Transcript What is a psychoactive drug

Making Sense of
Drug Use
Making Sense of Drug Use
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)
Making Sense of Drug Use
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)
Making Sense of Drug Use
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)
Making Sense of Drug Use
Key Motivators
• FUN (pleasure)
• FORGET (pain amelioration)
• FUNCTIONAL (purposeful).
Making Sense of Drug Use
The Pursuit of Pleasure
• Much, if not most,
drug use
is motivated
(at least initially)
by the pursuit of
pleasure.
Making Sense of Drug Use
Understanding Young People’s
Motivation to Use Drugs
1. Risk-takers/
pleasure seekers
2. Socially
disconnected
3. Self-medicators.
Making Sense of Drug Use
Types of Drug Users
Enormous variability
and range includes…
Experimenters
Social users
Regular heavy users
Dependent users.
Making Sense of Drug Use
A Typology of Users
Considered rejectors
Cocooned rejectors
Ambivalent neutrals
Risk controllers
Thrill seekers / Careful curious
Reality-swappers.
Making Sense of Drug Use
Patterns of Drug Use
dependent
intensive
purposive
experimental
Making Sense of Drug Use
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.
Making Sense of Drug Use
Social Determinants of Health
Social gradient
Early life
Work
Social support
Food
Stress
Social exclusion
Unemployment
Addictions
Transport.
Making Sense of Drug Use
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 individual’s response
to drugs and the propensity for
the development of
dependence.
Making Sense of Drug Use
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.
Making Sense of Drug Use
Psychoactive Drugs (1)
• Psychoactive drugs are generally defined as
substances which alter:
– mood
– cognition (thoughts)
– behaviour.
Making Sense of Drug Use
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)
Making Sense of Drug Use
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’.
Making Sense of Drug Use
Views About
AOD-related Issues
Our thinking about AOD related issues is
informed by factors such as:
•
•
•
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experience
culture
education
religion
• family / environment
• legislation
• theory.
Making Sense of Drug Use
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.”
Making Sense of Drug Use
Drug Classifications
Psychoactive drugs may be classified
according to their:
1. status
• legal
• chemical
• medical
• social.
2. action and properties
• depressant
• stimulant
• hallucinogenic etc.
Making Sense of Drug Use
Classifying Psychoactive Drugs
Depressants
Stimulants
Hallucinogens
Alcohol
Amphetamines
Benzodiazepines
Nicotine
LSD, DMT, magic
mushrooms, morning
glory
Mescaline, MDMA, DOB,
DOM/STP
Opioids
Cocaine
PCP, Ketamine
Solvents
Caffeine
Cannabis* (in high doses)
Barbiturates
Khat
Other (e.g. nutmeg/mace,
catnip, N2O, amyl or butyl
nitrite)
Cannabis*
* Cannabis has unique properties –
CNS depressant but hallucinogenic effects at high doses.
Making Sense of Drug Use
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.
Making Sense of Drug Use
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)
Making Sense of Drug Use
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)
Making Sense of Drug Use
Models of Drug Use (1)
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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.
Making Sense of Drug Use
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.
Making Sense of Drug Use
Types of Problems
Different patterns of drug use result in different types of problems.
Drug use may affect all areas of a patient’s life and problems are
not restricted to dependent drug use.
Intoxication
accidents / injury
poisoning / hangovers
absenteeism
high risk behaviour
I
R
D
Regular / excessive
Use
health
finances
relationships
child neglect
Dependence
impaired control
drug-centred behaviour
anxiety / isolation / social problems
withdrawal
Making Sense of Drug Use
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)
Making Sense of Drug Use
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)
Making Sense of Drug Use
An Interactive Model of Drug Use
route effects actions Drug form price availability
purity potency quality
interaction with other drugs
previous experience
The Drug Use
Experience
Individual
physical / emotional reaction
mood current health age
tolerance knowledge beliefs
memories expectations
Environment
where when who how
employment social context
supply peers legality culture
media advertising availability
Making Sense of Drug Use
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.
Person/
host
SET
Agent/
DRUG
Clarke et al. (2002, p. 17)
Environment/
SETTING
Making Sense of Drug Use
A Health Promotion Framework
For Identifying Factors Associated With or
Contributing to a Health Problem
Factor
Some Examples
individual
attitudes, knowledge, values and
beliefs
role models, social support
social
environmental
health service
financial
political
legislative
physical support, housing,
transport
availability, accessibility
financial incentives for
prevention
political self-efficacy,
opportunities for participation in
decision making
laws, regulations
Making Sense of Drug Use
Health Promotion
Addressing Risk Factors
Risk Factor
Description
Example
Predisposing
factors
Factors that predispose Intrapersonal
people to act in a certain stress
way
Enabling factors
Factors that enable a
Ready
behaviour or situation to availability of
occur
cheap drugs
Reinforcing
Factors that reward or
punish a behaviour, or
maintain a situation
Stress reduction
or pleasure
Making Sense of Drug Use
Drug Prevention Strategies
Individual Interventions
Objective
Rationale
Efficacy
 fear of drugs
scare tactics (deterrent)
Ineffective or
counterproductive
 perception of
drug-related harms
Information about risks
Ineffective or
and harms to assist
counterproductive if
informed decision-making information biased, or
misleading
Young people use drugs Ineffective or
due to low self-esteem
counterproductive:
low self-esteem is not
predictive of drug use
Young people are
Ineffective or small,
pressured to use as they short-term positive impact
lack the skills to resist
(depending on information
peer pressure
quality)
 psychological health
(e.g. self-esteem)
 social skills
(e.g. assertiveness
Making Sense of Drug Use
Risk Factors for
Problematic Drug Use
Individual
Local Environment
• Genetic predisposition,
behavioural undercontrol
• Personality (lack social bonding,
resistance to authority)
• Drug knowledge
• Academic problems
• Early age of first use.
• Traumatic experiences (child
abuse, refugee status)
• SES (socioeconomic status)
• Support (peers, community)
• Labelling.
Macro-environment
Family
• Ineffective parental techniques
• Negative communication
• Poor family relationships.
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Legislation
Law enforcement
Drug availability
Social message re drug use
and related problems.
Making Sense of Drug Use
Risk Factor
Child
Family
School
context
Protective Factor
 prematurity,
 social competence, IQ,
intelligence, insecure
family attachment,
attachment, alienation,
problem solving,
chronic illness
school achievement
 parental characteristics,  supportive parents and
family environment,
family harmony,
parental style
responsibility, strong norms
 academic failure,
inadequate behaviour
management
Life events  divorce, war
Community  low socioeconomic
status, poor social
and
supports
cultural
 positive school climate,
pro-social peer group,
responsibility,
sense of belonging
 meeting significant person,
opportunities at crucial
points
 access to support services,
community attachment,
strong cultural identify
Making Sense of Drug Use