Substance misuse

Paul Blacker Acupuncture for substance misuse

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In the UK, the prevalence of substance misuse is around 9 per 1,000 of the population aged 15-64 years, and around 3 per 1,000 inject drugs, in most cases opioids (NICE 2007). In 2005/6, around 181,000 people were using drug treatment services in England and Wales (Commission for Healthcare Audit and Inspection 2006). Also, research in England in 2005 estimated that 7.1 million people, or 23% of the adult population, could be categorised as hazardous or harmful alcohol users (Drummond 2005). Indeed, in England, 150,000 hospital admissions annually result from acute or chronic alcohol use, and alcohol use is implicated in 33,000 deaths each year (Academy of Medical Sciences 2004).

Dependence on drugs is a cluster of physiological, behavioural, and cognitive phenomena in which the use of a substance takes on a much higher priority for a given individual than other behaviours that once had a greater value (WHO 2007). Drugs of abuse include cannabis, opioids (opiates), CNS stimulants (cocaine, crack, amphetamines, ecstasy, crack), CNS depressants (barbiturates, benzodiazepines, alcohol), hallucinogens (LSD, psilocybin), and volatile substances (glues, gases, aerosols) (DTB 1997).

Opioid misuse and dependence are associated with a wide range of problems, such as overdose; infection with HIV, hepatitis B or hepatitis C; thrombosis; anaemia; poor nutrition; dental disease; criminal behaviour; relationship breakdown; lost productivity; unemployment; imprisonment; social exclusion; and prostitution, as well as withdrawal symptoms (Prodigy 2006; Gowing 2006; National Treatment Agency for Substance Misuse 2006). Problems associated with excessive alcohol use include hypertension, accidental injury, hand tremors, duodenal ulcers, gastrointestinal bleeding, cognitive impairments, anxiety and depression (Saunders 1990). The development of alcohol dependence appears to involve changes in brain neurotransmission (Littleton 1994; Tsai 1995).

Treatment programmes to help people with drug and alcohol problems include a range of individualised psychosocial interventions such as counselling, self-help groups, and rehabilitation programmes, in addition to medication.