NCBI Bookshelf. Drug Misuse: Psychosocial Interventions. This guideline is concerned with psychosocial treatment of the misuse of opioids, stimulants and cannabis. Opioid misuse occurs on a smaller scale but is associated with much greater rates of harm than either cocaine or cannabis.
Illicit use of opioids generally involves injecting, or inhaling the fumes produced by heating the drug.
Stimulants refer broadly to any substance that activates, enhances or increases neural activity WHO, Illicit stimulants include cocaine, crack cocaine and amphetamines. It is extracted from the leaf of the coca plant and generally sniffed in powder form. Crack cocaine is usually smoked but sometimes injected. Amphetamines are a group of synthetic substances with different chemical structures but broadly similar stimulant properties to cocaine, and include dexamphetamine sulphate a prescription drug d for the treatment of narcolepsy and attention-deficit hyperactivity disorder but which has misuse potential and methamphetamine.
Cannabis is a generic term denoting the various preparations of the cannabis sativa plant, including cannabis leaves the most common form, which is smokedhashish resin and the rarely used cannabis oil.
Tetrahydrocannabinol is the key constituent of cannabis that produces the psychoactive effect sought by most users, and the different forms of cannabis vary in their tetrahydrocannabinol content WHO, Drug misuse is defined as the use of a substance for a purpose not consistent with legal or medical guidelines WHO, It has a negative impact on health or functioning and may take the form of drug dependenceor be part of a wider spectrum of problematic or harmful behaviour DH, b.
In this guideline, dependence is defined as a what doe or sense of compulsion to take a substance, a difficulty in controlling its use, the presence of a physiological misuse state, tolerance of the use of the drug, neglect of mean pleasures and interests and persistent use of the drug, despite harm to oneself and others WHO, Dependence is diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders DSM -IV doe three or more of the following criteria are present in a month period: tolerance; withdrawal; increasing use over time; persistent or unsuccessful attempts to reduce use; preoccupation or excessive time spent on use or recovery from use; negative impact What social, occupational or recreational activity; and continued use despite evidence of its causing psychological or physical problems American Psychiatric Association [APA], The diagnosis of dependence is clearest with opioids.
The WHO states that:. Opioid misuse is not just a heavy use of the drug but a complex health connotation that has social, psychological and biological determinants and consequences, including changes in the brain. It is not a weakness of character or drug. However, dependenceas characterised by the above definition, can also occur with stimulants and cannabis. Repeated use of a drug can lead to the development of tolerance in which increased doses of the drug are required to produce the same effect. Tolerance develops to opioids, stimulants and cannabis.
Cessation of use le to reduced tolerance and this may present ificant risks for individuals who return to drug doses at a level to which they had ly developed tolerance. This can result in accidental overdoses and, in the case of opioid misuse, could lead to mean depression and death. Withdrawal syndromes have clearly been identified after cessation or reduction of opioid and stimulant use.
DSM -IV criteria for a withdrawal disorder include the development of a substance-specific syndrome due to cessation or reduction in use; the syndrome causing clinically ificant distress; and symptoms not due to a general medical condition or better explained by another mental disorder APA, While withdrawal effects have been associated with cessation of heavy cannabis use, their clinical ificance is uncertain at present Budney et al. Opioids, stimulants and cannabis also produce intoxication, that is, disturbances in psychophysiological functions and responses, including consciousness, cognition and behaviour, following administration WHO, These are described in greater detail in Section 3.
People who misuse drugs may present with a range of health and social problems other than dependencewhich may include particularly with opioid users :.
What is drug misuse?
Many people who misuse drugs use a range of substances concurrently and regularly known as polydrug misuse. People who misuse opioids in particular may often take a cocktail of substances, including alcohol, cannabis and prescribed drugs such as benzodiazepines, which can have especially dangerous effects in comparison with one of the does taken what. For example, more than 17, offences were reported by an NTORS cohort of participants in a day period before entering treatment Gossop et al.
Illicit drug use is also much more common among known offenders in the UK than among cohorts of comparable age drawn from the general population. The association between drug misuse and crime also applies in the younger population. In addition, young offenders who had taken a Class A misuse in the past year were more likely to be frequent offenders than those who reported using other types of drugs.
Drug treatment can lead to ificant reductions in mean levels Gossop et al. These figures are much lower for opioid use, with 0. However, estimates based on data that also take into other indicators such as current service usage provide an illicit drug-use figure of 9. Similar figures have emerged from Frischer and colleagueswho estimated 0. The epidemiology of drug misuse among young people differs considerably from that of the general population. Drug misuse is more common in certain vulnerable groups. For example, Ward and colleagues found that among care leavers aged between 14 and 24 years, drug misuse is much higher than in the general population, with three quarters of the sample having at some time misused a drug and over half having misused a drug in the month.
Drug misuse: psychosocial interventions.
There is also no question that numerous socioeconomic and psychological factors all play an important part in the aetiology of drug misuse. These conceptualisations are not mutually exclusive; rather they are facets of the multifactorial aetiology of drug misuse. The most robust evidence highlights peer drug use, availability of drugs and also elements of family interaction, including parental discipline and family cohesion, as ificant risk factors for drug misuse Frischer et al. Recent studies of twins, families and people who have been adopted suggest that vulnerability to drug misuse may also have a genetic component Prescott et al.
Risk factors for heavy, dependent drug use are much more ificant when they occur together rather than individually. The effects of many illicit drugs are mediated via various brain circuits, in particular the mesolimbic systems, which have evolved to respond to basic rewards such as food and sex to ensure survival. This has been well demonstrated in human brain-imaging studies Volkow et al.
Euphoria resulting from use then potentiates further use, particularly for those with a genetic vulnerability see below. Chronic drug use may produce long-lasting changes in the reward circuits, including reductions in dopamine receptor levels Volkow et al. In addition, other types of neurotransmitter systems for example, opioids, glutamates and cannabinoids are implicated in the misuse of specific drugs.
Although initiation into drug use does not lead inevitably to regular and problematic use for many people Anthony et al. Once dependence is established, particularly with opioids, there may be repeated cycles of cessation and relapse extending over decades National Consensus Development Panel on Effective Medical Treatment of Opiate Addiction, Vulnerability to use is highest among young people, with most problem drug users initiating by the age of 20 typically earlier for cannabis.
Individuals dependent on drugs often become so in their early twenties and may remain intermittently dependent for many years.
With cannabis and cocaine, recreational use is more common and it is likely that there are different patterns of use, with those taking cocaine being divided between those who take the drug on an episodic basis and those who take it daily; in contrast, usually only a small of people taking cannabis move to repeated daily increasingly heavy use, with many taking the drug intermittently.
A general US population survey of 8, individuals Anthony et al. The neurobiological of fundamental reward systems implicated in drug misuse may parallel the sociocultural—behavioural—cognitive model presented by Orford All involve activities that form strong attachment, and were once rewarding, but with excessive consumption result in compulsion and negative consequences. Secondary factors such as internal conflict knowing that the behaviour is harmful yet being unable to disengage from it potentiate these emotions and thus excessive use, but an alternative result is that the individual alters behaviour in order to resolve such conflict.
Misuse of prescription drugs research report
This crucially suggests that recovery is not impossible, but also that successful treatment attempts are likely to operate against a background of powerful natural processes Orford, Drug misuse is a relapsing and remitting condition often involving numerous treatment episodes over several years Marsden et al. Earlier initiation of drug use increases the likelihood of daily use, which in turn in a greater likelihood of dependence Kandel et al. Among people who misuse opioids, who form the predominant in-treatment population in the UK, most individuals develop dependence in their late teens or early twenties, several years after first using heroin, and continue using over the next 10—30 years.
Longitudinal data from the US also showed that the average time from first to last opioid use was 9. Although it is the case that problem drug users can cease drug use without any formal treatment Biernacki,particularly for individuals with primary cocaine or cannabis misuse, for many it is treatment that alters the course of opioid dependence.
Most initiation of cocaine use occurs around the age of 20, with the risk of cocaine dependence occurring early and explosively after first use, and persisting for an average of 10 years Anthony et al. Cannabis use typically begins in early adolescence with heaviest use in the 15—24 age group Harkin et al.
Is recreational use possible?
Most use tends to decline steadily from the mid 20s to the early 30s Bachman et al. Although drug misuse can affect all socioeconomic groups, deprivation and social exclusion are likely to make a ificant contribution to the maintenance of drug misuse ACMD, Factors that influence the cessation of drug use in adulthood are similar to those associated with lack of drug use in adolescence. Peer pressure is a major influence on experimental use and is also likely to affect a move towards regular use.
The level of drug use is again a clear predictor of continued use. Once an individual is dependent, drug use is generally a chronic condition, interspersed with periods of relapse and remission Marsden et al. Repeated interaction with the criminal justice system, long-term unemployment and increasing social isolation serve to further entrench drug use.
Drugs such as heroin and methadone are agonists, which stimulate the receptor.
Buprenorphine is a partial agonist ; that is, it occupies the receptor in the same way but only partially activates it. Soon after injection or inhalationheroin metabolises into morphine and binds to opioid receptors.
This is subjectively experienced as a euphoric rush, normally accompanied by a warm flush, dry mouth, and sometimes nausea, vomiting and severe itching. As the rush wears off, drowsiness, and slowing of cardiac function and breathing sometimes to the point of death in an overdosepersist for several hours National Institute on Drug Abuse [NIDA], a. The effects of methadone are similar but more drawn out and therefore less intense lasting up to 24 hours when taken orally as prescribed ; however, this may be circumvented by illicit users who inject the drug.
The most obvious consequence of long-term opioid use is the development of opioid dependence itself, and the associated harms.
Repeated injection will also have medical consequences, such as scarring, infection of blood vessels, abscesses, and compromised functioning of the kidney, liver and lungs with increased vulnerability to infections. As central nervous system stimulants, cocaine and amphetamine affect a of neurotransmitter systems in the brain but exert their effects primarily via dopamine, which mediates reward.
Cocaine blocks the presynaptic reuptake of dopamine, such that it is not removed from the intracellular space and le to extended firing of postsynaptic neurons, resulting in physiological arousal. Amphetamines also increase the availability of dopamine but are thought to do so by triggering a presynaptic leakage.
The acute subjective effects of cocaine are euphoria, increased energy, heightened alertness, sexual arousal, increased sociability and talkativeness. Physiologically there can be acute adverse effects on breathing, and the cardiovascular and central nervous systems: increased heart rate, blood pressure and body temperature, and pupil dilation. All these effects have near-immediate onset but also diminish quickly after roughly 15—30 minutes if the drug is snorted and 5—10 minutes if smokedas cocaine is metabolised rapidly by the body NIDA,