Alcohol and Drug Misuse

A Guide for Health and Social Care Professionals

G. Hussein Rassool

• Publisher: Routledge
• Year: 2017
• ISBN:
  9781315395487
• Edition: 2
• Topic: Medizin
• Subtopic: Gesundheitsversorgung

Written by an experienced academic author, lecturer and practitioner, this comprehensive textbook provides an introduction to alcohol and drug misuse. It presents:

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• the context of alcohol and drug misuse, and the nature and theories of addiction, including a historical overview and policy initiatives in contemporary society

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• an overview of the problems associated with psychoactive substances and their impact on groups such as culturally and linguistically diverse communities, young people, women, older people and the homeless

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• an understanding of the generic role responses to substance misuse in a variety of different settings and contexts, including primary care, the community and hospitals

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• a framework for assessment, care planning, harm reduction approaches, dealing with overdose, intoxication and withdrawals, and psychological and pharmacological interventions

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• an accessible and skills-oriented approach to assist students and practitioners in dealing with alcohol and drug misuse.

This new edition is fully updated and includes new material on: evidence-based pharmacological interventions; recent global strategies in alcohol and drug; dual diagnosis and women; shisha smoking; and current statistics on prevalence of alcohol and drug misuse

Alcohol and Drug Misuse takes into account current policy and practice for substance use and misuse and includes a range of pedagogical features to enhance learning. It is essential reading for nursing, health and social work students taking substance misuse modules, as well as related CPD courses for health and social care professionals.

Part 1

Alcohol and drugs and global policy initiatives

• Chapter 1 Introduction to substance use and misuse
• Chapter 2 Self-awareness and attitude
• Chapter 3 Historical overview
• Chapter 4 Models and theories of addiction
• Chapter 5 Nature of addiction
• Chapter 6 Global policy initiatives and strategies on alcohol and drugs

Chapter 1

Introduction to substance use and misuse

Learning outcomes

• Have an understanding of the global drug scene.
• Explain the meaning of the following terms: drugs, alcohol, substance misuse, substance use disorder, addiction, problem-drug use and problem-alcohol use, hazardous drinker, harmful drinker, severely dependent drinkers, drinkers with complex problems and binge drinking.
• Examine the components of the concept of dependence: tolerance, physical and psychological dependence.
• Differentiate between commonly abused legal and illicit substances/drugs.

Introduction

The nature and extent of the global drug and alcohol problem are interwoven with all aspects of sustainable development. It is stated that all aspects of sustainable development including social development, economic development, environmental sustainability, peaceful, just and inclusive societies and partnership shape the nature and dynamic of the drug problem (UNDOC 2016). In the 21st century, there is no dovetailing of interest in the use of psychoactive substances and plants on a global scale.

The natural and synthetic psychoactive substances whether acting as a stimulant, depressant, hallucinogenic or mind-expanding affect an individual’s thinking (cognitive), emotion (affective) and behaviours. The use of alcohol and drugs remain the social and psychological fabric of developed countries but now the emerging trend is that it is spreading in developing countries. For centuries, society has learned to co-exist with drugs and alcohol and its views of which drugs should be legal or illicit changes with time, economic and political considerations. Psychoactive substances have been used in ritual ceremonies, medicinally and recreationally. For example, tea, coffee and tobacco have all been illegal in this country at various points in history (Whitaker 1987), but with time, increasing availability and more widespread use opinions change, and the drug becomes “normalised”. Alcohol and drugs cause a host of physical, social, psychological and economic harm not only to the individual but to the family and the community. The harms include: higher risks of premature death; risk of acquiring blood borne virus such as hepatitis B and C and HIV; overdose; respiratory failure; physical and mental health problems and morbidities. Alcohol and drugs are so ingrained in the human psyche that it makes it improbable that these compounds will disappear from our society. Despite policy legislations in terms of supply and demand of drugs, increased taxation, penalties for possession and sale, extensive preventive health education and anti-drug “education” campaigns, alcohol and drugs remain a public health problem. It is stated that drug problems will not be beaten out of society by yet harsher laws, lectured out of society by yet more hours of “health education”, or treated out of society by yet more drug experts (Royal College of Psychiatrists 1987). However, the concern, from a public health perspective, is the rapid proliferation of new Novel Psychoactive Substances (NPS) with potential harms. In relation to gender and drug misuse, “men are three times more likely than women to use cannabis, cocaine or amphetamines, whereas women are more likely than men to engage in the non-medical use of opioids and tranquilizers” (UNDOC 2016 p. 13).

Global drug scene

The main problem of drugs at the global level continues to be cannabis, while amphetamines remain the second most commonly used drug. However, the use of opiates and prescription opioids is less common, but opioids, mainly heroin, remain one of the major drugs of public health concern with potential harm and health consequences (UNDOC 2016). It is reported that cocaine consumption increased significantly mainly because of an increase in cocaine use in South America and there appears to be some stability in the use of amphetamines (UNDOC 2016). It is estimated that “excluding alcohol, tobacco and caffeine products the top 10 drugs used across the world were: cannabis, MDMA, cocaine, amphetamines, LSD, magic mushrooms, prescribed and non-prescribed opioid medication, nitrous oxide, ketamine and poppers” (Global Drug Survey 2016). The Novel Psychoactive Substances (NPS), marketed as Spice, bath salts and herbal incense continue to be characterised by the large number of new substances being reported. By modifying the chemical compounds of the drugs, the new synthetic drugs on the market are circumventing existing laws. Most of the psychoactive substances in this category include cannabinoids, cathinones, opioids, phenethylamines, tryptamines, benzodiazepines and arylalkylamines (EMCDDA 2015; UNDOC 2016). However, there is limited information of the dangers and toxicity of most of the novel synthetic psychoactive drugs.

The harms caused by the high potency of cannabis and the increasing use of amphetamines have led to an increase in treatment demands for both substances. It is reported that more younger people are seeking treatment for cannabis and amphetamines use disorders more than any other drugs (UNDOC 2016), and that synthetic cannabinoids are more likely to lead to emergency medical treatment than any other drug (Global Drug Survey 2016). However, due to its potency it is estimated that users of NPS are three times more likely to end up seeking emergency medical treatment compared to the use of traditional drugs (Global Drug Survey 2016). The health consequences of the use of drugs and alcohol include physical and mental health problems (dual diagnosis) (Vanderplasschen et al. 2012). Mental health problems and substance use disorders sometimes occur together for a variety of reasons. Certain psychoactive substances can cause problem substance users to experience the symptoms of mental health problems. In addition, mental health problems including stress, traumatic disorder, personality disorder and depression can sometimes lead to alcohol or drug use. Some of the users who inject drugs are living with HIV or blood-borne infections. Drug-related deaths worldwide are mostly attributed to opioids overdose.

Alcohol remains our favourite social lubricant and is associated with adverse physical, mental and behavioural health conditions and social consequences related to its intoxication, toxicity and dependence. Alcohol and drug misuse, with tobacco, is by far the most prevalent addictive behaviour and causes the large majority of the harm (Gowing et al. 2015). The World Health Organization (WHO 2014) estimates that, globally, about 3.3 million deaths every year (or 5.9% of all deaths), and 5.1% of the global burden of disease, is attributable to alcohol consumption. More than 200 health conditions have been associated with alcohol consumption including major non-communicable diseases such as liver cirrhosis, some cancers and cardiovascular diseases and infectious diseases such as tuberculosis, HIV/AIDS and pneumonia (WHO 2014). In addition, there are trauma and injuries due to road traffic accidents, violence, suicides and fatal alcohol-related injuries.

In relation to the use of tobacco smoking globally, 12% of all deaths among adults (about 5 million adults) aged 30 years and over were attributed to tobacco; that is one death approximately every six seconds (WHO 2012). It is estimated that tobacco use is responsible for an estimated 7% of all deaths due to tuberculosis, 12% of deaths due to lower respiratory infections, 10% of all deaths from cardiovascular diseases, 22% of all cancer deaths, and 36% of all deaths from diseases of the respiratory system (WHO 2012). There is an upward trend in tobacco smoking in Third World countries and in Eastern Europe. With the rise in the trend in the use of waterpipe tobacco smoking (hookah), “e-hookahs”, “e-shisha” or “hookah pens” in Western countries, there are new dangers and harms. Hookah smoking that delivers the addictive drug nicotine carries many of the same health risks as cigarettes. However, hookah smoking has been associated with lung cancer, respiratory illness, low birth weight and periodontal disease (American Lung Association 2007, Akl et al. 2010, CDC 2015a).

Many substance users who used drugs recreationally or on a regular basis tend to be polydrug users meaning that they use a combination of drugs. There are wide variations in the patterns of drug use of polydrug users and this ranges from recreational alcohol and cannabis use to the daily use of a combination of heroin, cocaine, alcohol and benzodiazepines (EMCDDA 2009). The rationale for using a combination of drugs is to enhance, potentiate or counteract the effects of another drug (WHO 1994). The combinations in the use of different drugs, concurrently or sequentially, can be harmful and dangerous. For examples, some of the most dangerous combinations include alcohol and cocaine (Cocaethylene); alcohol and ecstasy; alcohol and methamphetamine or amphetamine; alcohol and benzodiazepines; opiates and cocaine; cocaine and ecstasy; opioids and benzodiazepines; opioids and benzodiazepines and alcohol; and alcohol and any other drug. Polydrug users are usually admitted for emergency medical treatment due to overdose and there is a high morbidity rate among this sub-population of drug users.

The nonmedical use of prescription drugs, that is misuse of prescription drugs, is a global health concern. The nonmedical use of prescription drugs means “taking a medication in a manner or dose other than prescribed; taking someone else’s prescription, even if for a legitimate medical complaint such as pain; or taking a medication to feel euphoria (for example, to get high)” (NIDA 2016). The most common types of psychoactive prescription medication include:

(a) opioids, such as hydrocodone, oxycodone, propoxyphene, hydromorphone, meperidine, and fentanyl; (b) other central nervous system depressants, including both barbiturates, such as pentobarbital sodium, and benzodiazepines, such as diazepam and alprazolam; and (c) central nervous stimulants, including amphetamines such as dextroamphetamine, and amphetamine-like stimulants, such as methylphenidate.

(UNDOC 2011, p. 2)

Groups of individuals who seem to be at greater risk of non-medical use of prescription drugs includes patients, young people, women, older adults and health care professionals (UNDOC 2011). The over-prescribing of psychoactive substances, mainly opioids, for pain or illness management has led to addictive behaviours and an increase in mortality. It is reported that overprescribing of opioid pain relievers has been associated with a rise of opioid addiction and overdose deaths (Kolodny et al. 2015; Rudd et al. 2016).

Opioid medications like Vicodin (hydrocodone), OxyContin (oxycodone) and methadone are responsible for the increase in addiction, drug overdoses and mortality (CDC 2015b, 2017).

The use of over the counter (OTC) drugs as self-medication has an important role to play in health and lay care systems. OTC drugs are medicines available without a prescription at pharmacies or supermarkets. Some commonly abused OTC medi...