Drug Abuse : An Overview

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Drug / Psychoactive Substance

• Any substance that when taken by a person modifies perception, mood, cognition, behaviour or motor functions.

• This definition includes legal and illegal substances, that can lead to dependence

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Part 1: Types of drugs

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Classification

• Alcohol

Alcoholic beverages

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• Alcohol is a brain depressant. In small amounts it relieves anxiety. it may also give a sense of strength

and result in boisterous behaviour It heightens the mood prior to intake,

be it sadness or happiness. Impairs judgement and performance

Alcohol: Psychological effects

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Classification

• Alcohol• Opioids

Opium

Heroin (Smack)

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Opioids: Psychological effects

• The effects differ widely between new and dependent users

New users

• Who is not in pain an unpleasant reaction.

• Who has pain or anxiety some relief

Dependent users

• Short lived in-tense experience – “rush”.

• A state of profound euphoria.

• A dreamlike state lasting longer

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Classification

• Alcohol• Opioids • Cannabis

Cannabis (Bhang, Charas, Ganja, Hashish)

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Cannabis products

• Bhang (leaves)• Ganja (dried flowering stem

of the plant)• Charas / Hashish (extracted

from the resin covering the plant)

• Hashish Oil (extracting THC using chemical methods)

Oral

Smoked

Smoked

Smoked

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Cannabis: Psychological effects

• A dreamy state with an increased tendency to fantasize State of euphoria, well being and

enjoyment. Generally followed by a period of

drowsiness.• Perceptual and sensory distortions.

Can prolong reaction time and impair coordination

Sounds and colours may become more intense

• Restlessness, fear and even panic may spoil the experience (“bad trip”).

• There may be driven activity (subject knows that one’s activities are meaningless, yet is unable to control them).

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Classification

• Alcohol• Opioids • Cannabis • Sedative – hypnotics

Valium, Avil, Cough Syrups

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Sedative – hypnotics & other pharmaceuticals

Medications for: • Sleep (Diazepam)• Allergy (Promethazine, pheniramine)• Pain (Pentazocine, Propoxyphene)• Cough (Codiene)• Diarrhea (Diphenoxalate)• Anesthesia (Ketamine)

General brain depressants

Opioid like actions

Hallucinogen

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Classification

• Alcohol• Opioids • Cannabis • Sedative – hypnotics • Cocaine and other stimulants

Coca leaf and cocaine powder

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Amphetamine Type Stimulants (ATS)

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Stimulants: Psychological effects

• Immediately after smoking the drug or injecting it- extremely pleasurable ‘rush’ or ‘flash’. Enhanced mood and body movement,

euphoria Increased respiration Increased heart rate, blood pressure Insomnia Reduced appetite

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Classification

• Alcohol• Opioids • Cannabis • Sedative – hypnotics • Cocaine and other stimulants• Hallucinogens

LSD

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Classification

• Alcohol• Opioids • Cannabis • Sedative – hypnotics • Cocaine and other stimulants• Hallucinogens • Tobacco

Tobacco

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Classification

• Alcohol• Opioids • Cannabis • Sedative – hypnotics • Cocaine and other stimulants• Hallucinogens • Tobacco • Volatile solvents

Volatile solvents (Inhalants)

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Classification

Stimulants• Cocaine • Amphetamine Type

Stimulants• Tobacco• Cannabis

Depressants• Alcohol• Opioids • Sedative –

hypnotics • Volatile solvents • Cannabis

Hallucinogens• LSD• Cannabis

Types of drugs

Legal (licit):• Medicine• Tobacco• Alcohol• Caffeine/tea • Bhang

Illegal (illicit):• Opium• Heroin• Cocaine• ATS,• Charas/Ganja

The Extent, Pattern and Trends of Drug Abuse in India:National Survey

1. National Household Survey (NHS)2. Drug Abuse Monitoring System (DAMS)3. Rapid Assessment Survey (RAS)4. Focused Thematic Studies (FTS)

Drug abuse and women in India Burden on women through abusing family

members Drug abuse in rural population Drug consumption in border areas Drug abuse in prisons

Components of the survey

Sample Size: 40,697 males (12-60 yrs)

Prevalence of ‘current’ use (i.e., during last month)

• Alcohol: 21%• Cannabis: 3%• Opiates: 0.7%

(heroin: 0.2%)• Any illicit drug: 3.6% (excl. tobacco and

alcohol)• IDUs (‘ever’): 0.1%• Poly-drug users: 22.3%

1. DATA HIGHLIGHTS – NHS

62.5 m8.7 m2 m

ALCOHOL 62.5 m 16.8% 10.5 m

CANNABIS 8.7 m 25.7% 2.3 m

OPIATES 2.0 m 22.3% 0.5 m

Current use Dependency ‘Volume of Work’

1. DATA HIGHLIGHTS – NHS

Part 2: Why Do People Take Drugs?

Why Do People Take Drugs?

To feel good

To have novel:feelings

sensationsexperiences

ANDto share them

To feel betterTo lessen:anxietyworriesfearsdepressionhopelessness

Why do some people become addicted while others do not?

Vulnerability

DRUG ADDICTION IS A COMPLEX ILLNESS

www.drugabuse.gov

www.drugabuse.gov

www.drugabuse.gov

There’s aBig Biological / Genetic

Contribution to Drug Abuse and Addiction…

….Overlapping with Environmental Influences that Help Make

Addiction a Complex Disease.

Biology/genes

Environment

Biology/EnvironmentInteractions

Environmental factors

• Drug related• Individual related• Society – community related

Drug related factors

• Availability – Legal and policy environment– Socio-cultural norms and attitudes

• Abuse liability– Reward or reinforcement– Non-toxic– route, duration of action

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Drugs: The vicious cycle

Presence makes you feel good… (euphoria)

Absence makes you feel miserable… (withdrawal)

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Taking drugs…

NOT Taking drugs…

..makes you feel good… (euphoria)

likely that you will continue..

..makes you feel miserable… (withdrawal)

..to avoid which you will continue..

Drugs: The vicious cycle

Individual related factors• Self-medication theory

– Co-morbid mental illnesses very common– Co-morbid symptoms even commoner

• Personality factors– ‘novelty seeking’

Society related factors

• Family influence• Peer influence • Cultural and religious sanction &

proscription• Legal & policy environment• The setting

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Part 3: Concept of Abuse

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Terminology

• Use• Misuse / harmful use• Abuse • Dependence • Addiction - older term, still used

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Terminology

• Use The ingestion of alcohol or other drugs

without the experience of any negative consequences.

If a student had drank a beer at a party and his parents had not found out we could say he had USED alcohol.

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Terminology

• Misuse When a person experiences negative

consequence from the use of alcohol or other drugs it is clearly misuse.

A 40-year old man uses alcohol occasionally, his boss throws a party and the man drinks more than usual and on the way home he is arrested by police.

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Terminology

• Abuse / harmful use Maladaptive pattern of use resulting in

physical, social, legal harm Continued use in spite of negative

consequences

The same 40-year old man continues drinking alcohol after the incident.

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Terminology • Dependence

Drug taken in larger amounts or over longer period Persistent desire or unsuccessful efforts to cut

down A great deal of time is spent in:

• obtaining the drug • using the drug • recovering from its effects

Important social, occupational, or recreational activities given up or reduced

Continued use despite harm Tolerance Withdrawal

• Addiction - older term, still used

Withdrawal symptoms

• Usually opposite of acute effects– Depressants: withdrawal-excitation– Stimulants: withdrawal-lethargy/’crash’

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Alcohol withdrawal: mild

• Anxiety• Restlessness • Insomnia• Tremors • Craving• Palpitation • Sweating • Breathlessness

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Alcohol withdrawal: severe

Severe Alcohol Withdrawal: “Delirium Tremens”

• All features of mild withdrawal• Disorientation (unawareness of self and

surroundings – time, place and person)• Hallucinations • Seizures (fits – ‘rum fits’)• Can be fatal

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Opioid withdrawal

Very distressing, but never fatal !• Opening of all holes !

Watering from eyes, nose Vomiting Loose motions

• Bodyache / pain• Anxiety, restlessness, insomnia• Premature ejaculation

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Cannabis withdrawal

Non specific• General discomfort• Intense craving• Anxiety, restlessness

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The usual drug-use ‘career’

Experimentation

• Depends upon Availability Peer pressure Socio-cultural norms Psychological factors

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Experimentation

Occasional / Irregular use

• Depends upon Initial

experiences Peer pressure

The usual drug-use ‘career’

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Experimentation

Occasional / Irregular use

Regular use

• May be ‘Abuse’ or ‘Misuse’

• Symptoms of harm start appearing

The usual drug-use ‘career’

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Experimentation

Occasional / Irregular use

Regular use

Dependence / Addiction

The usual drug-use ‘career’

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Alcohol / Tobacco

Charas / Ganja

Heroin / Smack

Injection Tidigesic

From ‘softer’ to ‘harder’ drugs…

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Terminology

Use Abuse Dependence

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TerminologyPurpose of

intervention

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