I clearly remember my first professional contact with a drug addict. As a junior hospital doctor, I was asked to go and administer a heroin injection to a registered addict who was a patient on the ward. I was astonished to meet a gentle and pleasant lady of the realm, who took the syringe from me and injected into her groin, as she had no other veins available.
The stereotype of the drug addict is far from accurate. They are not all either rock stars, celebs or 'it' girls on the one hand, or down-and-outs on the other. Many drug addicts are successful professionals, and the medical profession is one that has a significant number of addicts among its ranks.
What sort of drugs lead to addiction?
Many different types of drugs can cause addiction, particularly opiates, cocaine, amphetamines and prescription drugs. Less well known is the fact that cannabis and ecstasy can also become addictive.
The common feature of these drugs is that they produce an alteration in brain function (most often a stimulant effect) which is enjoyed by the user, and which they want to continue to achieve. With some of these drugs, the 'down' that follows the 'high' is very unpleasant, and the next dose is sought to banish these symptoms and regain the pleasant euphoria that the stimulant drugs produce.
How many people use drugs of addiction?
In 2001/2002, 15% of men and 9% of women aged 16-59 in England and Wales said that they had taken an illicit drug in the previous year. In the 16-24-year-old age group, 35% of men and 24% of women had done so during the last year. Cannabis was the most commonly used drug, but ecstasy was the most commonly used Class A drug. Ecstasy had been taken by 9% of men aged 16-24 and 4% of women in the same age group in the previous year. Cocaine use has increased dramatically since 1996, whereas use of amphetamines has reduced.
Opiates Heroin is the most widely used opiate. It can be injected, snorted or 'smoked' (heated to create a vapour that is inhaled). Soon after taking heroin, the user feels a surge of euphoria (a 'rush'), and a warm flushing of the skin, which is followed by a clouding of mental function and drowsiness. The effects disappear after a few hours.
With regular use, tolerance develops (the user has to take larger quantities to achieve the same effect). As higher doses are used over time, physical dependence develops. This means that attempts to stop the drug produce an extremely unpleasant physical withdrawal syndrome. Heroin addiction is one of the three most common causes of drug-related death. Death can occur as a result of overdose, contamination of the product, infections, lung complications and liver disease.
Cocaine and crack Cocaine is an extremely addictive drug. A single exposure can lead some users into addiction. It can be taken by snorting, injecting and 'smoking'.
Crack is the street name for cocaine that has been processed in a particular way. The name refers to the cracking sound heard when the drug is heated.
Cocaine creates an intense high and extreme feeling of well-being and pleasure. The user has reduced fatigue and a period of enhanced mental clarity. These feelings can last from five to 30 minutes. It is the intensity of the pleasure that drives addicts to continue using cocaine in spite of the risks. The inability to control cocaine use was well illustrated in the photos of a TV actress whose nasal septum was completely destroyed through cocaine snorting, but who was unable to break the addiction.
High doses or prolonged use can lead to paranoia, with crack smoking producing aggressive, paranoid behaviour in some users. When addicts stop using cocaine, they may become depressed, leading to further use to relieve the depression.
Amphetamines Amphetamines are stimulant drugs, which, like the others, produce a 'rush'. Methamphetamine is the most potent of this group of drugs. Tolerance to the drug occurs very rapidly (within a few minutes), so users try to maintain the rush by bingeing on the drug. Effects following the rush include increased energy levels, increased activity (hence the nickname 'speed') and decreased appetite. These stimulant effects last for much longer than with other stimulant drugs, and can even persist for 24 hours. High doses can have toxic effects on nerve endings in the brain. Chronic use can lead to psychotic behaviour with paranoia and hallucinations, confusion, insomnia and rages leading to extremely violent behaviour.
Prescription drugs An estimated 2% of the population use prescription drugs non-medically. These drugs have usually been prescribed for the individual for a defined medical problem, but their use extends beyond the time when they are required. The most common drugs to be used in this way include strong painkillers, tranquillisers, sleeping tablets and anti-depressants.
Ecstasy Ecstasy or MDMA is chemically similar to amphetamines, and produces both stimulant and psychedelic effects. Its major use is as a 'club drug'. The risk of sudden death is well known, but its addiction potential is less well recognised.
Cannabis This drug is widely used as a relaxant despite research proving that regular use can affect memory, attention and learning ability. Although it is much less addictive than the stimulant drugs, long-term use can lead to addiction.
What help is available to addicts who want to stop?
As with all addictions, the person has to be very motivated if they hope to succeed.
Heroin addicts can be weaned off with the help of a less addictive opiate called methadone. The weaning reduces the severity of the physical symptoms of the withdrawal syndrome. This is done by a specialist team, and can only be undertaken if the patient is a registered drug addict. The majority can be weaned off in the community, but some need an in-patient programme of rehabilitation. During the weaning-off process, addicts need a lot of social and emotional support, and some need psychotherapy for underlying emotional problems that have led to addiction.
Behavioural therapies can reduce the likelihood of the reformed addict returning to their addictive behaviour.
Treatment programmes are also being developed for cocaine addiction and amphetamine addiction. Medications are being developed to help alleviate the severe cravings that withdrawal from these particular drugs can produce. Meanwhile, the mainstay of treatment is cognitive behaviour therapy.
Addicts of prescription drugs can usually be gradually weaned off them, once the problem has been acknowledged.
