Committee: Health

Issue: Enforcing the Prevention and Treatment of Substance Abuse, Including Narcotic Drug Abuse and Harmful Use of Alcohol

Chair: Veya Ayra Mandapat

Introduction

        There are many substances known to be harmful to the human body, but none are as popular as two common ones. The term “substance abuse” refers to the harmful use of psychoactive substances, in which drugs and alcohol stand out. Drugs are any substances that cause a physiological change. They first became popular in the 1800s when a drug known as opium was used during the Civil War in the United States of America as a pain reliever;however, it soon led to the first ever morphine addiction. Alcohol is a flammable liquid that is mostly used in beverages such as wine, beer, and spirits. It was first used in what is now the country of Greece around 2000 BC. Though the two substances date back   many centuries , they are still as popular today -- maybe even more.

        Alcohol alone can cause millions of fatal accidents, most commonly car crashes. It can damage the brain by killing off its cells as well as hurting your liver. Drugs can cause heart attacks, damage organs in your body, including the brain and heart. They can make a person think unclearly. Together, these two substances can lead to a sudden death. While they are mostly used in the United States and several countries in Europe, drugs and alcohol are commonly found worldwide in different forms -- meaning that the effects of exploiting them can happen  everywhere. This is why it is important to focus on their prevention as well as the treatment of those who are suffering.

Key Terms

        Substance Abuse

        This refers to when a person has indulged too much or has become dependent on an addictive substance, particularly alcohol or drugs. It is also a form of substance-related disorder. They cause people to change the way they act, feel, or think.

Narcotic Drugs

        As stated earlier, drugs are any substances that can be inhaled, injected, consumed, etc., by the human body which leads to drastic change that could cause damage to the organs or even death. Some drugs, in fact, are used in medicine, such as Ketamine that is said to help those with a Bipolar Disorder. However, drugs that are narcotic affect the mood or behavior and are on the market for nonmedical reasons, most importantly, illegal ones.

        Recreational Drugs

        A recreational drug is one popularly used without any medical justification because of its psychoactive effects, meaning affecting behavior and mind, because many people think that it is a safe drug to use occasionally as it is not addictive. These drugs include cocaine and marijuana. For example, in the United States, especially West Virginia, there is an issue of epidemic proportions of opioid and heroin that strains resources from police and hospitals.

Drug Abuse

        Drugs themselves are very addictive substances due to their use of increasing dopamine in the brain. Dopamine is a chemical that occurs after a pleasurable experience, like after eating food, and that feeling can be mimicked by consuming drugs, which is why it is not surprising for them to be exploited. Drug abuse defines the habit of taking too many or illegal drugs that are very harmful to one’s health.

        Minimal Legal Drinking Age (MLDA)

        The MLDA is set to protect millions of lives. These laws state the legal age of when an individual can purchase or consume alcoholic beverages publicly. For example, the MLDA in the United States of America is age 21.

Zero-tolerance Laws

        These laws make it a criminal offense for those under 21 years of age to drive on the streets with even just a small amount of alcohol in their system. Each state has a different percentage of blood alcohol concentration (BAC) that when consumed are considered a criminal offense, ranging from 0.00% to 0.02%, but no more than 0.7%.

        Relapse Prevention (RP)

        The word “relapse” means going back to bad habits that one has already stopped doing. When a person is already sober, it is important to make sure that he or she does not go back to that lifestyle. Relapse Prevention is a behavioral approach made to make sure that a person who is cured of substance abuse will stay cured and will no longer return to their old habits.

        Detoxification

        When someone is detoxified, that person has been cleansed of a harmful substance or has stopped consuming them with medication and treatment. This process is important when it comes to curing oneself of the addiction of substance abuse. It is one of the first steps to be done.

General Overview

        

Substances Abused

        

It is important to know which substances exactly are those being abused in order to tackle the issue at hand. The first would be illegal drugs, such as heroin, cocaine, and cannabis. Then comes alcohol, such as vodka, wine, gin, etc. These two, though are the most common, are not the only forms of substances being abused. It could also be prescription medicines that were either used too much or maybe even taken by someone who they were not prescribed to. Solvents like glue and aerosols are also included, and last but not least, Novel Psychoactive Substances (NPS), which are also known as “legal highs.” A few examples of this would include benzylpiperazine, mephedrone, and methoxetamine.

Causes

        What leads a person to the life of a substance addict? Most of the time, it is not on purpose. A substance may simply be addicting as it is -- even just trying it once may lead to more times, until eventually, the person is pulled in and it’s hard to get out. The many causes of substance abuse would include being influenced by friends to do something unwanted (peer pressure), boredom, being under too much stress, being raised in an environment where the harmful use of alcohol and drugs are considered normal, dealing with a mental illness and performing self-medication, problems within a relationship, financial stress, dealing with a loss of a loved one, having a low self-esteem and turning to substances to boost confidence levels, a cause of personality disorder, being a rebellious teenager, or to simply lose themselves. These, however, are only a few examples of how someone can turn to drugs and alcohol for help. The number of possibilities of causes as to why there are around 208 million who consume illegal drugs and 136.8 million drinkers of alcohol are numerous.

pie_chart_lg2.png

(Source: Substance Abuse and Mental Health Services Administration, 2005 National Survey Use and Drug Health)

Effects

        When we talk about the effects of substance abuse, it is not only limited to the health of the person, though that is the direct effect, but also to those around them.

        Health

        

        The impact of substance abuse to the body can spread all over, infecting almost every possible organ. It could cause a wave of nausea, which includes vomiting and having abdominal pain; the immune system would start getting weaker, which increases the vulnerability to further infections in the body; there would be a huge range of cardiovascular conditions that include a heartbeat that is too fast or too slow and heart attacks; drugs that are injected affect the veins, causing them to collapse, as well as infections of blood vessels; there might be damage to the liver that causes it to work abnormally, leading to liver failure; having seizures, brain damage, and strokes that impact daily life as they are vulnerable to causing problems within the memory, listening skills, making decisions, confusion, and permanent damage of the brain; causing several changes in the body, leading to possibilities such as the development of breasts in men, decrease in appetite and increase in body temperature; and finally, even death. In fact, there are more deaths, illnesses, and disabilities that come from substance abuse than any other health conditions. The National Institute on Drug Abuse (NIDA) states that to this day, illicit drug use is the reason for one in four deaths.

        According to the United Nations Office on Drugs and Crime (UNODC), in year 2010, about 5% of the population, which is approximately 230 million, consumed an illicit substance. Out of those people, 27 million suffered from a recurrent drug use that was harmful to their health and caused psychological and social problems. In 2015, disorders began to surface that resulted in 307,400 deaths, which was a huge increase from the toll of 165,000 recorded in 1990.  

Substance-Use Disorder

Number of Deaths in 2015

Alcohol

137,500

Opioid

122,100

Amphetamine

12,200

Cocaine

11,100

        Drug use results in many mental disorders. Experts have been able to put together 9 that they say come directly from the use of drugs. Here are a few examples:

        Behavior

        

        The addiction of drinking alcohol and consuming drugs does not only affect the health, but the behavior as well. The victim starts to feel paranoid of their surroundings, they become aggressive toward other people, start seeing hallucinations, have a cloudy judgement, and lose their self-control. They may not see it, but substance abuse does not only affect them, but also the people around them. Alcohol, for example, is the reason for the 10,265 car accidents that occurred in the year of 2015. Out of those people, 209 were children between the ages of 0 to 14. Every person connected to a drug or alcohol addict is at risk of being hurt, abused, or being caught in a life-threatening situation.

Approaches to the Issue

        Substance Abuse Prevention, which is also known as drug abuse prevention, are efforts that focus on treating an addict either individually or by the environment around them. There are programs made that are proven to be helpful, such as the family-based prevention programs, where the protective factors around young children are strengthened by teaching them better and appropriate ways to approach members of their families, which also includes parents paying attention to their children and providing them with rules and discipline, lecturing them every once in awhile about the dangers of substances such as alcohol and drugs, and monitoring their lives. This is particularly thought to be helpful by the National Institute on Drug Abuse in 2003. Methods such as this program are important because of researches done by Smit, Verdurmen, Monshouwer, and Smil, who are members of the PubMed Health Community, and have collected data on the popularity of alcohol and drugs in the Western societies. They found that 18% of young adults who are between the ages of 12-14 in the United States are binge drinking, or consuming a large amount of alcohol in a short amount of time. In 2006, 73% of teens in the United States within the ages of 16 are reported to have an addiction to alcohol. In Northern Europe, however, the tolls have reached 90%, according to the World Health Organization.

        There are also school-based prevention programs which aim to educate students about the harmfulness of substance abuse. There are now oriented classes in numerous amounts of schools that are based on the awareness of substance abuse that have began for grades even as low as preschool. This can help break early behaviors and prevent drug and alcohol addiction in the future as 40% of children have already tried alcohol by the age of 10. These programs even teach children how to refuse drugs, which is proven a better method than non-interactive ones. Their resistance skills are increased and so increasing the protective factors in the coming generations.

        Last but not least is the example of community prevention programs which are ones that work directly with law enforcement, religious, and many other governmental organizations to strengthen the prevention of drugs and alcohol abuse. These programs even help schools, work, media, and even religious institutions. They also include the development of policies, enforcing regulations, awareness programs around the area, and methods through media. There are several organizations and agencies that are dedicated to the issue of substance abuse, such as the National Institutes on Health (NIH) and National Institute on Drug Abuse (NIDA).

        Another helpful event was one made in 2011, when President Obama officially made October the month of National Substance Abuse Prevention Month and let it serve as a tribute to those working in the society who are preventing abuse in the communities and fighting to make the country free of narcotic drugs. There is also an event known as the Red Ribbon Week, in which millions of Americans participate in the on-going activities, according to the National Family Partnership (NFP), who are responsible as the Red Ribbon’s national organizer. It is described as, “the most far-reaching and well-known drug prevention event in America,” by the Drug Enforcement America. The event served as a united symbol of a community dedicating to stopping the abuse of alcohol, drugs, tobacco, etc. for the next generation and for the people around them.

        Though a lot of prevention seems to be done across the globe, the same cannot be said for the Less Economically Developed Countries (LEDCs). They lack the resources used by the MEDCs, such as sources of media, that would help spread awareness about the situation. An example for this would be Afghanistan, a country with a drug-dependent population. The two most famous drugs are opium and hashish, and even alcohol is heavily drunk as it has been introduced by the upperclass. Factors that may result to the prevention, and even cure of the drugs and alcohol addiction that have infected the population have been discussed, but not much have been done.

        Another LEDC, Sudan, has made better efforts at targeting the influence of drug abuse within their population. They have opened up a field of prevention of drug risks and even received help from the United Nations that supported it technically, logistically, and medically. The government of Sudan has made national efforts to fight the crime of drugs through establishing centers and creating laws against drug dealers.

Treatments

        Treating Drug Abuse

        Drug abuse is possible to treat, but it is not an easy procedure seeing as it is a chronic disease. Therefore, the treatment done would have to be long-term. It starts with detoxification, where the body first has to rid itself of the drug, then moving to behavioral counseling, certain types of medication for the drug that was used, evaluating and treating the health issues caused by the drugs including depression, and lastly, constant follow-ups on the patient to make sure he or she does not go back to consuming the dangerous substance. The medications used to cure opioids include methadone, buprenorphine, and naltrexone.

        Other than medications, an added method of treatment is therapy. Therapy helps patients display a proper attitude and behavior that has been changed during the time of drug use, increasing the skills to a healthy lifestyle, and continuing with different forms of treatment, like medications. There are many different kinds of therapy, such as cognitive-behavioral therapy, where patients are taught to deal with situations wherein they would most likely use drugs, and even multidimensional family therapy, which helps families with a history of drug-related problems and overall improves family functioning.

        According to the data provided by the National Survey on Drug Use and Health, around 22.5 million people in the ages of 12 or older needed to be treated for a drug or alcohol problem in 2014. Out of those people, it was only 4.2 million who received medication, and only 2.6 million received the proper specialty treatment programs.

        Treating Alcoholics

        When it comes to treating an alcoholic, the person will always benefit from the type of treatment no matter how bad the case is. There are treatments that include helping to develop the skills that are needed to first reduce drinking, then to later stop, then build a strong support system, setting a goal, and finally, learning to fight what may trigger a relapse. For alcoholic medications, three are known to be approved:

  1. Naltrexone  - blocks the receptors responsible for the craving of alcohol and reduces the possibility of relapse.
  2. Acamprosate - reduces symptoms while newly withdrawing from drinking, such as anxiety and insomnia.
  3. Disulfiram - helps to build the body and reacts unpleasantly when in contact with alcohol; designed to help patients who are dedicated to quit drinking.

        Like curing drug abuse, therapy is also helpful when it comes to alcohol. Cognitive-behavioral therapy and family counseling is also used. There is also motivational enhancement therapy, which is only for a short period of time with the purpose of strengthening the motivation to quit drinking. Brief interventions are also recommended, which are very similar to a support group and a counseling session. For both curing alcoholics and drug addictions, rehab centers are also a healthy option as the patient enters a facility where he or she will be cleansed of any of the addictive substance. According to the American Addiction Centers, patients who are able to complete their stay at a rehabilitation center are 90% to 100% cured of addiction.

Case Study: A Preliminary Study of the Effects of Patient Feedback in Outpatient Substance Abuse Treatment Programs by the National Institute on Drug Abuse

        Currently, there are many patients undergoing treatment in substance abuse clinics. This study was made to evaluate the feedback system in order to improve the outcome of treatment. The test used for the feedback is called the Outcome Questionnaire-45 (OQ-45) which was shown to have effective results in mental health clinics, but were not yet tested in substance abuse treatment clinics. It was designed by the University of Pennsylvania, New York University School of Medicine, and the Brigham Young University.

        A new version of OQ-45 was made for drug and alcohol use and was administered to patients within substance abuse clinics. Phase 1 of the test was only the administration of the assessment instruments. Phase 2 involved feedback reports to their counselors based on the test during every treatment session all the way to Session 12. Patients who did not appear to progress at the average rate were given a questionnaire for a second feedback to the counselors.

        The results of this study were promising. The feedback that belonged to the patients that were off-track were compared to those with no feedback and led to linear reductions for the use of alcohol throughout the whole treatment until Session 12, according to the OQ-45 scores. This suggested that the OQ-45 should be used on a larger scale.

Countries and Organizations Involved

        Iran

        Substance Mostly Used: Heroin, 14.3% Per Capita

        Even though Iran has a government that strictly prohibits the use of drugs, especially under the religion of Islam, the country has opioid abuse. Since it is located on the Persian Gulf, the shipment of Southwest Asian heroin passes through it on its way to European markets. Iran has one of the highest opiate addiction rates in the world and the numbers are far from declining. Their religion uses the death penalty for those with drug offenses, but since they do not have enough funding to fight against drugs, there is not much they can do to stop the issue. The United Nations has already offered a helping hand with a budget of $13 million and the border controls are stricter so it has become harder for people to smuggle drugs.

        United Kingdom

        Substance Mostly Used: Alcohol, 13.7% Per Capita

        In the United Kingdom, there are about 1.6 million people who are dependent on alcohol, and yet only 6.4% of them receive treatment. Alcohol is 40% more affordable in England than how it was in the 80s, and 53% of men and women in the country drink more than the recommended amount. They also happen to be major consumers of heroin and cocaine. There is said to be a drug control expenditure that supposedly costs $8.65 billion.

        France

        Substance Mostly Used:  Prescription Pills, 13.2% Per Capita

        Prescription drug prices in France are much cheaper than they are in the United States, which makes them easier for the French citizens to acquire. The three most popular drugs consumed are benzodiazepines, buprenorphine, and methadone. To prevent drug abuse, the estimated amount used to around $32.28 billion.

        Slovakia

        Substance Mostly Used: Inhalants, 13.01% Per Capita

        The inhalant used is known as Toluene, which can result in the death of its users  , especially when used for the first time. Slovakia is said to use 0.05% of its gross domestic product (GDP) for order and safety, prevention, treatments, education, and reduction of harm.

        Russia

        Substance Mostly Used: Alcohol, 7.1% Per Capita

        The main alcohol in the country happens to be a legal one known famously as Vodka. Men who do not reach the age of 55 are said to have died because of consuming too much of the drink. The Head of the Federal Drug Control Service, Viktor Ivanov, states that Russians spend a lot of money on illegal drugs as well, mainly heroin.

        Afghanistan

        Substance Mostly Used: Heroin, 6.9% Per Capita

        A million people in Afghanistan are said to be addicted to opioids and the country itself is the leading producer of poppy opium. Parents happen to be giving the drugs to their children and, according to CIA World Factbook, anti-government groups such as the Taliban benefit from this opiate trade, which is also how they get inside Afghanistan. This makes it harder for the government to make a safe policy for drug reform.

        Canada

        Substance Mostly Used: Marijuana, 6.4% Per Capita

        It is said that at least 44.3% of the population use marijuana at least once in their lifetimes. This, along with other illicit drugs in Canada totals to $3.5 billion. In order to tackle this issue, the Canadian Drug Policy Coalition recommended decriminalizing the use of marijuana, which was supposed to happen in 2017.

        United States of America

        Substance Mostly Used: Prescription Pills, 6.2% Per Capita

        Data shows that more than half of the citizens of America have used at least one painkiller during their lifetime. The National Institute on Drug Abuse states that around 50 million people in the United States used prescription drugs and over 47,000 people died from overdoses in 2014, 61% being opioid abuse. Nowadays, it is said that around 5,500 Americans misuse their pills and that the government will take strong action against this issue.

        National Institutes on Health (NIH)

        This is an organization that is a part of the US Department of Health and Human Services. In the areas of substance abuse and their treatments, their studies have helped in better understanding the nature of substance abuse and the ways it affects the body. They also work on treatments to result in a positive impact for healing those on the journey to recovery.

        National Institute on Drug Abuse (NIDA)

        This is one of the institutes that are under the NIH and is dedicated to the research on drug addiction more than any of the other organizations in the world. They focus on following trends in the areas of drug use, studying the variety of substances in the body, and creating new prevention methods and treatments.

        United Nations Office on Drugs and Crime (UNODC)

        The UNODC is a known leader for the fight against drugs and crime. It operates all around the world and relies on contributions from governments and volunteers for 90% of its work. The organization strives to increase the knowledge of drugs and crime so as to have better working results for policies and enforcements.

        

Possible Solutions

Bibliography

To prevent drug and excessive alcohol use: https://www.surgeongeneral.gov/priorities/prevention/strategy/preventing-drug-abuse-excessive-alcohol-use.html

Different types of substance abuse: http://www.highspeedtraining.co.uk/hub/types-substance-abuse/

Reasons for substance abuse:

http://alcoholrehab.com/drug-addiction/reasons-for-substance-abuse/

The effects of drug addiction:

http://recovergateway.org/substance-abuse-resources/drug-addiction-effects/

Mental disorders caused by addiction:

http://www.dualdiagnosis.org/mental-disorders-caused-addiction/

Afghanistan drug abuse:

https://www.ncbi.nlm.nih.gov/pubmed/1048930

Sudan drug abuse:

https://www.sudanvisiondaily.com/index.php/new-posts/local-news/3860-un-reaffirms-support-to-sudan-for-prevention-of-drug-risks?start=216

To approach drug addiction:

https://www.drugabuse.gov/publications/drugfacts/treatment-approaches-drug-addiction

Treatments:

https://pubs.niaaa.nih.gov/publications/treatment/treatment.htm

https://www.orlandorecovery.com/drug-addiction-treatment/substance-abuse-organizations/#gref

Drug-addicted countries:

https://www.blvdcenters.org/blog/top-8-drug-addicted-countries

Preventing drug abuse:

https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/preventing-drug-abuse-best-strategy

Statistics on substance abuse:

http://americanaddictioncenters.org/rehab-guide/success-rates-and-statistics/

Case study:

http://www.med.upenn.edu/cpr/sa_feedback.html