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Definitions, categories and legal status of substances
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Aim of this resource
The aim of this resource is to provide an introduction to the main health and social issues associated with substance misuse in the UK today by:
• Identifying definitions of misuse.
• Outlining the main models of misuse & categories of substances.
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So, what is ‘misuse’?
• Addictive behaviour – binge drinking?
• Substance use – alcohol, caffeine, heroin, tobacco, aspirin?
• Drug dependence – physical, psychological, sociological?
• It all depends who you ask – what perspective you take.
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World health organization guidelines (definition of ‘misuse’):
• Unsanctioned use– Not approved by society.
• Hazardous use– Leading to harm or dysfunction.
• Dysfunctional use– Leading to impaired psychological or
social functioning.
• Harmful use– Known to cause tissue damage or
psychiatric disorders.
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Addictive behaviour - six main components (Griffiths 1995)
• SALIENCE - drug seeking/taking behaviour takes over a wide range of life activities – friends, partner, job etc.
• EUPHORIA - experience from behaviour – high, buzz, rush chill. • TOLERANCE - need to increase behaviour/amount to gain same
experience.
• WITHDRAWAL - unpleasant feelings when deprived.
• CONFLICT - conflicts with others who don’t share same salience – partner, family, employers, law, society. Also inner conflict from guilty conscience.
• RELAPSE - hard to give up addictive behaviour, but easy to take up again.
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Progress made, challenges ahead
In a report entitled Drug Treatment 2012: Progress Made, Challenges Ahead, Public Health England (2013) set out some of the key statistics about the number of people using drugs and entering treatment.
It reported that:
• drug use is declining, more drug users are recovering. • the original pool of people with problematic heroin and crack use is
shrinking.
This was reinforced further by data from subsequent years....
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NTA (2013) why invest?
• NTA (2013) why invest?
Public Health England reports fewer heroin and crack users in England...
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NTA (2013) why invest?Shorter waiting times for treatment....
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NTA (2013) why invest?
More successful treatment completions....
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NTA (2013) why invest?
And fewer young people needing treatment for hard drugs.
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Alcohol
• Alcohol is a regulated legal substance in the UK
• This means it is governed by laws regarding its supply, quality and use.
• For instance, it cannot be sold to people under 18. It must be labelled correctly. Advertising of alcohol is strictly limited.
• Despite being legal, it is responsible for most harm in the UK among all substances used (Nutt, 2009).
• Alcohol-related deaths in the UK peaked in 2008 to over 9000. • Scotland has the largest death rate in the UK at over double that of
England for men and women (Institute of Alcohol Studies, 2015).
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Alcohol (cont.)• 9 million adults drink at levels that increase the risk of harm to their health.
• 1.6 million adults show some signs of alcohol dependence.
• Overall, alcohol is the third biggest risk factor for illness and death.
• 15,479 people died from alcohol-related causes in 2010, up 30% since 2001
• 27% of social care serious case reviews mention alcohol misuse.
• There are recognised physical, psychological and behavioural problems for children of parents with alcohol problems.
• 16% of road fatalities are due to alcohol intoxication.
Sources: NTA (2013); The Alcohol Strategy (2012); Drug Strategy – Home Office, (2010); Drug Strategy Annual Review (2013)
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Categorising substances
regulatedillegallegal
Substances can be divided into different legal statuses.
• ‘Legal’ includes coffee, herbal remedies
• ‘Regulated’ includes alcohol, solvents and cigarettes, prescription-only & over the counter medication.
• ‘Illegal’ includes substances used outside the regulations, i.e. cannabis, heroin, cocaine.
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Misuse of Drugs Act 1971Substances are legally divided into schedules 1-5.
• Schedule 1 - no known medical use so totally banned, like LSD.
• Schedule 2 – controlled drugs like morphine.
• Schedule 3 - as above but less control like temazepam.
• Schedule 4 - typically, most prescription only drugs.
• Schedule 5 – typically, over the counter drugs.
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Misuse of Drugs Act 1971 (cont.)• Drug classes govern the legal ‘tariff’ for using illegally. i.e. The
possession or, supply of drugs.
• There are three classes, A – C.
• Class A drugs have the highest tariffs, class C the lowest.
• Drug classes change so you need to keep alert for changes. However, heroin and cocaine are likely to remain as Class A drugs.
• Go to the UK Government’s website for the main drug classification list. Be aware that it can change to accommodate new substances and policies. https://www.gov.uk/penalties-drug-possession-dealing
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Types of drug by effect
stimulantshallucinogensdepressants
Substances commonly misused can be divided into three types according to the effect they have on the nervous system.
These three types are:1. Depressants2. Stimulants3. Hallucinogens.
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Typical drug types are:• Depressants (they slow down the nervous system)
– Heroin, methadone, alcohol, benzodiazepines , some solvents
• Stimulants (they speed up the nervous system)– Cocaine, crack, amphetamines, ecstasy, crystal meth, many ‘legal
highs’ (new psychoactive substances)
• Hallucinogens (typically, change perception)– LSD, cannabis* & synthetic cannabinoids*, magic mushrooms
*these drugs can fit into a number of categories dependent on the type and use
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References• Griffiths E (2000) Alcohol, the Ambiguous Molecule. Harmondsworth, Penguin Books. • HM Govt. (2012) The Government’s Alcohol Strategy. Available at:
https://www.gov.uk/government/publications/alcohol-strategy • Home Office (2015) Drug Strategy Annual Review 2014-2015. Available at:
https://www.gov.uk/government/publications/drug-strategy-annual-review-2014-to-2015
• Institute of Alcohol Studies (2015) Alcohol related mortality rates. http://www.ias.org.uk/Alcohol-knowledge-centre/Health-impacts/Factsheets/Alcohol-related-mortality-rates.aspx
• NTA (2013) Why Invest? National Treatment Agency. Available at: http://www.nta.nhs.uk/uploads/why-invest-2014-alcohol-and-drugs.pdf
• NTA (2012) Drug Treatment: Progress Made, Challenges Ahead. London. National Treatment Agency.
• Nutt, D. (2009). Estimating drug harms: a risky business. London: Centre for Crime and Justice Studies.
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