Page 32 - Pagetit

1. INTRODUCTION

this includes liver cirrhosis and a host of other chronic illnesses; for nicotine
taken in cigarette form, this includes lung cancer, emphysema and other
chronic illnesses. Through the sharing of needles, heroin use by injection is a
main vector for transmission of infectious agents such as HIV and hepatitis
C virus. Second there are the acute or short-term biological health effects of
the substance. Notably, for drugs such as opioids and alcohol, these include
overdose. Also classed in this category are the casualties due to the substance’s
effects on physical coordination, concentration and judgement, in
circumstances where these qualities are demanded. Casualties resulting from
driving after drinking alcohol or after other drug use feature prominently in
this category, but other accidents, suicide and (at least for alcohol) assaults
are also included. The third and fourth categories of harmful effects comprise
the adverse social consequences of the substance use: acute social problems,
such as a break in a relationship or an arrest, and chronic social problems,
such as defaults in working life or in family roles. These last categories are
important in relation to alcohol and many illicit drugs, but are poorly
measured and mostly excluded from measurements of health effects such as
in the Global Burden of Disease (GBD).

Fig. 1.2 Mechanisms relating psychoactive substance use to health and
social problems

Form & patterns Amount of
of substance use substance use

Psychoactive
effects
(intoxication)
Toxic and
other biochemical Dependence
effects

Acute Chronic
Chronic Accidents/injuries social social
disease (acute disease)
problems problems

Source: adapted from Babor et al., 2003.
Note that some effects are beneficial rather than toxic, e.g. regular light alcohol
use as potentially reducing risk of coronary heart disease.

11