TOPIC FIVE: DRUGS AND SUBSTANCE ABUSE

Objectives

By the end of the topic the learner should be able to;

a) Define relevant concepts i.e. drug, substance use etc.

b) identify the incidence and prevalence of substance abuse in society
c) Distinguish the various health issues associated with drug abuse.
d) Describe the life skills necessary for reducing and preventing drug and
substance abuse
Definition of concepts (Drug, Substance, Drug abuse)
Drug

A drug is any substance that causes a change in an organism's physiology or /and

psychological state when consumed.

Drugs are typically distinguished from food and substances that provide nutritional
support. Consumption of drugs can be through inhalation, injection, smoking,
ingestion, absorption via a patch on the skin, or dissolution under the tongue.

The word “drug” refers to any substance or product that affects the way people
feel, think, see, taste, smell, hear, or behave. The World Health Organisation
(WHO) defines “a drug” as “any substance, solid, liquid or gas that changes the
function or structure of the body in some way”. Often, the term “substance use” is
preferred, so that all things that affect the way a person feels, thinks, sees, tastes,
smells, hears and behaves are included. Thus, glue is a substance used by many
street children. Sometimes we use the phrase “psychoactive substance" for drugs to
emphasize the fact that the substance produces a change in mental processes. A
drug can be a medicine such as morphine (used to treat moderate to severe pain),

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or it can be an industrial product such as glue. Some drugs are legally available,
such as approved medicines and cigarettes, while others are illegal, such as heroin
and cocaine. Each country has its own laws regarding drugs and their legality. The
use of drugs may have a little or a large effect on a person's life and health. The
extent of the effect depends on the person, the type of substance, the amount used,
the method of using it, and the general situation of the person.

In pharmacology, a drug is a chemical substance, typically of known structure,

which, when administered to a living organism, produces a biological effect.
A pharmaceutical drug, also called a medication or medicine, is a chemical
substance used to treat, cure, prevent, or diagnose a disease or to promote well-
being. Traditionally drugs were obtained through extraction from medicinal plants,
but more recently also by organic synthesis. Pharmaceutical drugs may be used for
a limited duration, or on a regular basis for chronic disorders.

Pharmaceutical drugs are often classified into drug classes or groups of related
drugs that have similar chemical structures, the same mechanism of action (binding
to the same biological target), related mode of action, and those which are used to
treat the same disease.

The Anatomical Therapeutic Chemical Classification System (ATC), is the most

widely used drug classification system which assigns drugs a unique ATC code,
which is an alphanumeric code that assigns it to specific drug classes within the
ATC system.

Another major classification system is the Biopharmaceutics Classification System

(BCS) This classifies drugs according to their solubility and permeability
or absorption properties.

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Psychoactive drugs are chemical substances that affect the function of the central
nervous system, altering perception, mood or consciousness. These drugs are
divided into groups like:

• Stimulants
• Depressants
• Antidepressants
• Anxiolytics
• Antipsychotics
• Hallucinogens.

These psychoactive drugs have been proven useful in treating wide range
of medical conditions including mental disorders around the world. The most
widely used drugs in the world include caffeine, nicotine and alcohol which are
also considered recreational drugs, since they are used for pleasure rather than
medicinal purposes. Abuse of several psychoactive drugs can cause psychological
or physical addiction. It's worth noting that all drugs can have potential side
effects. Excessive use of stimulants can promote stimulant psychosis. Many
recreational drugs are illicit and international treaties and as such as the Single
Convention on Narcotic Drugs exist for the purpose of their prohibition.

Substance Abuse

According to WHO Substance abuse refers to the harmful or hazardous use of

psychoactive substances, including alcohol and illicit drugs. Psychoactive
substance use can lead to dependence syndrome a cluster of behavioral, cognitive,
and physiological phenomena that develop after repeated substance use and that
typically include a strong desire to take the drug, difficulties in controlling its use,
persisting in its use despite harmful consequences, a higher priority given to drug

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use than to other activities and obligations, increased tolerance, and sometimes a
physical withdrawal state.

Factors associated with drug abuse

The old and young people take drugs for their immediate and short-term effects.
Usually many young people use drugs because they either add something to their
lives or help them to feel that they have solved their problems, however fleeting
(short time) this feeling might be. Drug use may also be influenced by a number of
factors, such as:

1. The individual: Adolescence is a time of immense physical and emotional

change. Young people often feel awkward and self-conscious. They may
feel caught between conformity and the urge to be different or the urge to fit
in with the peer group. Often, young people do not have the skills necessary
to deal with the stress and pressures of life and drugs may be seen as a way
of dealing with them.

2. Family and friends: Young people may learn about drugs and their uses
from their family and friends. Often, children living in families where
smoking, drinking alcohol and taking prescription drugs or any other
stimulant, is considered as part of life end up believing that drugs are
normal. They also believe that drugs are helpful in releasing stress or
worries. Friends and peers have a great influence on young people and drug
use may be considered normal and part of growing up.

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 3. Environmental factors: These include laws that control the supply and
availability of drugs such as advertising and promotion of alcohol and drugs
coupled with their availability (access).

Some examples of why young people use drugs:

Reasons for drug use Effects of the drug use

Hunger Lessens hunger pangs
Boredom Creates sense of excitement
Fear Generates a feeling of bravery
Feelings of shame, depression, and
Helps to forget
hopelessness
Lack of medicine and medical care Self-medication
Difficulty falling asleep because of
Produces drowsiness or overcrowding
noise
Need to stay awake for job protection Help user to stay awake
No recreational facilities Offers entertainment
Provides a sense of connection with
Social isolation
other drug users
Lack of sexual desire to engage in sex
Can enhance sexual desire
work
Loneliness Promotes socializing
Physical pain Relieves physical pain

Drug Dependence/Addiction

Dependence (or dependency syndrome, often referred to as addiction) occurs when

a person becomes dependent on one or many drugs. It is defined by WHO as “a
cluster of physiological, behavioral and cognitive phenomena of variable intensity,
in which the use of a psychoactive drug (or drugs) takes on high priority, more
than other behaviours that once had value”.

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Dependence may be defined as:

- A strong desire or sense of compulsion to take the drug;

- Difficulties in controlling drug-taking behaviour;
- A physiological withdrawal state when drug use has ceased or been reduced;
- Evidence of tolerance, i.e, increased doses required to achieve effects
originally produced by lower doses;
- Progressive neglect of alternative pleasure or interests due to substance use,
increased amount of time needed to obtain or take the substance or to
recover from its effects;
- Persisting with substance use, despite clear evidence of harmful
consequences (e.g., liver damage, depression, and impaired cognitive
functioning).

Drug use among the youth

Major patterns of drug use among the youth

Patterns of drug use vary greatly among youth, and may change over time. Some
develop a regular pattern of use while others may be quite haphazard and
opportunistic. Just because a young person starts to use one drug does not mean
that he or she will automatically progress to using other drugs or to more intensive
use. While recognizing the variability of drug use by the youth, it can be useful to
try to classify their use according to the level of use and risks or problems
experienced. It has been suggested that there are 5 kinds of drug use:

1. Experimental use: Young people go through a period of development that

involves experimentation, exploration, curiosity and identity search. Part of
such a quest usually involves some risk taking, which can include

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 experimenting with drugs. They are curious about drugs and want to
experience new feelings and sensations. It is important to note that, after
some experimentation, most young people stops using the drugs.

2. Functional use: For the majority of young people, drug use is not mindless
or pathological, but functional. Drugs have a specific purpose in their lives,
such as recreation, providing relief from anxiety or boredom, to keep awake
or to get to sleep, to relieve hunger and pain, to feel good and to dream. Such
use is often controlled and limited to specific circumstances and situations.
Young people may vary the type of drug they use, depending on the
situation, to achieve the desired effect. They are sometimes experienced
users and know what, when and how to use drugs. If their drug use is not
causing serious problems for them, there is little motivation for these
functional users to stop using drugs.

3. Dysfunctional use: Dysfunctional use is drug use that leads to impaired

psychological or social functioning. Typically, such use affects personal
relationships. As a result of their drug use, some young people may become
involved in fights or arguments with others or family members. It may
interfere with his or her education or work. S/he may not be able to
accomplish important survival tasks, such as finding adequate food and
avoiding violence. This behaviour may cause further alienation, including
rejection by other members of the peer group or family. Because of these
increasing difficulties, there may be some motivation to think about quitting
drugs. However, the benefits they perceive in using drugs may make it
difficult for them to break the habit.

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4. Harmful use: In harmful use, drugs cause damage to physical or mental
health. These harms include traumatic injuries from accidents and violence,
overdose and poisoning, suffocation, burns and seizures. Other body harms
result from the way in which the drug is used. Injecting drugs is particularly
dangerous because of the risk of hepatitis, HIV and other infections from
contaminated needles and syringes, along with collapsed veins and
overdose. Smoking drugs can result in disorders of the respiratory system
and burns. Some drugs are particularly toxic and can cause health damage in
even small amounts. Such drugs include leaded petrol, benzene and coca
paste. Although health damage is more likely to occur in individuals who
use drugs regularly and intensively, it can also occur in experimental and
occasional users, usually as a result of intoxication. As most young people
have not been using drugs for long enough, it is unusual to see them with
such disorders as alcohol-related liver disease or smoking- related lung
cancer, which tend to occur late in life.

5. Dependent use: Drug dependence is the name given to the most intensive
type of drug use. Users who are dependent on drugs often have poor control
over their intake. They may continue to use drugs despite very serious
consequences. In addition, they may spend more and more of their day in
activities related with drugs; earning money or trading sex for drugs.
Dependent users may develop a tolerance for certain drugs, that is, their
bodies may adjust to the drugs so that the same amount of the drugs no
longer produce the same effect and they require more of the drug to get the
effect previously experienced. A dependent user may also experience
withdrawal symptoms, if s/he goes too long without the drugs.

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 The young people who are dependent on drugs will need a lot of support to
change the behavior such as establishing good links with local health
agencies that deal with drug users is important. If workers are in isolated
areas and there are few health resources in the local community, links will
need to be formed with helpful professionals in other locations. Being
dependent on drugs can be like being very dependent on other people, food
or exercise. The drug can be like a reliable friend who usually gives what a
person wants or needs. Giving up the drug can be like losing a best friend.
Grief and loss issues need to be dealt with.

Names and types of substances commonly used by young people

There is an enormous number of substances that can be used. The generic name of
a drug is standard and used throughout the world. However, most drugs are
marketed under various trade names and also have many street names. Trade
names usually begin with a capital letter. For example, a commonly used drug to
reduce anxiety is diazepam (generic name) and is sold in some countries as Valium
(trade name). Another example is diacetylmorphine, which is the generic name for
Heroin, and has the street names, "brown sugar" in India, and "smack" in the USA
and Australia. It is also common for street names to change regularly.

The three main types of drugs, classified according to their effects on the
central nervous system are:

1. Depressants.
2. Hallucinogens.
3. Stimulants.

Depressants – They slow down, or depress, the central nervous system. They do
not necessarily make the user feel depressed. Depressant drugs include: Alcohol

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and Opiates including heroin, morphine, codeine, methadone, and pethidine,
Cannabis including marijuana, hashish and hash oil, Tranquillisers and hypnotics,
including Rohypnol, Valium, Serepax, Mogadon, and Euhypnos , Barbiturates,
including Seconal, Tuinal and Amytal , Solvents and inhalants including petrol,
glue, paint thinners and lighter fluid. In moderate doses, depressants can make
users feel relaxed. Some depressants cause euphoria and a sense of calm and well-
being. They may be used to wind down or to reduce anxiety, stress or inhibition.
Because they slow the nervous system down, depressants affect coordination,
concentration and judgment.

In larger doses, depressants can cause unconsciousness by reducing breathing and

heart rate. Speech may become slurred and movements sluggish or uncoordinated.
Other effects of larger doses include nausea, vomiting and, in extreme cases, death.
When taken in combination, depressants increase their effects and the danger of
overdose.

Hallucinogens - They distort perceptions of reality. These drugs include:

- LSD (lysergic acid diethyl amide); trips, acid, microdots

- Magic mushrooms (psilocybin): gold tops, mushies

- Mescaline (peyote cactus)

- Ecstasy (MDMA/methylenedioxymethamphetamine)

-Cannabis in stronger concentrations, such as in hashish and resin can act as an

hallucinogen in addition to being a central nervous system depressant;

-Ketamme also known as K or and Special K.

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The main physical effects of hallucinogenic drugs are dilation of pupils, loss of
appetite, increased activity, talking or laughing, jaw clenching, sweating and
sometimes, stomach cramps and nausea. Drug effects can include a sense of
emotional and psychological euphoria and well-being. Visual, auditory and tactile:
hallucinations may occur, causing users to see or hear things that do not actually
exist. The effects of hallucinogens are not easy to predict. The person may behave
in ways that appear irrational or bizarre. Psychological effects often depend on the
mood of the user and the context of use.

Negative effects of hallucinogens can include panic, paranoia and loss of contact
with reality. In extreme cases, this can result in dangerous behaviour like walking
into traffic or jumping off a roof. Driving while under the influence of
hallucinogens is extremely hazardous. It is common for users to take minor
tranquillizers to help them come down from a hallucinogenic drug.

3. Stimulants They speed up the body's systems, they are used by millions of
people every day. They include Coffee, tea and cola drinks contain caffeine, which
is a mild stimulant. The nicotine in tobacco is also a stimulant, despite many
smokers using it to relax. Other stimulant drugs, such as ephedrine, are used in
medicines for bronchitis hay fever and asthma. Amphetamines and other ATSs
(Amphetamine-type Stimulants, such as, forms of methamphetaime known as
“ice”, “shabu”, and “ya ba”) and cocaine are illegal in most countries. The use of
ATS is becoming a major problem in most countries and has begun to overshadow
heroin use.

Stimulants speed up or stimulate the central nervous system and can make the user
feel more awake, alert or confident. Stimulants increase heart rate, body

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temperature and blood pressure. Other physical effects include reduced appetite,
dilated pupils, talkativeness, agitation and sleep disturbance.

Higher doses of stimulants can over stimulate the user, causing anxiety, panic,
seizures, headaches, stomach cramps, aggression and paranoia. Prolonged or
sustained use of strong stimulants can also cause these effects. Strong stimulants
can mask the effects of depressant drugs, such as alcohol. This can increase the
potential for aggression and poses an obvious hazard if the person is driving.
Mental health difficulties (e.g., psychosis) can be associated with problematic ATS
use.

Symptoms that identify a person who may be using drugs

The following symptoms are indicative of drug use and may not always be related
to drug dependence:

1. Marked personality change: a placid, soft-spoken person suddenly becomes

noisy and abusive. The change may be gradual and only apparent when one
thinks about it. Sometimes, this may occur the other way around i.e., an
outgoing and talkative person may turn silent and withdrawn.
2. Mood swings: Mood may swing from high to low and back again,
seemingly, without reason. There may also be extreme behaviour
precipitated by the most innocuous events or statements.
3. Change in physical appearance or well-being: A change in weight, sleep
patterns and other signs, may be sudden or gradual. Other physical
symptoms may include slurred speech, staggering gait, sluggish reactions,
pinpoint or dilated pupils, sweating, talkativeness, euphoria, nausea and
vomiting.

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 4. Change in school or work performance: For students a significant
deterioration in performance, especially when the student has been diligent,
may be an indicator of difficulties. Equally, a rapid change from poor
performance to diligence may be important.
5. An increase in secretive communication with others: This is often seen as
cryptic telephone calls. Remember that some of this may just be typical
behaviour of adolescents.
6. Intuition: Also known as “gut feeling” or “guesswork”, but this warning sign
is based on the awareness you have of a young person you know well. You
may not be able to be specific, or clearly verbalize your hunch, but you will
know there is something wrong. You may find yourself telling others of the
change observed in a person you know.
7. An excessive need for or increased supply of money: Buying drugs costs
money, and the more drug dependent the person becomes, the greater their
need for money to finance their “habit”. Money, however, is not the only
transferable commodity for young people. For example, baseball caps, sport
shoes and sex are commonly traded for alcohol and other drugs.

‘Life skills’ and how life skills training help in reducing drug/substance use

Life skills are abilities for adaptive and positive behaviour that enable individuals
to deal effectively with the demands and challenges of everyday life (WHO 1994).
Based on the positive experience with life skills approaches in substance/drug use
prevention, life skills are a promising approach to strengthen protective factors in
treatment and aftercare, including relapse prevention.

Life skills applied to drug/substance use prevention are supposed to facilitate the
practice and reinforcement of psychosocial skills that contribute to the promotion
of personal and social development. They include:
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1. Self-awareness

2. Empathy

3. Communication skills

4. Interpersonal skills

5. Creative thinking

6. Critical thinking

7. Coping with emotions and coping with stress.

N/B: The above have been covered under the topic on General life skills and
can be adopted to this topic

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