Substance Use

Human beings have used brain and mental state altering substances from the beginning of civilization. Alcohol was probably the earliest drug used, from accidentally consuming fermenting fruit and grain. There is archaeological evidence to indicate the early use of substances like cannabis, opiates and cocaine too. The consequences and costs of alcohol must have become apparent very early, as there is evidence of severe strictures against the use of such drugs in early human societies. The popular belief continues to hold that these substances provide joy and enhance one’s brain and mental functions, but scientific evidence has yet to indicate any substance which enhances our thinking, emotion, memory, perception, consciousness or behavior. All these substances alter our mental functions, but there is little evidence to suggest that they enhance such functions.

The most dangerous drug people use is tobacco. An estimated 1.1 billion out of six billion people in the world use tobacco, causing over 4.2 million deaths an year. Approximately 11, 000 die every day from disorders related to tobacco use. We have heard about the HIV/AIDS epidemic, the SARS epidemic but not about the tobacco epidemic. The World Health Organization estimates that every year tobacco use kills more than AIDS, tuberculosis, maternal deaths, accidents, homicides and suicides put together. It is the most dangerous consumer product ever produced.

Alcohol, the second most commonly used and abused drug, is freely available in almost all countries. A third of the entire world health care cost is spent to treat disorders arising from alcohol and tobacco use. However, unlike tobacco (even one cigarette is harmful), there is no evidence to suggest that drinking within sensible and safe limits poses a health threat. The World Health Organization and the Royal College of Psychiatrists (U.K.) suggest that a person should drink no more than one or two drinks (a glass of wine, a measure of spirits, half a pint of beer) in any day and to include a few days of abstinence each week. Pregnant women should not drink at all as there is considerable evidence that drinking alcohol during pregnancy harms the fetus.

Caffeine, the mild stimulant in tea, coffee and other cola drinks, is perhaps the only drug we consume with little or no adverse health and social consequences. However, if the consumption is high enough a person could become addicted to caffeine and often anxiety symptoms stem from excessive caffeine.

Cannabis (marijuana) is the most commonly used illegal drug and world wide there are about 140 million users of this drug.

The use of heroin is estimated to have doubled or tripled since 1985. The risk of death, particularly among users who inject the drug, is about 20 to 30 times higher than non-drug users in the same age group.

Cocaine and its derivative “crack” cocaine has seen a global increase. Traditionally, people in Andean countries in South America chewed the coca leaves for thousands of years. It was relatively recently in 1860 when the main chemical, cocaine was isolated and became more widely available. In earlier times it was used mainly as a painkiller, but in the 1970s and 1980s it became very popular with young people in western European and North American countries.

It is perhaps more relevant and useful to look at these drugs through their action on the brain and the nervous system rather than in terms of legal or illegality of use. The objective evidence is that all these drugs tend to affect the brain and consequent behavior in an adverse manner. The responsibility of parents and educational institutions in particular, and society in general, is to give the skill to its young people to decide on the most healthy course of action in regard to use of substances of dependence. People need accurate objective information about drugs and society has a responsibility to protect children from exposure to drugs before they gain the skill and knowledge to make an informed choice. Research has revealed that educational programs focusing on learning how to manage emotions do better in persuading young people from using (no ‘of’ here) drugs, rather than direct programs focusing exclusively on drugs.

Promotion of healthy life styles should be given priority both for young and adult populations. These will include eating balanced meals, regular exercise, regular sleep, being engaged in a range of recreational and relaxation activities, being part of a supportive and affectionate social network, gaining abilities to solve routine life problems and to plan one’s life goals.

Every government has a responsibility to formulate and implement a national alcohol and drug policy to ensure a reduction in both supply and demand of drugs in a given country. Policies must work towards reducing availability of drugs, both legal and illegal, while health and educational policies must promote a reduction in demand for drugs. Research has again shown such preventive measures tend to give better value for money than money spent on treatment. This is so because treatment of the drug and alcohol dependent person is very challenging and the results are often disappointing.

In Bermuda a range of treatment services are available for persons having drug use related problems through a service known as Turning Point based at St Brendan’s Hospital. These include both in-and outpatient services provided by a multi disciplinary team of therapists. Outpatient services are available on all weekdays during working hours. In-patient treatment is provided by a detoxification unit, which helps patients withdraw from a drug under safe conditions. A team of therapists provides both psychological and pharmacological interventions and assists clients with their social problems. Turning Point encourages and welcomes the involvement of family and friends in the recovery programs of its clients.

In addition to the services provided by St Brendan’s Hospital, some non-governmental organizations also provide residential care. Alcoholics Anonymous and Narcotics Anonymous are the other therapeutic agencies, which help people with drug dependencies.

The availability of a range of therapies for alcohol, tobacco and other drug use related disorders needs to be emphasized and with good engagement in a therapy program many can look forward to a drug free life. Whether your addiction is tobacco, alcohol, heroin, cocaine or cannabis (marijuana) one can quit using their drug of dependence. A person may need to attempt several times before succeeding quitting and hence the phrase “DO NOT QUIT QUITING”.

Dr. Edirimuni Rodrigo completed his training in Sri Lanka and England, and is now a consultant psychiatrist at St. Brendan’s Hospital.

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