The use of psychoactive substances is deeply embedded in our cultural fabric. We use these substances, often referred to as “drugs,” to celebrate successes and to help us deal with grief and sadness. We use drugs to mark rites of passage and to pursue spiritual insight. We use them to get going and to unwind.
What are drugs?
A drug is something that alters the way our bodies function, either physically or psychologically. Psychoactive drugs act on the central nervous system (and the brain, in particular) to affect the way we think, feel or behave.
Drugs are often categorized as legal versus illegal, or soft versus hard. But these groupings can be misleading as they do not accurately reflect the levels of risk associated with using them. A more useful classification relates to the impact drugs have on the central nervous system:
These drugs are chemicals that tap into the brain’s communication system and influence the way nerve cells send, receive or process information.
Why do people use drugs?
There’s no society on earth that does not in some way celebrate, depend on, profit from, enjoy and also suffer from the use of psychoactive substances. The last century saw an upsurge in the cultivation, manufacture and trade of psychoactive substances, some quite ancient and others new. Some have been developed from pharmaceutical products made initially for treating pain, sleep or mental health problems (e.g., heroin, barbiturates and benzodiazepines). Others have been manufactured for recreational purposes (e.g., ecstasy). Still others, notably cannabis, are made from plants or seeds that have been cultivated and traded to new and much larger markets.
In general, people take psychoactive drugs for a variety of reasons:
Psychoactive drugs target the brain’s system that regulates movement, emotion, cognition, motivation and feelings of pleasure. Our brains are wired to associate life-sustaining activities with pleasure or reward. When people use drugs to achieve what they perceive as positive effects, they are manipulating this reward system in the brain.
So what is the problem?
Some drugs can have impacts on the reward system two to ten times that produced by naturally rewarding behaviours such as eating or sex. This intense response encourages repeated use of the drug. But the use of psychoactive substances involves risk and their use is associated with significant harm.
Some of the harms relate to the short-term intoxicating properties of psychoactive substances. These harms tend to be acute or immediate (e.g., injury or death resulting from impairment while engaging in activities that require acuity or dexterity).
Other harms relate to chronic conditions (like heart disease and cancer) that emerge from longer term use. These vary depending on characteristics of the drug itself or the mode in which it is taken. So, for example, much of the chronic harm related to tobacco is not from the drug (nicotine) but from inhaling the smoke.
If the brain is repeatedly exposed to a drug, it may respond by making several adaptations designed to re-establish an equilibrium but which may have other consequences as well. The brain may become less responsive to a particular chemical so that natural sources of reward no longer provide any significant pleasure and the person begins to feel flat, lifeless and depressed. As a result, the person needs to take drugs just to feel normal and sometimes needs to take larger and larger amounts. These adaptations within the brain can also lead to impairment of cognitive or motor functioning.
In addition to the structural adaptations, conditioning can lead to the association of certain environmental cues with the drug experience. Exposure to those cues can later trigger powerful cravings for the drug.
It is estimated that almost a quarter of the burden of disease in British Columbia results from substance use (illicit substances contribute about 2%, alcohol about 10%, and tobacco a further 12%).
What factors influence the risk of harm?
It is not all about the drug. The reasons a person uses a drug powerfully influences the pattern of use and the risk of harmful consequences. If the motive is fleeting (e.g., curiosity), then only occasional or experimental use may follow. If the motive is strong and enduring (e.g., a chronic sleep or mental health problem), then more long-lasting and intense substance use may follow. Motives for intense short-term use (e.g., to fit in, have fun or alleviate temporary stress) may result in risky behaviour with high potential for acute harm.
The places, times and activities associated with substance use also powerfully influence patterns of use and the likelihood of harm occurring. The use of alcohol by teenagers in the absence of parental supervision, for example, is particularly likely to be high risk. Being in a situation of social conflict or frustration while under the influence of alcohol or anti-anxiety drugs (e.g., benzodiazepines) can increase the likelihood of a conflict escalating to violence. Using substances before or while engaging in activities such as driving, boating or hiking on dangerous terrain increases the risk of injury.
The overall social and cultural context surrounding substance use is significant. The economic availability of different drugs is critically important – the cheaper and more available they are, the more likely they are to be used. Community norms also influence individual behaviour, and the degree of connection to family, friends and the wider community impact the pattern of substance use.
In addition, a variety of personal factors may affect the probability that a person will engage in risky substance use. These factors include physical and mental health status. For example, someone with anxiety or depression may try to feel better by drinking alcohol. Experience of adverse life events, such as physical, sexual or emotional abuse, may impact a person’s physical or mental health as well as contribute directly to risky substance use patterns. There is also evidence that genetic inheritance and personality or temperament may have an impact. For example, tendencies towards sensation seeking increase a person’s risk of harm from substance use.
Finally, certain factors about the drugs influence the risk of harm. All psychoactive substances have the potential to cause harm, and this has little correlation with their legal status. The amount used, the frequency of use, the purity of the drug, the mode of use as well as the chemical properties of the drug all influence the degree of risk involved and the type of harm that might result. For example, depressants such as alcohol or heroin have elevated risks related to overdose, whereas heavy use of stimulants can lead to psychotic behaviour. Injecting concentrated forms of cocaine is much more risky than chewing coca leaves even though the same drug is involved.
How can the risk be managed?
Psychoactive substance use involves risk. But when used with care, many psychoactive substances can be beneficial. That is, the positive impact may outweigh the risks involved. Substance use can be regarded as ranging along a continuum from mainly low-risk and sometimes beneficial use to clearly harmful use. Factors related to the context of use, the person and the substance all influence the likelihood of harm as illustrated in the diagram below.
Managing risk involves examination of the reasons or motivations for use as well as assessment of the risk and protective factors in play.
Some of the signs that suggest drug use may be risky or harmful include
Some signs suggesting substance use is less likely to be harmful include
Communities can contribute to reducing the risks related to substance use. This involves promoting a culture of inclusivity and responsibility among citizens. It also means addressing the social issues that might lead to risky substance use, and supporting citizens who are at risk of developing problematic substance use patterns. Communities should also ensure those who are experiencing problems related to substance use have ready access to a range of supportive services.