Health, psychological and behavioural aspects
Contact hours: 1 hour
Practical sessions: 2 hours
Self-study hours: 0.5 hour
Assessment hours: 0.5 hour
Description
This unit explores the multifaceted impacts of illicit drug use on health, psychological well-being, and behavior. Students will examine how illicit drugs affect the brain and nervous system, the body, mental health, and social functioning. By understanding these aspects, students will gain a comprehensive perspective on the challenges faced by individuals struggling with drug addiction and the broader societal implications
Learning Outcomes
At the end of Unit 3, participants should be able to:
Knowledge
- Identify how drugs work in the brain.
- Discuss the neurobiological changes that occur with drug addiction, including alterations in brain structure and function.
- Describe common behavioral patterns associated with drug addiction, such as compulsive drug-seeking, risk-taking behaviors, and social withdrawal.
- Explain the impact of drug use on the body and mental health, including the development of psychiatric disorders such as anxiety, depression, and psychosis.
Skills
- Apply knowledge of the health and psychological effects of drugs to develop comprehensive treatment and intervention plans.
- Critically assess real-world examples and case studies to identify patterns in drug use and its effects on behavior, using this data to inform evidence-based interventions and health communication strategies.
Competences
Communicate the health, psychological, and behavioral consequences of drug use to diverse audiences, including patients, healthcare providers, and policymakers.
Evaluation
The unit will be developed through:
- Theoretical exploration, lectures and readings
- Participation in group discussions debates and case study discussions to explore different viewpoints and lived experiences.
- Videos
The unit will be evaluated through:
Quizzes or tests throughout the unit to assess understanding of key concepts
The Human Brain: Major Structures and Functions
How do drugs work in the brain?
The nervous system consists of specialized nerve cells called neurons and glia ( supporting cells). The neurons send messages to each other by releasing chemical substances called neurotransmitters into the gaps between cells. These gaps are called synapses.
The neurotransmitter crosses the synapse and attaches to a receptor on another neuron, like a key fits into a lock. This is how neurons talk to each other to make your brain and body do things. For example, when you want to walk up a flight of stairs, your brain sends a message to your feet to move, using long chains of neurons.
Drugs interfere with the way neurons send, receive, and process signals via neurotransmitters. They can impact the brain by altering neurotransmitter levels and signaling. For example, dopamine, a neurotransmitter associated with reward and pleasure, is affected by drugs like amphetamines and cocaine, which can increase dopamine levels in the brain, leading to feelings of euphoria and reinforcing drug-seeking behavior (95)
Some drugs, such as marijuana and heroin, can activate neurons because their chemical structure mimics that of a natural neurotransmitter in the body. This allows the drugs to attach onto and activate the neurons. Although these drugs mimic the brain’s own chemicals, they don’t activate neurons in the same way as a natural neurotransmitter, and they lead to abnormal messages being sent through the network (95).
Other drugs, such as amphetamine or cocaine, can cause the neurons to release abnormally large amounts of natural neurotransmitters or prevent the normal recycling of these brain chemicals by interfering with transporters. This too amplifies or disrupts the normal communication between neurons.(35)
What parts of the brain are affected by drug use?
Drugs can alter important brain areas that are necessary for life-sustaining functions and can drive the compulsive drug use that marks addiction. Brain areas affected by drug use include:
- The basal ganglia, which play an important role in positive forms of motivation, including the pleasurable effects of healthy activities like eating, socializing, and sex, and are also involved in the formation of habits and routines. These areas form a key node of what is sometimes called the brain’s “reward circuit.” Drugs over-activate this circuit, producing the euphoria of the drug high. But with repeated exposure, the circuit adapts to the presence of the drug, diminishing its sensitivity and making it hard to feel pleasure from anything besides the drug.
- The extended amygdala plays a role in stressful feelings like anxiety, irritability, and unease, which characterize withdrawal after the drug high fades and thus motivates the person to seek the drug again. This circuit becomes increasingly sensitive with increased drug use. Over time, a person with substance use disorder uses drugs to get temporary relief from this discomfort rather than to get high.
- The prefrontal cortex powers the ability to think, plan, solve problems, make decisions, and exert self-control over impulses. This is also the last part of the brain to mature, making teens most vulnerable. Shifting balance between this circuit and the circuits of the basal ganglia and extended amygdala make a person with a substance use disorder seek the drug compulsively with reduced impulse control.
Some drugs like opioids also disrupt other parts of the brain, such as the brain stem, which controls basic functions critical to life, including heart rate, breathing, and sleeping. This interference explains why overdoses can cause depressed breathing and death. (35)
How drugs affect the brain and nervous system
All drugs that are taken in excess have in common direct activation of the brain reward system, which is involved in the reinforcement of behaviors and the production of memories. They produce such an intense activation of the reward system that normal activities may be neglected. Instead of achieving reward system activation through adaptive behaviors, drugs of abuse directly activate the reward pathways and produce feelings of pleasure, often referred to as a “high.” Furthermore, individuals with lower levels of self-control, which may reflect impairments of brain inhibitory mechanisms, may be particularly predisposed to develop substance use disorders, suggesting that the roots of substance use disorders for some persons can be seen in behaviors long before the onset of actual substance use itself.
Consequences of illicit drug addiction on the body
Illicit drug addiction has profound consequences on the body, affecting both physical and mental health. The physiological impacts of drug addiction are extensive, often leading to chronic health issues. For instance:
Physical Health Issues
- Cardiovascular Problems: Many drugs, including stimulants like cocaine and methamphetamine, can lead to increased heart rate, high blood pressure, and risk of heart attack or stroke (97)
- Respiratory Issues: Inhalants, opioids, and other substances can cause respiratory depression or damage to the lungs, leading to chronic respiratory diseases. Smoking drugs, such as crack, cocaine and marijuana, can damage the lungs, leading to chronic respiratory diseases, lung infections, and increased risk of lung cancer . (98)
- Infectious Diseases: Sharing needles for intravenous drug use increases the risk of contracting HIV, hepatitis B, and hepatitis C (99). Additionally, impaired judgment while under the influence of drugs may lead to risky sexual behaviors, further increasing the risk of sexually transmitted infections (STIs).
- Neurological Effects: Drug abuse can lead to long-term cognitive impairments, seizures, and other neurological issues, depending on the substance used. For instance, prolonged use of substances like methamphetamine has been associated with neurodegeneration and cognitive deficits that resemble those seen in neurodegenerative diseases. Volkow et al. (2016) discuss how these changes can lead to persistent difficulties in learning and memory, as well as increased vulnerability to mental health disorders, such as anxiety and depression. (100)
Mental Health Issues
- Increased Risk of Mental Disorders: Substance abuse is closely linked to the development of mental health disorders such as depression, anxiety, and schizophrenia (101).
- Cognitive Impairments: Chronic drug use can impair memory, attention, and decision-making skills, significantly affecting daily functioning (102).
- Co-occurring Disorders: Many individuals with substance use disorders also suffer from mental health issues, which complicates treatment and recovery (103).
- Suicidal Behavior: The risk of suicide is higher among individuals struggling with substance use disorders, often due to co-existing mental health conditions (104).
Behavioral Effects
The diagnosis of a substance use disorder is based on a pathological pattern of behaviors related to use of the substance such as:
- using the substance, or recovering from its effects. In some instances of more severe substance use disorders, virtually all of the individual’s daily activities revolve around the substance.
- craving is manifested by an intense desire or urge for the drug that may occur at any time but is more likely when in an environment where the drug previously was obtained or used. Craving has also been shown to involve classical conditioning and is associated with activation of specific reward structures in the brain. Craving is queried by asking if there has ever been a time when they had such strong urges to take the drug that they could not think of anything else. Current craving is often used as a treatment outcome measure because it may be a signal of impending relapse.
- social impairment: failure to fulfill major role obligations at work, school, or home. The individual may continue substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance. Important social, occupational, or recreational activities may be given up or reduced because of substance use. The individual may withdraw from family activities and hobbies in order to use the substance.
- risky use of the substance. This may take the form of recurrent substance use in situations in which it is physically hazardous. The individual may continue substance use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance.
- repeated relapses and intense drug craving when the individuals are exposed to drug-related stimuli.
- long-term approaches to treatment. Overall, the diagnosis of a substance use disorder is based on a pathological pattern of behaviors related to use of the substance.
- the individual may take the substance in larger amounts or over a longer period than was originally intended.
- the individual may express a persistent desire to cut down or regulate substance use and may report multiple unsuccessful efforts to decrease or discontinue use.
The individual may spend a great deal of time obtaining the substance.(1)
Substance/Medication-Induced Mental Disorders
The substance/medication-induced mental disorders are potentially severe, usually temporary, but sometimes persisting central nervous system (CNS) syndromes that develop in the context of the effects of substances of abuse, medications, or several toxins. They are distinguished from the substance use disorders, in which a cluster of cognitive, behavioral, and physiological symptoms contribute to the continued use of a substance despite significant substance-related problems. The substance/medication-induced mental disorders may be induced by the 10 classes of substances that produce substance use disorders, or by a great variety of other medications used in medical treatment. All substance/medication-induced disorders share common characteristics. It is important to recognize these common features to aid in the detection of these disorders. These features are described as follows:
- The disorder represents a clinically significant symptomatic presentation of a relevant mental disorder.
- There is evidence from the history, physical examination, or laboratory findings of both of the following:
- The disorder developed during or within 1 month of a substance intoxication or withdrawal or taking a medication.
- The involved substance/medication is capable of producing the mental disorder.
- The disorder is not better explained by an independent mental disorder (i.e., one that is not substance- or medication-induced). Such evidence of an independent mental disorder could include the following:
- The disorder preceded the onset of severe intoxication or withdrawal or exposure to the medication; or
- The full mental disorder persisted for a substantial period of time (e.g., at least 1 month) after the cessation of acute withdrawal or severe intoxication or taking the medication. This criterion does not apply to substance-induced neurocognitive disorders or hallucinogen persisting perception disorder, which persist beyond the cessation of acute intoxication or withdrawal.
- The disorder does not occur exclusively during the course of a delirium.
- The disorder causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.