SUBSTANCE (DRUG) USE AND ITS EFFECT ON MENTAL HEALTH
By Doctor Jackline A
A drug is any substance other than food which changes the way the body or mind functions. It may or may not have medicinal value. Drugs can come from plants or manufactured in laboratories. Their use can be legal, illegal, helpful or harmful. Helpful drug use by a doctor’s prescription can be in instances such as: · Getting better if one is ill · Reducing pain from illness or injury · Preventing illness by vaccination · Managing mental illness by balancing brain chemicals · Helping the body produce chemicals it may not do on its own like making insulin. Psychoactive drugs work on the mind or on behavior by altering one’s mood and the way they think and act. Their classification can be based on their status as well as action and properties. Status: · legal · chemical · medical · social Action and properties: · stimulant – caffeine, nicotine, khat, cocaine, amphetamines, methamphetamine (crystal meth) , MDMA (ecstasy) · depressant – alcohol, benzodiazepines, barbiturates, solvents, cannabis in low doses, opioids (heroin, morphine, pethidine) · hallucinogenic – cannabis in high doses, ketamine, mescaline, magic mushrooms, LSD (Lysergic acid diethylamide), DMT (N,N-Dimethyltryptamine), PCP (Phencyclidine), MDMA (methylenedioxymethamphetamine) Why do people use drugs?
· Experimenting · Relax/energize/excitement · Gain confidence/reduce anxiety · Be cool/socialize/have fun · Go to sleep/stay awake · Reduce physical and emotional pain · Forget problems · Boredom/depression · Loose/gain weight · Get high/experience altered states · Sports · Sex · Symbol of rebellion · Religious ritual · To avoid withdrawal symptoms if dependent
Substance abuse or misuse is any drug use that causes personal problems such as health, emotional, relationship, work, financial and legal. It is any drug use that breaks healthy connections with family, friends and society.
One does not have to be an addict or alcoholic to have a problem with substances.
Substance abuse can be in the form of: improper use; taking too much; taking for too long and improper combination
· Improper use –of the drug for a different illness or taking another person’s prescription
· Taking too much – at once or smaller doses more often
· Taking for too long – after the drug is no longer needed; extending the prescription
· Improper combination – of drugs such as alcohol and benzodiazepines that can produce unwanted dangerous outcomes including death
Substance use patterns include non-use; experimental use; social use; binge use; instrumental use; habitual use; compulsive use
Non-users – are those who chose to abstain from substance use due to;
· choice for personal, health, family or social reasons
· deciding that using is unpleasant or dangerous
· membership of particular religious or cultural group
· negative experiences of long-term substance abuse/ addiction seen in relatives and friends
Experimental Use –the first few times one tries alcohol or other drugs, due to;
· Friends or peers that use/ peer pressure/ need to belong
· Willingness to try the drug/ curiosity
· A sense of safety about the drug and the setting
· Boredom/ depression
· desire for stimulating or exciting alternatives
In experimentation, one is exploring their relationship with the substance such that if they do not enjoy the effects, they go back to non-use. If they do, they become social users.
There are risks such as;
· using too much and/or taking too strong a dose due to inexperience
· not knowing how much one’s body can handle
· teenagers bingeing with the intention to get drunk or high
· in the case of street drugs, not knowing the source, dealer or manufacturer
Social Use – using a substance in social settings as a factor in the event but not the main purpose of the gathering. Using does not take priority over other life activities and experiences and it does not affect one’s life negatively.
Instances can be to celebrate important occasions or just to socialize.
Binge Use – heavy drinking or drugging sporadically, with periods of little or no use in between. It can be as problematic as regular use and is often associated with higher levels of;
· domestic violence
· hostility and aggression
· hospital admissions (compared to heavy steady users)
· work problems
· police altercations
The unpredictable nature of binge use can create a destructive set of stressors for those involved in the user’s life.
Instrumental Use – use of a substance as an instrument to fulfill a purpose, often seeking pleasure or avoiding pain
· Seeking pleasure – for fun, feelings of power and control; feeling high by experiencing altered states and perceptions; reducing inhibitions
· Avoiding pain – physical pain- seeking relief from physical discomfort; psychological pain- suppressing negative feelings like anger, guilt, shame, grief and boredom
Habitual Use – drinking or using drugs regularly, potentially increasing risk for problems in one or more areas of one’s life. Problem use is generally characterized by frequent use of the substance. Problems may emerge in areas of health, relationships, school, work, finances or legal status.
Social life and circumstances may narrow to include only other users and social functions involving using.
At this point, one is still not considered dependent and has some choice about their substance use.
Compulsive Use – one experiences an overwhelming physical and psychological need to use the substance. Usually, the brain chemistry has changed, and one experiences physical and psychological dependence.
· Physical dependence – Tolerance (need for increasing doses to feel the same high) and Withdrawal (symptoms are characteristic of the particular drug, usually undesirable and are the opposite effect of the high)
· Psychological dependence – craving; an all consuming focus on the drug ( getting it, getting high, dealing with coming down, finding more) One experiences no choice about using and feels no control over the amount consumed.
Addiction can be described practically by “3 C’s”:
· Control – repeated attempts to cut back or control use, with episodes or loss of control in between
· Compulsion – one experiences a sense that they must use; tolerance, withdrawal or craving
· Consequences – substance use is continued despite significant negative consequences
According to the American Society of Addiction Medicine (ASAM), Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.
Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death.
Risk Factors for addiction can be internal (personal) or external.
Internal factors include:
· Genetics/ biological factors and drug effects
· Gender /sex
· Early drug use /age
· Physical or mental illness
· Personal characteristics – high vulnerability to anxiety/ depression; impulsiveness
· Lack of attachment to healthy adults/ mainstream culture
External factors include:
· Family of origin
· Abuse from the family and others
· Peers/ friends
· Availability of substances
· Stressors – poverty, unemployment, job stress, divorce, single parenting
· Exposure to trauma – rape, natural disaster, civil war, international conflict
There are other processes that maintain addiction even after drug use is no longer enjoyable. These include the fact that the drug use
· Provides one a form of identity, role and friends
· Helps one forget the past
· Is a way of avoiding responsibilities
· Helps one withdraw from intimacy
· Keeps away withdrawal symptoms
· May be a way of slow suicide or self punishment
· Is acting out of self hate
It is also important to note that since many factors which promote and maintain addiction are psychological and social, people can develop addictions to other human behaviour or experiences. These include: food, sex, gambling, pornography, exercise, internet, television, shopping, role-playing games, among others.
If anyone is concerned that they may be having a problem with substance abuse or addiction, it is important that they seek help immediately from the nearest health facility whereby they shall be directed to the appropriate health care providers.
Please remember that:
· Addiction is a disease, not a choice
· Addiction is progressive, chronic and can be fatal
· Young brains are at highest risk due to its unique stage of development (especially adolescents)
· Addiction is very treatable especially if one seeks help early
· It is important to focus on prevention of addiction
· Early interventions, assessment and treatment are the keys to successful recovery from addiction