1. Making Sense of Drug Use

2. 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)

3. 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)

4. 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” WHO (1989); Krivanek (1982) “… any substance people consider to be a drug with the understanding that this will change from culture to culture and from time to time”

5. Making Sense of Drug Use Key Motivators FUN (pleasure) FORGET (pain amelioration) FUNCTIONAL (purposeful). FUN (pleasure) FORGET (pain amelioration) FUNCTIONAL (purposeful). FUN (pleasure) FORGET (pain amelioration) FUNCTIONAL (purposeful).

6. 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.

7. Making Sense of Drug Use 1.Risk-takers/ pleasure seekers 2.Socially disconnected 3.Self-medicators. Understanding Young People’s Motivation to Use Drugs

8. Making Sense of Drug Use Enormous variability and range includes… Experimenters Social users Regular heavy users Dependent users. Types of Drug Users

9. Making Sense of Drug Use A Typology of Users Considered rejectors Cocooned rejectors Ambivalent neutrals Risk controllers Thrill seekers / Careful curious Reality-swappers.

10. Making Sense of Drug Use dependent intensive purposive experimental Patterns of Drug Use

11. Making Sense of Drug Use dependent intensive purposive experimental Patterns of Drug Use

12. 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.

13. Making Sense of Drug Use Social gradient Early life Work Social support Food Stress Social exclusion Unemployment Addictions Transport. Social Determinants of Health

14. 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.

15. 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.

16. Making Sense of Drug Use Psychoactive drugs are generally defined as substances which alter: –mood –cognition (thoughts) –behaviour. Psychoactive Drugs (1)

17. 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)

18. 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’.

19. Making Sense of Drug Use Views About AOD-related Issues experience culture education religion Our thinking about AOD related issues is informed by factors such as: family / environment legislation theory.

20. 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.”

21. Making Sense of Drug Use Psychoactive drugs may be classified according to their: 1. status legal chemical medical social. 2. action and properties depressant stimulant hallucinogenic etc. Drug Classifications

22. Making Sense of Drug Use Psychoactive drugs may be classified according to their: 1. status legal chemical medical social. 2. action and properties depressant stimulant hallucinogenic etc. Drug Classifications

23. Making Sense of Drug Use Classifying Psychoactive Drugs *Cannabis has unique properties – CNS depressant but hallucinogenic effects at high doses.

24. 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.

25. 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)

26. 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)

27. Making Sense of Drug Use Models of Drug Use (1) 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.

28. 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.

29. 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 Regular / excessive Use health finances relationships child neglect Dependence impaired control drug-centred behaviour anxiety / isolation / social problems withdrawal I R D

30. 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 Regular/excessive Use health finances relationships child neglect Dependence impaired control drug-centred behaviour anxiety/isolation/social problems withdrawal I R D

31. 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)

32. 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)

33. Making Sense of Drug Use Drug route effects actions purity potency quality form price availability interaction with other drugs previous experience physical / emotional reaction mood current health age tolerance knowledge beliefs memories expectations Individual where when who how employment social context supply peers legality culture media advertising availability An Interactive Model of Drug Use The Drug Use Experience Environment

34. Making Sense of Drug Use 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 Environment/ SETTING Clarke et al. (2002, p. 17) Public Health Model

35. Making Sense of Drug Use Emerged in 1960’s 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 Environment/ SETTING Clarke et al. (2002, p. 17) Public Health Model

36. Making Sense of Drug Use A Health Promotion Framework For Identifying Factors Associated With or Contributing to a Health Problem

37. Making Sense of Drug Use Health Promotion Addressing Risk Factors

38. Making Sense of Drug Use Drug Prevention Strategies Individual Interventions

39. Making Sense of Drug Use Risk Factors for Problematic Drug Use Individual Genetic predisposition, behavioural undercontrol Personality (lack social bonding, resistance to authority) Drug knowledge Academic problems Early age of first use. Family Ineffective parental techniques Negative communication Poor family relationships. Local Environment Traumatic experiences (child abuse, refugee status) SES (socioeconomic status) Support (peers, community) Labelling. Macro-environment Legislation Law enforcement Drug availability Social message re drug use and related problems.

40. Making Sense of Drug Use