DRUG AND SUBSTANCE ABUSE

BEST ‘A’ LEVEL BIOLOGY REVISION NOTES ®

DRUG AND SUBSTANCE ABUSE
Compiled by G. TARUVINGA

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‘A’ LEVEL NC BIOLOGY NOTES compiled by TARUVINGA G  +263 772 980 253 Page 1
 DRUG AND SUBSTANCE ABUSE

TOPIC 13: HEALTH AND DISEASES

8.8.1 DRUG AND SUBSTANCE ABUSE
KEY OBJECTIVES CONTENT SUGGESTED LEARNING SUGGESTED
CONCEPT Learners should be able to: (ATTITUDES, ACTIVITIES AND NOTES RESOURCES
SKILLS AND
KNOWLEDGE)
8.8.1 Drug  explain the meanings of - Drug  Discussing effects of - Adverts
and the terms drug dependence drug abuse.
- Resource
substance dependence and drug - Drug tolerance  Visiting psychiatric persons
abuse tolerance. - Addiction hospitals and
 distinguish between - (with reference to rehabilitation centres. - Print media
psychological and physical alcohol, tobacco,  Observing video clips of - ICT tools
dependence. heroin, cough evidence of drug abuse. - Braille
 describe the effects of mixtures,  Carrying out surveys on software/Jaws
tobacco smoking in the marijuana statistics on drug
{mbanje})
gaseous exchange and
- Psychological
abuse. - Resource
cardiovascular systems.  Debating on effects of persons
 describe the immediate dependence tobacco smoking and
and long term - Physical alcohol.
dependence - Fresh liver
consequences of alcohol  Illustrating the effects of tissue
consumption on the brain, - Atherosclerosis alcohol on liver tissue in
on the peripheral nervous - Coronary heart the laboratory. - Alcohol
system and on the liver. disease
- Strokes
- Cancer
- Social effects
- Long and short
term effects of
alcohol

DEFINITION OF A DRUG

- The term drug is difficult to define satisfactorily because in general conversation the word
is used in many different ways.
- Many people for example do not think of alcohol, aspirin or nicotine as being drugs.
- Others use 'drug' when they really mean narcotics whilst another group would include any
manufactured chemical in the list.
- The following are some examples of definitions which have been used in a more specific
context.
1. 'Any substance used in the composition of a medicine.'
 This includes many of the commonly used substances, but it excludes some
commonly used ones such as nicotine and tetrahydrocannabinol in cannabis.

2. 'Any chemical substance which alters a mood, perception or consciousness and is

used to the apparent detriment of society.'
 This includes most of the substances which are misused by people but excludes
many medically useful substances such as sulphonamides or even aspirin.

3. 'Any substance taken into the body which brings about a physiological change.'
 This definition also creates problems as it includes substances such as basic
nutrients and water but possibly excludes some psychotropic drugs, though in
time all of these may prove to bring about their effects by some physiological
change.

4. 'Any substance which when taken into the body may modify one or more of its
physical or mental functions.'

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 DRUG AND SUBSTANCE ABUSE
 This is probably the best working definition to use as it does not exclude any
substances which are considered to be drugs but it does perhaps include some,
like water or nutrients, which are not usually thought of as being drugs.

5. Drugs are chemicals which interfere with the nervous system and cause changes
in mental state and behaviour.
 These are psychoactive drugs, such as cannabis, alcohol, nicotine, and heroine. It
is drugs of this type which are dealt with in this chapter.
 Psychoactive drugs are drugs that affect the mind or mood or other mental
processes.

SOCIALLY ACCEPTABLE AND ILLICIT DRUGS

- Some drugs are accepted in all societies because of their medicinal properties e.g. pain-
killers such as paracetamol and aspirin are widely available over-the-counter drugs.
- Others such as antibiotics are available on prescription.
- Anaesthetics are used in hospitals and clinics.
- Other drugs have important medicinal use, but they have become popular drugs of misuse
because of their psychoactive effects e.g. Heroin and cannabis.
- Alcohol is used as a disinfectant and when drunk in moderation has few adverse effects on
the body. It has been shown to be beneficial in reducing the risk of heart disease. But in
large quantities alcohol increases the risks of cancer, depression, liver disease and brain
damage.
- Alcohol is the world‘s favourite mood-altering drug, so it is widely misused in many
societies.
- Cultural attitudes determine whether a drug is socially acceptable or not.
- Both cannabis and alcohol are intoxicants. Cannabis (Mbanje) is more intoxicating than
alcohol; however, it has been shown to relieve the symptoms of degenerative diseases.
Whereas alcohol is legal in many countries, the sale and possession of cannabis are illegal.
- Illegal drugs are those categorised under legislation. Legislation, therefore, is the best
indicator of the drugs society considers unacceptable.
- Attitude towards drugs change. Smoking was once fashionable, but after its health risks
were identified, less people now smoke.
- Alcohol and tobacco are widely accepted in certain societies, occupations, and social and
ethnic groups than others.

SOME RELEVANT TERMS

1. Withdrawal syndrome (a.k.a. Abstinence syndrome)

- Physical and psychological symptoms which occur when the drug is withheld from the
drug-dependent person.
- The nature of the withdrawal syndrome varies with the drug on which dependence exists.
- For most drugs the symptoms disappear after a time when the body has recovered its
normal state.
- Medical help may be needed to overcome the symptoms and a residual desire to take the
drug again may last almost indefinitely.
- Willpower is needed to resist the temptation to use the drug again.

2. Drug abuse
- This is the occasional or persistent excessive use of a drug for personal gratification.
- It should not be confused with drug misuse which implies medical or lay use of a drug to
treat a disease, not considered appropriate by the majority of medical opinion.

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3. Drug dependence (a.k.a. Addiction)

- Dependence occurs when a person feels compelled to take a drug for its mood-altering
effect or to avoid the discomfort produced by its absence.
- Drug dependence is divided into two types:

(a). Physical dependence is when the drug or one of its metabolites has become necessary for
the continued functioning of the body.
This means that on withdrawal of the drug there are definitely physical symptoms, often
very unpleasant for the dependent person - the abstinence syndrome is caused. It should
be noted that in addition to the overt physical symptoms, psychological ones also occur
which are a manifestation of the withdrawal effects on the brain.

(b). Psychological dependence consists of just emotional components with no physical

symptoms on withdrawal.
The emotional changes which occur when the drug is withheld may amount to only mild
discomfiture or may be such that the person is led to persist in using the drug. At its
extreme, psychological dependence may lead to changes in lifestyle and behaviour where
life revolves round drug taking and the company of others likewise involved. In these
circumstances the individual may live in a sub-culture of drug users separated by law or
behaviour from normal society.

4. Habituation
- A mild form of dependence where withdrawal does not result in severe abstinence
symptoms but which is noticed by the person and may cause slight, short-term discomfort
or craving for the drug.

5. Drug tolerance
- This is the need to use increasing doses of the drug to produce the same effect.
- It may depend on changed sensitivity of cell receptors, on increased rates of metabolism of
the drug or on changes in cell transmitter substances.

WHY DO PEOPLE ABUSE DRUGS?

- People take drugs because they want to change something in their lives.
- Here are some of the reasons young people have given for taking drugs:

 Peer pressure
 To fit in
 To escape or relax
 To relieve boredom
 To seem grown up
 To rebel
 To experiment
 Influenced by advertisements
 Influenced by celebrities

- They think drugs are a solution. But eventually, the drugs become the problem.
- Difficult as it may be to face one‘s problems, the consequences of drug use are always
worse than the problem one is trying to solve with them. The real answer is to get the facts
and not to take drugs in the first place.

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ALCOHOL ABUSE

What is alcohol?
- There are different kinds of alcohol. Ethanol (Ethyl alcohol) is the alcohol present in
alcoholic beverages. It is produced by the fermentation of grains and fruits. Fermentation is
a chemical process whereby the enzyme zymase in yeast acts upon carbohydrates in the
food, creating alcohol.
- Alcohol is classed as a depressant, meaning that it slows down vital functions—resulting in
slurred speech, unsteady movement, disturbed perceptions and an inability to react quickly.
- Alcohol is a drug that affects the mind by reducing a person‘s ability to think rationally and
distorts his or her judgment.
- Although classified as a depressant, the amount of alcohol consumed determines the type of
effect. Most people drink for the stimulant effect, such as a beer or glass of wine taken to
―loosen up.‖ But if a person consumes more than the body can handle, they then experience
alcohol‘s depressant effect. They start to feel ―stupid‖ or lose coordination and control.
- Alcohol overdose causes even more severe depressant effects (inability to feel pain, toxicity
where the body vomits the poison, and finally unconsciousness or, worse, coma or death
from severe toxic overdose). These reactions depend on how much is consumed and how
quickly.
- Alcohol abuse or dependence is called alcoholism.
- Alcohol is mainly taken orally, i.e. by drinking it.
- Binge drinking is the practice of consuming large quantities of alcohol in a single session,
usually defined as five or more drinks at one time for a man, or four or more drinks at one
time for a woman.
- Most of the alcohol consumed by youths under the age of 21 is in the form of binge drinks.

Alcohol (ethanol) content in alcoholic beverages

- Beer 2–6% alcohol
- Cider 4–8% alcohol
- Wine 8–20% alcohol

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- Tequila 40% alcohol
- Rum 40% or more alcohol
- Brandy 40% or more alcohol
- Gin 40–47% alcohol
- Whiskey 40–50% alcohol
- Vodka 40–50% alcohol
- Liqueurs 15–60% alcohol

DRINKING AND DRIVING

- The risk of a driver under the influence of alcohol being killed in a vehicle accident is at
least eleven times that of drivers without alcohol in their system.
- Alcohol distorts a person‘s perceptions and judgment. The reaction time of a drunken
person becomes slower than when sober. This makes driving or the operation of other
machinery dangerous when a person is drunk.

UNDERSTANDING HOW ALCOHOL AFFECTS THE BODY

- Alcohol is absorbed into the bloodstream via small blood vessels in the walls of the
stomach and small intestine. Within minutes of drinking alcohol, it travels from the
stomach to the brain, where it quickly produces its effects, slowing the action of
nerve cells.
- Approximately 20% of alcohol is absorbed through the stomach. Most of the remaining
80% is absorbed through the small intestine.
- Alcohol is also carried by the bloodstream to the liver, which eliminates the alcohol from
the blood by breaking it down into nontoxic substances. The liver can only metabolize a
certain amount at a time, leaving the excess circulating throughout the body. Thus the
intensity of the effect on the body is directly related to the amount consumed.
- When the amount of alcohol in the blood exceeds a certain level, the respiratory
(breathing) system slows down markedly, and can cause a coma or death, because oxygen
no longer reaches the brain.

Young people versus adults; what’s the difference?

- A young person‘s body cannot cope with alcohol the same way an adult‘s can.
- Drinking is more harmful to teens than adults because their brains are still developing
throughout adolescence and well into young adulthood. Drinking during this critical
growth period can lead to lifelong damage in brain function, particularly as it relates to
memory, motor skills (ability to move) and coordination.
- According to research, young people who begin drinking before age 15 are four times
more likely to develop alcohol dependence than those who begin drinking at age 21.

WHAT IS ALCOHOLISM OR ALCOHOL DEPENDENCE?

- Alcohol dependence (alcoholism) occurs when a person feels compelled to take alcohol
for its mood-altering effect or to avoid the discomfort produced by its absence.
- Alcohol dependence (alcoholism) consists of four symptoms:
 Craving: a strong need, or compulsion, to drink.
 Loss of control: the inability to limit one‘s drinking on any given occasion.
 Physical dependence: withdrawal symptoms, such as nausea, sweating, shakiness
and anxiety, occur when alcohol use is stopped after a period of heavy drinking.
- Serious dependence can lead to life-threatening withdrawal symptoms including
convulsions, starting eight to twelve hours after the last drink. The delirium tremens
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(D.T.‘s) begins three to four days later where the person becomes extremely agitated,
shakes, hallucinates and loses touch with reality.
- Alcohol tolerance is the need to drink greater amounts of alcohol in order to get high.
- An increasingly heavy drinker often says he could stop whenever he chooses—he just never
―chooses‖ to do so. Alcoholism is not a destination, but a progression, a long road of
deterioration in which life continuously worsens.

LONG AND SHORT-TERM EFFECTS OF ALCOHOL ON HEALTH

Short-term effects of alcohol

Depending on how much is taken and the physical condition of the individual, alcohol can
cause:

 Slurred speech
 Drowsiness
 Vomiting
 Diarrhoea
 Upset stomach
 Headaches
 Breathing difficulties
 Distorted vision and hearing
 Impaired judgment
 Decreased perception and coordination
 Unconsciousness
 Anemia (loss of red blood cells)
 Coma
 Blackouts (memory lapses, where the drinker cannot remember events that occurred
while under the influence of alcohol)

Long-term effects of alcohol

Binge drinking and continued alcohol use in large amounts are associated with many health
problems, including:

 Unintentional injuries such as car crash, falls, burns, drowning

 Intentional injuries such as firearm injuries, sexual assault, domestic violence
 Increased on-the-job injuries and loss of productivity
 Increased family problems, broken relationships
 Alcohol poisoning
 High blood pressure, stroke, and other heart-related diseases
 Alcoholic Liver disease
 Alcoholic hepatitis
 Liver cirrhosis
 Brain disorder
 Nerve damage
 Sexual problems
 Permanent damage to the brain
 Deficiency in thiamine and Vitamin B1, which can lead to Wernicke-Korsakoff
Syndrome (disorder characterized by amnesia, apathy and disorientation).
 Ulcers
 Gastritis (inflammation of stomach walls)
 Malnutrition
 Cancer of the mouth and throat
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The youngest victims-Effect of alcohol on the foetus

- When consumed by pregnant mothers, alcohol enters the bloodstream, passes through the
placenta and enters the foetus (unborn child).
- Alcohol can damage a foetus at any stage of pregnancy, but is most serious in the first few
months.
- There is risk of premature birth, miscarriage or stillbirth.
- There is also risk of alcohol-related birth defects including:
 low birth weight (growth deficiencies),
 facial abnormalities, and
 damage to the brain and nervous system.

Describe the immediate and long term consequences of alcohol consumption on the brain, on
the peripheral nervous system and on the liver.

EFFECTS OF ALCOHOL ON THE BRAIN

The immediate effects of alcohol on the brain

- Alcohol depresses brain functions by inhibiting the reticular activating system (RAS),
which regulates the cerebral cortex (front part of brain). As a result, intellectual facilities
are diminished. As the regulation of the cerebral cortex is disrupted, its role in inhibiting
other areas and integrating sensory and motor control are reduced. This leads to loss of
coordination, judgement, and control over fine movement.
- With increasing blood alcohol concentration, other centres of the brain are affected and so
are behaviour and mental abilities. These changes severely affect the ability to walk, cycle
or drive.

The long-term effects of alcohol on the brain

1. Brain shrinkage, which is an indication of brain damage, is caused by alcohol-induced
dehydration. Alcohol inhibits release of hormone ADH, so the kidneys remove more water
than they would normally.
- Brain cells are damaged by shortage of oxygen (hypoxia) and low blood sugar associated
with long-term abuse of alcohol.
- The symptoms of alcohol damage on the brain include:
 Loss of short-term memory.
 Loss of intellectual function such as calculation, comprehension, and learning new
tasks.
 Sleep is disturbed with the reduction of rapid eye movement and more waking
periods in the middle of the night.
2.Neglect of diet due to alcoholism leads to a deficiency in thiamine and Vitamin B1
which results in two forms of degenerative changes in the brain namely Wernicke’s
encephalopathy and Korsakoff’s psychosis. Together, they‘re referred to as Wernicke-
Korsakoff Syndrome. Their symptoms are:
Wernicke’s encephalopathy: confusion, disturbance of speech and walking, coma.
Korsakoff’s psychosis: loss of memory, inability to learn new material, confusion,
dementia.

EFFECTS OF ALCOHOL ON THE PERIPHERAL NERVOUS SYSTEM

- Neglect of diet due to alcoholism leads to a deficiency in Vitamin B1 which also causes
polyneuropathy.
- Polyneuropathy is the degeneration of nerves in the peripheral nervous system (nerves
outside the brain and spinal cord) due to vitamin B1 deficiency. The myelin sheaths
surrounding nerves are not maintained and become less efficient.

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- The symptoms of Polyneuropathy due to loss of nerve function are:
 Loss of sensory awareness in hands and feet.
 Some difficulty in movement.
 Feelings of pain, cramps, numbness, tingling and weakness.

EFFECTS OF ALCOHOL ON THE LIVER

The long-term effects of alcohol on the liver

- Alcohol and Liver Damage – The liver is the organ that metabolizes alcohol. Once a
person consumes alcohol, the liver begins working to process it — converting ethanol
to the toxin ethanal (a.k.a. acetaldehyde), which it breaks down into acetate, and
further breaks down into water and carbon dioxide.
- The liver can process about 10g of ethanol per hour, leaving the remaining amount in
the bloodstream. The blood alcohol concentration is a common way to measure how
drunk a person is.
- Long-term, regular heavy drinking can damage the liver and cause Alcoholic Liver
Disease (ALD), fatty liver, alcoholic hepatitis, liver cirrhosis and hepatic
encephalopathy (brain disorder).

Fatty liver disease

- The liver becomes swollen with cells full of fat droplets, cholesterol and plasma
proteins unable to leave the liver due to damage of the intracellular transport
mechanism.
- This condition is reversible if drinking is stopped.

Alcoholic Liver Disease (ALD)

- Ethanal produced as liver metabolises alcohol is very toxic as it is highly reactive. It
forms complexes with proteins, interferes with enzyme active sites and structural
proteins in cell membranes and mitochondria and inhibits protein synthesis. The
changed proteins are recognised as foreign and antibodies are formed against them. This
auto-immunity damages liver tissue leading to Alcoholic Liver Disease (ALD).

Alcoholic hepatitis
- The more alcohol the liver has to process, the more swollen its cells become and the
more fat is stored in them. The resulting swelling and inflammation are known as
alcoholic hepatitis or alcoholic steatohepatitis. If this is severe it may give rise to:
 jaundice (yellowing of eyes and skin that results from the inability of liver cells
to excrete bile pigments)
 nausea
 loss of appetite
 abdominal pain
- Alcoholic hepatitis can develop into Liver cirrhosis if drinking is not stopped.
- If drinking is stopped then the liver returns to normal.

Liver cirrhosis
- As heavy drinking continues, fibrosis, or scarring of liver cells occurs. Cells do not
receive a good blood supply. Liver functions deteriorate and jaundice gets worse.
Blood flow into liver is blocked and diverted to oesophagus arteries causing internal
bleeding and vomiting blood.
- Cirrhosis is not reversible but if drinking is stopped the progression of the disease is
stopped.
- Liver cancer develops in about one in five cases of cirrhosis.

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- These liver diseases can eventually lead to liver failure and possible death.

Brain disorder (hepatic encephalopathy)

- Liver dysfunction from alcohol consumption also causes a brain disorder called
hepatic encephalopathy. The disorder causes changes in basic things, like sleep
patterns and mood, but also has more serious effects, such as personality changes,
anxiety, depression and problems with physical coordination. The more serious cases
can be fatal.

SUMMARY- The long-term effects of alcohol on the liver

Of all the physical harm caused by drinking too much, damage to the liver is the most
prevalent and likely. The liver may develop Alcoholic liver disease due to ethanal poisoning,
become inflamed, and leading to scarring and eventual Liver cirrhosis. People who drink
heavily may also develop alcoholic hepatitis, fatty liver disease, or liver cancer.

LONG-TERM EFFECTS OF ALCOHOLISM ON THE HEART

- Excessive alcohol consumption can damage the heart in multiple ways, such as:

1. increasing risk of high blood pressure, heart disease, atrial fibrillation and
hemorrhagic stroke;
2. Raising triglyceride levels; and leading to obesity, which puts significant strain on the
heart.
3. While it is true that drinking in moderation can promote heart health, excessive
drinking can weaken the heart itself — called cardiomyopathy — and cause
premature death.

SOCIAL CONSEQUENCES OF ALCOHOL ABUSE

- Alcohol abuse is a factor in crime, family disputes, domestic violence, marital breakdown,
child neglect, absenteeism from work or school, vandalism, physical assault, petty crime,
drink-driving offences, grievous bodily harm, psychiatric illness, sadistic rape and sexual
assaults on children.

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- Family budgets are strained when the alcoholic spends money on alcohol.
- Financial strain on the family as the cost of treatment for some of the diseases due to
alcohol misuse can be expensive and long term.
- Being drunk or hung over can reduce work activity or lead to employment loss, which can
also cause financial problems. In addition, constant borrowing money and failure to return
back the debt, quarrels and thefts can be the result.
- Society ends up meeting the costs of rehabilitating of alcoholics in mental institutions and
by institutions such as the Alcoholic Anonymous.
- Personality traits of people who are dependent on alcohol include:
 Jealousy
 Selfishness
 Irritability
 Uncontrolled anger
 Frequent changes of job
 Changes of drinking habit
 Neglect of food intake
 Neglect of personal health
 Neglect of personal appearance
 Aggressive behaviour
 Grandiose behaviour.

ALCOHOL WITHDRAWAL SYMPTOMS

 rapid pulse, increased blood pressure
 rise in body temperature and
 sweating
 tremors, seizures
 loss of appetite
 insomnia
 nausea, and vomiting
 hallucinations
 agitation

CONCLUSION
Alcohol dependants need treatment as soon as possible to minimize the damage that is done
to their body, their social and professional life, and also to their family and social
environment.
Alcoholism is a medical condition that can result in physical withdrawal symptoms, which
can be dangerous if not treated.
Treatment comes in different forms. There is medication available to treat alcoholism,
individual counselling and therapy sessions with a therapist, group therapy, Alcoholics
Anonymous, and treatment centres that specialize in treating alcohol and drug addictions.

TOBACCO SMOKING
Describe the effects of tobacco smoking in the gaseous exchange and cardiovascular systems.

WAYS OF ADMINISTERING TOBACCO

Tobacco can be smoked in cigarettes, cigars, or pipes. It can be chewed or, if powdered,
sniffed. It is also consumed by placing it in the mouth against the gums for an extended
period of time.

TOBACCO SMOKE

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- There are over 4000 chemicals in tobacco smoke but three main components of tobacco
smoke which pose a threat to human health are:
1. Nicotine
2. Tar- a mixture of aromatic compounds
3. Carbon monoxide

Describe the effects of tobacco smoking in the gaseous exchange systems.

Effect of nicotine
- Nicotine, a stimulating and relaxing drug which, on entering the blood stream, is able to
cross the blood–brain barrier. In the brain it triggers the release of dopamine, the natural
neurotransmitter substance associated with our experience of pleasure.
- Long-term exposure to nicotine eventually comes to have the reverse effect, actually
depressing the ability to experience pleasure. So more nicotine is needed to ‗satisfy‘, and
cigarettes become addictive. Smokers therefore find it increasingly hard to quit the habit.
- Nicotine also increases the heart rate and blood pressure. It decreases the blood flow,
particularly in the hands and feet, and it makes blood clotting more likely. It can make
platelets stick together.

The effect of carbon monoxide

- Carbon monoxide, a gas that diffuses into the red blood cells and combines irreversibly
with haemoglobin to form carboxyhaemoglobin. This reduces the efficiency of red blood
cells to transport oxygen. In smokers, the blood is able to transport less oxygen. This puts a
strain on the heart and circulation during physical activity.
- Carbon monoxide also promotes the release of damaging free radicals and makes platelets
and neutrophils stick together.

Effect of tar in tobacco smoke on health

1. Chronic obstructive pulmonary disease (COPD)
- Tar blocks the small air ways and destroys alveoli.
- Sufferers experience breathlessness or difficulty in breathing because of the blockage.
- Blood is not well oxygenated causing an increase in blood pressure in the pulmonary artery.
- Right side of heart enlarges and fluid accumulates in the body, especially the legs.
- COPD is reversible in very rare circumstances.
- If smoking is given up when still young, lung function can improve.
- In older people such improvement is not possible.

2. Chronic bronchitis

- Tar in tobacco smoke stimulates the goblet cells to secrete more mucus and inhibits the
sweeping action of cilia.
- Mucus accumulates in the bronchioles and blocks the small bronchioles.
- As mucus is not moved, or is moved slowly, dirt, bacteria and viruses collect in the lungs
and cause ―smoker‘s cough‖.
- The changes to the linings of the airways can be summarised as follows:
 Mucus glands in the trachea and bronchi enlarge.
 Mucus glands and goblet cells produce much mucus.
 Cilia are destroyed.
 Epithelia are replaced by scar tissue

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 Smooth muscle become thicker
 Airways are blocked by mucus.
- These changes constitute chronic bronchitis.
- Sufferers have a severe cough, producing large quantities of phlegm (mixture of mucus,
bacteria and white blood cells).
- Chronic bronchitis contributes to development of emphysema.

3. Emphysema

- Due to chronic bronchitis, infections become more common.

- This leads to inflammation in the lungs: more macrophages and phagocytes line the lungs.
- Phagocytes release elastase, a protein digesting enzyme.
- Elastase destroys elastin in connective tissues so that alveoli do not stretch and recoil
when breathing in and out.
- Because of this the bronchioles collapse during exhalation trapping air in the alveoli and the
alveoli burst.
- Large spaces appear where the alveoli have burst. This reduces the surface area for gaseous
exchange.
- Cells in the alveoli release an elastase inhibitor (α1 antitrypsin) but smokers release less
than non-smokers, so there is little to reduce the effect of phagocytes.
- Loss of elastin makes it difficult to move air out of the lungs. The air remains in the lungs
and is not refreshed during ventilation.
- Poorly refreshed air and reduced surface area for gaseous exchange means people with
emphysema do not oxygenate their blood very well and have a very rapid breathing rate.
- The symptoms of emphysema include:
 Coughing,
 shortness of breath,
 and wheezing, developing into extreme difficulty in breathing.
- It can become worse in some people with emphysema so that they need a continuous supply
of oxygen through a face mask to stay alive.
- The pictures below compare diseased and normal lung tissue.

4. Lung cancer

- Tar in tobacco smoke contains carcinogens (cancer-causing chemicals).

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- These cause mutations of DNA of epithelial cells resulting in malignant tumours.
- The cancer spreads through the bronchial epithelium and enters the lymphoid tissues in the
lungs.
- Tumour cells break away and are carried to other organs of the body (such as the liver,
adrenal glands and brain), forming a secondary tumour (a process called metastasis).
- Unchecked, cancerous cells ultimately take over the body, leading to malfunction and
death.
- Lung cancer can be cured but only if it is detected early enough.
- The symptoms of the lung cancer are:
• Frequent and severe coughing that persists for more than three weeks
• The coughing up of blood
• Shortness of breath and a feeling of weakness or tiredness
• An unexpected and unexplained loss of weight
• Pain in the rib cage and/or the shoulder areas
• Chest infections that will not go away, even with antibiotics
• Hoarseness of the voice and swelling of the face and neck.

THE EFFECTS OF TOBACCO SMOKING IN THE CARDIOVASCULAR SYSTEM

Describe the effects of tobacco smoking in the cardiovascular system.

Nicotine: raises blood pressure; raises heart rate; makes platelets sticky and therefore
increases likelihood of thrombosis; decreases blood supply to the extremities.

Carbon monoxide: Combines with haemoglobin to form stable compound

carboxyhaemoglobin, with the result that less oxygen is transported in the blood.

Describe the effects of nicotine on the nervous system.

Nicotine interacts with receptors for the neurotransmitter acetylcholine. These may become
more numerous in a smoker, or the sensitivity of the receptors to nicotine may decrease, so
the smoker increases the number of cigarettes to maintain the same effect. Smokers who
switch to low tar and low nicotine brands often smoke more cigarettes each day to maintain
their intake of nicotine.

HEROIN
- HEROIN is an opiate (a type of depressant) and is modified chemically from morphine,
which is extracted from opium poppies.
- Heroin is a preferable drug than morphine as it does not stimulate the vomit and nausea
centres of the brain.
- Both heroin and morphine are used as pain killers for the terminally ill, especially cancer
patients.
- Heroin has its effect by binding with high affinity and specificity to receptor molecules at
synapses.
- Heroin has a molecular shape almost identical to a group of neurotransmitters, the
enkephalins; it mimics their activity by combining with their receptors.
- Enkephalins are neurotransmitters at synapses where sensory neurones from pain receptors
connect to relay neurones that convey impulses to the brain.
- Enkephalins are small peptides, just a few amino acids long. In normal circumstances they
are released to inhibit the activity of neurones concerned with pain.
- They are destroyed at the synapse very rapidly, so they do not act for long.

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- Heroin (and other opiates such as morphine) occupy the pain receptor sites and inhibit
transmission of pain in the same way as enkephalins.
- Opiates such as heroin are depressant drugs because they reduce or depress the activity of
the nervous system, including the respiratory and cardiac centres in the brain. This can
be fatal if activity decreases to such an extent that the diaphragm stops moving or the heart
stops beating.
- Heroin can be smoked, sniffed or injected into a vein.
- Injecting it creates additional risks for the user, who faces the danger of AIDS or other
infection on top of the pain of addiction.
- On the first few occasions when heroin is injected, the user experiences a warm ―rush‖ and
feels very peaceful. This pleasurable state of well-being is known as euphoria. Users
attempt to repeat this euphoric feeling with further does of heroin.

Describe the effects of heroin on the nervous system.

 Heroin mimics the action of enkephalin neurotransmitters at synapses concerned with

pain.
 It binds to opiate receptors to inhibit transmission of nerve impulses in the pain pathways.
 This has a pain-killing or analgesic action.

EFFECTS OF HEROIN ON BEHAVIOUR

- Heroine is expensive.
- As it is illegal it can only be obtained from illegal drug dealers.
- Users of heroin are usually alienated from society and may become more and more
isolated from friends and society.
- Continued use is often associated with difficulty in keeping a job and maintaining normal
social relationships.
- Money to fund the habit may be obtained from criminal activities such as shoplifting,
mugging, burglary and prostitution.
- Heroin addicts tend to neglect their appearance, their health and families.
- They often do not eat well or maintain good standards of hygiene.
- Those who share needles to inject heroin put themselves at risk of infection with HIV.

Short-term effects of heroin on health

 ―Rush‖
 Slowed breathing
 Clouded mental functioning
 Nausea and vomiting
 Sedation; drowsiness
 Hypothermia (body temperature lower than normal)
 Coma or death (due to overdose)

Long-term effects of heroin on health

 Bad teeth
 Inflammation of the gums
 Constipation
 Cold sweats
 Itching
 Weakening of the immune system

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 Coma
 Respiratory (breathing) illnesses
 Muscular weakness, partial paralysis
 Reduced sexual capacity and long-term impotence in men
 Menstrual disturbance in women
 Inability to achieve orgasm (women and men)
 Loss of memory and intellectual performance
 Introversion
 Depression
 Pustules on the face
 Loss of appetite
 Insomnia

MARIJUANA (a.k.a. CANNABIS OR MBANJE)

WHAT IS MARIJUANA/CANABIS?

Type: Plant
Family: Cannabaceae
Chemical name: Cannabis sativa
Common name: marijuana, hemp, ganja, weed, bud, jive stick, pot, hashish (concentrated
resin), kief (resin form)

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- Marijuana comes from the Indian hemp plant, Cannabis sativa, and the part that contains
the ―drug‖ is found primarily in the flowers (commonly called the ―buds‖) and much less in
the seeds, leaves, and stems of the plant.
- There are over 400 chemicals in marijuana. The chemical that causes intoxication or the
―high‖ in users is called tetrahydrocannabinol (THC). THC creates the mind-altering
effects that classify marijuana as a ―drug.‖
- As for the medical uses of marijuana, it contains another chemical called CBD (short for
cannabidiol). This is the substance most often associated with creating medical benefits.
Unlike THC, CBD does not cause a high. Its medical benefits are still being studied, as are
methods to breed marijuana plants with high CBD and low THC for medical use.
- Plants, like animals, have traits that protect them in the wild. Plants can have colours or
patterns that camouflage them from predators, or they can contain poisons or toxins that,
when eaten, make animals sick or alter their mental capacity, putting them at risk in the
wild. THC is the protective mechanism of the marijuana plant.
- Intoxication literally means ―to poison by taking a toxic substance into your body.‖ Any
substance that intoxicates causes changes in the body and the mind. It can create addiction
or dependence, causing a person to want to take that drug even if it harms him or her.
- You may have heard someone say that because marijuana is a plant, it‘s ―natural‖ and so
it‘s harmless. But it‘s not. Hemlock, a poisonous plant, is also ―natural,‖ but it can kill.
- The other thing to know is that burning dried leaves and buds and inhaling the smoke into
your lungs is definitely not ―natural‖ and like smoking cigarettes, can be harmful to your
body.

How is it used?

- Marijuana, when sold, is a mixture of dried out leaves, stems, flowers and seeds of the
hemp plant. It is usually green, brown or grey in color.
- Hashish is tan, brown or black resin that is dried and pressed into bars, sticks or balls.
When smoked, both marijuana and hashish give off a distinctive, sweet odour.
- Marijuana can be smoked as a cigarette (joint), but may also be smoked in a dry pipe or a
water pipe known as a ―bong.‖ It can also be mixed with food and eaten or brewed as tea.
These are called ―edibles‖ and are covered in detail later in this booklet. Sometimes users
open up cigars and remove the tobacco, replacing it with pot—called a ―blunt.‖ Joints and
blunts are sometimes laced with other, more powerful drugs, such as crack cocaine or PCP
(phencyclidine, a powerful hallucinogen).
- When a person inhales the smoke from a joint or a pipe, he usually feels its effect within
minutes. The immediate sensations—increased heart rate, lessened coordination and
balance, and a ―dreamy,‖ unreal state of mind—peak within the first 30 minutes. These
short term effects usually wear off in two to three hours, but they could last longer,
depending on how much the user takes, the potency of THC and the presence of other drugs
added into the mix.
- As the typical user inhales more smoke and holds it longer than he would with a cigarette, a
joint creates a severe impact on the lungs. Aside from the discomfort that goes with sore
throats and chest colds, it has been found that smoking one joint gives as much exposure to
cancer-producing chemicals as smoking four to five cigarettes.
- The mental consequences of marijuana use are equally severe. Marijuana smokers have
poorer memories and mental aptitude than do non-users.
- Recent studies on young adults that smoke marijuana, found abnormalities in the brain
related to emotion, motivation and decision-making.

IS MARIJUANA MEDICINE?

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- Components of the marijuana plant may have medicinal properties. That is not the same as
―medicine.‖ Medicine is made when a laboratory extracts the medicinal compound,
standardizes it (meaning that it will do the same thing every time), and doses it (a
standardized amount the doctor prescribes).
- The term ―medical marijuana‖ is often applied to the whole unprocessed marijuana plant or
its crude extracts, which are not scientifically recognized or approved as medicine.
- Because marijuana is sometimes marketed as a medicine, perception of the drug has
changed. But the basic facts about marijuana haven‘t changed just because it‘s marketed as
a ―medicine.‖ And while the debate over legalization presses on, legal does not equal safe.
Cigarettes are legal but there is no debate about the fact that smoking is a health risk.
Alcohol is legal but look at the number of people battling alcohol addiction or illnesses
associated with alcohol abuse.

MARIJUANA AFFECTS DRIVING

- The use of marijuana significantly impairs judgment, coordination and reaction time—all
skills needed to drive safely.
- Marijuana is the second most commonly psychoactive substance found among drivers
after alcohol.
- Marijuana users are 3 to 7 times more likely to have a car crash.

THE HARMFUL EFFECTS OF MARIJUANA (Cannabis)

The short term effects of taking marijuana

- The immediate effects of taking marijuana include rapid heartbeat, disorientation, and
lack of physical coordination, often followed by depression or sleepiness. Some users suffer
panic attacks or anxiety.
- But the problem does not end there because the active ingredient in cannabis, THC,
remains in the body for weeks or even months.
- Small amounts of marijuana can cause temporary sterility in men. Marijuana use can also
disrupt a woman‘s menstrual cycle.

The long-term effects of taking marijuana

- Marijuana smoke contains more carcinogens (cancer-causing substances) than tobacco

smoke. People who abuse marijuana are at risk of developing lung cancer.
- Long-time marijuana smokers often suffer from bronchitis, an inflammation of the
respiratory tract.
- Years of heavy marijuana use to cause brain abnormalities.
- Studies have shown a connection between continued marijuana use and psychosis.
- Marijuana can change the structure of sperm cells, deforming them.
- The mental functions of people who have smoked a lot of marijuana tend to be diminished.
- The THC in cannabis disrupts nerve cells in the brain, affecting memory.
- Cannabis is one of the few drugs that cause abnormal cell division, which leads to severe
hereditary defects.
- A pregnant woman who regularly smokes marijuana or hashish may give birth
prematurely to an undersized, underweight baby, child with reduced initiative and lessened
abilities to concentrate and pursue life goals, birth defects, mental abnormalities and
increased risk of leukaemia (cancer of the bone marrow) in children.

SHORT-TERM EFFECTS OF MARIJUANA ON HEALTH

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 Short-term memory problems
 Severe anxiety, including fear that one is being watched or followed (paranoia)
 Very strange behaviour, seeing, hearing or smelling things that aren‘t there, not being
able to tell imagination from reality (psychosis)
 Panic
 Hallucinations
 Loss of sense of personal identity
 Lowered reaction time
 Increased heart rate (risk of heart attack)
 Increased risk of stroke
 Problems with coordination (impairing safe driving or playing sports)
 Sexual problems (for males)
 Up to seven times more likely to contract sexually transmitted infections
than non-users (for females)

LONG- TERM EFFECTS OF MARIJUANA ON HEALTH

 Bronchitis
 Lung cancer
 Decline in IQ
 Poor school performance and higher chance of dropping out
 Impaired thinking and ability to learn and perform complex tasks
 Lower life satisfaction
 Addiction
 Potential development of opiate abuse
 Relationship problems, intimate partner violence
 Antisocial behaviour including stealing money or lying
 Financial difficulties
 Increased welfare dependence
 Greater chances of being unemployed or not getting good jobs.

COUGH MIXTURE ABUSE

- The psychoactive drugs which are abused in cough medicines are codeine,
dextromethorphan and alcohol.
- Parents of teen and pre-teen children may underestimate the potential for abuse of cough
medicine that is readily available in some areas. While many drugstores have moved
cough medicine bottles behind the counter to prevent shoplifting, in other stores, the
bottles are right out in the open. Among young people, this is one of the more popular
drugs of abuse but it is both addicting and its abuse can result in a fatal overdose.

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ABUSE OF OVER-THE-COUNTER COUGH MEDICINES

- The main intoxicating ingredient in over-the-counter cough medicines is

dextromethorphan (abbreviated as DXM). In large doses, it creates drunkenness,
hallucinations and a sense of being separated from one‘s body and identity. Know all the
effects of this drug so you can spot its use. Also learn how to educate young people to
protect them from harm or addiction.

Why Do Young People and Adults Abuse Dextromethorphan (DXM)?

- They are seeking the drunken, out-of-control feeling they get after drinking large
quantities of the cough syrup. They also experience dizziness and more symptoms are
euphoria distorted visual perceptions. Some people enjoy the dissociation (disconnection
from your own body, identity or thoughts) that occurs at high doses.
- The usual dose of dextromethorphan is 10 to 15 milligrams (mg) of the drug. At around
100 mg, these drunken sensations begin to occur for most people. However, some people
routinely drink more than this dosage or consume more pills or gelcaps, consuming 240 to
360 mg of the drug. Dosages as high as 600 mg and higher have been seen.
- When high doses of dextromethorphan are used, the symptoms can be severely disturbing.

They may include:

 Mania
 Loss of consciousness
 Poor judgment
 High blood pressure
 Numb fingers and toes
 Slurred speech
 Nausea and vomiting
 Disorientation
 Loss of coordination
 Distortions of color and sound
 Irregular or rapid heartbeat
 Hallucinations
 Seizures
 Agitation
 Psychosis

- If the dosage of DXM is high enough, it can suppress the central nervous system and cause
death. High dosages are also associated with an ―out of body‖ experience and the loss of
contact with all of a person‘s senses.

ABUSE OF PRESCRIPTION COUGH MEDICINES

- Prescription cough medications may contain codeine or pseudoephedrine, also addictive
and damaging.
- It was only in 2005 that scientists began issuing warnings about the abuse of this drug.
- Codeine is an opiate painkiller and a cough suppressant.
- These preparations will more likely be abused by an adult who has access to a physician to
prescribe its use.
- In Zimbabwe codeine is abused in the cough syrup called BronCleer which is
commonly known as ‘Bronco’ in the streets.
- BronCleer is manufactured in South Africa from where it is imported or smuggled into
Zimbabwe.

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Side Effects and Symptoms of Codeine Cough Syrup Abuse

- While codeine is used to treat pain and coughing in small doses, larger doses, such as
those resulting from the abuse of codeine-based cough syrup, it can have a variety of
harmful side effects.
- These side effects can often include:

 Relaxation
 Euphoria
 Reduced heart rate
 Dizziness and staggering
 Confusion, delirium, or hallucinations
 Small pupils
 Itchiness and scratching
 Constipation
 Nausea and vomiting
 Blue appearance to lips or fingernails
 Seizures

Codeine Cough Syrup Abuse May Lead to the Abuse of Other Opiates

- Codeine-based cough syrups are acting as a gateway drug, helping expose users to other
opiates. For example, if a user of codeine cough syrup finds that they are not getting the
same high they once did, they may begin turning to stronger prescription opiates or even
street drugs like Heroin.
- Another issue with codeine is the expense; some reports indicate that users pay up to $200
a bottle to purchase codeine-based syrup for illegal use. These high prices are another
reason why users (who may not be able to afford their addiction) will often begin using
less-expensive opiates to avoid experiencing codeine withdrawal.

ABUSE OF COUGH SYRUPS WHICH CONTAIN ALCOHOL

- Alcohol is used in cough medicines to mix the ingredients because it is a good solvent of
these ingredients.
- Cough medicine and alcohol can commonly lead to additive drug interactions, such as
drowsiness, sedation, difficulty concentrating, and dizziness.

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