A drug is any substance that when taken produces physical or psychological changes in a person. When people hear the term “drug” they often associate it with those substances that are illegal such as cannabis, speed or heroin. However, the definition of drug spans to include more commonly used substances such as alcohol, tobacco and caffeine as well as prescription and over the counter medications.

Drugs can be classified into a number of categories based upon the effects that they have on the human body. Some of the classes of drugs which act on the brain are described briefly below:

Depressants

This class of drugs act to slow down the brain and include alcohol and heroin. These drugs are commonly taken to decrease pain or anxiety and produce feelings of sedation, euphoria and relaxation.

Stimulants

This class of drugs work to speed up the brain and includes such drugs as caffeine, nicotine, cocaine, and speed or ice. These drugs are commonly taken to provide person with a “lift” and enhance mood with effects including increased heart rate, attention and muscle tension.

Hallucinogens

This class of drugs alter a person’s sensations and perceptions and includes such drugs as LSD, magic mushrooms, mescaline, psilocybin, and DMT. When taken (almost always ingested), these drugs can either heighten or distort a person’s awareness of reality and can result in effects similar to states of psychosis.

Others

Other drugs such as cannabis and ecstasy produce combined effects from some of the drug classes above. Cannabis for example can have a depressive effect and is used as a relaxant and euphoriant; however, sometimes people experience symptoms of paranoia and anxiety, and very rarely, visual or auditory hallucinations.

When are drugs considered to be a problem?

For many people, drugs form part of their regular day to day routine. From the daily coffee or cigarette, an aspirin for a headache to a glass of wine in the evening, people use drugs to stimulate themselves, relax or reduce pain. Although most people are able to use drugs in moderation, for some people drugs become a central part of their life, leading to harmful consequences.

Problems associated with drug use can include intoxication, drug abuse and drug dependence as well as the associated affect this would have on mental health and day to day life. These are detailed further below.

Intoxication

It is often assumed that the negative consequences of drug use are more relevant to those people that take drugs frequently or are dependent upon a particular substance. However, in reality, many people experience a number of unwanted physiological and psychological effects. These negative effects may include impaired judgement, altered mood, aggressiveness or violence which can result in significant repercussions such as drink driving and assault.

Drug abuse

Although some people may not be at the point where they are dependent upon a drug, their pattern of drug use may be having harmful effects on their physical and mental health, as well as their day to day functioning. For example, the physical effects of alcohol abuse may include liver damage, hepatitis or dangerous driving. Mental health can also be affected; substance abuse is significantly associated with mental illness. Furthermore, drug use may significantly interfere with a person’s everyday functioning at school, work or home. People with drug abuse problems often involve themselves in dangerous situations (such as driving or operating machinery under the influence) and have recurrent drug related financial or legal problems.

Drug dependence

Drug dependence is when a person feels that they cannot stop taking the drug. A person is likely to become dependent upon a drug after it has been used for an extended period of time. During this time the drug becomes a central part of the person’s life and the person finds it extremely difficult to reduce or stop using. Drug dependence may require intervention in the form of medication and rehabilitation in more serious cases.

Key indicators that a person has a drug dependency include:-

A strong desire or craving to take the drug
The person feels that need the drug to function
Increased difficulty controlling drug use
Experience of withdrawal symptoms when drug is stopped or reduced
Higher doses of the drug are needed to have the same effect
Normal everyday activities are neglected with more time devoted to obtaining and using the drug
Drug use continues despite awareness of harmful consequences

What impact can drugs have on a person’s life?

Drug use can have a significant impact on a person’s lifestyle with many negative changes occurring as a result. Such changes may include but are not limited to:

Increased conflict with family and friends
Marital difficulties and breakdowns
Withdrawal from social activities and isolation from family and friends
Difficulty maintaining personal and professional responsibilities
Financial hardship
Legal problems

Who is affected by drugs?

In Australia, ~7.7% of the population experience drug related disorders including abuse and dependence (ABS, 1997).
The rate of males with both alcohol and other drug dependence is much higher than that of females both within Australia and internationally (ABS, 1997; WHO, 2003).
Drug dependencies appear to be much more frequent in the younger population with many people experiencing difficulties before the age of 30.

The Causes

The mechanisms underlying drug use and dependence are best understood from a biopsychosocial framework. This theoretical framework emphasises the role of biological, psychological and social factors in the development of drug associated problems. Each of these components is discussed further below.

Biological factors

Studies of twins and adoptive children suggest that there is an inheritable or genetic component to drug use; however, the exact contribution of genetic factors is not understood. The physiological and genetic factors contributing to drug use and dependence are more established with regards to alcohol than other drugs. The pace of drug research has accelerated markedly in recent years. There are very promising new treatment approaches for drug addiction on the horizon such as addiction vaccines.

Psychological factors

People often use drugs to self-medicate. The reasons for self-medicating may include increasing pleasure, enhancing self esteem or decreasing emotional or physical pain. For some people drugs can assist in changing how they feel in the short term. Therefore it is not surprising that many people with mental illnesses such as depression, anxiety and bipolar disorder also use substances in order to change their mood.

Social and cultural factors

The environment a person lives in shapes their development and also influences their patterns of drug use. In particular, family and cultural attitudes towards drug use have an important role to play. Through modelling, children learn from their parents and peers what is acceptable behaviour. Research indicates that children of parents that use or abuse drugs are more likely to develop a drug problems themselves in the future: this is probably a combination of genetic and environmental factors. In some groups, clubs or communities, the use of alcohol and other drugs can be seen as a part of belonging or membership.

Other risk factors

In addition to the above factors, research has identified numerous factors that increase the risk that a person will develop a drug related problem (Gowing, et al. 2001). These include:

Individual disposition characterised by sensation seeking and rebelliousness.
Academic underachievement and low commitment to education.
Low socioeconomic status and neighbourhood disorganisation.
Lack of familial support, inconsistent family discipline and boundaries.
Traumatic life events including abuse and neglect, death of a family member, being a refugee in combination with inadequate coping skills and social support.
Family history of substance abuse
Personal and/or family history of mental illness

How might drug abuse change over time?

The course of drug use and associated problems is highly variable, depending upon the type of drug and the person with the drug use problem. Generally, the rates of alcohol and drug dependency decrease with age after adolescence and the 20s. Therefore, it may be assumed that many men and women either stop or reduce their drug use over time. Some people may be able to conquer their drug dependency on their own; other people may choose to seek outside help and support.

However, it is important to remember that drug dependency is considered to be a chronic and relapsing condition that can last for many years. During their road to abstinence or reduction, a person may experience periods of heavy use and severe problems followed by periods of total abstinence or non problematic use. Although long lasting changes can occur, these are highly contingent upon a person’s mental attitude and behavioural commitment.

What does treatment involve?

Treatment for drug use, abuse and dependence involves both physical and psychosocial components. On the physical dimension treatment involves assisting with the physiological adaptations associated with ceasing drug use, more commonly referred to as detoxification or withdrawal. The psychosocial component of treatment complements the physical aspects, in that it focuses upon the underlying reasons for drug use, as well as the consequences of a drug using lifestyle. It also places and emphasis on harm minimisation strategies which focus upon reducing some of the risks associated with drug use.

Pharmacological treatments

The medications utilised in the treatment of drug use and dependence varies depending upon the substance being used. Medications have been supported as an effective component of treatment for nicotine, alcohol and opiate abuse (Gowing et al., 2001). Although reviewing this information is far beyond the scope of this brochure, it is appropriate to discuss the various roles of medications in the treatment of drug problems with your doctor.

Alleviation of withdrawal symptoms

Depending upon the type of drug and severity of addiction, some people may experience withdrawal symptoms when they reduce or stop using a substance. These physical symptoms can be extremely unpleasant and are a major reason for relapse. For some people, medications may be prescribed to help reduce these physical effects. Whilst some people may be able to tolerate this treatment within the community while supported, others may benefit from the additional observation, safety and assistance provided by an inpatient detoxification clinic.

Substitution of a substance to lower risk of harm

Some people initially find it difficult to stop taking a drug or reduce their use. By substituting a prescription drug that has a similar action but lower degrees of risk, drug users have the opportunity to address the psychosocial aspects associated with their drug use before addressing the physical elements. Therefore, the substitute drug allows for the opportunity of a stepped or gradual approach to reducing drug use while dealing with the psychological component of addiction.

Stopping the drug from having a physiological effect on the body

The positive effect of a drug plays a large role in the initiation and continuation of drug use. That is, people often continue to use those drugs that make them feel good and produce positive effects. Some prescription medications can actually reduce or block this positive effect, thus reducing the possibility that a person will continue to use the original drug, as it is no longer achieving the desired effect.

Creating an aversive association to assist in drug cessation

Similar to the above rationale, medications can be prescribed that result in an aversive reaction each time the original drug is used. For example, one particular medication works by inducing vomiting each time alcohol is consumed. Over time, the cravings associated with the original drug decrease and instead it becomes associated with aversive consequences thus making the drug itself less attractive.

If you are currently taking medication it is important that you continue to take the prescribed dose at the appropriate times, on good days and bad days. This medication will help you to prevent future episodes and relapse.

If you are concerned about medication side effects and wish to change or stop taking you medication it is important that you discuss this with your doctor before taking any action. This is important as some medications must be stopped gradually in order to protect the person from dangerous side effects.

Psychosocial treatments

Cognitive Behavioural Therapy

Cognitive Behavioural interventions aim to help individuals recognise that they have a problem associated with drug use and to better understand what drives their drug use, how it developed and the personal triggers which continue to maintain the pattern of use.
CBT assists individuals in identifying and modifying unhelpful thinking styles underlying the drug use.
CBT also incorporates a skill training component, in which individuals are taught skills to help them to cope appropriately with cravings, how to monitor thoughts related to drugs and drug use as well as monitoring of high risk situations associated with relapse. Individuals are also provided with skills in problem solving, decision making and goal setting in order to produce enduring life changes.
In some cases exposure may be incorporated into treatment. Exposure encourages the individual to gradually begin to face situations where the person would usually use drugs. At this stage the person is equipped with positive coping skills.
Relapse prevention is an important part of CBT in which individuals increase their awareness of high risk situations or future obstacles. Based on this information the individual can develop a plan to deal with these events should they arise in the future.

How long will treatment last for?

The length of treatment depends upon a number of factors including the type of substance, duration of use, as well as the level of dependency and the type of treatment itself. Additionally individuals differ in their stage of change, and the rate at which they progress through the stages of change. These factors, taken together with the fact that drug dependence is considered to be a chronic and relapsing condition, are some reasons why treatments are very often lengthy. Some research suggests that lower intensity treatments for a longer duration are more effective in the treatment of drug use and dependence (Finney & Moos, 1998).

Expectations for the future

Treatment for drug use and dependency is considered to be just as effective as treatment for any other chronic disorder including those physical illnesses such as asthma and hypertension. Relapse rates for drug dependency have been reported to be 60% over a period of one year (Open Society Institute, 2005). A good treatment response however will largely depend upon the individual's level of motivation and their commitment to treatment, including medication compliance and behaviour changes, as well as their ability to deal with setbacks and continue treatment should they relapse.

What can I do to help myself?

If you have read this brochure and feel that the information in it is relevant to you then it is important that you seek the appropriate help. This can be done by:

Arranging to see a clinical psychologist at Sentiens where a thorough assessment can be conducted and an individual treatment plan developed.
Talking to one of the Mental Health Professionals at Sentiens about Sentiens Group Programs that are most suitable for you.
Organising a consultation with your doctor or psychiatrist.

You may wish to consider local support groups running in your community where you can meet other people experiencing similar difficulties to yourself.

Some people find self-help books to be a valuable resource. Self help books can be used in isolation or in combination with another form of treatment.

References

Australian Bureau of Statistics. (1997). Mental health and well-being: Profile of adults. Canberra: Australian Bureau of Statistics.

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed.) Text revision. Washington, DC: American Psychiatric Association.

Gowing, L., Proudfoot, H., Henry-Edwards, S., & Teeson, M. (2001). The effectiveness of interventions for illicit drug use (ANCD Research Paper). Woden, ACT: Australian National Council on Drugs.

Finney, J. W., & Moos, R. H. (1998). Psychosocial treatments of alcohol use disorders. In P. E., Nathan & J. M., Gorman (eds.). A guide to treatments that work. NY: Oxford University Press.

Open Society Institute. (2006). Drug addiction treatment program. Retrieved 9 January, 2006 from, http://www.soros.org/initiatives/washington/events/hivprevent_20051208/initiatives/ba...

World Health Organisation. (2000). Management of mental disorders: Volume 2 (3rd ed.). Sydney. World Health Organisation.

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