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Drug abuse

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Drug abuse has a range of definitions, all of them suggesting disaproval at the use or overuse of a drug for a nontherapeutic effect 1. Leon Wurmser goes as far as to say "The term is so wide and imprecise, contains such a hodgepodge of clinical and social phenomena, and is so dependent on the bias of the observer, that a systematic study of its etiology would be as vast and comprehensive as an inquiry into the etiology of fever" 16. Other definitions fall into four main categories:

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Drug abuse

Contents

Definitions

Medical definitions

The 1969 edition of the World Health Organization's International Statistical Classification of Diseases and Related Health Problems (ICD) manual defined drug abuse as "persistent or sporadic excessive drug use inconsistent with or unrelated to acceptable medical practice", modern editions have not used the term because of it's ambiguity 2), prefering to refer to the cluster of symptoms previously called 'drug abuse' as 'substance abuse'.

In the early 1950s, the first edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders refered to both alcohol and drug abuse as part of Sociopathic Personality Disturbances, which were through to be symptoms of deeper psychological disorders or moral weakness 14. By the third edition, in the 1980s, drug abuse was grouped into 'substance abuse'.

Although the two most used diagnostic tools in the world (the DSM and the ICD) no longer recognise 'drug abuse' as a current medical diagnosis, the Handbook on Drug and Alcohol Abuse, defines drug abuse as "nonmedical use of drugs, both drugs that have and those that do not have generally accepted medical value".

Because of ambiguity in the meanings, the World Health Organization presently prefers to use the terms harmful use and hazardous use in place of drug abuse to distinguish between the health effects of drug abuse rather than the social consequences.

Substance abuse

Main article: Substance abuse

In medical terms, both the DSM and the ICD have adopted substance abuse as a blanket term to include drug abuse and other things, however other definitions differ, and may entail psychological or physical dependence, and focuses on treatment and prevention in terms of the social consequences of substance use.

Public health definitions

In the past two decades, public health practicitioners have attempted to look at drug abuse from a broader perspective than the individual, emphasising the role of society, culture and availability. Rather than alcohol or drug "abuse" many public health professionals have adopted the terms "alcohol and drug problems" or "harmful/hazardous use" of drugs.14

Political and criminal justice definitions

In most countries, legislation on drug abuse is written to criminalise any use of illegal drugs, or illegal use of controlled drugs.

The US National Institute on Drug Abuse defines drug abuse as "The use of illegal drugs or the inappropriate use of legal drugs. The repeated use of drugs to produce pleasure, to alleviate stress, or to alter or avoid reality (or all three)." In place of this definition, WHO uses the term drug misuse, defined as the "use of a substance for a purpose not consistent with legal or medical guidelines, as in the non-medical use of prescription medications." According to WHO, the term misuse is preferred by some in the belief that it is less judgmental. [1] (http://www.who.int/substance_abuse/terminology/who_lexicon/en/). Further, drug abuse may sometimes be used to refer to any use of illegal drugs, even when such use does not meet clinical definitions of abuse or addiction.

In 1975, psychiatrist Jerome H. Jaffe (in his role as Drug Policy Director in the Nixon Administration) defined drug abuse as "the use, usually by self-administration, of any drug in a manner that deviates from the approved medical or social patterns within a given culture". According to Jaffe, the term "conveys the notion of social disapproval, and it is not necessarily descriptive of any particular pattern of drug use or its potential adverse consequences".2.

Abuse potential

Some of the most commonly abused drugs are alcohol, amphetamines, barbiturates, cocaine, methaqualone, opiates, cannabis and benzodiazepines. Drug abuse (like most drug use) may lead to poor health, addiction, and disturbed patterns of behavior.

Most drugs that are subject to abuse have 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. But, not all centrally acting drugs are subject to abuse, which suggests that altering consciousness is not sufficient for a drug to have abuse potential. Among drugs that are abused, some appear to be more likely to lead to uncontrolled use than others, suggesting a possible hierarchy of drug-induced effects relative to abuse potential.4

History

In the past, one was more likely to die from infectious diseases, other ailments, or occupational injuries before the medical consequences of alcohol or drug abuse presented themselves. This no longer appears to be the case. Modern neuroscientific research techniques enable scientists to study the neurophysiological and molecular changes that produce acute intoxication, and the increased longevity provided by advances in medical science allow the long-term consequences of alcohol and drug abuse to be more fully appreciated.5

Approaches to managing drug abuse

Attempts by government-sponsored drug control policy to interdict drug supply and eliminate drug abuse have been largely unsuccessful. 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. In spite of the best 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.6

In addition to being a major public health problem, some consider drug abuse to be a social problem with far-reaching implications. Stress, poverty, domestic and societal violence, and various diseases (i.e., injecting drug users as a source for HIV/AIDS) are sometimes thought to be spread by drug use. Studies have also shown that individuals dependent on illicit drugs experience higher rates of comorbid psychiatric syndromes. 7

Harm reduction

Main article: Harm reduction

One alternative involves replacing failed law enforcement policies with harm-reduction strategies, which focus on reducing the societal costs of drug abuse and other drug use. Techniques include education to avoid overdose, needle exchange programs to reduce the spread of blood-borne diseases, and opioid substitution therapy to reduce crime related to the procurement of drugs. This pragmatic approach is known as the harm reduction paradigm. Harm reduction also addresses special populations, such as drug-using parents, pregnant drug users and users with psychiatric comorbidity. The philosophy of harm reduction accepts that drug use is part of the community, but that it must be addressed as a public health issue rather than a criminal one.8

Harm-reduction measures are at odds with the prevailing framework of international drug control, which rests on law enforcement and the criminalization of behaviors related to illicit drug use. However, harm-reduction has had a notable impact and is slowly gaining popularity. In Brazil alone, a comprehensive harm-reduction and drug-access program successfully reduced AIDS mortality among injection drug users by 50%.9

Medical treatment

Beyond the sociological issues, many drugs of abuse can lead to addiction, chemical dependency, or adverse health effects, such as lung cancer or emphysema from cigarette smoking.

Medical treatment therefore centers on two aspects: 1) breaking the addiction, 2) treating the health problems.

Most countries have health facilities that specialize in the treatment of drug abuse, although access may be limited to larger population centers and the social taboos regarding drug use may make those who need the medical treatment reluctant to take advantage of it. For example, it is estimated that only fifteen percent of injection drug abusers thought to be in need are receiving treatment.10 Patients may require acute and long-term maintenance treatment and relapse prevention, complemented by suitable rehabilitation. 11

Therapy

The development of pharmacotherapies for drug dependency treatment are currently in progress. New immunotherapies that prevent drugs like cocaine, methamphetamine, phencyclidine, nicotine, and opioids from reaching the brain are in the early stages of testing. Medications such as Buprenorphine, which block the drugs active site in the brain are another new option for the treatment of opioid addiction. Depot forms of medications, which require only weekly or monthly dosing, are also under investigation.

Traditionally, new pharmacotherapies are quickly adopted in primary care settings, however, drugs for substance abuse treatment have faced many barriers . Naltrexone, a drug marketed under the name "ReVia," is a medication approved for the treatment of alcohol dependence. Unfortunately, this drug has reached very few patients. This may be due to a number of factors, including resistance by addiction treatment providers and lack of resources. 12

Legal treatment

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

Most countries have lists of controlled substances, which are those substances that the society has restricted for their abuse potential and other reasons. For controlled substances, the legal punishments for the creation, distribution, possession and even personal use can be quite severe (including the death penalty in some countries). Legal regimes vary across countries, and even within them, and have fluctuated widely throughout history.

Despite (and perhaps becuase of) the illegality of controlled substances, many large, organized criminal drug cartels operate world-wide. Advocates of decriminalization argue that it is the illegality of these substances which makes drug dealing such a lucrative business, and leads to much of the associated criminal activity.

See also

Notes

  • Note 1: (2002). Mosby's Medical, Nursing, & Allied Health Dictionary. Sixth Edition. Drug abuse defintion, p. 552. Nursing diagnoses, p. 2109. ISBN 0323014305.
  • Note 2: World Health Organization Lexicon (http://www.who.int/substance_abuse/terminology/who_lexicon/en/)
  • Note 3: 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.
  • Note 4: Winger, Gail. (1992). A Handbook on Drug and Alcohol Abuse: The Biomedical Aspects. Oxford University Press. ISBN 019506397X
  • Note 5: Brick, John. (2003). Handbook of the Medical Consequences of Alcohol and Drug Abuse. Haworth Press. ISBN 0789018632
  • Note 6: Wood, Evan, et al. (Apr 29, 2003). "Drug supply and drug abuse". Letters. Canadian Medical Association Journal 168:(9). See also: CMAJ, 2003;168(2):165-9.
  • Note 7: Diala, C. Muntaner, C. Walrath, C. (May, 2004). "Gender, occupational, and socioeconomic correlates of alcohol and drug abuse among U.S. rural, metropolitan, and urban residents". American Journal of Drug and Alcohol Abuse (http://www.findarticles.com/p/articles/mi_m0978/is_2_30/ai_n6167177).
  • Note 8: Phillips, Prashant. (Oct, 2004). "Care of Drug Users in General Practice: a harm reduction approach." Book review. Mental Health Practice 8:i2. p. 29.
  • Note 9: Editorial. (Mar 1, 2005) "HIV, harm reduction and human rights/VIH, reduction des prejudices et droits de la personne." Canadian Medical Association Journal. 172:(5). p.605.
  • Note 10: Appel, P. W. Ellison, A. A. Jansky, H. K. Oldak, R. (Feb, 2004). "Barriers to enrollment in drug abuse treatment and suggestions for reducing them: opinions of drug injecting street outreach clients and other system stakeholders". American Journal of Drug and Alcohol Abuse (http://www.findarticles.com/p/articles/mi_m0978/is_1_30/ai_n6170830/pg_1).
  • Note 11: Qureshi NA, al-Ghamdy YS, al-Habeeb TA. (2000). "Drug addiction: a general review of new concepts and future challenges". East Mediterr Health J. (http://www.emro.who.int/Publications/EMHJ/0604/13.htm) Jul;6(4):723-33. PMID 11794078
  • Note 12: Board on Behavioral, Cognitive, and Sensory Sciences and Education (BCSSE). (2004) New Treatments for Addiction: Behavioral, Ethical, Legal, and Social Questions (http://www.nap.edu/books/0309091284/html/). The National Acadamies Press. pp. 7–8, 140–141
  • Note 13: WHO Expert Committee on Drug Dependence. Sixteenth report. Geneva, World Health Organization ,1969 (WHO Technical Report Series, No.407.
  • Note 14: Schaffer Library on Drug Policy - Perspectives on Defining Substance Abuse (http://www.druglibrary.org/schaffer/library/studies/ota/appc.htm)
  • Note 15: Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR (Text Revision) (Diagnostic and Statistical Manual of Mental Disorders) ISBN: 0890420254
  • Note 16: WURMSER, L. (1974) PSYCHOANALYTIC CONSIDERATIONS OF THE ETIOLOGY OF COMPULSIVE DRUG USE. J. AMER. PSYCHOANAL. ASSN., 22:820 (APA)

External links

  • National Institute on Drug Abuse (http://www.nida.nih.gov/NIDAHome.html), Part of US National Institute of Health. Focused on research of drug abuse and addiction.
  • American Journal of Drug and Alcohol Abuse (http://www.dekker.com/servlet/product/productid/ADA/toc), Focusing on the pre-clinical, clinical, pharmacological, administrative, and social aspects of substance misuse, this journal provides an exchange of ideas between the various modalities involved in the study and treatment of drug abuse and alcoholism.
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