Substance Abuse

Abuse is a wrong use of anything. Substance abuse refers to the use or misuse of any substance for wrong and harmful purposes. Alcohol is one such substance which is abused. There are many other substances, classified as drugs, which are medicines or go into the making of medicines which are indispensable in medical and surgical practice. They are prescribed by doctors, and used strictly within the limits of such prescriptions, do a lot of good. However, intentional or unintentional misuse of these drugs leads to very harmful effects and in many cases to addiction from which it is difficult to extricate yourself. Most of these abuses begin unintentionally due to carelessness or ignorance. Some are induced by people around you or by those who would like to create a lucrative market for such substances, because once you are addicted to any of these substances, you become a helpless compulsive buyer. In some cases, easy availability of a drug across the counter makes it possible for a patient to go beyond the doctor's instructions and start prescribing the drug to himself self-medication. This is a very common cause of many such drug addictions. Strict laws for the sale of such substances and their implementation are very necessary, and most countries have them. 

Alcohol 

Alcohol is a depressant and an anesthetic. It affects the brain and the nervous system. The overall effects of alcohol on the body and on behaviour vary a great deal depending on many factors, significant among them being the amount you consume and percentage of alcohol in the blood as it reaches the brain. As this percentage increases, the functioning of the brain and the central nervous system is increasingly affected. Since alcohol gets gradually metabolised and eliminated from the blood, the process reverses itself. At a concentration of 0.03 per cent alcohol in the blood, no effects are visible. This is the amount' that will  find its way into the blood stream if you take 1.5 oz. of whisky or two small glasses of table wine, or two bottles of beer, and it will take 2 hours for this amount of alcohol to get metabolised and leave the body completely. If you take twice this number of drinks you will have twice the concentration of alcohol in the blood stream i.e., 0.06 per cent. This will give you a feeling of warmth and relaxation. At a concentration of 0.1 per cent alcohol in the blood stream, which means one part of every thousand parts of blood  is pure alcohol, the person is legally drunk. At this level the motor areas of the brain are affected and there is a noticeable lack of coordination in standing or walking. If the percentage goes to 0.15 per cent, the mental faculties are impaired and you can see physical signs of intoxication. A concentration of 0.4 per cent can cause coma. At levels 0.5 to 0.7 per cent there may be paralysis of the brain centres that control the functioning of the lungs and heart. This can be fatal. Alcohol is highly and progressively addictive. 

What happens to alcohol in the body? It is an energy producing food like sugar but its nutrient value is negligible. Unlike most foods it is quickly absorbed into the blood stream through the stomach and small intestines because it does not need to be digested. It is then carried to the liver where most of it is converted into heat and energy. The remainder is carried by the blood stream to the heart and pumped to the lungs. Some is expelled in the breath, some eventually reaches the sweat and urine and gets eliminated that way. From the lungs the alcohol is circulated to brain. People who use good judgement when drinking rarely get drunk. 

Habitual drinking of straight whisky irritates the lining membranes of the mouth and throat. It also causes thickening of the vocal cord tissue  resulting in a hoarse voice. It aggravates stomach ulcers, if there is any long term chronic misuse of alcohol it leads to more rapid ageing of the brain. Heavy drinkers often suffer from malnutrition  and are more susceptible to viral or bacterial infections. In general, their immunity to infections is lowered. Heavy drinkers also run a higher risk of hemorrhagic stroke. Although alcohol lowers inhibitions and increases sexual appetite, it reduces the ability to perform.

People suffering from diseases like peptic ulcers,kidney and liver infections and epilepsy, should never drink any alcoholic beverages without doctor's permission.

In many parts of the world, from time immemorial, alcoholic beverages have been used for medicinal purposes. Doctors in certain cases do recommend a particular alcoholic beverage as a tranquilizer, as a sleep-inducer or as an appetite stimulant. 

Drug Abuse 

Like alcohol, drug abuse is also reaching alarming proportions specially in metropolitan towns and college campuses, and like alcohol drugs also wreck lives. There are many such useful but potentially dangerous drugs available in the market. When used legitimately and sensibly they relieve pain, tension, anxiety, and induce relaxation and sleep, but in poisonous dosages, can do great harm to the mind and body. They are extremely habit-forming. Mildest examples of these in our daily lives are caffeine in coffee, tea and coca cola, alcohol, and nicotine in cigarettes. Sleeping pills and other tranquilizers prescribed by doctors fall in this class. Some of these are part of cough syrups and other medicines; for example, injections that are given for relieving pain. This is what makes their illegal use difficult to control  the legal and the illegal uses have such close connections. The drugs that are generally misused  fall into six categories: stimulants, depressants and narcotic preparations, all of which can have legitimate medical usages; hallucinogens, cannabinoids such as marihuana; and inhalants such as aerosal sprays, glues, and fuels.

Major drug classifications

Indiscriminate use of drugs leads to three kinds of dependency or addiction : 

1. Physical addiction : Unpleasant symptoms like nausea, headache or cold sweats, when the drug is not available to the addict. 
2. Psychological addiction : This is a stage when the addict believes he cannot cope without the drug. 
3. Functional addiction is when the user becomes dependent on the drug for alleviating a physical problem or condition, for example use of decongestant nasal drops. 

Among the drugs that doctors prescribe for patients there are some that have a tremendous potential for abuse. These are stimulants such as ampetamines, depressants such as sleeping pills, and narcotic pain killers such as morphine and codeine; when taken outside the context of the doctor's prescription,  they become harmful drugs. 

Drugs commonly abused : 

Amphetamines : These are stimulants very commonly used by students cramming for examinations, housewives trying to get through an exhausting day without collapsing, and tired businessmen needing to be alert for a morning meeting. Amphetamine abusers quickly develop a tolerance for the drug and have to keep on increasing the dosages. They also develop psychological dependence very quickly. 

Cocaine is a powerful stimulant for the central nervous system. It is either sniffed or taken intravenously. Physical dependence on cocaine is rare. Psychological dependence is much more common. It gives you a feeling of euphoria but when the dose wears off, deep depression may set in. The use of cocaine as a legal anaesthetic need not lead to addiction. It is generally used in surgeries of the mouth, throat and eyes. In extreme cases abusers may have hallucinations and feelings of paranoia and depression. They may imagine that insects are crawling all over their skin, and may have chest pains. 

Barbiturates :  These are depressants, and are prescribed legitimately to overcome insomnia, reduce high blood pressure, remove anxiety, treat mental disorders, and sedate patients before a surgery. They are also used to bring epileptic and other convulsions under control. Phenobarbital, pentobarbital, and sodium pentothal, are commonly used barbiturates in hospitals. Pentothal is used as an anaesthetic by dentists, Abusers generally begin by using sleeping pills, they go on to its use for relieving tension and anxiety. All this starts very innocuously at home but gradually grows into a drug dependency when the abuser begins to obtain the drug through illicit channels, and ends up spending most of the time in bed. Barbiturate abuse is considered to be far more dangerous than narcotic abuse. Chronic abuse leads to psychological as well as physical dependence. 

Tranquilizers are also depressants used legitimately to treat emotional tension and as muscle relaxants. They are the most commonly abused drugs because they produce both psychological and physical dependence. Valium and Calm pose are two of the commonly available tranquilizers in our market but to be sold only against doctors prescription. Combining tranquilizers with alcohol is highly dangerous.

Opium: This is a narcotic obtained from poppy. It is either eaten or smoked. It has been used in many cultures since prehistoric times as an addictive and also as a medicine. Many compounds can be derivcd from opium, but the two most important are morphine and codeine. The non narcotic normal seed of opium is Khas-Khas which is a common spice and was grown freely by farmers in our country till it was discovered that most of the poppy farming was getting diverted to the production of opium since that was much more lucrative. As a result, Government has brought all poppy farming under its strict control and close supervision.

Morphine is the chemical substance in opium that is responsible for its analgesic and sedative properties. On the illicit drug market it appears as a white powder. It can relieve any kind of pain. It also relieves fear and anxiety that go with such pain. It brings about drowsiness, euphoria, impairment of mental and physical performance, and also nausea, vomiting and sweating. In high doses it leads to respiratory depression, sometimes severe enough to cause coma and death. 

Codeine another derivative of opium is a mild pain reliever. It is milder than morphine and is an ingredient of some popular cough syrups. Next time look at the label of the cough syrup you buy. It does not necessarily lead to dependence. 

Heroin : It is several times as powerful as morphine. Heroin abusers rapidly develop tolerance to the drug. It leads to both psychological and physical dependence, the former being more difficult to break. It is either sniffed or injected under the skin or directly into the vein. 

LSD (Lysergic Acid Diethylamide) is a hallucinogen. Its user experiences hallucinations, illusions, and distorted perceptions. It is a colourless, tasteless and odorless compound of immense potency. It can be incorporated illegally into sugar cubes, candy, biscuits, on the surface of beads, into sweets and even in the gum of stamps and envelopes. Fortunately, abuse of LSD is difficult because the drug produces such a powerful effect that daily ingestion is out of question. Its use therefore does not lead to dependence. LSD induced hallucinations can often lead to tragedies. Convinced that they could fly some users have walked out of high windows to their deaths; others have walked in front of trains or cars. No one can predict the kind of hallucinations LSD will produce. 

Marihunna or marijuana is a smoking preparation made from the Indian hemp plant (Cannabis sativa). Some 300 million people around the world obtain drug preparations of one kind or the other from the plant. The male plant produces the fibre for hemp while the drug is obtained almost exclusively from the female plants. In India it is available in cakes called 'charas' and in the Middle East it is available as a brown powder called 'hashish'.  Cannabis cultivation is a major underground business in the U.S.A. There is an enormous amount of illegal traffic the world over in this drug. It is classed as a hallucinogen but much less potent than true hallucinogen. It is not a narcotic, and it resembles both stimulants and depressants in some of its effects. Its use does not lead to physical dependence, nor does the user develop tolerance. Users do acquire a slight to moderate psychological dependence, though perhaps less than regular users of alcohol and tobacco. 

Inhalants  : These include solvents used in cleaning compounds, aerosol sprays, fuels and glues. Abusers of these substances sniffle inhale the fumes for recreational and mind-altering purposes. These compounds were never meant for human consumption but  they have an appeal for persons who cannot afford or obtain the other kinds of drugs. Strictly speaking tobacco, cocaine and marihuana could be considered inhalants hut the term more commonly refers to solvents, aerosols and anesthetics. Young teenagers, mostly boys are the main inhalant abusers particularly those working in garages and workshops where these compounds are used - gasoline, transmission fluids, paint thinner, airplane cement, insecticides, spray paints etc. The fumes of these chemicals enter the blood stream quickly. They are then distributed to the brain and liver. Entering the central nervous system, the fumes depress such body functions as respiration and heart- beat. They can produce illusions, hallucinations and mental disturbances. Prolonged abuse can lead to nausea, muscular weakness, fatigue and weight loss, and also damage to kidney, liver, bone marrow and the brain.They can produce physical and psycholoeical dependence.