Making Sense of Drug Use

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Making Sense of Drug Use


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A Basic Drive?

• Psychoactive drug use is a ubiquitous thread in
  human history.
• It has been argued that the pursuit of
  intoxication is a fourth basic physiological
  drive, along with hunger, thirst and sex.
• Room (1991)

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Shades of Grey

• With drugs there is pleasure and death and
  everything in between.The consequences form a
  spectrum, a continuum, infinite shades of grey.

Drugs in American Society, Eric Goode (1989)
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Drugs Defined

• A drug is
• any chemical substance which, when taken into
  the body alters its function physically and
  psychologically

any substance people consider to be a drug
with the understanding that this will change from
culture to culture and from time to time
WHO (1989)
Krivanek (1982)
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Key Motivators

• FUN (pleasure)
• FORGET (pain amelioration)
• FUNCTIONAL (purposeful).

• FUN (pleasure)
• FORGET (pain amelioration)
• FUNCTIONAL (purposeful).

• FUN (pleasure)
• FORGET (pain amelioration)
• FUNCTIONAL (purposeful).

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The Pursuit of Pleasure

• Much, if not most, drug use is motivated (at
  least initially) by the pursuit of pleasure.

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1. Risk-takers/ pleasure seekers2. Socially
disconnected3. Self-medicators.
Understanding Young Peoples Motivation to Use
Drugs
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Enormous variability and range
includesExperimenters Social users Regular
heavy users Dependent users.
Types of Drug Users
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A Typology of Users

• Considered rejectors Cocooned rejectors
  Ambivalent neutrals Risk controllers Thrill
  seekers / Careful curious
• Reality-swappers.

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Patterns of Drug Use
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Patterns of Drug Use
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Factors that Influence Drug Use

• There are at least three different categories of
  factors to consider. These are
• predisposing factors
• precipitating (enabling) factors
• perpetuating (reinforcing) factors.

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Social gradientEarly lifeWorkSocial
supportFoodStressSocial exclusionUnemployment
AddictionsTransport.
Social Determinants of Health
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Drugs and Genes

• While psychological theories account for a large
  proportion of the behaviours related to drug use,
  other factors are also important
• It is increasingly recognised that genes play an
  important role in an individuals response to
  drugs and the propensity for the development of
  dependence.

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Environmental Factors

• A range of environmental factors impact on drug
  use, including price and availability of both
  licit and illicit drugs
• Cultural norms around drug use also act as
  powerful determinants of the use of both licit
  and illicit substances.

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Psychoactive Drugs (1)

• Psychoactive drugs are generally defined as
  substances which alter
• mood
• cognition (thoughts)
• behaviour.

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Psychoactive Drugs (2)

• Affect mental processes and behaviour
• Affect thought processes and actions
• Alter perceptions of reality
• Change level of alertness, response time and
  perception of the world
• Achieve effects by interacting with the Central
  Nervous System (CNS).

Carmichael (2001)
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Psychoactive Drug Use

• Is a common activity
• Is part of a range of human behaviours
• Can be classified in many ways, including legal
  status, drug effects
• Alters mood or consciousness, although there are
  other ways to achieve this
• e.g., skydiving, meditation, extreme (and
  non-extreme) sport, sex. Children, for example,
  love to alter their consciousness by spinning
  around.

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Views About AOD-related Issues
Our thinking about AOD related issues is
informed by factors such as

• experience
• culture
• education
• religion

• family / environment
• legislation
• theory.

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Differing Views of Drug Use

• In drunkenness of all degrees of every variety,
• the church sees only the sin,
• the world only the vice,
• the state the crime.
• On the other hand, the medical profession
• uncovers a condition of disease.

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Psychoactive drugs may be classified according
to their
Drug Classifications

• 1. status
• legal
• chemical
• medical
• social.

• 2. action and properties
• depressant
• stimulant
• hallucinogenic etc.

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Psychoactive drugs may be classified according
to their
Drug Classifications

• 1. status
• legal
• chemical
• medical
• social.

• 2. action and properties
• depressant
• stimulant
• hallucinogenic etc.

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Classifying Psychoactive Drugs
Cannabis has unique properties CNS
depressant but hallucinogenic effects at high
doses.
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Health Perspectives

• Most AOD use is experimental or recreational
• Most AOD use can be considered functional
• The period of illicit drug use for most people
  is relatively short
• Only a minority develop dependence.

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Drug Use and Health (1)

• General Practitioners will
• see many people using AOD in harmful ways
• have to treat the effects of harmful patterns of
  use
• be asked for help by family or friends
• be seen as credible health experts
• have opportunity for early intervention
• through their prescribing role, be a source of
  drugs that may cause problems for some people.

Hamilton Cape (2002, p. 15)
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Drug Use and Health (2)

• Patients with drug problems
• often have multiple health and social problems
• expect doctors to ask and provide information
  about AOD issues failure to inquire may lead to
  medical malpractice in some situations
• In addition
• some interventions are simple, brief and
  effective
• successful treatments are usually selective and
  targeted
• new and promising treatments often require
  medical involvement.

Hamilton Cape (2002, p. 15)
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Models of Drug Use (1)

• Moral
• Pharmacological
• Disease
• Cognitive
• Social learning
• Public health
• Educational
• Sociocultural
• Legal
• Biological
• Spiritual.

• Consider
• prevailing attitudes and beliefs
• time period
• culture of user
• substance itself
• who uses
• who defines the problems.

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Models of Drug Use (2)

• Advantages
• provide a framework to simplify complexity
• allow prediction
• enable commonality of language
• define what is relevant
• suggest interventions
• are useful if flexible and able to change in
  response to new data.

• Disadvantages
• can be rigid and inflexible
• may label or compartmentalise people and their
  behaviours inappropriately.

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Types of Problems

• Different patterns of drug use result in
  different types of problems.
• Drug use may affect all areas of a patients life
  and problems are not restricted to dependent drug
  use.

Regular / excessive Use health finances relationsh
ips child neglect
Intoxication accidents / injury poisoning /
hangovers absenteeism high risk behaviour
Dependence impaired control drug-centred
behaviour anxiety / isolation / social
problems withdrawal
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Types of Problems

• Different patterns of drug use result in
  different types of problems.
• Drug use may affect all areas of a patients life
  and problems are not restricted to dependent drug
  use.

Regular/excessive Use health finances relationship
s child neglect
Intoxication accidents/injury poisoning/hangovers
absenteeism high-risk behaviour
Dependence impaired control drug-centred
behaviour anxiety/isolation/social
problems withdrawal
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Problems Related to Intoxication

• It is impossible to quantify objectively such
  widespread damage.
• The economic costs of familiar violence,
  personal distress over fatal or disabling
  accidents, and the societal cost in terms of
  police manpower, court time, medical and related
  services, industrial inefficiency, and wasted
  potential cannot be gauged.
• Unfortunately so extensive is this carnage that
  our society has become inured to the costs, and
  this is specially so against a mass background of
  advertising which glamorises and sanitises
  alcohol.

Saunders (1986) cited in Helfgott (1996)
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Dependence

• Substance dependence is a condition
  characterised by a combination of physical
  changes, psychological states and behaviours that
  gives drug use greater priority over other
  activities.

Carmichael (2001, p. 30)
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An Interactive Model of Drug Use
Drug
route effects actions purity potency quality
form price availability interaction with other
drugs previous experience
The Drug Use Experience
Environment
Individual
where when who how employment social
context supply peers legality culture media
advertising availability
physical / emotional reaction mood current
health age tolerance knowledge beliefs
memories expectations
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Public Health Model

• Emerged in 1960s
• Drinking was considered a learned or functional
  behaviour
• Drinking was considered neither good nor bad.
• The effects of alcohol/drugs depend on the drug,
  set and setting.

Clarke et al. (2002, p. 17)
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Public Health Model

• Emerged in 1960s
• Drinking was considered a learned or functional
  behaviour
• Drinking was considered neither good nor bad.
• The effects of alcohol/drugs depend on the drug,
  set and setting

Clarke et al. (2002, p. 17)
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A Health Promotion Framework
For Identifying Factors Associated With or
Contributing to a Health Problem
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Health Promotion
Addressing Risk Factors
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Drug Prevention Strategies
Individual Interventions
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Risk Factors for Problematic Drug Use

• Individual
• Genetic predisposition, behavioural undercontrol
• Personality (lack social bonding, resistance to
  authority)
• Drug knowledge
• Academic problems
• Early age of first use.
• Family
• Ineffective parental techniques
• Negative communication
• Poor family relationships.

• Local Environment
• Traumatic experiences (child abuse, refugee
  status)
• SES (socioeconomic status)
• Support (peers, community)
• Labelling.
• Macro-environment
• Legislation
• Law enforcement
• Drug availability
• Social message re drug use and related problems.

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