drug abuse .ppt

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Slide 1:



Definition A drug is any substance/chemical – other than food - is taken to alter the way the body/mind functions (Psychoactive) A substance that when taken into a living organism may modify one or more of its functions (WHO 1981) Abuse is the maladaptive pattern of drug use manifested by recurrent and significant adverse consequences related to repeated use of the drug(s). Latest study says 3 of 4 new HIV infections are drug-related ( CDC /Dr. Scott Holmberg, 2004+ )


Definition Unsanctioned use: use of the drug is not approved by society Dysfunctional use: is the use of a drug that is leading to impaired psychological or social functioning e.g. Loss of job or marital problems. Harmful/Hazardous use: is that use of drug that is known to have caused tissue damage or mental illness. Abuse: is persistent or sporadic excessive drug use inconsistent with or unrelated to medical practice. Dependence: (addictive) (w.H.O) A state arising from respected administration of a drug on periodic or continuous bash. Psychological/physical

Mode of Administration:

Mode of Administration Orally Injection – IDU(!!!HIV) Smoked Sniffed Inhalation Intradermally (skin patches)

DSM IV TR Classification:

DSM IV TR Classification SUBSTANCE USE DISORDERS Substance Dependence Substance Abuse SUBSTANCE-INDUCED DISORDERS Substance Intoxication Substance Withdrawal Substance-induced Delirium Substance-induced Persisting Dementia Substance-induced Persisting Amnestic Disorder Substance-induced Psychotic Disorder Substance-induced Mood Disorder Substance-induced Anxiety Disorder Substance-induced Sexual Dysfunction Substance-induced Sleep Disorder

Substance Dependence :

Substance Dependence A maladaptive pattern use, leading to clinically significant impairment or distress, as maintained by: Tolerance: either A need for markedly increased amounts of the substance to achieve intoxication or desired effect; or Markedly diminished effect with continued use of the same amount of the substance Withdrawal: manifested either by The characteristic withdrawal syndrome for the substance; or The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms

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Substance taken often taken in larger amounts or over a longer period than was intended There is a persistent desire or unsuccessful efforts to cut down or control substance use. A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects. Important social, occupational, or recreational activities are given up or reduced because of substance use. The substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance.

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At least 3 or more at the same time Continuous 12 month period Specify With physiological dependence : evidence of tolerance or withdrawal Without physiological dependence: no evidence of tolerance or withdrawal Course specifiers Early full remission Early partial remission Sustained full remission Sustained partial remission On agonist therapy In a controlled environment

Substance Abuse:

Substance Abuse A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by: Recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home. Recurrent substance use in situations in which it is physically hazardous . Recurrent substance-related legal problems. Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance.


SUBSTANCE-INDUCED DISORDERS SUBSTANCE INTOXICATION The Development of reversible substance specific syndrome due to recent ingestion of a substance. Clinically significant maladaptive behavioural or psychological changes that are due to the effect of the substance on the CNS & develop during or shortly after use of the substance. SUBSTANCE WITHDRAWAL The development of a substance specific syndrome due to the cessation of substance use that has been heavy and prolonged. Syndrome causes significant impairment/distress.


CLASSIFICATION Depressants Alcohol, Barbiturates(Anxiolytics), Inhalants, Opiates, Antipsychotics Stimulants Caffeine, Khat, Nicotine, Amphetamines, Cocaine, Antidepressants Hallucinogens PCP, LSD, Marijuana Others Steroids OTCs

Depressants :

Depressants Reduce arousal by inhibiting the CNS


Alcohol Liquors, wine, beer Induce perceptual distortions, motor incoordination, (?Condom use) impaired judgement (?Condom, ?risk) Irritability Short attention span Decreased inhibitions (!!Sex, rape, incest, K st)

Alcohol Long Term-Effects:

Alcohol Long Term-Effects Neurological damage Liver cirrhosis Impotence Weight loss Wernicke-korsakoff’s syndrome

Alcohol Intoxication:

Alcohol Intoxication Inappropriate sexual / aggressive behaviour Mood liability Impaired judgement, attention, memory Impaired social/occupational functioning Slurred speech Incoordination / unsteady gait Nystagmus Stupor/coma

Alcohol Withdrawal:

Alcohol Withdrawal Autonomic hyperactivity – sweating, PR Hand tremor Insomnia Nausea & Vomiting Transient visual / tactile / auditory hallucinations / illusions Psychomotor agitation Anxiety Grand mal seizures

What Is Alcoholism? :

What Is Alcoholism? A disease known as alcohol dependence syndrome, the most severe stage of a group of drinking problems which begins with binge drinking and alcohol abuse.

Binge Drinking:

Binge Drinking Having 5+ drinks in one session for men and 4+ for women. Simply drinking to get drunk. Most common drinking problem for young people, under age 21. Highest Risk of Injury


Sedatives (Barbiturates /hypnotics/ anxiolytics/minor tranquilizers/benzodiazepines) – Valium, Mandrax Euphoria Irritability Mood liability Anxiety Intoxication Muscle contraction Talkativeness Impaired Attention/memory Disorientation Sexual aggressiveness (!!HIV, rape)

Sedative Intoxication:

Sedative Intoxication Slurred speech, Incoordination, Unsteady gait, Nystagmus, Impaired memory, stupor Inappropriate sexual / aggressive behaviour, mood liability, impaired judgement, impaired fxning

Alcohol Abuse:

Alcohol Abuse Binge drinking turns into alcohol abuse when someone's drinking begins to cause problems and the drinking continues anyway. Alcohol abuse is when someone continues to drink in spite of continued social, interpersonal or legal difficulties. Alcohol abuse can result in missing time at school or work, neglecting child or household responsibilities or trouble with the law.

What Is Alcohol Abuse? :

What Is Alcohol Abuse? Alcohol abuse differs from alcoholism in that it does not include an extremely strong craving for alcohol, loss of control, or physical dependence. In addition, alcohol abuse is less likely than alcoholism to include tolerance (the need for increasing amounts of alcohol to get "high"). Alcohol abuse is defined as a pattern of drinking that is accompanied by one or more of the following situations within a 12-month period:

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Failure to fulfill major work, school, or home responsibilities; Drinking in situations that are physically dangerous, such as while driving a car or operating machinery; Recurring alcohol-related legal problems, such as being arrested for driving under the influence of alcohol or for physically hurting someone while drunk; Continued drinking despite having ongoing relationship problems that are caused or worsened by the effects of alcohol. While alcohol abuse is basically different from alcoholism, it is important to note that many effects of alcohol abuse are also experienced by alcoholics.

Problem Drinker :

Problem Drinker Many people who have a problem with alcohol are not alcoholics, and in order to quit drinking they do not necessarily need medical treatment, peer group support, or a spiritual awakening.

Alcohol Dependence :

Alcohol Dependence Alcohol abuse becomes alcohol dependence when drinkers begin to experience a craving for alcohol, a loss of control of their drinking, withdrawal symptoms when they are not drinking and an increased tolerance to alcohol so that they have to drink more to achieve the same effect. Alcohol dependence is a chronic and often progressive disease that includes a strong need to drink despite repeated problems.

Is Alcoholism Inherited? :

Is Alcoholism Inherited? Alcoholism tends to run in families and a vast amount of scientific research indicates that genetics play a role in developing alcohol problems. But research also shows that a person's environment and peer influences also impact the risk of becoming alcohol dependent.

Sedative withdrawal:

Sedative withdrawal Autonomic hyperactivity Hand tremors Insomnia N & V Transient hallucinations/ illusions Psychomotor agitation Anxiety Grandmal seizures


Solvents/Inhalants Nitrous oxide, Paints, Glue, boot polish, petroleum products, aerosols, Cutex, stipex, etc Reduce inhibitions (!!Sex, rape, K) Sedation and sleep Sneezing, Nose bleeds, Blood-shot eyes, thirst, perceptual distortion, Nausea, Aerosols can cause cardio-pulmonary arrest Organ damage – liver, kidney, brain, bone, eye

Inhalant Intoxication:

Inhalant Intoxication Belligerence, assaultiveness, apathy, impaired judgement, impaired functioning Dizziness, nystagmus, incoordination, slurred speech, lethargy, depressed reflexes, psychomotor agitation, tremor, generalised muscle weakness, blurred vision/ diplopia, stupor/coma, euphoria

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HEROIN EFFECTS: At low doses, it triggers a dreamlike state of intoxication with such un-dreamy side effects as constricted pupils, reduced appetite, constipation, low body temperature, itching, sweating, and stupor. At higher doses, these effects increase, but breathing, heart rate, and blood pressure decrease. At very high doses, death results.


SIDE EFFECTS: Although heroin can be sniffed, more often it's injected or smoked. Needle use carries the most risks: Hazards include bacterial and HIV infection, collapsed veins, and hepatitis.


ADDICTION: Heroin is very addictive. Withdrawal symptoms include extreme physical discomfort (with flu-like physical sickness and pain), tremors, anxiety, and intense craving.


OVERDOSE: Heroin purity is uncertain, which increases the risk of accidental overdose. Symptoms include slow, irregular breathing; pinpoint pupils; and coma.

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Forms in which Heroin is available


Opiates Heroin, Morphine, Codeine, (“Narcotics”) Duration of Effects – 3-6 hrs Euphoria/dysphoria Pain relief Impaired attention/memory Sedation Apathy Psychomotor retardation IDUs (?HIV) Death

Opioid Intoxication:

Opioid Intoxication Euphoria the apathy, dysphoria, psychomotor agitation / retardation, impaired jugement, imapaired functioning Pupillary constriction (severe – dilattion) Drowsiness, slurred speech, impaired attention, memory

Opioid Withdrawal:

Opioid Withdrawal Dysphoria Nauseas and vomitting Muscle aches Lacrimation Rhinorrhoea Pupillary dilation Piloerection (goose pimples) Sweating Diarrhoea Yawning Fever Insomnia


Antipsychotics (Major tranquilizers) – used in SZP – largactil Psychomotor retardation Increased appetite Extra-pyramidal effects


Stimulants Increase arousal


Caffeine Coffee, tea, soft drinks, chocolate, cold pills, diet pills etc Low doses improve attention/concentartion High doses impair attn/conc Peptic ulceration Caffeinism – agitation, insomnia, anxiety++ Stimulates!

Caffeine Intoxication:

Caffeine Intoxication Restlessness Nervousness Excitement Insomnia Flushed face Diuresis GIT disturbance Muscle twitching Rambling flow of thought & Speech Tachycardia / Arrythmia Inexhaustability Psychomotor agitation


Nicotine Tobacco Initially increase information Processing, but later depresses – thus has to adjust Withdrawal symptoms – irritability, hand tremors, palpitations, difficulty concn. Reduces hunger & increase metabolism – weight loss Cough, Asthma, bronchitis, pneumonia, emphysema, constricted blood vessels Smoking associated with deaths due to CVAs & cancers

Nicotine Withdrawal:

Nicotine Withdrawal Dysphoria Insomnia Irritability Frustration Anger Anxiety ↓HR ↑Appetite /wt gain

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Amphetamines (Designer drugs), Khatt ( miraa ), Ecstasy, benzedrine , dexedrine etc More powerful stimulants than nicotine!! Hypervigilance Irritability Grandiosity Elation Insomnia Hallucinations Impaired judgement!! Psychomotor agitation Aggressiveness Violent behaviour Paranoia Disorientation Increased libido (!!HIV) Psychosis

Amphetamine Intoxication:

Amphetamine Intoxication Euphoria Hypervigilance Tension/Anxiety Anger Changes in sociability Hyper vigilance Interpersonal sensitivity Anxiety Tension / anger Stereotyped behaviours Impaired judgment Impaired functioning Tachycardia Pupilary Dilation ↕ BP Perspiration/Chills N & V Psychomotor agitation/Retardation Wt loss Muscular weakness Resp depression Arrythmias Seizures, dyskinesias, coma

Amphetamine Withdrawal:

Amphetamine Withdrawal Dysphoria Fatigue Vivid, unpleasant dreams Insomnia ↑ Appetite Psychomotor agitation/retardation




ECSTASY EFFECTS: MDMA, or 'ecstasy' is a 'psychedelic amphetamine' that has gained popularity over the past 20 years because of its ability to produce strong feelings of comfort, empathy, and connection to others. It most frequently comes in tablet form, although it is occasionally sold in capsules or as powder. It is most frequently used orally and rarely snorted. MDMA use is closely tied to the underground rave (and dance club) scene throughout the world, but has also been widely used by therapists as an adjunct to psychotherapy.


DURATION: The primary effects of MDMA last approximately 3-4 hours when taken orally. For many people there is an additional period of time (2-6 hrs) where it is difficult to go to sleep and there is definitely a noticeable difference from everyday reality, but which is not strong enough to be considered 'tripping'. Many people also experience a noticeable shift in mood for several days after use; for some this is a period of depression while others experience lifted mood.


THE CRASH: Some users of MDMA experience a dramatic worsening of mood as the peak effects wear off, often called the "crash". This is often the result of coming down from a wonderful experience, not wanting the feelings to go away, and being sad, scared, or annoyed afterwards. Crashes do not happen after every experience and some users never experience them. One of the primary problems associated with crashing is that some users find themselves redosing in order to stave it off.

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Forms of Ecstasy

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Cocaine Powder and 3 chunks

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Forms in which Cocaine is available:


Cocaine Induces a brief, but intense feeling of self confidence and euphoria Anxiety, elation, grandiosity, impaired judgement!!, paranoia, hallucinations, hypervigilance, psychomotor retardation Violence Insomnia Anorexia Brain damage Death


COCAINE EFFECTS: Cocaine is both a central nervous system stimulant and an anaesthetic. It is found in the leaves of the Erthroxylum coca plant. The traditional method of coca use is to chew the leaves, producing a mild stimulation. Outside of South America it is generally used in its more refined and extracted forms...either powder cocaine, or freebase cocaine and produces a much stronger effect than chewing the leaves. The term "Crack" is alternately used to refer to street quality freebase cocaine, or to refer to the product of a particular manufacturing process which uses sodium bicarbonate rather than a flammable solvent. Powdered cocaine is generally snorted (inhaled), and crack or freebase cocaine is generally smoked. Smoking freebase cocaine causes a strong, short-lived peak of about 3-5 minutes, while snorting cocaine provides a lower high with major effects lasting closerto 30 minutes.


PSYCHOLOGICAL EFFECTS: Varies with dose and the tolerance of the user. Increases alertness, wakefulness, elevates the mood, mild to high degree of euphoria, increases athletic performance, decreases fatigue, clearer thinking, increases concentration, increases energy, increased irritability, insomnia, restlessness. With high doses may exhibit a pattern of psychosis with confused and disorganized behavior, irritability, fear, paranoia, hallucinations, may become extremely antisocial and aggressive.


PHYSICAL EFFECTS: Inceases heart rate, blood pressure, and body temperature. Increases the blood pressure, temp, pulse, and resp., dilates the pupils, decreased sleep and appetite, seizures, strokes, heart attacks, death.


WITHDRAWL SYMPTOMS: Intense cravings, hunger, irritability, apathy, depression, paranoia, suicidal ideation, loss of sex drive, insomnia or excessive sleep. Often, more cocaine is taken to reduce these effects.


OVERDOSE SYMPTOMS: Agitation, hostility, hallucinations, convulsions, high temp., possible death, stroke, or heart attack.

Cocaine Withdrawal:

Cocaine Withdrawal Dysphoria Fatigue Vivid unpleasant dreams Increased appetite Psychomotor retardation


Hallucinogens Induce extreme alteration in consciousness


Phencyclidine Mescaline, LSD/PCP Duration of effect – 8-12 hrs Induces feelings of fear & depersonalization, illusions, hallucinations, Euphoria, grandiosity, SZP symptoms Sensation of slowed time/distance/space/images Violence Convulsions, flashbacks Death

PCP Intoxication:

PCP Intoxication

Hallucinogen Intoxication:

Hallucinogen Intoxication Depression/Anxeity++, Ideas of reference, Fear of lossing ones mind, Paranoia, Impaired judgement, Impaired functioning Percetual changes (intensification of perceptions, depersonalisation, derealisation, illusions, hallucinations, synthesias) Pupillary dilation, tachycardia, Sweating, palpiations, blurring of vision, tremors, incoordination FLASHBACKS

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MARIJUANA "46% of all drug arrests are directly attributed to marijuana"


MARIJUANA EFFECTS: The effect of any drug depends on the specific drug, the amount, how it was taken, what the person expects, previous exposure of the body to this and other drugs, the setting or location, the user’s mental state and other drugs being used. The user can experience the effects of cannabis even in doses of THC as low as two to three milligrams (mg). For those who are occasional users, a brief pleasurable "high" can result. A typical "joint" (500 mg) containing five mg or more THC may be sufficient for two or three non-tolerant smokers. However, a regular heavy user may smoke five or more joints a day. The effects of smoking are felt within a few minutes and last two to four hours. Performance of complex tasks may however be impaired for as long as 24 hours. When cannabis is eaten, the effects appear more gradually, last longer and are more difficult for the user to control than when it is smoked.


CONT….. TOLERANCE AND WITHDRAWL: Regular heavy users of cannabis develop tolerance, that is, a need for more drug to produce the same effect. Heavy, long-term use of cannabis can cause dependence. The user experiences craving for the mood-altering effects of the drug, and withdrawal occurs if drug use is abruptly stopped. Symptoms, which usually last less than a week, include troubled sleep, irritability, sweating, anxiety, upset stomach, and loss of appetite. Withdrawal may increase drug-seeking behavior and contribute to continued drug


HASH: Hashish is the dried sticky resin of the cannabis plant. It comes in solid pieces ranging in color from light brown to black and in texture from dry and hard to soft and crumbly. Hashish sold in North America generally contains two to 20 per cent THC. It is usually smoked in a pipe, water pipe (bong) or cigarette with tobacco or marijuana.

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Forms in which Cannabis is available

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Hashish Marijuana


Cannabis Hashish, hashish oil, THC Derived from the plant Cannabis sativa Duration of Effects – 2-4 hrs Anxiety then euphoria Altered perceptions, sensations of altered time, decreased concentration, lack of motivation, loss of short term memory, paranoia Impaired judgment!! Chronic use: Dependence, tolerance, withdrawal effects, Lung dx, brain damage, birth effects Anti social behaviour and precocious sexuality

Cannabis Intoxication:

Cannabis Intoxication Comjunctival infection Increased appetite Dry mouth Tachycardia


Cannabis Most widely used illicit substance Active ingredient: Delta-9-Tetrahydrocannabinal (THC) Most use intermittent, most users discontinue in Mid- to late 20s. Prevalence of lifetime use increasing Ease of cultivation increasing availability THC content has increased from 0.5-5 % (1960) to 10-30 % in 2001 (greenhouse growing)

Cannabis, Historical Aspects:

Cannabis, Historical Aspects Used to grow wild, now cultivated. Medicinal uses. Mainly smoked, but also added to food and drinks. Long recognised as cause of psychosis. Taboo on its use. In 1960, 10-40% of admissions to mental hospital “cannabis psychosis”.

Historical Aspects:

Historical Aspects Psychosis in first time users and vulnerable. Debates in WHO expert committees consensus till recently “cannabis does not cause psychosis”. Cannabis produced in Africa more potent. Genetic predisposition in Africans. Organic psychosis e.g. malaria common in Africa. Report by Egyptian delegation to the League of Nations that smoking cannabis was a frequent cause of psychosis led to it being placed under international control in 1925.

Effects of Cannabis :

Effects of Cannabis Historical Aspects Morean 1845 “ There is not a single manifestation of mental illness that cannot be found in the mental changes caused by cannabis” Ludlow 1857 “The hasheesh Eater. “ I clapped my hands and shouted with joy…… I glowed like a new born soul”

Effects of Cannabis (cont.):

Effects of Cannabis (cont.) Marshall 1892 “ I had the most irresistible desire to laugh. Every thing seems so ridiculously funny.” “How much time have passed and only a few minutes had lapsed” “My powers became super human, my knowledge covered the universe my scope of sight was infinite”

Effects of Cannabis (cont.):

Effects of Cannabis (cont.) Acute Effects (Positive) Relief of tension Relaxation Insight Enhanced mood Infectious laughter Enhanced social ability

Effects of Cannabis (cont.) :

Effects of Cannabis (cont.) Acute Effects (Negative) Anxiety Depression Panic Paranoia Hallucinosis Low energy,Apathy Memory impairment

Cannabis and Psychosis:

Cannabis and Psychosis Cannabis and Schizophrenia Large doses associated with psychotic symptoms Confusion, amnesia, anxiety Agitation, hallucinations, and delusions Hypomania Psychosis may persist after elimination of THC from the body ( Thornicroft 1990, Hall 1998) May precipitate schizophrenia in vulnerable individuals (Andreassen 1987) Continued use worsens prognosis of schizophrenia (Hall 1998)

Mechanism of Psychosis:

Mechanism of Psychosis Dopamine as the wind of Psychotic fire Acutely psychotic people show excessive release of striatal Dopamine Dopamine mediates the attachment of salience to ideas and objects Heightened Dopamine transmission leads to aberrant assignment of salience to external and internal stimuli.

Mechanism of Psychosis:

Mechanism of Psychosis Delusion arise from attempts to explain this abnormal salience Dopamine dyregulation causes psychotic symptoms Cannabis stimulates release of Dopamine in the brain. Only some cannabis users develop psychosis Genes for psychosis exist Early age of use (by 16) the highest risk

Cannabis and Cognitive Impairment :

Cannabis and Cognitive Impairment No evidence of severe impairment Subtle, cognitive changes detected Educational consequences on adolescents Gateway Drug


Uses of CANNABIS Medicinal use Relief of severe pain Glaucoma Nausea during chemotherapy Multiple sclerosis AIDS Other Uses Textiles, Ropes Food Oil for lamps

Other Drugs:

Other Drugs


STEROIDS From 1998 to 1999, the Monitoring the Future Survey reported an increase in lifetime use of steroids among 10th-graders and a decrease in perceived risk of harm among seniors.


DRUG EFFECTS: "Anabolic steroids" is the familiar name for synthetic substances related to the male sex hormones (androgens). They promote the growth of skeletal muscle (anabolic effects) and the development of male sexual characteristics (androgenic effects), and also have some other effects. The primary medical uses of these compounds are to treat delayed puberty, some types of impotence, and wasting of the body caused by HIV infection or other diseases. Anabolic steroids facilitate the growth of skeletal muscle, which led to use of the compounds first by bodybuilders and weightlifters and then by athletes in other sports. Steroid abuse has become so widespread in athletics that it affects the outcome of sports contests.


NEGATIVE EFFECTS: Steroids are bad because of the adverse side effects that result from long term and improper use. Most side effects are reversible, however, some are not. Like a lot of drugs, steroids promote addictive behavior. This often leads to long term use of highly androgenic drugs, which suppresses the bodies natural ability to produce testosterone and leads to negative side effects such as gynecomastia. Because steroids are only available on the black market (unless you have a prescription), counterfeit steroids are widely available. This is probably the biggest factor leading to negative side effects.

Progression of Drug Use:

Progression of Drug Use Alcohol/Nicotine Marijuana Tranquilizers Hypnotics Cocaine Heroin PCP/LSD Phenycyclinidine piperidine and Lysergic acid Diethylanide

Reasons for Drug Abuse:

Reasons for Drug Abuse Peer Pressure Curiosity Ignorance Alienation Changing social structures Unemployment Diet pills Reduce anxiety Fall asleep Get euphoric Enhance information processing Stay alert Relieve pain Stress (?HIV, books) Etc etc


Conclusion Drugs are very dangerous to the individual and the society Drugs play a major role in other problems in the society e.g. HIV/AIDS, violence, passivity, etc Concerted efforts are needed by all to stop this time bomb. Combined professional therapy techniques

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