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Drug abuse
Classification and external resources

Comparison of the perceived harm for various psychoactive drugs from a poll among medical psychiatrists specialized in addiction treatment[1]
ICD-10 F10.-F19.
ICD-9 303-305
DiseasesDB 3961
MeSH D019966

Drug abuse has a huge range of definitions related to taking a psychoactive drug or performance enhancing drug for a non-therapeutic or non-medical effect. All of these definitions imply a negative judgment of the drug use in question (compare with the term responsible drug use for alternative views). Some of the drugs most often associated with this term include alcohol, amphetamines, barbiturates, benzodiazepines, cocaine, methaqualone, and opium alkaloids. Use of these drugs may lead to criminal penalty in addition to possible physical, social, and psychological harm, both strongly depending on local jurisdiction.[2] Other definitions of drug abuse fall into four main categories: public health definitions, mass communication and vernacular usage, medical definitions, and political and criminal justice definitions.

Worldwide, the UN estimates there are more than 50 million regular users of heroin, cocaine and synthetic drugs.[3]

Drug abuse
Drug addiction
Substance abuse
Substance abuse prevention
Substance-abuse rehabilitation
Substance abuse treatment

Contents

Classification

Public health definitions

Public health practitioners have attempted to look at drug abuse from a broader perspective than the individual, emphasizing the role of society, culture and availability. Rather than accepting the loaded terms alcohol or drug "abuse," many public health professionals have adopted phrases such as "substance and alcohol type problems" or "harmful/problematic use" of drugs.

The Health Officers Council of British Columbia — in their 2005 policy discussion paper, A Public Health Approach to Drug Control in Canada — has adopted a public health model of psychoactive substance use that challenges the simplistic black-and-white construction of the binary (or complementary) antonyms "use" vs. "abuse". This model explicitly recognizes a spectrum of use, ranging from beneficial use to chronic dependence (see diagram to the right).

Medical definitions

In the modern medical profession, the two most used diagnostic tools in the world, the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM) and the World Health Organization's International Statistical Classification of Diseases and Related Health Problems (ICD), no longer recognize 'drug abuse' as a current medical diagnosis. Instead, DSM has adopted substance abuse[4] as a blanket term to include drug abuse and other things. ICD refrains from using either "substance abuse" or "drug abuse", instead using the term "harmful use" to cover physical or psychological harm to the user from use. Physical dependence, abuse of, and withdrawal from drugs and other miscellaneous substances is outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) ). Its section Substance dependence begin with:

"Substance dependence When an individual persists in use of alcohol or other drugs despite problems related to use of the substance, substance dependence may be diagnosed. Compulsive and repetitive use may result in tolerance to the effect of the drug and withdrawal symptoms when use is reduced or stopped. This, along with Substance Abuse are considered Substance Use Disorders...." [4]

However, other definitions differ; they may entail psychological or physical dependence [4] , and may focus on treatment and prevention in terms of the social consequences of substance uses.

Signs and symptoms

Depending on the actual compound, drug misuse including alcohol may lead to health problems, social problems, morbidity, injuries, unprotected sex, violence, deaths, motor vehicle accidents, homicides, suicides, physical dependence or psychological addiction.[5]

There is a high rate of suicide in alcoholics and drug abusers. The reasons believed to cause the increased risk of suicide include the long-term abuse of alcohol and drugs causing physiological distortion of brain chemistry as well as the social isolation. Another factor is the acute intoxicating effects of the drugs may make suicide more likely to occur. Suicide is also very common in adolescent alcohol abusers, with 1 in 4 suicides in adolescents being related to alcohol abuse.[6] In the USA approximately 30 percent of suicides are related to alcohol abuse. Alcohol abuse is also associated with increased risks of committing criminal offences including child abuse, domestic violence, rapes, burglaries and assaults.[7]

Drug abuse, including alcohol and prescription drugs can induce symptomatology which resembles mental illness. This can occur both in the intoxicated state and also during the withdrawal state. In some cases these substance induced psychiatric disorders can persist long after detoxification, such as prolonged psychosis or depression after amphetamine or cocaine abuse. A protracted withdrawal syndrome can also occur with symptoms persisting for months after cessation of use. Benzodiazepines are the most notable drug for inducing prolonged withdrawal effects with symptoms sometimes persisting for years after cessation of use. Abuse of hallucinogens can trigger delusional and other psychotic phenomena long after cessation of use and cannabis may trigger panic attacks during intoxication and with use it may cause a state similar to dysthymia. Severe anxiety and depression are commonly induced by sustained alcohol abuse which in most cases abates with prolonged abstinence. Even moderate alcohol sustained use may increase anxiety and depression levels in some individuals. In most cases these drug induced psychiatric disorders fade away with prolonged abstinence.[8]

Drug abuse makes central nervous system (CNS) effects, which produce changes in mood, levels of awareness or perceptions and sensations. Most of these drugs also alter systems other than the CNS. Some of these are often thought of as being abused. Some drugs appear to be more likely to lead to uncontrolled use than others.[9]

Traditionally, new pharmacotherapies are quickly adopted in primary care settings, however, drugs for substance abuse treatment have faced many barriers. Naltrexone, a drug originally marketed under the name "ReVia," and now marketed in intramuscular formulation as "Vivitrol" or in oral formulation as a generic, is a medication approved for the treatment of alcohol dependence. This drug has reached very few patients. This may be due to a number of factors, including resistance by Addiction Medicine specialists and lack of resources.[10]

Prevention

Disability-adjusted life year for drug use disorders per 100,000 inhabitants in 2002.
     no data      less than 40      40-80      80-120      120-160      160-200      200-240      240-280      280-320      320-360      360-400      400-440      more than 440

The Vienna conference in March 2009

The declaration from UN's Commission of Narcotic Drugs Fifty-second session in Vienna, 11–20 March 2009, with participation from 130 member countries, state that "We are determined to tackle the world drug problem and to actively promote a society free of drug abuse..." The concept drug abuse is used five times in the declaration.[11]

History

Total recorded alcohol per capita consumption (15+), in litres of pure alcohol[12]

United States

In 1932, the American Psychiatric Association created a definition that used legality, social acceptability, and even cultural familiarity as qualifying factors:

…as a general rule, we reserve the term drug abuse to apply to the illegal, nonmedical use of a limited number of substances, most of them drugs, which have properties of altering the mental state in ways that are considered by social norms and defined by statute to be inappropriate, undesirable, harmful, threatening, or, at minimum, culture-alien."
—Glasscote, R.M., Sussex, J.N., Jaffe, J.H., Ball, J., Brill, L. (1932). The Treatment of Drug Abuse for people like you...: Programs, Problems, Prospects. Washington, D.C.: Joint Information Service of the American Psychiatric Association and the National Association for Mental Health.

In 1966, the American Medical Association's Committee on Alcoholism and Addiction defined abuse of stimulants (amphetamines, primarily) in terms of 'medical supervision':

…'use' refers to the proper place of stimulants in medical practice; 'misuse' applies to the physician's role in initiating a potentially dangerous course of therapy; and 'abuse' refers to self-administration of these drugs without medical supervision and particularly in large doses that may lead to psychological dependency, tolerance and abnormal behavior.

In 1973 the National Commission on Marihuana and Drug Abuse stated:

...drug abuse may refer to any type of drug or chemical without regard to its pharmacologic actions. It is an eclectic concept having only one uniform connotation: societal disapproval. ... The Commission believes that the term drug abuse must be deleted from official pronouncements and public policy dialogue. The term has no functional utility and has become no more than an arbitrary codeword for that drug use which is presently considered wrong.[13]

Society and culture

Legal approaches

Related articles: Drug control law, Prohibition (drugs), Arguments for and against drug prohibition

Most governments have designed legislation to criminalise certain types of drug use. These drugs are often called "illegal drugs" but generally what is illegal is their unlicensed production, distribution, and possession. These drugs are also called "controlled substances". Even for simple possession, legal punishment can be quite severe (including the death penalty in some countries). Laws vary across countries, and even within them, and have fluctuated widely throughout history.

Attempts by government-sponsored drug control policy to interdict drug supply and eliminate drug abuse have been largely unsuccessful. In spite of the huge efforts by the U.S., drug supply and purity has reached an all time high, with the vast majority of resources spent on interdiction and law enforcement instead of public health.[14][15] In the United States, the number of nonviolent drug offenders in prison exceeds by 100,000 the total incarcerated population in the EU, despite the fact that the EU has 100 million more citizens.

Despite drug legislation (and some might argue because of it), large, organized criminal drug cartels operate worldwide. Advocates of decriminalization argue that drug prohibition makes drug dealing a lucrative business, leading to much of the associated criminal activity.

Cost

The UK Home Office estimated that the social and economic cost of drug abuse to the UK economy in terms of crime, absenteeism and sickness is in excess of £20 billion a year.[16].

It does not however estimate what portion of those crimes are unintended consequences of drug prohibition (crimes to sustain expensive drug consumption, risky production and dangerous distribution), nor what is the cost of enforcement. Those aspects are necessary for a full analysis of the economics of prohibition [17].

The Home Office has a recent history of taking a hard line on controlled drugs, including those with no known fatalities and even medical benefits[18], in direct opposition to the scientific community[19].

See also

Notes

  1. ^ Nutt D, King LA, Saulsbury W, Blakemore C (March 2007). "Development of a rational scale to assess the harm of drugs of potential misuse". Lancet 369 (9566): 1047–53. doi:10.1016/S0140-6736(07)60464-4. PMID 17382831.  edit
  2. ^ (2002). Mosby's Medical, Nursing, & Allied Health Dictionary. Sixth Edition. Drug abuse definition, p. 552. Nursing diagnoses, p. 2109. ISBN 0-323-01430-5.
  3. ^ "Drug Trade". BBC News.
  4. ^ a b c DSM-IV & DSM-IV-TR:Substance Dependence
  5. ^ Burke PJ, O'Sullivan J, Vaughan BL (November 2005). "Adolescent substance use: brief interventions by emergency care providers". Pediatr Emerg Care 21 (11): 770–6. PMID 16280955. 
  6. ^ O'Connor, Rory; Sheehy, Noel (29 Jan 2000). Understanding suicidal behaviour. Leicester: BPS Books. pp. 33–36. ISBN 978-1-85433-290-5. http://books.google.co.uk/books?id=79hEYGdDA3oC. 
  7. ^ Isralowitz, Richard (2004). Drug use: a reference handbook. Santa Barbara, Calif.: ABC-CLIO. pp. 122–123. ISBN 978-1-57607-708-5. http://books.google.co.uk/books?id=X0mxxfbIbp4C. 
  8. ^ Evans, Katie; Sullivan, Michael J. (1 March 2001). Dual Diagnosis: Counseling the Mentally Ill Substance Abuser (2nd ed.). Guilford Press. pp. 75–76. ISBN 978-1572304468. http://books.google.co.uk/books?id=lvUzR0obihEC. 
  9. ^ Jaffe, J.H. (1975). Drug addiction and drug abuse. In L.S. Goodman & A. Gilman (Eds.) The pharmacological basis of therapeutics (5th ed.). New York: MacMillan. pp. 284–324.
  10. ^ Board on Behavioral, Cognitive, and Sensory Sciences and Education (BCSSE). (2004) New Treatments for Addiction: Behavioral, Ethical, Legal, and Social Questions. The National Academies Press. pp. 7–8, 140–141
  11. ^ Commission on Narcotic Drugs Fifty-second session, Vienna, 11-20 March 2009
  12. ^ Global Status Report on Alcohol 2004
  13. ^ Second Report of the National Commission on Marihuana and Drug Abuse; Drug Use In America: Problem In Perspective (March 1973), p.13
  14. ^ Copeman M (April 2003). "Drug supply and drug abuse". CMAJ 168 (9): 1113; author reply 1113. PMID 12719309. PMC 153673. http://www.cmaj.ca/cgi/pmidlookup?view=long&pmid=12719309. 
  15. ^ Wood E, Tyndall MW, Spittal PM, et al. (January 2003). "Impact of supply-side policies for control of illicit drugs in the face of the AIDS and overdose epidemics: investigation of a massive heroin seizure". CMAJ 168 (2): 165–9. PMID 12538544. PMC 140425. http://www.cmaj.ca/cgi/pmidlookup?view=long&pmid=12538544. 
  16. ^ http://drugs.homeoffice.gov.uk/drug-strategy/drugs-in-workplace
  17. ^ Thornton, Mark. "The Economics of Prohibition". http://mises.org/story/2269. 
  18. ^ http://news.bbc.co.uk/1/hi/uk_politics/7386889.stm
  19. ^ http://www.bbc.co.uk/blogs/thereporters/markeaston/2009/11/why_was_david_nutt_sacked.html

Further reading

External links


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