Archived Newsletters 2009-11-07 DRUG DEPENDENCY
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
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