Concepts of chemical dependency 10th edition pdf free download

Raffoul, University of Houston "The authors have a good writing style. They write clearly and have the unique ability to simplify the most difficult concepts so that students can comprehend them The authors are careful and exhibit consistent use of a preliminary explanatory section of each part of the textbook.

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Only Cram is Textbook Specific. Accompanys: It will be welcomed by students, researchers and indeed anyone wanting critical but comprehensive coverage of key issues and trends concerning drugs and society - locally and globally, historically and today.

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How do we understand moral panics? What is the relationship between drugs and violence? How do people's social positions influence their involvement in drug use? Insightful and illuminating, this book discusses drugs in social contexts.

The authors bring together their different theoretical and practical backgrounds, offering a comprehensive and interdisciplinary introduction that opens up a wide scientific understanding moving beyond cultural myths and presuppositions. This is an invaluable reference source for students on criminology, sociology and social sciences programmes, as well as drug service practitioners such as drug workers, social workers and specialist nurses.

This innovative counseling guide will benefit the addiction counselor and help the addicted patient locate and understand the exact nature of his or her addiction as it relates to the mind.

A credentialed alcoholism and substance abuse counselor, author Leon Dickerson shows that by motivating the addicted person to participate in his or her treatment and commit to regular twelve-step program involvement, he or she will greatly enhance the odds of recovery. Dickerson also believes that spirituality plays a major role in finding and maintaining sobriety. Numerous twelve-step programs, including Alcoholics Anonymous, use the concept of a higher power in their treatment.

This program incorporates the use of educational material in the form of pamphlets, videos, and workbooks developed by leading practitioners in the field. Perfect for patients and counselors, Freudian Concepts of Id, Ego and Superego Applied to Chemical and Other Addictions sets the standard for chemical dependency treatment. Drug use is a major challenge for public services, healthcare professionals and policy-makers all over the world. This book offers a complete overview of the issues associated with substance misuse from an interdisciplinary perspective.

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Score: 5. But is being addicted to something necessarily bad? These attitudes are explicit both in contemporary medical literature and in popular, self-help texts. We categorise addiction as unnatural, diseased and self-destructive. We demonise pleasure and desire, and view the addict as physically and morally damaged. Helen Keane's thought-provoking text examines these assumptions in a new light. In asserting that the 'wrongness' of addiction is not fixed or indeed obvious, she presents a refreshing challenge to more conventional accounts of addiction.

She also investigates the notion that people can be addicted to eating, love and sex, just as they are to drugs and alcohol. What's Wrong with Addiction? It exposes strains in our society's oppositions between health and disease, between the natural and the artificial, between order and disorder, and between self and other. User icon An illustration of a person's head and chest. Sign up Log in. Web icon An illustration of a computer application window Wayback Machine Texts icon An illustration of an open book.

Books Video icon An illustration of two cells of a film strip. Video Audio icon An illustration of an audio speaker. Audio Software icon An illustration of a 3. This is not the only classification system in use.

The International Classification of Diseases is another such system, with the 11th edition available in The 10th edition is widely used by insurance companies in the United States and in other countries, and unfortunately is not entirely compatible with the DSM-5, which is a major shortcoming of the DSM-5 classification system.

Indeed, this was the reason Narcotics Anonymous was founded: Individuals who used illicit drugs and who attempted to join Alcoholics Anonymous AA in the s and s were told that they could only talk about their alcohol use disorder at meetings because AA was not intended to address drug addiction, only alcoholism. With the growth of polydrug11 disorders, the concept of drug of choice has fallen into disfavor and few clinicians now place emphasis on this concept.

Thus, for the sake of this text, the following definitions will be used: Social Use: A point of confusion is that use of a substance is equated with a substance use disorder, especially when a person is using illicit drugs.

Currently, alcohol, tobacco, Loss of Control is a poorly defined term. In essence, a person who cannot accurately predict in advance how much alcohol or drug s he or she will use on any given occasion might be said to have lost control An excellent example of how cultural norms govern substance use.

Many clinicians use the term dependence on a chemical, although some professionals still use the term addiction to refer to the more severe end of the spectrum of SUDs, despite the removal of the term from the DSM-5 terminology APA, Dependence was previously said to exist when the individual met the DSM-IV criteria for alcohol or drug dependence, as discussed in the Diagnostic and Statistical Manual of Mental Disorders 4th ed.

American Psychiatric Association, Dependence is marked by the development of a characteristic withdrawal syndrome for compound s being misused that have not been prescribed. If the drug was prescribed by a physician for the treatment of a disease state, the same process is called neuroadaptation. This process will be discussed in more detail in the next chapter. Tolerance to a drug s is said to develop when the individual must use more of a compound to achieve the effects once achieved at a lower dose.

Some of the more significant subforms of tolerance will be discussed in more detail in the next chapter. Withdrawal Syndrome is a phenomenon experienced when the individual either stops, or significantly reduces, his or her intake of a specific compound.

The neurons struggle to compensate, increasing the number of neurotransmitter receptor sites for excitatory neurotransmitters to overcome the inhibitory effects of the persistent alcohol use. This is experienced by the individual as anxiety, withdrawal tremors, and in extreme cases delirium tremens DTs , all of which are discussed in more detail in later chapters.

The world of the addictions is replete with a range of other terms that serve as a form of professional shorthand for individuals who work in the field, but the above terms should serve as a solid foundation from which the reader can begin to understand the world of substance use disorders. It is important to realize how other professionals as well as individuals encountered while conducting professional work use such terms.

Although there are similarities with the SUDs, there are also numerous differences Alavi et al. These behavioral addictions will not be discussed further in this text, as the focus is on substances in particular. Unanswered Questions If you were a devotee of the television talk shows, or read a small sample of the self-help books available, you would easily be left with the impression that researchers have discovered all that there is to be known about the cause s of and treatment s for substance use disorders.

Unfortunately, nothing could be further from the truth! Although few research studies identify the difference, the lifetime prevalence, which is to say whether a person has used a given chemical at any point in his or her life, differs from the period prevalence, that is, whether the Copyright Cengage Learning.

In many research studies, the two groups are lumped together as if they were a uniform group of individuals. Most people either use alcohol socially, or, upon encountering a sign of a serious alcohol use disorder, abstain from further use.

Neither clinical researchers nor substance rehabilitation professionals know how to identify the individual who will go on to develop a serious alcohol use disorder12 from the one who will experience a transient substance use problem, in spite of public displays of confidence. An inconvenient truth is that there are earnest questions that face researchers in the field of the addictions: Are those individuals who seek treatment the same as those who do not?

Are those individuals who occasionally use drugs different in some poorly understood way from those individuals who go on to become physically dependent on a drug or alcohol? Is research carried out on those individuals who seek treatment through the Veterans Administration hospital system applicable to the general population? How do men and women who have SUDs differ? Do the same treatment techniques work for each subgroup?

Are those individuals who misuse substances and who hold full-time employment the same as or different from those individuals who misuse substances who do not hold full-time jobs, and are individuals in either group the same as or different from those who are unemployed? Are those persons who limit their substance use to alcohol the same as those who use an illicit drug, or who use multiple drugs?

Alcohol use disorders AUDs are a subset of substance use disorders. When the discussion is limited only to alcohol, the terms alcohol use disorders or AUDs will be used. When the topic is limited to cocaine use or addiction, the term cocaine use disorders will be used, etc. How do these variables affect the processes of intervention and rehabilitation? It is difficult to answer these and a host of other questions, in part because much of the clinical literature addresses only the alcohol use disorders AUDs.

There are probably differences between persons with an AUD and persons with an opioid use disorder, to cite one possibility, but there is a dearth of clinical research into such differences.

The assumption that the forces that shape SUDs in men automatically are the same as those that apply to women has also been challenged. Thus, much of what we think we know about substance use disorders is not based on scientific research, but on assumptions, guesses, and limited data.

It is not the purpose of this text to deny that SUDs exact a terrible cost in individual suffering and to society, but hopefully the reader has started to understand how little is really known about the substance use disorders. Only the foundations of understanding have been established, as reflected by the basic concepts used by researchers and clinicians who work in the field of substance rehabilitation, as discussed in this chapter.

This chapter also established parameters for terms such as substance use, misuse, and addiction, as used in this text, to establish a common language. Some of the forces that contribute to the development of an SUD were introduced, and will be discussed in more detail in later chapters.

Unanswered questions facing mental health professionals in their quest to better understand SUDs were raised, as was the fact that there is still a great deal to learn about SUDs. To frame the discussion, it is important to realize that pharmacology is often discussed in terms of pharmacokinetics and pharmacodynamics, the first being how time impacts a drug moving through the body, and the second being the way in which a drug impacts the body, including for how long and how strong DeVane, A Basic Misconception It is surprising how often people discuss illicit drugs as if they were somehow a special class of chemicals that are unique.

In reality, most of the drugs that are misused were used as pharmaceutical agents in the past, and of those that were not actual pharmaceuticals, many were investigated as possible medications. Thus, they work in the same manner that the other pharmaceuticals do: by changing the biological function of target cells through chemical actions.

As is true for most 1 This chapter is designed to provide the reader with a brief overview of some of the more important principles of pharmacology. It is not intended to serve as, nor should it be used for, a guide to patient care.

In the case of drugs individuals are intending to misuse, the target cells are usually in the central nervous system. The Prime Effect and Side Effect of Chemicals It is often surprising for students to learn that it is virtually impossible to develop a mind-altering drug without unwanted side effects. Thus, in order to achieve the prime effect2 of a compound, the user must endure the side effects3 of that compound as well.

Some of these side effects will be relatively minor, while others might be life-threatening. This rule holds true both for pharmaceutical agents prescribed by a physician for a patient and for the drugs that are misused. For example, a person might ingest a dose of aspirin to help him or her cope with the pain of a minor injury. Another example of the difference between the primary and side effects of a medication is seen in the patient who has developed a bacterial infection in the middle ear a condition known as otitis media and who is prescribed an antibiotic such as amoxicillin.

The desired effect is the elimination of the offending bacteria in the middle ear, but an unwanted side effect might also be the death of bacteria in the gastrointestinal tract, where those bacterial strains assist in the process of digestion.

The point to keep in mind is that there are the desired primary effects and unwanted side effects, or what are also known as secondary effects, to every compound. The side effects can 2 See Glossary. See Glossary. Another factor is that the specific form in which a compound is administered will have a major impact on a the speed with which the compound begins to have an effect on the body, b the way that the compound is distributed throughout the body, c the intensity of its effects, and d the speed with which the individual will begin to experience any side effects from the compound.

Fortunately, most of the drugs that are misused are administered either by the enteral or the parenteral route. The most common form of enteral drug administration is in tablet form, which is essentially a selected dose of a compound mixed with a binding agent that acts to give it shape and hold its form until it enters the gastrointestinal GI tract. In most cases, the tablet is designed to be ingested whole, although in some cases it might be broken up to allow the patient to ingest a smaller dose of the medication or for ease of administration, if desired.

Once in the GI tract, the compound begins to break down and separate from the binding agent and is absorbed through either the stomach or the small intestine.

Another common method of oral medication administration is the capsule. This is a modified form of tablet, with the medication being suspended in a solution and surrounded by a gelatin capsule. The capsule is swallowed whole, and, once it reaches the GI tract, the gelatin capsule breaks down, allowing the absorption of the desired compound.

On rare occasions, medications are administered to adults in liquid form, and it Copyright Cengage Learning. A number of compounds might be absorbed through the blood-rich tissues found under the tongue. A chemical that is administered in this manner is said to be administered sublingually, which is a variation of the oral form of drug administration.

Some of the compounds administered sublingually include nitroglycerin and buprenorphine. However, in spite of this advantage, the sublingual form of drug administration is only rarely used, although buprenorphine is frequently used by individuals struggling with opioid use disorders Rosenthal et al. While many compounds are rapidly absorbed rectally, this method of drug administration is uncommon in medical practice, and it used to be virtually unheard of in those who use illicit drugs Jenkins, The parenteral method of drug administration involves the injection of a compound directly into the body.

There are several advantages to parental forms of drug administration, including the fact that the drugs are not exposed to gastric juices, delays caused by the stomach emptying process, or the danger of being mixed with food in the GI tract, which might delay absorption. It also avoids first-pass metabolism. Depending on the substance being discussed, the intravenous administration of that chemical might be the preferred method of administration, especially when a rapid onset of effects is desired.

However, the subcutaneous method of drug administration is not unheard of. This involves the injection of the compound just under the skin, allowing for a reservoir of the drug to be established in the body and a slower rate of absorption than the intravenous administration method. Another method of parenteral drug administration involves the injection of a compound s into muscle tissue intramuscular or IM injection.

Muscle tissues have a good supply of blood, and many compounds injected into muscle tissue will be absorbed into the general circulation more rapidly than compounds injected just under the skin.

This method of drug administration is used both for the 5 See Glossary. However, there are many compounds such as benzodiazepine chlordiazepoxide used with acute alcohol withdrawal that are poorly absorbed by muscle tissue, and are thus rarely if ever administered by this route DeVane, , Intravenous or IV injection is a frequently used method of drug administration.

In this process, the compounds of choice are injected directly into a vein, and are thus deposited directly into the general circulation DeVane, , This is a common method by which legitimate pharmaceuticals, and many illicit drugs, are administered. One serious disadvantage of the intravenous method of drug administration is that it does not allow the body very much time to adapt to the foreign chemical, and thus the individual is at risk for a serious adverse reaction to the compound within seconds of it being administered.

There are a number of additional forms of drug administration, which will only briefly be discussed in this text. The transdermal method of drug administration involves a compound being slowly absorbed through the skin.

This method of drug administration does not allow for one to rapidly establish any significant blood level of a compound in the body. Another method of drug administration, one that is used more frequently by those who misuse drugs than in medical practice, is the intranasal method. Cocaine and heroin powder, as well as methamphetamine, are often used in this manner.

This allows for a relatively rapid absorption of the drug s in question, but the absorption rate is often erratic and slower than the intravenous route of administration. The process of snorting is similar to the process of inhalation, which is used both in medical practice such as an inhaler for asthma or anesthetic gases used for surgery and with certain compounds by those who misuse drugs. Many of the drugs that are misused become able to cross over this Copyright Cengage Learning.

These compounds include heroin, methamphetamine, and cocaine. Finally, in the case of some compounds, the process of inhalation is able to introduce small particles into the deep tissues of the lungs, where they are deposited.

These particles are rapidly broken down into smaller and smaller units until they are small enough to pass through the tissue barrier of the lungs into the circulation. This is the process that takes place when tobacco cigarettes are smoked, for example. Each subform of inhalation takes advantage of the fact that the lungs offer a blood-rich, extremely large surface area, allowing for the rapid absorption of many compounds Jenkins, ; Lehne, However, many factors influence the amount of a given compound that actually is absorbed into the general circulation, including: 1 The individual must inhale the compound s at exactly the right point in the respiratory cycle to allow the drug molecules to reach the desired point in the lungs, and 2 some chemicals are able to pass through the tissues of the lung into the circulation more rapidly than others because of the chemical structure of the molecule.

Bioavailability To have an effect, a compound must enter the body in sufficient strength to achieve the desired effect. This is referred to as the bioavailability of a compound. Each of these processes will be discussed in more detail, below.

Absorption Except for topical agents, which are deposited directly on the site of action, such as an antifungal cream, most compounds must be absorbed into the body to have any effect Jenkins, ; Lehne, This involves the drug molecules moving from the site of entry through various cell boundaries to the circulatory system, where they are transported to the site of action.

Compounds that are weakly acidic are usually absorbed through the stomach lining, while compounds that are weak bases are absorbed in the small intestine Jenkins, ; DeVane, The human body is composed of layers of specialized cells, organized into specific patterns that carry out designated functions.

For example, as noted earlier, the circulation is separated from the air in the lungs by a single layer of tissue the cell walls of the individual alveoli.

Compounds that are able to cross this one-cell layer are able to reach the general circulation in a matter of seconds. In contrast to this, a compound that is ingested orally must pass through the layers of cells lining the GI tract and the blood vessels that surround it before it reaches the circulation.

Thus the oral method of drug administration is recognized as being much slower than inhalation, for example.

Drug molecules can take advantage of these transport mechanisms to move from the site of administration to the site of action. Without going into too much detail, it is possible to classify these cellular transport mechanisms as being either active or passive means of transport Jenkins, ; Lehne, ; DeVane, The most common method by which drug molecules move across cell membranes is called diffusion, a passive method of molecular transport.

Active methods involve the drug molecule taking advantage of one of several natural molecular transport mechanisms that move essential molecules into various cells. The process of drug absorption is variable, depending on a number of factors, the most important of which is the method of administration, as discussed earlier in this chapter. Another major variable is the rate of blood flow at the site of entry. For example, an intramuscular injection into the deltoid muscle of a person suffering from hypothermia will result in poor absorption, since the blood has been routed to the interior of the body to conserve body heat.

Under these conditions, the muscle tissue will receive relatively little blood flow, and this will reduce the speed at which the drug molecules injected into muscle tissue s might be absorbed into the general circulation.

Yet another variable is the molecular characteristics of the compound itself. Some drug molecules are more easily absorbed than others. Also, if the compound is administered orally, a factor that affects absorption of that drug is whether it is ingested on an empty stomach or not DeVane, , Most compounds are better absorbed when ingested on an empty stomach, although some others are Copyright Cengage Learning.

Further, one compound might best be absorbed if it does not have to compete with other drug molecules for admission into the body. All of these factors limit the absorption of some compounds into the circulation.

Distribution The process of distribution refers to how the molecules of a chemical are spread in the body. This includes both the process of drug transport and the pattern of drug accumulation within the body. Very little is known about drug distribution patterns of certain chemicals, especially if the individual has overdosed on one or more compounds Jenkins, Transport Once the drug molecules reach the general circulation, they can then be transported to the site of action.

Some chemicals are able to mix freely with the blood plasma, and as such are often referred to as water-soluble compounds. Much of the human body is water, so this provides a fine medium by which a water-soluble compound might be suspended and pumped around the body.

Alcohol is a fine example of a water-soluble compound, which, after absorption, becomes intermixed with the blood plasma and pumped through the body by the circulatory system.

The characteristics of some drug molecules allow them to bind to one of the fat molecules that circulate through the body. Such compounds are called lipid-soluble or lipophilic compounds. Any drug molecule that has attached itself to a lipid molecule will then be dragged along as the lipid molecule circulates. Body tissues are constantly absorbing lipid molecules from the circulatory system as part of the cellular maintenance process, allowing lipid-binding molecules attached to the lipid molecules relatively rapid access to body tissues.

It is important to keep in mind some characteristics of molecular binding. While the drug molecule is bound to the lipid molecule, it is safe from elimination from the body, but it is also unable to achieve its desired effects. To become active again, it must detach from the lipid molecule. There are advantages and disadvantages to this characteristic of lipid binding.

The process of lipid binding provides a drug reservoir within the body, as drug molecules detach from the lipid molecule over time. This allows new drug molecules to become active to replace those that have been eliminated from the body.

However, the lipid-bound drug molecules Copyright Cengage Learning. A compound that is lipid-soluble will thus become concentrated in the brain.

The ultra-short and short-acting barbiturates6 are excellent examples of this process. In contrast to the lipid-binding compounds, some drug molecules might bind to one of the protein molecules that circulate throughout the body in the circulation.

As with the process of lipid binding, some drug molecules form stronger bonds with the protein molecule than do others, and this is one factor that determines how long a given compound will remain in the body. As is true for lipid-bound molecules, protein-bound drug molecules are unable to have any biological effect as long as they remain bound to the protein molecule.

The number of binding sites on protein molecules is limited. If an individual were to take an unusually large dose of a drug, or if the molecules of more than one compound were competing for the same binding sites on the protein or lipid molecule, those binding sites would rapidly become saturated, leaving a larger than normal percentage of drug molecules free in the blood to have a biological effect.

This is one of the mechanisms through which pharmaceuticals might have a synergistic8 effect: The effects of one compound may reinforce the effects of a second compound, possibly with fatal results.

In humans, these defensive detoxification systems are nonselective, eliminating poisons found in food with the same enthusiasm that they eliminate prescribed medications, since drug molecules are as foreign to the body as are poisons.

In some cases, the body is able to simply filter the drug from the blood. Penicillin is an excellent example of such a compound. The penicillin molecules are filtered from the blood by the kidneys almost immediately. With the proper equipment it is possible to filter penicillin from the urine of a patient taking this compound, purify it and reuse it.

However, in the majority of cases the chemical structure of the drug s must be modified before they can be eliminated from the body. This is accomplished through a process that was once referred to as detoxification, or drug metabolism. They both reflect the same process, which is labeled one way if it is a prescribed pharmaceutical and the other if it is an illicit drug.

There are essentially two forms of biotransformation: a the zero-order biotransformation process, and b the first-order biotransformation process. In the zero-order biotransformation process, the biotransformation mechanisms quickly become saturated, and only a set amount of a 6 Discussed in Chapter 6.

The most common of which is albumin. Sometimes, compounds are referred to as albumin-bound, rather than protein-bound. Technically, drugs that are more acidic tend to bind to albumin, while drug molecules that are more basic tend to bind to the alpha1-acid glycoprotein molecules in the blood. Alcohol is an example of a compound that is generally biotransformed through a zero-order biotransformation process If the individual ingests alcohol more rapidly than his or her body can metabolize it, he or she will become intoxicated.

In the first-order biotransformation process, a set percentage of the compound s in question is biotransformed each hour, independent of the concentration of that substance in the blood.

There are many compounds that are biotransformed through a first-order biotransformation process. The chemistry of each form of biotransformation is quite complex, and is best reserved for those readers who wish to pick up a pharmacology textbook to review the biochemistry of the biotransformation process.

It is enough for the reader to remember that there are two different forms and four different chemical mechanisms of biotransformation.

In both forms of biotransformation, the drug molecules are chemically altered as rapidly as the enzymes involved in each step can accomplish, one molecule at a time. The original substance is referred to as the parent compound. The goal of the biotransformation process is to alter the foreign chemical molecule until it becomes a compound that can be eliminated from the body. In some cases, depending on the chemical characteristics of the drug s ingested, this process might involve several steps.

The intermediary molecules that emerge from this process are known as metabolites of the parent compound, some of which have psychoactive effects of their own. Compounds that are highly lipid-soluble require extensive biotransformation before they become less lipid-soluble and are more easily eliminated from the body, and some of these metabolites are themselves psychoactive Jenkins, ; Lehne, If the parent compound has no or minimal biological effect, and its major effects are achieved by the metabolites of that compound, then the parent compound is referred to as a prodrug.

Most compounds in use today are biologically active, and only a small number are prodrugs such as aspirin and codeine. Further, as a result of genetic variations, some individuals are able to biotransform a given compound more rapidly than are others, making them rapid metabolizers of that compound.

Genetic variations might endow a person with a body that is slower at breaking down a given compound than is normal, making them a slow metabolizer of that compound. There is no way to identify these individuals other than clinical experience obtained by giving the patient a drug and observing his or her reaction, although there is ongoing research in this area.

The human digestive tract is designed not to let any chemical that is absorbed pass directly into the circulation, but to filter it first through the liver. This is called the first-pass metabolism effect also known as presystemic elimination; DeVane, , By taking chemicals absorbed from the GI tract and passing them through the liver, any toxin in that food or drug might be identified and the biotransformation process started, hopefully before the compound can do any damage to the body itself.

One consequence of the first-pass metabolism process is that the effectiveness of many orally administered compounds is limited. For example, much of an orally administered dose of morphine is biotransformed by the first-pass metabolism effect before it reaches the site of action, limiting its effectiveness as an analgesic. Collectively, the first pass metabolism process, and the various subforms of biotransformation, work to prepare foreign chemicals for the last stage: elimination.

Elimination So closely intertwined are the processes of biotransformation and elimination that some pharmacologists consider them to be a single topic. The process of biotransformation changes the chemical structure of a compound so that the metabolites are more water-soluble, so that it can then be removed from the circulation by the organs involved in filtering the blood. An example of this is the small percentage of 12 Discussed in Chapter 5.

This may be complicated by compounds whose metabolites also have a biological effect on the body. The therapeutic half-life usually is a reference to a single dose of a compound, and regular dosing of that compound can alter the therapeutic half-life of a chemical. Finally, there is the elimination half-life of a compound. In medical practice, it is usually assumed that after the fourth or fifth dose, the individual will have achieved a steady state of a compound in his or her blood.

The elimination half-life of a compound might be extended in persons with impaired liver or kidney function, and the physician must make dosage adjustments for persons with such problems. The various half-lives of a compound are not the same. A compound might have a therapeutic half-life of minutes but an elimination half-life of hours, as is demonstrated by several of the ultra-short-acting barbiturates.