UNIT III

UNHEALTHY PRACTICES AND THEIR IMPACT ON HEALTH

3.1 Drug Classification
A drug (French-Drogue a dry herb) is defined as “any chemical agent which affects living
protoplasm and is intended for use in the treatment, prevention or diagnosis of disease.” The
branch of science which deals with drugs is called “pharmacology” (Pharmacon-drug, logos-
study).
Allopathic Drugs: The term "Allopathy" refers to the principle of curing a disease by
administering substances that produce the opposite effect of the disease when given to a healthy
human.

1. Anti-Hemorrhoid Drugs – to reduce the swelling and relieve the discomfort of

haemorrhoids.

2. Topical Antibiotics – to kill bacteria and helps in preventing infections caused by bacteria
that get into minor cuts, scrapes, and burns

3. Cough-Suppressants - to relieve dry, hacking coughs associated with colds and flu.

4. Anti-acne Drugs- to clear up pimples, black heads, white heads, and more severe forms of
acne. For example, lotions, soaps, gels, and creams containing benzoyl peroxide or tretinoin.

5. Non-steroidal Anti-inflammatory Drugs- for a variety of painful conditions, including

Arthritis, Bursitis, Tendinitis, Gout, sprains, strains, and other injuries.

Ibuprofen, Naproxen Sodium and Ketoprofen are all in the general category known as Non-
Steroidal Anti- Inflammatory Drugs (NSAIDs).

6. Antiseptics- to slow or stop the growth of germs and help prevent infections in minor cuts,
scrapes, and burns

7. Analgesics- to relieve pain of all sorts - headaches, backaches, joint pain, sore muscles and
pain.

Common Analgesics are Aspirin, Choline Salicylate, Magnesium Salicylate and Sodium
Salicylate.

8. Salicylates Drug- relieve pain and reduce fever. Aspirin belongs to group include Sodium
Salicylate, Choline Salicylate, and Magnesium Salicylate

9. Vasodilator - act directly on muscles in blood vessel walls to make blood vessels widen
(dilate). They are used to treat high blood pressure (hypertension).

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10. Antacids- to relieve acid indigestion, upset stomach, sour stomach, and heartburn. They
contain ingredients such as Aluminium Hydroxide, Calcium Carbonate, Magnesium Hydroxide,
and Sodium Bicarbonate

11. Expectorants- to loosen and clear mucus and phlegm from the respiratory tract. Guaifenesin
is an ingredient in many cough medicines.

12. Anti-fungal Drugs - to treat fungal infections.

13. Anti-Histamines- to block the action of histamine (a compound released in allergic

inflammatory reactions) at the H1 receptor sites, responsible for immediate hypersensitivity
reactions such as sneezing and itching.

அதி சி ம உ பாதி பி ெவளி ப இரசாயன ெபா

histamine

{ Antihistamines block the effects of a substance called histamine in your body. Histamine is
normally released when your body detects something harmful, such as an infection.

Antihistamines block your body's response to histamine and therefore reduce allergy
symptoms. In general, antihistamines do not suppress your body's vital immune response to
viruses, bacteria, or other foreign invaders.}

14. Antigas Agents - to relieve the uncomfortable symptoms of too much gas in the stomach and
intestines.

15. Smoking Cessation Drugs - to help people stop smoking cigarettes or using other forms of
tobacco. They contain Nicotine also called as Nicotine Substitution products or Nicotine
Replacement therapy.

3.2 TOXICOLOGY- ந றி ெபா க ப றிய அறிவ ய

3.2.1 History
Swiss Physician Paracelcus (1493-1541) credited with being “the father of modern
toxicology”. “All substances are poisons: there is none which is not a poison. The right dose
differentiates a poison from a remedy”. An apparently nontoxic chemical can be toxic at high
doses. Toxicology is the science dealing with properties, actions, toxicity, fatal dose, detection of
the interpretation of the result of the toxicological analysis and treatment of poisons. In other
words it is the branch of science concerned with the nature, effects, and detection of poisons.
Poisoning and knowledge of poisons have long been known to humans. ‘Socrates’ and
‘Cleopatra’ are two famous victims of poisoning in history.
 Socrates was forced to drink Hemlock for corrupting the youth of Athens.

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  Cleopatra committed suicide through the bit of an Asp (poisonous snake).
 In 15th century in Italy, Cesar and Lucrezia Borgia assassinated many of their political
rivals by poisoning with arsenic, copper and phosphorus.
 Lead caused poisoning in hundreds of thousands from the time of Roman era till 17th and
18th century as it was used in pottery, cosmetics, paints and in automobile fuels.
 Mustard gas and other poisonous gases were used in many wars starting from World War
I in 1914 by Germans.
 Chemical toxicities has caused disasters too like in Bhopal in 1984, where release of
Methyl Isocyanate killed many thousands of people.
Toxicology is an essential part of the development process of new drugs in the
pharmaceutical industry because ultimately the balance between safety and efficacy has to be
established. The resulting information on drug-induced toxicity, including different types of side-
effects and interactions, is of great concern for consumers of drugs as well as for pharmacists,
healthcare practitioners, agencies regulating medicinal products and others that have
responsibilities in different aspects related to the safe use of drugs.
Toxicity is often defined as the intrinsic ability of an agent to harm living organisms.
Toxicity can also be defined as an adverse health effect associated with a change, reduction or
loss of a vital function. This includes an impaired capacity to compensate for additional stress
induced by other (e.g. environmental) factors. For example, many survivors of the Bhopal
disaster in 1984 (in which severe lung toxicity occurred owing to the accidental release of methyl
isocyanate) had a reduced lung function that made them more sensitive to otherwise mild
infections. Although the accident occurred over 20 years ago, people still die because of that
tragic incident.

3.3 DRUG INDUCED TOXICITY

A drug is a substance that can be taken into the human body and, once taken, alters some
processes within the body. Drugs can be used in the diagnosis, prevention, or treatment of a
disease. Some drugs are used to kill bacteria and help the body recover from infections. Some
drugs assist in terminating headaches.
Physicians prescribe drugs to prevent or treat disease. Those same drugs can be toxic to certain
patients because of genetic predisposition, nonselective action, or inappropriate use or
administration of the drug. It must be recognized that no drug is entirely specific. All drugs have
both primary intended effects and secondary unintended effects, the latter known as side effects
or adverse effects. Although side effects can be neutral or even beneficial, side effects are
typically undesirable. Adverse effects can range in severity from nuisance to life threatening.
Drug toxicology focuses on the harmful effects of drugs in the animal and human body.

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 A drug will do more harm than good in an individual patient depending on many factors,
including the patient’s age, genetic makeup and preexisting conditions, the dose of the drug
administered, and other drugs the patient may be taking. For example, the very old or the very
young may be more susceptible to the toxic effects of a drug because of age dependent
differences in pharmacokinetic profiles or in drug-metabolizing enzymes. Adverse drug reactions
may be more likely in patients with preexisting conditions, such as liver or kidney dysfunction,
depressed immune function, or pregnancy. The clinical determination of a drug’s toxicity may
not always be straightforward, for example, a patient being treated with an antibiotic to combat
an infection can develop a high fever, skin rash, and significant morbidity due either to
recurrence of the infection or an adverse reaction to the antibiotic.

3.3.1 History of drug toxicity

 In the year 1937, Elixir sulphanilamide was an improperly prepared sulphanilamide
medicine that caused mass poisoning in the United States in 1937. It caused the deaths of
more than 100 people.
 In the year 1967, Clioquinol’s use as an antiprotozoal drug was restricted or discontinued
in some countries due to an event in Japan where over 10,000 people developed SMON
(Subacute Myelo-Optic Neuropathy).
 In the year 1990, Pemoline, for ADHD (Attention Deficit Hyperactivity Disorder), and
troglitazone, for Type-II diabetes, where both shown to damage the liver.

3.3.2 Harmful Immune Responses

Drugs are xenobiotics that can be recognized by the immune system as foreign
substances. If a drug is sufficiently large (e.g., a therapeutic peptide or protein), it may directly
activate the immune system. The two principal immune mechanisms by which drugs can produce
damage are hypersensitivity responses (allergic responses) and autoimmune reactions.
(i) Hypersensitivity reactions occur when the normally protective immune
system responds abnormally, potentially harming the body. Various autoimmune disorders as
well as allergies fall under the umbrella of hypersensitivity reactions, the difference being
that allergies are immune reactions to exogenous substances (antigens or allergens).
Hypersensitivity reactions are commonly classified into four types.

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 1. Type I hypersensitivity reactions are immediate allergic reactions (e.g., food and
pollen allergies, asthma, anaphylaxis).
2. Type II hypersensitivity reactions are referred to as cytotoxic, as they
involve antibodies that are specific to particular tissues within the body and cause
destruction of cells in these tissues (e.g., autoimmune hemolytic anemia, Goodpasture
syndrome).
3. Type III hypersensitivity reactions are immune complex-mediated, with tissue damage
caused by antigen-antibody complex deposition (e.g., many vasculitides and
glomerulonephritides).
4. Type IV hypersensitivity reactions (e.g., TB skin tests, contact dermatitis) are delayed
and cell-mediated and are the only hypersensitivity reaction that involves sensitized T
lymphocytes rather than antibodies.

(ii) Autoimmunity results when the organism’s immune system attacks its own cells.
Several drugs and a number of other chemicals can initiate autoimmune reactions.

Methyldopa can cause hemolytic anemia by eliciting an autoimmune reaction against the
Rhesus antigens (Rh factors).

Several other drugs, such as hydralazine, isoniazid, and procainamide, can cause a lupus-like
syndrome by inducing antibodies to myeloperoxidase (hydralazine and isoniazid) or DNA
(procainamide).

3.3.3 Types of Drug Toxicity

1. Cytotoxicity
2. Carcinogenicity
3. Mutagenicity
4. Teratogenicity

1. CYTOTOXICITY
This is the simplest form of drug toxicity, where the drug or an active metabolite causes
serious damage to the cells. The cells of a specific organ are affected, causing a potentially fatal
loss of function of the liver or kidney, damage to the eyes or ears, or abnormal clotting of the
blood.
Types of cytotoxicity

Non-covalent interactions
Lipid peroxidation
•Generation of toxic reactive oxygen species
•Reactions causing depletion of glutathione (GSH)
•Modification of sulfhydryl groups.

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Covalent interactions
Hepatotoxicity e.g. Paracetamol
Nephrotoxicity e.g.Aminoglycosides

2. CARCINOGENICITY
A carcinogen is any substance, radionuclide, or radiation that is an agent directly
involved in causing cancer. This may be due to the ability to damage the genome or to the
disruption of cellular metabolic processes. Several radioactive substances are considered
carcinogens, but their carcinogenic activity is attributed to the radiation, for example gamma rays
and alpha rays which they emit. Examples of non-radioactive carcinogens are inhaled asbestos
and tobacco smoke.

3. MUTAGENICITY (movie I and MAtran)

Some drugs can cause permanent changes to the DNA of germ cells - egg cells and
sperm cells - leading to mutations which are inherited by a patient's children. Example is
nitrogen mustard that destroy cancer cells by linking their DNA stands together with a nitrogen
atom, but can also link the DNA of germ cells, leading to deletion of DNA bases, thereby
causing mutations.

4. TERATOGENICITY

Some drugs can cause defects in the development of the foetus (வள த சிைன க ),
leading to gross abnormalities of the baby known as teratogenicity. The type of abnormality seen
depends on the stage at which the drug is taken, as different organs develop at different times
during pregnancy. Example: Thialidomide (C13H10N2O4)

3.3.4 Avoiding Toxicity

 Banning dangerous drugs or strictly controlling their uses.
 Drugs must go through both animal testing and small-scale trials on humans to detect
unexpected effects.
 To advise doctors not to prescribe toxic drugs to pregnant women.
 Child-proof containers have also been developed and clear labelling is used to warn
patients of risks.

3.3.5 Treatment
The first line of defence is to remove the drug from the patient before it is fully absorbed and
techniques include:

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  Irrigation to remove drugs applied to the eyes or skin.
 Gastric lavage where the stomach is washed out and drained using tubes.
 Activated charcoal, which is swallowed and soaks up the drug from the gut.
 Ipecac syrup, which causes vomiting in order to empty the stomach.
 Cathartics, laxatives which purge the drug from the gut.

The second line of defence involves the removal of the drug from the bloodstream by various
methods including:

 Changing urine pH to increase excretion of the drug into the urine.

 Forced diuresis, where drugs are given to increase urine production.
 Haemodialysis, where the blood is passed through a machine to remove the drug.
 Exchange transfusion to replace the patient's drug- filled blood with fresh blood.
Drug toxicity remains to be a major challenge of drug discovery and may affect various
biological processes involving a single or multiple target organs. Heart and liver, kidney, central
nervous system, developmental and genetic toxicity are among the most commonly observed
target organs and safety issues that need to be addressed before and during clinical development.

3.4 UNHEALTHY PRACTICES

Lifestyle is a way used by people, groups and nations and is formed in specific
geographical, economic, political, cultural and religious text. Lifestyle is referred to the
characteristics of inhabitants of a region in special time and place. It includes day to day
behaviors and functions of individuals in job, activities, fun and diet. In recent decades, life style
as an important factor of health is more interested by researchers. According to WHO, 60% of
related factors to individual health and quality of life are correlated to lifestyle. Millions of
people follow an unhealthy lifestyle. Hence, they encounter illness, disability and even death.
Problems like metabolic diseases, joint and skeletal problems, cardio-vascular diseases,
hypertension, overweight, violence and so on, can be caused by an unhealthy lifestyle. The
relationship of lifestyle and health should be highly considered. Malnutrition, unhealthy diet,
smoking, alcohol consuming, drug abuse, stress and so on, are the presentations of unhealthy life
style that they are used as dominant form of lifestyle.

3.4.1 DRUG ABUSE

Drug use pertains simply to the use of a drug. A drug may be injected (e.g., heroin and
speed), smoked (e.g., crack cocaine, marijuana, speed, heroin, and cigarettes), sniffed (e.g.,
inhalants and cocaine), huffed (inhalants), swallowed (e.g., pills), or sometimes absorbed
through the skin (e.g., the nicotine patch). Drug misuse means not using a drug in the manner in
which it was intended (as appropriate, as instructed, or as prescribed).
Drug abuse may be defined as the accumulation of negative consequences resulting from
drug misuse. It is a maladaptive pattern of drug use leading to clinically significant impairment

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or distress. It is the use of a chemical substance, legal or illegal, which causes physical, mental,
emotional or social harm to a person or to people close to him or her.
Drug abuse is frequently associated with toxic effects that evolve under regular use, over
dosage or the withdrawal syndrome that manifests during abstinence from the drug. It affects a
number of body systems leading to signals and symptoms of organ dysfunction, such as:
• Central nervous system (CNS) symptoms that may range from headaches and altered
mental status to coma and seizures.
• Cardiovascular alterations that include changes in blood pressure, heart rate, as well as
arrhythmias and organ ischemia.
• Respiratory changes that include respiratory arrest, pulmonary edema, and
pneumothorax.
• Metabolic effects, including alterations in body temperature, electrolytes, and acid–base
disturbances.
• Hepatic damage, from hepatitis to severe hepatotoxicity and liver failure that may
require liver transplantation.
• Renal damage, with symptoms derived from decreased filtration rate to acute kidney
failure.
• Reproductive consequences that may range from impaired fertility to teratogenesis,
intrauterine growth retardation, premature births and neonatal syndromes, and attention
deficit hyperactivity disorder (ADHD).
• Infectious complications from intravenous drug use, including viral infections such as
HIV and hepatitis B, and bacterial infections such as bacterial endocarditis, osteomyelitis,
and abscesses.

3.4.2 Some of the major effects of drug abuse are:

1. Nervousness and Psychosis:

Prolonged use of drugs leads to nervousness and psychosis. Drug addicts neglect their studies,
duty and bring frustration not only for themselves but also for their family and community. They
may lead to traffic and industrial accidents.

2. AIDS and Hepatitis:

Many drug addicts inject these drugs in their blood vessels with previously used needles. Studies
have shown that AIDS and Hepatitis-B are common in addicts using intravenous drugs.

3. Misuse of Drugs by Certain Sports Persons:

Misuse of drugs is done by certain sports persons to increase their performance. The side effects
of the use of anabolic steroids in females include masculinisation (males like features), increased
aggressiveness, depression, abnormal menstrual cycles, deepening of voice; excessive hair

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growth on the face and body and mood swings. In the adolescent male or female, stunted growth
takes place.

4. Impotency, Chromosomal Aberrations and Production of Abnormal Babies:

Continuous use of narcotics and stimulants cause impotency and chromosomal aberrations and
production of abnormal babies.

5. Effects on Kidneys:
Functions of kidney of drug abused persons are impaired and may be damaged.

6. Victims of various diseases:

It is evident that prolonged use of drugs causes permanent damage to some organs and the body
fails to work without the drugs. Therefore, the drug-users become victims of various diseases.

7. Hormonal Changes:
Hormonal changes include an increase in cortisol levels, inhibition of vasopressin, reversible
decrease in serum thyroxin and a more marked decrease in serum triiodothyronine (T3). Thyroxin
is also called tetraiodothyronine (T4).

8. Effect on Family:
The drug-users not only themselves suffer from the ill-effects of drug addiction, but also bring
miseries to the entire family.

9. Effect on Society:
Since drug abused persons get the supply of the drugs from illegal sources, they encourage
smuggling other associated illegal activities, resulting in several other social problems.

3.4.3. Drug addiction

Addiction is defined as a chronic, relapsing brain disease that is characterized by
compulsive drug seeking and use, despite harmful consequences. It is considered a brain disease
because drugs change the brain—they change its structure and how it works. These brain
changes can be long-lasting, and can lead to the harmful behaviors seen in people who abuse
drugs. Drug addiction is also a relapsing disease. Relapse is the return to drug use after an
attempt to stop.
Drug addiction seriously affects public health and represents a social burden worldwide.
The abuse of drugs has become a complex issue, mainly due to the development of synthesis and
purification procedures that enable an increase in the effective quantities of the active
compounds consumed and to the invention of the hypodermic syringe in the mid-nineteenth
century, which allowed the direct injection of purified active compounds into the bloodstream.
This also contributed to the increase of infections among drug addicts.

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3.4.4 Medical Consequences of Drug Addiction
People who suffer from addiction often have one or more accompanying medical issues,
which may include lung or cardiovascular disease, stroke, cancer, and mental disorders. Imaging
scans, chest X-rays, and blood tests show the damaging effects of long-term drug abuse
throughout the body. For example, research has shown that tobacco smoke causes cancer of the
mouth, throat, larynx, blood, lungs, stomach, pancreas, kidney, bladder, and cervix. In addition,
some drugs of abuse, such as inhalants, are toxic to nerve cells and may damage or destroy them
either in the brain or the peripheral nervous system.

3.4.5 Some Effects Of Specified Abuse Substances

1. Nicotine is an addictive stimulant found in cigarettes and other forms of tobacco.
Tobacco smoke increases a user’s risk of cancer, bronchial disorders, and
cardiovascular disease. Tobacco use killed approximately 100 million people during the
20th century, and, if current smoking trends continue, the cumulative death toll for this
century has been projected to reach 1 billion.
2. Alcohol is one of the most widely abused substances across the world. Alcohol
consumption can damage the brain and most body organs. Areas of the brain that are
especially vulnerable to alcohol-related damage are the cerebral cortex (largely
responsible for our higher brain functions, including problem solving and decision
making), the hippocampus (important for memory and learning), and the cerebellum
(important for movement coordination).

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3. Marijuana is the most commonly abused illegal substance. This drug impairs short-
term memory and learning, the ability to focus attention, and coordination. It also
increases heart rate, can harm the lungs, and can increase the risk of psychosis in those
with an underlying vulnerability.
4. Cannabis is one of the most widely used drugs across the world. Cannabis affects the
cannabinoid receptors in the brain. This drug comes in many different forms and affects
each user differently.
5. Cocaine and other stimulants is a short-acting stimulant, which can lead users to take
the drug many times in a single session (known as a “binge”). Cocaine use can lead to
severe medical consequences related to the heart and the respiratory, nervous, and
digestive systems. These drugs accelerate the activity of the CNS making a person feel
energized, focused, and alert for long periods of time. The converse reaction is that a
person feels edgy, paranoid and angry.
6. Amphetamines, including methamphetamine, are powerful stimulants that can produce
feelings of euphoria and alertness. Methamphetamine’s effects are particularly long-
lasting and harmful to the brain. Amphetamines can cause high body temperature and
can lead to serious heart problems and seizures.
7. LSD (Lysergic acid diethylamide) is one of the most potent hallucinogenic, or
perception-altering, drugs. Its effects are unpredictable, and abusers may see vivid
colors and images, hear sounds, and feel sensations that seem real but do not exist.
Users also may have traumatic experiences and emotions that can last for many hours.
8. Heroin is a powerful opioid drug that produces euphoria and feelings of relaxation. It
slows respiration, and its use is linked to an increased risk of serious infectious
diseases, especially when taken intravenously. People who become addicted to opioid
pain relievers sometimes switch to heroin instead, because it produces similar effects
and may be cheaper or easier to obtain.
9. Steroids, which can also be prescribed for certain medical conditions, are abused to
increase muscle mass and to improve athletic performance or physical appearance.
Serious consequences of abuse can include severe acne, heart disease, liver problems,
stroke, infectious diseases, depression, and suicide.
10. Drug combinations. A particularly dangerous and common practice is the combining
of two or more drugs. The practice ranges from the co-administration of legal drugs,
like alcohol and nicotine, to the dangerous mixing of prescription drugs, to the deadly
combination of heroin or cocaine with fentanyl (an opioid pain medication). It is critical
to realize that because of drug–drug interactions, such practices often pose significantly
higher risks than the already harmful individual drugs.
11. Inhalants. Mostly consumed through breathing, these drugs can exist in vapor form at
room temperature. Most inhalants are found in household items so they’re often used
by adolescents and children. They tend to be less addictive than other substances but
are incredibly dangerous.

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3.5 NARCOTICS
The term narcotic (from ancient Greek word narkotikos "numbing” or “deadening”)
originally referred medically to any psychoactive compound with sleep-inducing properties, and
euphoric properties. Although the term can refer to any drug that deadens sensation or produces
stupor, it is commonly applied to the opioids-that is, to all natural or synthetic drugs that act like
morphine. These are the drugs that produce tolerance, dependence and addiction and have
analgesic effects, depress the CNS (Central Nervous System) and tend to promote sleep. They
eventually make people physically and mentally dependent. Codeine and Demerol are common
synthetic narcotics. The “opiates”, a more powerful class of narcotics derived from the opium
poppy, include opium, morphine, and heroin.

3.5.1 Historical Background

Narcotics are the oldest as well as the strongest analgesics, or pain-relieving drugs,
known to humans. Ancient Sumerian and Egyptian medical texts dated as early as 4000 B.C.
mention the opium poppy ( Papaver somniferum ) as the source of a milky fluid (opium latex)
that could be given to relieve coughs and insomnia as well as ease pain. Traditional Chinese
medicine recommended the opium poppy, known to Chinese physicians as ying su ke , for the
treatment of asthma , severe diarrhea , and dysentery as well as chronic pain and insomnia.
Opium latex contains between 10 and 20 percent morphine, which in its purified form is a white
crystalline powder with a bitter taste.
Narcotics are central nervous system depressants that produce a stuporous state in the
person who takes them. These drugs often induce a state of euphoria or feeling of extreme well-
being, and they are powerfully addictive. The body quickly builds a tolerance to narcotics in as
little as two to three days, so that greater doses are required to achieve the same effect. Because
of the addictive qualities of these drugs, most countries in the twenty-first century have strict
laws regarding the production and distribution of narcotics. These laws became necessary when
opium addiction in the nineteenth century became a widespread social problem in the developed
countries. The invention of the hypodermic needle in the mid-nineteenth century, however,
increased the number of addicts because it allowed opioids to be delivered directly into the
bloodstream, thereby dramatically increasing their effect.

3.5.2 How Narcotics work

Opioids produce their actions at a cellular level by activating opioid receptors. These
receptors are distributed throughout the central nervous system (CNS) with high concentrations
in the nuclei of tractus solitarius, peri-aqueductal grey area (PAG), cerebral cortex, thalamus and
the substantia gelatinosa (SG) of the spinal cord. The central nervous system in humans and
other mammals contains five different types of opioid receptor proteins, located primarily in the
brain, spinal cord, and digestive tract. When a person takes an opioid medication, the drug
attaches to these opioid receptors in the brain and spinal cord and decreases the person's
perception of pain.

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 Different types of receptors give different instructions when they are activated. When
opioid receptors are activated, one of the things they do is to tell the nerves to slow down the
transmission of pain signals. That function is what makes narcotics useful for addressing pain.
Unfortunately, when narcotics activate opioid receptors they also have other, unwanted side
effects. One of those side effects is the activation of the brain’s reward system, which is the basis
of the addictive properties of narcotics. Overdoses of narcotics can cause drowsiness,
unconsciousness, and even death because these drugs suppress respiration.

3.5.3 What Are Narcotics Used For?

Narcotics have some valid medical uses, including:

 Pain management
 Anesthesia
 Reduction of respiratory distress for the dying
 Sedation
 Anti-diarrheal
 Antitussives (cough suppressant)
 Treatment of withdrawal and cravings in opioid-dependent individuals
 Lowering blood pressure and reducing fluid flow through the heart during an acute heart
attack.

3.5.4 Types Of Opiate Narcotics

Natural Narcotics:

 Occurring in nature as plants like roots, barks, leaves, flowers, fruits, seeds, resinous and
milky exudations.
 Ex. Opium, Morphine, Codeine

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Semi synthetic Narcotics:

 Crude and raw natural drugs are processed and isolated to active compounds by chemical
process.
 Such man made drugs derived from natural drugs are called semi synthetic drugs.
 Ex. Heroin, Brown sugar (Smack) etc.

3.5.5 Natural Narcotics:

3.5.5.1 OPIUM:

 Description
Opium is also known as paregoric, Dover’s powder. Opium comes under Natural type of
Narcotic drugs. The immediate precursor of heroin is morphine, and morphine is obtained from
opium. Opium is the dried milky, sticky white juice which is obtained by cutting slits of the
unripe seed pods of Papaver Somniferum, more commonly referred as the opium poppy. The
word “Papaver” is a Greek word meaning “Poppy”, “Somniferum” is from Latin and means to
dream or induce sleep. This milky white juice darkens to a blackish brown colour and thickens
upon exposure to air. The principle use of prepared opium is for smoking. It also grows wild in
many areas, but the largest quantities come from three main areas of the world, the areas known
as Golden Triangle (Laos, Burma and Thailand), the Golden Crescent (Afghanistan, Pakistan,
Iran) and Mexico. Opium contains various organic and inorganic substances like alkaloids, acids,
protein, sugar and inorganic elements etc. About 40 opium alkaloids have been known in the
opium out of which 5 are major. They are morphine, codeine, thebaine, papavarine and narcotine
(noscapine).

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 OPIUM

 Effects of components of Opium

 Narcotic Effect: (Phenanthrene Group)
1. Morphine –vali nivarani
2. Codeine – for sleeping
3. Thebaine -drug
 Analgesic Effect: (Iso-quinoline group)
1. Papaverine
2. Narcotine (Noscapine)

 Effects Of Opium
There is no safe level of drug use. Use of any drug always carries some risk. It’s important
to be careful when taking any type of drug.
Short term effects may include:
 euphoria
 relaxation
 analgesia
 slower, shallower breathing
 lower heart rate
 impaired reflexes
 temporary constipation
 loss of appetite.

 Symptoms of opium overdose:

 very slow breathing

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  loss of consciousness

 Untreated overdose can lead to brain damage and death.

 Long-term effects: Regular use of opium may cause:

 tolerance - needing to use more to get the same effect

 irregular periods and difficulty having children
 low sex drive
 constipation
 dependence on opium.

3.5.5.2 MORPHINE:
 Description
It is the most valuable, effective analgesic, derived from opium as colourless crystals or
white crystalline powder. It is synthesized as hydrochlorides, sulphates, acetates and tartrate
salts. It is administered by injection to relieve pain in cancer, internal hemorrhage, heart attacks
etc. It causes addiction.

A. Morphine Powder B. Crude morphine C. Morphine Tablets

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 Extraction of morphine from opium

 Effects and symptoms of Morphine Use

Morphine is a highly addictive Opioid drug that can cause a variety of potentially life-threatening
side effects when abused, including: respiratory depression, kidney failure, and hypotension.

 Decreased responsiveness
 Fever
 Increased thirst
 Swelling
 Increased blow pressure
 Muscle spasms
 Drug cravings

One of the greatest risks of drug misuse is overdose, which can result in coma and even
death. Excessive doses of Morphine can slow breathing to such an extent that an
individual can become oxygen deprived and suffer brain damage.

 Other long-term effects of Morphine use includes:

 Depressed breathing
 Memory problems
 Irregular menstrual cycles
 Anxiety
 Severe constipation
 Chronic sleep disturbances
 Loss of sex drive

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  Impaired muscle coordination
 Kidney failure
 Decreased metabolism
 Physical weakness
 Uncontrollable eye movements

3.5.5.3 CODEINE
 Description
Codeine is a natural opioid and one of the principal alkaloids of opium. It has very low
affinity for opioid receptors. Codeine is an Opioid used to relieve mild to moderate pain and to
reduce coughing. Though it is considerably weaker than most other Opioids, it works the same
way in the brain, inhibiting connections in pain receptors to stifle the body’s reaction. Codeine
can have the same dose-dependent adverse effects as morphine, making it no less dangerous.

 Side effects
The most common side effects of codeine are:
 dizziness
 tiredness
 confusion, difficulty concentrating
 euphoria, restlessness
 blurred vision
 dry mouth
 limbs feeling heavy or muscles feeling stiff
 sweating
 mild allergic rash, itching and hives
 decreased heart rate, palpitations
 stomach-ache, nausea, vomiting, constipation
 difficulty in urinating.

 Long-term effects of codeine

Regular use of codeine may eventually cause:

 Constipation
 Reduced sex drive
 irregular periods
 tension and muscle twitches
 needing to use more to get the same effect
 dependence on codeine
 financial, work and social problems.

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3.5.6 Semi Synthetic Narcotics

3.5.6.1 HEROIN (DIACETYLMORPHINE OR DIAMOPHINE)

 Description

Heroin is an illegal Opioid derived from Morphine, a naturally occurring substance found
in a variety of poppy plants, which are predominantly grown in South America, Central Asia,
and East Asia. This white or brown, crystalline, semi synthetic compound is derived from
morphine by acetylation. It is taken orally, inhaled, smoked or injected. Heroin is 4 to 8 times
potent than morphine and 200 times stronger than opium and is highly addictive. It is a banned
product. Heroin induces drowsiness, lethargy, impaired digestion, decreased weight, reduced
vision, sterility and severe dullness. Use of unsterilized syringe and needle and adulterated
heroin may lead to blood poisoning, serum hepatitis and formation of abscess. While most often
depicted in its purest form, white powder, it can also be a brown powder or a black tar-like sticky
substance (primarily coming from Mexico). “Black Tar” Heroin get its colour and texture, and
subsequently its name, from being the most crude and full of impurities. However, because the
white powder form of heroin is almost always mixed with other substances it is impossible to
determine purity from colour alone.

Heroin colours vary from dark brown sugar colour to whitish colour

Heroin comes in different forms, including:

 fine white powder

 coarse off-white granules
 tiny pieces of light brown ‘rock’.

 Other names
Gear, hammer, the dragon, H, dope, junk, harry, horse, black tar, white dynamite, poison

Because Heroin is most commonly injected, it is an especially dangerous drug from a

health perspective. The sharing of needles is one of the most common vectors by which a
number of incredibly serious diseases spread. Of these, Human Immunodeficiency Virus
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 (HIV), the disease that causes Acquired Immune Deficiency Syndrome (AIDS), is the
most feared and deadly.

 Side Effects of Heroin

 intense pleasure and pain relief
 relaxation, drowsiness and clumsiness
 confusion
 slurred and slow speech
 slow breathing and heartbeat
 dry mouth
 tiny pupils
 reduced appetite and vomiting
 decreased sex drive

If injecting drugs there is an increased risk of:

 tetanus
 infection
 vein damage.

If sharing needles there is an increased risk of:

 hepatitis B
 hepatitis C
 HIV and AIDS.

 Long-term effects
Regular use of heroin may eventually cause:
 Intense sadness
 Irregular periods and difficulty having children
 Constipation
 Damaged heart, lungs, liver and brain
 Vein damage and skin, heart and lung infections from injecting
 Needing to use more to get the same effect
 Dependence on heroin
 Financial, work or social problems.

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3.5.6.2 SMACK
 Description
It is a crude by-product of heroin, called “brown sugar”. It is heated and inhaled. Smack
is diacetylmorphine hydrochloride. It is stronger analgesic than morphine. Smack or Brown
sugar (an adulterated form of heroin), also called junk, skag, dope, and chaw, is a semi-
synthetic opioid derived from the morphine extracted from poppy plants. Pure heroin accounts
for only 20% of the brown sugar drug; the remaining 80% comes in the form of chalk powder,
zinc oxide, and even strychnine. These impurities make brown sugar much cheaper than the
typical, more purified form of heroin; they create a substance more dangerous than heroin, as the
user is unsure exactly how much heroin he is consuming. Being cheap, it is considered “poor
man’s heroin”.
Brown sugar is usually made available in powder form and is kept in small vials. The
substance is only about 20% heroin. Brown sugar drug making process involves mixing heroin
with other substances like chalk powder, zinc oxide and even strychnine. Because of these
impurities in the drug, brown sugar is usually cheaper, but more dangerous.

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  Smack (Brown sugar) Threats
Brown sugar threats are analogous to many of the dangers presented by heroin. Often
brown sugar abusers will develop a dependency on the drug, and as a result, they begin having
extreme withdrawal symptoms only a few hours after use.

 Some of the threats surrounding brown sugar abuse are:

 Weight loss
 Loss of appetite
 Insomnia
 Irritability
 Lack of concentration
 Depression and frustration

3.5.7 SYNTHETIC OPIATES

3.5.7.1 METHADONE
 Description

It is a synthetic drug, obtained in the form of white powder. It is an orally effective

analgesic, with slightly stronger and longer action than morphine. It is addictive, causing psychic
and physical dependence, but withdrawal symptoms are mild. It is used during treatment in
morphine and heroin addiction. Methadone is taken as a replacement for heroin and other opioids
as part of treatment for dependence on these drugs. Replacing a drug of dependence with a
prescribed drug in this way is known as pharmacotherapy. Methadone was originally created as a
synthetic substitute to Morphine. Like all Opioids, Methadone is a pain reliever that works by
binding to the body’s Opioid receptors, blocking the feeling of pain, and releasing dopamine to
induce calm. The drug is extremely effective and has a long duration of action. Methadone is
also used to relieve pain following heart attacks, trauma and surgery.

 Advantages of methadone maintenance over heroin use

 Using methadone on its own is unlikely to result in an overdose.

22
  Methadone maintenance keeps the person stable while they make positive changes in
their life.
 Health problems are reduced or avoided, especially those related to injecting, such as
HIV, hepatitis B and hepatitis C viruses, skin infections and vein problems.
 Doses are required only once a day, sometimes even less often, because methadone’s
effects are long lasting.
 Methadone is much cheaper than heroin

 Side effects
The most common side effects of methadone are:
 sweating (drink at least 2 litres of water each day to prevent dehydration)
 difficulty in passing urine
 loss of appetite, nausea and vomiting
 abdominal cramps
 constipation
 aching muscles and joints
 irregular periods
 rashes and itching
 lethargy, mental clouding and confusion.

Methadone, as an Opioid, has similar effects to Morphine and Heroin. It can block the
body’s receptors to pain and release dopamine, bringing on pleasant and calming feelings. A key
difference between Methadone and Morphine is that Methadone stays active in the body for
approximately 24 hours. As with any prescription Opioid, however, it comes with its own side
effects. These can include:

 Headache
 Stomach pain
 Dry mouth
 Sore tongue
 Difficulty urinating
 Mood changes
 Difficulty falling or staying asleep
 Energy loss
 Chills
 Constipation
 Nausea
 Sweating
 Slowed breathing
 Itchy skin
 Restlessness

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  Changes in menstrual cycle
 Dangers of Methadone
What many don’t realize is that going through Opioid withdrawal leaves your body
susceptible to another addiction. Methadone, despite its practical uses, is highly addictive and not
taking it as prescribed can mean developing a new addiction. However, when taken as
prescribed, Methadone users do not display the uncontrolled, compulsive and disruptive behavior
that is common among heroin users.

3.5.7.2 PETHIDINE (MEPERIDINE):

 Description
It is a widely used narcotic analgesic. It has sedative and euphoric effects. It has local
anaesthetic action. Although it is chemically unrelated to morphine yet is has many similar
actions. Its analgesic efficiency is near to morphine and is more than codeine. It is equally
sedative and euphoriant. It causes less histamine release and is safer in asthmatics. It is mostly
metabolized in liver. Demerol also called Pethidine an Opioid, is a popular prescription for
treating moderate to severe pain. Its euphoric effects make it highly addictive and increase the
likelihood of abuse. Demerol works by binding to the Opioid receptors in the brain and thereby
blocking pain receptors from transmitting signals. At the same time, Demerol releases feel-good
neurotransmitters. Overusing Demerol can bring on a euphoric feeling, often referred to as a
“rush.”

 Effects of Pethidine
Pethidine is most frequently used as a pre- and post-op medication. Anesthesiologists will
often use Pethidine as a pain killer, with or without putting someone to sleep. Pethidine can be
anywhere from one-tenth to half as potent as Morphine. While this may sound weak, it is
actually the recommended medication for most people going into surgery. As an Opioid, overuse
of Pethidine can easily lead to overdose. Symptoms of overdose include:
 Extreme drowsiness
 Stupor
 Weak or limp muscles
 Hypothermia
 Cold, clammy skin
 Coma
 Muscle twitches
 Blue lips or fingernails
 Breathing issues
 Snoring
 Cardiac arrest
 Nausea and vomiting

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  Convulsions
 Death

3.6 Treatment and Recovery

Addiction is a disease that affects both the brain and behaviour. Addiction is a treatable
disease. Because addiction is a chronic disease, people can’t simply stop using drugs for a few
days and be cured. Most patients need long-term or repeated care to stop using completely and
recover their lives.
Addiction treatment must help the person do the following:
 stop using drugs
 stay drug-free
 be productive in the family, at work, and in society
3.6.1 Treatments for Drug Addiction
There are many options that have been successful in treating drug addiction, including:
 behavioural counselling
 medication
 medical devices and applications used to treat withdrawal symptoms or deliver skills
training
 evaluation and treatment for co-occurring mental health issues such as depression and
anxiety
 long-term follow-up to prevent relapse
Medications and devices can be used to manage withdrawal symptoms, prevent relapse, and treat
co-occurring conditions.

 Different types of medications may be useful at different stages of treatment to help a

patient stop abusing drugs, stay in treatment, and avoid relapse.

 Treating Withdrawal. When patients first stop using drugs, they can experience a variety
of physical and emotional symptoms which includes dysphoric mood, anxiety, nausea or
vomiting, muscle aches, abdominal cramping, tearing, rhinorrhea (i.e., runny nose),
sweating, diarrhea, yawning, fever, and insomnia. Certain treatment medications are
designed to reduce these symptoms, which makes it easier to stop the drug use.
Medications and devices can help suppress withdrawal symptoms during detoxification.
Detoxification is not in itself "treatment," but only the first step in the process. This
involves clearing a substance from the body and limiting withdrawal reactions. Patients
who do not receive any further treatment after detoxification usually resume their drug
use. Withdrawal symptoms are experienced when physically dependent individuals cease
their drug use, particularly when cessation is abrupt.

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 Staying in Treatment. Some treatment medications are used to help the brain adapt
gradually to the absence of the abused drug. These medications act slowly to stave off
drug cravings and have a calming effect on body systems. They can help patients focus
on counseling and other psychotherapies related to their drug treatment.

 Preventing Relapse. Relapse happens because drugs change the wiring in a person’s
brain. Once addicted, a person is at high risk of using drugs when “triggered.”
Medications are being developed to interfere with these triggers to help patients sustain
recovery. Patients can use medications to help re-establish normal brain function and
decrease cravings. Medications are available for treatment of opioid (heroin, prescription
pain relievers), tobacco (nicotine), and alcohol addiction.

 Co-occuring conditions: Other medications are available to treat possible mental health
conditions, such as depression or anxiety, that may be contributing to the person’s
addiction.

 Behavioral therapies to treat drug addiction

Behavioral therapies help patients:
 modify their attitudes and behaviors related to drug use
 increase healthy life skills
 persist with other forms of treatment, such as medication

1. Cognitive Behavioral Therapy seeks to help patients recognize, avoid, and cope with the
situations in which they are most likely to abuse drugs.
2. Contingency Management uses positive reinforcement such as providing rewards or
privileges for remaining drug free, for attending and participating in counseling sessions,
or for taking treatment medications as prescribed.
3. Motivational Enhancement Therapy uses strategies to evoke rapid and internally
motivated behavior change to stop drug use and facilitate treatment entry.
4. Family Therapy (especially for youth) approaches a person’s drug problems in the
context of family interactions and dynamics that may contribute to drug use and other
risky behaviors.

3.6.2 Medications used to treat drug addiction

 Tobacco Addiction
• Nicotine replacement therapies (available as a patch, inhaler, or gum)
• Bupropion
• Varenicline
 Opioid Addiction
• Methadone

26
 • Buprenorphine
• Naltrexone
 Alcohol and Drug Addiction
• Naltrexone
• Disulfiram
• Acamprosate

3.6.3 How the Brain Changes and Recovers from Drug Use

The images above show that once addicted to drugs, the brain can be affected for a long time,
although recovery is possible.
 The first image shows a normal-functioning brain without drugs. A lot of yellow
means lots of brain activity.
 The next two images show the brain of someone addicted to cocaine, but who has
not used in 10 days and again in 100 days. The amount of brain activity (yellow)
increases over time.

3.6.4 Rehabilitation of Drug Addiction

Drug rehabilitation is the medical and psychotherapeutic treatment used to enable a
patient to cease substance abuse and become a normal and productive member of society. Drug
rehabilitation addresses the physical and psychological aspects of drug dependency.
 Eliminating the physical dependency may involve the use of chemical antagonists that
block the action of the addictive drugs. E.g.: methadone for withdrawal symptoms of
heroin, disulfiram for alcohol addiction.
 The psychological dependency on drugs is harder to treat because it involves learning
new patterns of behaviour. Drug rehabilitation programs attempt to teach the patient new
methods of interacting in a drug-free environment.

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 Rehabilitation programs need to work closely with the patient. Inpatient treatment is best
accomplished when physicians and nurses are available around the clock to ensure a safe
withdrawal from alcohol and other drugs. Rehabilitation is probably the hardest thing that an
addict will have to accomplish. It is not unusual for an individual to relapse or fall off the wagon
and resume drug or alcohol abuse.
Purpose of Drug rehabilitation: Drug rehabilitation program if proved to be successful, that
will avoid many legal, psychological, financial, physical and social consequences caused
particularly by extreme drug abuse.

3.6.5 Rehabilitation for heroin addiction

 The first phase in the treatment of heroin addiction is to minimize the severity of
withdrawal symptoms and other medical complications.
 This is done with several synthetic drugs that duplicate heroin in the body but can be
given in tapered doses until the addicted person can eventually be drug free.
 Opioids: Methadone, buprenorphine and naltrexone are used to treat opioid addiction.
Acting on the same targets in the brain as heroin and morphine, methadone and
buprenorphine suppress withdrawal symptoms and relieve cravings. Naltrexone blocks
the effects of opioids at their receptor sites in the brain and should be used only in
patients who have already been detoxified. All medications help patients reduce drug
seeking and related criminal behavior and help them become more open to behavioral
treatments.

Longer-term treatment programs for substance-related and addictive disorders can

be highly effective and typically focus on remaining drug-free and resuming function
within social, professional, and family responsibilities.

SMOKING

3.7 INTRODUCTION TO SMOKING

Smoking is a practice in which a substance, most commonly tobacco, is burned and the
smoke is tasted or inhaled. Smoking is rightly considered one of the biggest public health
problems of today.
The history of smoking dates back to as early as 5000BC in shamanistic rituals. Many ancient
civilizations, such as the Babylonians, Indians and Chinese, burnt incense as apart of religious
rituals, as did the later Catholic and Orthodox Christian churches. The smoking of tobacco, as
well as various hallucinogenic drugs was used to achieve trances and to come into contact with
the spirit world. Cannabis smoking was common in Sub-Saharan Africa through Ethiopia and the
east African coast in the Middle East before the arrival of tobacco, and was early on a common
social activity that centred around the type of water pipe called a hookah. Colombian sailors
transferred tobacco to Spain and Portugal, and from there it was spread across European

28
countries and other continents. In 1560, French Ambassador of Portugal Jean Nicot brought
tobacco seeds to the royal court and gave it to Queen Katarina Medici as a miraculous and
healing plant. Tobacco got its Latin name after his surname Nicotiana. There are 70 different
species of Nicotiana, and the best known is the one from
the Solanaceae family—Nicotiana tabacum . It is a 1-year plant that can grow up to 2 meters,
and tobacco is produced in the root and deposited in the leaves. The name is derived from the
Arabic word tobacco, meaning smoke. From 1600 to 1700, smoking spread across Europe in all
social classes. During the seventeenth century, tobacco planting was extended to other European
countries: Germany, Sweden, Denmark, Austria, and then the Far East and China.

3.8 CIGARETTE
A cigarette is a cylindrical roll of shredded or ground tobacco that is wrapped in paper or
another substance that does not contain tobacco. Many manufactured cigarettes also have filters
on one end that are intended to trap some of the toxic chemicals contained in cigarette smoke.

3.8.1 COMPOSITION
The composition of tobacco smoke is complex and varies with the type of tobacco and the
way it is smoked. The chief pharmacologically active ingredients are nicotine (acute effects) and
tars (chronic effects).The principal components are tar and nicotine, the amounts of which can
vary greatly depending on the country in which cigarettes are sold.
Cigar and pipe smokers thus obtain nicotine without inhaling (they also have a lower death rate
from lung cancer; which is caused by non-nicotine constituents).Smoke of cigars and pipes is
alkaline (pH 8.5) and nicotine is relatively un-ionised and lipid-soluble so that it is readily
absorbed in the mouth.
Smoke of cigarettes is acidic and nicotine is relatively insoluble in lipids. Polycyclic
hydrocarbons are responsible for the hepatic enzyme induction that occurs in smokers.
Carcinogenic substances (polycyclic hydrocarbons and nicotine-derived N-nitrosamines) have
been identified in tobacco smoke condensates from cigarettes, cigars and pipes. Tobacco smoke
contains 1-5% carbon monoxide, and habitual smokers have 3-7% (heavy smokers as much as
15%) of their haemoglobin as carboxy haemoglobin.
Tobacco smoke contains more than 4000 different compounds such as alkaloids; alcohols;
phenols; ethers; ketones; quinones; esters; nitrites; hydrocarbons; sulfur organic compounds;
various inorganic compounds of lead, iron, copper, manganese, nickel, hydrocarbon
molybdenum; and other metabolites. The composition of tobacco smoke depends on the type of
tobacco, the temperature and the rate of combustion, various supplements, the length of
cigarettes, the technological processing, and the production of cigarettes. The most potent
tobacco smoke ingredients introduced into the human body are nicotine, cyanide compounds,
and carbon monoxide. Nicotine, inhaled with other tobacco smoke ingredients or absorbed in the
mucous membrane of the mouth, penetrates the blood and enters all parts of the body. In 7 s, it
reaches the brain cells and increases dopamine gain, which causes euphoria and relaxation.

29
Smoke pollutes all parts of the nasal cavity with various poisons and makes the gas exchange
process difficult. The nasal mucus destroys and prevents viruses and bacteria fingernails
growing, and smoking tobacco reduces this function.

 tar – is the word for the solid particles suspended in tobacco smoke. The particles contain
chemicals, including cancer-causing substances (carcinogens). Tar is sticky and brown,
and stains teeth, and lung tissue
 carbon monoxide – is a poisonous gas. It is odourless and colourless and, in large doses,
quickly causes death because it takes the place of oxygen in the blood. In people who
smoke, the carbon monoxide in their blood makes it harder for oxygen to get to their
organs and muscles
 oxidizing chemicals – are highly reactive chemicals that can damage the heart muscles
and blood vessels of people who smoke. They react with cholesterol, leading to the build-
up of fatty material on artery walls. Their actions lead to heart disease, stroke and blood
vessel disease
 metals – tobacco smoke contains several metals that cause cancer, including arsenic,
beryllium, cadmium, chromium, cobalt, lead and nickel
 radioactive compounds – tobacco smoke contains radioactive compounds that are
known to be carcinogenic.

3.8.2 REASON TO SMOKE

Some of them are curious about cigarettes. They want to get attention. Some want to act cool or
act like someone special or dangerous. Peer pressure. They are stressed or nervous. Young
people attracted to images, cultural influences or family and friends are smokers.

3.8.3 TOLERANCE AND DEPENDENCE

People who use tobacco regularly tend to develop a tolerance to the effects of nicotine. This
means they need to smoke more tobacco to get the same effect. They may become dependent on
nicotine. Dependence can be psychological, physical, or both. People who are dependent on
nicotine find that using the drug becomes far more important than other activities in their life.
They crave the drug and will find it very difficult to stop using it. People who are
psychologically dependent on nicotine may find they feel an urge to smoke when they are in
specific surroundings or socialising with friends.
Physical dependence occurs when a person’s body adapts to the nicotine and gets used to
functioning with the nicotine present.

3.9 HEALTH EFFECTS

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There are more than 1.2 billions smokers in the world. Tobacco use kills hundreds of thousands
of people each year. Male and female smokers lose an average o f 13.2 and 14.5 years of life.

3.9.1 BRAIN

Nicotine from cigarettes is as addictive as heroin. Nicotine addiction is hard to beat because it
changes your brain. The brain develops extra nicotine receptors to accommodate the large doses
of nicotine from tobacco. When the brain stops getting the nicotine it’s used to, the result is
nicotine withdrawal. You may feel anxious, irritable, and have strong cravings for nicotine.

3.9.2 HEAD AND FACE

 Ears
One effect of smoking is reduced oxygen supply to the cochlea, a snail-shaped organ in the inner
ear. This may result in permanent damage to the cochlea and mild to moderate hearing loss.
 Eyes
Smoking causes physical changes in the eyes that can threaten your eyesight. One of the effects
of nicotine from cigarettes restricts the production of a chemical necessary for you to be able to
see at night. Also, smoking increases your risk of developing cataracts and macular degeneration
(both can lead to blindness).
 Mouth
Smoking takes a toll on your mouth. Smokers have more oral health problems than non-smokers,
like mouth sores, ulcers and gum disease. You are more likely to have cavities and lose your
teeth at a younger age. You are also more likely to get cancers of the mouth and throat.
 Face
Smoking can cause your skin to be dry and lose elasticity, leading to wrinkles and stretch marks.
Your skin tone may become dull and grayish. By your early 30s, wrinkles can begin to appear
around your mouth and eyes, adding years to your face.

31
3.9.3 HEART
 Stressed Heart
Smoking raises your blood pressure and puts stress on your heart. Over time, stress on the heart
can weaken it, making it less able to pump blood to other parts of your body. Carbon monoxide
from inhaled cigarette smoke also contributes to a lack of oxygen, making the heart work even
harder. This increases the risk of heart disease, including heart attacks.
 Sticky Blood
Smoking makes your blood thick and sticky. The stickier the blood, the harder your heart must
work to move it around your body. Sticky blood is also more likely to form blood clots that
block blood flow to your heart, brain, and legs. Over time, thick, sticky blood damages the
delicate lining of your blood vessels. This damage can increase your risk for a heart attack or
stroke.
 Fatty Deposits
Smoking increases the cholesterol and unhealthy fats circulating in the blood, leading to
unhealthy fatty deposits. Over time, cholesterol, fats, and other debris build up on the walls of
your arteries. This buildup narrows the arteries and blocks normal blood flow to the heart, brain,
and legs. Blocked blood flow to the heart or brain can cause a heart attack or stroke. Blockage in
the blood vessels of your legs could result in the amputation of your toes or feet.

3.9.4 LUNGS
 Scarred Lungs
Smokers' lungs experience inflammation in the small airways and tissues of your lungs. This can
make your chest feel tight or cause you to wheeze or feel short of breath. Continued
inflammation builds up scar tissue, which leads to physical changes to your lungs and airways
that can make breathing hard. Years of lung irritation can give you a chronic cough with mucus.
 Emphysema
Smoking destroys the tiny air sacs, or alveoli, in the lungs that allow oxygen exchange. When
you smoke, you are damaging some of those air sacs. Alveoli don’t grow back, so when you
destroy them, you have permanently destroyed part of your lungs. When enough alveoli are
destroyed, the disease emphysema develops. Emphysema causes severe shortness of breath and
can lead to death.
 Cilia and Respiratory Infections
Your airways are lined with tiny brush like hairs, called cilia. The cilia sweep out mucus and dirt
so your lungs stay clear. Smoking temporarily paralyzes and even kills cilia. This makes you
more at risk for infection. Smokers get more colds and respiratory infections than non-smokers.

3.9.5 DNA
 Cancer

32
 Your body is made up of cells that contain genetic material, or DNA, that acts as an “instruction
manual” for cell growth and function. Every single puff of a cigarette causes damages to your
DNA. When DNA is damaged, the “instruction manual” gets messed up, and the cell can begin
growing out of control and create a cancer tumor. Your body tries to repair the damage that
smoking does to your DNA, but over time, smoking can wear down this repair system and lead
to cancer (like lung cancer). One-third of all cancer deaths are caused by tobacco.

3.9.6 STOMACH AND HORMONES

 Belly
Bigger belly. Smokers have bigger bellies and less muscle than non-smokers. They are more
likely to develop type 2 diabetes, even if they don’t smoke every day. Smoking also makes it
harder to control diabetes once you already have it. Diabetes is a serious disease that can lead to
blindness, heart disease, kidney failure, and amputations.
 Lower Estrogen Levels
Smoking lowers a female’s level of estrogen. Low estrogen levels can cause dry skin, thinning
hair, and memory problems. Women who smoke have a harder time getting pregnant and having
a healthy baby. Smoking can also lead to early menopause, which increases your risk of
developing certain diseases (like heart disease).

3.9.7 LEVEL OF TOBACCO USE

There is no safe level of tobacco use. Use of any drug always carries some risk—even
medications can produce unwanted side effects. It is important to be careful when taking any
type of drug.
 Low to moderate doses
Some of the effects that may be experienced after smoking tobacco include:
 initial stimulation, then reduction in activity of brain and nervous system
 increased alertness and concentration
 feelings of mild euphoria
 feelings of relaxation
 increased blood pressure and heart rate
 decreased blood flow to fingers and toes
 decreased skin temperature
 bad breath
 decreased appetite
 dizziness
 nausea, abdominal cramps and vomiting
 headache
 coughing, due to smoke irritation.

 Higher doses

33
 A high dose of nicotine can cause a person to overdose. This means that a person has taken more
nicotine than their body can cope with. The effects of very large doses can include:
 an increase in the unpleasant effects
 feeling faint
 confusion
 rapid decrease in blood pressure and breathing rate
 seizures
 respiratory arrest (stopping breathing) and death.

 Long-term effects

Tar in cigarettes coats the lungs and can cause lung and throat cancer in smokers. It is also
responsible for the yellow–brown staining on smokers’ fingers and teeth.
Carbon monoxide in cigarettes reduces the amount of oxygen available to the muscles, brain and
blood. This means the whole body—especially the heart—must work harder. Over time this
causes airways to narrow and blood pressure to rise, which can lead to heart attack and stroke.
High levels of CO, together with nicotine, increase the risk of heart disease, hardening of the
arteries and other circulatory problems.
Some of the long-term effects of smoking (Quit Victoria, 2010) that may be experienced include:
 increased risk of stroke and brain damage
 eye cataracts, macular degeneration, yellowing of whites of eyes
 loss of sense of smell and taste
 yellow teeth, tooth decay and bad breath
 cancer of the nose, lip, tongue and mouth
 possible hearing loss
 laryngeal and pharyngeal cancers
 contributes to osteoporosis
 shortness of breath
 coughing
 chronic bronchitis
 cancer
 triggering asthma
 emphysema
 heart disease
 blockages in blood supply that can lead to a heart attack
 high blood pressure (hypertension)
 myeloid leukaemia, a cancer that affects bone marrow and organs that make blood
 stomach and bladder cancers
 stomach ulcers
 decreased appetite

34
 grey appearance
 early wrinkles
 slower healing wounds
 damage to blood vessel walls
 increased likelihood of back pain
 increased susceptibility to infection
 lower fertility and increased risk of miscarriage
 irregular periods
 early menopause
 damaged sperm and reduced sperm
 impotence.

3.10 OTHER EFFECTS OF TOBACCO USE

3.10.1 PASSIVE SMOKING

Passive smoking occurs when a person who is not smoking breathes in the smoke from people
who are smoking. It includes invisible smoke left in the air after a cigarette is extinguished.
Passive smoking can irritate the eyes and nose and cause a number of health problems such as
heart disease and lung cancer. Tobacco smoke is especially harmful to babies and young
children. Cigarette smoke deposits on furniture, clothing and other surfaces and smells.

3.10.2 USING TOBACCO WITH OTHER DRUGS

Nicotine can affect the way the body processes many different drugs. This can affect how these
drugs work. For example, nicotine can decrease the effectiveness of benzodiazepines. Smoking
while taking the contraceptive pill increases the risk of blood clots forming.

3.10.3 PREGNANCY AND BREASTFEEDING

 Read about the effects of tobacco use on pregnancy and breastfeeding.

 Many drugs can cross the placenta and affect an unborn child.
 In general, using drugs when pregnant can increase the chances of going into labour
early. This can mean that babies are born below the normal birth weight.
 If a mother uses drugs while breastfeeding, they may be present in her milk, and could
affect the baby.
 The effects of maternal smoking on an unborn baby include:
 increased risk of miscarriage, stillbirth and premature birth
 weaker lungs

35
  low birth weight, which may have a lasting effect of the growth and development of
children. Low birth weight is associated with an increased risk of heart disease, high
blood pressure, and diabetes in adulthood
 increased risk of cleft palate and cleft lip
 increased risk of attention deficit hyperactivity disorder (ADHD).
 Passive smoking (exposure of the non-smoking mother to second-hand smoke) can also
harm the fetus.
 If a parent continues to smoke during their baby’s first year of life, the child has an
increased risk of ear infections, respiratory illnesses such as pneumonia and
bronchitis, sudden unexpected death in infancy (SUDI) and meningococcal disease.

3.10.4 ECONOMICS
A male smoker in the United States that smokes more than one pack a day can expect an
average increase of $19,000 just in medical expenses over the course of his lifetime. A
U.S. female smoker that also smokes more than a pack a day can expect an average of
$25,800 additional healthcare costs over her lifetime.

3.11 MEASURES IN SMOKING REDUCTION, LAWS AND POLICIES

Schools and educational systems play an important role in the prevention and education
of the harmful consequences of tobacco smoking. Investigations have found that the earliest
people begin to smoke is at the age of 11–16. The level of knowledge of this population about
the harmful consequences of smoking is relatively low. It is important to educate and raise
awareness of the need for smoking cessation for educators, as they should demonstrate with their
example and point out to children and young people the smoking hazards.
Public and media are included in the national anti-smoking program under the leadership
and coordination of governmental institutions as well as other independent professional
associations and individuals. Their role, particularly television, radio, Internet, daily press, and
film industry, is extremely important in terms of systematic information gathering and educating
citizens about the adverse consequences of smoking tobacco, promoting health education, and
anti-smoking messages.
Smoking prohibitions or “smoke-free” laws imply public policies, including crime laws
and regulations on occupational health, which prohibit the use of tobacco at work and other
public places. The smoke-free environment appears to be effective as a control mechanism in
reducing the number of current and future smokers. The smoke-free environment protects the
non-smoker’s health and has a favourable outcome in reducing smoking. Smoking restriction in
public places reduces average tobacco consumption by 4–10%. The aim of the tobacco control
strategy is not only to stimulate smoking cessation but also to protect non-smokers from passive

36
exposure to tobacco smoke in public places, as well as to protect the rights of non-smokers in a
non-tobacco smoke environment.

3.11.1 SMOKING CESSATION

All smokers trying to quit smoking should be offered pharmacotherapy.

ALCOHOL

3.12 INTRODUCTION
Alcoholic beverages are widely consumed throughout the world. While most of the adult
population drinks at low-risk levels most of the time or abstains altogether, the broad range of
alcohol consumption patterns, from daily heavy drinking to occasional hazardous drinking,
creates significant public health and safety problems in nearly all countries. The increased health
risks (both physical and mental) associated with alcohol consumption as well as from the social
harms caused by alcohol. Besides the numerous chronic and acute health effects, alcohol
consumption is also associated with widespread psychosocial consequences, including violence,
child neglect and abuse, absenteeism in the workplace, and many other impacts. To reduce
alcohol’s impact on the burden of disease as well as on other social, legal, and monetary costs, it
therefore is imperative to develop effective interventions that can prevent or delay initiation of
drinking among those who do not drink.

3.12.1 WHAT IS ALCOHOL?

Alcohol (ethanol or ethyl alcohol) is the ingredient found in beer, wine and spirits which causes
drunkenness. Alcohol is formed when yeast ferments (breaks down without oxygen) the sugars
in different foods; for example wine is made from the sugar in grapes, beer from the sugar in
malted barley (a type of grain), cider from the sugar in apples, and vodka from the sugar in
potatoes, beets or other plants.

3.12.2 ALCOHOL DEPENDENCY

A physical or psychological dependence on alcohol, where the body requires more alcohol to
achieve the desired effect (e.g. of altered mood): use of alcohol interferes with a person’s life
(causing legal, work/study, relationship or social problems); a person continues to use alcohol
despite alcohol causing physical or mental problems; and, if alcohol is not taken, withdrawal
symptoms occur.

3.13 CONSEQUENCES

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The harmful use of alcohol is one of the world’s leading health risks. It is a causal factor in more
than 60 major types of diseases and injuries and results in approximately 2.5 million deaths each
year. Approximately 4.5% of the global burden of disease and injury is attributable to alcohol.
Alcohol consumption is estimated to cause from 20% to 50% of cirrhosis of the liver, epilepsy,
poisonings, road traffic accidents, violence and several types of cancer. It is the third highest risk
for disease and disability, after childhood underweight and unsafe sex. Alcohol contributes to
traumatic outcomes that kill or disable people at a relatively young age, resulting in the loss of
many years of life to death and disability.

3.13.1 HARM TO SOCIETY

 Work place
Social harm from drinking can be classified in terms of how they affect important roles
and responsibilities of everyday life: work, family, friendship and public character. Intoxication
interferes to a greater or lesser extent with most productive labour. The drinker’s own
productivity is reduced, and there may be adverse social consequences for the drinker, including
loss of their job. The productivity of others around the drinker may be diminished if they have to
take time out of their work to cover for the drinker’s mistakes, absencesor lateness. For instance,
heavy lunchtime drinking at factories may affect the quality of work and the economic survival
of the factories without it actually affecting any particular person. This, in turn, can affect the
economic viability of a community that depends on factory jobs. In this way, widespread heavy
drinking can adversely affect whole societies

 Family and Friends

Similarly, the ability of a parent or guardian to care for children is adversely affected by
intoxication. There may be serious adverse immediate and long-term effects for the children
because of neglect or abuse by the drinker. There also may be serious consequences for the
drinker from family members, social services or public safetyauthorities in response to neglect or
abuse by the drinker. Drinking and intoxication can also adversely affect intimate and family
relations, and friendships.
A study of 98 families in an urban Indian slum found that families with frequently
drinking husbands were much more likely to report a major illness or injury in the past year,
were more likely to be in debt, or deeper in debt .

 Accidents
Besides the adverse social impact on family members, relatives, friends and co-workers,
people’s drinking can also impact on strangers, who can be victims of road traffic accidents
caused by a drunk driver or be assaulted by an intoxicated person.

 Crime

38
 Intoxicated people commit many crimes where the victims are unknown to the perpetrators,
including homicide, robbery, sexual assault and property crimes. The wellbeing of others can
also be affected by verbal threats, noise and nuisance from intoxicated people. Again, these
offences often also impact the drinker if she or he is arrested and punished.

 Economy
Death, disease and injury related to alcohol consumption are clearly linked to economic
status, and this is true for individuals, countries and regions. Lower economic development
and socioeconomic status generally mean greater health problems related to alcohol, at
least among people who drink alcohol.

3.13.2 HEALTH

Alcohol affects all parts of the body including:

• blood and immune system

• bones and muscles
• brain and nervous
• breasts (in women)
• eyes
• heart and blood pressure
• intestines
• kidneys and fluid balance
• liver
• lungs
• mental health
• mouth and throat
• pancreas and digestion of sugar
• sexual and reproductive system – men
• sexual and reproductive system – women
• skin and fat
• stomach and food pipe (oesophagus).

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3.13.2.1 BLOOD AND IMMUNE SYSTEM

 Long-term effects of alcohol use

Chronic heavy alcohol use can cause abnormalities in the blood, leading to anaemia (low
haemoglobin, the component of blood that carries oxygen around the body) and low platelets
(platelets help prevent bleeding). Chronic heavy alcohol use also suppresses the immune system
(such as affecting the white blood cells that fight infections), making it more difficult for the
body to fight off both viral and bacterial infections. People who drink heavily over a long time
are more likely to suffer from infections after surgery, burns, trauma, hepatitis C infection,
HIV/AIDS, meningitis, tuberculosis and pneumonia (acute inflammation of the lung, usually due
to infection).

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3.15.2.2 BONES AND MUSCLES

 Immediate effects of alcohol use

Alcohol use causes many different types of injuries, including injuries from road traffic
accidents, assaults and falls. This is usually because high levels of blood alcohol impair the
brain’s thought processes and the coordination of muscles, causing clumsiness and difficulty
walking. Common injuries seen at the emergency department include cuts, bruises, sprains and
broken bones. The risk of injury in the six hours after drinking doubles with four standard drinks
and increases rapidly the more alcohol is drunk on a single occasion
 Long-term effects of alcohol use
Moderate alcohol use may protect against osteoporosis (thinning of the bones, which makes the
bones more likely to break). However, chronic heavy alcohol use interferes with the absorption
of calcium and bone formation and can actually lead to osteoporosis. Chronic heavy use is also
associated with a painful condition where bone tissue dies (osteonecrosis), gout (a type of
arthritis or inflammation of the joints, often affecting the joint of the big toe), and muscle
wasting and weakness.

3.13.2.3 BRAIN AND NERVOUS SYSTEM

 Immediate effects of alcohol use

Being drunk impairs judgment, inhibitions and concentration, and in increasing amounts leads
to drowsiness and coma. The loss of memory for a period of drunkenness (alcoholic blackout)
can occur in occasional as well as regular heavy drinkers, and is due to alcohol interfering with
the laying down of memories.

 Long-term effects of alcohol use

Chronic heavy alcohol use can damage the brain and nerves in a variety of ways. Some damage
to the brain, from mild to severe, occurs in around half of chronic heavy alcohol drinkers. This
may be a result of thiamine (vitamin B1) deficiency (secondary to alcohol use, either because of
poor diet or because alcohol reduces the absorption of thiamine from the gut and interferes with
how thiamine is used in the body).Thiamine deficiency can cause an acute, severe, life
threatening disorder called Wernicke’s encephalopathy, which usually presents with symptoms
of abnormal or paralysed eye movements, difficulty walking and confusion. It also causes a
chronic condition of memory loss (variously called Korsakoff’s syndrome, psychosis or
dementia), where loss of old memories occurs and difficulties in laying down new memories
may be profound. Both of these disorders are ultimately fatal without treatment with thiamine.
Chronic heavy alcohol use can also damage the part of the brain responsible for balance and
coordination (the cerebellum), leading to instability and problems with walking. It can also
damage peripheral nerves in the body, leading to pain, weakness, numbness and the inability to
sense touch. In rare cases it can damage specific centres in the brain, leading to loss of mental

41
function, inability to walk and death and can lead to the development of epilepsy (chronic fits)
and sleep disturbances. Although individuals suffering from insomnia sometimes use alcohol to
treat the insomnia, tolerance to the sedating effect of alcohol is likely to occur, increasing the risk
of excessive use. Also, if more than one or two drinks are taken in the evening, sleep can be
disrupted, increasing the chances of a person waking in the night and finding it hard to fall back
asleep. The relationship between alcohol use and stroke, where there is a sudden paralysis, loss
of sensation or inability to talk because the blood supply to the brain is interrupted, is complex.
Alcohol increases the risk of hemorrhagic stroke, where the stroke is caused by bleeding in the
brain. However, low to moderate alcohol use (one to two drinks a day) reduces the risk of
ischaemic stroke, which is caused by blockage of the blood vessels in the brain, but higher levels
of alcohol use increase the risk of ischaemic stroke.

3.13.2.4 BREASTS – WOMEN

Long-term effects of alcohol use

Long-term alcohol use increases the risk of breast cancer, with higher use resulting in a higher
risk of cancer. A significantly elevated risk is seen from drinking even one or two drinks of
alcohol a day. The risk increases on average by about 10 percent for every one standard drink of
alcohol per day.

3.13.2.5 EYES

Immediate effects of alcohol use

Being drunk can cause blurred or double vision.
Long-term effects of alcohol use
Chronic heavy alcohol use, when coupled with a diet low in vitamin B1 and B12, may lead to
decreased vision.

3.13.2.6 HEART AND BLOOD PRESSURE

Long-term effects of alcohol use

The evidence for the effect of alcohol on the heart is mixed. There is an opinion that light to
moderate alcohol use (up to one standard drink per day for women and up to two standard drinks
per day for men) can, in older age groups, reduce the risk of developing and dying from coronary
artery disease (narrowing and blockage of the arteries supplying blood to the heart resulting from
the build-up of fatty deposits inside the walls of the arteries , which can cause angina and heart
attacks). This appears to be because small quantities of alcohol alter the lipids and clotting
factors in the blood to make them protective against heart disease.
However, heavy drinking (both chronic and a pattern of heavy drinking sessions) increases the
risk of coronary artery disease. Heavy drinking (chronic and/or at a single session) is also

42
associated with sudden death from heart failure, with irregular heartbeats and with chronic
disease of the heart muscle (dilated cardiomyopathy). Dilated cardiomyopathy leads to heart
failure, where the heart can no longer pump blood around the body effectively. Heavy chronic
alcohol use is also linked to high blood pressure, particularly in men. Blood pressure increases
with drinking more than two or three drinks a day on average and restriction of alcohol lowers
the blood pressure. Drinking alcohol in order to ‘protect the heart’ is not advisable, since alcohol
is an addictive drug that causes cancer, increases the risk of injury and causes damage to the
fetus in pregnant women. People can find it difficult to limit their drinking to one or two standard
drinks a day and heavy drinking actually increases the risk of heart disease and. People who have
risk factors for or have established heart disease should focus on other factors such as cigarette
smoking, high cholesterol, high blood pressure, diabetes, overweight and physical inactivity.
Young and middle-aged adults, especially women, are more likely to experience harm than
benefit from alcohol use due to risk from injury and, for women, increased risk from breast
cancer.

3.13.2.7 INTESTINES

Long-term effects of alcohol use

Long- term alcohol use can cause cancer of the large bowel/intestines and rectum. Alcohol can
lead to malnutrition and diseases due to low vitamin levels, as it blocks the absorption of many
important vitamins and nutrients in the gut.

3.13.2.8 KIDNEYS AND FLUID BALANCE

Immediate effects of alcohol use

Alcohol is a diuretic, meaning that it causes water to be lost from the body through the kidneys
(into urine), which can lead to dehydration. Alcohol can also cause the loss of important minerals
and salts from the body such as magnesium, calcium, phosphate, sodium and potassium, either
directly or because alcohol induces vomiting. Low levels of these elements can cause many
problems ranging from irregular heartbeats to seizures.

3.13.2.8 LIVER

Long-term effects of alcohol use

Chronic heavy alcohol use can damage the liver, causing alcoholic liver disease. This occurs
across
a spectrum from fatty liver, to acute alcoholic hepatitis, to cirrhosis. Fatty liver, where fat builds
up in the liver cells, is very common in heavy drinkers and is reversible if drinking is reduced.
However, a small percentage of people with fatty liver will develop alcoholic hepatitis, cirrhosis
or liver cancer.

43
Alcoholic hepatitis develops in 10 to 35 percent of heavy drinkers and is an acute injury to the
liver which can present with symptoms of feeling unwell, tiredness, jaundice (yellow skin and
whites of eyes), swollen stomach and enlarged, tender liver. Death from liver failure can occur in
severe cases.
Cirrhosis of the liver develops in 5 to 15 percent of heavy drinkers and is where the liver is
permanently damaged and cells are replaced by scar tissue, so the liver can no longer function (to
detoxify the body, make vital proteins, store vitamins and sugars, and make chemicals necessary
for digestion). Cirrhosis can also lead to death from liver failure. Treatment for alcoholic liver
disease must include stopping the drinking of alcohol. Alcohol also causes liver cancer, and
treatment options are often limited if alcoholic liver disease is present or the cancer has spread
widely by the time of diagnosis. This means liver cancer is often quickly fatal.

3.13.2.9 LUNGS

Immediate effects of alcohol use

Being drunk increases the risk of pneumonia (inflammation of the lungs, usually caused by
infection from bacteria or viruses). This is because, at high blood concentrations, alcohol is
sedating and relaxes the mouth and throat, suppresses reflexes (like the gag and cough reflexes),
and reduces the ability of the lungs to clear mucus and foreign matter, so that vomit, saliva or
other substances may enter the lungs and cause inflammation and infection(bronchitis or
pneumonia).

Long-term effects of alcohol use

Chronic heavy alcohol use is also associated with higher rates of pneumonia, tuberculosis (an
infectious disease that affects primarily the lungs but also any other part of the body), and acute
respiratory distress syndrome (ARDS – a life-threatening condition in which the lungs fill with
fluid, which occurs as a rare complication of pneumonia, trauma and severe infections). In
addition to the ways in which acute alcohol use can cause pneumonia, chronic heavy alcohol use
also impairs the immune system and changes the bacteria present in the mouth to those more
likely to cause infections, making people more vulnerable to pneumonia.

3.13.2.10 MENTAL HEALTH

Immediate effects of alcohol use

Many people use low doses of alcohol for relaxation and to relieve tension, nervousness and
stress.
However, in some people alcohol creates rather than reduces stress through stimulating stress
hormones. Alcohol affects mood in a variety of ways, and can make people feel happy, sad or
aggressive, and can also cause moods swing. However, there is a risk of becoming dependent on
alcohol if it is used as a primary means to relieve stress and anxiety without addressing the

44
underlying causes. Because it removes inhibitions and increases aggression and recklessness,
alcohol is often found in the blood of people who selfharm.

Long-term effects of alcohol use

Alcohol is addictive and can lead to dependency. This is where the body requires more alcohol to
achieve the desired effect (e.g. altered mood), where use of alcohol interferes with a person’s life
(causing legal, work/ study, relationship or social problems), where a person continues to use
alcohol despite it causing physical or mental problems, and where, if alcohol is not taken,
withdrawal symptoms occur. The severity of withdrawal symptoms depends on the quantity of
alcohol consumed and the length of the drinking session. Symptoms include shaking of the
hands, which commonly occurs the morning after the drinking session and may be relieved by
more alcohol. If alcohol is not taken, symptoms can progress to insomnia, increased heart rate,
temperature and blood pressure, sweating, agitation, nausea, flushing of the face, nightmares,
hallucinations (seeing, hearing or feeling things that are not present) and fits. The most serious
withdrawal syndrome is ‘delirium tremens’, which develops in about 5 percent of people with
alcohol withdrawal (more if fits are not treated) and by definition includes the symptom of
delirium (an altered and confused state of mind). This syndrome has a death rate of around 5
percent. In people who drink heavily, alcohol commonly causes mood disorders, including
depression, anxiety and psychosis (a mental illness defined by changes in personality, a distorted
sense of reality, and delusions). If these disorders only occur during drinking sessions or
withdrawal, they will usually resolve once drinking is stopped. Alcohol abuse and dependency
are also common in people with pre-existing mental health conditions.

3.13.2.11 MOUTH AND THROAT

Immediate effects of alcohol use

Being drunk can have various effects on speech, such as making people more friendly, talkative,
unreserved, relaxed or argumentative. Increasing amounts of alcohol can cause aggressive,
antisocial, angry, slurred and confused speech.

Long-term effects of alcohol use

Alcohol is a carcinogen, meaning that it causes cancers in humans. Regular alcohol use increases
the risk of cancers of the mouth, throat and voicebox. Drinking around 50g of alcohol a day (five
standard drinks) increases the risk of these cancers by two to three times compared with non-
drinkers, but for people who smoke, this risk is increased much more. Drinking more increases
the risk of cancers, and drinking less decreases the risk of cancers.

3.13.2.12 PANCREAS AND DIGESTION OF SUGAR

Immediate effects of alcohol use

45
Heavy alcohol use on a single occasion can lead to dangerously low blood sugar
(hypoglycaemia), which can cause symptoms of shaking, sweating, dizziness, blurred vision and,
if not treated, brain damage.

Long-term effects of alcohol use

The pancreas is a gland that secretes digestive enzymes and releases insulin, which regulates
sugar
levels in the blood. Chronic heavy alcohol use can cause acute pancreatitis (sudden inflammation
of and damage to the pancreas that resolves over several days) and chronic pancreatitis
(inflammation of the pancreas that does not heal and worsens over time). Acute pancreatitis
typically causes abdominal and back pain, nausea and fever and may occur a few hours or up to
two days after drinking alcohol. In 20 to 30 percent of people, acute pancreatitis is a severe, life
threatening condition, which requires treatment in hospital. Chronic pancreatitis typically occurs
in people aged 30 to 40 years and can cause abdominal pain, weight loss, diabetes, malnutrition
and oily bowel motions (because the pancreas helps to digest fat and when the pancreas is
damaged, fats are excreted out of the bowel instead of being absorbed into the body). The risk of
acute and chronic pancreatitis increases with higher alcohol use. Moderate alcohol use is
associated with a reduced risk of developing type 2 diabetes, although the exact reason for this is
not certain.

3.13.2.13 SEXUAL HEALTH – MEN

Immediate effects of alcohol use

Being drunk increases the chances of having unsafe sex (without a condom), having sex that is
later regretted or experiencing sexual assault as alcohol impairs judgment and lowers inhibitions.
These factors are also likely to increase the risk of getting a sexually transmitted infection.

Long-term effects of alcohol use

Chronic heavy alcohol use can lead to impotence, loss of sex drive, wasting of the testicles and
reduced fertility. This is primarily because alcohol affects testosterone levels.

3.13.2.14 SEXUAL HEALTH – WOMEN

Immediate effects of alcohol use

Being drunk increases the chances of having unsafe sex (without a condom), having sex that is
later regretted or experiencing sexual assault as alcohol impairs judgment and lowers inhibitions.
Such sexual experiences are also likely to increase the risk of getting a sexually transmitted
infection or having an unplanned pregnancy.

Long-term effects of alcohol use

46
Chronic heavy alcohol use can lead to reduced fertility and can make periods heavy or irregular
or stop altogether. Consuming alcohol while pregnant may increase the risk of miscarriage, low
birth
weight, stillbirth and premature birth. It can also cause significant abnormalities in the unborn,
developing baby (fetal alcohol spectrum disorder).

3.13.2.15 SKIN AND FAT

Immediate effects of alcohol use

Acute alcohol use can lead to skin flushing and worsen the appearance of skin conditions such as
rosacea (a chronic facial skin rash).

Long-term effects of alcohol use

Chronic heavy alcohol use, when associated with serious liver disease and liver failure, can also
cause yellowing of the skin, decreased body hair and spider veins. Alcohol is a high-calorie
beverage. One standard drink (100ml of wine, 30ml of spirits or 280ml of standard beer)
contains 290kJ, close to half the energy of a can of fizzy drink. Alcohol is also an appetite
stimulant, and people tend to eat more when consuming alcohol with their meals. However,
while theoretically the potential for alcohol to increase weight is clear, and some studies find that
alcohol use is associated with increased weight, others find the opposite result. Alcohol seems
more likely to cause weight gain in those who drink intermittently (moderately to heavily), in
those who are already overweight, in those eating a high-fat diet, and in men For people
concerned about their weight, nutritionists advise people to take into account how much energy
alcohol is contributing to their diet. Chronic heavy drinkers are likely to be malnourished as
alcohol has little nutritional value and replaces nutritious food in the diet.

3.13.2.16 STOMACH AND FOOD PIPE

Immediate effects of alcohol use

Being drunk can lead to nausea and vomiting, diarrhoea, heartburn (when acid from the stomach
rises up into the food pipe, due to alcohol causing the muscle around the outlet of the stomach to
relax) and acute gastritis (inflammation of the lining of the stomach, which causes stomach pain,
nausea, loss of appetite and indigestion). Vomiting and diarrhoea can result in dehydration, salt
imbalances and the build-up of acids in the body, especially in combination with excessive
alcohol intake. Inhaling vomit can lead to bronchitis or pneumonia (infection of the lungs).
Vomit can block the airway and windpipe when blood alcohol is very high and breathing and
consciousness are impaired. Persistent vomiting and retching after heavy use on a single
occasion can sometimes (but only rarely) rip the food pipe (a Mallory Weiss tear), which leads to
vomiting of blood.

47
Long-term effects of alcohol use
Long-term alcohol use can cause cancer of the food pipe (oesophagus) and drinking 50g of
alcohol a day (five standard drinks) doubles the risk compared with a non-drinker. However, the
risk is much greater in people who drink alcohol who are also deficient in a liver enzyme that
metabolises alcohol (East Asian populations are commonly deficient in this enzyme). The risk is
also increased in smokers. Chronic heavy alcohol use can also lead to chronic gastritis but
alcohol may protect against infection from Helicobacter pylori, the bacteria that cause ulcers of
the stomach. In cases of advanced liver disease due to prolonged heavy alcohol use, the veins to
the stomach and oesophagus can swell and may burst, causing life-threatening bleeding.

3.13.2.17 DIABETES MELLITUS

People with diabetes are advised to discuss alcohol use with their health professional. Those with
well controlled diabetes can safely drink alcohol, although the risk of low blood sugar is
increased if alcohol is drunk without food and insulin is used. People with diabetes are advised to
monitor blood sugars when drinking and to wear an alert bracelet or similar identification
(alerting others of their diabetes in an emergency) because the symptoms of low blood sugar,
which is life threatening but quickly treatable, and drunkenness are very similar.

3.13.2.18 CANCERS

Alcohol is now recognised as a carcinogen – it is known to increase the risk of several different
types of cancer. This is based on assessments from the World Health Organization International
Agency for Research on Cancer (IARC) Monograph Working Group, a group of expert scientists
who review published studies and evaluate the evidence that alcohol increases
the risk of cancer.
Alcohol increases the risk of developing cancers of the:
• mouth, throat and voicebox
• oesophagus (food pipe)
• large bowel and rectum
• breast (in women)
• liver.

3.13.2.19 ALCOHOL POISONING

When a lot of alcohol has been drunk in a short time, blood levels of alcohol are high and
symptoms of extreme drunkenness are present, such that breathing has slowed, the individual is
only partially conscious or is unconscious, or some other complication is present that presents a
serious danger to health. Also known as ‘Acute intoxication’.

48
Alcohol is classed as a ‘sedative hypnotic’ drug, which means it acts to depress the central
nervous system at high doses.

3.13.2.20 Symptoms of drunkenness at different levels of blood alcohol

concentration (BAC)

BAC Symptoms

<50 mg/dL Some impairment in motor coordination and

thinking ability

Talkativeness

Relaxation

50-150 mg/dL Altered mood (increased well-being or

unhappiness)

Friendliness, shyness or argumentativeness

Impaired concentration and judgement

Sexual disinhibition

150-250 mg/dL Slurred speech

Unsteady walking

Nausea

Double vision

Increased heart rate

Drowsiness

Mood, personality and behaviour changes

which may be

49
 sudden, angry and antisocial

300 mg/dL Unresponsive/extremely drowsy

Speech incoherent/confused

Memory loss

Vomiting

Heavy breathing

>400 mg/dL Breathing slowed, shallow or stopped,

Coma

Death

3.14 PRICE AND TAX

One of the most effective strategies for reducing consumption of alcohol at the population level
is through increasing alcohol prices, usually accomplished by raising alcohol taxes. A recent
review of 112 studies of the effects of alcohol tax affirmed that when alcohol taxes go up,
drinking goes down – including among problem drinkers and youth. However, such steps can
only be effective if the illegal alcohol market is under control.

3.15 TREATMENT

Behavioural Treatments

Behavioural treatments are aimed at changing drinking behaviour through counselling. They are
led by health professionals and supported by studies showing they can be beneficial.

Medications

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Three medications are currently approved in the United States to help people stop or reduce their
drinking and prevent relapse. They are prescribed by a primary care physician or other health
professional and may be used alone or in combination with counselling.

24*7 De-addiction centres in India

The Ministry of Social Justice and Empowerment is now undertaking a National level Survey in
collaboration with National Drug Dependence Treatment Centre, AIIMS, New Delhi. . The survey
will provide national and state-level estimates of proportion and absolute number of individuals
using various drugs and suffering from substance use disorders.

The Survey estimated that about 7.32 Crore persons in India were users of alcohol and drugs. Of
these 87 lakh used Cannabis, 20 lakh used opiates and 6.25 Crore were users of Alcohol.

National Institute of Social Defence (NISD) has conducted 127 capacity building programme
imparting training to 4488 persons. They have also conducted 247 awareness generation
programmes in various Schools and Universities/Colleges covering 23006 beneficiaries.

This Ministry implements a “Central Sector Scheme of Assistance for Prevention of Alcoholism and
Substance (Drug) Abuse” under which financial assistance is provided to eligible Non-
Governmental Organizations, Panchayati Raj Institutions, Urban Local Bodies etc. for, inter-alia,
running and maintenance of Integrated Rehabilitation Centres for Addicts.

The de-addiction centres financially assisted by the Central Government in a State/UT depend on
the number of proposals received from the State Government/UT Administration.

SELF MEDICATION

3.16 Introduction
India, the largest democracy in the world has the second largest populous country in the world,
and it is said that for every 1700 Indian citizens, there is only one doctor! No wonder, the cases
of self-medication are on the rise.

But with mothers, grandmothers, aunts, uncles and of course, pados-wali aunty, who needs
doctors? Yes, we are regularly advised to have random tablet/capsule/syrup for any ailment, and
sadly, we end up doing so. In fact, such is the case that people prescribe doses of antibiotics and

51
other powerful drugs by themselves, never bothering to consult the doctor. Unfortunately, self-
medication has increased many health issues.

3.17 Self Medication

The traditional definition of self-medication is “the taking of drugs, herbs or home remedies on
one’s own initiative, or on the advice of another person, without consulting a doctor.” Self-
medication is the practice of an individual using available medications or substances to treat self-
diagnosed symptoms or conditions And it is a regular practice as it is a form of self-care of our
health. Self-medication of minor injuries and minor illnesses both gender (male and female),
socioeconomic states rich & poor, educated and non educated helps reduce the overall burden on
the healthcare system and is a common practice in all over the world.

3.17.1 The Self-Medication Hypothesis

The self-medication hypothesis seems intuitive but it has received mixed reviews from the
medical community and it has been both accepted and dismissed.

Regardless of the theories behind why someone with a mental health condition could be drawn to
substances, the linkage between mental health conditions and substance use disorders is
undeniable and has been of concern for many years. “Co-occurring disorder” is the term used
when a person is diagnosed with both a mental health condition and substance use disorder.
According to the 2017 National Survey on Drug Use and Health, of the 18.7 million adults aged
18 and older with substance use disorder, 8.5 million had co-occurring substance use disorder
and acute mental illness, and 3.1 million had co-occurring substance use disorder and serious
mental illness.

3.17.2 Why Self-Medicate?

Although the exact reason is very specific to an individual’s situation, there are some commonly
understood reasons including.

 The cost of medical treatment, including doctor visits and medications

 Fear of seeking treatment due to perceived negative stigmas
 Hiding or denying a condition
 Inefficient medications used for treatments in the past ,Fear of side effects from medications,
mild illness, previous experience of good results by some medicines

3.17.3 Self-medicated drugs

Common medicines used for self medication are analgesics, antipyretics, antacids, anti-diarrheal,
antidepressants, anti anxiety (sleeping pills), antiallergic, anti emitics, eye drops, ear drops, nasal
drops, skin ointment, antibiotics, steroids, vitamins, tonics, protein preparations.

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Conditions treated by self medication - Headache,body ache, cough cold, constipation, loose
motion, acidity, generalized weakness, sleep lessens (insomnia), fever. Skin infection, joint pain,
burns, menstrual pain, insect bites etc.
 The most widely self-medicated drugs were antibiotics (59%), followed by Non-steroidal
Anti-inflammatory Drugs - NSAID’s (31%), and cough and cold medicines ( 9%). (4%)
antimalarial drugs (|fever).
Side effects of self-medication
 Popping pills may get us instant relief but what we don’t realize is that it is not free of
side-effects. At times, a patient may be under prescribed medication for different health
issues, and self-medicating may lead to adverse reactions. This is because one drug may
react differently when consumed with another drug. This can even lead to death. Hence,
consulting a doctor is a must.

The risks of self-medication include:

1. Incorrect self-diagnosis
2. Delays in seeking appropriate medical advice and proper treatment
3. Potential adverse reactions
4. Worsening of the condition the individual is trying to self-treat
5. Dangerous drug interaction
6. Masking of severe diseases
7. Risk of dependence and abuse
8. Inaccurate choice of therapy
9. Fail to recognize unusual pharmacological risks
10. Uncommon but severe adverse effects
11. Fail to diagnosis of contraindications, interactions, warnings, and precautions
12. Fail to distinguish that the same active substance is already being taken under a
different name
13. Fail to report recent self-medication to the prescribing physician (double
medication/harmful interaction)
14. Fail to recognize or report adverse drug reactions
15. Incorrect route of administration
16. Excessive dosage
17. Excessively prolonged use
18. Food and drug interaction
19. Storage in incorrect conditions or beyond the recommended shelf life .

3.17.4 Self-Medication and Co-Occurring Disorders

Often when people are self-medicating with substances for undiagnosed mental health
conditions, it is difficult and sometimes impossible to determine which occurred first, the mental

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health condition or substance use disorder. The practice of self-medicating mental illness is very
dangerous as substance use disorder can worsen symptoms of mental illness. Improper treatment
of mental health conditions is very risky for the individual and can affect the way they act in
their relationships with other people. Improper treatment increases the risk for self-harm or harm
to others depending on the mental health condition present.

Some disorders with increased risk for self-medication include:

 Depression: Depression is a mood disorder associated with feelings of sadness, anger or

loss that impact daily life and are difficult to manage. The practice of self-medicating
depression could worsen symptoms because a key component of appropriate treatment
for depression is proper counselling from a trained professional. Without proper
treatment, symptoms of depression could turn into dangerous feelings of self-harm or
harm to others.
 Bipolar: Bipolar disorder is a severe psychiatric and psychological disorder that involves
specific variations of an individual’s mood, behaviour and emotions. Bipolar disorder
should be managed by a trained healthcare professional acting in the best interests of the
patient. Self-medicating bipolar disorder is unfortunately fairly common as individuals
with bipolar disorder are commonly diagnosed co-occurring substance use disorders,
especially alcohol misuse.
 Anxiety and Stress: Anxiety and stress are very common; however, it can be difficult for
people to realize that the anxiety and stress levels they are experiencing may require
professional treatment. Underlying stress can lead to high blood pressure and increased
risk of stroke. A study conducted in 2006 found that self-medication of anxiety increases
the risk for mood and substance use disorders as well as suicidal behavior. Self-
medicating to deal with stress and anxiety is very common and it can be hard for an
individual to realize when they should seek professional help and support.
 ADHD: Attention-Deficit/Hyperactivity Disorder (ADHD) is a mental health condition
that involves difficulty with attention and impulse control. Because ADHD is primarily
recognized in the adolescent and teenage years, the risks associated with ADHD self-
medication at those young ages are high. The American Journal of Addictions published
a study that found that more than one-third of adolescents and young adults found no
issues with using cigarettes and other substances for self-medication of ADHD.
 Trauma (PTSD): Self-medication is a common behavior associated with post-traumatic
stress disorder (PTSD) and can have many potentially hazardous and tragic outcomes.
A study estimated that approximately 20% of individuals with PTSD use substances in an
attempt to relieve their symptoms. PTSD treatment requires professional help and support
in order to help the individual properly cope with symptoms associated with their trauma.

Drug Dosage

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  A massive problem with self-medication is that we do not know about its dosage. This
means we often underestimate its strength and the less said, the better about its
composition. We have a clue as to how the drug should be taken, its side-effects and even
reactions. Ignorance is not bliss in this case.
 People take to self-medication because it is instant, and of course, there is no expense of the
doctor. But when eventually, they suffer from severe health issues, their medical expense
increases two-fold. Self-medication as a habit can damage one’s health irrevocably, causing
disabilities and even premature death.

Drug Interaction

 A drug interaction is defined as the modification of the effect (therapeutic effect and/
toxicity) of a drug by concomitant or previous administration of another drug or food .
The probability of prejudicial drug-drug interactions is expected to increase
exponentially with the number of drugs taken simultaneously by a patient .
Because of several reasons of physiological nature, the elderly are particularly exposed to
potential drug interactions. Firstly, since a larger number of co-morbid conditions are
present in this age group, the number of medications taken by older persons tends to be
large . Secondly, reduced renal drug elimination, decreased hepatic drug clearance,
reduction of the body water content and increment of body fat content make drug
interactions more likely at old age . As a result, adverse drug reactions occur two to
three times more frequently in patients over 65, and when taking 10 medications
simultaneously elder patients have a 100% chance of an adverse drug interaction.

 World Health Organization points out that responsible self-medication requires the
medicinal product to be supported with information describing how to take the medicine,
possible side-effects, monitoring, possible interactions, warnings, duration of use, etc. It
should also be noted that since herbal medicines are regulated as over-the-counter (OTC)
medicinal products, self-medication only medicines/drugs, dietary supplements,
functional or health food in most countries , the use of herbal medicines also constitutes a
potential case of responsible-self medication, provided that they are supported by the
appropriate, aforementioned information .

3.18.1 CASE STUDIES- ABUSE OF OTC MEDICATION

Drug Description
Orlistat Case report of a 45-year old normal-weight woman
abusing orlistat with an eating disorder. The woman
took orlistat more frequently and in larger doses than
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indicated in the label. She did not limited the fat ingest
per meal to 15 g, but purposefully ate large amounts of
food when taking orlistat.
Orlistat Report of two cases of normal-weight women with a
previous diagnosis of bulimia nervosa, using orlistat as
their only purging mechanism after binge episodes.
Orlistat Case report of abuse of orlistat by a normal-weight
woman with eating disorder and stimulant dependence.
Codeine, Cross-sectional pharmacy-based study performed in the
dextromethorphan, Midi-Pyrénées (France) based in self-administration of
pseudoephedrine, H1 an anonymous questionnaire. Patients requesting one
receptor antagonists drug from a list of psychoactive drugs used in self-
medication were included in the study. A control group
composed by patients requesting anti-acids was used.
Statistical significant differences on misuse/non-
medical use were found in the codeine group compared
to the antiacids groups.
Diphenhydramine Cross-sectional pharmacy-based study with a self-
administered questionnaire completed by 304
purchasers of Nytol or Sleepeaze revealed that 33.8%
of participants had used the product continuously for
more than indicated in the label (two weeks); 8.2%
took more of the recommended maximum dose.
OTC sleep aids Cross-sectional pharmacy-based study with a self-
administered questionnaire completed by 86 purchasers
of OTC sleep aids. 49% were classified as
inappropriate users (daily use for more than 30 nights,
weekly use starting using sleep aids more than two
years ago, use of
the OTC sleep aid to treat severe sleep disorders).
OTC analgesics Cross-sectional study based in administration of a
survey to 367 15-16 year old teenagers. 26% used OTC
analgesics on a daily or weekly basis. Analgesics were
commonly used to treat headache and muscle pain.
Pain or discomfort were related to long time spent in
front of
different screens, tight time schedules, drinking too
little and much noise in the classroom.
Prescription and Cross-sectional multi-center study based in a self-
OTC analgesics administered questionnaire to 358 patients diagnosed
musculoskeletal pain, aged 20-75 years old. The
General Health Questionnaire was used to assess
mental distress; Beck’s Depression Inventory was used

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 to assess depression. 28% had used drugs daily due to
pain and 29% has used multiple drugs simultaneously
due to pain. OTC drug use was associated to living
alone. Depression and mental distress were
 associated to daily use and multiple drug use. It was
also
noted that the main sources of antibiotic supply were community pharmacies (73%),
leftover of antibiotics, and supplies by family members and friends (10%). More than
one-tenth of the parents reported administering antibiotics to children according to their
own knowledge (8.5%) or advice given by family members and friends (6%) . A study
done in Karnataka, India found 30% SM prevalence for treatment of dental conditions. It
was reported that the main sources of drugs and instructions for self-medication were the
drug vendor (63%), and family and friends (38%) and male respondents were less likely
to have undertaken self-medication.

3.18.2 CASE STUDIES - SELF-MEDICATION WITH ANTIBIOTICS.

Type of study Main

findings
Review Between 70 and 80% of recommendations given
by pharmacies staff in Mexico for the treatment of
acute respiratory and gastrointestinal infections are
inappropriate.
Personal surveys to According to physician’s perceptions, self-
700 antibiotic medication with antibiotics is an extended
consumers and practice. The most usually self-prescribed
interviews to 28 antibiotics are amoxicillin, tetracycline,
physicians from ciprofloxacin and cephalosporin.
Paraguay
Cross-sectional based Throat symptoms, teeth symptoms and bronchitis
in administration of a were the most frequent reasons for self-medication
questionnaire to with antibiotics. Penicillins were the most self-
15548 people across prescribed antibiotics.
19 European
countries
Cross-sectional study Respiratory conditions were the most frequent
on 160 college indication for self-medication with antibiotics
students in Tehran (73.3%). Amoxicillin was the most self-prescribed 57
(Iran), based in self- antibiotic (40%).
administered
 questionnaire
Prospective survey 17% of participants had used leftover antibiotics,
on 1363 American mostly for the treatment of cough (11%) or sore
patients enrolled in throat (42%).
an emergency
department
Cross-sectional study Amoxicillin was the antibiotic most commonly
based in used (32.7%); around 10% of antibiotics were
administration of a obtained without a prescription; 24.4% of the
questionnaire to 467 respondents stored leftover antibiotics at home.
people in northern
Israel
Cross-sectional study Four out of ten participants have antibiotics at
based in home and one out of four people use them without
administration of a a
questionnaire prescription, against fever (44%), flu (32%), sore-
throat (19%) and cough (16%).
Cross-sectional study 53% of the respondents at least occasionally
based in consume antibiotics without prescription. Sore
administration of a throat (48%) and fever (18%) are among the main
personal survey to reasons for practicing self-prescription of
482 people from La antibiotics. Amoxicillin is the most consume
Plata (Argentina) antibiotic (70%).
Recommendations

Nevertheless, there are limitations that need to be taken care of to prevent and to avoid
unexpected side effects.

1. It can be added in the student’s curriculum also.

2. Health education of peoples, students, pharmacists. They should be actively involved in health
education.
3. Need for strict law enforcement to limit purchase of medicines out prescription.
4. Pharmacists should be made aware about media legal aspects, consumer’s protection act and
human rights about self medication.
5. Improving communication and improving a referral system between pharmacists and
physicians is an important issue.
6. Advertised of medicine knowledge to community about the drug regulation, which types of
medicine that cannot be consumption without medical doctor prescription.
7. Conduct fostering to the pharmacist organization not to give the ethical medicine to the patient
without medical doctor’s prescription.

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8. Build application about the assurance of self-medication and the danger of self-medication if
we used it away.
9. Public education about specific risk/side effects of self medication and its importance by mass
media and local government authorities.
10. Conduct workshops to update and improve the knowledge on managing simple complaints
and dispensing OTC drugs. Such workshops should emphasize that only those who could read
and write or who could be trained (either literate or not) could be patent/general medicine
dealers, just as traditional birth attendants, village or community health worker and so on, have
been trained irrespective of their educational level.
11. The practice of community pharmacy by registered Pharmacist should be encouraged
especially in areas where professional health care services are limited. The presence of such
professionals ensures that the practice of self medication is accompanied by appropriate training
on how to use medicines appropriately and effectively. Community Pharmacists can also play an
active role in the provision of primary health care by attending to minor ailments and referring
patients to physicians where patients require further investigation.

UNDUE USAGE OF ELECTRONIC GADGETS

“Too much of anything is good for nothing”

3.19 Introduction:
In the current world, we can see technology has been an integral part of our lives. It definitely
plays an important role in our day to day life. Technology has drastically increased at a fast pace
developing new gadgets frequently. From a young age to old age, we see everyone using
electronic gadgets. It might be TVs, smartphones, laptops, tablets, and so on. The list goes long if
we start listing out each gadget entered into the market. Technology has replaced a human life in
various ways including studying.

Gadgets can be classified as labour-saving or amusement devices. Useful as they are, gadgets are
increasingly being regarded as instruments of large-scale change in modern society--changes that
may not necessarily be regarded as good or desirable.

Technology and gadgets are now indispensable in our daily lives. In the past few years carrying a
miniature computer (a smart phone) in a pocket has become commonplace. Technology helps
advance the human race forward and makes doing mundane things more efficient and repeatable.
Technology has helped create the information revolution.
With technological advances, devices have evolved to be so powerful and smart that it feels like
having a super-computer on one’s hands. Humans now have an insatiable appetite for
information at their fingertips. When technology makes this happen, the natural tendency is for
this to become an expectation. When was the last time you printed a map or wrote a snail mail

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letter? If you did, then you belong to the elite endangered cadre of humans who are vanishing
rapidly. Welcome to the information age! Before we frame our problem, we would like to ponder
briefly over how our lives have changed with gadgets, compared to pre-digital era.

3.19.1 Life without Gadgets

In the olden days, women had to walk long distances to fetch potable water from a distant water
source; now they use municipal water supplied through pipelines. We washed our clothes by
hand; now we use the washing machine. We used to climb stairs; now we use the lift. We used to
walk, now we depend on mechanised transport. As a message circulating on a popular messaging
service put it recently, 'these days, people drive down to the gym to ride the bicycle.'

Today's children are amazed when their parents tell them that they did not have a television until
they were in their late teens or doing a school project meant going to the library and doing hours
of research by referring to as many book as the librarian would permit.
People born before the 1980’s would very well relate to life before the information age, when
people had no access to internet or personal gadgets. Let's briefly walk down the memory lane
to relive those moments — a life without gadgets.

 Children played together outdoor — they had a lot of physical activity.

 People talked to each other more often, and verbal communication face-face was at its
peak.
 Chat jargon did not exist and people knew their spellings well, as they read more books.
 People enjoyed spending more time outdoors with family and friends.
 It was commonplace to get the news from newspaper or radio.
 Entertainment came from playing board games, playing sports, going to the movies,
watching VHS tapes, etc.
 Writers often used either a type-writer or a word processor on their computer.
 Computers were expensive and bulky.
 Doing research was hard; frequent visits to the library or scouring through plethora of
papers, books, etc. were necessary.
 Communication was slow.

3.19.2 Life with Gadgets

As you can see, gadgets have helped hardworking women to save on time and provided them
with ready access to clean water. On the other hand, overuse of gadgets has rendered us
physically inactive. A logical consequence of the gadget-induced inertia is poor health and
stunted growth--both physical and mental--in children. And this is worrying.

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Gadgets equipped with internet have transformed our lives in several ways and brought about a
paradigm shift in our dependence on technology to perform key tasks in our everyday routine. To
highlight a few:

 Enormous amount of information at our fingertips

 Use Google Maps to get directions, watch YouTube videos to learn to cook, sing, draw,
learn science, etc.
 Health monitoring apps on the cell phone that would remind people to walk, run, bike,
check BP periodically, etc.
 Capability to share daily life or special events instantly with thousands of people and see
reaction in a matter of minutes, if not seconds
 Expedited research with access to information galore
 Ability to watch videos on demand from anywhere (Netflix, Amazon, etc.)
 Ability to read e-books online on demand — no more visits to library needed
 Use of mobile phones, tablets as pacifiers for kids
 Improved speed of communication by orders of magnitude leading to faster decision-
making
 Existence of mobile apps for entertainment, social interaction through digital media,
paying bills, accessing bank accounts, etc. (virtually for any purpose)

Let us list out some of the ill-effects of gadget over-indulgence both on children and grown-ups:
Health Concerns: The physical inactivity is the primary factor responsible for increased
instances of hypertension and diabetes even in young children.
Social Concerns: Human interaction is conducted virtually, eliminating the need for face-to-
face meeting. The fallout is social awkwardness and isolation among children.
Developmental Concerns: The ability to think clearly and coherently is what sets humans
apart from others. Overuse of gadgets stifles creativity in children.
A quick survey showed that most people panicked when they had misplaced their smartphones .

Survey results from “Lookout”

3.19.3 VIDEOGAMES

Most adolescents like to spend at least part of their free time playing video games. But for some
what starts out as innocent recreation can become an excessive use. Gamers spend so much time

61
on playing, that their personal relationships get neglected and loses sleep. Video games affect
adolescents by displacing time they spend doing home work.

3.19.3.1 Symptoms of Video game Excessive Use:

• Most non-school hours are spent on the computer or videogames.
• Falling asleep in School.
• Worsening grades.
• Lying about computer or videogame use.
• Choosing to use the Computer or play videogames, rather than seeing friends.
• Dropping out of other social groups (Clubs or sports)
• Being irritable when not playing a video game or being on the computer.

Physical symptoms
• Carpal tunnel syndrome.
• Sleep disturbances.
• Back aches or neck aches.
• Headaches.
• Dry eyes.
• Failure to eat regularly or regularly or neglecting personal hygiene.

3.19.3.2 Effects of video game Excessive use on adolescents.

 Suffering Relationship:-
Relationships with friends and family members may suffer if you are spending more time
gaming than you are talking to or going out with loved ones.
 Poor academic Performance:-
Long hours of playing video games will affect your performance in school or failing to work
at your optimum level. Completing homework, studying for test, and efforts during school
will become very low.
 Pre Occupation:-
A Video game excessive use can be harmful if you’re unable or unwilling to participate in
any interests or extracurricular activities other than gaming.
 Health problems:-
The Adolescent who spend more than two hours a day in front of a videogames in lieu of
participating in physical activity may suffer from childhood obesity.
 Increased Aggression:-
Videogames that features violent actions and sceneries may lead addicted players to be
desensitized.
 Financial consequences:-

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 Teens spend large amounts of money on new games, expansion packs, service fees and
computer upgrades.
 Emotional/Psychological Consequences:-
Those who use excessively computer games may experience depressed mood, low self
esteem, social anxiety, low frustration, tolerance, anger and feeling of guilt and shame for not
being able to control their gaming habits.

3.19.3.3 Guidelines for parents to reduce the effects of video games excessive
use on adolescents.

• Children should be helped to choose video games for them.

• It is always good to check the rating and content of the games before buying or renting.
• Parents most know the preference of the children in relation to game playing.
• They can talk to other parents for Advice and suggestions of good games.
• Parent can choose the games that are challenging and exciting without being violent.
• They should find games that require strategy and problem solving skills. If they have on
educational component, that’s Bonus.
• When choosing games for girls, it is desirable to look for ones that have, not – stereotypical
female character.
• Video games are expensive. So before it is bought, it is the responsibility of the parents to
make sure that the game has good play value.
• Always the parents must sit down and play when a new game is purchased.
• It is advisable to hare the computer or video game consoles in a public are of the house so that
everyone can observe what one is playing.
• Parents should explain to children why certain game is Objectionable. Inform them the effect of
playing violent video games.
• They must establish the rule for the duration and the frequency of playing video games &
strictly adhere to it.
• The child must be encouraged to involve in other interesting activities.

3.19.4 TELEVISION

In today’s world an exponential advancement has taken place in the electronic Media.
Television’s one of the important media for any group specially adolescents. Television has a
very heavy impact on youth. It has both pros and cons, but it depends on the person what they
take and what they discard in their life.

3.19.4.1 Symptoms of Television Excessive Use:

• Spending lot of time in front of television.
• Leave little or no time for outdoor games.

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• Insomnia.
• Lack of Communication.

3.19.4.2 Effects of Television on Adolescents.

 School Performance:-
Higher level of television viewing correlate with decrease in class room engagement, lowered
academic performance, especially reading scores.
 Parent Child Conflict:-
Children see the various kinds of advertisements on television and they pester their parents to
buy the same for them. When such demands are not met it results in parent child conflict.
 Violence:-
Increased aggressive behaviour after viewing violent TV Shows or Movies.
 Diet:-
Being glued to the television screen takes away one’s time away from play exercise and
activities.
 Emotional Effects:-
Adolescents are emotionally vulnerable. It makes them to feel like “Loser”.
 Cognitive Development:-
Excessive television watching diminishes the cognitive development.
 Poor Eye Sight:-
Artificial light or radiation being emitted from the television screens can lead to poor eyesight
problems in children and adolescents.
• Difficulties in language acquisition.
• Thinking and creative instincts are blocked.
• Continuous fatigue and headaches.
 Suggestions for parents to reduce the effects of viewing television:-
• Not to watch television before completing homework.
• Set time limit.
• Decide the type of programme want to watch.
 Participate:-
• Do not give children a television in the Bedroom.
• Accompany the children when watching TV. Discuss the programme. Ask them questions and
express your views. If there is anything not good directly tell them. So it does not happen
something fatal.
 Monitor:-
• Avoid shows, movies or videogames that have violent or sexual content.
• Encourage children to watch programmes which provoke compassion and cooperation.
• If your child becomes quite upset after a program, allow him to talk about what he saw, what he
is feeling and why.
 Be a good role Model:-

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• Set a good example with your own television viewing habits.
• Avoid watching programmes containing adult content when your child is in
the room/nearby.

 Other guidelines for parents:

TV is not a family member - Meal time should be family time.
 Work while you work, watch while you watch .
 Limit your viewing.
 Provide alternatives – stock plenty of non screen entertainment.
 Get organized –select programmes your family can watch together.
 Watch TV together
 A privilege to be earned- establish and enforce family viewing rules such as TV is
allowed only after homework is done.
 Lock that channel- often children view their favorite channels.

3.19.5 INTERNET

Today’s teens live in a world enveloped by communications technologies. The internet have
become a central Force that Fuels the rhythm of daily life. The internet is where we spend more
and more of our time. But for a growing number of people it’s an out of control habit instead of a
necessary part of life. Parents may feel outsmarted by their children’s computer and internet
abilities. The dangers inherent in this relatively uncontrolled “wired”. These dangers must be
unmasked and a wise parent will learn how to protect their adolescents.

3.19.5.1 Signs of Internet Excessive Use.

• Spending large amounts of time on line, especially at Night.

• Pornography on your computer.
• Receives phone calls from men you don’t know or is making calls, sometimes long distances,
you don’t recognize.
• Receives mail, gifts.
• Adolescents turn the computer monitor off quickly. Changes the screen on the Monitor when
you come into the room.
• Your child becomes withdrawn from the family.
• Using online Account Belonging to someone else.

3.19.5.2 Effects of internet excessive use on Adolescents:-

 Isolation:-
The internet can isolate from your family and friends Because of your online relationships.
 Guilt:-

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As you sit down to your computer each day, you may try to hide your internet use from your
family because you feel so guilty.
 Poor Diet:-
Those who were addicted to the internet had a poorer diet; including skipping meals, frequent
snacking of unhealthy food choices.
 Withdrawal:-
You may feel withdrawal symptoms when you aren’t able to use the computer, including feeling
agitated quite to anger to desperation.

 Suggestions for parents to reduce effect of Internet excessive use:-

1. Continue to keep family communication as open & Positive about computers as you can.
2. Create a list of internet house rules as a family includes the kinds of sites, internet hours, what
information should not be shared online.
3. Keep internet connected computers in an open area and not in a teen’s bedroom.
4. Insist that they never agree to meet an online friend.
5. Teach your teens responsible, ethical online behavior. They should not be using the internet to
spread gossip, bully or threaten other.
6. Discuss online gambling and its potential risks with your teens.
7. Always maintain access to your child’s on line account and randomly check his/her email.
8. Keep busy find activities to keep your teen’s mind of the internet.
9. Encourage your teen to tell you if something or someone online makes them feel
uncomfortable or threatened. Praise their Behaviour and encourage them to come to you again if
something happens.
10. Seek help- consult a physician if self help tactics or the intervention of family or friends
haven’t successfully curbed your internet use.

3.19.6 CELL PHONE

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Nowadays, cell phones are very popular. Nearly each of us have it. We like talking oncell
phones, sending SMS, playing games etc. Relationships are built in through phones..key boards
and keypads are becoming the keys to our teens heart. Cell phones create a distraction from real
life experiences and because of their ability to be taken anywhere. But is that a good way to
communicate?

The other major problem that needs to be highlighted is that these platforms have no way to
validate content being fed to users, i.e., fake news, articles generated to manipulate minds can be
easily spread with these apps with no regulations or checks in place.

3.19.6.1 Signs of Mobile Excessive use:-

• Often hanging with the Mobile phone.
• Not allowing others to touch their mobile.
• Late night conversation.
• Getting others Mobile and Manipulating.
• Stealing the money.
• Always keeping the Mobile in silent mode

3.19.6.2 Effects of mobile excessive use on adolescents:-

 Some people (especially teens) get addicted and waste large part of their time.
 Distraction in the class room.
 Cheating during examination.
 Health of those living in the vicinity of cell phone tower is becoming a growing concern.
 Cell phone monthly bill Increases
 It affects the sensitivity of the ears
 Cell phone blast due to excessive heating of battery
 Mobile phone radiation affects the electrical activity of the brain
 Increasing cause of accidents-because it deviates the attention of the driver
 Big nuisance in calm and silent places like libraries.
 The mobile phone advertisements through calls are becoming pain of the users.
 Electronic parts of a cell phone can be environmental hazard if not properly disposed.
 If affects the relationship (less interesting face – to - face interactions)

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  Decreased Male Fertility:-
Men who use cell phone for more than four hours per day had markedly poorer sperm quality.
 Increased Cancer risk:-
Using cell phone results in increase risk of Brain cancer, Because it is the organ in close
proximity to gadget.
Adolescents are more susceptible to play potential dangers because their nervous systems are
still in development. If central nervous system could be affected there by having impact on
Learning or behaviour. Radiations from cell phone only travel about 2 inches into the Brain of an
adult, but it goes beyond the center of a children Brain.

3.19.6.3 Parental guidelines:

Start simple:
Tell how to use the phone, pointing out valuable features like the key lock, vibrate, etc.,
Limit usage:
Designate time slots
Teaching responsibility:
Make sure your teen understands cell phone is not a
Keep it private:
Instruct them to use caution when giving out his / her number
Assess before answering:
Teach him not to answer calls or text message from numbers he doesn’t recognize.
Exercise etiquette:
Enforcing your own rules.
Protect your property
Teach him to be discreet and keep the phone locked away when not in use.
Utilize the landline
Recommend your child to use landline for necessary phone calls.
Beware of download overload

3.19.6.4 Mental and Emotional Health

Dopamine is a neurochemical that largely controls the pleasure and reward centers of the brain.
High levels of dopamine are usually associated with motivation and excitement to fulfil goals
that would lead to recognized rewards and thus reinforcement of a sense of pleasure while
achieving those goals. Procrastination, lack of enthusiasm and self-confidence, and boredom are
linked to low levels of dopamine.
Research has shown that the brain gets “rewired” as excessive amounts of dopamine get released
in the body on frequent interaction with a rewarding stimulus, i.e., using a smartphone app like
Facebook .Boredom triggers an interaction with the rewarding stimulus (Facebook app), which
in turn results in wide variety of rewards in the form of likes, messages, photos, etc. causing high

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releases of dopamine in the body. Frequent cycles such as these cause the brain’s receptors to
become more insensitive to dopamine, causing the body to experience less pleasure than before
for the same natural reward. This leads the person down a spiral, where one has increased
craving for the same reward to achieve normal levels of pleasure. If the increased craving cannot
be satisfied, it would lead to anxiety, lack of motivation and depression. Gadget addiction is
likened to addiction to alcohol or drugs since it results in similar negative consequences.
Studies have shown that children's cognitive and emotional development can be adversely
impacted by internet/gadget addiction. More screen time means more virtual interactions and
rewards through social media (shares, likes) and less face time. Less face-to-face interaction with
other people results in lack of empathy for fellow human beings. As social media glorify picture-
perfect lives and well-toned physiques, children’s self-esteem and self-confidence are eroded.
Lack of focus and more distraction during conversations is another expected negative impact. A
study on China high school students demonstrated that children with moderate to severe risk of
internet addiction are more than twice as likely to develop depressive symptoms than addiction-
free counterparts.
When one does not get the instant emotional support in the forms of likes, instant messages then
one starts feeling anxious, lonely and moody. Lot of the younger generation seem to start losing
self-esteem and self-confidence if their friends fail to like their picture or respond to their posts
instantly.
According to experts, “tech neck”, which leads to sagging skin, dropping jowls, and creases
above the clavicle, seriously affects facial looks of the person by causing frown lines, under eye
bags, and horizontal lines on the neck along with fat prominences. “People who bend down
constantly for long hours while using any handheld electronic device, like smart phones, tablet or
computers, are more likely to get wrinkles. The bending position while texting on mobile phones
can cause neck, back and shoulder pain, apart from headache, numbness, tingling in the upper
limb and pain in hands, arm, elbows and wrists,” said Vinod Vij, Cosmetic Surgeon, at Mumbai-
based Fortis Hospital.

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3.19.6.5 Self-awareness
Self-awareness is key to reducing gadget addiction.
We should increase awareness, spread the message such that consumers recognize the difference
between technology designed to extract the most attention from us, and technology whose goals
are aligned with our own. Consumers need to take control of their digital lives with better tools,
habits and demand to make this change.
Being self-aware enables us to be mindful and enjoy life moments without being glued to our
screens and spend quality time with our loved ones.

3.20 FAMILY INTERACTION

Introduction
Good parent-Children relationship matters in the later success of children. Creating a meaningful
close relationship with your adolescents begins from the moment they are born. You can’t turn
back the clock and if you are having a difficult time with your teen. It is still possible to build a
closer relationship.

Signs of poor family interaction:

 Parents not spending adequate time with their teens.

 Not helping in their studies.
 Lack of family meal time.
 No hang out with children.
 Lack of love.
 Not playing with their children.

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  Lack of communication.
Negative effects of family interaction:
 Teens spending more time on internet.
 Hanging with their mobile phone.
 Not respecting the parents.
 Getting addicted to drugs and alcohol.
 Poor academic performance.
 Bad company.
 Low self esteem.

Tips to strengthen family interaction:

 Say I love you:-
Tell your teen you love him/her every day. A simple “I love you” goes a long way toward
developing and then strengthening a relationship.
 Teach your faith.
Teach your teen about your faith and beliefs. Allow time for your teen to ask questions and
answer them honestly.
 Establish a special name.
The special name can be established to have special meaning between your child and you.
 Let your teen help you.
Parents some times in advertently miss out on opportunities to forge closer relationships by not
allowing the child to help them with various tasks and chores.
 Play with your children.
Play whatever is Fun and interesting. It doesn’t matter what you play. Just enjoy each other.
 Eat meals as a family.
Eating together sets the stage for conversation and sharing. Turn the TV off and don’t rush
through a meal.
 Seek out one –on –one opportunity often.
Some parents have special nights with their children whether it is a walk around the
neighbourhood or just a movie night. It is important to celebrate each child individually.
 Respect their choices.
Children reach out independence at a young age and parents can help to foster those decision
making skills by being supportive.
 Make them a priority in your life.
Your children need to know that you believe they are a priority in your life.
 Be a role model.

Parental Control devices:

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While all the major mobile device providers – Apple, Google, and Amazon included – offer
parental controls on their devices, Family Link is different because it’s a two-party system.
Instead, it works more like the third-party parental control and monitoring software already on
the market, where an app installed on a parent’s device is used to configure settings and establish
a child’s first Google account, as well as utilize a series of parental controls to manage and track
screen time, daily limits, device “bedtimes,” and which apps kids can use and keep an eye on
kids’ digital behavior.

Conclusion

“Social media addiction is thought to affect around 5% of young people, with social media being
described as more addictive than cigarettes and alcohol” Electronic gadgets have both positive
and negative effects but negative impact of electronic gadgets outweighs the positive impact. As
parents are the first teachers to their children they must assess the impact of electronic gadgets on
academic performance and family interaction and encourage their positive attitude and reduce
negative effects.

QUESTION BANK

Part A

1. Define a drug
A drug is defined as “any chemical agent which affects living protoplasm and is intended
for use in the treatment, prevention or diagnosis of disease.”
2. What are antacids?
Antacids are medicines used to relieve acid indigestion, upset stomach, sour stomach, and
heartburn. They contain ingredients such as Aluminium Hydroxide, Calcium Carbonate,
Magnesium Hydroxide, and Sodium Bicarbonate
3. Define Toxicity.
Toxicity can be defined as an adverse health effect associated with a change, reduction or
loss of a vital function./ It is the intrinsic ability of an agent to harm living organisms.
4. What is autoimmunity? Give example.

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 It is the response that results when the organism’s immune system attacks its own cells.
Methyldopa can cause hemolytic anemia by eliciting an autoimmune reaction against the
Rhesus antigens.
5. What is cytotoxicity? What are its types?
This is the simplest form of drug toxicity, where the drug or an active metabolite causes
serious damage to the cells. There are two types. They are Non-covalent interactions and
covalent interactions.
6. What is a carcinogen? What are its types? Give example for each type.
A carcinogen is any substance, radionuclide, or radiation that is an agent directly
involved in causing cancer. There are two types. They are radioactive carcinogens and
non radioactive carcinogens. Gamma rays and alpha rays are the examples for
radioactive carcinogen. Examples of non-radioactive carcinogens are inhaled asbestos
and tobacco smoke.
7. What is Teratogenicity? Give example
Some drugs can cause defects in the development of the foetus, leading to gross
abnormalities of the baby known as teratogenicity. Example: Thialidomide
8. Differentiate drug abuse and drug misuse.
Drug abuse may be defined as the accumulation of negative consequences resulting from
drug misuse. Drug misuse means not using a drug in the manner in which it was intended.
9. Define drug addiction.
Addiction is defined as a chronic, relapsing brain disease that is characterized by
compulsive drug seeking and use, despite harmful consequences.
10. What is Nicotine? What is the adverse effect of it?
Nicotine is an addictive stimulant found in cigarettes and other forms of tobacco.
Tobacco smoke increases a user’s risk of cancer, bronchial disorders, and cardiovascular
disease.
11. What are the medical uses of Narcotics?

Narcotics have some valid medical uses, including Pain management, Anesthesia,
Reduction of respiratory distress for the dying, Sedation, Anti-diarrheal, Antitussives
(cough suppressant), Treatment of withdrawal and cravings in opioid-dependent

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 individuals, Lowering blood pressure and reducing fluid flow through the heart during an
acute heart attack.

12. What are semisynthetic narcotics? Give example.

Crude and raw natural drugs are processed and isolated to active compounds by chemical
process. Such man made drugs derived from natural drugs are called semi synthetic
drugs. Ex. Heroin, Brown sugar (Smack) etc.

13. What are the long term effects of using heroin?

Regular use of heroin may eventually cause Intense sadness, Irregular periods and
difficulty having children, Constipation, Damaged heart, lungs, liver and brain, Vein
damage and skin, heart and lung infections from injecting, Needing to use more to get the
same effect, Dependence on heroin, Financial, work or social problems.

14. List out the Treatments for Drug Addiction.

There are many options that have been successful in treating drug addiction, including
behavioural counseling, medication, medical devices and applications used to treat
withdrawal symptoms or deliver skills training, evaluation and treatment for co-occurring
mental health issues such as depression and anxiety, long-term follow-up to prevent
relapse.

15. What is a cigarette?What do you mean by passive smoking?

A cigarette is a cylindrical roll of shredded or ground tobacco that is wrapped in paper or

another substance that does not contain tobacco. Passive smoking occurs when a person
who is not smoking breathes in the smoke from people who are smoking.

16. How does alcohol use affect the liver?

Chronic heavy alcohol use can damage the liver, causing alcoholic liver disease. This
occurs across a spectrum from fatty liver, to acute alcoholic hepatitis, to cirrhosis.

17. What is self medication?

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 The practice of taking of drugs, herbs or home remedies on one’s own initiative, or on the
advice of another person, without consulting a doctor.

18. List down some of the ill effects of self medication.

The risks of self-medication include 1. Potential adverse reactions 2.Worsening of the
condition 3. Dangerous drug interaction 4. Masking of severe diseases 5. Excessive
dosage

19. What are the problems of overuse of gadgets?

Overuse of gadgets has rendered us physically inactive. A logical consequence of the
gadget-induced inertia is poor health and stunted growth--both physical and mental--in
children.

20. List down the symptoms of excessive use of Television.

1. Spending lot of time in front of television. 2. Leave little or no time for outdoor games.
3. Insomnia. 4. Lack of Communication.

21. Give Suggestions for parents to reduce effect of Internet excessive use.
1. Continue to keep family communication as open & Positive about computers as you
can. 2. Create a list of internet house rules as a family includes the kinds of sites, internet
hours, what information should not be shared online. 3. Keep internet connected
computers in an open area and not in a teen’s bedroom. 4. Insist that they never agree to
meet an online friend.
22. List down the Signs of mobile excessive use.
1.Often hanging with the Mobile phone. 2. Not allowing others to touch their mobile.
3. Late night conversation. 4. Getting others Mobile and Manipulating. 5.Stealing the
money. 6. Always keeping the Mobile in silent mode.

23. What are the Signs of poor family interaction?

1. Parents not spending adequate time with their teens.
2. Not helping in their studies.

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 3. Lack of family meal time.
4. Lack of communication.

24. List out some of the ill-effects of gadget over use in physical and mental health.
The physical inactivity is the primary factor responsible for increased instances of
hypertension and diabetes even in young children. Overuse of gadgets stifles creativity in
children.
25. List down some of the long-term effects of smoking.
1. increased risk of stroke and brain damage
2. eye cataracts, macular degeneration, yellowing of whites of eyes
3. loss of sense of smell and taste
4. yellow teeth, tooth decay and bad breath
5. cancer of the nose, lip, tongue and mouth
PART B
1. What is a drug? How are drugs classified? (Pg.No. 1, 2)
2. What do you mean by drug abuse? Mention the signs of drug abuse and list down
the ill effects of it. ? (Pg.No. 7-9 )
3. Explain the ill effects of consuming alcohol. ? (Key points from Pg.No. 39, 48)
4. Give the guidelines for parents to reduce the effects of video games excessive use
on adolescents. ? (Pg.No. 64)
5. Discuss the signs of excessive internet use and list down the ill effects of it. Give
few guidelines to parents to reduce effect of Internet excessive use. ? (Pg.No. 66,
67)
6. What are the signs of excessive mobile use? List down the ill effects of it. Give
few guidelines to parents to reduce effect of excessive use of mobile phones. ?
(Pg.No. 68, 69)
7. What are the signs of poor family interaction? List down the ill effects of it. Give
some tips to strengthen family interaction. ? (Pg.No. 71, 72)
8. What are the symptoms of excessive television use? List down the ill effects of it.
Give some guidelines for parents to reduce the ill effects of excessive watching of
Television. ? (Pg.No. 64-66 )
9. Write notes on the effects of tobacco use in health. ? (Key points from Pg.No. 33
-35)
10. What are Narcotics? Write short notes on any two narcotic drugs.( Any two
Narcotics from Pg.No. 12 - 24)

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