CLASSIFICATION OF

DRUGS OF ABUSE 1. Drugs that reduce pain

Opiates, opioids, narcotic analgesics

2. Drugs that depress the nervous system

Alcohol, Benzodiazepines, Solvents and Gases

3. Drugs that stimulate the nervous system

Amphetamines, Cocaine, Alkyl Nitrites

Hallucinogenic Amphetamines: MDMA etc

Nicotine, Caffeine

4. Drugs that alter perceptual function

LSD, Hallucinogenic mushrooms,Cannabis, Mescaline

5. Drugs that affect the endocrine system

Anabolic Steroids

Alcohol• “1 Unit” ( = approximately 8 grams of Absolute Alcohol)• ½ Pint Beer or Cider• 1 Glass Table Wine (weak)• 1 small glass Sherry/Martini • 1 single ‘pub’ measure of spirits (1/6th Gill)count as units

Caffeine• 1 cup of Tea 40 mg• 1 cup of Instant Coffee 80mg• 1 cup of Fresh Coffee 120mg• (wide variation: Tea 8 – 91mg)• 1 can of Coca Cola (12oz) 46mgCount as cups of tea-equivalent

Nicotine• (100 mcg per puff)count number of cigarettes/week

Prescribed Psychotropic Drugs• (Hypnotics, Tranquillisers etc)count weekly dose

“Illicit Drugs”Describe week’s usage

0 10 20 30 40 50 60

Reasons for Drinking1988/9 (9 months only n=319)

Not known

Don’t know/none

Habit/dependency

Loneliness/depression/confidence

For physical effect

Reduce tension/anxiety

Boredom/something to do

Avoid withdrawals

Social/family pressure

Work pressures

Life pressures/oblivion

Sleep problems

Enjoys it

Other

0 10 20 30 40 50 60

Reasons for Drug TakingCDT 1988/9 n=196

Not known

Don’t know/none

Habit/dependency

Loneliness/depression/confidence

For physical effect

Reduce tension/anxiety

Boredom/something to do

Avoid withdrawals

Social/family pressure

Work pressures

Life pressures/oblivion

Sleep problems

Enjoys it

Other

Are You An Alcoholic?

1. Is drinking making your home life unhappy?2. Do you drink because you are shy with other people?3. Is drinking affecting your reputation?4. Have you ever felt remorse after drinking?5. Have you ever got into financial difficulties as a result of drinking?6. Do you lose time from work due to drinking?7. Do you turn to lower companions and an inferior environment when drinking?8. Does your drinking make you careless of your family’s welfare?9. Has your ambition decreased since drinking?10. Do you crave a drink at a definite time daily?11. Do you want a drink the next morning?12. Has your efficiency decreased since drinking?13. Does drinking cause you to have difficulty in sleeping?14. Is drinking jeopardising your job or business?15. Do you drink to escape from worries and trouble?16. Do you drink alone?17. Have you ever had a complete loss of memory as a result of drinking?18. Has your physician ever treated you for drinking?19. Do you drink to build up your self-confidence?20. Have you ever been to a hospital or institution on account of drinking?

To answer this question, ask yourself the following questions and answer them as honestly as you can.

Are You An Alcoholic?

• If you have answered YES to any one of these questions, there is a definite warning that you may be an alcoholic.

• If you have answered YES to any two the chances are that you are an alcoholic.

• If you have answered YES to three or more, you are definitely an alcoholic.

• (The above Test Questions are used by John Hopkins Hospital, Baltimore, Md., in deciding whether of not a patient is alcoholic)

• The questioning or denial of the validity of this test could in itself be an early-warning symptom of the illness.

“Alcoholics are those excessive drinkers whose

dependence upon alcohol has attained such a

degree that it shows a noticeable mental

disturbance or an interference with their bodily

and mental health, their personal relations and

their smooth economic functioning, or who

show the signs of such development. They

therefore need treatment.”

World Health Organisation (1952)

A problem drinker is any person who

experiences social, psychological or

physical problems as a consequence

of his of her own repeated drinking of

alcohol (or the repeated drinking of others).

Kessel W.I.N. (Chairman) 1978

CORNERSTONES OF THE DISEASE CONCEPT

• Fundamental bodily differences? genetic

• Fundamentally different reaction to alcohol:CravingInability to abstain

• Inexorability

• Thus sick role is applicable

Genetics

• Family and Twin Studies

• Bodily Damage

• Drink Preference

• Alcohol Metabolism

• Autosomal Linkage

If you want to develop alcohol problems,

pick parents:

• who drink problematically themselves

• who do not drink at all

• one of whom drinks problematically whilst the other does not drink at all

Experimental studies on loss of control• No alcoholic subjects allowed to freely programme their ethanol

intake showed loss of control or drank to oblivion.

• No alcoholic subjects drank all alcohol available, even when freely offered.

• Alcoholics allowed to drink for 30-60 days continuously often started and stopped during this experimental period.

• Amount of alcohol consumed by alcoholics was shown to be a function of amount of work or effort required to obtain alcohol.

• With sufficient money or other social rewards, alcoholics will abstain even though alcohol is freely available.

• Alcoholics demonstrate the ability to taper their drinking to avoid severe consequences of abrupt withdrawal.

• Alcoholics display social drinking and periods of abstinence during the course of a drinking career.

• Priming doses of alcohol do not lead to increased reported craving.

Mello, Nancy. K. (1972)

MARLATT; Expectancy Effects

Told they had received Alcohol?

Actually received Alcohol?

Yes No

Yes 1 2

No 3 4

A Tentative Chart of Alcohol Addiction and Recovery

Reproduced by kind permission of Dr MM Glatt ©1974. From “A Guide to Addiction and it’s Treatment”. MTP. Lancaster. 1974.

15 25 25 25 25 25 25 Age

0

20

40

60

80

100

120

140 per 10,000 pop

Incidence

TheoreticalPrevalence

Actual Prevalence

Victoria DataDrew, L.R.H. (1968)

20191715 1814 161312119 108764 5321

20

10

40

30

50

55

0F

50%

100%N= 49 46 39 36N

Years

Social Drinking

Abstinence

Atypical Abuse

Typical Abuse

CORNERSTONES OF THE DISEASE CONCEPT

• Fundamental bodily differences? genetic

• Fundamentally different reaction to alcohol:CravingInability to abstain

• Inexorability

• Thus sick role is applicable

“Which size would you like – mild euphoria, tiresome aggressiveness, maudlin self-pity

or lying in the gutter?”

Responsibility for Drinking

Not at allresponsible

Totallyresponsible

60

50

40

30

20

10

54%

1 2 3 4 5 6 7 8 9 10

% c

lient

s

Deaths due to or associated with alcoholism, drunkenness offences, and consumption of spirits in England and Wales 1860 – 1974

197019601950194019301920191019001890188018701860

200

100

504030

20

10

5432

1

Registrar General’s Statistical Review of England and Wales, various years.Wilson, G.B. (1940). Alcohol and the Nation.The Brewers’ Society. Statistical Handbook (1974).

1. Drunkenness Offences 1860 - 1937 rate per total population1938 - 1959 rate per population aged 15 years and over1960 – 1973 rate per population aged 14 years and over

2. Logarithmic scale.

Source

Notes

100

504030

20

10

543

2

1

.5

.4

.3

.2

.1

Death rateper millionpopulation

Drunkennessoffences per 10,000population

ConsumptionProof gallonsPer capita

Distribution of Alcohol Consumption by 30 million adults in France if consumption is Ledermann Distributed

(G.H. Miller and N. Agnew)

5

4

3

2

1

0 10 20 30 40 50 60 70 80 90 100 110 120 130 140

Mill

ions

of D

rinke

rs

Annual Consumption in litres of Alcohol

The Ledermann Consumption Model

60

50

40

30

20

10

0 2 4 6 8 10 12 14 16 18 20 22

Per

cen

tag

e o

f al

l dr iv

ers

Average annual consumption per drinker

(gallons of spirits)

Norway 3.24

Canada 6.11

France 16.50

Risk of Liver Disease

Norway

Canada

France

Nº of consumers

Quantity Consumed

Low Medium High Risk

Male <21

Female <14

21-50

15-35

>50

>35

Quantity of Drinking (Typical Dose)By Age

Frequency of DrinkingBy Age

Occ. 1 2 3 4 5 60

1.8

1.6

1.4

1.2

1

0.8

0.6

Drinks per day

Rate Ratio

Accidents

Cancer

Cerebrovasc.

All Causes

CHD

Tobacco consumption in the UK from 1890 – 1968(Reprinted from Royal College of Physicians report, 1971)

1890 1900

12

10

8

6

4

2

0

We

igh

t o

f to

ba

cco

(in

po

un

ds

– s

olid

lin

e)

4

3

2

1

Nu

mb

er

of

cig

are

tte

s(in

th

ou

san

ds

– b

roke

n li

ne

)

Women

cigarettes

Men

All tobacco

Men

cigar

ette

s

War WarRCP

Report

‘10 ‘20 ‘30 ‘40 ‘50 ‘60 ‘70

Chronic Caffeine Intoxication

• Restlessness

• Nervousness

• Excitement

• Insomnia

• Flushed Face

• Diuresis

• Gastrontestinal Complaints

Caffeine Withdrawal

Symptoms start 12 - 24 hours aftercessation:

HeadacheDecreased Arousal

Fatigue(Muscle cramp)

(Sweating)(Anxiety/Irritability)

Symptoms peak at 20 - 45 hours andmay last for a week. They are removedby restitution of Caffeine)

Caffeine Implicated Diseases

• Cancer:

– Pancreas– Ovary (women)– ? Bladder (men)– (Protective against Colonic and Rectal cancers)– (No consistent data on other, esp. breast, upper GI tract)

• Cardiovascular Disease

– Caffeine transiently raises blood pressure but it doesn’t cause hypertension by itselfBut

– Positive interaction between stress and caffeine is a risk factor for hypertension

• Osteoporosis

• Premenstrual Syndrome

• Pregnancy and Foetal development

Number of Prescriptions

1960

50M

40M

30M

20M

10M

01970 1980 1990

Benzodiazepines

Barbiturates

31M

‘Addicts’ Notified to the Home Office (1970, 1980,

1992-1996)

0

5000

10000

15000

20000

25000

30000

35000

1970 1980 1992 1993 1994 1995 1996

Males

Females

Total quantity of drugs (kg) seized in the UK1977-87. Source: Home Office.

77

400

300

200

100

0 78 79 80 81 82 83 84 85 86 87

Heroin

Cocaine

Amphetamines

Year

Am

ount

of d

rug

(kg)

Seizures of Controlled Drugs in Different Parts of the UK

1987-1997

0

20000

40000

60000

80000

100000

120000

140000

1987

1989

1991

1993

1995

1997

England

Scotland

Wales

Northern Ireland

Drug-Related Deaths(1988-1995)

0

200

400

600

800

1000

1200

19

88

19

89

19

90

19

91

19

92

19

93

19

94

19

95

Drug dep/non depabuse

Poisoning

AIDS

Psychoactive Drug-Related Deaths in Perspective

0

20000

40000

60000

80000

100000

120000

Annual deaths

Illicit drugs

Alcohol

Tobacco

Drug Deaths: Type of Drug(1995)

Morphine type

Cocaine

Amphetamines

Ecstasy

Solvents

Various

Persons Convicted of Drug Offences (1987-1997)

0

20000

40000

60000

80000

100000

120000

140000

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

Males

Females

Drug Offences 1997

Cannabis

Amphetamines

Heroin

Cocaine

LSD

Ecstasy

Why Women in England & Wales Were Sentenced to Prison

1997

Theft & fraud

Violence & sexual

Drugs

Robbery

Burglary

Other

Past month's cannabis use in Britain & Netherlands

0

5

10

15

20

Age group

British crime survey, 1998

Netherlands survey, 1997

Use by age group, %

Source: Guardian October 11th 2000