Understanding Drug Use 1

Drug / Psychoactive Substance Any substance that when taken by a person modifies : Perception Mood Cognition Behaviour Motor functions 2

Types of Drugs Used 3

Sedative – hypnotics Depressants 4

Cocaine Tobacco ATS Cannabis Stimulants 5

L S D Cannabis Hallucinogens 6

Classification of Drugs 7 Legal (Licit): Medicine Tobacco Alcohol Caffeine/Tea Illegal (Illicit): Opium Heroin Cocaine ATS Marijuana

Modes of Drug Use Drinking Swallowing Injecting Snorting Smoking 8

Why is Injecting Route preferred? Faster action (High/rush) More economical When availability is poor 9

Drugs Injected DepressantsStimulantsHallucinogens Heroin Diazepam Buprenorphine Pentazocine Spasmoproxyvon Cocaine Amphetamine Ketamine 10

Why do People Take Drugs? 11 To feel good To have novel: feelings sensations experiences AND to share them To feel better To lessen: anxiety worries fears depression hopelessness

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Why do some people become dependent (addicted) while others do not? Vulnerability 14

Biology/genes Environment Biology/ Environment Interactions 15

Environmental Factors Drug related Individual related Society/community related 16

Drug-related Factors Availability Legal and policy environment Socio-cultural norms and attitudes Abuse liability Reward or reinforcement Non-toxic Route; duration of action 17

Drugs: The Vicious Cycle 18 Presence makes you feel good… (euphoria) Absence makes you feel miserable… (withdrawal) Contd…

Taking drugs… NOT Taking drugs…..makes one feel good… (euphoria) likely that one will continue....makes one feel miserable… (withdrawal)..to avoid which one will continue.. Drugs: The Vicious Cycle 19

Individual Related Factors Self-medication theory Co-morbid mental illnesses very common Co-morbid symptoms more common Personality factors ‘Novelty seeking’ 20

Society Related Factors Family influence Peer influence Cultural and religious sanction & proscription Legal & policy environment The setting 21

Terminology Use Misuse/harmful use Abuse Dependence Addiction – older term, still used 22

Use The ingestion of alcohol or other drugs without experiencing any negative consequences Example If a student had drunk a beer at a party and his parents had not found out we could say he had USED alcohol 23

Misuse When a person experiences negative consequences from the use of alcohol or other drugs it is clearly misuse Example A 40-year old man uses alcohol occasionally, his boss throws a party and the man drinks more than usual and on the way home he is arrested by the police 24

Abuse/Harmful Use Maladaptive pattern of use resulting in physical, social, legal harm Continued use in spite of negative consequences The same 40-year old man continues drinking alcohol after the incident 25

Dependence A cluster of physiological, behavioural and cognitive phenomena in which use of a substance or class of substances takes on a much higher priority for an individual than other behaviours Three or more of the following criteria to be present for some time in a one-year period: Increasing tolerance Withdrawal Impaired control Preoccupation Continued use despite harm Craving 26

Tolerance Need for increasing the amount of substance consumed to achieve intoxication or the desired effect Markedly diminished effect with continued use of the same amount of substance Example A person ‘X’ started with one line of heroin smoking to get intoxicated; with time, he had to increase the dose to 1 pudiya per day to get the same amount of intoxication A person ‘Y’ started with 1 peg of whisky and got high; with continued use, has to now consume 3 pegs of whisky to get the same high 27

Withdrawal Set of symptoms experienced on stopping or reducing the amount of the substance after prolonged use Every class of substance (e.g. alcohol, opioids, etc.) has its own unique set of withdrawal symptoms 28

Early symptoms Anxiety Restlessness Yawning Nausea Sweating Runny nose Watery eyes Dilated pupils Abdominal cramps Early symptoms Anxiety Restlessness Yawning Nausea Sweating Runny nose Watery eyes Dilated pupils Abdominal cramps Delayed symptoms Restlessness Diarrhoea Vomiting Goose bumps Muscular spasm, pain Chills Increased heart rate, B.P. Increased temperature Delayed symptoms Restlessness Diarrhoea Vomiting Goose bumps Muscular spasm, pain Chills Increased heart rate, B.P. Increased temperature Opioid Withdrawal 29 Opening of all holes in the body!!

Impaired control of behaviour associated with substance use in terms of its starting the use of the substance, stopping the use of the substance, or controlling the level of use Example A person ‘X’ had thought that he would consume only 1 peg of alcohol on a given day, but he is not able to stop after 1 peg; continues to take more than 1 peg: loss of control A person ‘Y’ planned to stop his drug use, but is unable to do so: loss of control 30 Impaired Control

Preoccupation Preoccupation with the use of substance manifested as: Great amount of time spent in using the substance/procuring the substance/recovering from the effect of the substance Other activities which were pleasurable are given up as a result of the substance use Other interests/hobbies given up due to indulgence in substance use 31

Continuing use of the particular substance despite harmful consequences of the substance on the individual Strong desire to use the substance: Craving Craving can be spontaneous or in reaction to certain stimulus (e.g. place where the individual takes drugs, drug using friends, shop where the individual purchases drugs/alcohol, etc.). The craving in reaction to stimulus is called as ‘cue induced’ craving 32 Continued Use & Craving

Drug Dependence is : a chronic relapsing disorder a brain disorder, in which biological, psychological and social factors operate 33

Drugs and HIV risks Due to : Drug effects: Lowering of risk perception Mood changes- risk taking increases High risk behaviour – sharing of N/S Cognition impaired – may not remember to take precautions Motor functions – may not be able to take the precautions Mode of use : If injected: chances of sharing N/S and paraphernalia 34

Thank You 35