CHAPTER ONE
Introduction
Background to the Study
Globally, people abuse substances such as drugs, alcohol, tobacco and psychoactive substances for varied and complicated reasons, but it is clear that our society pays a significant cost. The toll for this abuse can be seen in our hospitals and emergency departments through direct damage to health by substance abuse and its link to physical and mental trauma. Jails and prisons tally the strong connection between crime, drug dependence and abuse. Substance abuse patterns though varied among youth populations across regions of the world are unprecedented and alarming (United Nations Office on Drugs and Crime, 2007). In Nigeria, this social malady is considered an issue of serious public health concern as it adversely affects the lives and performance of secondary school students involved as well as the harmonious functioning of entire structure of the society (Bachman, Schlenberg & Malley, 2011).
Substance has been variously defined in literature. Conceptualizing substance in this study offers profound insights into substance abuse. Hornby (2010) defines substance as a physical material from which something is made or which has discrete existence. He further refers to substance as an intoxicating, stimulating, or narcotic chemical or drug, especially an illegal one. Examples of substances include insulin, heroin, amphetamines, and cocaine. Due to availability and accessibility to these substances, individuals especially adolescents are more vulnerable to their overt or covert abuse (World Health Organization-WHO, 2012).
Abuse has been defined as the use of something in a way that is wrong or harmful (Hornby, 2010). WHO (2012) referred to abuse as non-medical or unsanctioned patterns of use, irrespective of consequences. When psychoactive substances are used in unsanctioned patterns, a phenomenon known as substance abuse ensues. The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) issued by the American Psychiatric Association (APA), the DSM-IV-TR, defines substance abuse as a maladaptive pattern of use indicated by continued use despite knowledge of having a persistent or recurrent social, occupational, psychological or physical problem that is caused or exacerbated by the use (or by) recurrent use in situations in which it is physically hazardous (American Psychiatric Association, 1994). It is a residual category, with dependence taking precedence when applicable.
Health Officers Council of British Colombia-HOC (2005) asserted that substance abuse also known as drug abuse is a patterned use of a substance (drug) in which the user consumes the substance in amounts or with methods neither approved nor supervised by medical professionals. Substance abuse or drug abuse is not limited to mood-altering or psychoactive drugs. If an activity is performed using the object against the rules and policies of the matter (as in steroids for performance enhancement in sport) it is also substance abuse. Therefore, mood altering and psychoactive substances are not the only types of drug abuse. Use of illicit drugs like narcotics, stimulants, depressants, (sedatives), hallucinogens, cannabis, even glues and paints are also considered to be classified as drug or substances abuse. Substance abuse often includes problems with impulse control and impulsive behaviours.
Substance abuse is also defined by United Nations International Drug Control Programme-UNIDCP (2007) as taking of substances without medical justification. This definition used by United Nations International Drug Control Programme is associated with taking of drugs without a physician’s prescription or advice which is dangerous to one’s health. In the same vein, National Institute on Drug Abuse-NIDA (2007) defined substance abuse as drug use that results in physical, mental, emotional and social impairment of the user. NIDA refers to the use of any drug to the point that it interferes with the individual’s health or with his economic or social adjustments as amounting to an abuse of such drug. Rahim (2010) defined substance abuse as self-administration of a drug for non-medical reasons, in quantities and frequencies which may impair an individual’s ability to function effectively, and which may result in social, physical, or emotional harm. Within the context of this study, substance abuse is conceptualized as the excessive and persistent self-administration of a drug or substance without regard for medically, culturally or socially accepted patterns. It is also seen as the use of performance enhancing drugs or substances for non-medical effects to the extent that it interferes with the health of an individual.
Drugs are an integral part of substances that are commonly abused. Drug abuse and substance abuse are synonymous though the former is used as a blanket term in APA’s (1994) DSM-IV-TR to incorporate other psychoactive substances. Also, the terms have been extensively used interchangeably in literature and non-medical contexts (Keane, Reaper-Reynolds, Williams, & Wolfe, 2006; Nutt, King, Saulsbury & Blakemore, 2007). Substances have been conceptualized by experts in medical science and public health in different perspectives though there is a common conceptual focus. Achalu (2004) defined substance as any material that composed chemical elements or constituents other than food that when taken into the body alters the structure or function of the body in some ways. He further affirmed that substances are chemicals or designed for the prevention or cure of disease or for relief of pain and discomfort. substances also include any natural or synthetic substance that can stimulate, suppress or alter the body’s structure and biological functions.
Achalu (2004) further stated that substances have been classified according to their effects on the body. These include; those that prevent disease; those that fight infections; those that affect the heart and blood vessels; those that affect the nervous system; those that correct imbalances in the body chemistry; those that relieve pain. The categories of drugs that affect the nervous system incidentally are the most widely abused. This is because they alter mood and feelings. These include analgesics, stimulants, depressants (tranquilizers and barbiturates), hypnotics, and hallucinogens. WHO (2008) defined drugs as any substance solid, liquid or gas which when introduced into the body changes the function or structure of the body in some way. Often, the term “substance use” is preferred, so that all things that affect the way a person feels, thinks, sees, tastes, smells, hears and behaves are included. Thus, glue is a substance used by many street children and methamphetamines are substances used by many adolescents who go to discos and bars. Sometimes the phrase “psychoactive substance” is used for drugs to emphasize the fact that they affect the central nervous system and alter mood, thinking, perception and behaviour (Hussein-Rassool, 1998). United Nations International Drug Control Programme-UNIDCP (2007) opined that drugs are in synthetic forms that affect the organism by altering its mood or behaviour. In addition, substances can be licit or illicit.
Licit substances are substances which have been determined to be safe, effective and given under the direction of a physician or any member of the health team for medical purposes only. Conversely, illicit substances are materials whose manufacture, sale, distribution, purchase for sale or possessions are prohibited by law. These include substances such as cannabis sativa, cocaine, heroin, and amphetamine among others. Though, the crux of this study centers on substance abuse patterns, there is a nexus between this concept and other critical concepts associated with substances/drugs, which include drug use and misuse. Drug use is a broad term to cover the taking of all psychoactive substances within which there are stages: drug-free (that is, non-use), functional use, experimental use, dysfunctional use, recreational use and harmful use, which is further sub-divided into misuse and dependence. Substance misuse is defined in APA’s (2000) DSM-IV-TR as any taking of a drug which harms or threatens to harm the physical or mental health or social well-being of an individual or other individuals or society at large, or which is illegal. Furthermore, there are myriads of drugs or substances that are commonly abused by adolescents including secondary school students in Bauchi Education zone. An expatiation on categories and examples of psychoactive drugs, other substances and associated consequences will facilitate ample comprehension of substance abuse patterns among secondary school students.
There exists considerable number of substances that are commonly used and abused by adults, youths, and adolescents including secondary school students in Bacuhi Education Zone. The generic name of a drug is standard and used throughout the world. However, most drugs are marketed under various trade names and also have many street names. Trade names usually begin with a capital letter. For example, a commonly used drug to reduce anxiety is diazepam (generic name) and is sold in some countries as Valium (trade name). Another example is diacetylmorphine, which is the generic name for Heroin, and has the street names, “brown sugar” in India, and “smack” in the USA and Australia. It is also common for street names to change regularly. The three main types of psychoactive drugs, classified by their effects on the central nervous system are: depressants, Hallucinogens, Stimulants. Other categories include inhalants and solvents, ecstasy and over the counter drugs-OTC (UNODC, 2007; WHO, 2008; European Monitoring Centre for Drugs and Drug Addiction-EMCDDA, 2012). This study adopts this classification.
Depressants slow down, or depress, the central nervous system. They do not necessarily make the user feels depressed. Depressant drugs include: alcohol, opiates and opioids including heroin, morphine, codeine, methadone, and pethidine. Cannabis including marijuana, hashish, hash oil, tranquillizers and hypnotics (Rohypnol, Valium, Serepax, Mogadon, and Euhypnos), and barbiturates (Seconal, Tuinal and Amytal). Cannabis, commonly known as the dried plant form of marijuana, can have a slight effect on one person and a much greater effect on another person. The initial effect for a new marijuana smoker can be a strong rush. There are negative health effects which result from abuse. Marijuana comes from the hemp plant, Cannabis sativa, which grows throughout most of the world. The cannabis plant is prepared for consumption in various ways. Three common forms of cannabis are marijuana, hashish, and hashish oil.
The term marijuana refers to the cannabis plant and to any part or extract of it that produces somatic or psychic changes. Drying the leaves and flowering-tops of the plant produces the tobacco-like substance. Hashish and hash oil are prepared from the resin of the cannabis plant. Some people become psychologically dependent on marijuana and must exert considerable effort or even obtain medical treatment to stop using it. When marijuana is smoked, the effects are felt within minutes, reach their peak in 10 to 30 minutes, and may linger for two or three hours. The most obvious and verified effect of marijuana on humans is a dose-related, temporary increase in heart rate, as high as 160 beats per minute. A reddening of the eyes is also a common physiological reaction to acute marijuana use. A “high” from cannabis can last for several hours. During this time’ most users feel relaxed and self-confident, and have altered perceptions of time and space. Some new users and heavy users experience confusion, anxiety and panic (Hussein Rassool, 1998; EMCDDA, 2012).
