Major Paper – FINALDUE: May 19, 2019 11:55 PMGrade DetailsGradeN/A                      Gradebook CommentsNoneAssignment DetailsOpen DateApr   1, 2019 12:05 AMGraded?YesPoints P

Major Paper – FINAL

DUE: May 19, 2019 11:55 PM

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Apr   1, 2019 12:05 AM



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Assignment Instructions

Major Paper Assignment Instructions and Grading Rubric

This assignment meets the following Course Learning Objectives:

– Articulate basic drug terminology and drug taking behavior – Identify the various addictive substances – legal and illegal – and their classifications – Analyze the reasons people commonly abuse substances – Analyze how substances affect the mind and body and society

In 2010, The American Academy of Pediatrics (AAP) released a policy statement addressing the complex relationships among children, adolescents, substance abuse, and the media. This assignment requires a critical examination of the AAP publication and a critique of a media portrayal of substance use, with links made to the AAP statement and course material. Conclusions about the implications of the media portrayals and the policies recommended by the AAP also should be made. Successful completion of this paper will require work over multiple weeks.  A two paragraph summary of the proposed example of substance use portrayal in the media was due by the end of Week 3. The full paper is due at the end of Week 7.

This is part one of the assignment that you did

This assignment proceeds in four steps: 


 Step One: Read the AAP Policy Statement located below. Make some notes for yourself about points of agreement or disagreement you have with the statement and specific findings regarding media depictions of substance use that you want to assess when you write the paper. 

 Step Two: Find a current example of substance use portrayal seen in the media; for example, scenes from a movie, a television show, or a commercial; print ads; or portrayals found in “new media” as discussed in the AAP article. The Internet is a good tool for finding film or television portrayals of substance use as well as examples of print ads if ready access to first-hand media is not available. A two paragraph summary of the proposed example of substance use portrayal in the media that will be used for the paper is due by the end of Week 3. This proposal is a separate assignment and is worth 10 points.


 Step Three: Write the paper. Begin the paper with an introduction that summarizes the main findings of the AAP article and previews what will be covered in the coming pages. Next, compare and contrast the portrayal of substance use found in the media with the information learned about that substance in the class and course readings. What messages about the substance are being portrayed? How accurate are those messages relative to the actual data on substance use? Be sure to cite the course readings as needed.

 Continue by comparing and contrasting the portrayal of substance use found in the media with the criticism of media portrayals found in the AAP paper. Does the media example match their arguments or contradict them? What links and connections can be made? Be sure to cite the article as needed. 

 Next, draw some conclusions about the portrayal of substance use found in the media, addressing the following: What are the implications of this type of portrayal? What messages are being sent and to whom? Are those messages an accurate representation of the use of this substance? Should media portrayals be required to be accurate in their depictions of use, showing both positive and negative consequences? 

 Finally, review the guidelines suggested by the AAP at the end of their policy statement and address the following: Although directed specifically at pediatricians, which of those recommendations is most important? Why? Are these recommendations necessary? If followed, will they be effective in addressing the concerns raised earlier in the article? Be sure to cite sources as needed.

 Step Four: 

The required length of this paper is 11 pages, plus a required a cover page and a reference list. Papers must comply with APA formatting rules, including font size and margins, and must have a scholarly focus and tone.  Quoting of published material and use of the first-person “I” are not permitted and will result in point loss. All source material must be paraphrased into your own words and cited appropriately. 

 On submission your work will auto-run through’s plagiarism checker software.    

 The grading rubric below details specific grading criteria.

The Final Major Paper document should be attached in the appropriate Assignment tab and will be evaluated using the rubric below: 




Needs Improvement 


Points Earned


15 Points Possible

Student provides a clear   introduction which summarizes the AAP article and previews the major points   to be covered in the paper.   

Student provides a mostly accurate   introduction which summarizes the AAP article and previews the major points   to be covered in the paper. At times description lacks coherence. 

Student provides a marginal   introduction which summarizes the AAP article and previews the major points   to be covered in the paper. Sufficient details and supporting evidence are   lacking.

Student does not provide an   introduction which summarizes the AAP article or preview the major points to   be covered in the paper.

Choice of Media Example

15 Points Possible

Discussion of chosen media   portrayal is clear, accurate, and related to the assignment. Sources are   credited and cited appropriately.   

Discussion of chosen media   portrayal is mostly accurate, and related to the assignment. Sources are   credited and cited. At times description lacks coherence. 

Discussion of chosen media   portrayal is marginally accurate, and related to the assignment. Sources   are credited and cited but not using appropriate formatting. Sufficient   details and supporting evidence are lacking.

Student does not chose a media   portrayal that is accurate and/or related to the assignment. Sources not   credited and cited.

Comparison of Media Example to   Class Material

25 Points Possible

Student provides a comparison of   media with information from class material that is clear and   thoughtful. Questions outlined in the assignment are   answered. Sources are credited and cited appropriately.   

Student provides a mostly accurate   comparison of media with information from class material that is largely   clear and thoughtful. Questions outlined in the assignment are mostly   answered. Sources are credited and cited appropriately. At times   description lacks coherence. 

Student provides a marginal   comparison of media with information from class material that is partial   clear and thoughtful. Questions outlined in the assignment are   marginally answered. Sources are credited and cited appropriately.   Sufficient details and supporting evidence are lacking.

Student does not provide a   comparison of media with information from class material. Questions   outlined in the assignment were not answered.

Comparison of Media Example to AAP   article

25 Points Possible

Comparison of media presented by   the student with information from the AAP article is clear and   thoughtful. Questions outlined in the assignment are   answered. Sources are credited and cited   appropriately.   

Comparison of media mostly presented   by the student with information from the AAP article is mostly clear and   thoughtful. Questions outlined in the assignment are mostly   answered. Sources are credited and cited appropriately. At times   description lacks coherence. 

Comparison of media marginally   presented by the student with information from the AAP article is mostly   clear and thoughtful. Questions outlined in the assignment are   marginally answered. Sources are credited and cited   appropriately. Sufficient details and supporting evidence are lacking.

Student did not compare media   presented with information from the AAP article. Questions outlined in   the assignment were not answered.  

Strength of Conclusion

40 Points Possible

Student provides an insightful and   creative conclusion, logically summarizing the main elements of the case   and the scholarly literature findings, articulating a personal reflection on   the case study analysis process

Student provides a mostly   cogent conclusion, logically summarizing the main elements of the case   and the scholarly literature findings, articulating a personal reflection on   the case study analysis process

At times description lacks   coherence. 

Student provides a   marginal conclusion, loosely summarizing the main elements of the case   and the scholarly literature findings, articulating a personal reflection on   the case study analysis process

Sufficient details and supporting   evidence are lacking.

Student does not provide a   clear conclusion or logically summarizing the main elements of the case   or reference scholarly literature findings; lacks a personal reflection on   the case study analysis process

Paper Format and Mechanics;   Spelling, Grammar and Punctuation

30 Points Possible

Work is presented in a logical and   coherent way. Writing is clear, articulate, and error free. Citations are   composed in proper format with few or no errors. Paper is the required   length, is double-spaced with 1-inch top, bottom, left and right margins, and   in Calibri or Times New Roman styles, size 12 font. Cover   page, paper body, citations and References are in the correct APA   format. There are few to no spelling, grammar, or punctuation   errors.

Work is grammatically sound with a   few minor errors. Citations are composed in the proper format with some   errors. 

Work contains frequent grammatical   errors. Citations are inaccurate or improperly formatted. 

Work does not demonstrate   appropriate graduate level writing. 

Summary Comments: 

Total Points:   (150   points total)

Supporting Materials




One of the most problematic, licit drugs in our society is alcohol. The simple process of fermenting sugar from a variety of naturally occurring fruits and grains has been ubiquitous across cultures and societies since the beginning of civilization. It is so pervasive within our society as to also seem to be a seamless part of it. One cannot easily characterize a particular type of person or group that is likely to be alcohol dependent; the affliction cuts across all imaginable demographics of society. Some people are able to drink on occasion for pleasure, whether alone or with friends. Others drink on a daily basis; others periodically binge. 

Here’s a quick, 9-minute history of the science, creation and use of alcohol across cultures, courtesy of

At present, it has been estimated that approximately 18 million Americans have a serious problem related to the use of alcohol. These 30% of all consumers of alcohol account for about 80% of all alcohol consumed. Men outnumber women in heavy alcohol use by a ratio of around three to one.

The heaviest users of alcohol, in turn, directly or indirectly impact an even larger percentage of the population with their subsequent behaviors while intoxicated. The costs of alcohol abuse and dependence are significant: this drug is the third leading cause of death and is implicated in over half of all deaths and injuries in car accidents and half of all physical assaults and homicides. Further, it has been estimated that at least four family members are directly affected from the maladaptive behaviors that follow from the alcohol-abusing individual; you can quickly begin to see extensive the social, familial, occupational, and emotional impact of this disorder. 

What’s the difference between alcohol abuse and alcohol dependence?

The initial psychiatric diagnosis that could be made for an individual that habitually uses alcohol to excess would be alcohol abuse. This diagnosis is characterized by the continued use of alcohol for at least a period of one month, despite having a recurrent physical problem or some serious personal problem in one’s social or occupational functioning because of the excessive drinking or the repeated use of alcohol in situations (e.g., driving) when consumption is physically hazardous.

The diagnosis of alcohol dependence reflects an even greater degree of impairment in individuals compared to alcohol abuse. Alcohol dependence typically involves at least three of the following serious circumstances: (1) drinking alcohol in greater amounts and over a longer period of time than intended by the individual; (2) a strong desire by the individual to reduce consumption and several unsuccessful attempts to do so; (3) spending a great deal of time drinking or recovering from the negative effects of excessive drinking; (4) continued drinking even though physical and/or psychological problems are apparent and problematic in the individual’s life; (5) social, work, or recreational activities have been significantly reduced or abandoned because of excessive drinking; (6) the development of marked tolerance for alcohol; and (7) consumption of alcohol specifically to avoid the symptoms of withdrawal. About 15 percent of men and 10 percent of women in the United States have met the diagnostic criteria for alcohol dependence during their lifetime.

How does alcohol affect the brain?

Alcohol, as a drug, acts as a depressant on the individual’s central nervous system. It is a small molecule and is quickly absorbed in the bloodstream. Alcohol is linked to inhibiting receptors for the neurotransmitter GABA. In low doses, alcohol depresses the inhibitory functions of the brain, including those areas of the brain that typically adhere to the social controls and inhibitory rules that people typically follow in society. As the alcohol concentration increases in the bloodstream, the depressive function of alcohol extends from the cerebral cortex to areas of functioning that are further (and deeper) into the brain’s primitive and reflexive areas of functioning. In extreme dosing, inhibition of respiratory and motor centers can occur with other symptoms that include stupor or unconsciousness, cool or damp skin, a weak rapid pulse, and shallow breathing. It should be noted that alcohol can only be metabolized and leave the body at a specific rate, regardless of how quickly (or how much) alcohol has been taken in by the individual, so attempts to quickly “sober up” an individual will be unsuccessful.

For more illustration of the science and physical problems associated with habitual alcohol consumption, check out this 4-minute video:

What are the behavioral effects of using alcohol?

Individuals experiencing alcohol intoxication will exhibit a variety of maladaptive changes in their behavior and psychological functioning. Examples include inappropriate sexual or aggressive behaviors, impaired judgment, quickly changing moods, incoordination, impaired gait, slurred speech, impaired attention and memory (sometimes to the point of blackout), stupor, and unconsciousness. The degree of symptoms is dose dependent with more pronounced symptoms occurring as the alcohol blood-level increases.

Withdrawing from alcohol intoxication (i.e., a hangover) is also dependent on recent dosing, history of chronic abuse, and involves a variety of symptoms which can include autonomic hyperactivity in the form of profuse sweating and rapid heartbeat, hand tremors, nausea or vomiting, fleeting illusions or hallucinations, psychomotor agitation, anxiety. At worst, grand mal seizures can occur following periods of prolonged and heavy use. Another significant withdrawal phenomenon that chronic, prolonged abusers of alcohol can experience is delirium tremens that is characterized by disturbances in cognitive functions (especially consciousness), autonomic hyperactivity, vivid hallucinations, delusions, and agitation.

Chronic alcohol dependence can lead to a medical condition known as Alcohol-Induced Persisting Amnestic Disorder (also known as Wernicke-Korsakoff’s Syndrome). This disorder is believed to be caused by deficiencies in thiamine and Vitamin B because their absorption in blocked with habitual alcohol consumption. Individuals afflicted with this disorders experience retrograde (the past) and anterograde (new knowledge) amnesia as well as confabulation, which is the tendency to attempt to compensate for memory loss by fabricating memories.

What are some of the life problems associated with heavy alcohol use?

The pervasive impact of chronic alcohol abuse can be seen across several important areas of in life that generally impair one’s ability to function adaptively (i.e., take care of oneself in a manner appropriate for one’s age) and experience a good quality of life. It is a complex problem in living with psychological, physical, and behavioral components. These include (1) demonstrating a preoccupation with alcohol and drinking; (2) demonstrating emotional problems (e.g., depression); (3) having overt problems at work, within one’s family, and other important social relationships because of alcoholism; and (4) associated physical problems that result from habitual alcohol consumption.

Given that alcohol is a central nervous system depressant, it shouldn’t be a surprise that depression can become a comorbid (or co-occurring) condition for some individuals. In general, the incidence of depression in substance abusers is quite high. People who drink alcohol heavily to the point of intoxication can experience very strong emotions and are frequently disinhibited (i.e., impulsive). Feelings of hopelessness, helplessness, and suicidal thoughts often accompany bouts of heavy drinking.

To review the relationship among amount (dosing) of alcohol consumed, blood alcohol levels, and effects on the central nervous system and behavioral performance, check out this five-minute Healthy McGill video here:

Who is at greatest risk for abuse or dependence?

Research has demonstrated that two risk factors can contribute significantly to the manifestation of alcohol abuse and dependence in the individual. The first risk factor is a family history of chronic alcohol abuse. Children of alcoholic parents have a higher statistical risk of becoming alcoholics themselves when compared to children of nonalcoholic parents. Whether this represents an increase genetic or environmental risk, however, is difficult to determine since both are intertwined in such instances. A second and independent risk factor that has been identified is those cases where an individual has a genetic predisposition to have low response to the psychoactive effects of alcohol (and, as a result, requires higher amounts of alcohol to become intoxicated). Individuals with this lower response to alcohol are more likely to abuse alcohol, as they require considerably more drinking to obtain the level of intoxication experienced by others who drink less to get the same effect.

When taken together, an adult child of an alcoholic who also possesses a low response to the effects of alcohol has an even higher statistical chance of developing a pattern of alcoholism. Keep in mind that all of these examples are just risk factors and statistically probabilities – none of these outcomes are written in stone. Further, research demonstrates that there are also protective factors (variables) in the environment that can also help promote resiliency in some individuals and lead them not to drink alcohol in an excessive or maladaptive fashion when they are present. Clearly, again, the path to alcoholism (and responsible drinking and abstinence) is multi-factorial.

What are some of the treatment options for Alcohol Dependence?

        Unfortunately, flaws in methodology jeopardize much of the research on the effectiveness of alcohol treatment programs. That is, the studies aren’t well controlled in terms of error variance and it cannot be clearly determined whether the observed changes in the studies are due to the employed treatment or other, uncontrolled, factors during the study. For example, many studies do not use untreated comparison groups. One generalization that can be made from the available research is that formal treatments are not always adequate or even necessary. A positive outcome to treatment appears to be related more to the presence of certain psychosocial factors like specific threats to one’s physical or social well-being (i.e., hitting “rock bottom”) than any particular intervention. 

        There are, however, some treatments that have had some success. These treatments have several components in common, including covert sensitization and other forms of aversive counterconditioning. Antabuse, for example, is a medication that, when taken, will result in an individual becoming violently ill should they consume alcohol. Other treatments that put together broad-spectrum interventions such as social skills training, learning to drink in moderation, stress management techniques, and teaching coping skills and other self-control techniques help to teach the individual better, healthier alternatives methods when faced with environmental triggers to consuming alcohol.

        Many modern programs incorporate aspects of Alcoholics Anonymous and/or the drug Antabuse. However, the effectiveness of these treatments has not been empirically demonstrated. One criticism that has been levied on these treatments is that they do not take into account individual differences and the wide variety of psychosocial problems and/or lack of resources that can make successfully managing alcohol consumption. In general, individuals with severe problems with alcohol require more intensive treatments (e.g., inpatient hospitalization), while those who experience less pathological problems require more periodic, milder interventions.

        Another criticism that has been raised about some current treatment programs for alcohol abuse and dependence is that they tend to be based on the belief that failures in treatment are largely due to the individual’s denial of having a problem or otherwise not having an adequate level of motivation. Many therapists have not supported this line of thinking, however. Research on treatment outcome, alternatively, points to the importance of therapist factors such as their level of empathy toward clients and their attitudes about what constitutes healthy recovery as being more related to positive outcomes than client’s own motivation or personality characteristics. 

        Some experts in the field of alcohol research have emphasized the importance of the clients’ reaction to instances of relapse, especially from a cognitive (how they think) and emotional (how they feel) perspectives.  Researchers stress the need to get away from the idea that a relapse represents a “violation of abstinence” which can lead to anxiety, depression, self-blame and an increased likelihood of further alcohol consumption. Alternatively, relapses should be characterized as a mistake that came about from external, controllable factors and not the result of internal factors (e.g., personality characteristics) that are essentially thought to be out of one’s control.

Dually diagnosed individuals (those with a mental illness or personality disorder in addition to a substance abuse disorder) usually have a hard time finding treatment in one place. In many jurisdictions, they have to see a therapist at a mental health center and a separate therapist at a substance abuse center, or they are forced to make a choice of one over the other. You will find that there is often a lack of cross-training between mental health and substance abuse professionals, and that makes it harder for clients to get the treatment they need. Furthermore, in some places, you may find that the treatment support groups for substance abuse have an interpretation of sobriety that prohibits the use of psychotropic medication.

Legal Drugs in Our Society – Part II

        Hopefully, you have found the historical account to date of which drugs have largely been considered illicit, those that have typically been licit and readily available, and those that have switched from one designation to the other, to be an interesting review. Such distinctions among different groups of people and across different periods of time often speak to the changing cultural, social, religious, and scientific beliefs and morays of the time. This week, you will be studying two very popular and legally sanctioned drugs, tobacco and caffeine, that have been readily consumed by people since the beginnings of structured societies. 


From its use in religious ceremonies and purported medicinal herb thousands of years ago to the image of sophistication and modernism it has held in industrialized societies over the last few hundred years, tobacco has occupied a role of prominence among individuals and groups alike.  Think about it: what other drug has been so popularized in society as to be physically accommodated with lighters and ashtrays in automobiles and airplanes? What about spittoons in the restaurants and bars of the late 1800s and early 1900s? How about the smoking cars in trains and smoking sections at airports and restaurants? All these examples serve to demonstrate just how indoctrinated tobacco use has been in modern culture. 

How did tobacco, the plant, get to be such a big deal? Check out this 8-minute history and science video from DNews Plus:

How have patterns of tobacco use changed over the decades in the United States and the world? What are some of the reasons for these changes?

Tobacco is interesting and noteworthy in that it is one of the only drugs that has been commercially available, openly accessible, and integrated within the culture of many societies for hundreds and hundreds of years. Further, it has been monetized as a commodity with economic value for the purposes of trade and payment of debts. In some circles, over time and across cultures, tobacco was even used as its own form of currency. In fact, one could certainly argue that the colonization, formation, and military defense of the United States of America occurred largely in part through the economic power generated through tobacco cultivation, sale, and distribution to other European countries.

It is interesting to note the relationship between the amount of government regulation that exists with the tobacco industry and the resultant use by population. There is a clear relationship between the growing regulation in the United States that began in the early 1970s and the eventual decline of tobacco use among large segments of the U.S. population. This can be especially seen in new generational cohorts; that is, the adoption of chronic smoking habits by younger people. Many other European and South American countries do not employ such heavy restrictions on the advertisement, marketing, and accessibility of cigarettes and other tobacco products upon their population. As a result, the decreases in use and dependence that have been realized in the United States have not been generalized to other countries across the world. The zenith of tobacco use in the United States has come and gone. The preponderance of research has clearly demonstrated its pathological effect on the body and that information, plus rigorous regulation, has helped contribute to the decline in its use.

There are a variety of ways to consume tobacco products as a vehicle by which to introduce the drug nicotine into the bloodstream and the brain. Smoking (via cigars, pipes, and cigarettes), chewing, and snuffing are all legitimized drug-using behaviors whose differing favorability has waxed and waned over the years. Over the years, most individuals were shaped into eventually preferring the use of tobacco cigarettes, which could be mass-produced in very high volumes inexpensively.

The intense and intentional role of marketing has been very significant in shaping the appeal to certain demographic groups of the population. The aggressiveness of early mass marketing campaigns also extended themselves, ultimately, to the denial and cover up by corporate America with regards to the deleterious effects of tobacco use. It wasn’t until 1964 that the federal government began to formally investigate the health effects and cost of tobacco use and to institute policies that would eventually lead to the restriction of marketing and sales in the United States. 

What are some of the adverse consequences of smoking?

The deleterious effects, both physically and psychologically, that result from chronic tobacco use have been well documented. The three-fold combination of carbon monoxide, tar, and nicotine can produce a wide variety of lifelong physical ailments, including a higher risk for cardiovascular disease, respiratory disease, and lung cancer than for nonsmokers. As is widely popularized, there are literally thousands of chemical found in cigarette smoke, including ones commonly used in pesticides. Additionally, other forms of cancer have also been implicated with chronic tobacco use. In fact, the vast majority of deaths each year that can be attributed to drug use and dependence are the result of tobacco use and nicotine dependence.

The primary psychoactive drug in tobacco, nicotine, has been determined by research trials to be a dependence-producing substance. As you recall from previous lectures, drug dependence is defined by continued use of a drug even in the face of obvious occupational, physical, familial, and social problems that one experiences in direct relation to its use. This also includes the psychological experience of craving and high drug-seeking behaviors. The rate at which nicotine is absorbed into the blood stream and penetrates the blood-brain barrier certainly speaks to its strong psychoactive properties. Withdrawal symptoms begin as early as six hours after the last dose. Within 24 hours, common complaints can include headache, irritability, problems concentrating, and sleep disturbance. Finally, in the late 1990s, the tobacco industry finally conceded publically that the products they were producing were not only physically harmful to individuals but also that the nicotine contained within then was a dependence-inducing substance.

What are some of the best strategies to employ when attempting to stop using tobacco products?

    You know just how difficult it is to treat nicotine addiction in terms of a smoking cessation program. The research has demonstrated, much like successful treatment programs for other types of drugs, that have a high degree of dependence, that a multimodal approach is best. This type of additive treatment program incrementally increases the probability of success by systematically addressing addiction from a biological, social, operant conditioning, and environmental cue framework. Individuals are encouraged to think deeply about, and even write down, their personal reasons to stop smoking. This cognitive-behavioral approach helps an individual really contemplate the meaning and reasons behind their decision to stop smoking – beyond the simplistic reasons often given by others or conveyed through warning labels or public service announcements. 

Much like treatment for opiate dependence, a gradual reduction of the addictive drug nicotine helps lessen the severity of the withdrawal symptoms that can often make smoking cessation very difficult. In other words, the strategy of simply going ”cold turkey” often does not result in a successful outcome. The research has shown that a gradual reduction in smoking, often coupled with the intermittent use of medications that can regulate nicotine such as transdermal patches, tends to have better and more long-lasting effects.

    Other strategies that have been shown to be useful in an individual’s armamentarium of treatment strategies include attempting to stop smoking within the context of a social support group. Research has demonstrated that when you confide your goals to others who have your best interests at heart, this can be a powerful social reinforcer to maintain attempts at smoking cessation. The support of other individuals can often also help assuage feelings of stress that one has in their life. Certainly, any attempts one can make at stress reduction in terms of their daily life challenges, the fewer external cues there will be to return to smoking which, for many people, has been used as the primary means for stress reduction in their life.

    From a behavioral perspective, it is important for individuals who want to stop smoking to remove from their environment the physical cues that are associated with the behavioral habits of smoking. This strategy is similarly employed with other types of illicit substance abuse where the act of taking the drug carries significant import. Cigarette butts, packets of tobacco products, ashtrays and even behavioral habits such as alcohol or coffee consumption that often accompany tobacco use need to be removed or significantly changed in the individual’s life to minimize the effects of the operant conditioning history. 

Like with treatment for other types of serious drug addiction, it is important to realize that relapse is a real possibility and that an individual should be rewarded and reinforced for attempts at cessation. Additionally, one should not be overly self-critical or invalidate the process of recovery when instances of backsliding or relapse occur. The research is shown that, in fact, quitting tobacco use is a process that often takes, on average, seven or eight failed attempts before finding a long-lasting successful outcome.

    Another important treatment modality is that of physical exercise. It primarily can serve as a substitution for many of the stress-relieving properties that tobacco use once served. In addition, the conditioning of an individual’s cardiovascular system can help rehabilitate bodily functions that have long suffered under the excessive burden that tobacco use, typically smoking, has brought on these organ systems. As with the other forms of drug treatment, the consultation of a physician during the process can aid in the chances of success. Physicians have as their disposal a variety of medications, including some in the antidepressant class, which have shown good efficacy in helping to curb cravings and the resultant irritability associated with withdrawal. However, they are certainly not without some risk factors and frequent monitoring by primary care professional is important.


What can one say about the drug caffeine? To state that it may be one of the most pervasively and ubiquitously consumed drugs throughout the world might just be an understatement. Next to the naturally occurring and arguably nutritious substance of sugar, it may be one of the substances that is most readily infused into the diet of most Americans in modern society. Put another way, caffeine use is one of the most popular forms of drug use in the world. One only needs to look at the recent proliferation of coffeehouses and coffee culture, and the subsequent indoctrination of younger generations of individuals to soft drinks and coffee use, to see a pattern of life-long use. In addition, a whole new line of product development and targeted marketing has occurred over the last 15 years: that of the ”energy” drinks and individual doses of caffeine in a one-shot delivery system. In other words, society has moved from caffeine being a desired byproduct of a consumable beverage to being its own means to a desired end.

Here’s a quick and humorous four-minute overview from on the world’s most popular psychoactive drug:

Tea is the world’s oldest caffeine containing beverage. Like tobacco, tea has historically been a commodity that has political power in terms of economics in trade. Typically, tea contains less caffeine than a cup of coffee, although particularly strong brews of tea can approximate the same caffeine level as found in coffee. There is some medical literature that suggests that consumption of tea in moderation does have specific health benefits. For example the bronchodilating effect of tea has been found to be helpful in the treatment of asthma symptoms and other respiratory problems. The flavonoids found in chocolate have been implicated in cardiovascular health by functioning as antioxidants within the bloodstream. There is a positive association or correlation found between the consumption of dark chocolate and reduced risk for cardiovascular disease and stroke. Coffee consumption has been present for several thousands of years and, at least in industrialized societies, has offered an alternative to excessive alcohol consumption in some circles of society. However, it should be noted that consumption of coffee and the caffeine therein can in no way abate the effects of alcohol intoxication or somehow “sober up” an individual faster; this is a common myth. Fortunately, most doses of caffeine taken in individual servings of substances such as a cup of coffee, a bar of chocolate, or a cup of tea are relatively low and benign in terms of their overall affect on individuals.

The most commonly ingested source of caffeine in our society is that of soft drinks or sodas. The largest segment of our population in terms of demographics uses these products. Approximately 95% of the caffeine that is found in soft drinks is artificially added through the manufacturing process; that is, unlike the coffee bean or the tealeaf, the caffeine is not naturally occurring as a part of the substance being consumed. The United States leads the world in per capita consumption of soft drink products. In addition, as has been previously stated, the United States is at the forefront of development of new energy drinks that are marketed for the express purpose of high dose caffeine ingestion. These energy drinks typically can contain anywhere from two to three times the levels of caffeine that would typically be found in a soft drink or single cup of coffee.

Caffeine can also be ingested from over-the-counter products typically sold in pharmacies. Products can range from pain relievers and cold remedies to weight control supplements. Caffeine acts a vascular dilator tour that can be helpful in treating asthmatic conditions as well as headache pain. Still other drugs are expressly designed to keep the individual awake and alert for a sustained period of time. When ingested, caffeine is absorbed into the body in 30 to 60 minutes with peak levels of caffeine seen in the bloodstream about an hour after in just station. Sometimes individuals will describe an immediate boost of energy as a symptom following caffeine consumption; however this is either simply psychological in nature in terms of an expectancy effect or, more likely, related to ingesting the sugar that commonly is paired in drinks.

What are some of the symptoms and effects of caffeine use?

Caffeine is a psychoactive stimulant drug that, when taken in excessive amounts, can certainly cause difficulties for the individual using it. High levels of caffeine use lead to intoxication, sometimes known as caffeinism, which involves symptoms of restlessness, nervousness, insomnia, excitement, flushed face, gastrointestinal problems, and diuresis (excessive urination) in comparison to low doses. One of the most commonly affirmed symptoms of caffeine is the tendency to delay onset of sleep and the reduction of quality of sleep that comes following its use. Many individuals certainly report that, as they age, they are unable to continue to drink caffeinated beverages into the late afternoon or early evening because of the disruption in their sleep patterns that will result.

Typically, users report a feeling of mental alertness and lack of fatigue after ingesting caffeine. Most individuals will report that they feel they are able to work more effectively and for longer periods of time, for example, after their morning cup of coffee. However, research examining the behavioral performance of individuals taking caffeine is mixed with regard to human performance. Caffeine use seems to help when individuals are faced with mundane and boring tasks by keeping their attentiveness high and their response time fairly fast. However, for more complex tasks in which individuals need to make intricate discriminations or weigh the relative consequences of different choices, caffeine seems to have little positive, and can actually be disruptive to this mental process.

When individuals ingest large doses of caffeine, the individual will experience more prominent symptoms such as muscle twitching, cardiac arrhythmias, rambling thoughts or speech, and psychomotor agitation. While there have been some studies that suggest physical problems or disease can be associated with caffeine use, the vast majority of these studies suffered from significant methodological problems and the results, therefore, have been inconclusive.

Research has demonstrated that there is physiological evidence of tolerance and withdrawal as well as psychological cravings associated with chronic caffeine use. There is certainly concern about the rapid increase in the last decade of children who are consuming larger doses of caffeine than we have previously seen. It will take some time for research to bear out whether or not deleterious effects are associated with excessive caffeine consumption in children whose brains are still developing. Certainly, the excessive amount of sugar that is often paired with caffeinated drinks also raises concern with regards to childhood obesity. In addition, the symptoms of nervousness and anxiety that are often reported with higher-level doses of caffeine have yet to be fully understood with regards to childhood consumption.

Enhancers and Depressants

There are three disparate groups of widely used drugs in our society: performance-enhancing drugs, depressants, and inhalants. 

How did the use and development of performance-enhancing drugs evolve over time and societies? Start by checking out this entertaining and informative nine-minute overview video from

Performance-Enhancing Drugs

As you read the chapter on performance-enhancing drugs, it is likely that you may think this area of drug abuse represents a tangent from your previous week’s studies and is a relatively new and esoteric realm of drug abuse. However, quite to the contrary, the abuse of drugs for the explicit purpose to gain a physical performance advantage in competition and battle has been in existence and documented since at least 300 B.C. and the first Olympic games. By the end of the 19th-century, recorded accounts are archived of professional athletes consuming a wide variety of drugs for the purposes of enhancing their physical prowess, including caffeine, alcohol, cocaine, opioids, and amphetamines. However, over the centuries, not all attempts to enhance performance through the ingestion of chemicals and drugs were successful; strychnine and nitroglycerin were two examples of substances that ended up causing more harm than help to those that used them. Occasional deaths were reported as a direct result of overdosing on some of these powerful drugs; the first recorded death of a professional athlete in such a manner occurred in the late 1800s with the collapse of a cyclist who was discovered to have used a combination of cocaine and heroin, commonly known as a ”speedball,” in a race to deleterious effect.

The advent of modern-day performance-enhancing drug use began in the 1930s with the manufacture of anabolic steroids, patterned after the male sex hormone testosterone. This class of drugs was noticeably different from its predecessors in that this drug actually changed (often permanently) aspects of an individual’s physiology rather than simply their experience or behaviors for a period of time. These effects were long lasting and often generalizable across a wider range of activities. Anabolic steroids were originally designed to help address the affects of severe anemia, malnutrition, and starvation in soldiers, victims of war, and other patients whose bodies were severely degraded. However, it quickly became apparent that the gains seen when administering these drugs two waylaid individuals could also be used to magnify the prowess and abilities of healthy individuals as well. It wasn’t long before coaches and athletes began to experiment with these drugs as a way to enhance performance, or produce ergogenic effects, across a variety of sports and competitive events.

How do anabolic steroids work?

Testosterone serves two fundamental purposes in the body: promoting the development of male sex characteristics and the development of muscle tissue. In typically developing males, a higher level of testosterone found in the bloodstream helps explain, in part, the larger muscles and sheer mass of men compared to their female counterparts. Anabolic steroids, which are developed through a manipulation of the testosterone molecule, produce similar effects, but in a more rapid manner, when taken by any individual. 

For much of the modern Olympic games, it was quite common for many athletes to use performance-enhancing drugs, including anabolic steroids. Their use was most prominent and acknowledged from the 1960s to the 1980s. While some athletes were placed on protocols of anabolic steroids secretly under the supervision of their coach and a physician, others athletes were part of large, systematic programs of drug use and performance measurement within their country. It wasn’t until the 2000 Olympic games that stringent restrictions were placed on the use of performance-enhancing drugs and all athletes had to attest that they were not using drugs or otherwise “doping” to enhance their performance. 

While the increase in regulations, restrictions, and sanctions have lessened overt use of performance enhancing drugs, there continues to be a dynamic, and well financed, amount of covert use in professional competition. By 2004, the World Anti-Doping Code was created, which codified the specific rules and regulations regarding performance-enhancing drugs and their use in sporting events. Since that time, and with the advent of better testing to identify cases in which athletes have violated the Code, there have been many high profile cases in the media that highlight the ongoing concern with performance-enhancing drugs. It should be noted that the sanctions received for violations have increased quite significantly in the last 15 years. In addition, legislation was passed in 1990, designating anabolic steroids as a Schedule III controlled substance, which makes them subject to criminal penalties if inappropriately manufactured, distributed, or used.

Some individuals may argue that the stakes in modern sports are higher than they have ever been in human history as a means for justifying, excusing, or explaining the use of performance enhancing drugs. However, while the records in sports that exist today are higher than they have been in the past, individual athletes still have to struggle to make a living and support their families, much like their predecessors. In addition, there was less revenue from multiple sources (e.g., commercial endorsements) available to athletes in the past, so making a living as a full-time professional athlete was even more precarious during past generations. In other words, the life of a professional athlete has always been difficult and always required sacrifice. Temptations to cheat and “game the system” have existed in various forms since the beginning of organized competition.  What has changed is the manner of sophistication and subtlety in which drugs can be used to enhance one’s performance.

Certainly, what passes as a standard for masculinity in our society has changed over time and this, in part, could be one source of cultural influence in today’s current climate of performance-enhancing drug use. In our modern society, the images that are portrayed in terms of masculinity, femininity, athletic prowess, and endurance can potentially influence individuals in terms of behaviors that they might engage in to meet or exceed an imagined cultural standard. 

What are some of the physical and psychological symptoms and side effects of anabolic steroid use in men and women?

There are several well-documented hazards associated with the use of anabolic steroids. One confound in determining the effects of various dose– response relationships is the fact that many individuals illegally abusing anabolic steroids take anywhere from 5 to 500 times the recommended dose. Because of this high degree of variance, it can be hard to gauge the relative risk from individual to individual. However, some generalizations can be made.  As these synthetic hormones enter the bloodstream and systemically flood the body with testosterone, changes occur across a wide variety of organ systems, and not all with an efficacious outcome. Given that the liver’s function is to help clear toxins and unnatural substances from the body, it should come as no surprise that this organ can suffer greatly from prolonged anabolic steroid use in both men and women. This is typically seen through the increased risk for tumors, the increase in lifetime risk for liver failure and, when they rupture, the need for emergency liver surgery. An increased risk for cardiovascular disease has also been noted with chronic anabolic steroid use.

One notable change in men with prolonged use is that an individual’s own testes glands begin to produce less testosterone in the body becomes as the body becomes acclimated to having it artificially introduced into the system at higher-than-normal levels. This not only causes male function to decrease (shrinking testicles, lower sperm count, enlarged prostrate) but the low, natural production level also results in less inhibition of naturally occurring estrogen which can result in and increase in feminine, secondary sex characteristics (e.g., enlarged breasts or gynecomastia). Some of these effects are reversible when hormone supplementation is stopped, while others are not.

        For women, the sustained use of anabolic steroids, and the introduction of a large amount of testosterone into their bodily systems, has an overall tendency to accentuate stereotypically male characteristics in them, including a lower voice, increased facial hair, increased aggressiveness, decreased body fat, diminished or stopped menstruation, increased acne, and decreased breast size. Again, some of these symptoms are reversible with discontinuation of anabolic steroids, while others continue to persist.

        Anecdotally, psychological problems in men and women who abuse anabolic steroids have included severe mood swings and a lower threshold for aggressive behavior, commonly referred to a “’roid rage.” However, more systematic research needs to be conducted in this area to determine more clearly the propensity of these symptoms for different individuals. In short, a variety of other, possibly confounding variables, come into play that can moderate the resultant mood changes with anabolic steroid abuse, such as an individual’s temperament, personality, and the social context within which a person lives and trains.

        In term of dependence to anabolic steroids, there is evidence to support the phenomenon of psychological dependence to the drug and associated drug-taking behaviors. Many athletes engage in drug use in a cyclic fashion, incrementally increasing the doses (whether taken orally, intramuscularly, or both) and then tapering down for a period of time, usually at the point when they suspect they will be tested for the presence of illegal drugs in their system. Some muscle atrophy or shrinkage has been noted with the lessening or cessation of anabolic steroids and this, when coupled with an individual who is inordinately preoccupied with their physical appearance, leads to concerns about losing physical appearance and prowess and a higher likelihood to continue to use the drug. 

From a perceptual standpoint, some individuals who chronically abuse anabolic steroids development “muscle dysmorphia,” which is a disturbance in their perception of their bodies, much like what is seen with some people who have eating disorders, where the individual believes that their bodies are weak and insufficient (thereby requiring more anabolic steroids), even in the face of physical evidence to the contrary. Unfortunately, it does not appear that in our dominant culture in the United States, with its focus on youth, attractiveness, and physical prowess, will be helping to ameliorate this social problem anytime in the near future.


You will now shift your study from performance-enhancing drugs to the class of medications that are collectively known as depressants. As classified, these medications collectively bring one “down” and create symptoms in individuals that are the antithesis of the stimulant class of medications (e.g., amphetamines, cocaine, caffeine) that you have previously covered in this course. Keep in mind that these drugs are manufactured in the laboratory and don’t naturally occur in the environment as many classes of drugs that you have previously studied in this course.

What are the major distinctions between barbiturates and benzodiazepines?

One of the original and major classes of depressants is that of barbiturates. They are tasteless and odorless and historically were prescribed as a sleep aid. Compared to benzodiazepines, which will be discussed shortly, barbiturates pose a greater health risk because of their broader, systemic effect upon the body. Depending on the dose taken, the effects of the barbiturates can range from mild relaxation to coma and death. As such, the threat of a lethal overdose is a significant concern. 

In and of itself, the effects of barbiturates are positively reinforcing; animal studies have shown how consistency they will respond in an operant learning environment to receive a continuous infusion of barbiturates into their system. Barbiturates are also known to have a synergistic, or additive, affect when taken with alcohol; one can take a non-lethal dose of both but, when taken together, they can be a lethal combination to the unsuspecting user.

Individuals who take barbiturates at relatively low dose report feeling a sense of relaxation and euphoria. As the dose level of barbiturates increase, more primitive areas of the brain are subsequently affected, including those that control autonomic functions like consciousness and respiration. At these higher doses, people report feeling heavily sedated and drowsy. While initially used as a sleep aid, researchers demonstrated that this class of drugs is typically not well suited for that purpose. Specifically, it has been noted that Rapid Eye Movement (REM) sleep is inhibited during the periods when barbiturates have been taken. REM sleep is generally thought of as being one of the deepest stages of sleep and highly restorative to bodily functions. As such, individuals taking barbiturates often report feeling tired upon wakening and describe their sleep as not very restful. Further, upon discontinuation of barbiturates, many individuals experience a sleep “rebound” effect in terms of REM sleep in that they experience inordinately longer cycles of REM sleep than typical and these periods of sleep are characterized by highly vivid and often disturbing dreams.

Using barbiturates as a primary treatment for sleep problems can certainly lead to symptoms of dependence. Physiologically, the body builds up dependence to the drug with regards to effects on sleep, requiring progressively larger amounts of the drug to achieve sleep-inducing effects. Compared to other classes of drugs, the withdrawal from barbiturates can be very dangerous if attempted without medical supervision. Symptoms of withdrawal include tremors, vomiting, perspiration, nausea, convulsions, confusion and high fever. Individuals are negatively reinforced to continue taking the drug in an attempt to avoid these undesirable symptoms. As a result, the use of barbiturates as a sleep aid has largely been discontinued in the United States because of these risks. 

Another important and more modern class of depressant is benzodiazepines. Compared to barbiturates, these are the next generations of depressants – they focus more selectively on the concerning symptoms of anxiety without causing global sedation across all bodily systems as its predecessor, barbiturates, do. This is preferred because the risk of a lethal overdose by shutting down the respiratory center in the brain is greatly reduced. In addition, benzodiazepines are absorbed more slowly into the bloodstream, avoiding any reinforcing “rush” effect where the resultant symptoms of relaxation more slowly with a longer duration of effect. As a result, this drug is a poor reinforcer of drug-using behavior. Benzodiazepines work by increasing the activity of the neurotransmitter GABA, which produces an inhibitory effect upon the central nervous system. 

It is interesting to note that one of the primary uses for depressants in our society over the years has been to aid and sleep and to lesson symptoms of anxiety. While these drugs have been used with varying degrees of success in treating these ailments, it should be noted that there are a wide variety of cognitive-behavioral interventions that have been supported in research studies to address these problems without the use of drugs. For example, there is a whole body of research on sleep hygiene and the appropriate behavioral habits, routines, and nighttime rituals which can help promote and sustain healthy, natural sleeping patterns in individuals. Similarly, the available psychological literature on cognitive-behavioral treatments to address symptoms of anxiety has been well documented. 

For a quick overview of anxiety disorders and how they can disrupt aspects of daily functioning like sleep, check out this 11-minute video:

Unfortunately, many individuals in our society as well as healthcare professionals espousing the medical model often look to pharmaceutical interventions as a first-line solution for many problems in living. While it certainly takes fewer appointments and less effort on the part of the individual and care provider to simply prescribe a medication to an individual, as you have learned in reviewing the reading materials and this lesson for the week, it is not without its own risks in terms of health and symptoms of dependence. Other avenues of non-pharmaceutical intervention should be actively explored; often, those strategies can be generalized broadly and have longer-lasting effects for individuals without the risks associated with overreliance on drugs to ameliorate their symptoms.


Inhalants, like most of the other drugs you have studied in this course, have been used throughout societies and cultures for thousands of years in an attempt to obtain mind-altering effects.  These drugs also fall into the general category of depressants in that brain activity (as measured by EEG) is significantly slowed down with their use. The first readily documented accounts occurred in the late 1700’s with the use of nitrous oxide and ether as pain-reliving analgesics that also produced a mild sense of euphoria, a sense of wellbeing, and a period of sedation.  

The aftermath of their use, however, can include nausea, vomiting and sensory confusion. Another significant concern with inhalants in that they dilute the amount of available oxygen for respiration when individuals cover their mouths and inhale other, noxious substances. Ether also has the dubious distinction of also being highly flammable. Beginning in the 1950’s, other substances, including glue and aerosol solvent chemicals, began to be abused, heralding in the modern area of what we typically know as common inhalants. 

What makes the use of inhalants appealing to children and teenagers?

Most substances used as inhalants are inexpensive, readily available and because they are found in common household products, don’t need to be hidden covertly from others like other illicit drugs. Unfortunately, because these substances are absorbed rapidly through the lungs, inhaling these substances produce a quick “high” which can be very reinforcing to the user and lasts about an hour with withdrawal symptoms that are relatively mild when compared to other drugs such as alcohol. 

Because of the ease of purchase and accessibility, this form of drug abuse is most commonly found in children and teenagers and chronic abuse, when it does occur, is most likely to be found among poor and disadvantaged children who are experiencing significant psychosocial problems. Perhaps the best outcome research that we have to date on inhalants is that many individuals stop using them after a period of time and that there use appears to be developmental and peer-influenced in nature. The long-term physical effects are not readily understood.

Medicinal Drugs

This week, you will be studying the use of different classes of psychoactive drugs that are not typically abused – leading to the diagnosis of a mental disorder relating to substance abuse or dependence – but, alternatively, are actually used to treat specific mental disorders in individuals. The development of these drugs has literally revolutionized the modern treatment of many major psychiatric conditions and provided substantial relief for millions of people, helping to assuage some very significant, chronic, and endogenous mental health conditions. These medications have also given researchers an effective means by which to test various hypotheses relating to the relative presence or absence of specific neurotransmitters in the brain and their relationship with moods, thoughts, sensorium, and behaviors. 

This working research framework has been described as the biochemical model of mental illness. This perspective holds that abnormal thoughts and behaviors largely result from abnormal biochemical processes in the brain. While this certainly does not account for the significant role that environment, relationships, and other personal resources have in moderating or ameliorating problems in living, it certainly has been a very significant area of research in understanding physiological processes that relate to drug response and mental illness. What follows is a discussion of the use of drugs that is relevant to several major classes of mental health disorders; namely schizophrenia and variants of what are collectively known as mood disorders (e.g., major depressive disorder, bipolar disorder).

To begin, review this 10-minute video on Depressive and Bipolar Disorders to gain a greater understanding of some of these chronic conditions and the role that neurotransmitter

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