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Substance Abuse

Alcohol and Tobacco are available legally although highly-taxed. The other substances are illegal in varying degrees.


For most people, a small amount of alcohol does little harm and it is enjoyable. Alcohol is best when you don't overdo it.

Drinking too much, or even drinking a little at the wrong time, can cause problems. The most important thing you need to know is the amount of alcohol in your drink and how different drinks compare. The following drinks each contain roughly the same amount of alcohol.

skunkYou can think of each as one unit.
One Unit
= half pint ordinary beer or lager
= single measure spirits, (e.g. scotch, gin) - 1fl/oz
= a standard glass wine
= a small glass sherry
= a measure vermouth or aperitif.

This rough guide only applies to drinks bought in bars and pubs. Home measures tend to be more generous. Home brews could be much stronger. Extra-strength lager contains almost three times as much alcohol as ordinary lager!

More and more people are drinking low-alcohol and alcohol-free drinks - lagers, beers, ciders, wines, or mineral water or fruit juices.

Supersweet alcohol blends designed to appeal to the younger or less sophisticated consumer are a derivative of the old style cordials such as Drambuie, Bacardi  etc.

If you need, or want to cut down your drinking, try changing to low-alcohol or alcohol-free drinks. One pint of strong lager contains 4 units of alcohol, while most pints of low-alcohol lagers have less than one unit. It is important to keep to sensible limits if you want to avoid damaging your health. Young and old people are more at risk and should drink less:
warning Men - up to 7 units/week
warning Women - up to 4 units/week

It's advisable to spread the amount throughout the week, with two to three drink-free days, as your body needs time to recover from drinking alcohol. Women are more at risk from harmful effects of alcohol since their bodies have more fat and less water content than men. Alcohol is more diluted in the extra body fluids found in a man's body.

Drinking alcohol when pregnant means you are feeding your baby alcohol. This is because when you drink, the alcohol passes into your bloodstream, through the placenta and is fed to your baby. If you're pregnant, or planning a pregnancy, never drink heavily or frequently. If you limit yourself to an occasional drink - e.g. one unit, one to two times a week - the risk to your baby will be very small. However, if you cut out alcohol completely, you cut out the risk completely. The same advice applies if you're breast-feeding, since alcohol can be passed to your baby through your breast milk.
Most alcohol is rapidly absorbed into the bloodstream. Nearly all alcohol has to be burnt up by the liver and the rest disposed of in sweat, urine or in the breath. On average, it takes 1 hour for the body to break down one unit of alcohol.

While in the bloodstream, alcohol affects people in different ways, depending upon individual body weight, size, height and sex. An empty stomach can also vary the effects.

Alcohol is a mood altering drug. It can make some people lively and talkative, others silent and miserable.

Alcohol is a depressant, in that it depresses certain brain functions. Therefore, it affects your judgement, self control and co-ordination.

Hangovers are caused by drinking too much alcohol. Dehydration is one of the problems. The alcohol tends to make water move out of body cells and this builds up in the blood. This is bad for the skin and leads to wrinkles and a puffy face.

Also each type of alcoholic drink contains natural substances which give it colour, smell and taste. These substances may add to a hangover.

Long Term Effects
The liver can only burn up one unit of alcohol in 1 hour. If it has to deal with too much alcohol over a number of years, it suffers damage. Heavy drinking can damage your sexual ability. Too much alcohol can make it difficult to conceive a baby. Drink can also lead to careless sexual behaviour. Many family rows and breakdowns are caused by people drinking too much.

Alcohol also plays a part in unlawful behaviour.
Most violent crimes are committed by people who have been drinking.
Drinking makes you pile on the pounds. (7 calories per gram with absolutely no nutritional value)
Alcohol has many calories (one pint of ordinary beer contains many calories!).
Heavy drinkers will get their energy from alcohol instead of food, but most alcoholic drinks lack essential nutrients and vitamins.

Alcohol causes:
warning Stomach disorders, e.g. ulcers
warning Brain damage
warning Depression and other psychiatric problems
warning Hepatitis
warning Cirrhosis - permanent scarring of liver
warning Cancer of mouth and throat
warning More problems for people with diabetes
warning Sexual difficulties
warning Vitamin deficiency
warning Muscle disease

Drinking And Driving
There are legal limits for drinking and driving. If you exceed these limits you can be prosecuted. However, there is no sure way of telling how much you can drink before you reach this limit. It varies with each person. Your driving ability can be affected by just one or two drinks. Even if you are below the legal limit, you can still be prosecuted if a police officer thinks your driving has been affected by alcohol. The only way to be sure you are safe is not to drink if you are going to drive.


Caffeine is a stimulant drug. It occurs naturally in coffee beans, tea leaves, cocoa beans and cola nuts, commonly used in soft drinks, notably cola. If consumed in large quantities, or by particularly sensitive individuals, unpleasant side-effects can occur. These include agitation, tremors, insomnia, even irregular heart rhythm.
People who regularly consume large amounts of caffeine (e.g. 5+ cups of coffee/day) often find that their tolerance to the substance has increased. This requires an increased intake to obtain the same stimulant effect.
Possible withdrawal symptoms include tiredness, headaches and irritability. These may occur through going without caffeine for just a few hours. There is sometimes a strong psychological dependence too. Because of its stimulant effect, caffeine can improve short-term athletic performance and, therefore, its use is banned in sporting competitions.
Caffeine is often included in various drug preparations, particularly in combination with certain painkillers. Note: the same brand of drug sold in one country might contain caffeine and in another country not include it.

General Drug Abuse

Among the many reasons for drug abuse is the desire to escape from reality and curiosity about a drug's effects. There are a number of signs which could indicate drug abuse:
warning Sudden changes of mood
warning Unexpected irritability or aggression
warning Loss of appetite
warning Losing interest in hobbies, work/schoolwork, etc.
warning Bouts of drowsiness or sleeplessness
warning Increased evidence of telling lies or furtive behaviour
warning Money or belongings disappearing
warning Unusual smells, stains or marks on the body or clothes, or around the house
warning Unusual powders, tablets, capsules, scorched tinfoil, needles or syringes.

With prolonged chronic use, the addict may lose interest in food, personal hygiene and social relationships. Additional financial and health problems may result. Like any addiction, drug abuse can be more easily overcome if it is caught early. Be vigilant and if you see any of these signs, particularly with children, get them professional help fast.

Cannabis ('Pot, dope, hash, grass, weed')

Hard brown sticky material, or herbal mixture, usually rolled into a cigarette and smoked. It can also be smoked in a pipe, brewed into a drink or put in food. Cannabis use is often a socially shared experience.

Short-Term Use
The use of cannabis impairs ability to drive or perform other skilled tasks where precision and alertness are essential. The effects generally start a few minutes after smoking. They may last up to 1 hour with low doses and for several hours with high doses. There is no hangover of the type suffered with alcohol.

Long-Term Use
A person who inhales cannabis smoke over several years could develop similar disorders associated with cigarette smoking, such as bronchitis and lung cancer.

Alcoholics can rapidly become dependant on cannabis and regular users often feel a psychological need for the drug's effects or may rely on it in social situations.

Cocaine ('Coke')

Fine white powder. Usually a small amount is sniffed, or 'snorted' up the nose through a tube. It is absorbed into the blood supply via the nasal membranes. 'Freebasing' sometimes happens - the smoking of cocaine base, also known as 'crack'. This is a more potent method than snorting. Cocaine can be injected, but this is less common.

Short-Term Use
Generates a strong feeling of euphoria and alertness. Also, decreased hunger, indifference to pain and fatigue, and feelings of great physical strength and mental capacity. Damaging effects may include anxiety or panic. Effects are short-lived and last about 15-30mins. This means dose may have to be repeated every 20mins to maintain effect.

Large doses, or a series of quickly repeated doses, can lead to an extreme state of agitation, anxiety, paranoia and, perhaps, hallucination. These effects generally fade as the drug is eliminated from the body. The after-effects include fatigue and depression.

Excessive doses can cause death from respiratory or heart failure.

Long-Term Use
Physical dependence develops quickly since user wants repeated feelings of physical and mental well-being and is often tempted to increase dosage. Withdrawal from habitual use can be unpleasant with insomnia, restlessness, nausea, weight loss and sometimes severe depression. Repeated sniffing can damage nasal membranes and nasal septum.

Heroin ('Smack, skag')

White or speckled brown powder. May be swallowed, dissolved in water and injected, sniffed up the nose, or smoked by heating on silver foil and inhaling fumes ('chasing the dragon').

Short-Term Use
User feels detached from reality and relaxed, drowsy, warm and content, relieved of stress and discomfort. For people who have developed physical dependence and tolerance, this positive pleasure is replaced by the relief of obtaining the drug, and a regular need, just to stay 'normal'. First experiments with heroin sometimes cause nausea and vomiting.

Little interference with the senses, even at doses enough to produce euphoria. At higher doses, sedation takes over and overdose results in stupor and coma. Death can result from respiratory failure.

Overdose is more likely if combined with other depressant drugs. There can be fatal reactions if mixed with other substances (e.g. glucose powder, flour), by illicit manufacturers and traders.

Long-Term Use
As tolerance develops, dosage increases to achieve repeated euphoria. A user can overdose when taking a usual dosage after a break (during this time tolerance has faded). Physical dependence develops rapidly with a strong psychological dependence. After several weeks on high doses, an addict who attempts to reduce intake or stop the habit experiences withdrawal symptoms.

Effects are comparable to influenza, muscle cramps, nausea and vomiting. The higher the daily intake reached, the more severe the withdrawal symptoms. They generally fade in 7-10 days, but feelings of weakness last for several months. Unsterile injecting may cause hepatitis, septicaemia or gangrene. Injectors also risk AIDS.

Repeated heroin sniffing can damage nasal membranes.

LSD-'Lysergic Acid Diethylamide' ('Acid, Trips')

White powder. It may be made into small pills, tablets, or capsules. The drug may also be absorbed on gelatin sheets or sugar cubes. Sometimes LSD is offered as a colourless, tasteless, odourless liquid, impregnated on small paper squares. It is taken by mouth.

Short-Term Use
'Trip' begins less than 1 hour after dose. Peaks after 2-6 hours and fades after 12 hours, depending on dose.

Effects depend on dose size and user's mood, expectations and personal company. Effects include intense colour perception and visual or sound distortions. True hallucinations are rare. Emotional awareness may include heightened self-awareness, mystical or ecstatic experiences.

A feeling of being outside one's body is commonly reported. Unpleasant reactions, or bad 'trips', may include depression, dizziness, disorientation and sometimes panic (more likely if user is unstable, anxious or depressed).

Death from suicide or hallucination is rare. Accidents can occur while under influence of drug. It's never safe to drive a motorcycle or car during or while recovering from LSD.

Long-Term Use
There is no clear evidence of physical damage from repeated use of LSD. The main hazards are psychological, rather than physical. Serious anxiety or psychotic reactions may occur, but can usually be dealt with by friendly reassurance.

Brief, but vivid flashbacks of part of a previous trip may occur months later. These can leave the person feelingdisorientated and can be distressing, but are only very rarely dangerous.

There is no physical dependence. For several days after taking LSD, further doses are less effective and thisdiscourages frequent use.

Magic Mushrooms

Several species of mushrooms can have hallucinogenic effects. However, distinguishing hallucinogenic from poisonous mushrooms is a complex skill, requiring knowledge of botany and mushroom classification.

They may be eaten fresh, cooked, or brewed in tea, and can be preserved by drying.

Short-Term Use
Effects like mild LSD experience, but may also include euphoria and increased heart-rate, blood pressure and pupil  size. Effects occur after 30min, peaking 3 hours later and lasting 4-9 hours.

Low dose effects are euphoria and detachment. At higher doses, visual distortions progress to vivid hallucinations of colour and movement, often with nausea, vomiting and stomach pains.

Occasionally 'bad trips' invoke deep fear and anxiety, and may develop into a psychotic experience. These are most common after repeated or unusually high doses, or if user is inexperienced or anxious. They can usually be dealt with by friendly reassurance.

By far the greatest danger is the risk of using a poisonous mushroom by mistake (final trip).

Long-Term Use
As with LSD, tolerance rapidly develops and the next day it might take twice as many mushrooms to repeat the experience, which discourages frequent use. Sometimes longer lasting disturbances, such as anxiety attacks and flashbacks to the original experience, can occur.

Speed ('Billy Whiz')

White or brown powder. May be in tablet or capsule form. Taken by mouth in tablet form, or as a powder, sniffed, smoked or dissolved in water and injected.

Short-Term Use
Breathing and heart rate increase, pupils widen and appetite lessens. Initially, user feels more energetic, confident and cheerful. Later, feelings turn to anxiety, irritability and restlessness.

High doses can produce hallucinations, delirium, panic and paranoia. Effects of one dose last 3-4 hours and leave user feeling tired. It can take a few days for the body to fully recover.

Long-Term Use
Risk of psychological dependence. Regular use takes increasing dose to maintain effects.

Heavy use debilitates through lack of food and sleep and lowers resistance to disease, and risks damaged blood vessels or heart failure.

Withdrawal effects include lethargy, extreme hunger and depression. Short term effects of high doses (delusions and paranoia), may cause psychotic state.


Most are powders, usually in capsule form. Used medically to calm people and as sleeping pills. Mis-users generally take them by mouth, occasionally with alcohol. They may also inject.

Short-Term Use
Depending on dose, effects last 3-6 hours. Large dose can cause unconsciousness, respiratory failure and death.

Fatal overdose is an ever-present danger as amount which can cause death isn't much more than normal dose.

Effects/hazards are magnified by alcohol.

Long Term Use
Psychological and physical dependence may develop. Withdrawal symptoms include irritability, restlessness, trembling, faintness, nausea, confusion and delirium. Sometimes convulsions, which may be associated with lasting brain damage. Sudden withdrawal from high doses can be fatal.

Heavy users are also more prone to bronchitis and pneumonia because cough reflex is depressed. May suffer from hypothermia because drug blocks normal responses to the cold. Also risk of repeated accidental overdose. Most of these hazards are increased if drug is injected.

Tranquillisers ('Tranks')

Tablet or capsule form. Usually taken by mouth, rarely injected. Most widely used are Benzodiazepines. These drugs have come to replace barbiturates for most medical purposes because they are much safer.

Short-Term Use
Reduce anxiety, generally without marked drowsiness and clumsiness associated with barbiturates.
However, prolonged use may cause anxiety, instead of curing or reducing it. They impair driving and similar skills. Effects usually last 3-6 hours.
Many more tranquillisers than barbiturates have to be taken for fatal overdose. Effect is reached at lower dosage level if alcohol has also been taken.

On their own, tranquillisers rarely produce euphoria associated with barbiturates or alcohol. This probably accounts for their lack of widespread popularity as recreational drugs.

Long-Term Use
Psychological dependence quite common among long-term users; physical dependence and tolerance may develop.

Withdrawal effects may occur even with therapeutic dosage. Effects, though not potentially fatal as with barbiturates, can be very unpleasant and protracted. They include anxiety, nausea, insomnia and, after unusually high doses, convulsions and mental confusion.

Cigarette Smoking

cigarettes do thisCigarettes are plant leaves which have been dried and wrapped in special easy-burn paper. The leaves are ignited and allowed to smoulder. The smoke and vapours that are given off are inhaled into the lungs of the user. It is now known that smoking is a major health hazard both to the smoker and to those around them.

Cigarettes contain numerous harmful substances.

The dangers of three of them are particularly important:
warning Nicotine: This is the substance that causes addiction to tobacco. It stimulates the body to produce adrenaline - this makes the heart beat faster and pushes up blood pressure.
warning Tar: This produces chronic irritation of the respiratory system and is thought to be a major cause of lung cancer.
warning Carbon Monoxide: A poisonous gas which cuts down the amount of oxygen the blood can carry to the heart and all other parts of the body. (often with side effects as shown in the picture)
Both nicotine and carbon monoxide may encourage thrombosis, or blood clotting. When you inhale cigarette smoke, the little hairs, cilia, in the air passages stop working.
Mucus carrying waste substances, tar and nicotine slips back into your lungs. Eventually the cilia stop working even when you are not smoking.
About a quarter of smokers die of diseases directly caused by smoking. Many others suffer years of pain and discomfort.
About 1,000 men and women in the U.K. die each week from diseases of the heart and circulation system caused by smoking.

The three main diseases related to smoking are:
1 Coronary heart disease
2 Lung cancer
3 Chronic bronchitis and emphysema.

The nicotine raises blood pressure and makes the heart work harder. The heart needs oxygen to do that extra work, but the carbon monoxide in cigarette smoke cuts down the amount of oxygen getting to the heart.

With this extra strain on the heart, it is easy to understand how smoking doubles the risk of dying of a heart attack (see 'Reducing The Risk Of A Coronary' in 'Looking After Your Heart').

Young smokers are even more vulnerable, a man under 45, smoking 25+ cigarettes/day, increases the relative risk 10-15 times. The smoker's cough can put further strain on the heart.

Smoking cigarettes is the main cause of lung cancer.

Of every 10 people who die of lung cancer, 9 are smokers. The more cigarettes smoked per day and the lower the age at which smoking started, the greater the risk of lung cancer. However it should not be assumed that deaths from lung cancer are always caused by smoking.

Certain cells in the lungs which engulf bacteria, also absorb tar from cigarette smoke. Chemicals in the tar can start lung cells changing into cancer cells. The cancer cells multiply, destroy the lungs and spread around the body to start new cancers.

warning A cough - first and most common symptom
warning Coughing up blood
warning Shortness of breath
warning Chest pain
warning Wheezing

Less than 10% of lung cancer patients survive 5 years after the disease is diagnosed.

The highest chance of cure is when the cancer is discovered and treated early. However, if the cancer has spread beyond the chest, a cure is highly unlikely.

Diseases often coexist to cause a persistent disruption of air flow into and out of the lungs. Chronic bronchitis is caused when tar and mucus damage the small air tubes and air sacs in the lungs. This leads to narrowing of these airways causing breathlessness. A persistent cough will also be present.

Smoking stimulates the production of mucus in the lining of the bronchi and thickens the bronchi muscular walls and those of the bronchioles. Often the person becomes increasingly short of breath and eventually may become housebound.

Emphysema is a disease in which the alveoli in the lungs become damaged, and lose their elasticity. They become unable to expand and contract.

The patient becomes breathless and in severe cases respiratory or heart failure may occur. There is also a risk for smokers of developing circulatory diseases which, at their worst, can lead to gangrene in the leg and leg amputation.

Smoking during pregnancy passes nicotine and carbon monoxide into the baby's bloodstream. Nicotine makes the baby'sheart beat too fast. Carbon monoxide means that less oxygen and nutrients reach the baby. A still birth is more likely and a higher risk of a premature or underweight baby.

Physical and mental development of children of mothers who smoke during pregnancy can be affected.

Breathing air which contains other people's smoke was thought to be no more than a nuisance, but recent research shows that it can cause lung cancer among non-smokers.

A burning cigarette gives off two types of smoke - mainstream and sidestream. The smoker breathes mainstream, the passive smoker breathes sidestream - the smoke that comes off the end of a lit cigarette.

Sidestream smoke is a mixture of irritating gases and tar particles that reach deeper into the lungs because they are small.

Many non-smokers find smoke causes unpleasant effects such as sore or runny eyes, sneezing, coughing, wheezing, hoarseness and headaches.

Non-smokers run a small risk of getting lung cancer. This risk is increased if they have lived or worked with smokers over many years.

There is even more risk of the non-smoker suffering a heart attack. A recent survey found non-smokers living with smokers have 30% higher risk of death from heart attacks.

Researchers found that passive smoking increases stickiness of platelets (tiny fragments in blood that aid clotting). Platelets can form clots in fat-clogged arteries, causing heart attacks.

Passive smoking is the third leading preventable cause of death (after smoking and alcohol). Children of smokers are more likely to suffer serious chest illnesses (e.g. pneumonia and bronchitis ) and are at more risk of developing heart problems.

Research by the Medical College of Virginia showed this risk to adolescent children of smokers. The children were passive smokers since birth.
They had increased amounts of cholesterol and lower levels of a protein in blood that is believed to protect against heart attacks.

Damage is done quickly and children may suffer health problems after only a few months' exposure to smoke. Statistics prove that your children are twice as likely to smoke, if you do.

The risks of smoking decrease dramatically on giving up. However, this may be difficult since nicotine is addictive.

Withdrawal symptoms can be experienced, such as irritability and restlessness. These should only last a few weeks, however, and will be well worth the effort. The person will feel and smell much fresher.

The efficiency of the lungs improves and the risk of developing heart diseases decreases. Generally, the person will feel much fitter. In younger smokers, the risk of heart attack can be halved within 5 years compared with those who continue smoking.


This is the practice of inhaling (breathing in) the vapours given off by solvents in order to get 'high'. Feeling 'high' is rather like getting drunk on alcohol.
Glue sniffing is the most common form of solvent abuse. Other substances are used, such as lighter fuel, aerosols, typewriter correcting fluid, stain removers and paints.
It is usually a group activity which occurs in isolated places away from adults. 12-16 age group are mainly involved.

For most people, it is a passing phase which lasts for no more than a few months. A small proportion will continue sniffing for several years.

In the U.K., over two young people die each week as a result of solvent abuse, some of whom are first time sniffers.

Short-Term Use
Effect of inhalation is similar to becoming drunk, or getting high on drugs. Sometimes dream-like experiences occur. However, these are not true hallucinations as sniffers do not confuse them with reality.

Effects of solvent vapours occur quickly and disappear within 5-30mins if sniffing is stopped. It can cause headache, vomiting, stupor and confusion. The person may experience a mild hangover for about a day. While someone is sniffing repeatedly, the hangover produces effects of pallor, fatigue, forgetfulness and loss of concentration which can become a daily pattern.

This could affect their work or studies, but these symptoms will clear up when sniffing is stopped.

Long-Term Use
These include damage to the membrane lining the nose and throat, and damage to the kidney, liver and nervous system.

Fatalities have occurred, caused by:
warning Suffocation through inhaling vomit
warning Accidents while intoxicated or while hallucinating
warning Toxic effects of solvent causing heart failure
warning Suffocation using a plastic bag while sniffing (this can become trapped on face and cause suffocation)

Common signs of solvent abuse include:
warning Chemical smell on breath
warning Traces of glue or other solvents on body or clothes
warning Empty containers (aerosols, tins, etc.)
warning Rash or red ring around nose and mouth
warning Flushed face
warning Appearing drunk or 'high', confused, restless
warning Slurred speech
warning Persistent, irritable cough
warning Loss of weight/not eating
warning Personality change - moodiness, irritability, apathy
warning Secrecy about movements
warning Sudden decline in standard of school work

Young people who are glue-sniffing need understanding and support. Encourage them to talk about any worries or problems. Sometimes young people take to glue-sniffing out of boredom. They may need encouragement to get involved in activities at school or in the area. It can help to talk to someone else, such as a doctor, for guidance.

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