Objective Two

To describe the current patterns of use of alcohol, tobacco, marijuana and cocaine, and other mood altering substances in our society.

A reasonable place to start your study of Substance abuse is to become familiar with the substances your patients may use and become familiar with their characteristics. An easy way to do this is to "surf" the The Web of Addictions pages put together by Andrew L. Homer Ph.D. and Dick Dillon. These fact sheets contain a wealth of information about the various drugs you should know about.

Next you should have some idea of the trends we are seeing in the use of these drugs within our society. There are many good sources for the research findings related to the use trends. A good place to start your review would be The National Clearinghouse for Alcohol and Drug Information. They have an excellent page on the WEB that reviews the current statistics regarding the use and abuse of the various drugs. I would like to particularly direct your attention to four of the studies listed on their page:

PRIDE Survey - 1997

1997 DAWN Advance Report #17

1997 National Household Survey on Drug Abuse

1997 Monitoring the Future Survey

These four studies give you a good sense of what is happening in the general public in terms of substance abuse and its related problems.

Study Questions:
Alcohol:

  1. Your patient tells you that he drinks 4 or 5 bottles of beer a day.
    1. How much pure alcohol is he consuming each day at this rate?
    2. How many drinks of Vodka would you need to consume to get the same amount of ethyl alcohol as you would in 5 bottles of beer?
    3. How many 5oz. glasses of wine would you need to consume to get the same amount of ethyl alcohol as you would in 4 bottles of beer?
    4. BAC has to do with the amount of alcohol per volume of blood. What are the factors that determine a person's BAC? (Hint: The Addictions Research Foundation (ARF) article gives you a nice explanation of the above issues - although the article describes quantities in Canadian terms the numbers are very similar to the USA market)
  2. The ER doctor calls and tells you one of your patients was just in an automobile accident and is being treated at the hospital for broken bones and lacerations. Her BAC tested out at 250 mg/dL but she is wide awake and conversing sensibly with the ER staff. What does this tell you about her drinking habits?
  3. What is tolerance and how does it work? (Hint: The Addictions Research Foundation (ARF) article on alcohol)
  4. What is the fetal Alcohol Syndrome? (Hint: Facts about FAS/E)
  5. Of the 111 million drinkers in America in 1997, how many were heavy drinkers as defined by the 1997 National Household survey?


    Tobacco:
  6. According to the 1997 National Household Survey on Drug Abuse about what percentage of Americans smoke or use smokeless tobacco?
  7. What is the relationship between smoking and the use of other drugs? (Hint: Tobacco section of the National Household Survey on Drug Abuse)
  8. How many smoking related premature deaths per year does the World Health Organization predict will occur world-wide in 30 to 40 years if current smoking trends continue? (Hint: Tobacco and Health: The Facts)
  9. Which drug has been named by the World Health Organization as the single largest preventable factor in premature death, disability, and disease. (Hint: Tobacco)
  10. According to the 1997 National Household survey about how many new daily smokers are there each year?
  11. According to the Monitoring the Future Study what percent of high school seniors are currently daily smokers?

    Other Drugs:
  12. What effects of daily use of marijuana are particularly serious for students. (Hint: National Families in Action: Drug Info)
  13. In a special study performed in Memphis Tennessee, what percentage of drivers stopped for reckless driving were found to high on marijuana? (Hint: National Families in Action: Drug Info)
  14. How long do chemicals from marijuana stay in the blood after marijuana is smoked? (Hint: ADA fact sheet)
  15. What is crack? (Hint: ARF article)
  16. What are some of the physical symptoms of chronic snorting of cocaine? (Hint: ARF article)
  17. What is the most commonly abused opiate in the USA? (Hint: Facts on Opiates)
  18. The drug most likely to cause violent behavior is PCP. What is PCP? (Hint: Facts on PCP)
  19. What is ICE? (Hint: ICE)
  20. According to the 1997 DAWN Survey approximately how many hospital emergency department episodes were there in the United States in 1995 directly related to the use of an illegal drug or the non-medical use of a legal drug.
  21. According to the 1997 DAWN Survey approximately what percent of hospital emergency drug related episodes were cocaine related?
  22. In 1997, 111 million Americans who were 12 and older used alcohol in the previous month according to the 1997 National Household survey how many cocaine users were there in the overall population during the same time?
  23. What is the relationship of "perceived harmfulness or risk" of drug use to actual use according to the Monitoring the Future Study?

Essay Questions:

  1. Alan I. Leshner argues that addiction is a brain disease and that it matters. Why does it matter according to Leshner?

  2. After reading the "Here's to Your Health" article by Dr. Ellison and the The New England Journal of Medicine article on Alcohol consumption and mortality, what is your opinion of Dr. Ellison's assertion that, "Based on all of the available research data, we can conclude that abstaining from alcohol, that being a non-drinker, should be added to the list of important risk factors for coronary heart disease?" (You will be evaluated on your reasons not on your opinion. Try to show that you understand the issues and that your choice is based on your analysis of the research presented.)