Non-Medical Use of Drugs: Addiction, Dependence, and Effects

1. (By Tabrez Uz Zaman) Non-Medical Use of Drugs, Drug Dependence, Cocaine, Tobacco, Alcohol, Cannabis etc

2. Some highlights • What is Addiction? • Non-Medical Use of Drugs • Drug Dependence • Drug Effects • World Drug Report, 2015 • Drug trafficking • Drugs and Sports • 10 most dangerous drugs in the world • Change Model

3. What is Drug Addiction? • The drives that persuade or compel a person more or less mentally healthy to resort to drugs to obtain “chemical vacations from intolerable selfhood” (1) can be called drug addiction. • Addiction is a chronic, often relapsing brain disease that causes compulsive drug seeking and use, despite harmful consequences to the addicted individual and to those around him or her.

5. Non-Medical Use of Drugs • The dividing-line between legitimate use of drugs for social purposes and their abuse is indistinct for it is not only a matter of which drug, but of amount of drug and whether the effect is directed anti-socially or not.

6. Non-Medical drug use has two principal forms: • Continuous use where there is a true dependence e.g. opiates, alcohol, barbiturates • Intermittent or occasional use to obtain an experience e.g. LSD, cannabis, solvents

7. Motives for non-medical (or non-prescription drug use : • Relief of anxiety, tension and depression: escape from personal psychological problems • Search for self-knowledge and for meaning of life, including religion • Rebellion against or despair about orthodox social values and the environment • Fear of missing something, and conforming with own social subgroup • Fun, amusement, recreation, excitement, curosity

8. Drug Dependence • It is a state arising from repeated, periodic or continuous administration of a drug, that results in harm to the individual sometimes to the society. Some phenomena’s: • Emotional (psychic) dependence • Physical dependence • Tolerance (e.g., LSD) • In 1964, WHO Expert Committee on Addiction-producing Drugs recommended that the term “drug dependence” should be substituted for both “addiction” and “habit”

9. Drug Effects

10. Fowler et al., Synapse, 1989 Image YELLOW SPOTS - Binding of Cocaine in the Brain (e.g,striatum)

11. Emergency Medical Treatment cases Global Drugs Survey, 2015

12. A tripling in those seeking EMT in the last 12 months among ‘ecstasy users’

13. World Drug Report, 2015 • It is estimated that a total of 246 million people, or 1 out of 20 people between the ages of 15 and 64 years, used an illicit drug in 2013. • That represents an increase of 3 million over the previous year • Due to increase in the global population, illicit drug use has in fact remained stable. • The magnitude of the world drug problem becomes more apparent when considering that more than 1 out of 10 drug users is a problem drug user.

14. World Drug Report, 2015 • In other words, some 27 million people, or almost the entire population of a country the size of Malaysia, are problem drug users. Almost half (12.19 million) of those problem drug users inject drugs, and an estimated 1.65 million of those who inject drugs were living with HIV in 2013.

15. Public Health Burden • Illicit drug use places a heavy burden on public health systems in terms of the prevention, treatment and care of drug use disorders and their health consequences. • Only one out of every six problem drug users in the world has access to treatment, as many countries have a large shortfall in the provision of services.

16. Drug Smuggling Facts • No one likes to get high alone, so the use of now illegal substances spread until it became a worldwide phenomenon. • There are many illegal drugs abused in many parts of the world, but the global drug trafficking network primarily centers on six illegal substances: • Cocaine • Meth • Marijuana • Crack (crack cocaine) • Heroin • Oxycodone (a synthetic analgesic drug which is similar to morphine in its effects.)

17. TRAFFICKING • Trafficking involves production, distribution and sales, a complex international network. Some of the largest producers in the world include: • Afghanistan: opium • Columbia: cocaine • Kazakhstan: cannabis • Mexico: opium (second largest) • Morocco: hashish • Paraguay: cannabis (for South American market)

18. Global Trafficking of Cocaine

19. Global Trafficking of Heroin

20. Executions or Punishments

21. United Nations Office on Drugs and Crime

24. Drugs and Sport • The rewards of competitive sport, both financial and in personal and national prestige, are the cause of determination to win at almost any cost. • Drugs are used optimistically to enhance performance • Detection can be difficult.

25. Some types of sports drugs • “Anabolic steroids” anabolic-androgenic steroids (abbreviated AAS )is the familiar name for synthetic variants of the male sex hormone testosterone—Used for weight lifting, rowing, shot putting etc. e.g., methandienone, stanozolol • Stimulants (e.g., amphetamine) – taken for “explosive” events (e.g., 100m sprint) • Caffeine – swallowing caffeine in a tablet to be “doping”

26. 10 Most Dangerous Drugs in the World • Marijuana • MDMA • Ketamine • Crystal Meth • Cocaine • Alcohol • Tobacco • LSD • Heroin • Speedball

27. Marijuana • Marijuana is mostly a recreational drug. • Marijuana isn't seen as being comparable to other drugs on the list. • However, it does figure in the list, for prolonged use can lead to depression and anxiety.

28. MDMA • Commonly referred to as ecstasy, MDMA is, once again, not a very harmful drug until a certain point. • It is illegal in many countries and long term use can severely affect the central nervous system. • MDMA is one of the most common party drugs that increases the feeling of intimacy and induces a sense of euphoria. An overdose can be disastrous, especially when combined with alcohol.

29. Crystal Meth • Crystal Meth has wide ranging effects that severely affect the brain's functioning. • If used frequently, hallucinations, memory loss • Moreover, withdrawal effects are quite severe too.

30. Cocaine • A popular party drug, cocaine comes next on the list of most dangerous drugs. • It is also one of the most addictive drugs in the world. It releases massive quantities of dopamine, a feel good chemical released by the brain. • Withdrawal effects can be hard to take.

31. Tobacco • Tobacco is the deadliest drug in the world as far as number of deaths is concerned. • It is worse than marijuana and other recreational drugs. • Largest sources of government revenue for many countries- probably why it hasn't been made illegal yet.

32. 8. LSD • A powerful psychedelic drug, LSD, short for Lysergic Acid Diethylamide, is the most powerful psychedelic drug. • Prolonged use can lead to severe and irreversible paranoia. • The drug induces hallucinations and  hallucinations and delusions. • An LSD trip lasts for almost 12 hours.

33. 9. Heroin • Known as the queen of all drugs, heroin is the most harmful drug in the world. • The amount of dopamine released in the brain while on heroin is about a hundred times higher. • Lighter drugs like methamphetamine is administered to reduce the withdrawal effects from heroin. 

34. 10. Speedball • This deadly combination of heroin and cocaine takes you to a new dimension altogether. • Heroin addicts who cannot get enough of heroin often prefer the speedball. • Death from a speedball overdose isn't an uncommon phenomenon

35. prevention is always the best option

36. Transtheoretical Model • The Transtheoretical Model (Prochaska & DiClemente) • An integrative model of behavior change. • The model describes how people modify a problem behavior or acquire a positive behavior. • The central organizing construct of the model is the Stages of Change.

37. Stages of Change Model

38. Precontemplation Stage • Individuals typically deny having a problem with drugs or alcohol and commonly resist change • Therapeutic goal - • Increase their consideration of the possibility that they may have a problem • Increase the individual's awareness that the behavior, problematic substance use, and its consequences may merit his/her attention and consideration.

39. Contemplation Stage • Individuals begin to think about changing use of drugs/alcohol • Commonly express ambivalence about changing their behavior. • Benefit from a discussion of the pros and cons of changing their behavior. • Referred to as a "decisional balance" discussion. • Individual may be considering change, in this stage they have not committed to change.

40. Preparation/determination stage • Individuals appear ready for and committed to action. • Have decided to stop the problematic behavior and initiate positive behavior. • Commitment to change does not necessarily mean that change is automatic but instead requires action by the individual.

41. Action stage of change • Individual is actively engaged in modifying the target behavior and their environment. • Typically they have developed a plan for change with their social worker. • Seeking support of family and friends facilitates success in this stage of change. • Clients publicly stating their commitment • Typically requires three to six months, but the actual length will vary

42. Maintenance phase • Therapeutic focuses on maintaining the new behaviors. • Behavioral patterns generally require time to emerge and stabilize. • Clients may seek additional treatment for supporting recovery. • Always the threat of relapse or return to the old problematic behavior.

43. Relapse or recycling stage of change • Does not occur for all individuals, but relapse is very common in substance abuse in populations. • People can regress from any stage to an earlier stage. • Relapse may occur secondary to • Unexpected urges or temptations, • Relaxing their guard about the dangers of abuse • Individuals may test their ability to resist the temptations of drugs or alcohol and fail, and • There may be an erosion of their sense of self-efficacy or commitment to change.

44. Motivational Interviewing Intervention • Motivational interviewing is an evidence-based intervention designed to enhance client motivation for change. • Tested in a variety of clinical intervention modalities including • brief 30-minute interventions, • multiple sessions, • ongoing counseling, and • client assessment

45. References • Laurence, D.R., and P. N. Bennett, P.N., (1980). Clinical Pharmacology. Churchill Livingstone: Harlow, 5, 447-500 • Huxley, A (1954). The Doors of Perceptions. London: Chatto and Windus • Velicer, W. F, Prochaska, J. O., Fava, J. L., Norman, G. J., & Redding, C. A. (1998) • World Drug Report, 2015 • United Nations Office on Drugs and Crime Report 2010 • http://www.boldsky.com/insync/pulse/2014/most-harmful-drugs-in-the-world-044093.html#slide47270