Health News Report: Alcohol, Tobacco, and Other Drugs: A Community Concern

Community and Public Health (MLS 200)

Julie J. Tiu, RMT, MSPH Professor

Rowena Nibres Batoon Francis Gale Difunturom Coalie Medrano Ainah Charina Tapic Kenneth Keirulf Jose Mari Seto BMLS 3B

April 25, 2012

I.

Introduction Before anyone ever takes a puff, a hit or a drink, there is a decision made. A healthy or an

unhealthy decision. Sometimes making the healthy choice is hard because you are stressed, angry or pressured. However, learning the facts about drugs and alcohol can help you make informed decisions about your health. More deaths, illnesses and disabilities can be attributed to substance abuse than any other preventable health condition. Economic costs include direct cost (healthcare, premature death, impaired productivity) and indirect cost (crime and law enforcement, courts, jails and social works). Those abusing are a threat to themselves, their families and the community.

Definition Of terms:

Drug substance other than food and vitamins that, when taken in small quantities alter one physical, mental, emotional state.

Psychoactive drugs Drugs that alter sensory perception, mood, through processes or behaviors.

Drug misuse inappropriate us of prescriptive or non-prescriptive drugs. Drug/alcohol abuse taking a drug for a non-medically approved purpose./ the use of alcohol by those who are underage. Or the usage of alcohol with no limit at all.

Drug dependence when one believe that a particular drug is necessary for normal functioning.

Legal drugs drugs that can legally bought and sold in a marketplace. Illegal Drugs Drugs that are disapproved and are illegally sold and used. Nicotine Psychoactive and addictive drug found in tobacco products.

II.

Factors that Contribute to the Abuse of Alcohol, Tobacco and Other Drugs

Alcoholism and drug addiction are chronic conditions characterized by changes in the brain that cause a person to have an uncontrollable desire to abuse alcohol or other drugs, despite harmful consequences. There is no single factor that determines whether a person will develop alcoholism or a drug addiction. A person's overall risk for addiction is determined by their biological makeup, including genetics, and their exposure to drugs and alcohol.

a. Environmental Risk Factors 1. Media Influence Television shows, advertisements and movies often glamorize alcohol, tobacco and drug abuse. Teenage characters may dabble with alcohol, tobacco and drugs, making the use of these seem "cool" and "normal." As the media desensitizes its viewers to the use of alcohol, tobacco, and drugs, people are more likely to experiment, and some people will become addicted to abusing these. Unfortunately, the media tends to show the "fun" side of alcohol, tobacco and drugs without the consequences, which lulls viewers into believing that they are not at risk for becoming dependent upon these things themselves. 2. Availability ( price and access ) Alcohol and tobacco are very available in the market which is accessible to the students, and they can choose the cheapest brand available. In terms of the drugs, the accessibility is linked to peer environment. The easier it is for a person to obtain drugs, the more likely he will use the drugs. Schools with higher levels of drug availability see a higher level of drug abuse among students.

3. Family environment / Exposure Alcohol, tobacco, and drug abuse by other members of a family plays a fundamental role in determining a higher risk for children later developing a potential for these abuse. Through habitually observing parents abuse alcohol, tobacco and drugs, children may learn that the use of these is normal. 4. Stress / Trauma Many people with a history of child abuse or trauma struggle with alcohol, tobacco and drug abuse because they experience many deep and painful emotions that they do not want to feel. Taking these provides child abuse survivors with temporary relief from powerful emotions. Unfortunately, when the high wears off, the pain is still there, which perpetuates the cycle of turning to alcohol, tobacco and drugs to alleviate the pain. Healing the underlying pain from the child abuse can help the person overcome the addiction. 5. Peer pressure Adolescents exposed to a peer group involved with alcohol, tobacco and other drugs are more likely to take drugs, drink and smoke. As they see their peers taking drugs, smoking and drinking, they view the behavior as "normal" and believe that it is safe to experiment with these things. And teens often want to do what appears to be "cool" or what they think will enable them to "fit in" and make friends, even if this means taking drugs and be wasted. 6. Lack of Parents supervision Preteens and teenagers have no supervision after school. While their parents are at work, many teens tend to spend their time bonding with their friends or going to

other friends house where they can have the privacy of drinking liquors, smoking and the worst is using drugs instead of going home early. This scenario is due to the fact that teenagers dont want to go home early just to find out that no ones at home. And because their parents are busy, they dont have the time to talk to them about their problems so they choose to be with their friends where they could find the attention that they need.

b. Inherited Risk Factors Research shows that the risk for developing alcoholism or drug addiction can be inherited. This means that if you have a family member with an addiction, you have a greater likelihood of becoming an addict yourself. There are reviews suggesting that certain genetic
factors contribute to the development of alcohol and other drug (AOD) use disorders, as well as to the development of a variety of forms of externalizing psychopathologythat is, psychiatric disorders characterized by disinhibited behavior, such as antisocial personality disorder, attention deficit/hyperactivity disorder, and conduct disorder.

Several genes have been identified that confer risk to AOD dependence. Some of these genes:

GABRA2 and CHRM2 apparently act through a general externalizing phenotype. In particular, the DRD2 gene has been associated with alcohol dependence (Blum et al. 1990) and, more broadly, with various forms of addiction. This association remains controversial, however, and more recent studies suggest that the observed association

actually may not involve variants in the DRD2 gene but variants in a neighboring gene called ANKK1.

The increasingly rapid pace of genetic discovery also has resulted in the identification of several genes encoding other types of proteins that appear to be associated with alcohol use and/or dependence. These include, for example, two genes encoding taste receptors (i.e., the TAS2R16 gene and the TAS2R38 gene) and a human gene labeled ZNF699.

III.

Types of Drug Abused and Resulting Problems

A. Legal Drugs drugs that can be legally bought and sold in the marketplace. 1. Alcohol - Ethyl alcohol, or ethanol, is an intoxicating ingredient found in beer, wine, and liquor. Alcohol is produced by the fermentation of yeast, sugars, and starches. It is a central nervous system depressant that is rapidly absorbed from the stomach and small intestine into the bloodstream. A standard drink equals 0.6 ounces of pure ethanol, or 12 ounces of beer; 8 ounces of malt liquor; 5 ounces of wine; or 1.5 ounces (a "shot") of 80-proof distilled spirits or liquor (e.g., gin, rum, vodka, or whiskey).

Effects: a. In an individual Alcohol affects every organ in the drinker's body and can damage a developing fetus. Intoxication can impair brain function and motor skills; heavy use can increase risk of certain cancers, stroke, and liver disease. Alcoholism or alcohol dependence is a diagnosable disease characterized by a strong craving for alcohol, and/or continued use despite harm or personal injury. Alcohol abuse, which can lead to alcoholism, is a pattern of drinking that result in harm to one's health, interpersonal relationships, or ability to work. b. In the community Alcohol is a major problem in America and also in other countries because it caused injuries and deaths of those people who used it in excessive amounts, the amount of money used for it became wasted, and it has social and economic cost to the society through broken homes and lost wages. Study proves that those who engage in alcohol drinking in a younger age have a high possibility of alcohol dependence compare to those who engage in an older age. Young drinkers have a high chance of destroying their own lives as well as the lives of others by reckless driving, risky sexual behavior which could lead to transfer of diseases and unwanted pregnancies and the commission of other violent and injurious acts. Alcoholism leads to low performance of an individual in work and also in studies. Thus, this causes the low productivity and slow improvement in a community.

2. Nicotine - Nicotine is highly addictive. It is a psychoactive and addictive drug found in tobacco products such as cigarettes. The tar in cigarettes increases a smoker's risk of lung cancer, emphysema, and bronchial disorders. The carbon monoxide in smoke increases the chance of cardiovascular diseases. Pregnant smokers have a higher risk of miscarriage or low birth weight babies. Secondhand smoke causes lung cancer in adults and greatly increases the risk of respiratory illnesses in children. Through the use of tobacco, nicotine is one of the most heavily used addictive drugs and the leading preventable cause of disease, disability, and death in the U.S. Cigarette smoking accounts for 90% of lung cancer cases in the U.S., and about 38,000 deaths per year can be attributed to secondhand smoke. Cigarettes and chew tobacco are illegal substances in most U.S. states for those under 18; a handful of states have raised the age to 19. But recently, the prohibition of tobacco products to minors are uneven that leads to the point of allowing them to purchase cigarettes from vending machines. The tobacco companies especially in America have put a lot of efforts to market cigarette to children and adolescent by selling fruit, candy and liquor-flavored cigarette and also having commercials promoting cigarette use. This is the reason why Synar Amendment is made. Synar Amendment is a federal law that requires all states to adopt legislation that prohibits the sale and distribution of tobacco products under age of 18. States that do not

comply with this regulation lose federal dollars for alcohol, tobacco and other drug prevention and treatment program.

3. Over the Counter (OTC) Drugs are drugs, with the exception of nicotine and alcohol, which could be purchased without the prescription of a physician. 4. Prescription Drugs purchased only with the instruction of a physician due to its dangerous effects. i. Health Effects: a. Acute - Increased alertness, attention, energy; irregular heartbeat, dangerously high body temperature, potential for cardiovascular failure or seizures b. Chronic In high doses or alternate routes of administration (e.g., snorting, injecting): Anxiety, hostility, paranoia, psychosis; addiction c. In combination with alcohol - Masks the depressant action of alcohol, increasing risk of alcohol overdose; may increase blood pressure; jitters d. Withdrawal symptoms - Depression, fatigue, increased appetite, insomnia or hypersomnia, vivid unpleasant dreams, psychomotor retardation or agitation Associated Special Vulnerabilities/Populations: a. Female adolescents - Unlike some illicit drugs and alcohol, stimulants are used at equal or greater frequency by young females vs. males. Use is often to lose weight, stay awake to study, or perform better on exams. Prescription Stimulants (Amphetamine, Methylphenidate)

b. Mixing with antidepressants or OTC cold medicines - May enhance adverse effects; cause blood pressure to become dangerously high or lead to irregular heart rhythms. Treatment options: a. Medications - There are no FDA-approved medications to treat stimulant addiction. b. Behavioral Therapies - Behavioral therapies that have proven effective for treating addiction to illicit stimulant drugs, such as cocaine and methamphetamine, may be useful in addressing prescription stimulant addiction. ii. Prescription Sedatives, sleeping pills or anxiolytics

Central nervous system depressants include barbiturates (e.g., Nembutal) and benzodiazepines (e.g., Valium, Xanax)

Health Effects: a. Acute - Drowsiness, relaxation; overdose b. Long-term - Tolerance, physical dependence, addiction c. In combination with alcohol - Slows both heart rate and respiration, which can be fatal d. Withdrawal symptoms - Discontinuing prolonged use absent a physicians guidance can lead to serious withdrawal symptoms, including seizures. For barbiturates, abrupt cessation can be life-threatening. Treatment options: a. Medications - Addicted patients should undergo medically supervised detoxification because the treatment dose must be gradually tapered.

b. Behavioral Therapies - Behavioral therapies, such as cognitive behavioral therapy, that have proven effective for treating addiction to other illicit substances may be useful in addressing addiction to prescription sedatives.

iii. Health Effects:

Prescription Opioids (Hydrocodone, Oxycodone, Codeine)

a. Acute - Pain relief, drowsiness, nausea, constipation, euphoriain some When taken by routes other than as prescribed (e.g., snorted, injected), increased risk of depressed respiration, leading to coma, death; CDC reports marked increases in unintentional poisoning deaths since late the 1990s, due mainly to opioid pain reliever overdose (often in combination with alcohol or other drugs). b. Long-term - Tolerance, addiction In combination with alcohol - Dangerous slowing of heart rate and respiration, coma, or death c. Withdrawal symptoms - Restlessness, muscle and bone pain, insomnia, diarrhea, vomiting, cold flashes with goose bumps ("cold turkey"), and leg movements. Associated Special Vulnerabilities/Populations: a. Youth - 8-10% of high school seniors have used Vicodin nonmedically in the past year; 5% have abused OxyContin b. Pregnancy - Spontaneous abortions; low birth weight c. Older Adults - The higher prevalence of pain in this population renders a greater number of prescriptions written for opioid medications. Unintentional misuse or abuse could have more serious health consequences for elderly patients because of

comorbid illnesses (and multiple prescriptions), potential for drug interactions, and age-related changes in drug metabolism. Treatment options: a. Medications Methadone, Buprenorphine, Naltrexone (short and long-acting)

iv.

Androgenic Anabolic Steroids

- Synthetic substances related to testosterone; promote growth of skeletal muscle (anabolic) and development of male sexual characteristics (androgenic); taken orally or by injection in doses much higher than would be prescribed. Health Effects: a. Acute - Headaches, acne; fluid retention (especially in the extremities), gastrointestinal irritation, diarrhea, stomach pains, and an oily skin, jaundice, and hypertension; infections possible at injection site b. Long-term - Liver damage; CVD: high blood pressure; increases in LDL (bad cholesterol); and decreases in HDL (good cholesterol); cardiac hypertrophy, atherosclerosis Addiction: Different from other drugs since abuse is not driven by euphoric effects. Nevertheless, individuals often continue abuse despite adverse physical/social consequences. Currently, few users of anabolic-androgenic steroids (AAS) seek substance abuse treatment, but those that present with AAS addiction display a distinctive pattern of comorbid psychopathology, overlapping with that of individuals with other forms of substance dependence

c. In combination with alcohol - May be synergistic in precipitating impulsive violent behavior (more research is needed) d. Withdrawal symptoms - Mood swings, fatigue, restlessness, loss of appetite, insomnia, reduced sex drive, and steroid cravings, and depressionsometimes lead to suicide attempts. Associated Special Vulnerabilities/Populations: a. Males - Shrunken testicles, reduced sperm count, infertility, baldness, development of breasts, increased risk for prostate cancer and striae distensae when injected b. Females - Facial hair, male-pattern baldness, changes in or cessation of the menstrual cycle, enlargement of the clitoris, deepened voice, circumscribed hypertrichosis c. Adolescents - Stunted growth due to premature skeletal maturation and accelerated puberty changes. B. Illicit Drugs - Drugs that are disapproved and are illegally sold and used. 1. Cannabis or Marijuana - Greenish-gray mixture of the dried, shredded leaves, stems, seeds, and/or flowers of Cannabis sativa or cannabis indicathe hemp plant. Health Effects: a. Acute - Heightened sensory perception; euphoria, followed by drowsiness/relaxation; impaired short-term memory, attention, judgment, coordination and balance; increased heart rate; increased appetite

b. Long-term - Addiction: About 9 percent of users; about 1 in 6 of those who started using in their teens; 25 to 50 % of daily users

Mental disorders: May be a causal factor in schizophreniform disorders (in those with a pre-existing vulnerability); is associated with depression and anxiety

Smoking related: Chronic cough; bronchitis; lung and upper airway cancers is undetermined c. In combination with alcohol - Magnified tachychardia and effect on blood pressure; amplified impairment of cognitive, psychomotor, and driving performance d. Withdrawal symptoms - Irritability, difficulty sleeping, strange nightmares, craving, and anxiety Associated Special Vulnerabilities/Populations: a. Youth - Almost 44 percent of teens have tried marijuana by the time they graduate from high school (MTF, 2010). Treatment options: a. Medications - There are no FDA-approved medications to treat marijuana addiction.

2. Cocaine - White crystalline powder that can be snorted, injected or smoked. Health Effects: a. Acute - Dilated pupils; increased body temperature, heart rate, and blood pressure; nausea; increased energy, alertness; euphoria; decreased appetite and sleep High doses: Erratic and violent behavior, panic attacks

b. Long-term - Addiction, restlessness, anxiety, irritability, paranoia, panic attacks, mood disturbances; insomnia; nasal damage and difficulty swallowing from snorting; GI problems; HIV c. In combination with alcohol - Greater risk of overdose and sudden death than either drug alone d. Withdrawal symptoms - Depression, fatigue, increased appetite, insomnia or hypersomnia, vivid unpleasant dreams, psychomotor retardation or agitation Associated Special Vulnerabilities/Populations: a. Pregnancy - Premature delivery, low birth weights, and smaller for gestational age

3. Methamphetamine - White, odorless, bitter-tasting crystalline powder that is easily dissolved in water or alcohol; can be ingested orally, intranasally, injected, or smoked. Health Effects: a. Acute - Enhanced mood; increased heart rate, blood pressure, body temperature, energy and activity; decreased appetite; dry mouth; increased sexuality; jawclenching b. Long-term - Addiction, memory loss; weight loss; impaired cognition; insomnia, anxiety, irritability, confusion, paranoia, aggression, mood disturbances,

hallucinations, violent behavior; liver, kidney, lung damage; severe dental problems; cardiac and neurological damage; HIV, Hepatitis c. Withdrawal symptoms - Depression, anxiety, fatigue, and intense craving for the drug.

Associated Special Vulnerabilities/Populations: a. Pregnancy - Increased risk of premature birth, placental abruption, fetal growth retardation, and heart and brain abnormalities.

4. Inhalants - Volatile solvents, Aerosols, Gases, Nitrites (Poppers): Effects depend on properties of chemical; inhalation common route of abuse. Health Effects: a. Acute - Confusion; nausea; slurred speech; lack of coordination; euphoria; dizziness; drowsiness; disinhibition, lightheadedness, hallucinations/ delusions; headaches; suffocation; convulsions/seizures; hypoxia; heart failure; coma; sudden sniffing death (butane, propane, and other chemicals in aerosols)

Nitrites: Systemic vasodilation; increased heart rate; brief sensation of heat and excitement; dizziness; headache b. Long-term - Myelin break down leading to muscle spasms, tremors and possible permanent motor impairment; liver/kidney damage

Addiction: A minority inhale on a regular basis, but among those, some report symptoms of addiction (need to continue using, despite severe adverse consequences). Nitrites: HIV/AIDS and hepatitis; lipoid pneumonia c. In combination with alcohol - Nitrites: Increased risk of adverse cardiovascular effects; Alcohol may increase the blood-vessel relaxant effect of organic nitrates (such as amyl nitrite) and result in dangerously low blood pressure.

d. Withdrawal symptoms - With Long-Term Abuse: Mild withdrawal syndrome (e.g., irritability, restlessness, insomnia, headaches, poor concentration). Associated Special Vulnerabilities/Populations: a. Youth Abused mostly by younger (8th graders) rather than older teens (10th and 12th graders)

Nitrites: Linked to high risk sexual behaviors and HIV transmission; because of vasodilating actions on anal sphincter, frequently used to facilitate anal intercourse by men who have sex with men b. Pregnancy - Although rigorous studies have not been conducted, data from occupational exposure to abused solvents like toluene suggest increased spontaneous abortion and fetal malformations. 5. Street Opioids (Heroin, Opium) - Processed from poppy plants; white or brownish powder or black sticky substance known as black tar heroin; Usually smoked or injected, could be taken orally. Health Effects: a. Acute - Euphoria; warm flushing of skin; dry mouth; heavy feeling in extremities; clouded thinking; alternate wakeful and drowsy states; itching; nausea; depressed respiration b. Long-term - Addiction; physical dependence; collapsed veins; abscesses; infection of heart lining and valves; arthritis/other rheumatologic problems; HIV; Hepatitis C c. In combination with alcohol - Dangerous slowdown of heart rate and respiration, coma, or death

d. Withdrawal symptoms - Restlessness, muscle and bone pain, insomnia, diarrhea, vomiting, cold flashes with goose bumps ("cold turkey"), and leg movements. Associated Special Vulnerabilities/Populations: a. Pregnancy - Spontaneous abortions; low birth weight 6. Hallucinogens - LSD, PCP, MDMA (Ecstasy), Psilocybin, Salvia, Ketamine Health Effects: a. LSD 1. Acute - Elation, depression, arousal, paranoia or panic; impulsive behavior, rapid shifts in emotions; distortions in perception. Increased body temperature, heart rate, blood pressure; nausea; loss of appetite; jaw-clenching; numbness; sleeplessness; dizziness, weakness, tremors

High doses: Panic, paranoia, feelings of despair, fear of insanity and death 2. Long-term - Frightening flashbacks, Hallucinogen Persisting Perception Disorder (HPPD), low addictive potential; however, tolerance possible b. PCP 1. Acute - Low Doses: Shallow, rapid breathing, increase in heart rate and blood pressure; nausea, blurred vision, dizziness; numbness; slurred speech; confusion; loss of coordination; muscle contractions; analgesia; altered perceptions; feelings of being separated from ones body

High Doses: Feelings of invulnerability and exaggerated strength; seizures, coma, hyperthermia.

c. MDMA (Ecstasy) 1. Acute Euphoria; increased energy, alertness, tactile sensitivity, empathy; decreased fear, anxiety; increased/irregular heartbeat; dehydration; chills; sweating; impaired cognition and motor function; reduced appetite; muscle cramping; teeth grinding/clenching; in rare caseshyperthermia, rhabdomyolysis, and death 2. Long-term - Impulsiveness; irritability; sleep disturbances; anxiety addiction d. Psilocybin 1. Acute Low doses: Relaxation; altered sensory perception; increased energy, heart rate; decreased appetite.

High doses: Effects similar to LSD, including visual hallucinations, altered perceptions; nervousness, confusion, panic, paranoia 2. Long-term - Low addictive potential however may produce tolerance e. Salvia 1. Acute - Short-lived, but intense hallucinations, altered visual perception, mood, body sensations; emotional swings, feelings of detachment from ones body; highly modified perception of external reality and self; sweating 2. Long-term - Unknown addictive potential f. Ketamine (similar to PCP) 1. Acute - Anxiety; agitation; insomnia; euphoria; excitement; slurred speech; blurred vision; irregular heartbeat.

Low Doses: Nausea; elevated blood pressure; sedation; analgesia; impaired attention; memory and motor function.

Higher Doses: Immobility; distortions of auditory and visual perceptions; feelings of being separated from ones body and environment; hallucinations; memory problems. 2. Long-term - Cognitive impairment, including verbal and short-term memory; blurred vision; loss of coordination 3. In combination w/alcohol - Increased risk of adverse effects

IV.

Prevention and Control of Drug Abuse

A. Primary - aimed at preventing a problem from occurring, including preventing the use of drugs or delaying the uptake. a. Recreational activities for teens have also changed. b. c. Impromptu street hockey Touch football games are less frequent due to parental fears of predators, the growth of video gaming. d. Advent of scheduled recreational activities.

e. Focus on performance, overscheduling, and worries about the future put added pressure on teenagers and some find relief in the form of mood-altering drugs. f. Diet g. Exercise B. Secondary - aimed at high risk groups and intervening early to prevent the problem from occurring.

Health screening a. Companies to taking direct action with an employee. b. Diagnosis and treatment of employees that show symptoms of drug or alcohol problems. C. Tertiary - aimed at people already suffering from a drug use disorder or dependency and seeks to reduce harm to the individual and community. a. Early warning systems b. Overdose prevention

c. Safe bar programs d. Information, education, and communication e. Community-based outreach f. Drug courts

g. Rehabilitation center D. The Philippine Government implements different Drug Prevention and Control programs. By virtue of the Comprehensive Dangerous Drugs Act of 2002 ( Republic Act No. 9165), the Philippine Drug Enforcement Agency (PDEA) was created for the efficient and effective law enforcement of all the provisions on dangerous drugs and/or precursors and essential chemicals as provided in R.A. No.9165; PDEA is the implementing arm of the Dangerous Drugs Board (DDB). The DDB is the policy-making and strategy-formulating body in the planning and formulation of policies and programs on drug prevention and control.

Every third week of November of every year has been declared as the "Drug Abuse Prevention and Control (DAPC) Week." Via Presidential Proclamation No. 12.

Family Drug Abuse Prevention Program and the Special Drug Education Center (SDEC) from Department of Social Welfare and Development - communitybased prevention program designed to educate and prepare communities in general, and families in particular, about the adverse effects of drug and substance use and abuse.

References: http://www.drugabuse.gov/drugs-abuse/tobacco-addiction-nicotine http://books.google.com.ph/books?id=ZBxeWu_r0R8C&pg=PA335&lpg=PA335&dq=inherited +risk+for+tobacco&source=bl&ots=ZezfNvOHNG&sig=dQzIk3J1LthwJPEGByOrha0StI&hl=tl&sa=X&ei=oF6WTgszPeYBaKG9dAO&ved=0CCMQ6AEwAQ#v=onepage&q=inherited%20risk%20for%20tobac co&f=false http://www.breakingnews.ie/world/mhojojidmhgb/rss2/#ixzz1t0V55iMH