Alcoholism and Drug

dependance
• Drug: Any substance that, taken into any living
organism which may modify its one or more
functions.
• Drug abuse: Self administration of drug for
non medical reason, in quantities and
frequency which may impair individual’s
ability to function effectively, and which may
result in social, physical and emotional harm.
 Drug dependence
• described as "a state, psychic and sometimes also
physical,resulting from the interaction between a
living organism and a drug, characterized by
behavioural and other responses that always
include a compulsion to take the drug on a
• continuous or periodic basis in order to
experience its psychic effects, and sometimes to
avoid the discomfort of its absence.
• A person may be dependent upon more than one
drug
 Agent factors
• Dependence producing drugs: ICD-10 recognises following as
dependence producing drugs:
• Alcohol
• 2. Opioids
• 3. Cannabinoids
• 4. Sedatives or hypnotics
• 5. Cocain
• 6. Other stimulants including caffeine
• 7. Hallucinogens
• 8. Tobacco
• 9. Volatile solvents
• 10. Other psychoactive substances, and drugs from
• different classes used in combination.
• The WHO expert committee recommended to include
tobacco and other nicotin containing product to be
included in this list.
• It is also suggested that WHO should consider
including substances such as
• anabolic steroids, which are used because of their
performance-enhancing effects. Anabolic steroids are
being abused by people who wish to increase muscle
mass for cosmetic reasons or for greater strength.
• In addition to the medical problems, the practice is
associated with significant
• mood swings, aggressiveness, and paranoid delusions.
• Alcohol and stimulant use is higher in these individuals.
• Withdrawal symptoms of steroid dependency include
• fatigue, depressed mood, restlessness, and insomnia .
• This form of use is described in ICD-10 under the
category F-55, ''Abuse of non-dependence-producing
substances".
• The development of other performance enhancing
drugs may present new types of drug use problems in
the future.
 AMPHETAMINES AND COCAINE
• Amphetamines are synthetic drugs, structurally
like adrenaline.
• they are used to treat obesity, mild depression,
narcolepsy and certain behaviour disorders in
children.
• The ordinary therapeutic dose is 10-30 mg a day
• There are various brands of amphetamines: the
common names are Benzedrine, Dexedrine,
Methedrine, etc.
• They produce mood elevation, elation, a
feeling of well-being and increased alertness
and a sense of heightened awareness.
Because they give a tremendous boost to self-
confidence and energy, while increasing
endurance, they are called "superman" drugs.
The use of these drugs results in psychic
dependence. With large doses, such
dependence, is often rapid and strong.
• Cocain derived from leaves of cocoa plant was
used as local anaesthetic.
• It produces a sense of excitement, heightened
and distorted awareness and hallucinations.
Unlike amphetamines, it produces no
tolerance. There is a 'no physical dependence;
no ·withdrawal symptoms', per se.
• The chewing of coca leaves is a very common
practice in Bolivia and Peru in South America.
 Barbiturates
• Major component in sleeping pills produce
sedation.
• Users prefer short acting barbiturates.
• The addiction to barbiturates is one of the
worst forms of suffering. It leads to craving, or
both physical and psychic dependence.
 Cannabis
• Most widely used drug
• Derived from hemp plants – Canabis sativa, c. indica and C.
americana.
• The resinous exudate from the flowering tops
• of the female plant contains most of the active ingradients
called hashish or charas.
• The dried leaves and flowering shoots are called bhang;
• the resinous mass from the small leaves and brackets of
inflorescence is called ganja.
• In USA, the term marijuana is used to refer to any part of the
plant which induces somatic and psychic changes in man.
• The most common reaction is the development of a
:
• dreamy state of altered consciousness. Relaxation,
euphoria,
• and an increased tendency to laugh, greater
awareness of colours and sounds, interference with
perception of both time and space, and paranoia
are among the psychological effects. Human death
appears to be a rare phenomenon. There is a
psychic dependence.
 Heroin
• Heroin, morphine, codein, methadone,
• pethidine are narcotic analgesics.
• Addiction to heroin is perhaps the worst type of
addiction because it produces craving. With
narcotics generally psychic dependence is
• strong and tends to develop early. Tolerance to
narcotics also occurs rapidly, making it
necessary to take increasing doses of the drug
to achieve the same effect.
 LSD
• Lysergic acid diethylamide (LSD) was
• synthesized in 1938 by Hoffmann in the Sandoz
Laboratories in Switzerland. Its psychic properties
were noticed much later in 1943, when he accidentally
sniffed a few micrograms of it.
• LSD is a potent psychotogenic agent. Although
amounts as low as 20-25 μg may produce subjective
disturbances, oral doses in the range of 100-250 μg are
usually required to effect intense depersonalization.
The lethal dose in man is not known.
• LSD alters the structure of perception-
individual senses the world differently.
• There is intensification of colour perception
and auditory acuity; body image distortions,
visual illusions, fantasies pseudohallucinations
are common. Colours are heard and
• music becomes palpable. Subjective time is
deranged so that seconds seem to be minutes
and minutes pass as slowly as hours.
 Alcohol
• By pharmacological definition, alcohol is a drug and
may be classified as a sedative, tranquillizer, hypnotic
or anaesthetic, depending upon the quantity
consumed.
• Alcohol is rapidly absorbed from the small intestine.
Within 2-3 minutes of consumption, it can be
detected in the blood-the maximum concentration is
usually reached about one and half hour after
consumption. The presence of food in the stomach
inhibits the absorption of alcohol because of dilution.
• Over the past 30-40 years, increasing
percentages of young people have started to
drink alcoholic beverages, their alcohol
consumption has increased in quantity and
frequency, and the age at which drinking
starts has declined i.e. they start it at an early
age now.
• This situation is disturbing because the young
people concerned may run a greater risk of
alcoholic problems in later life and also, in the
short term, because of increased rates of
drunkenness and involvement in road
accidents.
• It is not a "stimulant" as long believed, but a
primary and continuous depressant. Alcohol
produces psychic dependence of varying
degrees from mild to strong. Physical
dependence develops slowly.
• According to current concepts, alcoholism is
considered a disease and alcohol a "disease
agent" which causes acute and chronic
intoxication, cirrhosis of the liver, toxic
psychosis, gastritis, pancreatitis,
cardiomyopathy and peripheral neuropathy.
Also, evidence is mounting that it is related to
cancer of the mouth, pharynx, larynx and
oesophagus..
• Further, alcohol is an important aetiologic
factor in suicide, automobile and other
accidents, and injuries and deaths due to
violence. The health problems for which
alcohol is responsible are only part of the total
social damage which includes family
disorganization and loss of productivity
 Tobacco
• It causes more deaths than all other
psychoactive substances combined.
• About 3 million premature deaths a year (6
per cent of the world total) are already
attributed to tobacco smoking.
• Tobacco is responsible for about 30 per cent
of all cancer deaths in developed countries.
• More people die from tobacco related
diseases other than cancer such as stroke,
myocardial infarction, aortic aneurysm and
peptic ulcer.
• The earlier the young people start smoking
the earlier they develop cough, phlegm
production and difficulty breathing on
exertion.
• The risk of developing conditions like chronic
bronchitis, emphysema, cardiovascular diseases
and lung cancer are more in those who start
smoking earlier.
• Three factors are considered responsible for
young people to start smoking:
• Peer pressure
• Following the example of sibling and parents
• Employment outside the home
• Women who smoke run even more risks than
men. For example, the adverse effects of oral
contraceptive use are markedly increased in
women smokers.
• Osteoporosis accelerated with tobacco use.
Some evidence indicates that fertility is
impaired with smoking.
• Tobacco' use is also associated with a higher rate of
spontaneous miscarriages. In pregnancy, smoking
contributes to perinatal complications such as bleeding,
which is dangerous for both mother and fetus.
• Intrauterine growth retardation and low-birth­weight
babies are known out-comes of smoking during
pregnancy.
• The babies of mothers who smoke may weigh, on an
average, 200 grams less at birth than those of non­
smokers
 Passive smoking
• Smoking harms non-smokers too. The first conclusive
evidence of the danger of passive smoking came from
a study carried out by Takeshi Hirayama, in 1981, on
lung cancer in non-smoking Japanese wives married to
men who smoked. Surprising at the time, those
women showed a significantly increased risk of dying
from lung cancer, despite never having smoked a
cigarette. Hirayama believed that passive smoking (i.e.
breathing in the smoke from their husbands) caused
these women's excess cancer risk. About 40 further
studies have confirmed this link.
• research indicates that passive smoking can also
give rise to other potentially fatal diseases such as
heart disease and stroke.
• The per head consumption of tobacco is reduced in
developed countries and has increased in
developing countries among both men and
women.
• Since the mechanization of cigarette manufacturing
at the turn of the 20th century, global consumption
of cigarettes has been rising steadily.
• With the expansion of the tobacco industry's
marketing campaigns into the developing
world, more and more people are taking up
smoking in countries least able to deal with
the grave public health consequences of
tobacco use.
• China produces about a third of all the
cigarettes in the world. It is also a major
tobacco counsumer, since nearly 60% of adult
Chinese males smoke, representing one-third
of all smokers globally. Currently, it is
estimated that one out of every three
cigarettes in the world is smoked in China. In
India about 47 per cent of males and about 17
per cent of females smoke.
• The withdrawal symptoms include
• irritability,
• anxiety,
• craving,
• sleep problems,
• headache,
• tremors, and lethargy.
• Withdrawal symptoms may continue for 4-6 weeks,
and craving may continue for many months.
 VOLATILE SOLVENTS
• In a number of countries, the sniffing of
substances such as glue, petrol, diethyl ether,
chloroform, nitrous oxide, paint thinner,
cleaning fluids, typewriter correction fluid
etc., is causing increasing concern, as it can
result in death, even on the first occasion.
• These substances are central nervous system
depressants and produce effects comparable
to those produced by alcohol.
• There may be initial euphoria and xhilaration,
followed by confusion, disorientation and
ataxia.
• Some of the substances like petrol and
toluene may also produce marked euphoria,
grandiosity, recklessness, delusions and
hallucinations and a substantial loss of self-
control.
• With increasing doses, there may be
convulsions, coma and death.
• In chronic abusers damage to the brain,
peripheral nervous system, kidney, liver, heart
or bone marrow may occur .
• Lead encephalopathy can be associated with
sniffing lead gasoline.
 caffeine
• Symptoms of caffeinism (usually associated
with ingestion of over 500 mg/day) include
anxiety, agitation, restlessness, insomnia and
somatic symptoms referable to the heart and
gastrointestinal tract.
• Withdrawal from caffeine can produce
headache, irritability, lethargy, and occasional
nausea .
 Host factors
• The motives behind drug dependence has been
described as pleasure, desire to experiment,
sense of adventure, wish for self-knowledge,
and desire to escape.
• Increasingly, people are unwilling to accept even
minor discomforts and are looking to drugs for
solutions. Many of them have shown symptoms
of social and psychological maladjustment
resulting from personal handicaps of all sorts.
• The average age of drug users has decreased
considerably in recent years. Multiple drug-
use has also become more common.
• In countries with long experience of heavy
drug use, there is a tendency to prefer a single
drug, perhaps because a continuous supply is
less problematic. Multiple drug use may be
more common where drug abuse is a
relatively recent occurrence.
 Symptoms of drug addiction

• Loss of interest in sports and daily routine;

• Loss of appetite and body weight;
• Unsteady gait, clumpsy movements, tremors;
• Reddening and puffiness of eyes, unclear
vision;
• Slurring of speech;
• Fresh, numerous injection marks on body and
blood stains on cloths ;
• Nausea, vomiting and body pain;
• Drowsiness or sleeplessness, lethargy and
passivity;
• Acute anxiety, depression, profuse sweating;
• Changing mood, temper tantrums;
• Depersonalisation and emotional detachment;
• Impaired memory and concentration; and
• Presence of needles, syringes and strange packets
at home.
 Environmental factors
• It includes rapid technological developments
with associated need for extended periods of
education, along with the in-applicability of
old solutions to novel problems.
• Television, world travel, affluence, freedom to
speculate and experiment have encouraged
youngsters to question and often reject the
values and goals of their parents.
 Factors associated with a high risk
for drug abuse
• unemployment
• - living away from home
• - migration to cities
• - relaxed parental control
• - alienation from family
• early exposure to drugs - leaving school early
• broken homes; one parent families
• - large urban environments
• - areas where drugs are sold,traded, or produced
• - certain occupations (tourism, drug production
or sale) - areas with high rates of crime or vice
• - areas where there are drug ­using gangs
•
 Prevention
• Legal approach : The legal control on the
distribution of drugs, when effectively applied
has been and remains an important approach
in the prevention of drug abuse. Controls may
be designed to impose partial restriction or to
make a drug completely unavailable.
Legislation may be directed at controlling the
manufacture, distribution, prescription, price,
time of sale, or consumption of a substance.
• The antismoking measures suggested are:
• (a) prohibition of the sale of tobacco products
to minors;
• (b) restriction on the sale of cigarettes from
automatic vending machines;
• (c) prohibition of smoking in schools and
other places frequented by young people;
• (d) prohibition of smoking in public;
• (e) prohibition of cigarette advertising at
times, and in places and ways, calculated to
ensure its maximum impact on adolescents;
• (f) establishment of mandatory public health
education on health consequences of
smoking;
• (g) insisting on the placing of mandatory
health warning on cigarette packets.
 Educational approach
• Educational programmes in schools & colleges
• public information campaigns on electronic media
• The message should be clear and unambiguous to
the intended audience, and come from credible
source of information. The message should also
provide specific advice, rather than general, and
as far as possible the information should be new
to the audience and should be capable of
provoking discussion or action.
 Community approach
• There should be a strong emphasis on action at the
community level to prevent drug abuse. Initiating
preventive interventions in the community brings
preventive action to the level of people's every day
lives and actions, and contributes to emphasis on
strengthening primary health care. Action at the
community level is also important since
communities often bear the main burden of
dealing with the harmful use of drugs and drug
related problems.
• Such activities as the establishment of groups
or organizations interested in athletics, sports,
music, public policy, religion, artistic activities
of various kinds, and improvement of the
environment through the prevention of
pollution.
• Non-governmental organizations play a
crucial role in the development of such
activities and are likely to become important.
 Treatment
• Long term treatment is not only a medical problem,
but needs the cooperation of psychologists and
sociologists. There is a high relapse rate with all
treatment methods.
• Measures include:
• identification of drug addicts and their motivation
for detoxication
• detoxication (requires hospitalization) post-
detoxication counselling and follow-up (based on
clinic and home visits), and
• rehabilitation.
• Simultaneously with medical treatment,
changes in environment (home, school,
college, social circles) are important.
• The patient must effect a complete break with
his group, otherwise the chances of relapse
are 100 per cent. Psychotherapy has a
valuable place in the management of the
addict.
 Rehabilitation
• The rehabilitation of former drug user,
regardless of age, is in most cases a long and
difficult process.
• Facilities for vocational training and
sometimes the provision of sheltered work
opportunities are useful in rehabilitation and
help to prevent relapse.
• facilities for the registration, diagnosis,
treatment, after-care, etc., of drug­dependent
individuals and groups should be regarded as
indispensable integrated parts of the health
and social services structure of any
community in which drug-dependence exists.
• It is suggested that when there is evidence of
significant "alienation" among a group,
especially of younger persons, it should be
regarded as indication of possible presence of
actual or potential drug-takers, and should
lead to an analysis of the situation and to such
preventive or remedial action as may be
indicated.