ARO-HEALING

DRUG DEPENDENCY - Many drugs, including everyday ones such as nicotine and alcohol, have the potential to be misused. Dependency - or addiction - is widespread and can have profound effects on health and well-being

Drug dependency happens when someone takes a drug regularly or to excess, Eventually, the user has to take the drug continuously because he needs to feel the effects again or feels ill if he doesn't do so,

Dependency can be either psychological, when someone craves a drug or experiences emotional distress when he is not able to take it; or physical, when the body adapts to the drug, and there are unpleasant physical effects on withdrawal. Only certain substances are truly addictive in the sense that they create both physical and psychological dependence.

 EVERYDAY SUBSTANCES  

Drugs such as 'ecstasy' are being increasingly taken by young people at dances, or raves.

I found a can of lighter fuel outside my son's bedroom window. Could he be abusing solvents?

Drug dependency can occur even when a person is taking prescribed drugs such as tranquillizers. There's nothing wrong with social drinking but solid dependence can result in alcoholism.

The word 'addiction' tends to conjure up images of needles and hard drugs like heroin and cocaine but in fact all sorts of substances can cause dependency. These include nicotine in cigarettes; alcohol; caffeine in coffee and tea, and tranquillizers that are originally prescribed for perfectly legitimate reasons,

Dependency is most likely to occur with drugs that alter mood or behaviour and which work relatively quickly, Injecting drugs intravenously produces a rapid effect, which is why injected drugs are potentially so addictive.

All addictive drugs affect the nervous system and the brain. If used in large quantities, they alter the body's chemistry, Some mimic a naturally-occurring chemical in the body - for example opiates, the most powerfully addictive drugs, resemble endorphins, the brain's chemical transmitters, Others reduce the release of other body chemicals, such as nicotine which reduces the release of the stress hormone, adrenalin.

Addictive drugs may also have a potent effect on key points in the pathways of nerves. The more a drug becomes built in to the body's natural processes, the stronger the potential for addiction,

Another feature of dependency is known as tolerance, It simply means that the body becomes so used to the drug that increasingly large doses are needed to provide the same effect.

The popular image of a drug addict is of a pale, gaunt youth, lying in a public toilet with a syringe held to his arm. A surprisingly large number of addicts are in fact middle class professionals who work by day and indulge in their habit in the evenings. Drugs may be injected, but they can also be taken as pills, , free - based' (vaporized and inhaled from a pipe), snorted (inhaled through a drinking straw or rolled-up paper), smoked, or, as in the case of heroin, heated up and the fumes inhaled (known as 'chasing the dragon').

There is no proof on this alone. Suspicious signs include red, unfocused or glazed eyes, cracked lips, pimples around the nose and mouth, sore nose and breath smelling of chemicals.

 THE ROAD TO ADDICTION   

Peer pressure, unemployment or problems at home can lead a young person further down the road to addiction.

Many people experiment with drugs at some time during their lives, but not all become addicted, There's no simple way of telling if someone is likely to become dependent, but some people seem to be more susceptible than others,

Peer group pressure, poverty, unemployment, difficulties in family life, and the availability of drugs can all playa part. Occasionally, an addiction begins because a seriously ill or badly injured person has been on pain-killing drugs for longer than necessary.

However, the fact remains that most people who experiment with drugs, even hard drugs such as heroin, do not become dependent.

NEW DISCOVERIES 

New clues about drug dependency are now emerging from genetic research, It has been found, for example, that people who possess a particular gene, known as the D2Al, are more likely to become dependent. The D2 receptor in the brain is part of the brain's pleasure centre and drug users seem to possess a much higher proportion of the Al form of the gene than the rest of the population.

The opiates - so called because they are derived from opium - are closest to the popular image of addictive drugs, They include morphine, and synthetic varieties such as diamorphine, better known as heroin, and pethidine, the drug used to relieve pain in childbirth.

Like all drugs, the opiates, also known as narcotic (sleep inducing) drugs, have benefits as well as risks. They are potent painkillers and playa vital role in medical care in allaying the pain of serious injuries and making the final stages of terminal illness bearable.

THE POWER OF HEROIN 

All the opiates can cause drug dependence, but heroin is the most commonly abused because it is fast-acting, potent and easy to obtain through black market or illegal channels.

The effects of different opiates vary from person to person, But the 'high', or feeling of pleasure, tends to go through several phases, It starts with a warm feeling of calm, then often progresses to, or is combined with, sensations of nausea and drowsiness.

Heroin dependency can cause a host of health- related problems as well as tolerance. These include scars from injections, ulceration, skin abscesses, weight loss and impotence. The transmission of blood-borne infections, e.g. the virus that causes AIDS and hepatitis B, is also a risk. Addicts may also suffer from the effects of poor diet, disrupted relationships and general neglect.

There is also the danger of overdose. In a confused, irrational or reckless state, as a result of taking the drug, an addict may accidentally or deliberately take a lethally large dose.

 CRIMINAL BEHAVIOUR 

An addiction to nicotine can be extremely difficult to break. Addicts believe that smoking a cigarette is essential in stressful situations.

Acquiring and maintaining a habit is extremely costly and often results in a slow slide into crime.

Faced with worsening health, the addict may suffer from a lack of direction and motivation - losing the urge to do anything except take the drug. From here, it is a short step to losing his job. Without money to purchase the expensive, and often contaminated, black market supplies needed to maintain his habit, it's all too easy for the addict to turn to crime, including drug trafficking and prostitution, to pay for his increasing drug need.

The motivation to maintain the habit is considerably strengthened by the problems of coming off, or withdrawing from, the drug.

For those who have taken heroin for just a few months, withdrawal may be no worse than a bad dose of flu with symptoms such as a runny nose, yawning, sneezing, watering eyes and sweating.

However, for those who have been addicted to ever-increasing doses for a long time, withdrawal can be truly horrific. 'Cold turkey' (stopping abruptly without the help of other drugs) symptoms can include diarrhoea, vomiting, abdominal pains, cramp, sweating, shaking, insomnia, general agitation and, in extreme cases, collapse.

COCAINE AND CRACK 

Cocaine comes from the leaves of the Erythroxylon coca plant which is native to South America. Made into a white powder and injected or snorted, it produces euphoria, increased energy, excitement and rapid flow of thought, leading to talkativeness. At one time, cocaine was used as a local anaesthetic but now it has largely been replaced by other drugs.

Both cocaine and crack have a high potential for creating drug dependency. Other effects may include paranoia and temporary cocaine psychosis. Overdose can result in high blood pressure, rapid heartbeat or fits, which can lead to respiratory and heart failure.

 TRANQUILLIZERS  

Cannabis is one of the most widely used illegal drugs and is quite easy to obtain through black market channels.

In the 1960s, tranquillizers of the benzodiazepine group, such as Valium, Librium, Mogadon and Ativan, were hailed as a safer and less addictive alternative to barbiturates. However, in recent years, tranquillizer abuse has been recognized as a major problem. Tranquillizers help reduce anxiety by altering certain chemical activity in the brain and daytime drowsiness, forgetfulness and dizziness may ensue. Other more serious side-effects may include unsteadiness and slowed reactions. Sudden withdrawal can lead to anxiety, nightmares, restlessness, confusion, toxic psychosis, convulsions and a condition that resembles delirium tremens - the characteristic trembling and hallucinations caused by with­drawal from alcohol.

Sleeping pills can also cause dependency. When injected, they cause elation and removal of inhibitions, but this then gives way to confusion lack of co-ordination, a slowing of breathing rate and even unconsciousness.

SLEEPLESS NIGHTS 

Even those who use sleeping pills responsibly, to help with sleeping problems. sometimes find that they begin to lose their effectiveness after a while. When a heavy user stops taking them, there may be mental disturbances which in turn lead to further loss of sleep.

The search is now on for sleep drugs which don't have this kind of hangover effect. Knowledge of the problems is leading doctors to prescribe barbiturates and other tranquillizers as little as possible, though they are still useful for certain conditions.

A variety of substances, such as glue, dry-cleaning fluid, paints, sprays and petroleum fuel products, are sniffed or inhaled for their effects. Generally, they give a disappointing, short-lived high, typically a fuzzy or confused state.

As with the sense-distorting drugs, these are not actually addictive, but their physical effects can be devastating. Accompanying, or following soon after, the so­called high, there are likely to be effects such as slurred speech, stupor, a general state of confusion and a lack of co-ordination.

A large dose of vapour can be fatal because of an immediate toxic effect on the heart, which leads to a cardiac arrest. Heart, liver and brain damage are real dangers in long-term use.

 STIMULANT DRUGS 

Stimulants, such as amphetamines, boost a person's energy, confidence and concentration by stimulating their central nervous system. Amphetamine sulphate, which comes as a white powder and can be snorted in lines, taken in a drink, eaten in rolled-up paper or injected, is now the second most popular illegal drug after cannabis in the UK. It is frequently taken at dances or 'raves'.

Although such drugs don't seem to be strongly addictive, tolerance can develop quite rapidly. The initial feeling of elation they bring often gives way to depression, feelings of persecution and hallucinations. Long-term use may lead to severe mood swings and amphetamine psychosis, which is similar to schizophrenia.

Withdrawal from stimulants may create psychological problems including severe agitation and depression. Another danger is that the drug is often impure because it has been 'cut', or mixed, with other substances, such as caffeine, glucose, paracetamol, chalk or simply talcum powder.

MISPLACED ECSTASY 

Many youngsters become addicted to the 'high' produced by solvent abuse. Anything from glue to paints are placed in a bag and then the fumes are inhaled.

Cocaine is set in 'lines' and inhaled through the nose using a straw or a rolled-up piece of paper. The drug is then absorbed into the bloodstream through the lining of the nose.

MDMA, or ecstasy, is another amphetamine-derived drug which is commonly taken at 'raves'. It can be particularly risky because reactions to it can be severe and unpredictable. Developed as an appetite suppressant, ecstasy creates a feeling of euphoria, a feeling of closeness towards others, and enhanced perception. It can have many adverse effects such as appetite loss, grinding of the teeth, nausea, muscle aches, stiffness, lack of co-ordination, sweating, speeded-up heartbeat and high blood pressure. Ecstasy can also cause paranoia and hallucinations. These effects will usually resolve within a couple of days. Fatigue and insomnia are common after-effects.

One of the biggest problems is that ecstasy can cause severe, sometimes fatal, reactions. These include overheating, followed by fits, collapse and kidney failure. These effects are made worse by high temperatures.

People who take ecstasy are advised to wear loose clothing, drink plenty of fluids and stop dancing if they feel exhausted. If untoward symptoms do occur, the victim should get plenty of fresh air and sit down - to lower the heart rate and body temperature - and obtain medical help.

Another problem is that some tablets sold as ecstasy are in fact made from MDA - the parent drug from which MDMA is derived. This is far more dangerous in terms of toxicity and the potential for causing permanent brain damage.

No one knows for sure what the effects of long-term use of ecstasy might be but it seems likely that it may cause liver damage, long-term psychiatric effects or, in some cases, permanent brain damage.

IN AN EMERGENCY

If you find someone ill through solvent abuse, you should take the following steps:

Take the solvent away from the person involved

Remove or loosen clothing which might restrict breathing

Open windows and doors to ventilate the room

If in doubt - and always if the person is unconscious - call an ambulance

Lie the person on their stomach with their head to one side in case they vomit

Do not give them anything to eat or drink

Try not to frighten or panic the person as this can cause the heart to stop

Stay with them until the emergency is over

LOW DEPENDENCY RISK 

Drugs such as cannabis and LSD (which is short for lysergic acid diethylamide) are considered to have a very low potential for physical dependence.

Cannabis is the most commonly abused illicit drug in the UK. There are over 60 cannabinoids (the active ingredient in cannabis), some of which are now being investigated for potential medical uses, for example in treating illnesses such as multiple sclerosis.

The 'high' develops within a few minutes of being smoked, and within one to three hours if eaten. The drug causes merriment and elation, but many first-time users report no effect. At high dosage, illusions and hallucinations can occur, but these are rare.

Regular users may develop bronchitis, and men who regularly use the drug may develop lowered testosterone levels and decreased sperm counts. Symptoms of schizophrenia may be made worse in existing sufferers.

LSD use can be potentially dangerous because some people can react to it in disturbed ways, becoming violent, experiencing feelings of persecution or even developing strange and possibly dangerous beliefs, for example that they can jump off buildings and fly.

 COMING OFF DRUGS 

The traditional opinion that 'once an addict always an addict' is in fact a myth. The good news is that most people who are dependent upon drugs do give them up eventually, though it can take a long time and several relapses before they give up completely. Some hospitals and private centres offer controlled withdrawal. or 'detoxification', programmes. The drug is prescribed in ever smaller doses, and the addict is given treatment for withdrawal symptoms when they occur.

In some cases, other drugs, such as methadone, a drug similar to heroin, or anti-depressants are prescribed to alleviate withdrawal symptoms. However, for some addicts, this can create even more serious problems - methadone, for example, is even more addictive and toxic than heroin itself.

A HELPING HAND 

One of the best known drug withdrawal methods is called The Minnesota Plan. It uses a 12-step programme based on those used by Alcoholics Anonymous, which involves the addict facing up to being addicted and out of control. Sharing experiences and mutual support is an important part of this withdrawal method.

A few addicts give up without any help. though it can take several attempts. But whatever the method decided upon. addicts need a large dose of willpower and support from those around them to succeed.

 Historical perspectives 

The Andean Indians have chewed coca leaves (the basis of cocaine) for thousands of years to enable them to tolerate hunger, exposure and fatigue at high altitudes.

Only a century ago, addicts could buy opiates freely in shops.  In the past, cannabis was used to treat toothache, rheumatism and earache.

The sap of the opium poppy, which grows mainly in the Far East, has been recognized throughout history for its effect on the mind. The ancient Greek writer, Homer, noted its euphoric effects in his work.

 Taken from THE HEALTH FILE  A Complete Medical Encyclopedia, A MARSHALL CAVENDISH REFERENCE COLLECTION,NATURE’S CLINIC  by DR JOHN CORMACK, WEEKLY Australia, New Zealand, Malaysia Singapore Malta RSA Other Countries Namibia.

DR JOHN CORMACK, BDS MB BS MRCS LRCP, is the medical consultant to The Health File. The senior partner in an Essex­ based practice, he is also a member of the General Medical Council and has written for numerous magazines and news­papers as well as for the medical press. He is a regular broadcaster on television and radio and has scripted a number of award-winning educational videos.

Note: Where gender is unspecified, individuals are referred to as 'he', This usage is for convenience only and not intended to imply that all doctors and patients are male. Medicheck charts are only a rough guide to diagnosis, Always seek medical advice if you have worrying symptoms.

Copyright Marshall Cavendish 1995, Printed in Great Britain, Published by Marshall Cavendish Partworks Ltd, 119 Wardour Street, London WIV 3TD