WHAT IS DRUG ABUSE?
Drug abuse or substance abuse simply refers to the use of certain chemicals for the purpose of creating pleasurable effects on the brain. There are currently over 190 million drug users around the world and the problem has been increasing at alarming rates, especially among young adults under the age of 20.
TYPES OF DRUGS:
WHAT ARE THE CAUSES OF DRUG ABUSE?
Drug abuse are usually psychoactive drugs that are used by people for various different reasons which may include:
i. Curiosity and peer pressure, especially among school children and young adults.
ii. The use of prescription drugs that were originally intended to target pain relief may have turned into recreational use and become addictive.
iii. As a means of obtaining creative inspiration.
WHAT ARE THE CATEGORIES OF DRUGS?
Drugs of abuse can be categorized under the three groups namely:
i. Depressants: These cause depression of the brain faculties and examples include sleeping pills (barbiturates) and heroin.
ii. Stimulants: These cause stimulation of the brain, giving rise to alertness and increased burst of activity. A rapid heart rate, dilated pupils, raised blood pressure, nausea or vomiting and behavioral changes such as agitation and impaired judgement may also result. In severe cases, there may be delusion psychosis which can occur with the use of cocaine and amphetamines.
iii. Hallucinogens: these cause hallucinations and an “out of this world” feeling of dissociation from oneself. Hallucinogens may cause distorted sensory perception, delusion, paranoid and even depression. Examples includes ecstasy, mescaline and LSD.
WHAT IS DRUG ADDICTION?
Drug addiction is a biopsychosocial phenomenon; chronic disease characterized by compulsive or uncontrollable drug seeking and use despite harmful consequences and changes in the brain, which can be long lasting. These changes in the brain can lead to the harmful behaviors seen in people who use drugs. Drug addiction is also a relapsing disease. Relapse is the return to drug use after an attempt to stop.
The path to drug addiction begins with the voluntary act of taking drugs. But over time, a person’s ability to choose not to do so becomes compromised. Seeking and taking the drug becomes compulsive. This is mostly due to the effects of long-term drug exposure on brain function. Addiction affects parts of the brain involved in reward and motivation, learning and memory, and control over behavior.
Addiction is a disease that affects both the brain and behavior.
CAN DRUG ADDICTION BE TREATED AND/OR MANAGED?
Yes, but it’s not so simple. Because addiction is a chronic disease, people can’t simply stop using drugs for a few days and be cured. Most patients need long-term or repeated care to stop using drugs completely and recover their lives.
Addiction treatment must help the person do the following:
- stop using drugs
- stay drug-free
- be productive in the family, at work and in society
PRINCIPLES OF EFFECTIVE TREATMENT
Based on scientific research since the mid-1970s, the following key principles should form the basis of any effective treatment program:
- Addiction is a complex but treatable disease that affects brain function and behavior.
- No single treatment is right for everyone.
- People need to have quick access to treatment.
- Effective treatment addresses all of the patient’s needs, not just his or her drug use.
- Staying in treatment long enough is critical.
- Counseling and other behavioral therapies are the most commonly used forms of treatment.
- Medications are often an important part of treatment, especially when combined with behavioral therapies.
- Treatment plans must be reviewed often and modified to fit the patient’s changing needs.
- Treatment should address other possible mental disorders.
- Medically assisted detoxification is only the first stage of treatment.
- Treatment doesn’t need to be voluntary to be effective.
- Drug use during treatment must be monitored continuously.
- Treatment programs should test patients for HIV/AIDS, hepatitis B and C, tuberculosis, and other infectious diseases as well as teach them about steps they can take to reduce their risk of these illnesses.
WHAT ARE TREATMENTS FOR DRUG ADDICTION?
There are many options that have been successful in treating drug addiction, including:
- Behavioral counseling
- Medical devices and applications used to treat withdrawal symptoms or deliver skills training
- Evaluation and treatment for co-occurring mental health issues such as depression and anxiety
- Long-term follow-up to prevent relapse
A range of care with a tailored treatment program and follow-up options can be crucial to success. Treatment should include both medical and mental health services as needed. Follow-up care may include community- or family-based recovery support systems.
HOW ARE MEDICATIONS AND DEVICES USED IN DRUG ADDICTION TREATMENT?
Medications and devices can be used to manage withdrawal symptoms, prevent relapse, and treat co-occurring conditions.
- Relapse prevention
- Co-occuring conditions:
Medications and devices can help suppress withdrawal symptoms during detoxification. Detoxification is not in itself “treatment,” but only the first step in the process. Patients who do not receive any further treatment after detoxification usually resume their drug use. One study of treatment facilities found that medications were used in almost 80 percent of detoxifications (SAMHSA, 2014). In November 2017, the US Food and Drug Administration (FDA) granted a new indication to an electronic stimulation device, NSS-2 Bridge, for use in helping reduce opioid withdrawal symptoms. This device is placed behind the ear and sends electrical pulses to stimulate certain brain nerves.
Patients can use medications to help re-establish normal brain function and decrease cravings. Medications are available for treatment of opioid (heroin, prescription pain relievers), tobacco (nicotine), and alcohol addiction. Scientists are developing other medications to treat stimulants (cocaine, methamphetamine) and cannabis (marijuana) addiction. People who use more than one drug, which is very common, need treatment for all of the substances they use.
Methadone (Dolophine®, Methadose®), buprenorphine (Suboxone®, Subutex®, Probuphine® , Sublocade™), and naltrexone (Vivitrol®) are used to treat opioid addiction. Acting on the same targets in the brain as heroin and morphine, methadone and buprenorphine suppress withdrawal symptoms and relieve cravings. Naltrexone blocks the effects of opioids at their receptor sites in the brain and should be used only in patients who have already been detoxified. All medications help patients reduce drug seeking and related criminal behavior and help them become more open to behavioral treatments. A NIDA study found that once treatment is initiated, both a buprenorphine/naloxone combination and an extended release naltrexone formulation are similarly effective in treating opioid addiction. Because full detoxification is necessary for treatment with naloxone, initiating treatment among active users was difficult, but once detoxification was complete, both medications had similar effectiveness.
Nicotine replacement therapies have several forms, including the patch, spray, gum, and lozenges. These products are available over the counter. The U.S. Food and Drug Administration (FDA) has approved two prescription medications for nicotine addiction: bupropion (Zyban®) and varenicline (Chantix®). They work differently in the brain, but both help prevent relapse in people trying to quit. The medications are more effective when combined with behavioral treatments, such as group and individual therapy as well as telephone quitlines.
Three medications have been FDA-approved for treating alcohol addiction and a fourth, topiramate, has shown promise in clinical trials (large-scale studies with people). The three approved medications are as follows:
o Naltrexone blocks opioid receptors that are involved in the rewarding effects of drinking and in the craving for alcohol. It reduces relapse to heavy drinking and is highly effective in some patients. Genetic differences may affect how well the drug works in certain patients.
o Acamprosate (Campral®) may reduce symptoms of long-lasting withdrawal, such as insomnia, anxiety, restlessness, and dysphoria (generally feeling unwell or unhappy). It may be more effective in patients with severe addiction.
o Disulfiram (Antabuse®) interferes with the breakdown of alcohol. Acetaldehyde builds up in the body, leading to unpleasant reactions that include flushing (warmth and redness in the face), nausea, and irregular heartbeat if the patient drinks alcohol. Compliance (taking the drug as prescribed) can be a problem, but it may help patients who are highly motivated to quit drinking.
Other medications are available to treat possible mental health conditions, such as depression or anxiety, that may be contributing to the person’s addiction.
HOW ARE BEHAVIORAL THERAPIES USED TO TREAT DRUG ADDICTION?
Behavioral therapies help patients:
- Modify their attitudes and behaviors related to drug use
- Increase healthy life skills
- Persist with other forms of treatment, such as medication
Patients can receive treatment in many different settings with various approaches.
Outpatient behavioral treatment includes a wide variety of programs for patients who visit a behavioral health counselor on a regular schedule. Most of the programs involve individual or group drug counseling, or both. These programs typically offer forms of behavioral therapy such as:
- cognitive-behavioral therapy, which helps patients recognize, avoid, and cope with the situations in which they are most likely to use drugs.
- multidimensional family therapy—developed for adolescents with drug abuse problems as well as their families—which addresses a range of influences on their drug abuse patterns and is designed to improve overall family functioning.
- motivational interviewing, which makes the most of people’s readiness to change their behavior and enter treatment.
- motivational incentives (contingency management), which uses positive reinforcement to encourage abstinence from drugs
Treatment is sometimes intensive at first, where patients attend multiple outpatient sessions each week. After completing intensive treatment, patients transition to regular outpatient treatment, which meets less often and for fewer hours per week to help sustain their recovery.
In September 2017, the FDA permitted marketing of the first mobile application, reSET®, to help treat substance use disorders. This application is intended to be used with outpatient treatment to treat alcohol, cocaine, marijuana, and stimulant substance use disorders.
Inpatient or residential treatment can also be very effective, especially for those with more severe problems (including co-occurring disorders). Licensed residential treatment facilities offer 24-hour structured and intensive care, including safe housing and medical attention. Residential treatment facilities may use a variety of therapeutic approaches, and they are generally aimed at helping the patient live a drug-free, crime-free lifestyle after treatment. Examples of residential treatment settings include:
- Therapeutic communities, which are highly structured programs in which patients remain at a residence, typically for 6 to 12 months. The entire community, including treatment staff and those in recovery, act as key agents of change, influencing the patient’s attitudes, understanding, and behaviors associated with drug use.
- Shorter-term residential treatment, which typically focuses on detoxification as well as providing initial intensive counseling and preparation for treatment in a community-based setting.
- Recovery housing, which provides supervised, short-term housing for patients, often following other types of inpatient or residential treatment. Recovery housing can help people make the transition to an independent life—for example, helping them learn how to manage finances or seek employment, as well as connecting them to support services in the community.
Points to Remember
o stop using drugs
o stay drug-free
o be productive in the family, at work, and in society
o behavioral counseling
o medication (for opioid, tobacco, or alcohol addiction)
o evaluation and treatment for co-occurring mental health issues such as depression and anxiety
o long-term follow-up to prevent relapse
o modify their attitudes and behaviors related to drug use
o increase healthy life skills
o persist with other forms of treatment such as medication
HOW QUICKLY CAN SOMEONE BECOME ADDICTED TO A DRUG?
There is no easy answer to this common question. If and how quickly you become addicted to a drug depends on many factors, including your biology (your genes, for example), age, gender, environment, and interactions among these factors. Vast differences affect a person’s sensitivity to various drugs and likelihood of addiction vulnerability. While one person may use a drug one or many times and suffer no ill effects, another person may overdose with the first use or become addicted after a few uses. There is no way of knowing in advance how quickly you will become addicted, but there are some clues—an important one being whether you have a family history of addiction.
HOW DO I KNOW IF SOMEONE IS USING OR IS ADDICTED TO DRUGS, AND HOW CAN I FIND HELP?
The signs of drug use and addiction can vary depending on the person and the drug, but some common signs are:
- impaired speech and motor coordination
- bloodshot eyes or pupils that are larger or smaller than usual
- changes in physical appearance or personal hygiene
- changes in appetite or sleep patterns
- sudden weight loss or weight gain
- unusual smells of breath, body, or clothing
- changes in mood or disinterest in engaging in relationships or activities
If a person is compulsively seeking and using a drug(s) despite negative consequences, such as loss of job, debt, family problems, or physical problems brought on by drug use, then he or she is probably addicted. And while people who are addicted may believe they can stop any time, most often they cannot and need professional help to quit. Support from friends and family can be critical in getting people into treatment and helping them to stay drug-free following treatment.
WHAT DRUGS COMMONLY CAUSE PROBLEMS, AND HOW DO THEY AFFECT THE BODY?
Most drugs of abuse can alter a person’s thinking and judgment, leading to health risks, including addiction, drugged driving and infectious disease. Most drugs could potentially harm an unborn baby; pregnancy-related issues are listed in the chart below for drugs where there is enough scientific evidence to connect the drug use to specific negative effects.
IF A PREGNANT WOMAN USES DRUGS, HOW DOES IT AFFECT THE BABY DURING AND AFTER PREGNANCY?
Many substances, including alcohol, nicotine, medications, and illicit drugs, can have negative effects on the developing fetus because these substances reach the fetus through the placenta. Nicotine has been connected with premature birth and low birth weight, as has the use of cocaine. Heroin exposure results in dependence in the newborn, requiring treatment for withdrawal symptoms. Drug use during pregnancy is also linked to brain and behavioral problems in the baby, which may lead to cognitive challenges for the child. It is often difficult to tease apart the various factors that go with drug use during pregnancy—poor nutrition, inadequate prenatal care, stress, and psychiatric comorbidities—all of which may affect a baby’s development.
Women and men may face unique issues when it comes to substance use, as a result of both sex and gender. Sex differences result from biology, or being genetically female or male, while gender differences are based on culturally defined roles for men and women, as well as those who feel uncomfortable identifying with either category; such roles influence how people perceive themselves and how they interact with others. Sex and gender can also interact with each other to create even more complex differences between men and women.
WHAT IS DETOXIFICATION, OR “DETOX”?
Detoxification is the process of allowing the body to rid itself of a drug while managing the symptoms of withdrawal. Detox alone is not treatment, but is often the first step in a drug treatment program. Treatment with behavioral therapy and/or a medication (if available) should follow detox.
DO YOU HAVE A JOURNAL/NEWSLETTER I CAN SUBSCRIBE TO?
Yes, you can. The Journal of African Council on Narcotics – The ANTI-NARCOTICS
HOW CAN I RECEIVE MATERIALS REGARDING DRUG USE?
By Visiting out website frequently and/or subscribing to our quarterly Journal.
HAS YOUR COUNCIL GOT PROVISION FOR DRUG DEMAND REDUCTION (DDR) ACTIVITIES LIKE COUNSELING, TREATMENT AND AFTER-CARE SUPPORT?
Yes. African Council on Narcotics (ACON) undertakes DDR activities including counseling services, referral services for treatment and after-care support and mentoring services for victims of drug abuse. We should hopefully commence treatment activities once our facilities for such purpose have been established.
HOW DOES THE COUNCIL GET FUNDS FOR PROGRAMS AND PROJECTS?
ACON depend on assistance, support and grants from public spirited individuals and donor organizations for programs and projects execution.
IS THE COUNCIL PLANNING TO ESTABLISH HER PRESENCE IN OTHER PARTS OF AFRICA SEEING THAT THE DRUG MENACE IS ALL OVER THE CONTINENT?
Yes, the Council plans to set up regional offices in North, South, Central and East Africa and country offices in the US, Canada, Germany, Australia and Singapore.