Chapter 13
Substance abuse
By the end of this chapter you should be able to:
a discuss the meaning o the term ‘substance
abuse’, with reerence
reerence to legal and illegal
drugs;
b distinguish between psychological and physical
dependence;
c describe the short-term and long-term
consequences o alcohol consumption on the
nervous system and the liver,
liver, with reerence to
atty liver, hepatitis, cirrhosis, cancer, impaired
nervous transmission, demyelination, and
dehydration o the brain cells;
Legal and illegal drugs
A drug can be dened as a substance that alters
the body’s physiology. Drugs may be used to treat
specic health problems, and this is known as
therapeutic drug use. There are also drugs that
people use to change their mood, such as caeine,
alcohol, nicotine, cannabis and heroin.
Although all o these drugs can have benecial
eects in some circumstances, most o them also
have
ha ve the potential to cause enormous problems
or their users and others i they are abused.
Drug (or substance) abuse means using the drug
in a way that causes harm, either to onesel or
to others. Misuse o drugs seriously damages the
physical and mental health o many people in
the Caribbean each year,
year, as well as harming
har ming their
amilies and other members o the society in which
they live and work.
Many o the most harmul drugs are illegal.
However, the act that a drug is legal does not
mean that it is harmless. Most doctors agree that
alcohol, although it is a legal drug, does more
harm each year than any o the illegal drugs. It
has been suggested that, i alcohol was discovered
or the rst time today, it would immediately be
d discuss the social consequences o excessive
alcohol use;
e describe the eects o the components o 
cigarette smoke on the respiratory and
cardiovascular
cardiov ascular systems, including reerence to
passive smoking.
banned as being extremely dangerous
dangerous to health.
In this chapter, we will look in detail at two legal
drugs which, between them, contribute to very
large numbers o deaths and serious illness each
year.. These are alcohol and nicotine.
year
Drug dependency
Many drugs aect what happens at synapses, either
in the brain or elsewhere in the body. Postsynaptic
neurones contain receptors in their plasma
membranes into which the transmitter substance
used at that synapse precisely ts. Drugs that act at
synapses may do so by mimicking the action o the
transmitter substance; that is, they have the same
shape and aect the postsynaptic neurone in the
same way that the transmitter would. They may
prevent the breakdown o the transmitter – or
example, by inhibiting the enzyme that normally
does this. Or they may inhibit the action o the
transmitter itsel.
I the drug is taken over a period o time, then
the body may adjust to its use. For example, i 
the drug blocks particular receptors at synapses,
then new receptors may be produced to make up
or the ones that are no longer in use. This means
269
 Chapter 13: Substance abuse
that more drug has to be taken to have have the same
eect. This is known as tolerance to the drug. An
increasing tolerance is an indication o increasing
dependence on the drug.
The ways in which people use mood-changing
drugs such as nicotine, heroin and alcohol are
sometimes classied according to how much
control a person has over their drug-taking
behaviour.
Recreational use invol
involves
ves a person taking a drug
•
occasionally, in such a way that they do not
suer any health problems as a result, nor does
their use o the drug aect their behaviour in
ways that cause problems or anyone else. For
example,, having a glass o wine or beer with
example
a meal would be classed as recreat
recreational
ional use o  begun taking it to help them to get through a
alcohol.
Abuse occurs when the drug starts to damage
•
the health o the person taking it, or o people
around them or in their amilies. An example o  to experience an envir
drug abuse would be a person drinking enough
alcohol to make them aggressive and cause them
to act violently.
Dependency occurs when, as a result o changes
•
in the brain and other parts o the body, the
person can no longer manage without the drug.
Their lie begins to revolve around getting the
drug and using it.
Dependency can be classied as physical or
psychological. This distinction is useul in working
out the best way to help a person to escape rom
the hold that the drug has over them. However,
there is no sharp dividing line between these two
types o dependency, and in the end they both
probably
proba bly result rom changes that occur in the
body as a result o taking the drug.
Physical dependency occurs because there have have
•
been changes in the structure and physiology o  recommend that each person should stay within
neurones in the brain. I the person stops taking
the drug, they suer rom withdrawal symptoms
(abstinence syndrome). Withdrawal rom heroin
produces some o the very worst withdrawal
withdrawal
symptoms.. The person
symptoms p erson will eel anxious,
restless and irritable. They will not be able
to sleep. Their eyes water and nose runs, and
they salivate excessively, and may vomit, have
abdominal pain and diarrhoea. The pupils o  orm channels in the membranes. In particular,
270
their eyes dilate and they may eel pain all over
the body.
body. These extremely unpleasant symptoms
start about 8 to 16 hours ater withdra
withdrawal
wal
begins, and then can last or a week. The person
will eel cravings or the drug or many weeks
aterwards, as well as a general eeling o being
unwell and being unable to relax or sleep.
Psychological dependency is also due to what
•
is happening in the brain as a result o taking
the drug, but the person does not experience
unpleasant withdrawal
withdrawal symptoms when they
stop taking it. They do, however, constantly
crave
cra ve the drug. It seems as essential to them
as ood or water does to you when you eel
very hungry or very thirsty. They may have
particular problem in their lives,
lives, and i that
situation re-emerges they may start taking it
again. Their drug-taking may also ha have
ve led them
environment
onment that they enjoyed
 – or example,
example, injecting drugs along with others;
they may miss all the paraphernalia associated
with this environment and eel a tremendous
need to go back to it. Indeed, psychological
dependency may be harder to get over than
physical dependency.
Alcohol
Alcohol – more correctly ethanol – has been used
by humans or thousands o years. It was drunk
in beer,
beer, wine and other drinks produced by the
ermentation o substances such as grapes by
yeasts.. It was also widely used as a solvent in the
yeasts
preparation o herbal remedies.
remedies.
As you will see below, drinking too much
alcohol can cause serious damage to the liver
liver,, brain
and other parts o the body.
body. Health proessionals
daily alcohol limits (DALs) o no more than 2 or 3
units or a woman, and no more than 3 or 4 units
or a man. A ‘unit’ is explained on page 274.
How alcohol affects the body
Alcohol molecules dissolve very easily in the atty
acid tails o phospholipids that make up cell
surace membranes. This distorts the proteins that
particular, it
 Chapter 13: Substance abuse

aects the shape o receptors in the membranes

o neurones in the brain that respond to a
neurotransmitter called GABA, which inhibits the ethanol aldehyde
dehydrogenase dehydrogenase
ormation o action potentials. Alcohol increases ethanal ethanoate
ethanol
and prolongs the eects o GABA. (acetaldehyde) (acetate)
Alcohol also aects another, stimulatory, oxidised reduced oxidised reduced
neurotransmitter called glutamate. This is the NAD NAD NAD NAD
commonest neurotransmitter in the brain, and is
responsible or much o the interaction between enters Krebs cycle
neurones.. Alcohol blocks the receptors on cell
neurones
membranes that glutamate would normally bind to.
So, alcohol increases the eect o the inhibitory Figure 13.1 Detoxication
Detoxication o alcohol in the liver.
neurotransmitter GABA and reduces the eect o 
the stimula
stimulatory
tory neurotransmitt
neurotransmitter er glutamate
glutamate.. Both deposited in the liver
liver.. There is a strong correlation
o these actions reduce or depress the activity o  between the amount o alcohol consumed and the
the brain, so alcohol is a depressant. The eects amount o at deposited in a person’s
person’s liver.
liver. The
are especially great in the cortex o the cerebrum at is stored in the hepatocytes, and can severely
and in the cerebellum. As the activity o the cortex reduce their
th eir eciency at carrying
car rying out their
th eir other
is depressed, the person becomes less able to unctions.. This condition is known as atty liver
unctions
think clearly and logically and to make decisions. (Figure 13.2). (Alcohol consumption is not the
Inhibitions are reduced, and this helps some only cause o atty liver – other risk actors include
people to relax and interact socially.
socially. Depression o  diabetes and obesity.)
the activity o the cerebellum inhibits coordination Excessive intake o alcohol may also cause the
o movements
movements.. liver to become infamed, a condition known as
I drunk in large amounts, alcohol can kill. hepatitis.
Inhibition o various areas o the brain causes A combination o the excess storage o at in
drowsiness
drows iness and eventually unconsciousness.
unconsciousness. It can the hepatocytes, plus the direct damage done to
cause coma. When the nervous stimulation o the hepatocytes by ethanol, can lead to a condition
muscles used in breathing is inhibited by alcohol, known as cirrhosis. The damaged hepatocytes
breathing movements
movements stop and the person may die. are replaced by brous tissue. The structure o 
Alcohol is broken down inside the cells
o the liver,
liver, the hepatocytes
h epatocytes.. The enzyme
that catalyses the breakdown o ethanol is
ethanol dehydrogenase, also known as alcohol
dehydrogenase. Ethanol is rst converted to
ethanal by this enzyme, and then to ethanoate by
aldehyde dehydrogenase. Ethanoate can enter the
Krebs cycle in mitochondria and be metabolised to
produce ATP (Figure 13.1).
I large quantities o alcohol are consumed on
a regular basis, then the tissues within the liver can
be damaged. You can see, in Figure 13.1, that the
breakdown o ethanol produces reduced NAD. NAD.
In its oxidised state, NAD is involved in oxidising
atty acids in the liver cells. I the NAD has been Figure 13.2 This is an MRI scan o a person
reduced, then it cannot do this. The atty acids suering rom atty liver. The at deposits can be
accumulate and are converted to ats, which are seen as yellow patches in the liver.
271
 Chapter 13: Substance abuse
the blood supply is lost, so that some blood that
arrives in the hepatic portal vein simply goes
straight past and into the hepatic vein, without
ever passing through the channels between the
hepatocytes on the way.
A liver aected by hepatitis or cirrhosis cannot
carry out its normal
nor mal unctions. The liver has a
very wide range o roles
roles,, involving many dierent
metabolic reactions,
reactions, so damage to it has ar-
reaching eects on the body. For example, the
hepatocytes can no longer convert ammonia into
urea, so ammonia concentration in the blood
increases and can cause major damage to the
central nervous system. In severe cases, coma and
even death may result.
Long-term alcohol consumption also causes
high blood pressure which in turn increases the risk
o heart attacks and strokes.
strokes. Alcohol can damage
the lining o the stomach. It increases the loss o  the eect that alcohol has on them. It helps to
water in urine, so can cause dehydration. Brain
cells are especially susceptible to this
this.. The neurones
in some parts o the brain also tend to lose their
myelin sheaths, a process known as demyelination.
This severely aects brain unction.
Alcohol is a major cause o cancer. People who
regularly drink large quantities o alcohol have a
greatly increased risk o developing cancer in the
mouth, oesophagus, liver, breast or bowel.
Some people are able to drink large amounts
o alcohol without becoming dependent on it,
but others run the risk o developing dependency.
dependency.
It is not understood whwhy y some people become
beco me
alcoholics (dependent on alcohol) while others do
not. Alcoholics experience unpleasant withdra withdrawal
wal
symptoms i they have to go or any length o  one unit
time without drinking it. I they wish to give up
drinking alcohol, they can be helped through these
withdrawal symptoms with the use o drugs such
as diazepam. Howev
However er,, a person who has once
been dependent on alcohol can easily all back into
the same dependency again, unless they completely
give up drinking alcohol or control their drinking
very rigorously.
272
Social consequences of alcohol abuse
Drinking and driving
Drinking alcohol increases reaction time, and
adversely aects judgment. Both o these eects
mean that a driver who has drunk alcohol is much
less likely to react appropriately and rapidly to
danger. A high proportion o accidents involve
involve
drivers who have
have been drinking. They oten also
involve
invol ve pedestrians who have been drinking.
Many Caribbean countries have laws that limit
the amount o alcohol that a driver can legally
have in their blood. In the majority, this is 0.08%
is, 80 mg o alcohol in every 100 cm3 o 
 – that is,
blood. In Jamaica, the limit is higher than this, at at
0.35%. In Barbados and Cuba, the limit is zeroz ero..
How can you judge your blood alcohol
concentration? Just going by how you eel doesn’t
work, as people generally greatly underestimate
underestimate
think about ‘units’ o alcohol. One unit can be
considered to be hal a pint o low strength beer,
or just under one hal o a ‘regular’ glass o wine
with an ABV (alcohol by volume) o 13% (Figure
13.3). These each contain 8 g o alcohol.
two units one unit
Figure 13.3 Units o alcohol in some drinks.
To calculate the number o units in a drink,
multiply the volume o the drink in ml by its ABV,
ABV,
and divide by 1000:
volume o drink × ABV
number o units =
1000
On average,
average, each unit increases blood alcohol
concentration by 15 mg per 100 cm3 (though this
may be higher in a small person, and tends alwa
always
ys
 Chapter 13: Substance abuse

to be higher in women). The liver breaks down alcohol at all, and gets all o his or her (non-
about one unit each hour. alcoholic) drinks paid or by the rest o the group.
group.
Many people, however, think that the best rule is
not to drink at all i you are going to drive (Figure Violence
13.4). There really is no ‘sae limit’ or drinking Some people become aggressiv
aggressivee and violent when
and driving. Young
Young people on an evening out oten they have been drinking alcohol. They may be
appoint a ‘designated driver’, who doesn’t drink almost unaware o this eect on them, thinking
that they are just beha
behaving
ving normally and like
everyone else. However, this kind o behaviour can
have
have very severe eects on others who get caught
up in it. Alcohol-uelled violence happens not only
out in the streets, but also within the home. Family
members may suer at the hands o a drunken
parent or partner. Each year, many amilies break
up as a result o aggressiv
aggressivee behaviour caused by
drinking alcohol.

Crime
We have seen that drinking alcohol damages
 judgment and weakens inhibitions.
inhibitions. In some people,
Figure 13.4 The amount o alcohol in the breath this can lead to them committing crimes such as
is directly related to the concentration o alcohol thet, which they would not commit i they were
in the blood. not drunk.

SAQ 

1 The graphs show the number o people who b Compare the pattern you have described in a
were admitted to hospital in one part o the with that shown by cannabis.
USA in the year 2000 or drug-related illnesses.
illnesses. c Compare the pattern you have described in
In all cases, the drug was being abus
abused
ed and was a with the pattern o admissions or alcohol
a direct cause o the need or admission. amongst women o dierent ages.
ages.
a Describe the pattern o alcohol abuse that d Explain why
why these data do not give useul
resulted in hospital admission, amongst men inormation about the percentage o people
o dierent ages.
ages. who were using these dierent categories
o drugs.

  s
males females
   d 400 400
  n ages
  a
  s
  u 40+
  o 300 300
   h
   t
   / 30–39
  s
  n
  o 200
   i 200 20–29
  s
  s
   i <20
  m
   d 100 100
  a
   f
  o
  r
  e 0 0
   b
  m alcohol cocaine stimulants alcohol cocaine stimulants
  u
   N opiates cannabis other  opiates cannabis other 

273
 Chapter 13: Substance abuse

Smoking Lung diseases

Tobacco smoke contains many dierent chemicals. Lung diseases are a major cause o illness and
These include: death. They include:
tar – a mixture o substances, some o which chronic obstructive pulmonary disease (COPD)
• •
can cause cancer;  – this includes many related
related diseases,
diseases, such as
nicotine – the addictive substance in cigarette emphysema, that prevent the normal fow o air
•
smoke; it aects the brain and other parts o  through the gaseous exchange system;
the nervous system, and also the cardiov
cardiovascular
ascular lung cancer, where cells in the lungs divide
•
system; uncontrollably and orm a tumour;
carbon monoxide – a gas, produced by illnesses caused by inectious organisms
• •
incomplete oxidation o some o the substances (pathogens), such as bronchitis.
in tobacco, which reduces the oxygen-
oxygen-carrying
carrying
capacity o the blood; Chronic obstructive pulmonary disease
particulates – tiny particles,
particles, mostly o carbon, COPD is an illness in which the airfow into and
•
that cause irritation in the lungs and airways. out o the lungs gradually and progressively
progressively
Each o these substances is potentially harmul becomes more and more obstructed. COPD
to health. Compounds ound in cigarette smoke happens to everyone to a certain extent as they get
are the direct cause o serious lung diseases, and older,, but it is hugely accelerated and worsened
older
increase the risk o developing CHD or suering by smoking. It is thought that around 600 million
a stroke. Even breathing in someone else’s people worldwide suer rom COPD, and that 300
cigarette smoke – passive smoking (Figure 13.5) –  million die rom it each year. Somewhere between
signicantly increases the risk o developing these 80% and 90% o these cases are caused by smoking
health problems. cigarettes.
Cigarette smoke contains a wide range o 
dierent chemicals, many o which stimulate
neutrophils – a type o white blood cell (Figure
13.6) – to come to the scene. Neutrophils
are an important part o the body’s deence
against inectious disease, but here they behave
inappropriately
inappropria tely and actually cause illness
illness..
The neutrophils secrete an enzyme called
neutrophil elastase.
elastase. This enzyme is a protease
p rotease and,
as its name suggests, it breaks down elastin, which
orms the elastic bres in the tissues o the airways.
airways.
Usually, there are inhibitors present that prevent
this enzyme rom doing very much harm. But, in
a smoker,
smoker, the balance between the concentrations
o the protease enzymes and inhibitors tips too ar
in avour
avour o the enzymes. The proteases gradually
break down the elastin tissues in the lungs, causing
irreversible damage.
One o the eects o this tissue damage is that
the walls o many o the alveoli are broken down.
Instead o millions o tiny alveoli, separated rom
blood capillaries by exceptionally thin walls, the
lungs become lled with larger spaces, much much more
Figure 13.5 Passive smoking. widely separated rom the blood capillaries. What’s
274
 Chapter 13: Substance abuse

make it more dicult or air to move into and out

Inspiration Expiration
o the lungs.
The damage to the airways also involves the
ciliated cells and the goblet (mucus-producing)
cells, which
which normally help to keep the lungs clear
o dust, bacteria and other oreign particles in the
air that is breathed in. In smokers, the goblet cells
oten prolierate, producing much larger numbers
than in a non-smoker
non-smoker.. The production o large

alveolus
elastin fbre

a Healthy alveoli partially deflate when breathing

out due to the recoil o elastin fbres.

Inspiration Expiration

b Neutrophils rom the blood make pathways through

alveolar walls by digesting elastin and, ater many
years o this destruction, the alveoli do not deflate
very much.

Figure 13.6 The development o emphysema.

more, many
many o these capillaries also disappear.
The total surace area or gaseous exchange is
thereoree greatly reduced. This condition is called
thereor
emphysema (Figure 13.7). Not surprisingly,
someone with emphysema has great diculty in
getting enough oxygen into their blood.
The progressive
progressive damage to the lungs causes
them to lose their elasticity,
elasticity, while damage to the Figure 13.7 a Photomicrograph o lung tissue
airways
airwa ys causes their walls to thicken. This happens rom a person with chronic emphysema, showing
because the attempts by the tissue to repair itsel  large spaces where there should be many tiny
cause it to become brous. Both o these changes alveoli, b photomicrogr
photomicrograph
aph o normal lung tissue.
275
 Chapter 13: Substance abuse
numbers o ‘extra’ cells is called hyperplasia. As
a result, more mucus is produced, but the cilia
do not beat and so there is nothing to carry the
mucus up and out o the bronchi and trachea.
Instead, mucus accumulates in the airways,
where it provides a breeding ground or bacteria.
People with this condition thereore tend to suer
rom bacterial inections o the bronchi, called
bronchitis. They may have a chronic cough, as they
attempt to clear the mucus rom their lungs.
There is not really a great deal that can be done
to help a person
p erson who has COPD. Once the tissues
have
ha ve been damaged, it is very dicult or them to
recover. Usually, the best that can be done is to
prevent the disease rom getting any worse.
The rst thing that anyone with COPD will be
told to do is to stop smoking. This will almost
immediately
immediatel y produce a reduction in the requency
and severity o inections, and may also reduce the
cough. Ciliated cells and goblet cells can recover
to a certain extent. But it is unlikely that large
improvements
impro vements will be made in the breathlessness
that is caused by emphysema. Emphysema
Emphysema appears
to be irreversible.
Many patients maymay be helped a little by drugs
called beta agonists, which dilate the airways by
causing the smooth muscle in their walls to relax.
As the patient ages, and the symptoms get
worse, they may need to breathe oxygen on a
regular basis. This can be done at home, where the
patient has an oxygen cylinder and breathing mask
that they can use whenever they need to. In the
advanced stages o the disease, even walking a
ew steps becomes impossible without getting out
o breath.
Lung cancer  developing cancers in almost every part o
While COPD causes about 15% o smoking-
related deaths,
deaths, lung cancer causes almost double
that number. Smokers are almost 20 times as likely
to die rom lung cancer as are non-smokers.
non-smokers. Lung
cancer is one o the most dicult cancers to treat
successully.
Cigarette smoke contains several chemicals
that are carcinogenic. Carcinogens are substances
that damage the control o cell division. Cells
may begin to divide much more than they should,
276
orming a lump o disorganised cells called a
tumour (Figure 13.8). The tumour can be almost
anywheree in the gas exchange system, but most
anywher
requently grows
grows where the trachea branches into
the two bronchi, or at other branching points.
Figure 13.8 Micrograph showing a tumour
(darker purple) in a human lung (×16).
As the tumour grows, it displaces other tissues.
Eventually,, this can lead to the blockage o the
Eventually
airways or other parts o the lungs. The person
may nd it dicult to get their breath, and may
have
ha ve a chronic cough, sometimes bringing up
blood. They may experience pain or tightness in
the chest. As the cancer progr
progresses,
esses, they may lose
weight.
Cancerous cells may break away rom the
primary (original) tumour and begin to orm
secondary tumours in other parts o the body.
I this happens, survival rates are very low.
Some o the carcinogenic substances enter
the bloodstream in the lungs, and are carried
all over the body. It is thereore not surprising
that smoking signicantly increases the risk o 
 
the body.
Smoking and the cardiovascular system
Smoking increases the risk o developing CHD.
Nearly everyone
everyone who develops CHD in their 30s
or early 40s is a smoker
smoker.. Smoking can cause high
blood pressure. A smoker with high blood pressure
has a 20 times greater risk o stroke than a non-
smoker who does not have high blood pressure.
 Chapter 13: Substance abuse

Nicotine can sometimes cause problems such as dizziness,

One o the culprits is the nicotine in cigarettes. weakness,, headache and joint pain.
weakness
Nicotine is a neurotoxin – a chemical that damages
the nervous system. It is used as an insecticide. Hypertension, CHD and stroke
Nicotine is extremely addictive,
addictive, and this is the We have seen that nicotine increases blood
reason why smokers nd it so dicult to give up. pressure, which can increase the risk o developing
Nicotine molecules are relati
relatively
vely small, and they atherosclerosis
atheros clerosis and CHD (Chapter 12). It is not
easily move out o the blood and into every part o  only the coronary arteries that are aected – 
the body,
body, including the brain. Nicotine increases atherosclerosis
atheros clerosis can develop in any arteries in the
the levels o a transmitter substance called body.. Smokers run a higher risk than non-smokers
body
dopamine in the parts o the brain that are known o atheroscl
atherosclerosis
erosis developing in blood vessels that
as ‘reward circuits’. Activation
Activation o these circuits supply the brain. This greatly increases the risk o 
gives eelings o pleasure
pleasure,, and this is wh
why
y people suering a stroke (page 254).
enjoy smoking. Smokers tend to have more viscous blood than
Nicotine also causes the release o adrenaline non-smokers. This can increase the risk o blood
into the blood. Adrenaline increases the rate o  clots orming inappropriately, which once again
heart beat, blood pressure and breathing rate. rate. increases the risk o strok
stroke.
e.
Nicotine is a vasconstrictor – it causes the
smooth muscle in the walls o arteries and
arterioles to contract, narrowing the lumen and
thereoree making it harder or blood to be pumped
thereor
through. This,
This, too, tends to increase blood pressure
and the risk o blood clots orming (page 250).

Carbon monoxide
Carbon monoxide diuses rom the alveoli into
the blood in the lung capillaries.
capillaries. Here it combines
with haemoglobin, orming a bright red compound
called carboxyhaemoglobin. It holds on tightly;
haemoglobin has a very high anity or carbon
monoxide.. With a proportion o the haemoglobin
monoxide
tied up in this way, there is less available or the
transport o oxygen. Smoking thereore
thereore reduces
the delivery o oxy
oxygen
gen to the tissues
tissues,, including the
heart muscle. Smokers have less energy available to
their muscles when they exercise.
The body may respond to the oxygen shortage
by producing larger numbers o red blood cells.
A hormone called erythropoetin, produced by
the kidneys, is secreted in larger amounts when
the amount o oxygen in the blood is low. low. This
hormone stimulates the production o red blood
cells by the stem cells in the bone marrow
marrow.. and
smokers usually have
have a higher red blood cell
count (the number o red cells per unit volume o 
blood). This might seem to be a good thing, but it

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 Chapter 13: Substance abuse

SAQ 
2 The chart below is used to work out how likely a b What could each o these people do to reduce
person is to have a heart attack or stroke. their risk o ha
having
ving a heart attack or strok
stroke?
e?
a Use the chart to nd the predicted risk or: c Suggest how a risk calculator like this could
a 56-year-old woman who smokes, has a be produced.
•
blood pressure o 160/95 and whose total
cholesterol : HDL-cholesterol
HDL-cholesterol ratio is 5
a 45-year-old man who does not smoke
smoke,,
•
whose blood pressure reading is 160/95 and
whose total cholesterol : HDL-cholesterol
ratio is 8.

Men Women
Non-smoker Smoker  Non-smoker Smoker 
ratio total chol : HDL-chol ratio total chol : HDL-chol
4 5 6 7 8 4 5 6 7 8 4 5 6 7 8 4 5 6 7 8
180/105
160/95
 Age 70–79
140/85
120/75
  g
   H 180/105
  m 160/95
  m  Age 60–69
   / 140/85
  e
  r 120/75
  u
  s
  s 180/105
  e
  r
  p 160/95
   d  Age 50–59
  o 140/85
  o
   l
   B 120/75
180/105
160/95
 Age 40–49
140/85
120/75

Notes:
Risk – 5 yr cardiovascular fatal Events prevented
1 ‘ratio total chol : HDL-chol’
HDL-chol’ is
+ non-fatal events per 100 treated for 5 yrs
the ratio o the total amount o 
cholesterol in the blood to the
>30% >10 amount o cholesterol transported
very high 25–30% 9 in high density lipoprotein in the
20–25% 7.5 blood.
15–20% 6
high / moderate 2  A ‘cardiovascular
‘cardiovascular event’ in
10–15% 4
this table is reerring to newly
5–10% 2.5 diagnosed angina, myocardial
mild 2.5–5% 1.25 inarction, death rom CHD or 
<2.5% <0.8 stroke.

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 Chapter 13: Substance abuse

Summary
Substance abuse is the misuse o a drug or other substance, so that it causes harm to the user or to
•
other people.
Although alcohol and nicotine (in cigarettes) are legal drugs, their use can cause serious health
•
problems.
Physical dependency on a drug occurs when the structure and physiology o the body is changed
•
by the drug use, so that withdrawal
withdrawal symptoms are experienced when the drug is no longer taken.
Psychological dependency occurs when the person eels they cannot manage without the drug, even
i no withdrawal
withdrawal symptoms are experienced. There is no sharp dividing line between physical and
psychological dependency.
In the short-term, alcohol aects the neurotransmitters GABA and glutamate in the brain, which
•
together causes the activity o the brain to slow down. It is thereore a depressant. Inhibitions are
reduced, coordination is lost and nervous transmission is slowed, lengthening reaction time. I so
much alcohol is drunk that the breathing muscles are inhibited, the person may die.
Alcohol is broken down in the liver by the hepatocytes. Long-term excessive
excessive consumption o alcohol
•
oten leads to atty liver,
liver, hepatitis and cirrhosis and also greatl
greatly
y increases the risk o developing
many types o cancer.
Alcohol consumption is a causativ
causativee actor in many vehicle and other accidents, in incidents involving
•
violence and aggression, and in petty crime.
Smoking cigarettes, and the inhalation o smoke rom other people’s
people’s cigarettes, causes a very wide
•
range o serious health problems. These include COPD and lung cancer, CHD and stroke.
stroke.

Questions
Multiple choice questions
1 Drug abuse is:
A the use o a drug or personal gratication, causing damage to health.
B the compulsion to use a drug on a periodic or continuous
co ntinuous basis to avoid
avoid discomort rom its
absence.
C the need or increasing quantities o the drug to produce the same eect.
D the occasional use o the drug to lessen pain.
2 Which o the ollowing best describes ‘physical dependence’?
A the emotional changes i the drug is withheld
B the need or an increasing dose o the drug to produce the same eect
C when a drug or one o its metabolites has become necessary or the continued unctioning
o the body
body
D a mild orm o dependence that does not produce withdrawal symptoms

continued ...

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 Chapter 13: Substance abuse

3 Which o the ollowing is not a consequence o long-term use o alcohol?

A the development o swswollen
ollen cells with wispy cytoplasm in the liver cells
B the accumulation o at in the liver cells
C the constriction o blood vessels in the liver
D the development o brous tissue in the liver
4 How many grams o absolute (pure) alcohol does one ‘unit’ o alcohol contain?
A 7
B 8
C 15
D 25
5 Fat accumulates in the liver when alcohol is consumed regularly because:
A at absorbs alcohol and helps detoxiy it.
B alcohol is used to synthesise at molecules in the liver.
C liver cells use alcohol instead o at as an energy source.
D alcohol prevents liver cells rom secreting at molecules.
6 Which component o tobacco smoke causes an increased risk o lung cancer?
A nicotine
B carbon dioxide
C carbon monoxide
D tar
7 How does nicotine in cigarette smoke increase the risk o cardiac disease?
A by reducing the diameter o arterioles
B by attaching to haemoglobin
C by stimulating the sino-atrial node directly
D by orming plaque in blood vessels
8 Which o the components o tobacco smoke lowers the capacity o haemoglobin to
transport oxy
oxygen?
gen?
A carbon monoxide
B nicotine
C tar
D carcinogens

continued ...

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 Chapter 13: Substance abuse

9 The images below are enlarged views o alveoli rom a non-smoker and a smoker.

alveoli o a non-smoker alveoli o a smoker  

Why may a smoker have to consciously contract his muscles to breathe out?
A increased mucus production by goblet cells
B paralysis o the cilia
C excess tar in the alveoli
D loss o elasticity in the alveolar walls

Structured questions
10 a What do you understand by the ollo
ollowing
wing terms?
i drug
ii drug abuse
iii drug dependence
iv drug tolerance
v abstinence syndrome (withdra
(withdrawal
wal symptoms) [10 marks]
b Distinguish between:
i physical and psychological dependence
ii legal and illegal drugs
drugs.. [5 marks]
11 The ollowing drinking guidelines have
have been developed or people over 18 years o age,
based on medical advice.

Men
It is recommended that men drink no
more than 3 to 4 units o alcohol a
4 day day and no more than 21 units over 
21 week the course o the week.

Women
It is recommended that women drink
no more than 2 to 3 units o alcohol
a day and no more than 14 units
3 day over the course o the week.
14 week

continued ...

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 Chapter 13: Substance abuse

a What do you understand by the term ‘unit o alcohol’? [1 mark]

b Wh
Whyy are the recommended units given in both units per day as well as units
per week? [2 marks]
c Wh
Whyy are the recommended units per day o alcohol or men and women dierent? [4 marks]
d Alcohol is absorbed quickly rom the gastrointestinal tract into the blood.
What properties o alcohol acilitate the ast absorption rates? [2 marks]
e Recently the Trinidad and Tobago Government introduced breathalyzer testing in
order to reduce road accidents.
i Copy and complete the table below which shows the eects o drinking and
blood alcohol concentrations on driving beha
behaviour
viour..

Blood alcohol Efects o alcohol on

concentration / g 100 cm−3 driving
0.02 – 0.05
0.05 – 0.08
[4 marks]
3
ii The legal limit or drinking in Trinidad and Tobago
Tobago is 0.08 g per 100 cm blood.
Explain why
why a breathalyzer test can be used to determine whether a driver is
above this limit. [2 marks]
12 a Name three main constituents o cigarette smoke that are harmul to the body
body.. [3 marks]
Diagram a below shows the alveoli o a smoker and non-smoker during expiration,
and image b shows the coronary artery o a smoker.
smoker.

a b wall o artery
I
II

III

b Identiy the alveoli o the smoker and the non-smoker.

non-smoker. Give a reason or
or your answer
answer.. [3 marks]
c i Name the disease that is characterised by the alveoli o the smoker
smoker.. [1 mark]
ii Explain why the smoker would have dicul
diculty
ty in breathing. [2 marks]
d i Identiy structure III in image b. [1 mark]
ii Name the disease that is characterised by image b. [1 mark]
iii State our symptoms that might be experienced by a person whose artery has
been narrowed as shown in image b. [2 marks]
iv Explain how cigarette smoking may account or the appearance o the artery
artery.. [2 marks]

continued ...

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 Chapter 13: Substance abuse

Essay questions
13 Explain the ollowing terms using alcohol and the components o cigarette smoke
as examples.
a physical dependence
b psychological dependence
b tolerance
b abstinence syndrome (withdra
(withdrawal
wal symptoms) [15 marks]
14 Cigarette smoke contains many substances that are harmul to the bo dy and which
cause disease. Explain how the components o cigarette smoke increase the risk o 
developing the ollowing diseases.
a coronary heart disease
b lung cancer
c chronic bronchitis
d emphysema
e hypertension
  strokes [15 marks]
15 a Briefy describe the short-term and long-term consequences o alcohol
consumption on:
i the liver
ii the nervous system. [9 marks]
b Discuss the actors which aect blood alcohol level. [3 marks]
c Discuss the social consequences o excessiv
excessivee alcohol consumption. [3 marks]

283