugs at the same time.
more of the drug is needed to achieve the
other illegal drugs on college campuses
According to another study, a national sur-
desired effect. Occasional pharming
had increased by 52 percent in 2005
vey on drug use called “Monitoring the
parties can quickly spiral into an out-of-
over 1993 rates. (Marijuana use was not
Future,” students who obtained prescrip-
control addiction.
included in the study.) CASA findings dur-
tion painkillers from peers reported higher
Sources: Excerpt from C. Banta, “Trading for a
ing this time also show that the proportion
levels of binge drinking and marijuana
High,” Time, August 1, 2005; L. D Johnston
of students abusing prescription drugs had
abuse than nonabusers or those who
et al., Monitoring the Future: National Survey
significantly increased:
received painkillers from family. This poses
Results on Drug Use, 1975–2004: Volume II,
College Students and Adults, NIH publication
■
343 percent for opiods such as
another set of problems, because alcohol
no. 05-5727 (Bethesda, MD: National Institute
Percocet, Vicodin and OxyContin
in combination with any one of these
on Drug Abuse, 2005); L. Whitten, “Studies
■
93 percent for abuse of stimulants
medications can make a dangerous
Identify Factors Surrounding Rise in Abuse of
such as Ritalin and Adderall
cocktail.
Prescription Drugs by College Students,” NIDA
■
450 percent for tranquilizers such as
Because abuse of prescription medi-
Notes 20, no. 4, 2006; The National Center on
Addiction and Substance Abuse at Columbia
Xanax and Valium
cines is a growing and not highly recog-
University, “Wasting the Best and the Bright-
nized problem, many people do not realize
est,” March 2007, www.casacolumbia.org/
supportcasa/item.asp?cID 12&PID 155.
Most OTC drugs are manufactured from a basic group of
be switched from prescription to OTC status, it must meet the
1,000 chemicals. The many different products available to us
following criteria.
are produced by combining as few as two and as many as ten
1. The drug has been marketed as a prescription medication
substances.
for at least 3 years.
How Prescription Drugs
2. The use of the drug has been relatively high during the
time it was available as a prescription drug.
Become Over-the-Counter
3. Adverse drug reactions are not alarming, and the fre-
Drugs
quency of side effects has not increased during the time
ISBN: 0-558-34154-3
it was available to the public.
The FDA regularly reviews prescription drugs to evaluate
Since this policy has been in effect, the FDA has moved
how suitable they would be as OTC products. For a drug to
hundreds of drugs to OTC status. Some examples are
194 PART THREE Avoiding Risks from Harmful Habits
Health: The Basics, Eighth Edition, by Rebecca J. Donatelle. Published by Benjamin Cummings. Copyright © 2009 by Pearson Education, Inc.

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ibuprofen, Claritin, and Prilosec. Many more prescription
drugs are currently being considered for OTC status.
TABLE 7.1
Types of Over-the-Counter Cold,
Cough, and Allergy Relievers
Types of Over-the-Counter
■ Expectorants. These drugs loosen phlegm, which allows the
user to cough it up and clear congested respiratory passages.
Drugs
GRAS and GRAE reviewers question the effectiveness of
The FDA has categorized 26 types of OTC preparations.
many expectorants. When combined with other medications,
Those most commonly used are analgesics; cold, cough,
particularly among those used by frail or very ill individuals,
safety issues may arise.
allergy, and asthma relievers; stimulants; sleeping aids and
relaxants; and dieting aids.
■ Antitussives. These OTC drugs calm or curtail the cough
reflex. They are most effective when the cough is dry (does not
produce phlegm). Oral codeine, dextromethorphan, and
Analgesics More than 50 million Americans experience
diphenhydramine are the most common antitussives that are
chronic pain. Is it any wonder that we spend more than
on both the GRAE and GRAS lists.
$2 billion annually on analgesics (pain relievers), the largest
■ Antihistamines. These central nervous system depressants dry
sales category of OTC drugs in the United States? These
runny noses, clear postnasal drip, clear sinus congestion, and
pain relievers come in several forms. Aspirin, acetaminophen
reduce tears.
(Tylenol, Pamprin, Panadol), ibuprofen (Advil, Motrin,
■ Decongestants. These remedies reduce nasal stuffiness due
Nuprin), and ibuprofen-like drugs such as naproxen (Aleve)
to colds.
and ketoprofen (Orudis) are the most common.
■ Anticholinergics. These substances often are added to cold
Most pain relievers work at receptor sites by interrupt-
preparations to reduce nasal secretions and tears. None of the
ing pain signals. Some are categorized as NSAIDs (non-
preparations tested have been found to be GRAE or GRAS.
Some cold compounds contain alcohol in concentrations that
steroidal anti-inflammatory drugs), also called prostaglandin
may exceed 40 percent.
inhibitors. Prostaglandins are chemicals released by the
body in response to pain. Prostaglandin inhibitors restrain
the release of prostaglandins and thus reduce the pain.
Common NSAIDs include ibuprofen, naproxen, and aspirin.
Besides relieving pain, aspirin lowers fever by increasing
Cold, Cough, Allergy, and Asthma
the flow of blood to the skin surface, which causes sweating
Relievers Most cold, cough, allergy, and asthma relievers
and cools the body. Aspirin long has been used to reduce the
are designed to alleviate the discomforting symptoms associ-
inflammation and swelling associated with arthritis. It is
ated with maladies of the upper respiratory tract. The opera-
widely accepted that a low dose of aspirin has anticoagulant
tive word in this category is reliever; unfortunately, no drugs
effects (that is, it interferes with blood clotting) and can
exist to cure the actual diseases. The drugs available provide
reduce the risk of heart attack and stroke.
only temporary relief until the sufferer’s immune system pre-
Possible side effects for many NSAIDs include allergic
vails over the disease. Table 7.1 describes the basic types of
reactions, ringing in the ears, stomach bleeding, and ulcers.
OTC cold, cough, and allergy relievers.
Combining aspirin with alcohol can compound aspirin’s gas-
tric irritant properties. As with all drugs, read the labels.
Sleeping Aids and Relaxants A study by the
Some analgesic labels caution against driving or operating
World Health Organization, conducted in 15 health centers
heavy machinery when using the drug, and most warn that
around the globe, found that 27 percent of patients reported
analgesics should not be taken with alcohol.
difficulties with sleeping.15 Many people routinely treat their
Research has also linked aspirin to a potentially fatal con-
insomnia with OTC sleep aids (such as Nytol, Sleep-Eze, and
dition called Reye’s syndrome. Children, teenagers, and
young adults (up to age 19) who are treated with aspirin
while recovering from the flu or chickenpox are at risk for
analgesics Pain relievers.
developing this syndrome. Aspirin substitutes are recom-
prostaglandin inhibitors Drugs that inhibit the
mended for people in these age groups.
production and release of prostaglandins, hormone-like
Acetaminophen is an aspirin substitute found in Tylenol
substances often associated with arthritis or menstrual pain.
and related medications. Like aspirin, acetaminophen is an
Also called non-steroidal anti-inflammatory drugs (NSAIDS).
effective analgesic and antipyretic (fever-reducing drug).
However, it does not relieve inflamed or swollen joints. The
Generally Recognized as Safe (GRAS) A list of drugs
side effects associated with acetaminophen generally are
generally recognized as safe, which seldom cause side effects
minimal, though overdose can cause liver damage. Both
when used properly.
aspirin and acetaminophen are on the government’s lists
Generally Recognized as Effective (GRAE) A list of
of medications that are Generally Recognized as Safe
drugs generally recognized as effective, which work for their
(GRAS) and Generally Recognized as Effective (GRAE).
intended purpose when used properly.
ISBN: 0-558-34154-3
CHAPTER 7
Addictive Behaviors, Licit and Illicit Drugs
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Health: The Basics, Eighth Edition, by Rebecca J. Donatelle. Published by Benjamin Cummings. Copyright © 2009 by Pearson Education, Inc.

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