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Illicit substance use

Contents

Incidence
Issues that need to be addressed when assessing drug use
Adolescent illicit substance use
Classification of illicit substances
Multiple drug use

 

Last partial update: July 2016 - Please read disclaimer before proceeding

Incidence

The use of mood altering drugs has been taking place for thousands of years. While the figures in the table above would suggest that illicit drug use is relatively common in Australia, most of the 38 per cent who state that they have used illicit drugs have tried cannabis perhaps once or twice and most of the others are infrequent users who are not addicted and who suffer no significant long term or short term harm from their use. However, likely harm does depend on the type of drug taken and the recent increase in the use of the dangerous drug methamphetamine or 'Ice' is quite worrying. It should be emphasised that there is no safe level of drug use. It is also worthwhile remembering at this point that alcohol and tobacco cause far more harm than illicit drugs in both adults and adolescents. (Alcohol-use disorders are about three times as common as illicit drug disorders.)

Illicit substance abuse in Australia in 2001
Illicit substance	% of Australian adults using
Any illicit drug	37.7
Cannabis	33.1
Amphetamines	8.9
Hallucinogens	7.6
Ecstasy / Designer (Party) drugs	6.1
Pain killers/ analgesics	6.0
Cocaine	4.4
Tranquillisers / sleeping pills	3.2
Inhalants	2.6
Injected drugs	1.8
Heroin	1.6
Barbiturates	0.9
Steroids	0.3
Methadone (non maintenance)	0.3

Both short term and long term drug use can cause serious health problems and the problem of addiction can occur with most drugs. Illicit drug use causes about one per cent of the total burden of illness in Australia. The rate of substance-use disorders is maximum in the 18 to 24 year age group and decreases with age and there is little difference between rural and urban communities.

When does illicit drug use usually start? Most young people who do experiment with illicit drugs do not start until they leave high school; often in their twenties once they have left home. Use is much less common in teenage years, although to some extent cannabis use is an exception to this rule. One important reason is that most teenagers cannot afford to purchase illicit drugs, which is a good reason for parents to be wary about giving teenagers too much money. (The other reason is that most teenagers would not know where to access drugs; they are not being sold on every street corner as the media would often have us believe. Most teenagers who are able to afford drugs get them from acquaintances at school who get them a couple of tablets as a favour. These high school student providers usually do not distribute a lot of drugs and thus do not make much out of their dealings. Often there is just get an extra tablet or two for themselves.)

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Issues that need to be addressed when assessing drug use

There are always multiple concerns when assessing an individual’s problems with drug use and, when deciding on what interventions might be helpful, it is therefore important to look at all possible issues including:

• The reasons the person is taking the drugs (see risk factors below)
• Underlying medical problems that may precipitate use, such as depression
• Medical problems associated with drug administration. The mode of drug administration can be responsible for significant illness, not the least of which are viral diseases such as hepatitis B and C and HIV, which may occur with injecting drug use.
• Social / environmental problems associated with drug use. These include crime, financial problems, violence, employment and relationship problems, legal issues, and poor living standards. While they are more common in chronic dependent users, some problems, such as violence and legal problems associated with drug use, can occur with infrequent users also.
• Reducing harm from drug use. Harm minimisation is an integral part of reducing physical and mental illness due to substance abuse. Harm can originate from many aspects of drug use. Its reduction involves all of the following.
• Access to good medical care that provides adequate treatment and drug education so that harm can be reduced from:
• Medical problems caused by the drug. Psychiatric illness, such as depression or psychosis, occurs in some people who abuse drugs. Multiple drug use can make these problems considerably more likely.
• Problems with drug overdose. It is often difficult to know how much of a particular drug is present in the substance purchased. Many people feel that once they are used to taking a drug their risk of overdose is reduced. In fact, the opposite is the case because more frequent users have a greater chance of occasionally getting a higher dose than normal and are more complacent about the risks involved in drug taking.
• Reduce the risk of over-dosage by:
• never taking drugs when alone. Make sure at least one person who is a non-user is present.
• Start with a small dose
• Use only one drug at a time
• Seek help if feeling unwell
• If taking ecstasy, keep well hydrated (500mL of water per hour) and rest regularly to keep temperature down.
• Harm from increased risk taking is another issue that needs to be addressed with people taking drugs, including driving under the influence.
• Harm from the use of drugs while pregnant. It is not wise to use any drugs when pregnant or possibly pregnant.
• Access to adequate social services to avoid harm from living in a socially disadvantaged / financially poor situation. This includes harm from:
• lack of adequate accommodation and food
• other people who may take advantage of a person who chronically abuses drugs.

The information that follows gives a brief outline of some of the drugs in use in Australia at present. However, drug use is constantly changing and people affected by this health issue need to continually update their knowledge. The web sites included are excellent resources, as is your GP. You can also discuss any drug related problem by contacting the Alcohol and Drug Information Service in your state. 

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Adolescent illicit substance use Adolescents often use more than one drug at a time e.g. cannabis and alcohol or alcohol and caffeine. Alcohol and tobacco are the most common drugs abused by adolescents. Then follows over-the-counter pain killers and sniffing substances. Illicit substance abuse is more common in young adults than it is in teenagers. (This is because their older age / increased independence makes gaining access to illicit substances easier and they have more money to pay for them.) Unfortunately this means that getting teenagers successfully through the high school years is not the end of the 'illicit substance story'. Sniffing substances include aerosols, paint, glue, petrol, cleaner fluid is quite common in younger adolescents, peaking in the 13 to 14 year age group. It is then often replaced by other, usually more expensive, drug use. Sniffing can give a feeling of happiness and relaxation which lasts one to three hours. Its adverse effects include drowsiness, agitation, cough, runny nose, sneezing, headache, slurred speech, nausea and vomiting, unsteadiness when walking and reckless behaviour. Sudden death can occur due to heart arrhythmias. Over-the-counter drugs are commonly abused. As well as pain killers mentioned above, these substances include cough medicines containing codeine, antihistamines and decongestants. Prescription drugs found in the home are often abused by adolescents. These include stimulant drugs used for ADHD and sedatives such as diazepam and oxazepam. Amphetamines and ecstasy are often used at dance parties. It is important to make sure the adolescent: Is as safe as possible regarding harm from drug use and from other people Has a home situation / other accommodation that provides adequate shelter and safety Is provided with good community support Has good medical care, including drug education and therapy as needed. Continues their school / tertiary education Drug use is more common in socially deprived families Drug use is less common in those born outside Australia. Risk factors for alcohol / illicit substance abuse in teenagers Drug use by peers. (This is a very strong predictor.) Parental illicit substance use or inappropriate alcohol use. Also parental permission of alcohol use in adolescence and an overall favorable attitude to drug use increases risk. Poor inconsistent parenting practices. Setting boundaries that are adhered to and focusing on positives is always important. Poor relationships with parents also increases risk. Early onset of substance use e.g. drinking alcohol before the age of 15 years. Alcohol abuse is also a risk factor for later illicit substance use. Psychosocial problems, including eating disorders, depression / anxiety, ADHD. Poor socialisation Protective factors against drug use Happy family environment with strong parent child bond Environments that encourage a healthy lifestyle, including participation in sporting and community activities. Educational achievement. Adolescents that finish school are at less risk. A supportive school environment where there is a good relationship with teachers. High achieving role models. Peer group that conforms to conventional values. Some behaviours that MAY suggest adolescent illicit substance abuse (These symptoms occur in numerous other conditions also.) A drop in school grades An unexplained dropping of usual activities, such as sport A change of friends without obvious reason Lethargy / loss of motivation Unusual behaviour Mood swings Reduced interaction with family Valuable items / money missing from home Changes in eating patterns Ways to entice adolescents to talk about drugs Be part of their lives – Take an interest in their activities and school. Parents should keep the lines of communication open by regularly talking to their child every day and listening to what they have to say. Any topic will do. This will make it easier when difficult issues arise. Parents can show they are comfortable talking about drugs by bringing up the subject regularly. Keeping up to date with illicit drug use issues relevant to teenagers will help.  Parents should try not to be ‘know it alls’ and need to listen to what teenagers have to say! Be calm. Parents should not panic if they suspect their child may be using illicit substances. Looking for appropriate opportunities to bring up the subject of drug use amongst others at school / friends etc can help initiate discussion; for example, following reference to drug use in a movie, TV program or magazine / paper or following an incident at school. If a teenager denies use and the parent still suspects it, bringing up the subject again at a time close to when a worrying behaviour has occurred may be helpful. Getting help from your GP or contacting one of the support services mentioned at the end of this section is very worthwhile when worried. Try to avoid conflict. It is important to keep the lines of communication open and to express opinions without becoming angry. Listening to the child’s opinion helps greatly. If things are getting too heated, stop and come back to the subject when things have cooled down.

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Classification of illicit substances

Drugs that act on the brain (psychoactive drugs) can be classified into two broad groups; those that stimulate brain activity and those that depress it. The commonly used drugs in each group appear in the table below.

Stimulant drugs tend to make people more alert and excited and have effects on the body such as raising pulse rate and body temperature. These effects are exaggerated in stronger drugs or when an overdose is taken, and this can lead to anxiety, agitation, hallucinations, aggression, and psychotic episodes. (A psychotic episode occurs when the person losses touch with reality. As might be expected, hallucinations commonly occur as part of these episodes.)

Depressant drugs are the most commonly used group and tend to slow down the brain, giving a calm relaxed feeling. When these are taken to excess they can slow the brain down so much that the person goes into a coma and eventually stops breathing. (This is the cause of deaths that occasionally occur with a heroine overdose.)

Types of drug commonly used in Australia (Listed in approximate decreasing order of use in Australia)
Stimulants	Depressants
Caffeine	Alcohol
Nicotine	Cannabis / marijuana
Amphetamines	Heroine
Ecstasy	GBH (‘Fantasy’)
Methamphetamine (‘Ice’)	Ketamine
Cocaine
LSD

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Multiple drug use

The effects of a drug can be increased by taking another drug of the same type (e.g. taking two depressants such as alcohol and cannabis or taking two stimulants such as amphetamines and cocaine). The addition of these effects can lead to overdose type effects and this is the main reason that multiple drug use is dangerous (especially as the user is often unaware of the strength of the individual drugs being taken.)

When taking a stimulant (e.g. Ecstasy), some people will take a depressant type drug as well (e.g. alcohol) in an attempt to reduce unwanted stimulant effects such as anxiety. Such mixing of stimulants and depressants unfortunately causes several problems including;

• the possibility of being addicted to several drugs, making quitting more difficult.
• suffering the adverse mental and physical health effects of multiple drugs, with significant relationship and workplace consequences.
• increased difficulty in treating overdoses.
• extra financial cost, often resulting in financial stress and the risk of involvement in illegal activities.

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What is in illicit substances?

It is very important to realise that illicit drugs are not made in factories with high standards of quality control. They are made in the back yards and garages of people who could not care less about the people who are taking their products, which are often a mix of all manner of substances that may interact harmfully and vary hugely in potency, thus making some of them very dangerous to use. There is no guarantee regarding the contents of the drug received. Until recently pill-making machines were relatively easily procured in Australia and it is easy for popular ‘brands’ of drugs to be copied, so there is no guarantee, even with a ‘favourite brand’. (One survey found that about 10 per cent of Ecstasy tablets contained no Ecstasy at all.)

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Further reading

Teenagers, Alcohol and Drugs  What your kids really want and need to know about alcohol and drugs. by Paul Dillon. Published by Allen & Unwin, 2009.

 

Further information

Alcohol and Drug Information Service in your state.
This service will provide information and/or advice regarding problems. They can also refer callers to health professionals that can help them personally regarding alcohol and other drug problems.
ACT Ph 6205 4545; NSW Ph 9361 8000 or 1800 422 599: NT 8981 8030 or 1800422 599; Qld Ph 3236 2414 or 1800 177 833; SA Ph 1300 131 340; Tas 1800 811 994; Vic Ph 9416 1818 or 1800 136 385; WA Ph 9442 5000 or 1800 198 024) Check directory assistance if these numbers have changed.

Australian Drug Information Network www.adin.com.au
Information about alcohol, tobacco and other drugs.

Australian Drug Foundation www.adf.org.au.
Another good general site regarding drug use; easy to access information about most types of drugs.

Family Drug Support 24 hour hotline www.fds.org.au
Ph 1300 368 186 (throughout Australia)

National Health and Medical research Council National Guidelines on Responsible Drinking https://www.nhmrc.gov.au/health-topics/alcohol-guidelines

National Cannabis Information and Prevention Centre https://ncpic.org.au

Brief Intervention: the Drink-less package (University of Sydney)  http://sydney.edu.au/medicine/addiction/drinkless/index.php
This site the very helpful and commonly used alcohol reduction program ‘Drink-less’. It can be downloaded free or orders can be taken from the site.

 

Information for doctors

Specialist advice for doctors regarding drug and alcohol problems (24 hour service)
NSW: Drug and Alcohol Specialist Advisory Service: Ph: 1800 023 687 or (02) 9361 8006
Vic, Tas, NT: Drug and Alcohol Specialist Advisory Service. Ph: 1800 812 804 or (03) 9416 1818
ACT: Alcohol and Drug Program. Ph: (02) 6205 4545
WA: Dept of Health Clinical Advisory Service. Ph 1800 688 847 or (08) 9442 5042
Qld: Alcohol and Drug Information Service. Ph: (07) 3636 7098 or (07) 363607599

 

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