Substance misuse

Substance misuse


Psychoactive drug users come into contact with medical services when acutely intoxicated, dependent or mentally ill. Acute intoxication is a transient alteration in the level of consciousness, accompanied by changes in behaviour, mood, perceptions and cognition, occurring after taking the drug. Dependence on a psychoactive substance generally occurs after prolonged and regular use, and shares many of the characteristics of alcohol dependence, including primacy of drug taking over other activities, tolerance and withdrawal symptoms following abstinence.


The majority of adults in the developed world use psychoactive drugs at some time in their life. The legally available drugs, such as alcohol and tobacco, are the most widely used but a substantial proportion of young people regularly use illicit drugs such as cannabis and ecstasy, and up to a third of people will use an illicit drug at some time in their lives. The point at which ‘use’ of these drugs becomes ‘misuse’ or ‘abuse’ is unclear, and the various agencies involved apply different criteria. It is important to distinguish between unsanctioned drug use (use that is not approved of by society) and hazardous drug use that has harmful consequences for the user. It is the latter that mental health services are concerned with, in particular if the drug use impacts on the individual’s psychological, social or occupational functioning.


Substance misuse occurs in all social classes, and there is little evidence that its onset is associated with social deprivation. There is though likely to be downward social drift as a consequence of dependence on drugs and those protected by social advantage are less likely to suffer adverse consequences. Most users of illegal drugs are young and a Merseyside study found that 92% of the opiate abusers were less than 30 years old. The middle-aged are more likely to be dependent on prescribed medication such as benzodiazepines. Men are twice as likely to use illicit drugs as women, and most are single and unemployed. Up to 50% of people attending drug treatment centres have a history of conviction, and the rate of criminal activity is inevitably much higher than this. The most commonly used drugs are described in Table 1.


Table 1 Drugs of abuse





























Drug Route Effects

Opiates

Heroin, methadone, pethidine
 Oral, sniffed, inhaled, smoked, injected
Intense, but brief euphoria. Tolerance and physical dependence occur.

Withdrawal symptoms include anxiety, depression, restlessness, insomnia, nasal secretion, musculoskeletal pains, anorexia, vomiting, diarrhoea, dilated pupils, yawning and gooseflesh (‘cold turkey’)

Benzodiazepines

Temazepam, Diazepam, Lorazepam, etc.
 Oral, occasionally intravenous
Anxiolytic and sedative effects. Tolerance and physical dependence occur.

Withdrawal symptoms include anxiety, tremor and convulsions acutely, and over a longer period depression, fatigue, insomnia, sensitivity to light and sounds, visual distortions and muscle weakness
Amphetamine Oral, sniffed, intravenous Stimulant action, causing euphoria, increased energy, reduced need for sleep and reduced appetite. Tolerance and physical dependence may occur. Chronic use can result in an illness resembling schizophrenia
Cocaine Oral, sniffed, smoked, intravenous Causes a feeling of intense pleasure and excitement (the rush) lasting seconds, followed by less intense feelings for about 30 minutes, and then by depression, irritability, insomnia and craving for more. Repeated intoxication can result in hallucinations or persecutory delusions, and there may be violent behaviour. Tolerance develops
Cannabis Oral, smoked Causes mild euphoria and relaxation, sense of heightened perception and occasionally hallucinations. Physical effects include reddening of conjunctivae, dry mouth, and fast pulse

LSD
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Jul 12, 2016 | Posted by in PSYCHIATRY | Comments Off on Substance misuse

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