Unit 2

Drugs and Alcohol in the Criminal Justice System

Depressants and Stimulants

Depressants include: alcohol, barbiturates, sedatives/tranquilizers, and narcotics.

Stimulants include: nicotine, caffeine, cocaine, amphetamines

Depressants “depress” the CNS, while Stimulants “stimulate” the CNS.

Depressants• Typically addicting. • Possibility of relationship between chemical deficiencies and

propensity (or likeliness) for addiction to depressants.• During 1970s, independent researchers discovered endorphins in

brain and body tissues. Endorphins have many characteristics of morphine, inhibiting pain. Self-medication can occur with deficiency in endorphin system.

• As well, difficulties dealing with stress place a person at-risk for drug abuse. Some drugs such as Heroin inhibit stress hormones (i.e. cortisol and adrenaline).

• Stress can determine why some individuals can use heroin for years without addiction (and self-administer morphine for pain without increasing dosage). Those without stress or chemical deficiencies, may not become addicted.

What do Depressants do??

• Slow breathing rate• Reduce blood pressure• Lower level of motor activity

Depressants Cont.

• Heroin – alleviates dull, chronic, less localized pain.

• Effects last only 4 to 6 hours, so withdrawal occurs several times per day.

• Daily withdrawals elicit production of stress hormones, which may cause individual to be hypersensitive and irritable/aggressive

• Normally, endorphins inhibit stress hormones (naturally produced in body), but heroin and morphine add to this effect.

Heroin Info. Cont.

• Heroin banned in U.S. since 1924. • Controversy over use for cancer patients (may

be beneficial).• Most powerful narcotic is synthetic chemical

etorphine (5,000-10,000 times more powerful than heroin). Used by vets to immobilize large, wild animals.

Effects of Opiates

• Euphoria, drowsiness, respiratory depression, dilated pupils, nausea.

Dangers of Heroin Use• Pure (aka “hot shot”) may be fatal• Most heroin “cut” for street sale for financial gain. “Cut”

means heroin is mixed with other substances, some fatal in themselves and other producing fatal interactions with heroin. In 1990s, consumer-based heroin (IV use) typically only 5% purity. Now believed to be around 60% purity. For sniffing and smoking, 40% purity, which makes it attractive drug for youth, especially those who fear AIDS.

• AIDS from shared hypodermic needles. Also, hepatitis. In NYC, it is believed there are approx. 200,000 heroin addicts. Believed that 60% may be infected with AIDS virus.

Heroin Tolerance

• Users will increase dosages to until it is no longer economically feasible (usually, then, entering drug rehabilitation program).

• Cross Tolerance – tolerance to heroin carries over to other narcotic drugs, such as morphine and methadone (synthetic heroin), but not to other depressants, such as alcohol and barbiturates.

Morphine and Codeine

• Strong depressants, used medically, but not Schedule I narcotics.

Withdrawal Symptoms• Most depressants, including heroin, are painful to stop using.

Usually withdrawal has rebounding effect; symptoms are opposite of effects produced by drug.

• Anxiety• Hyperactivity• Shaking• Cold Sweats

**** Unlikely healthy individuals will die as result of withdrawal but cause death of fetus in pregnant addict.

Withdrawal symptoms peak in 24 hours and subside in about one week. Psychological symptoms, though, may persist indefinitely.

Clonidine, non-addicting drug, sometimes prescribed to alleviate severity of withdrawal symptoms.

Oxycodone

• Synthetic version of morphine (DEA Schedule II Drug) was first introduced in 1995 and marketed under trade name OxyContin.

• Powerful depressant effective for severe pain.• Highly abused.

Barbiturates

• About 2,500 derivatives of barbituric acid.• Lawfully produced – found in tablet or capsule

form• Illegal found as liquid for IV use

What do Barbiturates do??

• Unlike opiates, barbiturates do not decrease reaction to pain (may increase it!!).

• Depress sensory cortex, decrease motor activity, alter cerebellar function, and may produce drowsiness, sedation, and hypnosis.

• In certain individuals, may create opposite effect (hyperactivity).

Barbiturates Include

• Amobarbital• Pentobarbital• Phenobarbital• Secobarbital• Amobarital-Secobarbital combination

Barbiturate Effects

• Slurred speech, disorientation, drunken behavior without odor of alcohol.

Tolerance

• Unlike opiates, there is a fatal dosage level and margin between intoxicating dosage and fatal dosage becomes smaller with continued use.

• Barbiturates are often used as “substitute” for alcohol. Combined with alcohol use, individuals may forget they’ve taken barbiturates, and this is a fatal error.

Medical Use of Barbiturates

• Primarily used for treatment of insomnia and as anticonvulsants to help prevent or mitigate epileptic seizures.

• Barbiturates used less frequently now with availability of tranquilizers/benzodiazepines.

Withdrawal from Barbiturates

• Anxiety, insomnia, tremors, delirium, convulsions, possible death.

Benzodiazepines

• Minor tranquilizers or sedatives, referred to as sedative-hypnotics. Among most highly prescribed of all drugs.

• One of the earliest was Valium (diazepam). Approved by FDA in 1963. Other include Librium and Equanil. Most recently, Prozac widely prescribed (SSRI) and newer, longer-lasting Klonopin. Klonopin believed to have fewer withdrawal symptoms b/c metabolized more slowly and leaves body gradually.

• Major or antipsychotic tranquilizers such as Thorazine do not produce euphoria and are rarely used nonmedically.

Effects of Minor Tranquilizers or SSRIs

• Absorbed into bloodstream and affect CNS, slowing physical, mental, and emotional responses.

• Slurred speech, disorientation, drunken behavior with odor of alcohol.

• Largely replaced barbiturates. Upper limit of effectiveness (after certain point, increasing dosage does not increase effect, and overdoses are rarely fatal).

Withdrawal from Benzodiazepines

• Symptoms may include anxiety, insomnia, agitation, anorexia, tremor, muscle twitching, nausea/vomiting, hypersensitivity to sensory stimuli and other perceptual disturbances, and depersonalization. After prolonged exposure (use), discontinuation may lead to hallucinations, delirium, grand mal convulsions/seizures, and, on rare occasions, death.

Dangers of Tranquilizer Use

• Short-term effects: drowsiness, dizziness, confusion, mood swings.

• Long-term effects: lethargy, irritability, nausea, loss of sexual interest, increased appetite, weight gain.

• Combined with use of alcohol, can be fatal.• Some individuals may become aggressive.• Valium overdose is second leading cause of drug-related ER

admissions in U.S.• Some tranquilizers block receptors for neurotransmitter

dopamine, leading to symptoms of Parkinson’s Disease.

Alcohol• Alcohol and tobacco use regularly go hand-in hand• Alcohol is a psychoactive (mind-altering) that (like heroin and

tranquilizers) depresses the CNS. While at first individual may appear less inhibited and more talkative, as dosage increases so do depressant effects.

• Brain has difficulty communicating with nerves and muscles.• Slurred speech, staggering, and loss of emotional control common.• Further ingestion may lead to stupor, severe respiratory depression,

coma, and death.• Binge drinking major problem among college students, leading to

dangerous behaviors and death.

Alcohol and Violence

• Alcohol is associated with great deal of violence and crime. Individuals (males, especially) are more especially provoked into fighting while under the influence.

Alcohol and Gender

• Alcohol females appear more vulnerable than alcoholic males to many medical consequences of alcohol abuse. Alcoholic women develop cirrhosis of liver, alcohol-induced damage of heart muscle cardiomyopathy), and nerve damage (peripheral neuropathy) after fewer years of heavy drinking than do alcoholic men.

Genetic Influence on Alcohol Use

• Asians often carry a gene which makes them physically ill prior to consuming addicting quantity of alcohol.

• Many studies clearly indicate genetic factors influence alcoholism (differ in estimate of degree of influence).

• Some people with particular inherited characteristics (i.e. how an individual metabolizes alcohol, hormonal and behavioral effects of alcohol, and tolerance of high levels of alcohol in blood) are at greater risk for addiction.

Genetic Influence on Alcohol Use Cont.

• First-degree relatives of alcoholics more likely to become alcoholics

• Adopted children of alcoholic parents more likely to become alcoholics

• Identical twins about twice as likely as fraternal twins to resemble each other in terms of presence of alcoholism.

Tolerance to Alcohol• Individuals do not develop tolerance to rewarding effects but rather

become tolerant to many unpleasant effects of alcohol. Even with increased consumption, individuals do not appear intoxicated.

• Alcohol abuse may result in liver and brain damage. Cirrhosis results in scar tissue replacing normal tissue and presents liver from working effectively.

• When late-stage cirrhosis develops (symptoms include jaundice, fluid in abdomen, and/or gastrointestinal bleeding), the survival rate is only 60 percent for those who stop drinking and 35 percent for those who continue drinking.

Fetal Alcohol Syndrome

• Fetus at greatest risk during first three months of pregnancy.• Fetal Alcohol Spectrum Disorders – variety of conditions that

occur as result of mother drinking during pregnancy. Serious effects of FAS include mental retardation, growth deficiency, head and facial deformities, joint and limb abnormalities, and heart defects.

• Because alcohol affects so many areas of the brain, viewed as most harmful drug pregnant female can use. Much damage ascribed to cocaine, esp. crack, appears to be primarily the result of mother using alcohol as well!!

Stimulants

• Stimulate the CNS! Two common stimulants are nicotine (found in tobacco products) and caffeine (found in coffee, tea, and some soda).

• More powerful stimulants are Cocaine and Amphetamines.• Hypothesis: cocaine and amphetamine compensate for

deficiency in three neurotransmitters – dopamine, norepinephrine, and epinephrine (adrenaline). Self-medicating to address depression or apathy?

Tolerance - Stimulants

• Tolerance can develop rapidly! Heavy users of cocaine, for instance, may inject themselves every few hours and continue until their supply is exhausted. Both physical and psychological dependence can occur. Abrupt cessation (even after a weekend “binge”) may be followed by depression, anxiety, drug craving, and extreme fatigue. This is referred to as a “crash.”

Genetics?

• In 1995, a variant of dopamine receptor D 4 was found to be associated with novelty seeking behavior (i.e. skydriving and other extreme sports). Individuals with this genetic factor tend to be highly extroverted, quick-tempered, impulsive, and easily bored. Even small amounts of extra dopamine, provided by stimulants, is an extreme reward. These people are more prone to drug abuse.

Effects of Cocaine

• Increased alertness, excitation, euphoria, increased pulse rate and blood pressure, insomnia, loss of appetite.

• Neurological Effects: Smoked, snorted, or injected cocaine rapidly enters the bloodstream and penetrates the brain. Main psychological effect (high) achieved by build-up of dopamine.

Effects of Cocaine Cont.

• In small doses, cocaine use may result in euphoria, indifference to pain, illusions of increased mental and sensory alertness and physical strength.

• Studies suggest cocaine actually heightens body’s sensitivity to stress (user fails to recognize this). Cocaine activates stress symptoms, much like when opiate user goes into withdrawal, but user fails to recognize this.

Tolerance - Cocaine

• Biological basis of tolerance to cocaine not yet fully understood. Definitely a psychological tolerance develops, particularly with cocaine, where user “chases” the “rush.”

• Withdrawal includes psychological depression, irritability, extreme fatigue, and prolonged periods of restless sleep.

Medical Use of Cocaine

• Cocaine has anesthetizing qualities; cocaine restricts blood vessels when applied topically. Only local anesthetic that has this effect, and cocaine was anesthetic of choice for eye surgery. It continues to be used in surgery of ear, nose, and throat where tubes need to pass through (about 200,000 surgeries per year). Plastic surgeons use cocaine for nose alterations.

Dangers of cocaine use

• Thought that, in very small doses, cocaine is no more harmful than equally moderate doses of alcohol and marijuana.

• Large doses of cocaine, irrational behavior is sometimes evident. Extreme reactions include delirium, hallucinations, muscle spasms, and chest pain.

• Psychosis Syndrome characterized by bizarre, paranoid agitation that frequently ends in death.

• Cardiac and Circulatory Dangers: increased heart rate and blood pressure. Cumulative effect of constriction of blood vessels can narrow arteries causing strokes, bleeding inside brain, thinking and memory deficits, and other brain disorders.

Crack Cocaine

• Oftentimes referred to as the “poor man’s drug.” Became popular on the street in the 1980s. Crack may contain any combination of freebase residue, concentrated caffeine, or different amphetamines.

• Crack is inhaled directly into the lungs (via a glass pipe, usually) and so takes only 5 seconds to take effect.

Crack Cocaine Cont.

• Wide appeal to youth. • “Hysteria” in 1980s, but appeal of drug as

subsided as label of “crackhead” took hold.• Intense craving for more after using (much

like cocaine)• Crack appears to be less addictive than

nicotine but more addictive than alcohol.• Crack users today likely “older” (20s-30s)

Crack Babies

• Cocaine use in any form has been linked to various abnormalities in infants due to reduced supply of blood and oxygen to fetus.

• Difficulties are more likely linked to poor nutrition and health of mother. Environmental factors as well.

• Crack or cocaine exposure in utero has not been linked to physical growth. Studies did not find any language or cognitive developmental problems in preschool children, but one study did find emotional and behavioral problems.

Amphetamines

• Very harmful (physically, physically, and socially). Why? Produced in laboratory/synthetic drugs.

• Methamphetamine , according to WHO, is second only to marijuana as most abused drug in world.

• Known as “speed,” “crank,” “go,” “crystal,” “crystal meth.”

Effects of Methamphetamines

• Increased alertness, excitation, euphoria, increased pulse rate and blood pressure, insomnia, loss of appetite.

• Truck drivers often abuse this drug to stay awake on long hauls. Risks “crash” and destruction to people and property.

• Medical uses? Treating obesity.• Please read about Nicotine and Caffeine.