Health Sciences Center Library, Kuwait University

Substance Use Disorders

The variety of substances abused is very wide, but common ones are stimulants (cocaine, amphetamine and ecstasy), sedatives (temazepam and diazepam), hallucinogens (LSD, magic mushrooms), opioids, cannabis and tobacco.

Experimentation with one or more (polydrug abuse) drugs is particularly common amongst teenagers. Some people use drugs recreationally (e.g. at weekends only). Regular use (e.g. daily) may lead to dependency (e.g. opiates) where continued use is required to prevent withdrawal symptoms.

This section will cover some of the common drugs of misuse.

Cannabis (Dope, Hash, Weed, Skunk and Tack.)

The active element is Tetrahydrocannabinol It is usually smoked, producing a profound sense of relaxation and mild euphoria.. Its use is widespread and subject to controversy about whether it should be legalised.

It may produce mild paranoid ideation. There are some suggestions that it can produce an acute confusional state with delusions and hallucinations. It is now being used increasingly by those suffering chronic disorders such as multiple sclerosis allegedly for pain relief.

Stimulants (Amphetamine, MDA family (MDMA - Ecstasy/E, MDEA, MDA)

When ingested they produce an elevation of mood, increased alertness and physical activity. They may be taken orally or injected intravenously (amphetamine). Rapid tolerance is common.

Amphetamine can cause what is known as Amphetamine Psychosis - a florid, schizophrenia like illness. The condition usually subsides in about a week though it can occasionally persist for months.

Sedatives - Benzodiazepines especially Temazepam ('Wobbly Eggs')

Many problems with benzodiazepines were, until recently iatrogenic.

Though benzodiazepines were initially considered safe hypnotic and anxiolytic drugs their capacity to produce tolerance, dependency and withdrawal states is now widely recognised. Hence, they are now used only for short courses of treatment and short acting variants e.g. Lorazepam should be avoided in most circumstances.

In more recent times, injecting the short-acting drug, Temazepam has become widespread practice, leading to it being rescheduled under the Misuse of Drugs Act.

Hallucinogens (LSD (acid) Phencyclidine (Angel Dust), Magic Mushrooms)

These have been known and used for many years. They are usually taken orally, giving rise to heightened perceptions, vivid imagery, illusions and hallucinations and often a state of euphoria. Sometimes a 'bad trip' occurs with terrifying hallucinations and delusional thinking.

Those who use the drug regularly may experience 'flash backs' to a 'bad trip'. Neurological damage can occur.

Cocaine (and Crack Cocaine)

This stimulant is derived from the leaves of the Coca plant. It is usually smoked or snorted although it can also be injected intravenously. In the North East of England, its use has been limited by its very high price but this is changing.

It rapidly produces CNS stimulation and a sense of euphoria. Persons often develop a craving for cocaine, tolerance and psychological dependency. Chronic usage can lead to paranoid psychosis. Cocaine abusers sometimes experience Formication (Cocaine bugs), a feeling as if insects are crawling under the skin.

Opiates

These are a group of alkaloids, diamorphine (heroin) being the most commonly abused among them. They are frequently inhaled (smoked) but may be taken intravenously. They produce a sense of euphoria, detachment and well being in addition to analgesia. They are rapidly fatal in overdose - often by respiratory depression, which leads to cardiac arrest.

Prolonged use leads to the development of tolerance and dependency. Cessation of use leads to an unpleasant though not life-threatening (c.f. alcohol) withdrawal state ('Cold Turkey') characterised by:

Restlessness, insomnia, piloerection, pupillary dilatation, nasal discharge, sweating, vomiting, diarrhoea, abdominal pain, hyperaesthesia, paraesthesia and cramps.

Harmful Effects of Drug Use

Harmful effects of drug use Drug users, particularly injecting drug users, have high morbidity and mortality rates. Complications of drug use may be related to:

Drugs effects (intoxication, dependence / withdrawal, accidental overdose )
Social problems related to the drug use (legal, financial, family problems and occupational).
Method of administration (needle sharing, unsterile injecting techniques and contaminants like talc) which can cause infections such as tetanus, abscesses, endocarditis, hepatitis B/C/D, HIV , HTLV and septicaemia.
Miscellaneous non-infectious medical problems, pertaining to different organ systems:
1. Vascular: Track marks, thrombophlebitis, venous thrombosis and arterial insufficiency.
2. Pulmonary: Respiratory failure (excess sedatives/opiates/stimulants), pulmonary oedema (opiates, cocaine), polyarteritis nodosa (due to hepatitis B), pulmonary hypertension (talc granulomas), pulmonary emboli.
3. Neuro-psychiatric: Psychosis, depression, neuropathy and brain damage.

Treatment of Substance Misuse

The key to successful intervention is to bring about change; in the individual, his/her life situation or the availability of drugs, otherwise continued drug taking is likely. The first step is a thorough and accurate assessment. General measures of intervention aim at long term change and may involve one or more of the following:

Establishing a therapeutic/supportive relationship
Motivational interviewing
Behavioural techniques
Cognitive behavioural therapy
Contingency management
Cue exposure
Relapse prevention
Group/family therapy, drug counselling

In addition, specific drug related problems might require treatment (e.g. physical or psychiatric illness).

Specific Treatment Approaches

Detoxification - Although opiate withdrawal is not fatal it can be very unpleasant deterring the client from abstaining. Detoxification can be carried out relatively rapidly as an in-patient, or more slowly (sometimes after a period of stabilisation) as an out-patient using, for example, methadone (an opioid with long duration of action).
Harm reduction/minimisation
Many clients will choose to continue using drugs despite intervention. For these limiting harm may be the aim and includes needle/syringe exchange facilities and methadone maintenance programmes.
Rehabilitation/therapeutic communities
Self-help groups e.g. narcotics anonymous

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