healthcare notes

1. Meaning of drug abuse
Drug abuse or substance abuse refers to the use of certain chemicals for the purpose of
creating pleasurable effects on the brain.
What Is Drug Addiction?
Addiction is a disease that affects your brain and behavior. When you’re addicted to drugs, you
can’t resist the urge to use them, no matter how much harm the drugs may cause. The earlier you
get treatment for drug addiction, the more likely you are to avoid some of the more dire
consequences of the disease.
Drug addiction isn’t about just heroin, cocaine, or other illegal drugs. You can get addicted
to alcohol, nicotine, sleep and anti-anxiety medications, and other legal substances.
You can also get addicted to prescription or illegally obtained narcotic pain medications, or opioids.
This problem is at epidemic levels in the United States. In 2018, opioids played a role in two-thirds
of all drug overdose deaths.
At first, you may choose to take a drug because you like the way it makes you feel. You may think
you can control how much and how often you use it. But over time, drugs change how your brain
works. These physical changes can last a long time. They make you lose control and can lead to
damaging behaviors.
Difference between substance abuse and drug abuse
One can abuse a drug without having an addiction, but abuse can lead to addiction. Substance
abuse is characterized by the destructive use of a drug, leading to problems in the user's
everyday life. Performance at work or school suffers and legal or financial problems arise as a
result of the drug use.
Causes of drug use
Drugs of abuse are usually psychoactive drugs that are used by people for various different
reasons which may include:
 Curiosity and peer pressure, especially among school children and young adults
 The use of prescription drugs that were originally intended to target pain relief may have
turned into recreational use and become addictive
 Chemicals may be used as part of religious practices or rituals
 Recreational purposes
 As a means of obtaining creative inspiration
Drug categories
Drugs of abuse fall into three groups and these include:

2.  Depressants: These cause depression of the brain's faculties and examples include
sleeping pills (barbiturates) and heroin.
 Stimulants: These cause stimulation of the brain, giving rise to alertness and increased
bursts of activity. A rapid heart rate, dilated pupils, raised blood pressure, nausea or
vomiting and behavioral changes such as agitation, and impaired judgment may also
result. In severe cases, there may be delusional psychosis which can occur with the use
of cocaine and amphetamines.
 Hallucinogens: These cause hallucinations and an "out of this world" feeling of
dissociation from oneself. Hallucinogens may cause distorted sensory perception,
delusion, paranoia and even depression. Examples include ecstasy, mescaline and LSD.
Examples of drugs are:
 Alcohol
 Tobacco
 Cocaine from coca
 Opium and opioids from poppy plants
 Hashish or marijuana from cannabis
 Synthetic drugs such as heroin, ecstasy and LSD {Lysergic acid diethylamide, also
known colloquially as acid, is a psychedelic drug. Effects typically include intensified
thoughts, emotions, and sensory perception. At sufficiently high dosages LSD manifests
primarily visual, as well as auditory, hallucinations}
Administration
There are several different routes of administration for drugs of abuse including orally in the
form of a pill, intravenously in the form of an injection, by inhaling the substance in the form
of smoke or via snorting the substance so it is absorbed into the blood vessels of the nose.
Epidemiology of drug abuse
Cannabis, marijuana and hashish are the most widely abused drugs in the world. Around 141
million people worldwide consume cannabis. The use of stimulants such as amphetamine and
ecstasy is also widespread, with nearly 30 million people abusing these drugs. Cocaine is used
by around 13 million people across the globe, with the highest number of users in the United
States. Abuse of heroin and other opioids is less common than with other drugs and is taken up
by around 8 million people worldwide, mainly in South-East and South-West Asia and Europe
and Africa

3. Drug abuse is seen in various different age groups and in individuals from nearly all walks of
life and socioeconomic strata. However, men are more likely to abuse drugs than women, single
people are more likely than married individuals and urban dwellers more likely than rural
dwellers. Prisoners, street children and younger individuals are also more likely to abuse drugs.
Symptoms of drug abuse
Drug abuse leads to symptoms of drug dependence and addiction. According to the Diagnostic
and Statistical Manual of Mental Disorders, drug or substance abuse tends to be recurrent and
may cause severe damage and harm to the body in the short or long term. While some of the
damage is physical, there may also be a social element, with the individual failing to fulfil their
responsibilities in life and having difficulty with family relationships. Drug abuse also leads to
risky and dangerous behaviors.
Some of the symptoms and consequences of drug abuse include:
 Failure to fulfil ones responsibilities (e.g., as a parent, spouse or student)
 Taking risks such as driving under the influence of drugs or alcohol
 Encounters with the law and criminal activities both as a result of drug side effects and
as a means of securing funds to feed the addiction
 Domestic abuse and recurrent fights
 Absence from work or school
 Inability to overcome cravings despite awareness of the harm caused by the drug
 Withdrawal syndrome when the drug is stopped abruptly. This gives rise to unpleasant
physical symptoms that result in intense cravings for the substance after an addict tries
to stop using it. This is a typical feature of drug dependence and addiction after heavy,
prolonged use. Most people with these symptoms often return to using the substance to
ease the discomfort associated with withdrawal and to satisfy cravings. Withdrawal
symptoms may be wide ranging. For example, alcohol withdrawal may cause nausea,
vomiting, dry mouth, weakness, depression, headaches, anxiety, sleeplessness, high
blood pressure and hallucinations. Opioids and stimulants are substances that may also
lead to withdrawal syndrome if their use is stopped.
 Development of tolerance or the need for a higher dose of the drug than before to
achieve the same degree of pleasurable sensation
 Tell-tale injection marks among needle users. People who snort or inhale the drug may
have a damaged mucosal lining in the nose

4.  Lack of hygiene may be evident in addicts whose preoccupation with a drug has led to
neglect of hygiene
 Features of severe malnutrition and vitamin deficiency
 Skin infections
 Transmission of blood-borne viral infections such as HIV, Hepatitis B and C as well as
sexually transmitted infections due to risky sexual behavior while under the influence
of a substance
Other signs include
You may have one or more of these warning signs:
 An urge to use the drug every day, or many times a day
 Taking more drugs than you want to, and for longer than you thought you would
 Always having the drug with you, and buying it even if you can’t afford it
 Using drugs even if they cause you trouble at work or make you lash out at family and
friends
 Spending more time alone.
 Not taking care of yourself or caring how you look
 Stealing, lying, or doing dangerous things, like driving while high or having unsafe sex
 Spending most of your time getting, using, or recovering from the effects of the drug
 Feeling sick when you try to quit
Effect on Your Brain
Your brain is wired to make you want to repeat experiences that make you feel good. So you’re
motivated to do them again and again.
The drugs that may be addictive target your brain’s reward system. They flood your brain with
a chemical called dopamine. This triggers a feeling of intense pleasure. You keep taking the
drug to chase that high.
Over time, your brain gets used to the extra dopamine. So you might need to take more of the
drug to get the same good feeling. And other things you enjoyed, like food and hanging out
with family, may give you less pleasure.
When you use drugs for a long time, it can cause changes in other brain chemical systems and
circuits as well. They can hurt your:
 Judgment
 Decision-making
 Memory
 Ability to learn
Together, these brain changes can drive you to seek out and take drugs in ways that are beyond
your control.

5. Who’s Most Likely to Become Addicted?
Each person’s body and brain are different. People also react differently to drugs. Some love
the feeling the first time they try it and want more. Others hate it and never try again.
Not everyone who uses drugs becomes addicted. But it can happen to anyone and at any age.
Some things may raise your chances of addiction, including:
 Family history. Your genes are responsible for about half of your odds. If your parents
or siblings have problems with alcohol or drugs, you’re more likely as well. Women
and men are equally likely to become addicted.
 Early drug use. Children’s brains are still growing, and drug use can change that. So
taking drugs at an early age may make you more likely to get addicted when you get
older.
 Mental disorders. If you’re depressed, have trouble paying attention, or worry
constantly, you have a higher chance of addiction. You may turn to drugs as a way to
try to feel better. A history of trauma in your life also makes you more likely to have
addiction.
 Troubled relationships. If you grew up with family troubles and aren’t close to your
parents or siblings, it may raise your chances of addiction.
How to Prevent Addiction to Prescribed Painkillers
Most people who take their pain medicine as directed by their doctor do not become addicted,
even if they take the medicine for a long time. Fears about addiction should not prevent you
from using narcotics to relieve your pain.
But if you’ve abused drugs or alcohol in the past or have family members who have, you may
be at a higher risk.
To avoid pain medicine addiction:
 Take the drug exactly as your doctor prescribes.
 Tell your doctor about any personal or family history of drug abuse or addiction; this
will help them prescribe the medicines that will work best for you.
Remember, it’s common for people to develop a tolerance to pain medication and to need higher
doses to get the same level of pain relief. This is normal and is not a sign of addiction. With
addiction, you may need to use higher doses, but it’s not for pain relief. Still, talk to your doctor
if this effect becomes troubling.
Drug abuse treatment
More often than not, it is a drug abuser's family members who seek treatment for the abuser's
problem. Although abusers are usually aware of the harm caused by their habit as well as their
dependence on it, most do not really want to stop and do not seek treatment on their own.
Relapses are also a large problem in the treatment of drug abuse.
Treatment involves multiple approaches that include:

6.  Pharmacological treatment
 Substitution therapy
 Psychological approaches such as counselling
 Support groups
 Rehabilitation
Treatment usually takes place in a hospital, a residential centre or even at the doctor's office.
With time, the patient improves and gradually returns to family, work or school environments.
These environments may be those in which the drug abuse began and became habitual. At this
stage, the patient is susceptible to relapse and counselling and psychological therapy are
employed to help prevent addiction re-establishing.
Pharmacological treatment
This involves the use of medication that can help reverse the pleasurable sensations obtained
from drug use and deter the abuser. For example, disulfiram is a medication prescribed to
alcoholics that causes them to experience deeply unpleasant symptoms when they drink alcohol,
therefore deterring them from consuming more. Naltrexone is an opioid antagonist that can be
used to block the euphoric effects of opioid use and help the patient overcome addiction to the
substance. Another opioid antagonist, naloxone reverses the life threatening effects of opioid
overdose such as reduced lung function and shallow breathing.
Medications may also be used to treat withdrawal symptoms that arise after stopping drug use.
For example, clonidine is useful in treating opioid withdrawal symptoms.
Medications are also used to treat other psychiatric illnesses that may exist alongside the drug
addiction such as depression, anxiety, panic disorders, and post-traumatic stress disorder.
Substitution therapy
Often, a very potent drug such as heroin is replaced by a less potent opioid to help wean a
patient off the drug without causing the onset of severe withdrawal symptoms. Use of the low
potency opioid is then tapered off and eventually the drug user is free of the drug altogether.
Examples of these drugs include methadone and buprenorphine.
Nicotine replacement therapy is another example of a drug substitute, used to help individuals
wean themselves off nicotine and is available in the form of chewing gum, skin patches, and
nasal sprays.

7. Psychological approaches and counselling
Cognitive behavioural therapy and counselling help a patient during the initial treatment of drug
addiction as well as in maintaining a drug free existence and helping to prevent relapses in the
long term.
Support groups
Alcoholics anonymous and similar support groups for drug abusers help prevent relapses and
reduce the risk of depression and other co-morbid psychological problems.
Rehabilitation support
This involves helping a person re-establish themselves in society and address problems in the
family and at work places to help prevent homelessness and other social problems. This is a
major treatment step in the prevention of relapses.