Drugs can be understood as any substance or agent which when enters the body can cause temporary changes in the physiological or psychological state of the individual. There are different reasons why people use drugs, like for enjoyment, to cope up with their environment, out of curiosity, as a form of self medication, as a form of defence mechanism, as a form of rebellion, due to increased availability and promotion, popular media and peer pressure. In this essay, the different reasons why people in the UK have turned to drug and the factors promoting such use will be discussed. Drug use in this aspect shall refer to the use of illicit or recreational substances, and not medicine (disambiguation).
Studies by Boys, Marsden and Strang showed that 50% of youth between the age group of 16 to 24 years have used drugs at some point in their lives, most of whom have used cannabis (40%), followed by amphetamine (18%-24%), LSD (10%-13%), Ecstasy (8%-12%), cocaine (3%-9%). The author’s points out that usage of multiple types of drugs (poly-drugs or multi-drug) is not uncommon among the youth. This involves the usage of more than one psychoactive substance to produce a simultaneous effect. Which the authors have termed as ‘concurrent drug use’. Earlier studies have shown that users often take multiple drugs in order to enhance the effect of the other drug or to manage the adverse effect. Many evidences show that rational appraisal process is one of the factors why most youth decides to use drugs, instead of a passive reaction to context, as pointed by Boys et al. (2000) and Wibberley and Price (2000). Boys, Marsden and Strang highlights that the reasons of the drug use among the youth varies between reasons like how the drugs makes the users feel good, to an increase in self confidence . Based on how the drugs interacts with the body, and the changes it makes, drugs have been categorized in to different types by different authors like Carman et al. (1979), Butler et al. (1981), Newcomb et al. (1988), Cato (1992); McKay et al (1992). Such differences in the effects of different drugs (like the effect of the different drugs on the nervous system) can reflect the different reasons why people use drugs. Some use to drugs to increase nervous stimulation (excitant) or decrease the stimulation (depressant).
Instrumental drug use has been found to be common among vehicle drivers to increase their concentration and attention, and alleviate tiredness, as well as by people trying to lose weight, since their usage reduces appetite. Sadava suggested that understanding the functions of drugs is vital to realize how environmental and behavioural factors affect the patterns of drug use.
Discussed below are some of the factors influencing the prevalence of drug use in the UK, based on other studies?
Studies by Nesse and Berridge points out that a lot of people are attracted to drugs that stimulate positive emotions, giving a false signal of fitness, utilizing the mechanism of ‘liking’ or ‘wanting’ to continue the usage of drugs in order to prolong the stimulated emotions. Many of such drugs targets the dopamine centres of the limbic and mesolimbic system, which are related to regulation of motivation. The opioid receptors o the target neurons react to the drugs, thereby activating the cells to release dopamine, the ‘feel good factor’ in the brain, which simulates the feeling of pleasure or happiness. On the other hand, the drugs that block negative emotions like anxiety, low mood, or even depression are used as a defence mechanism to cope up with different stressors experienced by the user.
Studies by Kendler, Myers and Prescott suggests that genetic risk factors for substance dependency on psychoactive drugs cannot be attributed by a single factor, and instead is due to an interplay between both genetic and environmental factors. Studies made on twins have shown that the environmental and genetic risk factors were shared between the twins, showing a common aetiology. The studies also showed that individuals tend to have a genetic predisposition to use alcohol, nicotine, caffeine apart from the illicit drugs. However the risk of genetic predisposition is difficult to isolate from the environmental factors favouring the predisposition, and hence is difficult to analyze individually. However, it has been pointed out that the use of drugs spread due to an evolutionary advantage provided by the drugs, causing the user to feel better, and hence develop a dependency on it.
Several environmental factors like deprivation, unemployment, poor living conditions, have negative impact on the psychological health of individuals, which causes an increase in negative emotions like stress or depression. In such circumstances, the individuals opt for drug use to manage the stresses they are exposed to, and alleviate their psychological well being. Additionally, poor economy also results in the individuals indulging in small scale drug supply in order to supplement their economic and social status. Studies by Baumann et al. supports the view that deprivation, lack of employment is related with a greater incidence of drug use among individuals in the community . Sinha also points out that stress acts as a significant risk factor that facilitates drug use as well as the vulnerability of a relapse among people who quit drugs. Chronic exposure to stress can increase self administration of drugs as well as drug seeking behaviour. Such behaviour is linked to the effect of the drugs on the corticostriatal-limbic motivational, learning, and adaptation systems, which involves mesolimbic dopamine, glutamate, and gamma-amino-butyric acid (GABA) pathways. Mood and anxiety disorders caused due to environmental factors or stressors, like post traumatic stress disorder (PTSD) can also increase the propensity of drug use among people. Sinha points out different types of adverse events or trauma that can act as stressors, that can predict the risk of addiction like: loss of parent, parental divorce or conflict, isolation, single parent family stress, living away from family or parents, loss of child, infidelity among married couple, loss of home due to accident or disaster, death of spouse, victims of violence, observing violence or victimization, physical neglect, physical abuse, emotional abuse, emotional neglect, sexual abuse, rape and poor emotional and behavioural control.
Figure 2: Model showing the inter relation between stress and drug use on behavioural and neurological function, mediated by reward pathways. Column A shows 3 types of vulnerability factors, Column B shows alteration in the neurobiological pathways that are related to the regulation of stress, cognition and behaviour, and Column C shows the behaviour outcomes due to the stress; source: (Sinha et al.)
Figure 3: Diagram showing the relation between peak cravings and anxiety; source: (Sinha et al..)
About two thirds of drug users have stated that they stared using drugs out of sheer curiosity (69% of the drug users). Webb, Ashton and Kamali adds that ‘pleasure’ is the biggest reason why students in school, colleges or universities use drugs. Also, anxiety, sleep difficulties, can have significant stress effect, that might increase the propensity of drug use. The authors also point that lifestyle of the students are over to their later lives, and causes the continuation of drug use among them. They found that a major part of smokers also used cannabis, showing a high prevalence. Since curiosity is a very common human psychology, that enables individuals to try new and different things, a curiosity towards the effects of the drugs plays an important role especially in children who are easily impressed, and would think that trying it once won’t cause any problems. This allows individual a firsthand experience about the effects of the substances, and can lead to dependency.
Figure: Different reasons for drug use; source: (British Drugs Survey 2014)
Several studies have shown that a lot of people take drugs as a form of self medication for depression and mood disorders. Khantzian points out those individuals with drug use problems, often self medicate with opiates in order to manage painful emotional states, providing them short term benefits, which can cause dependence . Weiss et al. also pointed out that drug users self medicate themselves to treat depression, and negative mood . Studies by Markou, Kosten and Koob also indicate a relation between drug dependence and depression, both sharing a common neurobiological pathway . Thus self medication provides the drug users a way of managing the psychological conditions, and help them feel better.
Among several people, drug use is related to an act of rebellion. Kohn and Mercer suggests that students who considered themselves more rebellious tended to be more permissive regarding drugs, especially cannabis, compared to peers who were more authoritarian. Braucht et al. hypothesized that drug usage among adolescents can be a form of group rebellion against a sense of isolation or alienation from the mainstream culture and society .
Peer Cluster Theory suggests that the socialization factors associated with adolescents interacts with each other to form peer clusters that can either encourage drug use or provide sanctions against it. The peer clusters can be a small cohesive unit that has huge effects on the behaviour of children and adolescents. The authors suggests that social factors like socialization, family strength, family sanctions, religious belief, adjustment with school can effect drug use by affecting the peer clusters. Farrel and White points out that peer influence acts as the strongest predictor of drug use among adolescents, apart from parental influences (drug use by parents). Other factors like presence and quality of an affectionate and non conflicting parent, adolescent relationships, parenting practices, conflict level in the family, degree of bonding between children and parents can affect the propensity of drug use.
Another factor that facilitates drug use is the cost and availability of certain drugs. Drugs like cannabis are generally cheaper and more easily available in many places. This can be correlated with the higher prevalence of using cannabis among people. Studies show that in the UK use of marijuana is at 81% among drug users, compared to 28% for cocaine, 28% for ecstasy, 22% for magic mushroom, 20% for Amphetamine, 19% for LSD, 10% for Mephedrone, 9% for Ketamine, 6% for Heroin and Crystal meth, 3% for Crack and 1% for steroids.
Studies have shown that the usage of psychoactive drugs dates back to ancient human history. Evidences suggest usage of drugs derived from certain cacti during 8600 BC, and cultivation of poppies for opium during 6000BC by the Neanderthals. Similarly, fermenting for alcohol production started as early as 7000BC in China. Between 8600 to 5600 BC, ancient Peruvians were using Echinopsis pachanoi (species of cactus) to extract mescaline. Evidences from 13000 year old remains from Southern Philippines suggest the consumption of betel nut leafs, and has also been found prevalent in most of Asia. Usage of Cannabis also dates back to the Bronze Age in Turkmenistan, Romania around 2000BC. Usage of Nicotine was evidenced from hairs of mummies in South America, before the arrival of Europeans. The history of smoking tobacco in pipes in North Americas dates back from 3000 to 2000 BC. Similarly, usage of magick mushrooms dates back to the Neolithic and Bronze Age in Europe, Guatemala, Mexico, Honduras and El Salvador. Many suggest that the usage of drugs in the ancient times were mostly related to ceremonial rituals, rather than for recreational purposes. The history of drug usage probably started when ancient people started cultivating plants containing psychoactive substances and fermented drinks to produce alcohol, and shows an almost uninterrupted series of evidence through history, ever since .
Historians have pointed out that Alexander the great used to drink alcohol regularly, and was also familiar with opium, which he introduced to Persia and India. Emperor Shennong of China used marijuana to treat rheumatism and gout, and encouraged massive production for medical usage as far back as 2700 BC. Marcus Aurelius of the Roman Empire used opium to help his sleep, and took it regularly due to his health problems. The Greek Oracles of Delphi inhaled certain fumes from Kerna springs, that seemed to have hallucinogenic properties, as well as oleander leaves, that have psychoactive substances. Ramses the third of Egypt also smoked marijuana for medicinal purposes, like curing eye sores. Even Queen Elizabeth used marijuana for medicinal purposes to relive menstrual cramps
Statistics from Home Office Crime Survey for England and Wales 2015/16 shows that 8.4% of adults between ages 16-59 (about 2.7 million people) have taken drugs in the previous year, and 35% of adults in the same age group have taken drugs at some point in their lives. The statistics also shows that cannabis was the most common drug in the UK, followed by Cocaine and Ecstasy. Other drugs commonly taken are LSD, Mephedrone, Ketamine and Steroid. 87% of the people who took drugs also believed that they never had any problems due to the drug use, while 13% (about 2 million) believed that they faced problems due to drug use, with nearly half of them being able to break the habit. 23% of the users are confessed regular users, while 84% of the total users have used drugs in their own or friend’s home. The high prevalence of drug use have been seen among youths between the ages 16-18 (41%), followed by children below 16 years (23%). 82% of the users also have started drug use with marijuana, while 69% of the users stated that they did drugs out of curiosity .
Different Theories of addiction explains the causes and maintenance of addiction, like neurobiological theory, psychological theory, and socio cultural theory.
The Neurobiological theory considers the effect of drugs on neurobiology, or the function of the brain. The effect is through two distinct pathways, the dopamine system and opioid system. This can explain how different drugs are affecting the brain, like Alcohol has inhibitory effect of GABA (Gamma Amino Butyric Acid) channels, increases serotonin (5HT-3) activity, dopamine release in the opiate receptors, and suppressing action on glutamate receptors of the brain. Nicotine has antagonistic effect on nicotinic receptors, which results in an increased secretion of acetylcholine, nor epinephrine, dopamine, serotonin, glutamate and endorphin. Cannabis that has tetrahydrocannabinol as an active substance prevents the uptake of dopamine, serotonin, GABA and nor epinephrine. Opiates acts as antagonists to opiate receptors of the brain. Cocaine has inhibitory role in dopamine re uptake, while Amphetamines increases the release of dopamine and monoamines, while also inhibiting the reuptake of dopamine. This leads to dependence of the drugs, due to changes occurring in the nervous system due to exposure to the drugs, as a form of Neuroadaptation. This also underlies the hereditary vulnerability to drug dependency in people.
Psychological theories link behavioural problems like impulsive or compulsive behaviour or obsessive compulsive disorders or gambling with dependency on drugs. Emphasis is given on learning and conditioning, cognitive effects, behavioural tendencies and the model of rational choice to explain the psychological basis of drug dependency. Behaviour theory suggests that dependency can be caused due to the effect on the brain as well as through reinforcing effect of the experience, which can be used to explain the onset of cravings for drug. The cravings can also be triggered by several external cues like smell, taste, sight or internal cues like state of mind. Personality theory identifies an addictive personality state as related to substance dependency. Cognitive theory suggests that a lack of self regulation, and an increased reliance on external sources to maintain physical and psychological balance. Rational Choice theory suggests that dependency is through voluntary engagement in self destructive behaviours.
The social theory of addiction considers that observation of drug use by others can be a motivation for drug use for some people. The theory suggests that our decisions are based on our observation of our peers, family, or role models, which can facilitate the acquisition of new habits, developing inhibition or lack of it for certain behaviours, and also facilitates the responses of self destructive behaviour. Additionally, expecting positive outcomes can also increase the prevalence and perception of the effect of the drugs, and hence the maintenance of dependency.
Drug usage is seen across social boundaries, however, impoverished drug users tend to use public places more often for drug use, and can include public bathrooms, and open spaces or dilapidated houses. Survey from 2014 in UK however shows a decline of drug use in public places. 16% of respondents of the study preferred club or bar or pubs for drug use, and 84% preferred their own or a friend’s home for that purpose. Most of the users of drugs in public places or outside their homes tend to be young individuals between 16 and 24, and also showed a higher prevalence of drug use out of home in women (25%) compared to men (6%). Studies have shown a decline in of drug use in pubs or bars from 35% in 2008 to 16% presently. Introduction of smoking bans in public places might have also contributed to the decline.
In the media, the use of drugs has been frequently shown. Television, movies and social media have been frequently accused of taking the subject of drug use lightly, and have even glamorized the use. Popular songs about smoking marijuana or films showing drug use can have an adverse effect on the viewers, motivating them to try these, fears many healthcare advocates. One of the key reasons why celebrities who endorse usage of drugs or alcohol is that they have reached fame and fortune while being exposed to these substances, and being in the altered state of mind, due to which they seem to attribute their success, at least partially on these substances. Other mass media platforms where usage of drugs have been advertised includes newspapers, public services, internet sites like YouTube, twitter, face book, or other message boards.
Addiction is a treatable condition, which can include removal of the substance or activity that is causing addiction, managing withdrawal symptoms caused due to withdrawal, while behavioural therapies or cognitive therapies are used to identify, circumvent or cope with situations that can trigger drug use. Additionally, family therapies can also be effective to ensure a supportive environment. The treatment for drug use needs to include the following objectives: stoppage of drug use, staying drug free, being productive.
The treatment can be based on the following principles:
The steps of the treatment can include:
Conclusion:
With an overview of the different studies on drug use, it can be inferred that the prevalence of drug use among people in UK can be attributed to different factors such as psychological factors (like anxiety, stress, depression and mental health issues), social factors (like peer pressure, unemployment, deprivation, poverty and social interactions or isolation), apart from biological factors (like genetic predisposition). A lot of youth also start using drugs out of curiosity, and easy availability of drugs like cannabis, and often start using multi drugs to enhance the psychoactive effects, which can often lead to dependency on the substance. Usage of drugs dates back to ancient history, with famous people often associated with the usage of alcohol, opiates, marijuana, mushroom and other psychoactive substances for both medical and recreational use. Ancient cultures have also shown evidences of ritualistic drug use, across the globe. The biological perspective of drug dependency highlights a neurobiological predisposition of drug dependency on people that can be attributed to the evolutionary process of neuron adaptation. Behavioural problems and social determinants also influence drug use, stemming from mutual reinforcement from drug users and from the effects of the drug itself. Therefore, treatment for drug use must address the various factors that increase the prevalence of the usage, in order to maintain independence from drugs.
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