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Problems Faced by Children

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Hookah are a single or multi-stemmed (often glass-based) water pipe for smoking. Originally from India. The hookah was a symbol of pride and honour for the landlords, kings and other such high class people.

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Now,the hookah has gained immense popularity, especially in the Middle East. A hookah operates by water filtration and indirect heat. It can be used for smoking herbal fruits, tobacco, or cannabis. * Kretek Kretek are cigarettes made with a complex blend of tobacco, cloves and a flavoring “sauce”. It was first introduced in the 1880s in Kudus, Java, to deliver the medicinal eugenol of cloves to the lungs.

The quality and variety of tobacco play an important role in kretek production, from which kretek can contain more than 30 types of tobacco. Minced dried clove buds weighing about 1/3 of the tobacco blend are added to add flavoring. In 2004 the United States prohibited cigarettes from having a “characterizing flavor” of certain ingredients other than tobacco and menthol, thereby removing kretek from being classified as cigarettes. * Passive smoking Passive smoking is the usually involuntary consumption of smoked tobacco.

Second-hand smoke (SHS) is the consumption where the burning end is present, environmental tobacco smoke (ETS) or third-hand smoke is the consumption of the smoke that remains after the burning end has been extinguished. Because of its perceived negative implications, this form of consumption has played a central role in the regulation of tobacco products. * Pipe smoking Pipe smoking typically consists of a small chamber (the bowl) for the combustion of the tobacco to be smoked and a thin stem (shank) that ends in a mouthpiece (the bit).

Shredded pieces of tobacco are placed into the chamber and ignited. Tobaccos for smoking in pipes are often carefully treated and blended to achieve flavour nuances not available in other tobacco products. * Roll-Your-Own Roll-Your-Own or hand-rolled cigarettes, often called ‘rollies’, are very popular particularly in European countries. These are prepared from loose tobacco, cigarette papers, and filters all bought separately. They are usually much cheaper than ready-made cigarettes. * Vaporizer A vaporizer is a device used to sublimate the active ingredients of plant material.

Rather than burning the herb, which produces potentially irritating, toxic, or carcinogenic by-products; a vaporizer heats the material in a partial vacuum so that the active compounds contained in the plant boil off into a vapor. Medical administration of a smoke substance often prefer this method as to directly pyrolyzing the plant material. a) Physiology A graph that shows the efficiency of smoking as a way to absorb nicotine compared to other forms of intake. The active substances in tobacco, especially cigarettes, are administered by burning the leaves and inhaling the vaporised gas that results.

This quickly and effectively delivers substances into the bloodstream by absorption through the alveoli in the lungs. The lungs contain some 300 million alveoli, which amounts to a surface area of over 70 m2 (about the size of a tennis court). This method is not completely efficient as not all of the smoke will be inhaled, and some amount of the active substances will be lost in the process of combustion, pyrolysis. Pipe and Cigar smoke are not inhaled because of its high alkalinity, which are irritating to the trachea and lungs. However, because of its higher alkalinity (pH 8. ) compared to cigarette smoke (pH 5. 3), non-ionised nicotine is more readily absorbed through the mucous membranes in the mouth. Nicotine absorption from cigar and pipe, however, is much less than that from cigarette smoke. The inhaled substances trigger chemical reactions in nerve endings. The cholinergic receptors are often triggered by the naturally occurring neurotransmitter acetylcholine. Acetylcholine and Nicotine express chemical similarities, which allows Nicotine to trigger the receptor as well. These nicotinic acetylcholine receptors takes are located in the central nervous system and at the erve-muscle junction of skeletal muscles; whose activity increases heart rate, alertness, and faster reaction times. Nicotine acetylcholine stimulation is not directly addictive. However, since dopamine-releasing neurons are abundant on nicotine receptors, dopamine is released. This release of dopamine, which is associated with pleasure, is reinforcing and may also increase working memory. Nicotine and cocaine activate similar patterns of neurons, which supports the idea that common substrates among these drugs. When tobacco is smoked, most of the nicotine is pyrolyzed.

However, a dose sufficient to cause mild somatic dependency and mild to strong psychological dependency remains. There is also a formation of harmane (a MAO inhibitor) from the acetaldehyde in tobacco smoke. This may play a role in nicotine addiction, by facilitating a dopamine release in the nucleus accumbens as a response to nicotine stimuli. Using rat studies, withdrawal after repeated exposure to nicotine results in less responsive nucleus accumbens cells, which produce dopamine responsible for reinforcement. b) Demographics As of 2000, smoking was practised by around 1. 2 billion people. At current rates of ‘smoker replacement’ and market growth, this may reach around 1. 9 billion in 2025. Smoking may be up to five times more prevalent amongst men than women in some communities, although the gender gap usually declines with younger age. In some developed countries smoking rates for men have peaked and begun to decline, while for women they continue to climb. As of 2002, about twenty percent of young teenagers (13–15) smoked worldwide. From which 80,000 to 100,000 children begin smoking every day, roughly half of whom live in Asia.

Half of those who begin smoking in adolescent years are projected to go on to smoke for 15 to 20 years. The World Health Organization (WHO) states that “Much of the disease burden and premature mortality attributable to tobacco use disproportionately affect the poor”. Of the 1. 22 billion smokers, 1 billion of them live in developing or transitional economies. Rates of smoking have leveled off or declined in the developed world. In the developing world, however, tobacco consumption is rising by 3. 4% per year as of 2002. The WHO in 2004 projected 58. million deaths to occur globally, from which 5. 4 million are tobacco-attributed, and 4. 9 million as of 2007. As of 2002, 70% of the deaths are in developing countries. i. Psychology a) Takeup Sigmund Freud, whose doctor assisted his suicide because of oral cancer caused by smoking Most smokers begin during adolescence or early adulthood. Smoking has elements of risk-taking and rebellion, which often appeal to young people. The presence of peers that smoke and media featuring high-status models smoking may also encourage smoking.

Because teenagers are influenced more by their peers than by adults, attempts by parents, schools, and health professionals at preventing people from trying cigarettes are unsuccessful. Children of smoking parents are more likely to smoke than children with non-smoking parents. One study found that parental smoking cessation was associated with less adolescent smoking, except when the other parent currently smoked. A current study tested the relation of adolescent smoking to rules regulating where adults are allowed to smoke in the home.

Results showed that restrictive home smoking policies were associated with lower likelihood of trying smoking for both middle and high school students. Behavioural research generally indicates that teenagers begin their smoking habits due to peer pressure, and cultural influence portrayed by friends. However, one study found that direct pressure to smoke cigarettes played a less significant part in adolescent smoking, with adolescents also reporting low levels of both normative and direct pressure to smoke cigarettes.

A similar study suggested that individuals may play a more active role in starting to smoke than has previously been thought and that social processes other than peer pressure also need to be taken into account. Another study’s results indicated that peer pressure was significantly associated with smoking behaviour across all age and gender cohorts, but that intrapersonal factors were significantly more important to the smoking behaviour of 12–13 year-old girls than same-age boys.

Within the 14–15 year-old age group, one peer pressure variable emerged as a significantly more important predictor of girls’ than boys’ smoking. It is debated whether peer pressure or self-selection is a greater cause of adolescent smoking. Psychologists such as Hans Eysenck have developed a personality profile for the typical smoker. Extraversion is the trait that is most associated with smoking, and smokers tend to be sociable, impulsive, risk taking, and excitement seeking individuals. Although personality and social factors may make people likely to smoke, the actual habit is a function of operant conditioning.

During the early stages, smoking provides pleasurable sensations (because of its action on the dopamine system) and thus serves as a source of positive reinforcement. b) Persistence The reasons given by some smokers for this activity have been categorised as addictive smoking, pleasure from smoking, tension reduction/relaxation, social smoking, stimulation, habit/automatism, and handling. There are gender differences in how much each of these reasons contribute, with females more likely than males to cite tension reduction/relaxation, stimulation and social smoking.

Some smokers argue that the depressant effect of smoking allows them to calm their nerves, often allowing for increased concentration. However, according to the Imperial College London, “Nicotine seems to provide both a stimulant and a depressant effect, and it is likely that the effect it has at any time is determined by the mood of the user, the environment and the circumstances of use. Studies have suggested that low doses have a depressant effect, while higher doses have stimulant effect. ” c) Patterns

A number of studies have established that cigarette sales and smoking follow distinct time-related patterns. For example, cigarette sales in the United States of America have been shown to follow a strongly seasonal pattern, with the high months being the months of summer, and the low months being the winter months. Similarly, smoking has been shown to follow distinct circadian patterns during the waking day—with the high point usually occurring shortly after waking in the morning, and shortly before going to sleep at night. ii. Impact a) Economic

In countries where there is a publicly-funded healthcare system, society covers the cost of medical care for smokers who become ill through in the form of increased taxes. Two broad debating positions exist on this front, the “pro-smoking” argument suggesting that heavy smokers generally don’t live long enough to develop the costly and chronic illnesses which affect the elderly, reducing society’s healthcare burden, and the “anti-smoking” argument suggests that the healthcare burden is increased because smokers get chronic illnesses younger and at a higher rate than the general population.

Data on both positions has been contested. The Centers for Disease Control and Prevention published research in 2002 claiming that the cost of each pack of cigarettes sold in the United States was more than $7 in medical care and lost productivity. The cost may be higher, with another study putting it as high as $41 per pack, most of which however is on the individual and his/her family.

This is how one author of that study puts it when he explains the very low cost for others: “The reason the number is low is that for private pensions, Social Security, and Medicare — the biggest factors in calculating costs to society — smoking actually saves money. Smokers die at a younger age and don’t draw on the funds they’ve paid into those systems. ” By contrast, some non-scientific studies, including one conducted by Philip Morris in the Czech Republic and another by the Cato Institute, support the opposite position.

Philip Morris has explicitly apologised for the former study, saying: “The funding and public release of this study which, among other things, detailed purported cost savings to the Czech Republic due to premature deaths of smokers, exhibited terrible judgment as well as a complete and unacceptable disregard of basic human values. For one of our tobacco companies to commission this study was not just a terrible mistake, it was wrong. All of us at Philip Morris, no matter where we work, are extremely sorry for this.

No one benefits from the very real, serious and significant diseases caused by smoking. ” Between 1970 an 1995, per-capita cigarette consumption in poorer developing countries increased by 67 percent, while it dropped by 10 percent in the richer developed world. Eighty percent of smokers now live in less developed countries. By 2030, the World Health Organization (WHO) forecasts that 10 million people a year will die of smoking-related illness, making it the single biggest cause of death worldwide, with the largest increase to be among women.

WHO forecasts the 21st century’s death rate from smoking to be ten times the 20th century’s rate. (“Washingtonian” magazine, December 2007). b) Health Tobacco use leads most commonly to diseases affecting the heart and lungs, with smoking being a major risk factor for heart attacks, strokes, chronic obstructive pulmonary disease (COPD), emphysema, and cancer (particularly lung cancer, cancers of the larynx and mouth, and pancreatic cancer). Cigarette smoking increases the risk of Crohn’s disease as well as the severity of the course of the disease.

It is also the number one cause of bladder cancer. Lung Cancer The World Health Organization estimate that tobacco caused 5. 4 million deaths in 2004 and 100 million deaths over the course of the 20th century. Similarly, the United States Centers for Disease Control and Prevention describes tobacco use as “the single most important preventable risk to human health in developed countries and an important cause of premature death worldwide. ” Lung cancer occurs at non-smokers in 3. 4 cases per 100 000 population. At people smoking 0. packs of cigarettes a day this figure rises to 51. 4 per 100 000, 1-2 packs – up to 143. 9 per 100 000 and if the intensity of smoking is over 2 packs a day – up to 217. 3 per 100,000 population. Rates of smoking have leveled off or declined in the developed world. Smoking rates in the United States have dropped by half from 1965 to 2006 falling from 42% to 20. 8% in adults. In the developing world, tobacco consumption is rising by 3. 4% per year. Passive smoking presents a very real health risk. Six hundred thousand deaths were attributable to second-hand smoke in 2004. c) Social

Famous smokers of the past used cigarettes or pipes as part of their image, such as Jean Paul Sartre’s Gauloises-brand cigarettes; Albert Einstein’s, Douglas MacArthur’s, Bertrand Russell’s, and Bing Crosby’s pipes; or the news broadcaster Edward R. Murrow’s cigarette. Writers in particular seem to be known for smoking, for example, Cornell Professor Richard Klein’s book Cigarettes are Sublime for the analysis, by this professor of French literature, of the role smoking plays in 19th and 20th century letters. The popular author Kurt Vonnegut addressed his addiction to cigarettes within his novels.

British Prime Minister Harold Wilson was well known for smoking a pipe in public as was Winston Churchill for his cigars. Sherlock Holmes, the fictional detective created by Sir Arthur Conan Doyle smoked a pipe, cigarettes, and cigars. The DC Vertigo comic book character, John Constantine, created by Alan Moore, is synonymous with smoking, so much so that the first storyline by Preacher creator, Garth Ennis, centered around John Constantine contracting lung cancer. Professional wrestler James Fullington, while in character as “The Sandman, is a chronic smoker in order to appear “tough”.

The problem of smoking at home is particularly difficult for women in many cultures especially Arab cultures where it may not be acceptable for a woman to ask her husband not to smoke at home or in the presence of her children. Studies has shown that pollution levels in door places are higher than levels found on busy roadways, in closed motor garages, and during fire storms. Furthermore, smoke can spread from one room to another, even if doors to the smoking area are closed. The ceremonial smoking of tobacco, and praying with a sacred pipe, is a prominent part of the religious ceremonies of a number of Native American Nations.

Sema, the Anishinaabe word for tobacco, is grown for ceremonial use and considered the ultimate sacred plant since its smoke was believed to carry prayers to the heavens. In most major religions, however, tobacco smoking is not specifically prohibited, although it may be discouraged as an immoral habit. Before the health risks of smoking were identified through controlled study, smoking was considered an immoral habit by certain Christian preachers and social reformers. The founder of the Latter Day Saint movement, Joseph Smith, Jr, recorded that on February 27, 1833, he received a revelation which discouraged tobacco use.

This “Word of Wisdom” was later accepted as a commandment, and faithful Latter-day Saints abstain completely from tobacco. Jehovah’s Witnesses base their stand against smoking on the Bible’s command to “clean ourselves of every defilement of flesh” (2 Corinthians 7:1). The Jewish Rabbi Yisrael Meir Kagan (1838–1933) was one of the first Jewish authorities to speak out on smoking. In the Baha’i Faith, smoking tobacco is discouraged though not forbidden. iii. Public policy On February 27, 2005 the WHO Framework Convention on Tobacco Control, took effect.

The FCTC is the world’s first public health treaty. Countries that sign on as parties agree to a set of common goals, minimum standards for tobacco control policy, and to cooperate in dealing with cross-border challenges such as cigarette smuggling. Currently the WHO declares that 4 billion people will be covered by the treaty, which includes 168 signatories. Among other steps, signatories are to put together legislation that will eliminate secondhand smoke in indoor workplaces, public transport, indoor public places and, as appropriate, other public places. a) Taxation

Many governments have introduced excise taxes on cigarettes in order to reduce the consumption of cigarettes. In 2002, the Centers for Disease Control and Prevention said that each pack of cigarettes sold in the United States costs the nation more than $7 in medical care and lost productivity, around $3400 per year per smoker. Another study by a team of health economists finds the combined price paid by their families and society is about $41 per pack of cigarettes. Substantial scientific evidence shows that higher cigarette prices result in lower overall cigarette consumption.

Most studies indicate that a 10% increase in price will reduce overall cigarette consumption by 3% to 5%. Youth, minorities, and low-income smokers are two to three times more likely to quit or smoke less than other smokers in response to price increases. Smoking is often cited as an example of an inelastic good, however, i. e. a large rise in price will only result in a small decrease in consumption. Many nations have implemented some form of tobacco taxation. As of 1997, Denmark had the highest cigarette tax burden of $4. 2 per pack. Taiwan only had a tax burden of $0. 62 per pack. The federal government of the United States charges $1. 01 per pack. Cigarette taxes vary widely from state to state in the United States. For example, Missouri has a cigarette tax of only 17 cents per pack, the nation’s lowest, while New York has the highest cigarette tax in the U. S. : $4. 35 per pack. In Alabama, Illinois, Missouri, New York City, Tennessee, and Virginia, counties and cities may impose an additional limited tax on the price of cigarettes.

Sales taxes are also levied on tobacco products in most jurisdictions. In the United Kingdom, a packet of 20 cigarettes typically costs between ? 5. 22 and ? 8. 00 depending on the brand purchased and where the purchase was made. The UK has a significant black market for tobacco, and it has been estimated by the tobacco industry that 27% of cigarette and 68% of handrolling tobacco consumption is non-UK duty paid (NUKDP). In Australia total taxes account for 62. 5% of the final price of a packet of cigarettes (2011 figures).

These taxes include federal excise or customs duty, and the more recently introduced Goods and Services Tax (GST). b) Restrictions An enclosed smoking area In June 1967, the US Federal Communications Commission ruled that programmes broadcast on a television station which discussed smoking and health were insufficient to offset the effects of paid advertisements that were broadcast for five to ten minutes each day. In April 1970, the US Congress passed the Public Health Cigarette Smoking Act banning the advertising of cigarettes on television and radio starting on January 2, 1971.

The Tobacco Advertising Prohibition Act 1992 expressly prohibited almost all forms of Tobacco advertising in Australia, including the sponsorship of sporting or other cultural events by cigarette brands. All tobacco advertising and sponsorship on television has been banned within the European Union since 1991 under the Television Without Frontiers Directive (1989). This ban was extended by the Tobacco Advertising Directive, which took effect in July 2005 to cover other forms of media such as the internet, print media, and radio.

The directive does not include advertising in cinemas and on billboards or using merchandising – or tobacco sponsorship of cultural and sporting events which are purely local, with participants coming from only one Member State as these fall outside the jurisdiction of the European Commission. However, most member states have transposed the directive with national laws that are wider in scope than the directive and cover local advertising. A 2008 European Commission report concluded that the directive had been successfully transposed into national law in all EU member states, and that these laws were well implemented.

Some countries also impose legal requirements on the packaging of tobacco products. For example in the countries of the European Union, Turkey, Australia and South Africa, cigarette packs must be prominently labeled with the health risks associated with smoking. Canada, Australia, Thailand, Iceland and Brazil have also imposed labels upon cigarette packs warning smokers of the effects, and they include graphic images of the potential health effects of smoking. Cards are also inserted into cigarette packs in Canada. There are sixteen of them, and only one comes in a pack. They explain different methods of quitting smoking.

Also, in the United Kingdom, there have been a number of graphic NHS advertisements, one showing a cigarette filled with fatty deposits, as if the cigarette is symbolising the artery of a smoker. Many countries have a smoking age, In many countries, including the United States, most European Union member states, New Zealand, Canada, South Africa, Israel, India, Brazil, Chile, Costa Rica and Australia, it is illegal to sell tobacco products to minors and in the Netherlands, Austria, Belgium, Denmark and South Africa it is illegal to sell tobacco products to people under the age of 16.

On September 1, 2007 the minimum age to buy tobacco products in Germany rose from 16 to 18, as well as in the United Kingdom where on October 1, 2007 it rose from 16 to 18. Underlying such laws is the belief that people should make an informed decision regarding the risks of tobacco use. These laws have a lax enforcement in some nations and states. In China, Turkey, and many other countries usually a child will have little problem buying tobacco products, because they are often told to go to the store to buy tobacco for their parents.

Several countries such as Ireland, Latvia, Estonia, the Netherlands, France, Finland, Norway, Canada, Australia, Sweden, Portugal, Singapore, Italy, Indonesia, India, Lithuania, Chile, Spain, Iceland, United Kingdom, Slovenia, Turkey and Malta have legislated against smoking in public places, often including bars and restaurants. Restaurateurs have been permitted in some jurisdictions to build designated smoking areas (or to prohibit smoking). In the United States, many states prohibit smoking in restaurants, and some also prohibit smoking in bars.

In provinces of Canada, smoking is illegal in indoor workplaces and public places, including bars and restaurants. As of March 31, 2008 Canada has introduced a smoke-free law ban in all public places, as well as within 10 metres of an entrance to any public place. In Australia, smoke-free laws vary from state to state. Currently, Queensland has completely smoke-free indoor public places (including workplaces, bars, pubs and eateries) as well as patrolled beaches and some outdoor public areas. There are, however, exceptions for designated smoking areas.

In Victoria, smoking is restricted in railway stations, bus stops and tram stops as these are public locations where second-hand smoke can affect non-smokers waiting for public transport, and since July 1, 2007 is now extended to all indoor public places. In New Zealand and Brazil, smoking is restricted in enclosed public places including bars, restaurants and pubs. Hong Kong restricted smoking on January 1, 2007 in the workplace, public spaces such as restaurants, karaoke rooms, buildings, and public parks (bars which do not admit minors were exempt until 2009).

In Romania smoking is illegal in trains, metro stations, public institutions (except where designated, usually outside) and public transport. c) Ignition safety An indirect public health problem posed by cigarettes is that of accidental fires, usually linked with consumption of alcohol. Numerous cigarette designs have been proposed, some by tobacco companies themselves, which would extinguish a cigarette left unattended for more than a minute or two, thereby reducing the risk of fire. Among American tobacco companies, some have resisted this idea, while others have embraced it.

RJ Reynolds was a leader in making prototypes of these cigarettes in 1983 and will make all of their U. S. market cigarettes to be fire-safe by 2010. Phillip Morris is not in active support of it. Lorillard, the US’s third largest tobacco company, seems to be ambivalent. iv. Gateway drug theory The relationship between tobacco and other drug use has been well-established, however the nature of this association remains unclear. The two main theories are the phenotypic causation (gateway) model and the correlated liabilities model.

The causation model argues that smoking is a primary influence on future drug use, while the correlated liabilities model argues that smoking and other drug use are predicated on genetic or environmental factors. v. Cessation Smoking cessation, referred to as “quitting” is the action leading towards abstinence of tobacco smoking. There are a number of methods such as cold turkey, nicotine replacement therapy, antidepressants, hypnosis, self-help, and support groups. I. Alcohol Alcohol abuse, as described in the DSM-IV, is a psychiatric diagnosis describing the recurring use of alcoholic beverages despite negative consequences.

Alcohol abuse is sometimes referred to by the less specific term alcoholism. However, many definitions of alcoholism exist, and only some are compatible with alcohol abuse. Binge drinking is another form of alcohol abuse. Frequent binge drinking or getting severely drunk more than twice is classed as alcohol misuse. Experimentation with alcohol and drugs during adolescence is common. Unfortunately, teenagers often don’t see the link between their actions today and the consequences tomorrow. They also have a tendency to feel indestructible and immune to the problems that others experience.

Using alcohol and tobacco at a young age has negative health effects. While some teens will experiment and stop, or continue to use occasionally, without significant problems. Others will develop a dependency, moving on to more dangerous drugs and causing significant harm to themselves and possibly others. It is difficult to know which teens will experiment and stop and which will develop serious problems. Teenagers at risk for developing serious alcohol and drug problems include those: * with a family history of substance abuse * who are depressed * who have low self-esteem, and who feel like they don’t fit in or are out of the mainstream There’s no question that drinking is a problem in most high schools. Alcohol is our most pervasive drug. Teens have access to it at parties, can obtain it from older friends who are of legal age to buy it, or may simply raid their parents’ liquor cabinets. Moreover, unlike drug use, the moderate use of alcohol is considered perfectly acceptable in most adult social circles. Teens see their parents enjoying a cocktail after work or having a glass of wine at dinner. Drinking comes to represent a very sophisticated and adult thing to do mom and Dad do it… hy shouldn’t I? the teen may reason. Parental acceptance of moderate to heavy use, however, may send the message that alcohol use has little inherent danger. All alcohol use by teens should be regarded as dangerous, not only because of the risk of alcoholism but because teen drinkers put themselves in harm’s way. Each year more that 10,000 young people in the United States are killed and 40,000 injured in alcohol-related automobile accidents. To some college students, heavy drinking that leads to vomiting is not alcohol abuse but simply having a good time and being “one of the gang. To many whose religion requires abstinence, simply tasting an alcohol beverage is not only alcohol abuse but a sin. To many activists, a married couple quietly enjoying a drink with their dinner is guilty of abusing alcohol if they happen to be twenty years of age. To the National Highway Traffic Safety Administration, an accident is alcohol related (and implicitly caused by alcohol abuse) if a driver who has consumed a drink is sitting at a red light and rear-ended by an inattentive teetotaler. i. Definitions

Alcohol abuse is a pattern of drinking that results in harm to one’s health, interpersonal relationships, or ability to work. According to Gelder, Mayou ; Geddes (2005) alcohol abuse is linked with suicide. They state the risk of suicide is high in older men who have a history of drinking, also if a person is suffering from depression. Certain manifestations of alcohol abuse include failure to fulfill responsibilities at work, school or home; drinking in dangerous situations, such as while driving; legal problems associated with alcohol use; and continued drinking despite problems that are caused or worsened by drinking.

Alcohol abuse can lead to alcohol dependence. Alcohol abuse has both short-term and long-term risks. If a person has driven while drunk or regularly binge drinks (more than 5 standard drinks in one drinking session), they are considered to have been involved in alcohol abuse. Short-term abuses of alcohol include, but are not limited to, violence, injuries, unprotected sexual activities and additionally social and financial problems. Binge Drinking In the USA, binge drinking is defined as consuming more than 5 drinks in men and 4 drinks in women.

It increases chances for vandalism, fights, injuries, drunk driving, trouble with police, and negative health, social, economic, or legal consequences to occur. Binge drinking is also associated with neurocognitive deficits of frontal lobe processing and impaired working memory as well as delayed auditory and verbal memory deficits. Binge drinking combined with the stress of returning to work is a contributing factor to Monday deaths from heart attacks. ii. Symptoms ; Signs Symptoms are the defining characteristic of alcohol abuse and are reviewed above in Definitions.

Patient will often complain of difficulty with interpersonal relationships, problems at work or school, and legal problems. Additionally patients do complain of irritability and insomnia. Signs of alcohol abuse are related to alcohol’s effects on organ systems. However, while these findings are often present, they are not necessary to make a diagnosis of alcohol abuse. Signs of alcohol’s effects on the central nervous system acutely include inebriation and poor judgment; chronic anxiety, irritability, and insomnia often feature.

Alcohol’s effects on the liver include elevated liver function tests (classically AST is at least twice as high as ALT). Prolonged use leads to cirrhosis and failure of the liver. With cirrhosis patients develop an inability to process hormones and toxins. The skin of a patient with alcoholic cirrhosis can feature cherry angiomas, palmar erythema and – in fulminent liver failure – jaundice and ascities. The derrangements of the endocrine system lead to gynecomastia. Inability to process toxins leads to hepatic encephalopathy.

Binge drinking is associated with individuals reporting fair to poor health compared to non-binge drinking individuals and which may progressively worsen over time. Binge drinking is associated with alcohol poisoning, unintentional injuries, suicide, hypertension, pancreatitis, sexually transmitted diseases, and meningitis, among other disorders. Other negative consequences include social costs (including interpersonal violence), drunk driving, and lost economic productivity. Impairments in neurophysiological and neurocognitive function can result from binge drinking.

A substantial proportion of alcohol-related deaths are due to binge drinking. Children aged 16 and under who consume alcohol heavily display symptoms of conduct disorder. It’s symptoms include troublesome behaviour in school, constantly lying, learning disabilities and social impairments. iii. Causes Peer pressure influences individuals to abuse alcohol; however most of the influence of peers is due to inaccurate perceptions of the risks of alcohol abuse. According to Gelder, Mayou and Geddes (2005) easy accessibility of alcohol is one of the reasons people engage in alcohol abuse as this substance is easily obtained in shops. v. Prevention Preventing or reducing the harm has been called for via increased taxation of alcohol, stricter regulation of alcohol advertising and the provision of brief Interventions. Brief Interventions for alcohol abuse reduce the incidence of unsafe sex, sexual violence, unplanned pregnancy and, likely, STD transmission. Information and education on social norms and the harms associated with alcohol abuse delivered either via the internet or face to face has been found to result in a decrease in harmful drinking behaviours in young people. v. Epidemiology

Alcohol abuse is said to be most common in people aged between 15 and 24 years: however this particular study of 7275 college students in England collected no data about other age groups or other countries. Societal and economic costs Alcohol abuse is associated with many accidents, fights, driving offenses and unprotected sex. Alcohol is responsible in the world for 1. 8 million deaths and results in disability in approximately 58. 3 million people. Approximately 40 percent of the 58. 3 million people disabled through alcohol abuse are disabled due to alcohol related neuropsychiatric disorders.

In South Africa, where HIV infection is epidemic, alcohol abusers exposed themselves to double the risk of this infection. Additionally, alcohol abuse increases the risk of individuals either being the victim of sexual violence or perpetrating sexual violence. Alcohol misuse costs the National Health Service (UK) 3 billion pounds sterling per year and the cost to employers is 6. 4 billion pounds sterling per year. These figures do not include the crime and social problems associated with alcohol misuse. The number of women regularly drinking alcohol has almost caught up with men. i. Prognosis Alcohol abuse during adolescence, especially early adolescence (i. e. before age 15), may lead to long-term changes in the brain which leaves them at increased risk of alcoholism in later years; genetic factors also influence age of onset of alcohol abuse and risk of alcoholism. For example, about 40 percent of those who begin drinking alcohol before age 15 develop alcohol dependence in later life, whereas only 10 percent of those who did not begin drinking until 20 years or older developed an alcohol problem in later life.

It is not entirely clear whether this association is causal, and some researchers have been known to disagree with this view. College/university students who are heavy binge drinkers (3 or more times in the past 2 weeks) are 19 times more likely to be diagnosed with alcohol dependence, and 13 times more likely to be diagnosed with alcohol abuse compared to non-heavy episodic drinkers, though the direction of causality remains unclear. Occasional binge drinkers (one or two times in past 2 weeks), were found to be 4 times more likely to be diagnosed with alcohol abuse or dependence compared to non-heavy episodic drinkers. vii.

Alcopops The introduction of alcopops, which are flavoured alcoholic drinks which have a sweet and pleasant taste was responsible in Sweden for half of the increase in alcohol abuse in 15-16 year olds in a survey. In the case of girls the alcopops, which disguise the taste of alcohol, were responsible for two thirds of the increase. The introduction of alcopops to Sweden was a result of Sweden joining the European Union and adopting the entire European Union law. Alcohol abuse is highly associated with adolescent suicide. Adolescents who abuse alcohol are 17 times more likely to commit suicide than adolescents who don’t drink. iii. Association with violence Alcohol abuse is significantly associated with suicide and violence. Alcohol is the most significant health concern in Native American communities because of very high rates of alcohol dependence and abuse; up to 80 percent of suicides and 60 percent of violent acts are a result of alcohol abuse in Native American communities. The overuse of alcohol has led to 16% of intoxicated people that have abused children. Abusing children can also come in the form of verbal abuse while under the influence, as well as physical abuse.

Alcohol can impair one’s judgment and make emotions more easily emphasized, such as anger towards a minor topic, which can cause them to become extremely dangerous. ix. Warning signs Warning signs of teenage alcohol and drug abuse may include: Physical: Fatigue, repeated health complaints, red and glazed eyes, and a lasting cough. Emotional: personality change, sudden mood changes, irritability, irresponsible behavior, low self-esteem, poor judgment, depression, and a general lack of interest. Family: starting arguments, breaking rules, or withdrawing from the family.

School: decreased interest, negative attitude, drop in grades, many absences, truancy, and discipline problems. Social problems: new friends who are less interested in standard home and school activities, problems with the law, and changes to less conventional styles in dress and music. Some of the warning signs listed above can also be signs of other problems. Parents may recognize signs of trouble and possible abuse of alcohol and other drugs with their teenager. If you have concerns you may want to consult a physician to rule out physical causes of the warning signs.

This should often be followed or accompanied by a comprehensive evaluation by a child and adolescent psychiatrist or mental health professional. x. In American Society Our historical background and multi cultural population have created wide and strong disagreements in American society over what constitutes alcohol abuse. * Our Colonial tradition taught us that alcohol is the “good gift of God” to be used and enjoyed by all, including small children. * Our temperance and Prohibition experiences taught us that alcohol is “demon rum,” the cause of almost all poverty, crime, violence, and other problems. So convinced were they that alcohol was the cause of virtually all crime that, on the eve of Prohibition, some towns went so far as to sell their jails. Temperance systematically promoted both fear and hostility toward alcohol beverages, much of which continues to this day. * Repeal of Prohibition left us with a society in which the majority of people enjoy alcohol beverage in moderation, but a large minority (today about 1/3) of the population abstains. And a substantial proportion of American abstainers favor imposing prohibition again on the entire population.

The prohibition impulse has never died and has re-emerged in a different form today. * Alcohol policy actually results not from science, logic, or evidence, but from a continuing struggle between those who wish to use alcohol beverages and those who don’t want them to. Repeatedly throughout our national life, movements have emerged to promote abstinence by persuasion, but failing to succeed, they have then resorted to coercion. The current neo-prohibition movement attempts to reduce consumption in general and to prevent it entirely among targeted groups, such as those under the age of 21. i. Young People Prohibition for those under the age of 21 currently enjoys wide support in the United States and is imposed by force of law. Often it is enforced with a vengeance. “Carter Loar, a senior at Park View High School in Loudoun County, Virginia was suspended for ten days in February for violating the school’s alcohol policy. ” Carter’s violation was using mouthwash at school. School officials confiscated the contraband and “He was charged with violating the school’s alcohol policy which prohibits the possession or use of alcohol on school property.

As part of his ten day suspension, Carter was required to attend a three day Substance Abuse Program sponsored by Loudoun County. ” Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Mr. Loar was a victim of “zero tolerance,” which is now all the rage. But what does such a zealous level of intolerance accomplish and what messages does it send our young people? It probably achieves about as much as the scare tactics characteristic of the temperance movement and is almost certainly counter-productive.

One apparent message is that those who promote such intolerance have lost touch with youth, another is that they are unrealistic and impractical, and another is that their alcohol education messages are naive. xii. Youthful Drinking While a continuing barrage of newspaper articles, TV shows, and special interest group reports claim that drinking among young people is a growing epidemic, the fact is quite the contrary. Drinking among young people, like drinking among the larger population, is actually on the decline. Drinking among young people continues to drop.

For example, the proportion of young people aged 12 through 17 who have consumed any alcohol during the previous month has plummeted from 50% in 1979 to 16% in 2006, according to the federal government’s annual National Survey on Drug Use and Health. Thus, while one in two were drinkers in 1979, significantly fewer than one in five were in 2006, the most recent year for which statistics are available. College student drinking attracts much attention in the press. But the proportion of college freshmen who drink continues to decrease.

Freshmen entering college in 2006 reported the lowest rates of drinking in the 41-year history of the national college Freshman Survey. The proportion reporting occasional or frequent beer drinking dropped to an historic low, down 43% since 1982. xii. Drunk Driving Fatalities While we must do even more to reduce drunk driving, we have already accomplished a great deal. Alcohol-related traffic fatalities have dropped steadily. * The U. S. has a low traffic fatality rate (drunk, as well as sober) and is a very safe nation in which to drive. And it’s been getting safer for decades.

There are now fewer than one and a half deaths (including the deaths of bicyclists, motorcyclists, pedestrians, auto drivers, and auto passengers) per one hundred million vehicle miles traveled. Alcohol-related traffic fatalities have dropped from 60% of all traffic deaths in 1982 down to 39% in 2005 (the most recent year for which such statistics are available). * Alcohol-related traffic fatalities per vehicle miles driven has also dropped dramatically — from 1. 64 deaths per 100 million miles traveled in 1982 down to 0. 56 in 2005 (the latest year for which such statistics are available). The proportion of alcohol-related crash fatalities has fallen 35% since 1982, but the proportion of traffic deaths NOT associated with alcohol have jumped 53% during the same time. We’re winning the battle against alcohol-related traffic fatalities, but losing the fight against traffic deaths that are not alcohol-related. The declining proportion of accidents involving intoxication is good news. However, we can do even more to reduce drunk driving deaths. Through our individual actions we can do much right now to protect ourselves and others. xiii.

Health Problems While the moderate consumption of alcohol is associated with better health and longer life than is abstinence, the heavy consumption of alcohol, especially over a period of many years, can lead to serious health problems and even death. Fetal Alcohol Syndrome Fetal Alcohol Syndrome (FAS) is an irreversible condition associated with excessive consumption of alcohol by pregnant women and is, therefore, completely preventable. Each and every case of FAS is a needless tragedy. Victims suffer serious physical deformities and often mental deficiencies.

And, they suffer these problems for their entire lives. While most cases occur among alcoholics who consume alcohol heavily throughout their pregnancies (usually in combination with smoking and often illegal drug use), no one knows for certain what level of alcohol consumption is safe for a pregnant woman. The Royal College of Obstetricians and Gynaecologists recently conducted a study including 400,000 American women, all of whom had consumed alcohol during pregnancy. Not a single case of FAS occurred and no adverse effects on children were found when consumption was under 8. drinks per week. While it would appear that moderate consumption is safe, the safer choice would be to abstain. Of course, tobacco and illegal drugs are clearly to be avoided, and a pregnant woman should maintain good nutrition and see her physician on a regular basis throughout her pregnancy. xiv. Help The Saint Jude Thaddeus Program is the most effective approach to alcohol abuse and alcoholism, with a very high independently-verified success rate. Moderation Management stresses balance, moderation, self-management, and personal responsibility to eliminate alcohol abuse.

Drink Wise is a brief, confidential educational program for people with mild to moderate alcohol problems who want to eliminate the negative consequences of their drinking. Habit Smart promotes the reduction of harmful behaviors and harm through habit change and wise choices. Alcoholics Anonymous (AA) is the oldest and best-known “twelve-step” program of self-help for alcoholics who wish to abstain from drinking alcohol. Founded in 1935 and based on a religious movement of the time, members are expected to follow the Twelve Steps of Alcoholics Anonymous.

Al-anon seeks to help families and friends of alcoholics recover from the effects of living with alcohol abuse. Alateen is the recovery program for young people sponsored by Al-anon members. Both Al-anon and Alateen are adapted from Alcoholics Anonymous and are based on the Twelve Steps. Rational Recovery is an alternative to the spiritual nature of AA as well as its view that alcoholics are powerless and must submit to God’s will in order to recover. Rational Recovery stresses the innate power and strength of individuals themselves to overcome obstacles such as alcohol abuse.

It rejects the AA belief that “once an alcoholic, always an alcoholic. ” Rational Recovery teaches people how to become independent of both alcohol addiction and of organizations dealing with alcohol abuse. Secular Organizations for Sobriety (SOS), also known as Save Our Selves, stresses the need to place the highest priority on sobriety and uses mutual support to assist members in achieving this goal. The Suggested Guidelines for Sobriety emphasize rational decision-making and are not religious or spiritual in nature.

Self-Management and Recovery Training (SMART Recovery) views alcohol dependence as a bad habit and attempts to use common sense techniques to break the habit. Women for Sobriety mutual support groups work to enhance the self-esteem of members. Women for Sobriety groups are non-religious and the meetings also differ from those of AA in that they prohibit the use of tobacco, caffeine and sugar. II. Drug Substance abuse, also known as drug abuse, refers to a maladaptive pattern of use of a substance (drug) that is not considered dependent.

Substance abuse/drug abuse does is not limited to mood-altering or psycho-active drugs. Activity is also considered substance abuse when inappropriately used (as in the case of propofol and Michael Jackson’s death, or steroids for performance enhancement in sports). Therefore, mood-altering and psychoactive substances are not the only drugs of abuse. Substance abuse often includes problems with impulse control and impulsivity. The term “drug abuse” does not exclude dependency, but is otherwise used in a similar manner in nonmedical contexts.

The terms have a huge range of definitions related to taking a psychoactive drug or performance enhancing drug for a non-therapeutic or non-medical effect. All of these definitions imply a negative judgment of the drug use in question. Some of the drugs most often associated with this term include alcohol, amphetamines, barbiturates, benzodiazepines (particularly temazepam, nimetazepam, and flunitrazepam), cocaine, methaqualone, and opioids. Use of these drugs may lead to criminal penalty in addition to possible physical, social, and psychological harm, both strongly depending on local jurisdiction.

Other definitions of drug abuse fall into four main categories: public health definitions, mass communication and vernacular usage, medical definitions, and political and criminal justice definitions. Substance abuse is a form of substance-related disorder. Drug use is associated with a variety of negative consequences, including increased risk of serious drug use later in life, school failure, and poor judgment which may put teens at risk for accidents, violence, unplanned and unsafe sex, and suicide.

Parents can prevent their children from using drugs by talking to them about drugs, open communication, role modeling, responsible behavior, and recognizing if problems are developing. Teenagers abuse a variety of drugs, both legal and illegal. Legally available drugs include alcohol, prescribed medications, inhalants (fumes from glues, aerosols, and solvents) and over-the-counter cough, cold, sleep, and diet medications. The most commonly used illegal drugs are marijuana (pot), stimulants (cocaine, crack, and speed), LSD, PCP, opiates, heroin, and designer drugs (Ecstasy). The use of illegal drugs is increasing, especially among young teens.

The average age of first marijuana use is 14, and alcohol use can start before age 12. The use of marijuana and alcohol in high school has become common. Since 1975 the Monitoring the Future (MTF) survey has measured drug, alcohol, and cigarette use and related attitudes among adolescent students nationwide. Survey participants report their drug use behaviors across three time periods: lifetime, past year, and past month; for some drugs, daily use is also reported. 1 Initially, the survey included 12th-graders only, but in 1991 it was expanded to include 8th- and 10th-graders.

The MTF survey is funded by NIDA and is conducted by the University of Michigan’s Institute for Social Research. The 36th annual study was conducted during 2010. This year’s Monitoring the Future Survey raises concerns about increases in drug use among the Nation’s teens, particularly the youngest. * Daily Marijuana use increased among 8th, 10th, and 12th graders from 2009 to 2010. Among 12th graders it was at its highest point since the early 1980s at 6. 1%. This year, perceived risk of regular marijuana use also declined among 10th and 12th graders suggesting future trends in use may continue upward. In addition, most measures of marijuana use increased among 8th graders between 2009 and 2010 (past year, past month, and daily), paralleling softening attitudes for the last 2 years about the risk of using marijuana. * Marijuana use is now ahead of cigarette smoking on some measures (due to decreases in smoking and recent increases in marijuana use). In 2010, 21. 4 percent of high school seniors used marijuana in the past 30 days, while 19. 2 percent smoked cigarettes. * Steady declines in cigarette smoking appear to have stalled in all three grades after several years of improvement on most measures. After marijuana, prescription and over-the-counter medications account for most of the top drugs abused by 12th graders in the past year. Among 12th graders, past year nonmedical use of Vicodin decreased from 9. 7% to 8%. However, past year nonmedical use of OxyContin remains unchanged across the three grades and has increased in 10th graders over the past 5 years. Moreover, past-year nonmedical use of Adderall and over-the-counter cough and cold medicines among 12th graders remains high at 6. 5% and 6. 6%, respectively. * After several years of decline, current and past year use of Ecstasy has risen among 8th and 10th graders.

From 2009 to 2010, lifetime use of ecstasy among 8th graders increased from 2. 2% to 3. 3%, past year use from 1. 3% to 2. 4%, and current use 0. 6% to 1. 1%. This follows declines in perceived risk associated with MDMA use seen over the past several years. * Alcohol use has continued to decline among high school seniors with past-month use falling from 43. 5% to 41. 2% and alcohol binge drinking (defined as 5 or more drinks in a row in the past 2 weeks) declining from 25. 2% to 23. 2%. Declines were also observed for all measures among 12th graders reporting the use of flavored alcoholic beverages.

Past-year use fell from 53. 4% to 47. 9%. Monitoring the Future Study: Trends in Prevalence of Various Drugs for 8th-Graders, 10th-Graders, and 12th-Graders 2007-2010 (in percent)* | 8th-Graders| 10th-Graders| 12th-Graders| | 2007| 2008| 2009| 2010| 2007| 2008| 2009| 2010| 2007| 2008| 2009| 2010| Any Illicit Drug Use| Lifetime Past Year Past Month| 19. 0 13. 2 7. 4 | 19. 6 14. 1 7. 6 | 19. 9 14. 5 8. 1| 21. 4 [16. 0] [9. 5]| 35. 6 28. 1 16. 9 | 34. 1 26. 9 15. 8 | 36. 0 29. 4 17. 8| 37. 0 30. 2 18. 5| 46. 8 35. 9 21. 9 | 47. 4 36. 6 22. 3| 46. 7 36. 5 23. 3| 48. 2 38. 3 23. 8| Marijuana/Hashish| Lifetime

Past Year Past Month Daily| 14. 2 10. 3 5. 7 0. 8 |  14. 6 10. 9 5. 8 0. 9 | 15. 7 11. 8 6. 5 1. 0| 17. 3 [13. 7] [8. 0] [1. 2]| 31. 0 24. 6 14. 2 2. 8 | 29. 9 23. 9 13. 8 2. 7 | 32. 3 26. 7 15. 9 2. 8| 33. 4 27. 5 16. 7 [3. 3]| 41. 8 31. 7 18. 8 5. 1| 42. 6 32. 4 19. 4 5. 4| 42. 0 32. 8 20. 6 5. 2| 43. 8 34. 8 21. 4 [6. 1]| Inhalants| Lifetime Past Year Past Month| 15. 6 8. 3 3. 9| 15. 7 8. 9 4. 1| 14. 9 8. 1 3. 8| 14. 5 8. 1 3. 6| 13. 6 6. 6 2. 5 | 12. 8 5. 9 2. 1 | 12. 3 6. 1 [2. 2]| 12. 0 5. 7 2. 0| 10. 5 3. 7 1. 2| 9. 9 3. 8 1. 4| 9. 5 3. 4 1. 2| 9. 0 3. 6 1. 4| Hallucinogens| Lifetime Past Year

Past Month| 3. 1 1. 9 1. 0| 3. 3 2. 1 0. 9 | 3. 0 1. 9 0. 9| 3. 4 2. 2 1. 0| 6. 4 4. 4 1. 7| 5. 5 3. 9 1. 3| 6. 1 4. 1 1. 4| 6. 1 4. 2 1. 6|   8. 4 5. 4 1. 7| 8. 7 5. 9 [2. 2]| 7. 4 [4. 7] [1. 6]| 8. 6 5. 5 1. 9| LSD| Lifetime Past Year Past Month| 1. 6 1. 1 0. 5|  1. 9 1. 3 0. 5| 1. 7 1. 1 0. 5| 1. 8 1. 2 0. 6|   3. 0 1. 9 0. 7 | 2. 6 1. 8 0. 7| 3. 0 1. 9 0. 5| 3. 0 1. 9 0. 7|  3. 4 2. 1 0. 6| 4. 0 2. 7 [1. 1]| 3. 1 [1. 9] [0. 5]| 4. 0 [2. 6] [0. 8]| Cocaine| Lifetime Past Year Past Month|   3. 1 2. 0 0. 9|   3. 0 1. 8 0. 8 | 2. 6 1. 6 0. 8| 2. 6 1. 6 0. 6|   5. 3 3. 4 1. 3| 4. 5 3. 0 1. 2| 4. 6 2. 7 [0. ]| 3. 7 2. 2 0. 9|  7. 8 5. 2 [2. 0]| 7. 2 4. 4 1. 9| [6. 0] [3. 4] [1. 3]| 5. 5 2. 9 1. 3| Crack Cocaine| Lifetime Past Year Past Month|   2. 1 1. 3 0. 6|  2. 0 1. 1 0. 5| 1. 7 1. 1 0. 5| 1. 5 1. 0 0. 4|  2. 3 1. 3 [0. 5]| 2. 0 1. 3 0. 5| 2. 1 1. 2 0. 4| 1. 8 1. 0 0. 5|  3. 2 1. 9 0. 9|  2. 8 [1. 6] 0. 8| 2. 4 1. 3 0. 6| 2. 4 1. 4 0. 7| Heroin| Lifetime Past Year Past Month|  1. 3 0. 8 0. 4|   1. 4 0. 9 0. 4  | 1. 3 0. 7 0. 4| 1. 3 0. 8 0. 4| 1. 5 0. 8 0. 4| [1. 2] 0. 8 0. 4| [1. 5] 0. 9 0. 4| 1. 3 0. 8 0. 4|  1. 5 0. 9 0. 4|  1. 3 0. 7 0. 4| 1. 2 0. 7 0. 4| 1. 6 0. 9 0. 4| Tranquilizers| Lifetime Past Year

Past Month|   3. 9 2. 4 1. 1| 3. 9 2. 4 1. 2| 3. 9 2. 6 1. 2| 4. 4 2. 8 1. 2|   7. 4 5. 3 2. 6| 6. 8 4. 6 [1. 9]| 7. 0 5. 0 2. 0| 7. 3 5. 1 2. 2|  9. 5 6. 2 2. 6| 8. 9 6. 2 2. 6 | 9. 3 6. 3 2. 7| 8. 5 5. 6 2. 5| Alcohol| Lifetime Past Year Past Month Daily| 38. 9 31. 8 15. 9 0. 6| 38. 9 32. 1 15. 9 0. 7| [36. 6] 30. 3 14. 9 [0. 5]| 35. 8 29. 3 13. 8 0. 5|  61. 7 56. 3 33. 4 1. 4| [58. 3] [52. 5] [28. 8] [1. 0]| 59. 1 52. 8 30. 4 1. 1| 58. 2 52. 1 28. 9 1. 1| 72. 2 66. 4 44. 4 3. 1| 71. 9 65. 5 43. 1 2. 8| 72. 3 66. 2 43. 5 2. 5| 71. 0 65. 2 [41. 2] 2. 7| Cigarettes (any use)| Lifetime Past Month Daily /2-pack+/day| 22. 1 7. 1 3. 0 1. 1| 20. 5 6. 8 3. 1 1. 2| 20. 1 6. 5 2. 7 1. 0| 20. 0 7. 1 2. 9 0. 9| 34. 6 14. 0 7. 2 2. 7| [31. 7] [12. 3] [5. 9] [2. 0]| 32. 7 13. 1 6. 3 2. 4| 33. 0 13. 6 6. 6 2. 4| 46. 2 21. 6 12. 3 5. 7| 44. 7 20. 4 11. 4 5. 4| 43. 6 20. 1 11. 2 5. 0| 42. 2 19. 2 10. 7 4. 7| Smokeless Tobacco| Lifetime Past Month Daily|   9. 1 3. 2 0. 8| 9. 8 3. 5 0. 8  | 9. 6 3. 7 0. 8| 9. 9 4. 1 0. 9| 15. 1 6. 1 1. 6| [12. 2] 5. 0 1. 4| [15. 2] [6. 5] [1. 9]| 16. 8 7. 5 2. 5| 15. 1 6. 6 2. 8| 15. 6 6. 5 2. 7| 16. 3 8. 4 2. 9| 17. 6 8. 5 3. 1| Steroids| Lifetime Past Year Past Month|   1. 5 0. 8 0. 4| 1. 0. 9 0. 5| 1. 3 0. 8 0. 4| 1. 1 [0. 5] 0. 3|   1. 8 1. 1 0. 5| 1. 4 0. 9 0. 5| 1. 3 0. 8 0. 5| 1. 6 1. 0 0. 5|   2. 2 1. 4 1. 0| 2. 2 1. 5 1. 0| 2. 2 1. 5 1. 0| 2. 0 1. 5 1. 1| MDMA| Lifetime Past Year Past Month|   2. 3 1. 5 0. 6|  2. 4 1. 7 0. 8| 2. 2 1. 3 0. 6| [3. 3] [2. 4] [1. 1]|   5. 2 3. 5 1. 2| 4. 3 2. 9 1. 1| 5. 5 3. 7 1. 3| 6. 4 [4. 7] [1. 9]|   6. 5 4. 5 1. 6| 6. 2 4. 3 1. 8  | 6. 5 4. 3 1. 8| 7. 3 4. 5 1. 4| Methamphetamine| Lifetime Past Year Past Month| 1. 8 1. 1 0. 6| 2. 3 1. 2 0. 7 | [1. 6] 1. 0 0. 5| 1. 8 1. 2 0. 7|   2. 8 1. 6 0. 4| 2. 4 1. 5 [0. 7]| 2. 8 1. 6 0. 6| 2. 5 1. 6 0. 7|  [3. ] [1. 7] 0. 6| 2. 8 1. 2 0. 6 | 2. 4 1. 2 0. 5| 2. 3 1. 0 0. 5| Vicodin| Past Year|   2. 7| 2. 9| 2. 5| 2. 7|   7. 2| 6. 7 | 8. 1| 7. 7|   9. 6| 9. 7| 9. 7| [8. 0]| OxyContin| Past Year|   1. 8| 2. 1| 2. 0| 2. 1|   3. 9| 3. 6| 5. 1| 4. 6|   5. 2| 4. 7 | 4. 9| 5. 1| Cough Medicine (non-prescription)| Past Year|   4. 0| 3. 6| 3. 8| 3. 2|   5. 4| 5. 3| 6. 0| 5. 1|   5. 8| 5. 5| 5. 9| 6. 6| * | i. Classification d) Public health definitions Public health practitioners have attempted to look at drug abuse from a broader perspective than the individual, emphasizing the role of society, culture and availability.

Rather than accepting the loaded terms alcohol or drug “abuse,” many public health professionals have adopted phrases such as “substance and alcohol type problems” or “harmful/problematic use” of drugs. The Health Officers Council of British Columbia — in their 2005 policy discussion paper, A Public Health Approach to Drug Control in Canada — has adopted a public health model of psychoactive substance use that challenges the simplistic black-and-white construction of the binary (or complementary) antonyms “use” vs. “abuse”.

This model explicitly recognizes a spectrum of use, ranging from beneficial use to chronic dependence e) Medical definitions In the modern medical profession, the three most used diagnostic tools in the world, the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM),the World Health Organization’s International Statistical Classification of Diseases and ICRIS Medical organization Related Health Problems (ICD), no longer recognize ‘drug abuse’ as a current medical diagnosis.

Instead, DSM has adopted substance abuse as a blanket term to include drug abuse and other things. ICD refrains from using either “substance abuse” or “drug abuse”, instead using the term “harmful use” to cover physical or psychological harm to the user from use. Physical dependence, abuse of, and withdrawal from drugs and other miscellaneous substances is outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) . Its section Substance dependence begins with: Substance dependence When an individual persists in use of alcohol or other drugs despite problems related to use of the substance, substance dependence may be diagnosed. Compulsive and repetitive use may result in tolerance to the effect of the drug and withdrawal symptoms when use is reduced or stopped. These, along with Substance Abuse are considered Substance Use Disorders…. ” However, other definitions differ; they may entail psychological or physical dependence, and may focus on treatment and prevention in terms of the social consequences of substance uses. ) Drug misuse Drug misuse is a term used commonly for prescription medications with clinical efficacy but abuse potential and known adverse effects linked to improper use, such as psychiatric medications with sedative, anxiolytic, analgesic, or stimulant properties. Prescription misuse has been variably and inconsistently defined based on drug prescription status, the uses that occur without a prescription, intentional use to achieve intoxicating effects, route of administration, co-ingestion with alcohol, and the presence or absence of abuse or dependence symptoms.

Tolerance relates to the pharmacological property of substances in which chronic use leads to a change in the central nervous system, meaning that more of the substance is needed in order to produce desired effects. Stopping or reducing the use of this substance would cause withdrawal symptoms to occur. g) As a value judgment Philip Jenkins points out that there are two issues with the term “drug abuse”. First, what constitutes a “drug” is debatable.

For instance, GHB, a naturally occurring substance in the central nervous system is considered a drug, and is illegal in many countries, while nicotine is not officially considered a drug in most countries. Second, the word “abuse” implies a recognized standard of use for any substance. Drinking an occasional glass of wine is considered acceptable in many Western countries, while drinking several bottles is seen as an abuse. Strict temperance advocates, which may or may not be religiously motivated, would see drinking even one glass as an abuse, and some groups even condemn caffeine use in any quantity.

Similarly, adopting the view that any (recreational) use of marijuana or amphetamines constitutes drug abuse implies that we have already decided that substance is harmful even in minute quantities. ii. Signs and symptoms Depending on the actual compound, drug abuse including alcohol may lead to health problems, social problems, morbidity, injuries, unprotected sex, violence, deaths, motor vehicle accidents, homicides, suicides, physical dependence or psychological addiction. There is a high rate of suicide in alcoholics and other drug abusers.

The reasons believed to cause the increased risk of suicide include the long-term abuse of alcohol and other drugs causing physiological distortion of brain chemistry as well as the social isolation. Another factor is the acute intoxicating effects of the drugs may make suicide more likely to occur. Suicide is also very common in adolescent alcohol abusers, with 1 in 4 suicides in adolescents being related to alcohol abuse. In the USA approximately 30 percent of suicides are related to alcohol abuse.

Alcohol abuse is also associated with increased risks of committing criminal offences including child abuse, domestic violence,

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