1. Expat Health Substance Abuse Awareness - 1 Revised: Barbey 05/2003 What is substance abuse?  Substance abuse is defined as any substance, legal or illegal, used in an improper way, that chemically modifies the body ’s function, results in psychological or behavioral changes and can lead to dependency and/or physical addiction.

2. Expat Health Substance Abuse Awareness - 2 Revised: Barbey 05/2003 The categories of substance abuse Substance Abuse can be divided into: 1 - Alcohol 2 - Illegal drugs 3 - Medication:prescription medication over-the-counter medication 4 - Other: caffeine, nicotine, khat, etc.

3. Expat Health Substance Abuse Awareness - 3 Revised: Barbey 05/2003 Substance abusers all have MORE:  Behavioral problems  Divorces  Family violence  Anxiety and depression  Car accidents  Work-related accidents  Absenteeism  Errors of judgement  Missed deadlines  Loss of productivity  Health problems  Days of hospitatlization

4. Expat Health Substance Abuse Awareness - 4 Revised: Barbey 05/2003 Alcohol - Some false ideas Alcohol is thirst quenching.  False. It dehydrates the body increasing urine production. Alcohol gives you strength.  False. It may give a feeling of strength due to the  impression of euphoria it provides, however,  exhaustion upon effort rapidly appears. Alcohol is warming.  False. The sensation of warmth is due to the dilatation of the blood vessels under the skin. Alcohol is less toxic if diluted with water.  False. 10 coins in a glass of water or 10 coins on the table still equal 10 coins ! Alcohol speeds up the reflexes.  False. On the contrary, it increases reaction time !

5. Expat Health Substance Abuse Awareness - 5 Revised: Barbey 05/2003 Alcohol - Some false ideas There is less alcohol in a glass of beer than in a glass of whiskey.  False. A glass of beer (in a beer glass) and a glass of whiskey  (in a whiskey glass) both contain 10 grams of pure alcohol. Alcohol is not fattening.  False. Just look at the beer bellies of heavy beer drinkers ! Exercise speeds up the elimination of alcohol.  False. You may sweat more but it does not increase the elimination of alcohol. Coffee and a cold shower will reverse the effects of alcohol.  False. They may wake you up a bit, but you will still be under the influence of alcohol.

6. Expat Health Substance Abuse Awareness - 6 Revised: Barbey 05/2003 Acute drinking  Alcohol enters the blood through the stomach and intestines and within a few minutes reaches the brain where it produces a certain degree of euphoria and modifies: Judgment Concentration and memory Visual perception measuring distances identifying obstacles Reflexes Perception of speed Alcohol slows down coordination and response rate. It increases reaction time.

7. Expat Health Substance Abuse Awareness - 7 Revised: Barbey 05/2003 Over the years alcohol: Destroys brain cells  sleep disorders, neurological problems Destroys liver cells  cirrhosis and cancer Provokes digestive problems (gastritis, ulcers, etc.) Increases the risk of numerous cancers (mouth, tongue, throat, esophagus, pancreas, colon, rectum) Increases the risk of breast cancer in women Reduces libido and sexual performance Interacts with other drugs and medication

8. Expat Health Substance Abuse Awareness - 8 Revised: Barbey 05/2003 Alcohol and Driving Alcohol is a major factor in car accidents It is found in: 25 % of accidents causing injury to driver or passenger 50 % of fatal collisions 65 % of accidents where a single driver is involved Never Drink and Drive

9. Expat Health Substance Abuse Awareness - 9 Revised: Barbey 05/2003 Time (hours) 0 1 2 3 4 5 6 7 8 0.9 0.8 0.7 0.6 0.5 0.4 0.3 0.2 0.1 Blood Alcohol Concentration (BAC)/ time 75 kg man 50 kg woman Evolution of two glasses of alcohol drank at time = 0.

10. Expat Health Substance Abuse Awareness - 10 Revised: Barbey 05/2003 Alcohol and Driving Make a Choice... Take a Taxi Designate a Driver Make a Commitment Behave responsibly. It is your personal choice and your future. Think about your family and your friends.

11. Expat Health Substance Abuse Awareness - 11 Revised: Barbey 05/2003 Plan... think ahead Designate a Driver BEFORE taking the first drink. Stick to the plan Make the Commitments... I will NOT drive after drinking I will NOT allow my colleagues to drive after drinking Alcohol and Driving

12. Expat Health Substance Abuse Awareness - 12 Revised: Barbey 05/2003 Illegal Drugs What is an illegal drug? A medication, altered, modified or mixed Used for non-medical purposes By someone who has no medical problem Use of illegal drugs is prohibited in most countries Prison sentence in most countries Death sentence in some countries

13. Expat Health Substance Abuse Awareness - 13 Revised: Barbey 05/2003 Effects of Drug Abuse Leads to addiction and dependency Provokes withdrawal symptoms when stopped Toxic for the human body, and can lead to death Can provoke serious health problems (AIDS, hepatitis B & C) Reduces safety and increases driving and work-related accidents Reduces concentration, efficiency, performance and productivity Increases absenteeism

14. Expat Health Substance Abuse Awareness - 14 Revised: Barbey 05/2003 Illegal Drugs What are the Illegal Drugs ?  Cannabis (marijuana)  Opiates Opium Morphine Heroin Codeine  Cocaine (crack)  Amphetamines (speed, ecstasy)  Hallucinogens (LSD, PCP)  Inhalants or Organic Solvents (glue)

15. Expat Health Substance Abuse Awareness - 15 Revised: Barbey 05/2003 Treatment or Rehabilitation Rehabilitation is identical for alcohol and drugs Four steps are required for rehabilitation to work: 1-Recognizing the problem 2-Taking the decision to stop 3-Weaning 4-Starting a new life without alcohol/drug  The decision must be made by the substance abuser for it to be effective.

16. Expat Health Substance Abuse Awareness - 16 Revised: Barbey 05/2003 Prescription & Over-the-counter Medications Any medication taken regularly can become habit forming and addictive. Dependency can be physical as well as psychological. 40% of all car accident victims were taking a legally prescribed or over- the-counter medication before the accident. All of the following, and many more, can become addictive and interfere with a person ’s vigilance and performance: Tranquilizers, sleeping pills, antidepressants Muscle relaxants Antihistamines Certain medication to treat high blood pressure Cough medicine Certain painkillers

17. Expat Health Substance Abuse Awareness - 17 Revised: Barbey 05/2003 In conclusion: Illegal drugs are dangerous and can lead to death Alcohol can be dangerous Never drink and drive Never take medication with alcohol Never take medication when driving or working on machinery If taking a medication, take it at the prescribed dosage Avoid over-the-counter medication and self-medication Don ’t get hooked! Substance abuse can lead to severe family, professional and health consequences.