Drug abuse

Summary

• Drug abuse, particularly the abuse of illegal drugs, may lead to a variety of health and social problems, physical dependence and psychological addiction.
• Almost three-quarters of drug users start taking drugs in their teens.
• Drug abuse is a growing problem, and more and more youngsters are getting involved in the use of illegal drugs, such as cocaine, heroin and dagga.
  

Drug abuse and addiction
Addiction usually refers to continued drug use, even when users know that it is harmful to their health and interferes with their general ability to function.

When someone has been taking an opiate on a regular basis, the brain adapts and changes its circuitry. However, when the opiate is no longer taken, inhibited neurons start functioning again, causing an imbalance of chemicals in the brain, which interacts with the nervous system to produce classic withdrawal symptoms.

The reasons for the abuse of any type of drug are:

• Habit
• To alter mood
• To improve health
• To cope with personal, social or interpersonal situations
• Stress relief
• To forget or escape from problems
• To be a rebel and a risk-taker
• Relief of boredom/desire to have fun
• To escape from making difficult decisions
• To feel special
• To be part of a certain group of people
• Addiction
• Curiosity
• For enjoyment, personal taste [according to the Medical Research Council (MRC)]

Drug abuse trends in SA
Studies by the MRC have revealed the extent and nature of drug abuse in South Africa:

• Ecstasy, LSD and Speed are used more commonly by youngsters. This also applies to the inhaling of solvents.
• Dagga, Mandrax and glue are mainly used by people from disadvantaged communities, while cocaine and Ecstasy are more commonly used by people from the middle and upper classes.
• Dagga, Mandrax, alcohol and crack are frequently used by sex workers.
• With the exclusion of alcohol, the most common way of ingesting drugs is through smoking.
• Local research has found that the rate of foetal alcohol syndrome in certain high-risk communities is in excess of 30 per 1000. This is at least three times higher than the highest rates reported in high-risk communities in the USA.
• The MRC estimates that crime committed in South Africa in order to support people's drug habits adds up to more than R10 billion per year.

Tips for dealing with drug abusers

• Listen to what they are saying and the feelings behind their words.
• Educate yourself and your children about the (positive and negative) effects and risks of using mood altering substances. Allow your children to educate you.
• Take a stand against the use of alcohol and other drugs. Set clear standards of behaviour and reaction that you are willing and able to enforce. (Avoid delayed reaction and empty threats that don't make sense.)
• Be prepared to do without their affection for a while and avoid taking on guilt for their poor decisions.
• Discuss topics like the use of drugs and alcohol in a caring and sharing atmosphere. (In the case of children, don't moralise or shame them. Let them explain their views, share your own values and explain why you feel the way you do.)
• Practise what you preach and be a positive role-model (e.g. how to relax or have fun without alcohol).
• Mentor them by showing an interest in their life and encourage healthy and fun activities that are alcohol and drug free.
• Get to know your child's activities, friends and teachers.
• Get support. Know where to get help and don't be afraid to ask. (You'll probably find many others in a similar situation.)
• Connect with others who share your concerns.

Treatment

The best treatment for people who abuse drugs is a drug rehabilitation programme, in conjunction with counselling.

Different types of substances

The three types of substances that are most commonly abused are:

• Opiates: This group includes heroin, morphine and opium. They mimic endorphins (the brain's feel-good hormones) and bring about a state of peaceful euphoria.
• Amphetamines: They stimulate the nervous system. Cocaine, nicotine, Ecstasy and speed fall into this group. These are the so-called "uppers".
• Downers: namely alcohol and barbiturates. These are nervous system depressants. Alcohol is legal, but can produce very similar effects to mind-altering substances. Alcohol detoxification can be quite dramatic and in severe cases resemble heroin detoxification.

Commonly used drugs

Cocaine:

• A white powdery substance made from coca leaves or manufactured synthetically. It is a local anaesthetic and acts as a stimulant to the central nervous system.
• It is also referred to as Coke, Crack, Dust or Snow.
• Cocaine is inhaled, injected, smoked or applied directly to the nasal membrane or gums. Inhaled doses are usually between 125 and 150 mg.
• Excessive cocaine use often leads to death from cardiac or respiratory arrest.
• Other physiological symptoms of excessive long-term use are: ulceration of the nasal membrane, weight loss, tremors, insomnia, impotence, constipation and seizures.
• Personality changes brought on by excessive use include a sudden onset of deceptive behaviour, stealing, a superior attitude, short-temperedness, work-related problems, depression, being accident-prone, confusion, anxiety, paranoia, dulled emotional responses and a loss of interest in sex.
• Cocaine can cause a tremendous increase in blood pressure that can lead to bleeding on the brain. If blood vessels constrict, it can lead to a stroke. Respiratory and heart failure could result in death.

Ecstasy:

• Ecstasy tablets are generally used in pill form.
• They are usually small and white, but are also sometimes brown and yellow, depending on the source.
• They can be pulverised and snorted or injected, but this is not common in South Africa.
• Ecstasy is known by a number of names on the street, e.g. "E", Swallows, White Doves, Yellow Callies, X, XTC, Love Doves.
• Excessive use can be anything more than one tablet. Although few people have died from an Ecstasy overdose, its use in conjunction with other drugs can be very dangerous.
• Ecstasy use over an extended period changes the structure of the brain and "prunes" serotonin receptors.
• It is thought that it might, in the long run, inhibit the body's ability to produce serotonin, which is the "feel-good" hormone produced in the brain.
• There have been cases of people dying of heat stroke, heart failure, stroke, blood clotting and liver damage after using Ecstasy, but effects differ vastly from one individual to another.
• The psychological effects of heavy use have been known to include fits of depression, anxiety attacks and feelings of intense paranoia.

Heroin:

• Pure heroin is a white powder with a bitter taste.
• Most illicit heroin is distributed in powder form. It may vary in colour from white to dark brown, because of impurities from the manufacturing process or the presence of additives.
• Because it physically resembles many other pulverised products on the market, many things can be added to it without users becoming overly suspicious.
• On the street, heroin has many different names, e.g. Smack, Junk, Thai White and Jive.
• Heroin is most often injected. However, high-purity heroin may also be snorted or smoked.
• It is also sometimes used in conjunction with other drugs, but a lot less often than substances like dagga.
• It is usually heated on tin foil, usually over an open flame, so that it liquefies; it is then injected.
• Counsellors say that because heroin is so highly addictive, there is no such thing as moderate use of heroin. Once is too often.
• The symptoms of heroin use include mood swings, personality changes, dilated pupils, changes in weight and general appearance (looking worse), slurred speech, decreased sex drive and retarded social and emotional development.
• It is easy to overdose on heroin as the strength of the drug is uncertain at best. It can lead to unconsciousness and respiratory failure.
• Hospitals can usually diagnose heroin overdose by the needle marks on the body of the patient.
• Smaller doses can lead to severe agitation and psychotic attacks, high fever, coupled with dehydration and bleeding disorders.

Mandrax:

• Mandrax was initially marketed as a sedative or sleeping tablet by French pharmaceutical giant Roussel Laboratories. It turned out to be highly addictive and was banned in 1977.
• Mandrax tablets are also known as Buttons, Whites and Mandies.
• It can be swallowed or injected, but is usually smoked.
• The tablets are usually crushed and mixed with dagga and then smoked, using a pipe or a bottleneck. This pipe is also known as a "white pipe".
• Nausea, vomiting and stomach pains are not unusual.
• A user will often have red, glazed or puffy eyes, especially if Mandrax is taken with dagga.
• Increased usage in order to achieve the same effects as before is usually the first sign of the development of a full-scale addiction.
• In many cases users feel tired after taking Mandrax and may sleep for long periods.
• Depression is also not uncommon and is part and parcel of the Mandrax "hangover".
• This often leads to extended use of Mandrax to counteract the negative and unpleasant feelings.

Dagga:

• Dagga looks a bit like loose tobacco. It consists of the dry leaves of the Cannabis sativa plant.
• The dried leaves are brown or dark green in colour and also look a bit like mixed herbs. Dagga is relatively cheap.
• The active ingredient of dagga is THC (tetrahydracannabinol).
• Dagga is either smoked or ingested.
• It is often mixed into dough and baked and is also used like tea leaves.
• It is also sometimes mixed with methaqualone-powder to make a "white pipe", for which a bottleneck is often used.
• Many users roll their own cigarettes, sometimes mixed with normal tobacco.
• Dagga is often mixed and inhaled with other substances, such as Mandrax.
• Some drug counsellors see dagga as a portal drug, in other words a drug which introduces a potential drug addict to other mind-altering substances.
• One has to use vast quantities of dagga over a long period of time before the symptoms of drug abuse become as apparent as in the case of heroin and cocaine.
• People who smoke only five joints a week expose themselves to as many cancer-causing chemicals as people who smoke a pack of cigarettes a day. They inhale more deeply and keep the smoke in their lungs for longer.

The effects of long term use of dagga include:

• Glassy, red eyes
• Socially inappropriate behaviour such as loud talking and puzzling bursts of laughter
• Sleepiness, often at strange times
• A sweet, burnt scent on the user, or in the room
• Loss of interest in activities formerly enjoyed
• Loss of motivation
• Weight gain or loss
• Lung and respiratory problems related to smoke inhalation
• Concentration difficulties
• Memory lapses
• Difficulty learning new things

Inhalants:

• Inhalants come in many different forms - from glue to petrol to laughing gas and "poppers".
• Glue is the most commonly abused inhalant in South Africa and glue-sniffing is prevalent amongst many young children, many of whom who live on the streets.
• Many people do not see inhalants as drugs because they are freely available in the home or workplace, and they have other uses. These inhalants give off breathable chemical vapours that can have mind-altering effects.
• The different categories of inhalants are:

Solvents - household or industrial, such as paint thinners and different types of glue

Art or office supply solvents - correction fluids, felt-tip marker fluid

Gases - these are used in many products including lighters or refrigeration gases.

Aerosol propellants - spray paints, hair or deodorant sprays

Medical anaesthetic gases - ether chloroform and laughing gas

Amyl nitrate -also known as poppers

• Inhalants are breathed in through the nose or the mouth. Often a paper or plastic bag is held over the substance. This concentrates whatever substance is being inhaled.
• Physical effects can be very serious and include liver and kidney damage, blood oxygen depletion, suffocation, heart failure and sudden death.
• It also appears that people who are HIV positive tend to develop Karposi's sarcoma (the most common form of cancer amongst AIDS patients) more frequently if they have a history of using poppers.