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Substance Abuse and dependence are major burdens to society

 About 15% of patients admitted to hospitals have alcohol or some kind of substance abuse and dependence disorders. About 70 % of individuals in prisons have used illegal drugs regularly. Substance related offenders account for more than one-third of the growth in state prison population. The economic burden for dependence is twice as that of any other disease affecting the brain.

Adverse health consequences of substance abuse

1. Safety Hazard: Most of these psychoactive drugs reduce physical coordination, impair the senses, attention and capacity of judgment. This impairment can pose severe safety threats, specially for the persons who are involved in driving or operating machinery. Alcohol and drug abuse (intoxication) is one of the major factors of road traffic accidents. People who have consumed alcohol/ drugs are often unaware of the extent of their impairment. Decreased physical coordination and impaired judgment can lead to falls and other serious accidents.

2. Physical Health Problems: All drugs (alcohol and other drugs) not only affects brain but other organs also. effects of substance use range from mild to very severe damage to organ affected. For example, Smoking or chewing tobacco can cause damage to oral cavity, lungs and other part of respiratory system lung damage and can lead to oral or lung cancer. Alcohol addiction affects almost every part of body but liver is the organ which is affected most. Chronic use of alcohol can cause cirrhosis of liver which further can lead to portal hypertension and hepatic encephalpathy. Sniffing substances can damage the inside of the nose. Frequent use of injections by the people for injecting drugs can cause hematoma and abscesses at injection site. These addicts are also more prone to get infected with HIV infection by sharing needles.

Substances abusers are also more prone to many kind of infections like TB, STD’S (including HIV through unprotected sex), fungal infections, parasitic infections

Finally, dependent users have been shown to have a significantly increased likelihood of reporting a wide range of respiratory symptoms and exhibiting decreased lung functioning and a number of problems including bronchitis, coughing and wheezing even after controlling for age, tobacco use and asthma. Prolonged use of substances may result in lower threshold of seizures resulting in additional complication of seizure disorder. Due to irregular eating pattern, persons abusing substances may develop nutritional deficiencies resulting in development of diseases such as anemia, Wernicke‖s encephalopathy, neuropathies etc.

3. Mental Health Problems: Some drugs can cause short-term confusion, anxiety or mental disturbance. In the longer term, substance abuse can result in personality disturbances, learning problems, loss of memory, organic brain diseases and can contribute to mental disorders. A person who turns to drugs as a way of avoiding normal anxiety and sadness may

be establishing a pattern of behaviour that can be hard to break. Many people who use drugs in this way come to believe that they cannot function normally without drugs.

People with histories of serious emotional or mental health problems may also turn to drugs as a way of coping with unpleasant feelings. A correlation has been reported between substance use and lack of motivation. A condition called “amotivational syndrome” entails apathy, loss of effectiveness and a diminished ability to concentrate, difficulty to follow routines and inability to master new learning.

Research has suggested that substance abusers are more likely than non-abusers to report feeling depressed and heavy use may actually increase depressive symptoms. Furthermore, individuals with dependence are at greater risk of suicide attempts. Also, experience of physical or sexual abuse is common among people abusing substances. Substance Use Disorders | Manual for Paramedical Professionals 

4. Tolerance

Tolerance means that, over time and with regular use, a person who uses drugs needs more and more of a substance to get the same effect. Tolerance increases the physical health risks of any substance simply because it can result in increased substance use over time. Tolerance also increases the risk of dangerous or fatal overdose. As people age, physiological changes may mean they need less of a substance to get the same effect. This result may be compounded if their liver or kidneys have been damaged by chronic disease.

5. Physical Dependence

Physical dependence occurs when a person’s body becomes so accustomed to a particular substance that it can only function normally if the substance is present. If people who use drugs drastically reduce their level of use or stop using the substance abruptly, they may experience a variety of signs and symptoms ranging from mild discomfort to seizures. These effects, some of which can be fatal, are collectively referred to as “withdrawal”. Withdrawal symptoms are often opposite to the effects produced by taking the drug, e.g. when a person stops using a stimulant substance such as cocaine they may become depressed, need to sleep a lot, and have increased appetite when they awaken. To avoid the discomfort of withdrawal, the person who uses drugs may start to use again or feel unable to stop using the drug. Not all drugs produce physical dependence, but they may still be abused because the person who uses drugs becomes psychologically dependent on the drug’s effects.

6. Psychological Dependence

Psychological dependence exists when a substance is so central to a person’s thoughts, emotions and activities that it is extremely difficult to stop using it, or even stop thinking about it. A strong desire or “craving” to use a substance may be triggered by internal or external cues such as the end of a meal for smokers or seeing injection equipment for people who inject drugs. Like physical dependence, psychological dependence is a cause of continued substance use. An individual may be both psychologically and physically dependent on a drug. Substance Use Disorders | Manual for Paramedical Professionals 

Combining Drugs (polydrug use)

Many drugs become more dangerous when they are mixed. People may combine drugs intentionally to enhance the effects, or to counteract undesirable side-effects, or they may use a hazardous combination of drugs without intending to do so. For example, they may take sleeping medications after drinking alcohol without being aware that using these drugs together is hazardous. People who use drugs illegally may mix drugs unknowingly because they do not know what they are taking.

Many drugs taken together have the potential to interact with one another to produce greater effects than either substance taken alone. Or, the combination of drugs may produce a new or unexpected effect. For example, alcohol, opioid analgesics (like codeine), and benzodiazepines (like diazepam) are all depressant drugs. When taken alone, they can cause relaxation, dis-inhibition, loss of coordination and sleepiness. If these depressant drugs are taken at the same time, these effects are increased. Such combinations may result in confusion, injuries from falls, depressed breathing, coma and death.

Some antidepressants and many drugs taken to treat epilepsy, nausea, allergies and colds also have depressant effects. When taken with other depressants like alcohol, they can dangerously slow or stop breathing. Alcohol can also interact with common medications for heart problems, blood clotting disorders, fungal and bacterial infections, and diabetes,

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either making them less effective or producing unexpected and undesirable effects. Combining drugs may also seriously impair a person’s ability to operate a motor vehicle or other machinery.

Comorbid use of alcohol may also increase substance dependence. Although it is difficult to determine the exact causal relationship between alcohol and substance use, alcohol does appear to moderate the association between abuse of drugs and dependence.

7. Overdose

An overdose of any substance is a dose that can cause serious and sudden physical or mental damage. An overdose may or may not be fatal, depending on the substance and the amount taken. Dangerous overdoses are more likely to occur in people who have developed a tolerance for some effects of a substance more than others, those who return to substance use after a long period of abstinence, or those who use drugs illegally and have no way of knowing the exact potency of what they are buying. Sudden increases in the purity of some illegal drugs (e.g., heroin), may result in unintentional fatal overdoses.

Adverse Legal consequences of substance abuse

Hazards of Using Drugs Illegally

Using drugs illegally has its own set of risks. People who use drugs that have been obtained illegally can never know exactly what they are taking. Dealers may not know (or reveal) exactly what they are selling. Some drugs are laced with other drugs or chemicals, or contaminated by fungi or moulds, that can be harmful. Often one substance is sold in place of another. As a result, many bad substance reactions, including fatal overdoses, have occurred. People who use drugs heavily may use any substance that is available at the right price. As well, people who regularly use drugs illegally, Substance Use Disorders | Manual for Paramedical Professionals 27

particularly people who inject drugs, are at increased risk for a range of health, legal and social problems.

Crime and criminality

Drugs and crime are also related in several ways. Drug-related crime occurs primarily in the form of trafficking-related criminal activity, including violence between groups in competition for increased market share at the wholesale and retail levels. There is a correlation between substance use and prostitution.

Violence

Use of drugs is sometimes associated with violence and crime. Although, alcohol or other drugs do not cause violence, both the victims and perpetrators of violence may be using certain drugs. Date rape is one example, where the effects of benzodiazepines or alcohol may put the victim at increased risk for such violence. Two drugs, Rohypnol (flunitrazepam) and GHB (gamma-hydroxybutyrate) have been associated with date rape because their effects incapacitate the victim and make the person unable to resist the sexual assault. Because they are colourless, odourless and tasteless, the victim may not be aware that the substance has been deliberately added to their drink.

People may also commit crimes in order to make money to buy drugs, and substance problems are frequent among criminal offenders.

Hazardous Driving

Researchers have found that cannabis use is associated with a doubling of the risk of being involved in a fatal collision. In our country too, alcohol has been cited as a frequent factor behind road traffic accidents.

Adverse Social consequences of substance abuse

Among the social consequences of substance abuse and illicit drug trafficking, the most prominent include the effects on Family.

The fragmentation of many families for

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example, is due to the wedge represented by substance abuse; many studies have found that family disintegration correlates more strongly with substance abuse than with poverty. Substance Use Disorders | Manual for Paramedical Professionals 28

Stigma and Discrimation

Due to stigma and discrimination people with mental health and substance use problems keep their problems a secret. As a result they avoid getting the help they need. Stigma affects people’s access to treatment for substance use problems. Someone with a problem may be reluctant to seek help (even through “anonymous” support groups are becoming increasingly popular) for fear of society’s reaction if they were found to have a substance use problem.

Stigma can be of two types:

Stigma by others: Stigma and discrimination exclude people with substance use problems from activities that are open to other people. This limits people’s ability to:

§ Get and keep a job

§ Get and keep a safe place

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to live

§ Get health care (including treatment for substance use and mental health problems) and other support

§ Be accepted by their family, friends and community

§ Find and make friends or have other long-term relationships take part in social activities.

Self Stigma: Stigma and discrimination often become internalized by people with substance use problems. This leads them to:

§ Believe the negative things that other people and the media say about them

§ Have lower self-esteem because they feel guilt and shame.



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