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Overview of Drugs
failure
■ cerebrovascular events – cerebral haemorrhage/thrombosis, abscess, tumour
■ cardiovascular events – arrhythmias, myocardial infarction
■ respiratory failure
■ infection – meningitis, encephalitis
Once intoxication or overdose has been treated it is important to:
■ ask about depression, suicidal ideation (may need a referral to a psychiatrist)
■ explore withdrawal management and treatment options
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Coexisting Mental Health Problems
In patients using alcohol and other drugs coexisting mental health problems, such
as anxiety and depression, are not uncommon.
It is important to distinguish symptoms which are:
■ part of a primary psychiatric disorder
■ secondary to problems such as marital conflict, homelessness or legal
problems
■ drug or alcohol induced
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Drug Seeking
Clinical Features: Patients seeking prescribed drugs for nonmedical use often approach
emergency departments of major hospitals or general practitioners’ surgeries at busy
times or shortly before closing. Patients may choose a general practitioner who does
not know them or who are known to prescribe drugs very readily.
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Drug seeking patients are usually:
■ polydrug using
■ males
■ aged in their twenties or thirties
The drugs sought are usually:
■ opioid analgesics; or
■ benzodiazepines
The presentations for analgesics usually involve painful conditions where there
are few physical signs, such as headache, renal colic or backache. The names of
analgesics which have proved effective on previous occasions are often referred to
with familiarity.
The most frequently requested opioid is pethidine by injection. Commonly, patients
will claim that analgesics other than the preferred type:
■ have previously proved ineffective and/or
■ resulted in severe side effects including an allergic reaction.
Illustrated Handbook of Drugs & Alcohol Related Health Issues
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A careful history plus physical examination contributes substantially to the diagnosis
and management plan. Suspicion of illicit drug use is supported by a history of
common complications of drug use (such as hepatitis C, endocarditis or previous
incarceration). Physical examination should include inspection for track marks. It
is often helpful to have a patient discretely observed by an experienced nurse for
signs of variability in the severity of signs of pain.
Overview of Drugs
81
Management
As special tests usually cannot prove if the patient’s symptoms result from organic
disease, the final clinical decision depends on the doctor’s judgment and experience.
In most cases, decisions are relatively easy. When uncertain, the choice has to
be made between possibly withholding analgesia from a patient in severe pain or
possibly prescribing an opioid analgesic to a malingering patient. The former is a
far more serious error.
Buprenorphine is a potent analgesic which provides minimal euphoria but this
can precipitate opioid withdrawal if the patient has withheld a history of recent
opioid use. Presentations for benzodiazepines often involve a history of anxiety or
insomnia due to a recent bereavement. Short-acting benzodiazepines should only
be prescribed in very special circumstances and then only in small quantities. If
benzodiazepines have to be prescribed, it is better to select longacting forms but
in small quantities.
General Management Approaches
Support and treatment for drug users should follow the general supportive and
commonsense approaches described below.
Clinicians should:
■ not judge the user and should not insist on abstinence
■ seek to engage and retain the user in treatment for as long as possible,
as retention is associated with better outcomes
■ ensure understanding of the client/patient’s treatment goals:
• to make it through an acute crisis?
• to reduce frequency and/or quantity of drug use?
• to achieve long-term abstinence?
■ Tailor the treatment where possible to meet those goals, including referral
when appropriate to:
• treatment programs
• individual counsellors
• family counselors
• self-help groups such as NA
■ Remember the need for flexibility of service delivery; as goals and outcomes
change throughout the course of treatment, the treatment program should
be adjusted to reflect these changes
■ Provide as multifaceted and intensive a program as possible, as more
intensive psychosocial treatment programs are associated with better
outcomes.
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Illustrated Handbook of Drugs & Alcohol Related Health Issues
REFERENCES
1. http://eschooltoday.com/drug-abuse-and-teens/types-and-effects-of-drugs.html
2. https://www.hccfl.edu/media/44316/17_introduction_to_drugs.pdf
3. http://www.drug-addiction-support.org/Introduction-of-Drug-Addiction.html
4. http://www.wisegeek.com/what-is-a-crude-drug.htm
5. https://healthyhorns.utexas.edu/studydrugs.html
6. https://www.drugabuse.gov/publications/drugfacts/understanding-drug-useaddiction
7. http://listverse.com/2007/09/27/top-10-drugs-and-their-effects/
8. https://www.gov.je/Health/AlcoholDrugs/Pages/DrugsEffects.aspx
9. https://www.hhs.gov/about/strategic-plan/introduction/index.html
10. https://en.wikipedia.org/wiki/Harm_reduction
11. http://www.health.gov.au/internet/publications/publishing.nsf/Content/
drugtreat-pubs-front5-wk-toc~drugtreat-pubs-front5-wk-secb~drugtreat-pubsfront5-wk-secb-6~drugtreat-pubs-front5-wk-secb-6-1
12. http://www.wisegeek.net/what-is-acamprosate.htm
13. https://archive.ahrq.gov/clinic/epcsums/alcosumm.htm
14. http://www.wisegeek.com/how-effective-is-naltrexone-for-alcoholism.htm
CHAPTER 2
ALCOHOL
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Illustrated Handbook of Drugs & Alcohol Related Health Issues
INTRODUCTION
Alcohol is a licit drug. Its consumption
is sanctioned by cultural norms and
social practices, and its production
contributes significantly to Australia’s
gross national product (GNP). Alcohol
is a central nervous system (CNS)
depressant. Its psychoactive properties
contribute to changes in mood, cognition
and behaviour. The main psychoactive
ingredient in beverage alcohol is ethyl
alcohol (ethanol, or C
It is classed as a depressant, meaning that
it slows down vital functions—resulting
in slurred speech, unsteady movement,
disturbed perceptions and an inability to
react quickly. As for how it affects the
mind, it is best understood as a drug
that reduces a person’s ability to think
rationally and distorts his or her judgment.
Although classified as a depressant, the
amount of alcohol consumed determines
2 H5
OH).
the type of effect. Most people drink
for the stimulant effect, such as a beer
or glass of wine taken to “loosen up.”
But if a person consumes more than the
body can handle, they then experience
alcohol’s depressant effect. They start to
feel “stupid” or lose coordination and
control.
Alcohol overdose causes even more
severe depressant effects (inability to
feel pain, toxicity where the body vomits
the poison, and finally unconsciousness
or, worse, coma or death from severe
toxic overdose). These reactions depend
on how much is consumed and how
quickly. There are different kinds of
alcohol. Ethyl alcohol (ethanol), the only
alcohol used in beverages, is produced
by the fermentation of grains and fruits.
Fermenting is a chemical process whereby
yeast acts upon certain ingredients in the
food, creating alcohol.
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Alcohol
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OVERVIEW OF ALCOHOL
An alcoholic drink is a drink that contains a substantial amount of ethanol, a
depressant which in low doses causes euphoria, reduced anxiety, and sociability
and in higher doses causes intoxication, stupor and unconsciousness. Long-term use
can lead to alcohol abuse, physical dependence, and alcoholism. Drinking alcohol
plays an important social role in many cultures. Most countries have laws regulating
their production, sale, and consumption; some countries ban such activities entirely.
However, alcoholic drinks are legal in most parts of the world.
■ A legal, sedative drug which changes the way we feel
■ Pure alcohol is a colourless, odourless and inflammable fluid
■ Alcohol as a drug does not contain any nutrients for the body.
■ Alcoholic beverages have been used in many societies for many purposes.
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Alcohol Commercially
■ Alcohol is a major economic commodity that is associated with substantial
governmental tax receipts and considerable consumer expenditure.
■ The EU is considered the centre of the global alcohol industry, acting as
both the largest market and the major producer of alcoholic drinks.
■ Excise duty from the sale of alcohol in Ireland in 2011 was €829.3 million
■ The estimated yield from VAT on alcohol in Ireland in 2011 was approximately
€1 billion
• Expenditure on alcohol marketing by the alcohol industry in 2008 was €82
million (Nielsen Media research), up →13 million on the previous year.
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Illustrated Handbook of Drugs & Alcohol Related Health Issues
Alcohol and Pleasure
■ The fact that alcohol improves the drinkers mood in the short term is an
important reason why many people drink and that mood change can be
regulated according to the amount consumed.
■ Alcoholic beverages are used for their mood-changing properties. The
more you drink the more parts of your brain become numbed from the
sedative drug-alcohol.
■ As the alcohol moves quickly to the brain it acts like an anaesthetic to
the various parts. First affected is the frontal lobe with immediate effects
of increased enjoyment, euphoria, happiness, and the general expression
of positive moods.
■ These feelings are experienced more strongly in groups than when drinking
alone and very much influenced by expectations.
■ The first thing to be “switched off “or “depressed” are inhibitions
• The good news is that this can make you more relaxed
• The bad news is that it can take away your judgment.
• This is why people risk unprotected sex, pick fights or become violent
■ Drinkers’ expectances of positive outcomes from drinking are associated
with increasing consumption levels.
Pharmacology
Pharmacology is the scientific study of the actions and interactions of drugs within
a living organism. When external drugs, whether pharmaceutical or otherwise,
enter the body of a person or animal they become the study of a pharmacologist.
Pharmacology science encompasses the study of drugs that alter the functions of
a given person or organism. These drugs can be medicinal or not. As an official
science the study dates back to the 1840s and is not to be confused with pharmacy,
which links health sciences with chemical sciences.
The job of the pharmacologist is to study the properties of a given drug. They
must determine the make-up of the drug, how it came to be composed, and the
interactions the drug has within the body of living organisms. The pharmacology
student attempts to discover how it will react with the human body, how it will
react with other substances, and what outcomes these reactions will have. They
must determine the toxicology of the drug, as well as its possible uses in therapy
and medicine; namely, how it will affect the biological functioning of the body.
Alcohol
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The different branches of the study of pharmacology include clinical pharmacology, the
study of medicines; toxicology, the study of the harmful effects of drugs; posology, the
study of what drugs can and should be taken in what doses; and neuropharmacology, the
study of effects on the nervous system. These, among many other fields, help to inform
the Food and Drug Administration in the United States. Drugs are then stamped with
guidelines and approval if they are fit for using.
Citation: http://images.wisegeek.com/male-and-female-scientists-in-lab-coats-in-lab.jpg
It is thought that the study of pharmacology first began with Avicenna, the 11th
century Persian physician and philosopher. His Canon of Medicine, published in
the early 1000s, features the first mention of pharmacological practices, and was
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soon followed by descriptions in John of St. Amand’s Commentary on the Antedotary
of Nicholas. With the development and surge of medicinal and recreational drugs
in the 19th century, pharmacology took a leap forward when the first educational
department was established by Rudolf Buccheim at the University of Dorpat in
modern day Estonia in 1847. In these days, morphine and quinine were among
the most studied pharmaceuticals.
In the 21st Century, pharmacology programs are offered at universities and colleges
around the world. Preparing students for careers in laboratory settings, these programs
are among the most difficult to enter in many universities.
Illustrated Handbook of Drugs & Alcohol Related Health Issues
Absorption
Alcohol is rapidly absorbed from the small bowel via portal circulation (around
80%), and stomach (around 20%). Alcohol is water soluble, and little or no alcohol
enters fatty tissue. It reaches the brain within five minutes of ingestion, with blood
concentrations peaking between 30 to 90 (typically 45) minutes.
Absorption rate varies with:
■ the drug (e.g. beverage type, presence of food in the stomach)
■ individual factors (e.g. age, gender, size, drinking rate and experience)
Distribution
Alcohol is rapidly distributed throughout the body water accumulating in tissues
with high water content. Alcohol readily crosses blood–brain and placental barriers
Metabolism
Ninety-five per cent of alcohol is metabolised by the liver into carbon dioxide
and water, and 1–5% is excreted unchanged in saliva, urine, faeces and sweat.
The enzyme alcohol dehydrogenase (ADH) (and to a smaller extent, cytochrome
P450 2E1 (or CYP2E1)) is the catalytic agent for transforming ethyl alcohol into
acetaldehyde. The second metabolic process involves aldehyde dehydrogenase
(ADLH) as the catalytic agent responsible for oxidising acetaldehyde into acetic
acid. Long-term high-risk consumption results in increased production and activity
of CYP2E1, thought to be responsible for increasing elimination of alcohol amongst
high-risk/dependent users.