The Medical College - Page 24
C.
a conclusion that Fitzgerald was an
autobi-
ographical writer.
D.
a conclusion that the flapper was judged
to
be immoral by the middle-brow
American
reading public.
Passage II (Questions 8–15)
The dependence process begins with an initial
expo-
sure to a psychoactive drug. The drug experience
allows
an individual to perceive two contrasting
altered states
of consciousness, the normal state versus the
drug-
induced state. If the drug state is perceived by
an indi-
vidual as more pleasurable (or producing a less
painful
state) than the nondrug state, then such an
individual
may make a choice of maintaining the drug
state. The
word "pleasurable," however, has many meanings,
and
may not be related to "feeling good." Thus,
someone
may initiate smoking tobacco, for example, not
because
it makes him/her feel good (most times it
doesn't) but
because his/her specific peer group dictates
tobacco use
as a means of acceptance. Belonging to the
group is
pleasurable, not the use of tobacco; any drug
can serve
such a purpose. Many examples of this
drug–human
interaction can be noted, and the lesson
learned, is that
humans take drugs for many reasons that
essentially
meet their own individual needs, whether it be
feeling
good, peer pressure, or whatever.
Therefore, drugs may not always serve primarily
as
reinforcers of behavior but may have important
sec-
ondary reinforcing qualities as well.
Regardless of the
reasons for using a specific chemical agent,
however, it
should be understood that most drugs produce
their
effects via an alteration of brain
neurochemistry, which
can lead to other more long-term problems,
especially
if the drug is consumed on a chronic
basis.
Once an individual takes on the responsibility
of using
a given chemical agent chronically, then he/she
is begin-
ning to allow other variables to take over
his/her own
drug-taking behavior, and to some degree will
lose
his/her ability to control this behavior.
Taking drugs
repeatedly means that one swallows, injects,
sniffs, or
smokes a given agent at certain times, in
certain places
and possibly with certain people. Each time a
drug is
taken all these events become cumulatively
conditioned
with the drug, forming a conditioned-stimulus
(cs) com-
plex (learned associations). If repeated enough
times, the
drug takes on stimulus properties initiating
certain effects
psychologically. Thus, if one associates
smoking behav-
ior with feeling good with friends (peer
control), then
one may need to smoke when those friends are
not
present to feel good. Conversely, the presence
of friends
may also act as a stimulus to smoking. What
occurs is
that the use of the drug can come under
environmental
(stimulus) control and behavior comes under
drug-
induced stimulus control. Over time these
events can
merge to a point where drug taking becomes more
and
more contingent upon environmental events. The
exam-
ple of this stimulus-complex may be too
simplistic, but
one may be able to significantly reduce his/her
pain by
going through the drug taking ritual without
administer-
ing the drug. Thus, the pharmacological effects
of mor-
phine, for example, may be elicited by going
through the
ritual including an injection of water.
Counselors feel
that some heroin addicts may be addicted to the
needle,
and thus the term "needle freaks." Much of
these effects
are difficult to detect but have been verified
in controlled
human experiments. We should not take these
effects
lightly and should suspect that similar CS
complex can
occur with most drugs we take.
Acute behaviorally effective doses of
psychoactive
drugs generally disrupt most learned behaviors.
Thus,
alcohol acutely disrupts the ability of any
individual to
drive an automobile. However, if the individual
contin-
ues to drive under the influence of alcohol,
then two
things can occur. First, the individual will
develop
behavioral tolerance to the alcohol. That is,
such a per-
son will learn to adapt to the drug state and
will learn
how to manage his/her automobile in spite of
the phar-
macological effects of alcohol. As this process
contin-
ues, the learning of how to drive the car and
how to get
to certain places (to the ABC store) can also
become
contingent upon the alcohol state. Thus, an
individual
may have difficulties finding the ABC store
when sober.
This phenomena is called drug-induced state
dependent
learning. Its premise is that the retention of
information
learned under the drug state is contingent upon
the rein-
stitution of the drug state. There are many
examples of
this with most psychoactive drugs. In fact, one
might
consider this a form of dependence. Thus, a
person may
need to continue using a specific drug in order
to per-
form specific tasks learned under the drug
state.
Drugs that are abused by man appear to have
very
subtle but profound effects on specific
neurotransmitter
systems in the brain. In the normal state these
chemi-
cals, which are the means by which nerves
communi-
cate with each other, are in a very delicate
balance,
allowing one to perceive his/her environment
and make
adjustments to act in accordance with his/her
own
needs. Psychoactive drugs tend to disrupt this
balance,
which in effect alters an individual's ability
to respond
in his/her environment.
At this point there is one theoretical model
that sug-
gests that the drug-dependent person's
neurochemical
system is out of balance and that the
individual uses a
given drug to allow his/her neurochemical
systems to
function in a more normal fashion. This theory
has
been promoted as a mental health model in order
to
Adapted from John A. Rosecrans, "Psychological
and Neuro-
chemical Mechanisms Involved in the Maintenance
of Chemi-
cal Dependencies" Drug Dependence Outline,
MCV/VCU,
1990.
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