Effects of problematic substance use: physical and psychological harms

OutcomesThe aim of this learning resource is to identify the physical, psychological and social harms associated with the misuse of substances.

Specifically it will:

• Describe the main effects of the major substances.

• Outline the common harms linked to these substances.

• We will look at each category and identify what the substance is, its main effects, how it is used and what the potential major harms are.

• Go back to the resource ‘Definitions, categories and legal status’ for more on the categories of substances.

Opiates This group of drugs include heroin, diamorphine, oramorph, pethadine, morphine, diclofenac,codamol, codeine, tramadol.

Opiates - They link to opiate receptors in brain – the pleasure centre, they are non-toxic to the body.

Depressant - Opiates switch off arousal system after initial high therefore they slow the nervous system.

Tolerated - The body adapts quickly by stopping production of natural opiates (endorphins). Hence the need for sustained supplies.

Type of use - intravenous (IV) use with cut ‘dirt’ in unsterile conditions. Also associated with polydrug use – users commonly also use alcohol, cocaine and amphetamines with the opiate. Can be smoked which carries less risk of infection but still addictive.

Risks of opiate misuse(Webb et al 2003)

Overdose• Opiates cause stupor, anoxia, respiratory depression, inability to

self-protect such as not lying on your back when asleep or suffocating.

Health impact• There is a mortality risk from respiratory depression & choking,

infection, neural damage, brain damage, amputation, poor self-care – diet, gum disease, lice, etc

Social impact • Opiate misuse is commonly associated with crime, anti-social

behaviour, social alienation, depression, low self-esteem, poor parenting, relating, unemployment.

Alcohol (ethanol, C2H5OH)Toxic• It mimics GABA – a natural anxiolytic – therefore alcohol relaxes the drinker

Depressant• Alcohol switches off the neural arousal system (ARAS) so users fall asleep until

the system is clear of alcohol

Use • Regulated and so used and marketed legally

Overdose/intoxication • Too much alcohol can lead to death through respiratory failure, choking or an

accident

Withdrawal • Sudden withdrawal can cause status epilepticus (a seizure) and death typically

from cardiac failure or stroke.

AlcoholPhysical harm• death by overdose is rare but can happen,

especially to younger people. Physical harm and death is more likely to occur through accidents.

Social impact• anti social behaviour, unemployment,

social exclusion, family disruption, poor parenting, relating, poor self-care, depression, anxiety, poor self-esteem.

Stimulants and hallucinogens This group of drugs includes crack, cocaine, cannabis, amphetamines, metamphetamine, new psychoactive substances* (‘legal highs’), ecstasy, LSD, magic mushrooms) .

Effects• These speed up the nervous system impacting

on a whole body ‘fight or flight’ response.

Biological impacts • Stimulants can cause cardiovascular & respiratory problems,

psychosis, flashbacks, depression (crack crash & withdrawal – 96 hrs), anxiety, suicidal thoughts; risk-taking behaviour when high. Some new psychoactive substances carry a greater risk of acute toxicity and death (Abdulrahmin 2015).

*NPS could also be classed as depressants depending on their type.

Stimulants (uppers)

Behavioural impacts• Stimulants are not biologically addictive but do create a

‘psychological’ addiction. The drug can become highly important to the person (salience), leading to compulsive drug-seeking, social avoidance, lack of motivation, anti-social behaviour. There are strong cueing effects so being in a drug environment can lead to drug seeking.

Psychosocial• They can create a psychological dependency, and can cause

paranoia, social exclusion, social withdrawal, poverty, exploitation, mental illness.

References• Abdulrahim D & Bowden-Jones O, on behalf of the NEPTUNE Expert Group.

Guidance on the Management of Acute and Chronic Harms of Club Drugs and Novel Psychoactive Substances. Novel Psychoactive Treatment UK Network (NEPTUNE). London, 2015.

• NICE (2010) Alcohol-use disorders: preventing the development of hazardous and harmful drinking. NICE public health guidance 24.

• RSA (2007) Drugs – Facing Facts. RSA Commission on Illegal Drugs, Communities and Public Policy.

• Webb et al (2003) Cause and manner of death in drug-related fatality: an analysis of drug-related deaths recorded by coroners in England and Wales in 2000. Drug and Alcohol Dependence, 72, 67-74.

Resources• National Institute on Drug Abuse (USA)

http://www.drugabuse.gov/publications/drugfacts/drug-related-hospital-emergency-room-visits

• Talk to Frank – drugs A-Z http://www.talktofrank.com/drugs-a-z