Understand Drug abuse
Contact hours: 2 hours
Practical sessions: 1 hour
Self-study hours: 0.5 hour
Assessment hours: 0.5 hour
Description
Unit 1 aims to provide a thorough understanding of drug abuse, encompassing its definitions, risk, and protective factors. Participants will explore the various types of drugs commonly abused, their impact on individuals and society, and the complex interplay of biological, psychological, and social factors that contribute to substance abuse.
Learning Outcomes
By the end of Unit 1, participants should be able to:
Knowledge
- Define drug abuse and drug addiction, distinguishing it from recreational drug use and medically supervised drug use.
- Identify and explain the biological, psychological, and social factors that influence susceptibility to drug abuse, including risk factors (e.g., trauma, genetics) and protective factors (e.g., strong support networks, access to education).
- Categorize and describe the different classes of drugs (stimulants, depressants, hallucinogens, opioids, etc.), including their effects, potential for abuse, and related health risks.
Skills
- Analyzing the risk and protective factors associated with drug abuse.
- Conducting research on drug abuse trends and patterns.
- Identifying various types of drugs
- Engage in critical thinking to propose interventions aimed at reducing substance abuse in specific populations or communities.
Competences
- Apply knowledge of drug abuse definitions, risk, and protective factors to real-world scenarios, such as designing community programs or contributing to policy development aimed at prevention and treatment.
- Demonstrate empathy and cultural sensitivity when interacting with individuals or families affected by drug abuse, showing an understanding of the challenges faced during recovery.
- Collaborate with healthcare professionals, counselors, and community leaders to develop a multi-faceted approach to combat drug abuse.
Delivery and Assessment
The unit will be developed through:
- Theoretical exploration, lectures and readings on the definitions, effects, and social context of drug abuse.
- 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
- Written assignments at the end of the unit on the role of assessment in treatment planning and progress monitoring
1.1 Definitions
Drug Abuse:
Drug abuse is the inappropriate use of drugs, whether prescription medications or illicit substances, leading to negative consequences. This includes behaviors such as taking a drug for non-medical purposes, using a medication in ways other than prescribed, or combining drugs with other substances like alcohol (92).
Among the various definitions of ‘‘abuse,’’ the major characteristic that frequently appears is that the substance be used for nontherapeutic purposes to obtain psychotropic (e.g., euphoric, sedative, or anxiolytic) effects.
The essential feature of a substance use disorder is a cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues using the substance despite significant substance-related problems. An important characteristic of substance use disorders is an underlying change in brain circuits that may persist beyond detoxification, particularly in individuals with severe disorders.(1)
Drug Addiction: is defined as a chronic, relapsing disorder characterized by compulsive drug seeking and use despite adverse consequences.(1) It is considered a brain disorder, because it involves functional changes to brain circuits involved in reward, stress, and self-control. Those changes may last a long time after a person has stopped taking drug.
Tolerance: Tolerance in the context of drug addiction refers to a phenomenon where repeated exposure to a substance leads to a decreased response, necessitating higher doses to achieve the same effect as initially experienced. This gradual decrease in responsiveness is a hallmark of tolerance, indicating the body’s adaptation to the presence of the drug.
The degree to which tolerance develops varies greatly across different individuals as well as across substances and may involve a variety of central nervous system effects.(1) In the addiction triad, which includes cravings, tolerance, and withdrawal, tolerance plays a crucial role in the development and maintenance of addiction. Opioid addiction, for example, is characterized by significant tolerance development, where individuals require increasing amounts of opioids to achieve the same effects, as well as experiencing withdrawal symptoms upon cessation of drug use (93).
Withdraw: Withdrawal in substance abuse refers to the onset of symptoms that occur when an individual stops using a substance to which they have developed dependence. These symptoms can vary depending on the type of drug used but often include physical and psychological manifestations such as cravings, anxiety, irritability, insomnia, sweating, nausea, and muscle aches (1)
The severity and duration of withdrawal symptoms can also be influenced by factors such as the type of drug, the duration of use, and individual differences in metabolism and physiology
Development and Course: Individuals ages 18–24 years have relatively high prevalence rates for the use of virtually every substance. Intoxication is usually the initial substance-related disorder and often begins in the teens. Withdrawal can occur at any age as long as the relevant drug has been taken in sufficient doses over an extended period of time. (1)
Illicit Use of Drugs: Illicit drug use encompasses the consumption of substances that are illegal or prohibited for non-medical purposes. It is associated with a range of negative consequences and poses significant challenges to public health and safety.
- illicit drugs – drugs prohibited from manufacture, sale or possession, including (83). They can occur naturally as with marihuana or cocaine, or they can be prepared from naturally occurring substances such as the case with heroin, or they can be totally synthetic as is the case with amphetamines and most other prescription drugs. Illicit drugs can also be classified by major effects. There are four major types: stimulants, depressants, narcotics, and hallucinogens (90)
- pharmaceuticals – drugs available from a pharmacy, over-the-counter or by prescription, which may be subject to non-medical use (when used for purposes, or in quantities, other than for the medical purposes for which they were prescribed). Examples include opioid-based pain relief medications, opioid substitution therapies, benzodiazepines, steroids, and over-the-counter codeine (not available since 1 February 2018)
- other psychoactive substances – legal or illegal, used in a potentially harmful way – for example, synthetic cannabis and other synthetic drugs; inhalants such as petrol, paint or glue (Department of Health 2021).
1.2 Drug Abuse and Influential Factors
Risk and Protective Factors
Risk factors are attributes or conditions that increase the likelihood of drug abuse, while protective factors are characteristics that reduce the likelihood of drug abuse and promote resilience. Numerous studies have delved into these factors to gain a better understanding and tackle substance abuse issues.
Risk Factors: Understanding these factors is crucial for developing effective prevention and intervention strategies to address drug abuse among adolescents.
Three Domains: a) Individual b) Family and c) Community
a. Individual
- Experience of maltreatment or a negative upbringing
- Personal psychiatric disorders such as conduct problems and major depressive disorder – teens and people with mental disorders are at greater risk of drug use and addiction than others.(28 )
- Previous substance history
- Comorbidity
- Individual’s attitude and perception – Aggressive behavior in childhood (13,14);
- Low peer refusal skills (13,17,18)
- Academic stress; long-term use of prescription medications (94)
- major life challenge e.g. maintain a balance between job and family life, which tends to increase the risk of substance abuse, especially if they are in a high-stress profession, such as lawyers, healthcare workers, or military personnel (94)
- Experiencing grief, or the loss of a close member of a family or friend can lead to substance abuse (94)
b. Family
- biological factors that can affect a person’s risk of addiction include their genes, stage of development, and even gender or ethnicity. Scientists estimate that genes, including the effects environmental factors have on a person’s gene expression, called epigenetics, account for between 40 to 60 percent of a person’s risk of addiction.(27)
- Negligence from a parental perspective
- lack of parental supervision,
- uncontrolled pocket money spending among children,
- presence of substance-using family members -Parents or older family members who use drugs or misuse alcohol, or who break the law, can increase children’s risk of future drug problems.(29)
c. Community
- Availability of drugs at school (21,23)
- Community poverty (24,25)
- Friends and other peers can have an increasingly strong influence during the teen years. Teens who use drugs can sway even those without risk factors to try drugs for the first time. Struggling in school or having poor social skills can put a child at further risk for using or becoming addicted to drugs.(30)
Other domain
Early use. Although taking drugs at any age can lead to addiction, research shows that the earlier people begin to use drugs, the more likely they are to develop serious problems.(31) This may be due to the harmful effect that drugs can have on the developing brain.(32) It also may result from a mix of early social and biological risk factors, including lack of a stable home or family, exposure to physical or sexual abuse, genes, or mental illness. Still, the fact remains that early use is a strong indicator of problems ahead, including addiction.
Protective Factors
Protective factors play a crucial role in mitigating the risk of drug abuse among individuals
a. Individual factors
- Self-efficacy/belief in self-control(15)
- Good grades(17,22)
According to El Kazdouh et al., individuals with a strong belief against substance use and those with a strong desire to maintain their health were more likely to be protected from involvement in drug abuse
b. Family Factors:
- Parental monitoring and support(16-18)
- Positive relationships(17,19)
El Kazdouh et al. noted that support and advice could be some of the protective factors in this area [46].
c. Community factors
- School anti-drug policies(17)
- Neighborhood resources(26)
- Employment has also been highlighted as a protective factor against drug abuse relapse (Doostian et al., 2019)
How the drug is taken
Smoking a drug or injecting it into a vein increases its addictive potential.33,34Both smoked and injected drugs enter the brain within seconds, producing a powerful rush of pleasure. However, this intense high can fade within a few minutes. Scientists believe this powerful contrast drives some people to repeatedly use drugs to recapture the fleeting pleasurable state.
1.3 Classes of Drugs
According to the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), substance-related disorders are categorized into 10 classes based on use of the following substances:
- alcohol
- caffeine
- cannabis
- hallucinogens (with separate categories for phencyclidine and other hallucinogens)
- inhalants
- opioids
- sedatives
- hypnotics and anxiolytics
- stimulants(amphetamine-type substances, cocaine, and other stimulants)
- tobacco and other (or unknown) substance.
These 10 classes are not fully distinct.(1)
From those drugs some of them are legal such us:
- alcohol
- caffeine
- tobacco
Other are legal when prescribed such as:
- sedatives
- hypnotics
- anxiolitics
- opioides
Finally cannabis is legal in some countries but not in others.
Guide to Cannabis Law by Country -2023(36)
Canada and Uruguay are the only countries that have legalized all forms of cannabis at the federal level.
The United States retains its existing federal prohibition on marijuana.
However, each state is free to ignore the federal prohibition by creating its own marijuana program. Today, most states have legalized marijuana in some form, with nearly half permitting recreational use. As it stands, 37 states have medical marijuana programs in America.
In 2021, Mexico’s Supreme Court decriminalized the private recreational use of marijuana, with full legalization expected soon.
In 2022, the government of Argentina decriminalized small amounts of cannabis for personal use.
Belize decided to decriminalize personal cannabis usage in 2021.
In Chile while cultivation, transportation, and sale remain illegal, the country has examined its approach to cannabis prohibition recently.
Ecuador has made significant strides to transform its approach to cannabis. Personal use was decriminalized in 2019, up to 10 grams, and the government authorized several cannabis-based products and industrial hemp production.
In Jamaica cannabis has only been decriminalized since 2015. All Jamaicans can grow up to five plants for personal use.
Countries in Europe where cannabis is Legal:
- Decriminalization for personal use has been in effect since 2010, but weed remains illegal in the Czech Republic.
- The law in Luxembourg also permits people to consume cannabis at home, with small fines replacing criminal proceedings for public possession and consumption
- Malta became the first European country to legalize recreational cannabis and use in 2021.
- The Netherlands operates a tolerance policy, enabling anyone to buy, possess, and consume weed. Despite this, no move toward full legalization has been made recently.
- Portugal decided to take the unprecedented step of decriminalizing all drugs in 2001. It remains illegal to import and sell cannabis. Also, home cultivation remains illegal.
- In Spain, you cannot possess or consume cannabis in public places, but it’s permitted to have up to 100 grams of cannabis for personal use.
Countries in Asia, Africa & the Middle East where Cannabis is Legal:
These three parts of the world typically make up most of the countries where weed is illegal, with
some countries opting for long prison sentences and even the death penalty for some cannabis-related crimes.
Israel is one country where recreational marijuana legalization could be on the cards. Since the 1990s, Israel has allowed medical cannabis use for pain-related illnesses.
Thailand stunned the world in 2022 when it opened its Amsterdam-style coffee shops.
Drug Classifications Based On Effect (84)
Depressants
More commonly referred to as “downers,” Depressants create feelings of relaxation and tiredness. While many serve legitimate purposes in the fight against mental illness and sleep deprivation, they are very commonly abused because they may also create feelings of euphoria. Depressants are not only some of the most highly addictive drugs, but they are also some of the most highly dangerous and likely to cause overdose. Examples of Depressants include:
- Opiates
- Barbiturates
- Benzodiazepines
- Alcohol
Stimulants
Also known as “uppers,” the primary use of stimulants is to increase energy, concentration, and wakefulness. Stimulants are said to provide a “rush.” In the short term, Stimulants are believed to increase productivity and performance while producing an excited high of pleasure. In the long term, Stimulants are incredibly addictive and have a very high potential for abuse. Examples of illicit stimulants include:
- Cocaine
- Crystal Meth
- Crack
Hallucinogens
They alter the user’s perception of reality. Often this results in auditory and visual hallucinations, a process known as “tripping.” Although Hallucinogens are generally less addictive than other drug classifications, their immediate impacts are generally more severe and dangerous. Examples of Hallucinogens include:
- LSD
- PSILOCYBIN MUSHROOMS
- PCP
- HIGH-POTENCY CANNABIS
Inhalants
They are a vast range of chemicals that are ingested primarily by breathing them in, or huffing. Most inhalants are commonly used materials that are in no way designed to be ingested by humans. While there is incredible variety between inhalants, most produce feelings of a high. Inhalants are less studied than most other drugs. While they tend to be less addictive than many other substances, the use of Inhalants is incredibly dangerous and causes many serious health effects. Examples of commonly abused Inhalants include:
- Paint thinne
- Nail polish remover
- Gasoline