6. Discuss the idea of the switch card with students. Does anyone really know at what point in drug abuse the brain changes and the abuser becomes an addict? How could you modify the card game to account for this?

In life, a person does not know when he or she will reach the point at which drug abuse becomes drug addiction. To reflect this in the card game, students can play the game leaving the switch card face down.

7. When the students play the game this time, they will not look at the switch card. Have them keep the switch card face down and continue the game as before.

8. Continue the discussion of the game and its relation to drug abuse and drug addiction.

The main points that students should learn through this activity are

• Drug abuse involves choice.
• The point at which a person's brain is changed and drug abuse becomes drug addiction is different and unknown for each individual.
• Everyone has risk factors.
• A person does not become addicted to drugs after one episode of abuse.

9. (optional) A person does not become addicted to drugs after one episode of abuse, but a person can die as a result of one episode of drug abuse. The drugs can act on other body systems with a lethal outcome. If you want to modify the game to add this scenario, insert the jokers into each pile of choice cards and have the students play the game a fourth time. If a student draws a joker, the game is over for that student.

If you decide to do this optional modification to the game, make sure that students understand that the joker does not indicate addiction. The joker would, perhaps, represent a batch of drugs that contain a lethal contaminant that would cause some body organ to fail and, therefore, cause the abuser to die. Another person, for example, takes a large enough dose of opiates to completely inhibit the neurons in the brain that control respiration; those neurons no longer stimulate the lungs to contract, causing death.

Content Standard C: An individual's mood and behavior may be modified by substances.

Content Standard F: Personal choice concerning fitness and health involves multiple factors.

ACTIVITY 4: ENVIRONMENTAL, BEHAVIORAL, AND SOCIAL INFLUENCES ON DRUG ABUSE AND ADDICTION

Note to teachers: This activity, as described in the following steps, is designed as a class discussion. An alternative approach is to have individual students write their answers to the questions and then discuss the questions as a class.

1. Display a transparency of Master 4.5, Who Is Addicted?, showing only the top section (to the first horizontal line). Ask students to answer the question.

Students may respond differently to the question about who is addicted to morphine. At this stage, any answer is acceptable if the student can explain the reasoning underlying his or her answer. Some students will say that Chris is addicted because of the higher dose of morphine being taken over a longer period of time. Some students will say Pat because this could be a larger dose than what Chris is taking (if Chris is at 50 mg per day). Students could also believe that both individuals are addicted because of their continued drug abuse. Conversely, students could respond that possibly neither one is addicted and more information is needed before a judgment could be made.

2. Reveal the next section on Master 4.5 (to the next horizontal line). Again have students answer the question and discuss the responses.

Students may respond in a variety of ways. Answers could involve aspects of genetics, dose, or even random chance.

3. Reveal the remaining section of Master 4.5 and have students read the case studies.

4. Discuss the cases with the class. Use the following questions to guide the discussion.

• Why did these two individuals begin taking morphine and then continue to take morphine?
  
  Pat began abusing morphine basically for social reasons. Chris began taking morphine for medical reasons.
  
  
• What are the differences in how Chris and Pat take morphine?
  
  Pat takes an injection of morphine one time each day. Chris also receives morphine through injection, but he receives a dose many times each day.
  
  
• How may these differences have influenced whether addiction develops?
  
  Although Chris receives a higher total dose of morphine during a day, each single injection is a smaller dose. The smaller single dose does not lead to the same "high" that results from a larger dose. Perhaps the fact that Chris does not feel the euphoria when he receives the morphine is important in keeping him from being addicted. (It is acceptable for students to propose answers here even if they cannot be sure.)
  
  
• Is a larger dose of a drug the only factor to consider when thinking about the causes of drug addiction? Explain your answer based on the case studies.
  
  No, because Chris took a larger dose and did not become addicted.
  
  
• Is the length of time that someone has been taking drugs enough to determine if addiction will develop? Explain your answer based on the case studies.
  
  No, because Chris took morphine for a longer period of time and did not become addicted while Pat took morphine for a shorter period of time and did become addicted.
  
  
• What factors other than the amount (dose) of the drug taken and the period of time for which the drug is taken may contribute to addiction?
  
  The expectation of feeling a "rush" may be a factor. A person getting morphine in a hospital would not be taking morphine just to get that feeling. The context of drug (medication) use influences whether a person becomes addicted. Pat's use of drugs to escape problems contributed to the development of drug addiction.
  
  The cases should reveal to the students that just a high dose of a drug is not enough to cause addiction. The behaviors and motivations for taking drugs are important factors in the development of addiction. The street addict was using drugs with the expectation of a rush, or high, and trying to escape life. The patient was taking drugs without the expectation of a high. The patient experiencing pain uses drugs in order to function normally. Scientists do not completely understand why pain patients do not become addicted after drug use, but the statistics clearly show that these individuals are at very low risk of becoming addicted.
  
  You may also want to discuss the case of Vietnam veterans with students. For many years, the media portrayed Vietnam veterans as hopeless drug addicts. Although drug addiction was a problem for some veterans while in Vietnam, the vast majority of those veterans have had no problems with drug addiction since returning to the United States. They may have started using drugs (and subsequently became addicted) to relieve the stress of combat, to rebel against society, or even to relieve boredom, but once they were back in a "normal" environment, they were able to function without drugs.

Content Standard A: Scientists rely on technology to enhance the gathering and manipulation of data.

ACTIVITY 5: LONG-TERM EFFECTS OF DRUG ABUSE AND ADDICTION

Having students view the Web site mini-documentary on the long-term effects of drugs on the brain is the strongly preferred approach for this activity. If computers with Internet access are not available, follow the procedure for the alternate version of the activity.

1. Have students view the mini-documentary, Long-Term Effects of Drugs on the Brain, on the Web site.

Open the Web site in your browser (see Using the Web Site). To view the mini-documentary, click on Web Portion of Student Activities, then select Lesson 4—Drug Abuse and Addiction.

2. After viewing the Web site segment, ask students to write their answers briefly to the following questions.

• What was the most surprising thing you learned about the effect of drugs?
  
  
• What makes this fact surprising to you?
  
  
• Based on what you have learned through the rat experiment analysis, the card game, and the mini-documentary, would you say that drug addiction is a disease? Justify your answer.
  
  

  Having students write their answers to the questions encourages them to organize their thoughts and reflect on what they have learned. Listening to students explain their views about drug addiction as a disease will help you evaluate their understanding.

  Students should be encouraged to relate what they learned in Activities 1 through 4 to what they learned from the mini-documentary.

3. After students have completed their answers to the questions, discuss the questions as a class.

Drug addiction is a disease that causes physical and functional changes in the brain. This is similar to other diseases in which a part of the body does not function properly.

4. Encourage students to learn about how drugs affect other body systems by doing library or Internet searches.

Because the focus of this unit is the brain, the curriculum supplement does not address how drugs act on other parts of the body. However, a great deal of additional information is available online. See the section Additional References for Teachers for some informative Web sites.

ALTERNATE VERSION OF ACTIVITY 5 FOR CLASSES WITHOUT ACCESS TO COMPUTERS

1. Give each student a copy of Master 4.6. Instruct students to read the handout Long-term Effects of Drugs on the Brain and answer the questions.

After students finish reading and answering the questions, discuss the responses as a class.

SAMPLE ANSWERS TO QUESTIONS ON MASTER 4.6

Question 1. What are some of the ways that drugs cause long-term changes in the brain?

The continued use of drugs may cause the brain to become resistant to the effects of the drug (tolerance). Some drugs, such as alcohol and MDMA, can kill brain cells. Cocaine and amphetamine can cause the activity level of the brain to decrease for a long period of time after drug use is stopped.

Question 2. How does the brain adapt to the presence of drugs?

The brain adapts to the presence of drugs by developing tolerance for the drugs and by the developing of cravings if drug use is stopped.

Question 3. How may the abuse of drugs relate to the plasticity of the brain?

Plasticity means that the brain can modify connections (synapses) in response to experiences. Drugs that cause neuron death can decrease the plasticity of the brain because neurons are not present to form new connections and because existing connections are lost.

Question 4. What are some problems that scientists have when they investigate the effects of drugs on the brain?

Scientists have difficulty investigating the effects of drugs on the brain because many drug abusers abuse more than one drug. Scientists must understand how each drug affects the brain and body because drugs taken in combination may have different effects. Also, many drug abusers have other medical conditions that make it difficult for scientists to determine what effects are due to the drug and what effects are due to the other medical problem.

2. If students want to learn more about how drugs affect other parts of the body, encourage them to do library or Internet searches for additional information.

Because the focus of this unit is the brain, the curriculum supplement does not address how drugs act on other parts of the body. A great deal of information is available online. See the section Additional References for Teachers for some informative Web sites.

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