GRADE 13

SUBSTANCE
ABUSE
Focus: Alcohol
By Micha’el Meggo
and Mekhi Reid
WHAT IS
DRUG ABUSE?
A drug can be defined as a substance that alters
the body’s physiology. Drug (or substance)
abuse refers to using the drug in a way that
causes harm,, either to oneself or to others.
 Many of the harmful drugs are illegal, e.g. cocaine,
methamphetamine, heroin, and ecstasy. However, the
fact 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 of
the illegal drugs.
 01
DRUG
DEPENDENCY
PHYSICAL AND PSYCHOLOGICAL
What is drug
dependence?
Drug dependence is the technical term for what we
refer to as an addiction. If the drug is taken over a
period of time, then the body may adjust to its use.
For example, if the drug blocks particular receptors at
synapses, then new receptors may be produced to
make up for the ones that are no longer in use.
This means that more drug has to be taken to have the
same effect. This is known as tolerance to the drug.
An increasing tolerance is an indication of increasing
dependence on the drug. The drug-dependent person
does not have control over their drug use; it becomes
a habit. There is a craving for the drug and the drug
users continue using despite adverse consequences
which have deterred non-drug users.
PHYSICAL DEPENDENCE
Physical dependence occurs because there have been
changes in the structure and physiology of neurones in
the brain. If the person stops taking the drug, they suffer
from withdrawal symptoms - unpleasant physical
symptoms including anxiety, restlessness, irritability,
nausea, vomiting, diarrhoea, excessive saliva, watery
eyes and runny nose, and insomnia. These extremely
unpleasant symptoms start about 8 to 16 hours after
withdrawal and then can last for a week. The person will
feel cravings for the drug for many weeks afterwards, as
well as the general feeling of being unwell and being
4
unable to relax or sleep.
PSYCHOLOGICAL DEPENDENCE
Psychological dependency is also due to what is
happening in the brain as a result of taking the drug, but
the person does not experience unpleasant withdrawal
symptoms when they stop taking it. They do, however,
crave the drug. It seems as an essential to them as food or
water does to you when you are very hungry or thirsty.
They may have begun taking the drug to help them get
through a particular problem which may reignite drug
use if the situation re-emerges. Psychological symptoms
may include anxiety, depression, hallucinations, and
paranoia. The euphoric use of the drug may act as a
4
strong positive reinforcement for continued use.
 CONSEQUENCE
02 S OF ALCOHOL
CONSUMPTION
on the nervous system and
liver
 SHORT TERM EFFECTS
FATTY LIVER
There is a strong correlation between the
amount of alcohol consumed and the
amount of fat deposited in a person’s liver.
The fat is stored in the hepatocytes, and
can severely reduce their efficiency at
carrying out their other functions. It occurs
within hours of significant alcohol
drinking but it is reversible if the person
abstains from drinking.
HEPATITIS
Excessive intake of alcohol may also cause the liver
to become inflamed, a condition known as hepatitis.
It is accompanied by the destruction of individual
liver cells. The damaged cells are replaced by
collagen-rich fibrous tissue. Most people with
alcoholic hepatitis are undernourished and have
symptoms of fatigue, fever, jaundice, increased
white blood cell count, enlarged tender liver, and
spider-like veins on skin. It may be mild and
reversible if the person abstains from drinking.
Alternatively, it can become life-threatening.
 LONG TERM EFFECTS
CIRRHOSIS
A combination of the excess storage of fat in the
hepatocytes, plus the direct damage done to
hepatocytes by ethanol, can lead to a condition
known as cirrhosis. The damaged hepatocytes are
replaced by fibrous tissue. The structure of 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 affected by cirrhosis cannot carry
out its normal functions.
CANCER
Researchers have hypothesized multiple ways that
alcohol may increase risk of cancer. One way is by
metabolizing ethanol in alcoholic drinks to
acetaldehyde, which is a toxic chemical and a
probable human carcinogen; acetaldehyde can
damage both DNA and proteins. Another hypothesis
is that alcohol generates reactive oxygen species
which can damage DNA, proteins, and lipids
through oxidation.
 LONG TERM EFFECTS
IMPAIRED NERVOUS
TRANSMISSION
Alcohol molecules dissolve very easily in the fatty
acid tails of phospholipids that make up cell surface
membranes. This distorts the proteins that form
channels in the membranes. In particular, it affects
the shape of receptors in the membranes of
neurones in the brain that respond to a
neurotransmitter called GABA, which inhibits the
formation of action potentials. Alcohol increases
and prolongs the effects of GABA. Alcohol also
affects another, stimulatory, neurotransmitter called
glutamate. This is the commonest neurotransmitter
in the brain, and is responsible for much of the
interaction between neurones. Alcohol blocks the
receptors on cell membranes that glutamate would
normally bind to.
DEMYELINATION AND
DEHYDRATION OF BRAIN
CELLS
Alcohol is a diuretic, which means it increases the
loss of water in urine, so can cause dehydration. It
does this by inhibiting the production of a hormone
called vasopressin, which plays a large role in the
regulation of water excretion. Brain cells are
especially susceptible to this. The neurones in some
parts of the brain tend to lose their myelin sheaths,
known as demyelination. This severely affects brain
function.
WHAT IS ONE ‘UNIT’ OF ALCOHOL?

One unit can be considered to be half a pint of low

strength beer, or just under one half of a ‘regular’
glass of wine with an ABV (alcohol by volume) of
13%. These each contain 8g of alcohol.
 SOCIAL
CONSEQUENCES
OF ALCOHOL
CONSUMPTION
 DRINKING
AND
DRIVING
Drinking alcohol increases reaction
time, and adversely affects
judgement. Both of these effects
mean that a driver who has drunk
alcohol is much less likely to react
appropriately and rapidly to danger.
A high proportion of accidents
involve drivers, as well as
pedestrians, who have been
drinking.
 DAILY
ALCOHOL
LIMITS
(DAL)
The advised daily alcohol limit for men is
2-4 alcohol units and for women 1-3
alcohol units. Many Caribbean countries
have laws that limit the amount of alcohol
that a driver can legally have in their
blood. In the majority, this is 0.08%, i.e.,
80 mg of alcohol in every 100 cm^3 of
blood. In Jamaica, the limit is higher than
this, at 0.35%. In Barbados and Cuba, the
limit is zero.
 VIOLENC
E
Some people become aggressive and
violent when they have been drinking
alcohol. They may be almost unaware of
this effect on them, thinking that they are
behaving normally and like everyone else.
However, this kind of behaviour can have
very severe effects on others who get
caught up in it. Alcohol-violence happens
both inside(intra-family violence) and
outside of the home. Family members may
suffer at the hands of a drunken parent or
partner. Each year, families break up as a
result of aggressive behaviour caused by
drinking alcohol.
CRIME
As mentioned earlier, drinking alcohol damages
judgement and weakens inhibitions. In some people,
this can lead to them committing crimes such as
theft, which they would not commit if they were not
drunk.
 END OF
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