Drug Abuse is the use of drugs against therapeutic advice. Today, the more acceptable term to use is substance abuse which includes alcohol, tobacco, cocaine, marijuana (ganja), stimulants, LSD and inhalants. The word substance is generally preferable to the word drug, because drug implies to a manufactured chemical whereas many substances associated with abuse patterns occur naturally (such as opium) or are not meant for human consumption (glue sniffing).
Description
Any drug may be used in a medically sanctioned manner when it is prescribed by doctors for the purpose of treatment. For example, people suffering from cancer, whose pain is treated for months with morphine do not become dependant. In addition, having an alcoholic drink with a friend or tobacco smoking among adults are socially acceptable behaviours in most societies. Drug abuse on the other hand, is mainly defined by behaviours that are dysfunctional and disapproved by society. The use of a substance (either drug or alcohol) to modify or control the mood or state of mind in a manner that is illegal or harmful to oneself or others is considered problematic use or abuse. The rampant abuse of anabolic steroids among athletes in the long-term causes hazardous effects. In general, the potential consequences include accidents or injuries, blackouts, violent behaviours, homicides and suicides.
How does drug abuse develop?
Drug abuse involves more than a drug's functioning actions. It refers to the dysfunction and maladaptation brought on by the use of the drug. The brain is the organ that controls all our body functions, moods and behaviours. Drugs and alcohol disrupt the normal functioning of the brain. This will eventually result in interference with socialising and ability to work and also initiate destructive behaviours. The process of disruption is influenced by the drug's chemical properties and effects. The drug user's personality has a role in determining whether he or she becomes a drug abuser.
What are the risk factors for drug abuse?
Substance abuse occurs in all socio-economic groups and involves highly educated and professional people as well as those who are uneducated and unemployed. There are many risk factors that may lead to drug abuse.
The lifestyle of the rich and famous such as those in the world of entertainment provide the temptation to many of us. We are tempted to capture a little of their glamour for our own lives. The pressure to live life in the so called "fast-lane" is very tempting to many.
Prevalence
Quantitative information on the prevalence and incidence of substance abuse are difficult to obtain because of the unwillingness of abusers to accurately disclose the habit. It has however, been reported that in the United States , substance abuse is the number one cause of preventable illness and death. At the 36th World Health Assembly, alcohol-related problems had been ranked among the world's major public health concern. Locally, studies related to alcohol in Malaysia are few. In 1985, it was reported that there were about 200,000 identified alcoholics. The prevalence of alcoholism in a hospital population is reported as 11%; this figure is not far from the 10 to 35% figures estimated in other countries.
What are the symptoms for drug abuse?
The detection of an individual who is suspected of drug abuse may include the following:
Physical symptoms
What are the complications of drug abuse?
The prolonged use of excessive drugs and alcohol will damage many organs of the body. Alcohol in particular will destroy the liver, brain and the heart. An alcohol-damaged liver is less able to rid the body of toxic substances. A person developing hepatic coma becomes dull, sleepy, stuporous and confused and usually develops flapping tremors of the hand. Hepatic coma is life threatening and needs to be treated immediately.
Drug abusers, especially if the drugs are injected with shared, unsterilised needles may damage their brain, liver, lungs, bones and the immune system. Infectious organisms from unsterile needles can sometimes infect the brain, causing meningitis and brain abscess. Viral hepatitis which can spread through shared needles, causes liver damage. Many abusers begin with subcutaneous injections (below the skin) which can cause skin sores. When the veins are later used, this will lead to scarring of the tissue and blocked veins. Problems with the immune system can develop. Addicts who inject drugs intravenously lose the ability to fight infections. Because the human immunodeficiency virus (HIV) can spread through shared needles, large numbers of addicts develop AIDS.
Drug overdose presents a serious threat to life particularly because it can lead to suppression of breathing and death. The latter is usually because of the lack of blood supply to the brain, initially resulting in coma and ultimately death.
What investigations are usually done in drug abuse cases?
Early substance abuse is rarely diagnosed on physical examinations. Common investigations include screening for the substance abused in urine or blood. Nevertheless, the urine test is insensitive for intermittent drug abuse. In cases of alcohol abuse, it can be detected in the breath or in the blood. Testing of hair for abuse of drugs may be useful for drug use over a longer period of time.
What treatment is available for drug abuse?
Treatment Pharmacology
Fortunately, treatment can be effective when substance abuse is identified early. Providing treatment requires an understanding of the natural history of recovery from addiction. This is usually a long-term process that often requires multiple attempts and many behavioural changes. However, it should be noted that substance abuse is a life long disease that can only be controlled, not cured. Most people relapse several times regardless of whether the substance of abuse is nicotine, cocaine, heroine or other addictive substances.
Brief Interventions
Illicit drug abusers may sometimes respond to brief interventions such as those used for smoking or alcohol abuse. Sometimes this approach may successfully modify the patient's behaviour by itself. In brief intervention, the abusers are provided with information and education materials about the problem and also given suggestions to help modify his or her behaviour.
Detoxification
Detoxification is the process by which an individual who is physically dependent on a substance is withdrawn from it. Often this is done by gradual administration of decreasing doses of the drug. This approach is less expensive and less disruptive to the individual's life than inpatient therapy. Moreover, the process of outpatient detoxification can be done in the same environment in which the individual must continue to live, work and later remain abstinent. The primary objective of detoxification is to relieve symptoms while the individual adjusts to a drug-free state. To qualify for such outpatient detoxification, the individual must agree to abstain from using any drugs other than those being prescribed by the attending doctor. Inpatient detoxification is usually necessary for drugs such as barbiturates and benzodiazepines which can have life-threatening consequences.
For all of the above, it should be remembered that detoxification is not in itself a treatment for addiction because it does not affect the long-term course of addiction.
Pharmacotherapy
This has traditionally been limited to the management of withdrawal symptoms and medical complications. However, in the case of heroin addiction, methadone can be given as a way of overcoming the addiction.
How can drug abuse be prevented?
Primary prevention involves helping individuals at risk avoid the development of addictive behaviours. This should mainly be directed to children and adolescents at risk. A good approach is to emphasise the health risks of drug and alcohol abuse.
Secondary prevention consists of uncovering potentially harmful substance use prior to the onset of symptoms. Maintaining alertness for early signs of drug abuse or a history suggestive of drug abuse is the way to detect the early stages or relapse. Because addiction is a chronic relapsing disorder, the individual remains at risk for relapse or for developing problems with another substance.
Finally, tertiary prevention involves treating the medical consequences of drug abuse and facilitating entry into treatment so that further disability is minimised.
In summary, the most common means of relapse prevention will probably be the continued and frequent monitoring, counselling, family encouragement and environmental manipulation. The latter includes preventing him or her from mixing with old peers and to prevent easy accessibility to drugs. It is important to keep track of such individuals.
