Dependence. Worldwide projected mortality. Youth risky behavior (substance abuse) and its relation with communicable diseases (HIV/AIDS, STD)

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1 Dependence Youth risky behavior (substance abuse) and its relation with communicable diseases (HIV/AIDS, STD) Dr. Aurelijus Veryga Kaunas university of medicine This is defined as: A cluster of behavioral, cognitive and physiological phenomena that develop after repeated substance use and that typically include a strong desire to take the drug, difficulties in controlling its use, persistent use despite harmful consequences, a higher priority given to drug use than to other activities and obligations, increased tolerance, and sometimes a withdrawal state. Development of addiction Euphoria Development of dependency for persons who tried drug 6 or more times (%) Abstinence Normal physical and psychological state Drug dose Tobacco 87 Cocaine 86 Heroin 82 Alcohol 54 Amfetamin 44 Cannabis 42 Woody et al, 1993 Tobacco s public health toll worldwide One-third of the adult global population smokes 1 Approximately 1.3 billion smokers in the world 2 Number of smokers is expected to reach 1.6 billion by Responsible for one in 10 adult deaths 1 Tobacco is responsible for approximately 4.9 million deaths every year, 11,000 every day 1 1. The World Bank. Curbing the epidemic: governments and the economics of tobacco control Corrao MA, et al. Bulletin of the World Health Organization 2000; 7: Global number of deaths attributable to smoking (millions) Worldwide projected mortality Peto R, et al. Nature Medicine 1999; 5: Year 1

2 Most teenagers try tobacco before high school graduation (in Lithuania about 80%) If person do not start smoking until age 25, he or she usually do not start newer Many adolescent smokers are addicted to nicotine Tobacco is often a gateway drug Adolescents with low school achievement, poor skills to resist influences, low self-image and more friends who use tobacco are more likely to become smokers Cigarette advertising appears to increase young people s risk of becoming smokers Community-wide efforts (tobacco tax increases, enforcement of minor s access laws, youth-oriented mass media campaigns, and school-based tobacco-use prevention programs) may be successful in reducing adolescent use of tobacco Major Conclusions of the 1994 Surgeon General s Report Tobacco industry It is important to know as much as possible about teenage smoking patterns and attitudes. Today s teenager is tomorrow s potential regular customer, and the overwhelming majority of smokers first begin to smoke while still in their teens The smoking patterns of teenagers are particularly important to Philip Morris. Philip Morris Companies Inc Components of cigarette smoke a dirty syringe Alcohol Nicotine Tar Acetone Arsenic In Lithuania alcohol cause about 4000 death s each ear. That is second place in mortality after smoking. Carbon monoxide Cadmium Hydrogen cyanide Cigarette smoke Contains > 4,000 chemicals including 40 known carcinogens 1. Shiffman S, et al. Annual Review of Public Health 1998; 19: Alcohol using health effects Death s cause Alcoholic psychosis Alcoholic dependence and abstinence syndrome Alcoholic cardiomiopathy Sudden alcoholic hepatitis Alcoholic cirrhosis Non alcoholic liver cirrhosis Sudden pancreatitis Chronic pancreatitis Alcoholic intoxication Alcoholic polineuropathy Oral cancer Esophagus cancer Stomach cancer Liver cancer Larynx cancer Esencial hypertenzion Diseases of brain vessels % because of using alcohol Tuberculosis of lungs 25 Pneumonia and flu 5 Diabetes 5 Auto accidence 42 Accident s in bike and water sport 20 Death's in fire 45 Sinking 38 Air crushes 16 Fall from high 35 Other accident s 25 Suicides 28 Homicides 46 Evaluation and monitoring of action on alcohol. WHO Regional publications, European series No

3 Fetal alcohol syndrome Comparison of two female subjects who had volumetric MRIs created in a GE 1.5 Tesla MRI machine Drug groups DRUG ADDICTION IS A COMPLEX ILLNESS Barbiturates; Benzodiazepines; Hallucinogens; Opiates; Stimulants; Volatile substances; Miscellaneous substances. 3

4 Cannabis Cause respiratory problems associated with smoking. Psychological disturbance and hallucinations with heavy use. Pupils who start smoking cannabis 104 times more try to use another illicit drug. LSD (Lysergic Acid Diethylamide) No evidence of physical dependency. Trips begin up to one hour after dose and last for two to 12 hours depending on strength. Flashbacks (reexperiencing previous trip) common. Suicides and accidental deaths reported. Ecstasy/MDMA Stimulant with mild psychedelic effect. Possible hallucinogenic effect, particularly in high dozes. Use associated with the dance music scene. Ecstasy use can be associated with anxiety, panic attacks and insomnia, especially in cases of long term use, or use of large doses. 4

5 Ecstasy increases body temperature and has a dehydrating effect. Users should take care to replenish lost body fluids and take regular breaks from physical exertion to help avoid dehydration and overheating. Some deaths associated with the taking of ecstasy have been attributed to dilutional hyponatremia. That is people have drunk too much water in attempting to counteract the dehydrating effect of the drug. Ecstasy cause the release of a anti-diuretic hormone which prevents the production of dilute urine. Excessive drinking in turn causes fluid build up inside the body cells, particularly in the brain which soaks up the fluid and is eventually crushed as it swells against the inside of the skull. All its functions are irreparably damaged which leads to death. A dose of 500 mg of MDMA is fatal. Such a dose is the equivalent of 3 MDMA tablets. Reasons for illicit drug use Predisposition (genetic) Personality/psychological factors (addictive personality) Hedonism (enjoyment) Age Gender Risk-taking Peer pressure Locus of control Availability Social, economic and cultural (environmental) factors Educational disturbance Family disruption Self-attributed reasons (to escape reality, to relax) Drug-related harm Community harm: Theft; Cost of police, court system, prisons, probation orders, health and personal social services; Violence between drug users; Poor or under-performance at school, college or work; Discarded needles, ie left in areas used by young people; Risk of spread of HIV infection, if injecting. Individual harm: Accidental overdosing physical damage, death; Long-term excessive use physical and psychological harm; Relations with friends, family and employers may be harmed; Employment prospects can be damaged by having a criminal record or non or poor attendance at work or training scheme; Academic achievement and educational prospects may be harmed through poor performance or non or poor attendance; Exclusion from school or college could affect educational prospects; Reputation may be hard to live down leading to a person heaving to move. 5

6 Reduce Risk Factors ineffective parenting chaotic home environment lack of mutual attachments/nurturing inappropriate behavior in the classroom failure in school performance poor social coping skills affiliations with deviant peers perceptions of approval of drug-using behaviors in the school, peer, and community environments Enhance Protective Factors strong family bonds parental monitoring parental involvement success in school performance prosocial institutions (e.g. such as family, school, and religious organizations) conventional norms about drug use..target all Forms of Drug Use... and be Culturally Sensitive Include Interactive Skills-Based Training Resist drugs Strengthen personal commitments against drug use Increase social competency Reinforce attitudes against drug use Prevention Programs Should be.... Family-Focused Involve Communities and Schools Provides greater impact than parentonly or child-only programs Include at each stage of development Involve effective parenting skills Media campaigns and policy changes Strengthen norms against drug use Address specific nature of local drug problem 6

7 Duration of Treatment Medical Detoxification Depends on patient problems/needs Less than 90 days is of limited/no effectiveness for residential/outpatient setting A minimum of 12 months is required for methadone maintenance Longer treatment is often indicated Detoxification safely manages the physical symptoms of withdrawal Only first stage of addiction treatment Alone, does little to change long-term drug use Effectiveness of Treatment Goal of treatment is to return to productive functioning Treatment reduced drug use by 40-60% Treatment reduces crime by 40-60% Treatment increases employment prospects by 40% Drug treatment is as successful as treatment of diabetes, asthma, and hypertension Thank you! 7