Prison staff and harm reduction Core module session 1 Training Criminal Justice Professionals in Harm Reduction Services for Vulnerable Groups funded by the European Commissions Directorate General for Health and Consumers

2 Activity: True and false statements on drugs Overview on drugs Session 1

3 Activity: True and false statements on drugs True and false statements on drugs Activity

4 Lecture on drugs

5 What is a drug? WHO definition: "..any substance that, when taken into a living organism, may modify its perception, mood, cognition behaviour or motor function.“ (WHO,1993)

6 Why do people take drugs?

7 How are drugs taken? Swallowed (e.g. in the form of pills or liquids like alcohol) Inhaled (e.g. smoking tobacco or marihuana) Snorted (e.g. cocaine) Injected (e.g. heroin)

8 Effects of drugs What kind of drug is used The amount used The way the drug is used (e.g. taken orally, smoked etc.) Personal characteristics like sex, weight, age and psychological state The social setting in which the drugs are used Previous experience with the drug The effect a particular drug has depends on various factors like:

9 Drug dependence Strong desire and sense of compulsion to take the drug(s) Difficulties in controlling substance-taking behaviour Withdrawal symptoms upon cessation Development of a “tolerance” Highest priority of drug use Persistent use despite other harmful consequences Symptoms of drug dependence

10 Drug withdrawal Withdrawal symptoms include: Chills Nausea Diarrhoea Muscle cramps Mood swings Psychoses

11 Underlying factors of drug use Drug dependence is a complex behavioural disorder that is influenced by biological, psychological and sociological factors Drug dependence is a chronic relapsing disease Psychiatric diseases often underlie drug use Over 50% of those with a substance use disorder are found to have a co-occurring mental health disorder (Regier et al., 1990)

12 AlcoholI. Most commonly used drug in the world Effects: talkativeness, reduced inhibition, amnesia, semi- and unconsciousness, fatal overdoses Chronic heavy consumption can lead to negative and fatal health consequences (e.g. liver cirrhosis)

13 AlcoholII. Critical is a regular consumption of more than 40 grams of pure alcohol per day for men (=1 litre of beer) more than 20 grams of pure alcohol per day for women (=half a litre of beer) (WHO, 2000)

14 Tobacco Belongs to the most widely used drugs in the world Desired effects: increased arousal and attentiveness, suppressed appetite Associated with a wide range of health problems (diseases of the breathing system, heart diseases and cancer)

15 Cannabis Third most popular drug in developed countries Usually smoked or taken orally Consumed in the form of marihuana or hashish Possible effects: euphoria, relaxation, perceptual distortion, increased appetite, cognitive and psychomotor impairment, anxiety and paranoia

16 Amphetamines and Methamphetamines Belong to the central nervous system stimulants Street names: “speed”, “crystal”, “ice” Either orally ingested, snorted, smoked or injected Symptoms include: increased breathing and heart rate, raised blood pressure, dilated pupils Adverse effects: irregular heartbeat, loss of coordination, collapse

17 Ecstasy Belongs to the central nervous stimulants Usually orally ingested (rarely snorted, smoked or injected) Desired effects: euphoria, increased sensory awareness Adverse effects: irregular heartbeat, loss of coordination, collapse, body overheating

18 Cocaine Belongs to the central nervous system stimulants Cocaine is usually snorted; crack (a highly potent derivative of cocaine) is smoked Effects: severe mood swings including euphoria, dysphoria and in extreme cases cocaine psychosis and heart problems Cocaine is highly addictive

19 LSD and other hallucinogens “Magic mushrooms”, LSD Mind altering, psychedelic drug Desired effects: perceptual distortion of time and place, visual hallucinations and synaesthesia (sounds are seen, colours are heard) Adverse effects: dizziness, disorientation, anxiety, depression and flashbacks

20 Benzodiazepines Belong to the sedative-hypnotics In low doses help against anxiety; in high doses effect sedation and sleep Legal prescription drug (Valium) appearing on the illegal market Benzodiazepines are swallowed or injected Alcohol increases their effect

21 Opioids Opioids are central nervous system depressants Therapeutically used as pain killer Heroin is a relatively potent opioid, quickly passing the blood-brain barrier

22 Heroin I. Either injected, snorted or smoked Desired effects: drowsiness, euphoria, reduced anxiety and/ or pain Adverse effects: lowered breathing, sedation, dependence and overdoses Associated to far more accidental overdoses and fatal poisonings than any other scheduled substance

23 Heroin II. Heroin dependence is a chronic, relapsing disease Causes strong psychic and physical withdrawal symptoms

24 Poly-drug use “The use of more than one drug or type of drug at the same time or sequentially” Health risks of poly-drug use differ depending on the combination of drugs