Substance Abuse

1. Substance Abuse A Kasturiratne Community Health Stand

2. Introduction • Overindulgence in and dependence on a psychoactive substance leading to effects detrimental to the individual’s physical, mental and social wellbeing • Improper use of substances harmful for health • Alcohol • Tobacco • Cannabis • Narcotics (opium derivatives) • Other addictive drugs including non prescriptive drugs

3. Introduction • Substance abuse is characterised by • continued pathological use of a substance (medication/ non medically indicated drug/ toxin) • Repeated adverse social consequences relating to substance use e.g. failure in work/ family or school obligations interpersonal conflicts legal problems

4. Introduction • Substance dependence defined in terms of physiological and behavioural symptoms of substance use • Substance abuse defined in terms of socialconsequences of substance use • Addiction a compulsion to continue using the substane despite negative consequences. May or may not involve chemical dependency

5. Tobacco “ ……only legally available consumer product which kills people when it is entirely used as intended” - The Oxford Medical Companion “ The major preventable cause of death” -World Health Organisation

6. Tobacco • Dried leaves of Nicotiana tabacum and Nicotina rustica plants • Origin in North America • Imported to Europe, Asia and Africa in the 16th century

7. Smoking tobacco • Cigarettes • Shredded/ reconstituted tobacco processed with numerous chemicals • Often with a filter • Machine manufactured • Commonest form

8. Smoking tobacco • Bidis • Small amounts of tobacco hand wrapped in dried temburni leaf and tied with a string • Tar and CO delivery can be higher than in cigarettes

9. Smoking tobacco • Cigars • Made of air cured and fermented tobacco with a tobacco wrapper • Many shapes and sizes • Revival in cigar smoking at the end of 20th century Kreteks, pipes and sticks are the other forms of smoking tobacco

10. Smoking tobacco • One billion male smokers in the world • 35% of men in developed countries • 50% of men in developing countries • 250 million female smokers • 22% in developed countries • 9% in developing countries

11. Smoking tobacco Quantification of cigarette smoking Pack years = Number of years smoked at an average of 20 cigarettes per day e.g. The number smoked by a person in a day=5 Number smoked in a year = 5 X 365 Duration of smoking = 20 years Number of pack years smoked = 5 X 365 X 20 = 5 20 X 365

12. Smokeless tobacco Chewing tobacco Also known as plug, loose leaf and twist. Pan masala or betel quid consist of tabacco, areca nut and slaked lime wrapped in a betel leaf May also contain other sweetenings and flavouring agents

13. Smokeless tobacco Moist snuff A small amount of ground tobacco held in the mouth between the cheek and gum. Available pre-packaged into small paper or cloth packets

14. Smokeless tobacco Dry snuff Powdered tobacco that is inhaled through the nose or taken by mouth.

15. Beverages containing ethanol A product of fermentation of carbohydrates Types Beer (barley) – 5% alcohol Wines (grapes) – 12% alcohol Spirits (cereals, vegetables and fruits) – 40% alcohol Adult consumption = 4 L/ year (9 g/ day) 3% of average caloric intake Alcohol

16. Alcohol • Wide regional variation in use • Minimum (< 1L/ year) - Western and Southern Asia & Northern Africa • Maximum(> 12 L/ year)– Central and Southern Europe • Unofficial use also present

17. Alcohol • Safe limit of alcohol use • Male < 14 units/ week • Female < 7 units/ week One unit equivalent to 10 ml (8 g) of pure alcohol Beer (350 ml) Arrack (50 ml) Spirits (Whisky) (25 ml) Wine (125 ml/ one glass)

18. Other addictive substances • Narcotics • Opiods, opioid derivatives and their synthetic/ semi synthetic substances e.g. Heroin • Cannabis • Cocaine • Steroids

19. Prevention • Primary prevention most effective • Educational interventions • Secondary Prevention • Behavioural modifications • Treatment of outcomes • Tertiary Prevention • Treatment of complications