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PREFACE
A drug is any substance that, when inhaled, injected, smoked, consumed, absorbed
through a patch on the skin, or dissolved under the tongue, causes a physiological
change in the body. Drug or alcohol problems is a pattern of harmful behavior involving the misuse or overuse of substances for mood-altering purposes. This means that
the drug or alcohol changes how a person behaves or feels. Drugs that are psychoactive, such as cannabis, alcohol, ecstasy and heroin, have the ability to affect the mood.
They can arouse certain emotions or dampen down others.
Illustrated Handbook of Drugs & Alcohol Related Health Issues brings a concise information on drug and alcohol use, discussing types of drugs, reasons for using, and the
dangers of using chemical substances.
Excessive consumption and abuse of alcohol is a common problem for people of all
ages. With habitual consumption and abuse of alcohol, the body develops a higher
tolerance for it. A person may drink increasing amounts of alcohol more frequently in
response to the increasing desire and need for it. This progressive consumption may
result in negative health consequence, both physical and emotional, and may strain
personal relationships. An addicted person may displace healthy relationships and
activities with alcohol consumption. Drinking large amounts of alcohol, known as
binge drinking, can have serious repercussions. Alcohol and other drug use may also
lead to other health problems such as respiratory depression, cancer, Fetal Alcohol
Syndrome, elevated blood pressure, and, in some case, death. Heavy drinking, especially bingeing, makes platelets more likely to clump together into blood clots, which
can lead to heart attack or stroke. Heavy drinking can also cause cardiomyopathy, a
potentially deadly condition in which the heart muscle weakens and eventually fails,
as well as heart rhythm abnormalities such as atrial and ventricular brillation. Atrial
brillation, in which the heart’s upper chambers (atria) twitch chaotically rather than
constrict rhythmically, can cause blood clots that can trigger a stroke. Ventricular brillation causes chaotic twitching in the heart’s main pumping chambers (ventricles).
It causes rapid loss of consciousness and, in the absence of immediate treatment, sudden death. In addition, some drugs of abuse, such as inhalants, are toxic to nerve
cells and may damage or destroy them either in the brain or the peripheral nervous
system. Drug abuse and mental illness often co-exist. In some cases, mental disorders
such as anxiety, depression, or schizophrenia may precede addiction; in other cases,
drug abuse may trigger or exacerbate those mental disorders, particularly in people
with specic vulnerabilities.
The Illustrated Handbook of Drugs & Alcohol Related Health Issues is predominantly useful for students and researchers in the Nursing and Allied Health areas.
CHAPTER 1
OVERVIEW OF
DRUGS
2
Illustrated Handbook of Drugs & Alcohol Related Health Issues
INTRODUCTION
A drug is any chemical you take that
affects the way your body works. Alcohol,
caffeine, aspirin and nicotine are all drugs.
A drug must be able to pass from your
body into your brain. Once inside your
brain, drugs can change the messages
your brain cells are sending to each other,
and to the rest of your body. They do
this by interfering with your brain’s own
chemical signals: neurotransmitters that
transfer signals across synapses. A drug
is any substance which, when taken into
the body, alters the body’s function either
physically and/or psychologically. Drugs
may be legal (e.g. alcohol, caffeine and
tobacco) or illegal (e.g. cannabis, ecstasy,
cocaine and heroin).
It is any substance that, when inhaled,
injected, smoked, consumed, absorbed
via a patch on the skin, or dissolved
under the tongue, causes a physiological
change in the body. In pharmacology,
a pharmaceutical drug, also called a
medication or medicine, is a chemical
substance used to treat, cure, prevent, or
diagnose a disease or to promote wellbeing. Traditionally drugs were obtained
through extraction from medicinal plants,
but more recently also by organic
synthesis. Pharmaceutical drugs may
be used for a limited duration, or on
a regular basis for chronic disorders.
Pharmaceutical drugs are often classified
into drug classes groups of related drugs
that have similar chemical structures, the
same mechanism of action, a related
mode of action, and that are used to
treat the same disease.
Citation: https://fthmb.tqn.com/Bu8pQ2FDlq_QHGQXOJRG-J3qTlo=/1500x1000/filters:no_
upscale():fill(87E3EF,1)/about/Pharmacist-5691835e5f9b58eba48f4fc9.jpg
The Anatomical Therapeutic Chemical Classification System (ATC), the most widely
used drug classification system, assigns drugs a unique ATC code, which is an
alphanumeric code that assigns it to specific drug classes within the ATC system.
Another major classification system is the Biopharmaceutics Classification System.
This classifies drugs according to their solubility and permeability or absorption
properties. Psychoactive drugs are chemical substances that affect the function of the
central nervous system, altering perception, mood or consciousness. They include
alcohol, a depressant, and the stimulants nicotine and caffeine. These three are
Overview of Drugs
the most widely consumed psychoactive drugs worldwide and are also considered
recreational drugs since they are used for pleasure rather than medicinal purposes.
Other recreational drugs include hallucinogens, opiates and amphetamines and
some of these are also used in spiritual or religious settings. Some drugs can cause
addiction and all drugs can have side effects. Excessive use of stimulants can
promote stimulant psychosis. Many recreational drugs are illicit and international
treaties such as the Single Convention on Narcotic Drugs exist for the purpose of
their prohibition.
In the case of recreational drug use, harm reduction is put forward as a useful
perspective alongside the more conventional approaches of demand and supply
reduction. Many advocates argue that prohibitionist laws criminalise people for
suffering from a disease and cause harm; for example, by obliging drug addicts to
obtain drugs of unknown purity from unreliable criminal sources at high prices,
thereby increasing the risk of overdose and death. The website Erowid.org collects
and publishes information and first-hand experience reports about all kinds of
drugs to educate (potential) drug users. While the vast majority of harm reduction
initiatives are educational campaigns or facilities that aim to reduce drug-related
harm, a unique social enterprise was launched in Denmark in September 2013 to
reduce the financial burden of illicit drug use for people with a drug dependence.
Michael Lodberg Olsen, who was previously involved with the establishment of a drug
consumption facility in Denmark, announced the founding of the Illegal magazine
that will be sold by drug users in Copenhagen and the district of Vesterbro, who
will be able to direct the profits from sales towards drug procurement.
3
BASIC CONCEPT OF DRUG RELATED HEALTH ISSUES
Definition of a drug is “any substance that alters normal metabolism in any part of
the body”. Also refers to any chemical substance taken to cure or prevent disease,
enhance mental or physical performance, or to cope with or escape from dealing
with reality. The ability of a drug to operate effectively is linked to the drug/nutrient
interactions. Be very careful to follow appropriate directions! Ex: take only on empty
stomach, take only on full stomach, take without certain nutrients (such as milk
or juice) present, or take with specific nutrients present. Drugs can affect nutrition
by causing alterations in appetite, nutrient absorption, metabolism and excretion.
Problems in these areas can be caused by the use of over-the-counter, prescription
and/or illicit drugs. Most legal drugs do not have a profound nutritional impact
unless they are taken long term.
Many medications have a direct impact on the GI tract, such as mouth dryness,
stomach irritation, gastric upset and decreased nutrient absorption. In class we will
review examples of various drugs and their effects on the GI tract. Abuse of drugs
has always been a problem! Generational amnesia refers to the fact that we tend to
focus on the current, most dangerous drug. It means that we forget the lessons of
the past regarding other drugs that are also very dangerous. Some drugs have social/
cultural acceptability and therefore are not considered to be drugs, such as alcohol,
4
nicotine, caffeine and aspirin. Drugs that alter behavior and/or consciousness are
known as psychoactive drugs. Some prescription drugs may produce psychoactive
side effects, such as steroids, antihistamines and propanalol.
Citation: http://www.empowher.com/sites/default/files/herarticle/drugs-cost-more-US.jpg
Illustrated Handbook of Drugs & Alcohol Related Health Issues
Terms that indicate a dependency upon psychoactive drugs include: tolerance,
dependence, drug abuse, substance abuse and addiction. There are specific criteria for
addiction: (1) physical tolerance and (2) physical dependence. A drug is considered
addictive if both of these criteria are met. A more precise definition states that a
person is addicted if they crave a drug, even though they may lack the symptoms
of withdrawal. Craving is defined as a behavioral addiction. The term tolerance
refers to the fact that the effects of a drug can depend upon a user’s experiences.
Types of tolerance include:
■ physical
■ behavioral
■ acute
■ cross
■ reverse
Dependence behavior is characterized by the expression of at least three of these
behaviors:
■ physical tolerance,
■ withdrawal,
■ consumption of large amounts,
■ a desire to cut down that persists,
■ time and effort spent on the acquisition of the drug,
Overview of Drugs
Loss of normal activities because of drug usage and usage continues despite physical
and emotional problems that directly result from the usage.
5
Medication
A medication or medicine is a drug taken to cure or ameliorate any symptoms of an
illness or medical condition. The use may also be as preventive medicine that has
future benefits but does not treat any existing or pre-existing diseases or symptoms.
Dispensing of medication is often regulated by governments into three categories
over-the-counter medications, which are available in pharmacies and supermarkets
without special restrictions; behind-the-counter medicines, which are dispensed by a
pharmacist without needing a doctor’s prescription, and prescription only medicines,
which must be prescribed by a licensed medical professional, usually a physician.
Pharmaceutical drugs are usually categorised into drug classes. A group of drugs
will share a similar chemical structure, or have the same mechanism of action,
the same related mode of action or target the same illness or related illnesses. The
Anatomical Therapeutic Chemical Classification System (ATC), the most widely
used drug classification system, assigns drugs a unique ATC code, which is an
alphanumeric code that assigns it to specific drug classes within the ATC system.
Another major classification system is the Biopharmaceutics Classification System. This
groups drugs according to their solubility and permeability or absorption properties.
Citation: http://www.smi-online.co.uk/eventImages/5102_overview.jpg?width=1036
Problems caused by the use of psychoactive drugs touch all areas of medicine and
health care. Some problems are well known and highly visible such as the respiratory
illnesses caused by smoking, liver disease from harmful alcohol consumption and
overdose from heroin injection. Others are more subtle and often missed by health
professionals as an underlying cause of a wide range of health and social harms.
Personal and social problems from drug use are substantial and cut across all
6
domains of functioning including personal relationships, family life, employment
and psychological health.
The health and economic costs associated with the use of drugs are high, with costs
of legal drugs estimated to be substantially higher than those from illegal drugs.
The annual cost of drug use in Australia is estimated to be $34.4 billion of which:
■ $21.1 billion was from tobacco
■ $7.6 billion from alcohol
■ $6.1 billion from illicit drugs
The Australian Institute of Health and Welfare estimated that in 1998 there were
23,313 drug-related deaths in Australia of which 19,019 were due to smoking
tobacco, 3,271 to risky alcohol use and 1,023 to illicit drug use. The bulk of the
latter comprised deaths from heroin overdose.
In addition to drug-related deaths, in 1997–1998 there were:
■ 142,525 hospital separations attributable to tobacco smoking
■ 71,422 attributable to risky alcohol use
■ 14,471 to illicit drugs
There are three main patterns of risky drug use with corresponding patterns of
problems.
Illustrated Handbook of Drugs & Alcohol Related Health Issues
Citation: http://www.health.gov.au/internet/main/publishing.nsf/content/E5203E6D5CBAA69
6CA257BF0001E02ED/$File/aodgp.pdf
These are:
■ intoxication (e.g. violence, falls, road trauma, overdose)
■ regular use (e.g. liver disease, cancer)
■ dependence (e.g. withdrawal symptoms, social problems)
Overview of Drugs
These three distinct patterns of use can occur within the one person, or in different
individuals.
There are also growing problems associated with injecting drug use including the
spread of blood borne viruses. While the rate of HIV infection amongst Australian
injecting drug users is still very low by world standards (1–2%), hepatitis C is an
emerging concern and is likely to generate some thousands of cases of liver disease
in future years
7
Types of Drugs and their Effects
There ae many different categories and types of drugs, with different street names
and nicknames, and they all have different effects and health implications.
Identifying Harms
Alcohol- and drug-related harms are not specific to the effects of the drug. Harms
result from the interaction between:
The Drug
■ patterns of use (how much, when used,
■ how often)
■ and other drugs used
The Individual
■ age, weight, gender and general health
■ tolerance and previous experience of the
■ substance including intoxication, after effects
■ and withdrawal
■ expectations of use and effects
■ current mood and psychological health
The Environment
Factors that influence the drug’s effects and patterns of use such as:
■ social settings and company
■ context of use
■ patterns of drug use according to ritual or culture
8
Citation: https://www.justthinktwice.gov/sites/justthinktwice.com/files/field/image/drugs.jpg
Illustrated Handbook of Drugs & Alcohol Related Health Issues
Amphetamines (speed or whiz)
Amphetamine is a synthetic stimulant. It comes in powder form and is usually white,
yellowish, grey or a pinky colour. It is snorted or ingested and it takes effect after
about half an hour. It has varied effects including:
■ feelings of wakefulness
■ alertness
■ increased confidence
■ sociability
■ physical or mental activity
But as the body’s energy levels reduce the user is prone to feelings of anxiety,
irritability, restlessness and dizziness.
Users can develop tolerance to amphetamines with increased use, withdrawal is
primarily emotional, but users may experience a mild physical withdrawal including
feelings of depression, lethargy and extreme hunger.
Benzodiazepines
Benzodiazepines are prescription only medicines under the Medicines Act. They
can be abused and bought illegally on the black market.
They are usually prescribed for short term treatment of anxiety and sleep problems.
When taken at low doses tolerance does not develop to a great extent, but when
people use large amounts their tolerance can develop rapidly and there is a danger
of dosage increase.
Withdrawal symptoms can last from several days to several weeks, and in some
extreme cases, months. These withdrawal symptoms include: