Drug abuse and condition of Bangladesh

Abstract
Drug abuse has been a rising social and economic problem in post-war Bangladesh.
Drug abuse and addiction are a major burden to any society. Staggering as these numbers are,
however, they do not fully describe the breadth of deleterious public health and safety
implications, which include family disintegration, loss of employment, failure in school,
domestic violence, child abuse, and other crimes. The objectives of this study are to
investigate the perception and behavior about drugs of abuse among students of private
universities in Dhaka city. Private University students have chosen due to fact that they
represent part of the youth of Bangladesh. Data have collected from the students of 10 private
university of Bangladesh in Dhaka city by a structured questionnaire form. Questionnaire
form consisted of three points, which is socio demographic data, behavior and perception
about drug abuse. The numbers of total participants were 344 students. The samples had
consisted of both undergraduate (83%) and graduate (17%) students. Most of the participants
were male (82%). Most most of the participants were Muslim (89%). About 23% of the
participants were involved with drug of abuse. Among them 81% were male and the rest were
female. Almost all students (95%) had knowledge about drugs of abuse including their
harmful effects. About 90% students said that drugs of abuse are very common in
Bangladesh. About 90% students said drug abuse is very common in Bangladesh. In case of
drug abuser, it is 96%. About 26% of the students told that it happens due to lack of honesty.
Other reasons were lack of Government law enforcement (13%), lack of knowledge (19%),
and lack of practice of religion (15%). In case of drug abuser, it was lack of honesty (59%),
lack of Government law enforcement (11%), and lack of knowledge (18%). Most of the
students (83%) had previous idea about dependency of a prescription drugs. In case of drug
abuser, it is 86%. Most of the students came to know about this information from physicians
(23%), media (20%), friends (20%), and pharmacists (16%). The Government of Bangladesh
should take proper steps for controlling it; otherwise, it may cause serious damage in our
young generation as well as for our society as a whole.

1.1 Drug abuse

Drug abuse or substance abuse is the use of any chemical substance especially
controlled substances such as psychoactive drugs, narcotics, hormones, prescription
medication or over the counter medicines in a way that society deems harmful to the user or

others. A person who abuses a drug uses illegal drugs, or uses legal drugs in a manner that
conflicts with the directions given by a physician. Abused drugs include narcotic pain
medications, marijuana, heroin, cocaine, sedative, stimulants, and drugs that cause
hallucinations. Physical dependence on a drug is called drug dependency. Psychological
dependency results in drug addiction. [1]
Drug abuse is most commonly associated with addictive substances. Alcohol is also
addictive and prone to abuse; however, the term alcohol abuse is generally used distinctly
from "drug abuse. Some of the most commonly abused drugs are alcohol; nicotine;
marijuana; amphetamines; barbiturates; cocaine; methaqualone; opium alkaloids; synthetic
opioids; benzodiazepines, including flunitrazepam (Rohypnol); gamma-hydroxybutyrate; 3,4methylenedioxymethamphetamine (MDMA, ecstasy); phencyclidine; ketamine; and anabolic
steroids. Drug abuse may lead to organ damage, addiction, and disturbed patterns of behavior.
Some illicit drugs, such as heroin, lysergic acid diethylamide, and phencyclidine
hydrochloride, have no recognized therapeutic effect in humans. Use of these drugs often
incurs criminal penalty in addition to the potential for physical, social, and psychological
harm. [2]
1.2 Prescription drug abuse
Prescription drug abuse is the use of a prescription medication in a way not intended
by the prescribing doctor. Prescription drug abuse includes everything from taking a friend's
prescription painkiller for your backache to snorting ground-up pills to get high. [2]
An increasing problem, prescription drug abuse is especially common in young
people. The prescription drugs most often abused include painkillers, sedatives for anxiety
and sleep disorders, and stimulants for attention-deficit/hyperactivity disorder (ADHD)
Identifying prescription drug abuse early can help fix the problem before it becomes more
serious or turns into an addiction. [6]
The easiest way of defining drug abuse is observing that a person uses a drug for
something other than a medically prescribed purpose. That is, they have a habit of taking a
drug to get high or feel better. They take more than prescribed amounts. They take the
drugs for recreation. Some drugs that are used for recreation may not be prescription meds,
or over-the-counter medications, or even street drugs. They can be common, everyday
chemicals. For example, people inhale glue or solvents to get high. [5]
People want to have a mood change, to feel good. Professional drug counselors will
tell you that any use of illegal drugs is drug abuse. Those drugs are illegal because they are
potentially very addictive and harmful to a persons health. That broadens our definition of
drug abuse even more. Therefore, a medical professional prescribes any illegal drug use, or

any use of prescription or non-prescription medication use beyond what, or any use of a
chemical to get high, is drug abuse. [6]
There are some drugs that are used to relax, to feel good, to be sociable. Alcohol is the
most common drug used in America for this purpose. Its legal, and if taken in moderation, is
not harmful. But alcohol is addictive. Some people say marijuana is not addictive, and
therefore should be legal, but researchers have found that marijuana has other harmful effects,
even if someone is not addicted. People can become psychologically addicted, even if there
is no physical dependence. [6]
Almost any substance can abuse. People abuse cigarettes, caffeine and other common,
legal substances every day. Sometimes the line between use and abuse is fuzzy. For example,
people might go to the tavern after work and have a couple of drinks with their friends. Is that
abuse? Some might argue that it becomes abuse when it becomes a regular, daily occurrence.
Too many cigarettes, too much coffee, to many diet sodas. The person determines the line. [7]
1.3 Causes of prescription drug abuse [7]
Teens and adults abuse prescription drugs for a number of reasons. Some of these include:
1.4. Vital Statistics [7]
Today there are about 190 million drug users around the world.
1.5 Common signs and symptoms of drug abuse [8]
1.6 Effects of drug
Drugs can be harmful in a number of ways, through both immediate effects and
damage to health over time. Even occasional use of marijuana affects cognitive development
and short-term memory. In addition, the effects of marijuana on perception, reaction and
coordination of movements can result in accidents. Hallucinogens (such as LSD) distort
perceptions, alter heart-rate and blood pressure and, in the long term, cause neurological
disorders, depressions, anxiety, visual hallucinations and flashbacks. Cocaine and
amphetamines first cause tremors, headaches, hypertension and increased heart rate. [8]
Long-term effects are nausea, insomnia, and loss of weight, convulsions and
depression. Heroin use initially results in nausea, slow respiration, dry skin, itching, slow
speech and reflexes but, over a long period, there is the serious risk of developing physical
and psychological dependence, which in the end can lead to acute overdose, which can lead
to death due to respiratory depression. There is some tendency towards presenting some
drugs (such as cannabis and ecstasy) as less harmful than they actually are, without taking
into consideration their long-term effects and the effects they have on adolescent

development, especially of certain critical cognitive functions like the capacity to memorize.
[8]

While ecstasy is said to have little or no side effects, studies show that its use alters,
perhaps permanently, certain brain functions and damages the liver and other body organs.
Although not listed as illicit, inhalants are widely abused, especially by disadvantaged youth.
Some of these volatile substances, which are present in many products such as glue, paint,
gasoline and cleaning fluids, are directly toxic to the liver, kidney or heart, and some produce
progressive brain degeneration. [8]
The major problem with psychoactive drugs is that when people take them, they focus
on the desired mental and emotional effects and ignore the potentially damaging physical and
mental side effects that can occur. There is no illicit drug that can be considered safe. In one
way or another, the use of psychoactive substances alters the normal functioning of the
human body, and in the long run, can cause serious damage [8].
1.6.1 Physical warning signs of drug abuse [9]
1.6.2 Behavioral signs of drug abuse [9]
1.6.3 Psychological warning signs of drug abuse [9]
1.7 Causes of drug abuse
When we take drugs, for either medical purposes or recreation, there is a benefit or
reward that we are trying to achieve. For example, pain medication is intended to bring relief
to an injured or stressed area of our body. The beginning stages of drug abuse causes us to
crave more and to use more. The unintended consequences of that is our need to take more
and more of the drug to get the same result. [10]
Many factors can cause drug addiction. However, with the right drug addiction
treatment, anybody can be reformed to lead a healthy, productive life. Drug abuse causes the
pathways inside the brain to be altered. The drug brings on physical changes in the nerve
cells. These cells (neurons) communicate with each other releasing neurotransmitters into the
gaps or synapses between the nerve cells. This makes some drugs are more addictive than
others are. Several other factors contribute to drug abuse. Well go into greater detail on
another page, but for now the major factors are ones genetic makeup, personality and peer
pressure. Again, we will explain these as we go along. [6]
1.8 Obtaining prescription drugs
Most prescriptions are written for people who have a true medical need for these
drugs. But many households have a drawer or cabinet filled with old prescription bottles
containing leftover drugs. Because prescription drugs have medical uses, teens often believe
these drugs are a safe alternative to street drugs. In some cases, a doctor's prescription is not

even needed. Some countries do not require prescriptions for opioid painkillers or other
commonly abused drugs, so they can be obtained from some websites without a prescription.
Obtaining drugs online from pharmacies that do not require a prescription can be risky. Some
websites sell counterfeit drugs that contain potentially dangerous substances. [7]
1.9 Risk Factors of drug abuse
Genetic/Inherited
We are all a product of our parents. If your parents have addiction struggles, chances
are you are more susceptible to addiction. That is, why drug abuse is more common in some
families than in others. If your parents smoke, chances are good you will smoke. If your
parents used alcohol, probably follow and use that drug in much the same way. If your father
was an alcoholic, you have a predisposition to abusing that drug. Drug abuse causes one
generation to pass it on to the next. [7]
Personality
Aside from the inherited factors, some people have a personality that is more likely to
become drug dependent. People are curious, so that alone can lead a person to try a drug. We
experiment and see what happens. We are looking to relax and have pleasure. We all want to
feel good, and we are by nature impatient. Drugs give us an instant gratification that other
things do not, so for that moment or hour of for whatever timeframe, we feel good. We want
what we want. Someone diagnosed with depression, attention deficit disorder, or
hyperactivity. Maybe there has been some stress, or anxiety in their life. Whatever the case,
these are contributing factors. Even some common personality characteristics, such as
aggression, may be a factor. Children who do not have confidence, healthy self-esteem may
be prone to turning to drugs to fill the void. Drug abuse causes negative changes in
personality that can lead to an even more destructive behavior. [9]
Peer Pressure/Social
We are all wired to have relationships, and sometimes those relationships cause us to
give in to something we otherwise would avoid in order to maintain the relationship. Peer
pressure is huge and nowhere is this greater than during our teenaged years. Kids want to be
cool. It begins as a social action, to take the drugs to be a part of the group, to be accepted.
Its not just teenagers, as peer pressure takes so many different forms. There is social
etiquette, for example, to take a drink during a party. Im a social drinker. How many times
have you heard that? Some people actually believe that drug abuse causes you to be accepted
and part of the 'popular' group. [9]
Easy Access

If one wants to get drugs, he or she will not have to look far because they are
everywhere. High school students can tell you this. Drug abuse causes people to sell drugs to
the most vulnerable population, children. It is not just the stereotypical poor sections of the
inner city that serve as the hotbed for drugs. Drugs are found in suburban shopping malls,
rural schools, and well-to-do private school, on the job in factories, offices and remote job
sites. [9]
Race, Ethnicity
We include this heading because we want to stress that there is no data to support any
claim that one race of people or any particular cultural group is more prone to drug abuse
than another. Drug abuse is a human problem and crosses all boundaries. Drug abuse causes
do not include race. [9]
Loneliness, Depression
We want to feel good physically and emotionally. Sometimes drugs are the
substitution for a healthy life experience. The person in pain and they want to numb the pain.
The drug numbs the pain and for a moment, they do not feel as poorly. The person needs to
escape the pain of the life experience, and for a short while, the drug takes them away and
they feel better. [9]
Anxiety
Sometimes people need some help coping with life. Everyday life becomes a struggle
and simple things become too much to handle. Drugs are used to deal with it. In the case of
addiction, we are not talking about the use of medication, under the care and observation of a
doctor. People who have been clinically diagnosed with anxiety can lead a very good life.
Were talking here about people who just need to escape. Their drug of choice facilitates that
escape. [9]
1.10 Types of Drug abuse
When talking about causes and factors leading to drug abuse, it is necessary to take a
moment and look at the various types of drugs. As we mentioned before, these all have their
characteristics. [9]
1.11 Drug addiction
Addiction is a chronic, often relapsing brain disease that causes compulsive drug
seeking and use despite harmful consequences to the individual who is addicted and to those
around them. Drug addiction is a brain disease because the abuse of drugs leads to changes in
the structure and function of the brain. Although it is true that for most people the initial
decision to take drugs is voluntary, over time the changes in the brain caused by repeated
drug abuse can affect a person's self control and ability to make sound decisions, and at the
same time send intense impulses to take drugs. [10]

It is because of these changes in the brain that it is so challenging for a person who is
addicted to stop abusing drugs. Fortunately, there are treatments that help people to
counteract addiction's powerful disruptive effects and regain control. [9]
Research shows that combining addiction treatment medications, if available, with
behavioral therapy is the best way to ensure success for most patients. Treatment approaches
that are tailored to each patient's drug abuse patterns and any co-occurring medical,
psychiatric, and social problems can lead to sustained recovery and a life without drug abuse.
[10]

The word addiction means getting habituated with something. In case of drugs when a

human body gets dependent on some stimulating things, and after a certain period it creates a
habit, which means that the body has become dependent on the stimulant, which is addiction.
[11]

World Health Organization (WHO) defines it: Drug is a chemical substance of synthetic,

semi synthetic or natural origin intended for diagnostic, therapeutic or palliative use or for
modifying physiological functions of man and animal. [10]
Addiction is a complex disorder characterized by compulsive drug use. People who
are addicted feel an overwhelming, uncontrollable need for drugs or alcohol, even in the face
of negative consequences. This self-destructive behavior can be hard to understand. The
answer lies in the brain. Repeated drug use alters the brain causing long-lasting changes to
the way it looks and functions. These brain changes interfere with your ability to think
clearly, exercise good judgment, control your behavior, and feel normal without drugs. These
changes are also responsible, in large part, for the drug cravings and compulsion to use that
make addiction so powerful. Addiction is influenced by a person's biology, social
environment, and age or stage of development. The more risk factors an individual has, the
greater the chance that taking drugs can lead to addiction. [10]
1.12 Biology
The genes that people are born with in combination with environmental influences -account for about half of their addiction vulnerability. Additionally, gender, ethnicity, and the
presence of other mental disorders may influence risk for drug abuse and addiction. Many
studies show how alcohol affects the brain and many of the physical aspects of the body.
What this article seeks to explain is the body systems that are tied to addiction. There are
many different reasons that a person might initially become alcohol dependent. A person
might drink because he or she is impulsive, stressed, depressed or seeking some form of
pleasure experience. Once a drinking pattern is established, there is a common neurobiology
experienced by all people and this article aims to explain some of the neurobiological
changes that are involved in addiction. [11]

1.12.1 The Neurotransmitter System

To understand how alcohol use associated with alcohol dependence affects brain
function, it is important to understand how neurons communicate with each other through
electrical and chemical signals. Nerve signals are transmitted from one region of the brain to
another region of the brain or to the rest of the body through communication between two or
more neurons located next to each other. [11]
When a neuron is activated, an electrical signal is generated which travels along the
membrane surrounding the neuron body and the axon the long extension protruding from
the neuron body. When the signal reaches the end of the axon, it triggers the release of
neurotransmitters from the cell. These neurotransmitters travel across the narrow space
separating one neuron from another. On the signal-receiving neuron, the neurotransmitter
molecules then interact with receptors, and this interaction either promotes or prevents the
generation of new electrical signals in that neuron, depending on the neurotransmitters
involved. [12]
Many neurotransmitters can have both excitatory and inhibitory effects, depending on
which brain region is studied and which receptors are present on the signal-receiving neurons.
Neurotransmitters that often have excitatory effects include dopamine, glutamate, and
serotonin; the neurotransmitter that primarily has inhibitory effects is gamma-amino butyric
acid. Alcohol is said to possess acute positive reinforcing effects because of its interactions
with individual transmitter systems within the general reward circuitry of the brain. [12]
The intracellular events elicited by alcohol can lead to changes in many other neural
processes, including those that trigger long-term alcohol effects which eventually lead to
tolerance, dependence, withdrawal, sensitization and, ultimately, addiction. The general
reward circuitry of the brain centers on connections between the ventral tegmental area and
the basal forebrain (which includes the nucleus accumbens, olfactory tubercle, frontal cortex,
and amygdala). Because the neurotransmitters help to complete these connections in the
brain, they are primary elements in the neurobiological study of addiction. [12]
1.12.2 Excitatory Neurotransmitters
Neurotransmitters that increase the excitability of neurons and promote the generation
of a new nerve signal.
Dopamine
Dopamine is a chemical naturally produced in the body. We depend on our brain's
ability to release dopamine in order to experience pleasure and to motivate our responses to
the natural rewards of everyday life, such as social interaction, the sight or smell of food and
the immediate reinforcing properties of all drugs of misuse, including alcohol.

Activation of the mesolimbic pathway increases the firing of dopamine neurons in the
ventral tegmental area (VTA) of the midbrain and subsequently increases dopamine release
into the nucleus accumbens and other areas of the limbic forebrain, such as the prefrontal
cortex. Alcohol activates the mesolimbic pathway indirectly, by activating beta-endorphins
that innervate the ventral tegmental area and the nucleus accumbens, producing a net effect of
excitation as information is transmitted to the dopamine receptors in these brain areas. It is
thought that antagonists of dopamine, GABA, opioid, and serotonin, may decrease the
rewarding properties of alcohol and drugs of abuse, resulting in reduced consumption.
Positron Emission Topography studies have allowed researchers to directly investigate the
role of dopamine and the reward system in alcohol consumption in humans. [12]
1.12.3 The Endogenous Opioid System
Endogenous opioids are small protein molecules (i.e., peptides) formed naturally in
the body and chemically related to morphine and heroin. These opioids are produced
primarily in the pituitary gland and brain. They apparently act like excitatory
neurotransmitters to stimulate neurons. They are involved in various physiological processes,
such as pain relief, stress response, euphoria, and the rewarding and reinforcing effects of
various drugs, including alcohol. Three distinct families of endogenous opioids exist:
endorphins, enkephalins, and dynorphins. The most potent endogenous opioid is betaendorphin. [14]
1.12.4 Endogenous Opioids and Alcohol
One-time alcohol ingestion in both humans and experimental animals may stimulate
the release of endogenous opioids in both the brain and the rest of the body. Thus, the body
may respond to alcohol as if the person had ingested a small quantity of an opioid drug. A
special protein called the mu-opioid receptor, which is located in the membranes of nerve
cells, detects internal opiate neurotransmitters, such as beta-endorphin, that the brain uses to
allow nerve cells to communicate with each other. A specific gene (named OPRM1) encodes
the mu-opioid receptor.[15]
1.12.5 The HPA Axis the stress response system
The hypothalamic-pituitary adrenal (HPA) axis is a hormone system that plays a
central role in the body's stress response. This axis involves hormones that are produced in
the brain's hypothalamus and anterior pituitary gland as well as in the adrenal glands atop the
kidneys. This system, which controls a wide variety of metabolic functions, is activated in
response to all kinds of stress, both physical and psychological.[15]

1.12.6 The HPA Axis and Alcohol

A person experiencing stress may be more likely to turn to alcohol to find relief (i.e.
relief drinking) and thus may be more sensitive to the relieving effects of alcohol creating a
pathway to heavy use and even dependence. Ingestion of small amounts of alcohol can
biochemically prepares a person to cope with subsequent stress. [16]
1.12.7 Serotonin
The excitatory neurotransmitter serotonin helps regulate such functions as bodily
rhythms, appetite, sexual behavior, and emotional states. Serotonin subtly modifies the
function of neurons by interacting with receptors on the neuron's surface. It is an important
modulator within what is called the behavior inhibition system and it is very likely influenced
by genetics, and early stress experiences. [16]
1.12.8 Glutamate
Glutamate exerts its effects by interacting with several types of receptors, including
one called the N-methyl-D-aspartate (NMDA) receptor. Alcohol acts on these NMDA
receptors,

inhibiting

their

functions

and

thereby

diminishing

glutamate-mediated

neurotransmission. NMDA receptors may play a role in memory formation. Prenatal, acute,
or chronic alcohol exposure may hinder the person's ability to learn and to retain new
information. [11]
1.12.9 Inhibitory Neurotransmitters
Inhibitory neurotransmitters are neurotransmitters that reduce the excitability of
neurons and prevent the generation of a new nerve signal. [16]
GABA
Gamma-aminobutyric acid (GABA) is the primary inhibitory neurotransmitter in the
mammalian central nervous system that carries signals between certain nerve cells. It
modulates the activity of neurons by binding to GABA-specific receptors (GABAA,
GABAB, etc) in their cell membranes and literally inhibiting their ability to respond to
signaling. GABA actions are mediated primarily by the GABAA receptor. [15]
Alcohol and GABA
Alcohol consumption causes motor incoordination and sedation as does high activity
of inhibitory neurotransmitters, therefore researchers have suspected that GABA and the
GABAA receptor contribute to alcohol's effects on the brain In a study done in 1995,
researchers Nevo and Hamon discovered that alcohol appears to enhance the inhibitory
actions of GABA. Chronic alcohol consumption leads to a decline in the number of GABA
receptors in the brain and thus reduces GABA's ability to bind to its receptors. [15]
1.12.10 Genetics

It is estimated that 4060% of the vulnerability to addiction is attributable to genetic

factors. Genetic differences in the body's hormonal responses to stress and alcohol ingestion
exists between people. Those differences likely play an important role in determining a
person's sensitivity to alcohol's pleasurable effects, level of craving for alcohol, and extent of
vulnerability to excessive drinking and alcohol dependence. In animal studies, several genes
have been identified that are involved in responses to drugs and alcohol, and experimental
modification of these genes has reduced the self-administration of drugs and alcohol by the
animal subjects. [15]
1.13 Drugs of abuse
Opiates
The opiates and their synthetic analogues are the most effective analgesic agents
known, and at the same time can produce tolerance, dependence (including somatic
dependence), and addiction. Physical dependence on opiates can contribute to addiction, but
can also occur independently of it. For example, patients with cancer pain may become
physically dependent on these drugs but do not compulsively abuse them. [17]
Nicotine
Nicotine is the main psychoactive ingredient of tobacco and is responsible for the
stimulant effects, reinforcement, and dependence that result from tobacco use. Cigarette
smoking rapidly delivers nicotine into the bloodstream. Nicotine differs from cocaine and
opiates in that it is powerfully reinforcing in the absence of subjective euphoria. The effects
of nicotine are caused by its activation of nicotinic acetylcholine receptors (nAChRs).
Nicotinic AChRs are ligand-gated cation channels located both presynaptically and
postsynaptically. Presynaptic nAChRs facilitate neurotransmitter release. The reinforcing
effects of nicotine depend on an intact mesolimbic dopamine system. Nicotine induced
increases in locomotor behavior are also blocked by destruction of mesolimbic dopamine
nerve terminals or cell bodies. Moreover, nicotine increases dopamine neurotransmission and
energy metabolism in the nucleus accumbens. [15]
Cannabinoids
Tetrahydrocannabinol (THC) is the major psychoactive compound contained in
marijuana. THC produces fects in humans that range from mild relaxation, euphoria,
analgesia, and hunger to panic attacks. Reinforcing effects of cannabinoids comparable to
those of other addictive drugs have not been demonstrated in animals, but cannabinoids have
been shown to decrease reward thresholds andpromote conditioned place preference in rats.
THC increases mesolimbic dopamine transmission in the NAc shell, probably via a opioid
receptor-mediated mechanism because receptor antagonists prevent the THCinduced

dopamine increases in the brain mesolimbic area . Cannabinoids have also been reported to
inhibit excitatory glutamatergic neurotransmission in the substantia nigra pars reticulate. [18]
Phencyclidine-Like Drugs
Phencyclidine (PCP or angel dust)and ketamine are related drugs classified as
dissociative

anesthetics. These drugs exhibit psychotomimetic properties, but are

distinguished from hallucinogens by their distinct pharmacologic effects, including their

reinforcing properties and risks related to compulsive abuse. The reinforcing properties of
PCP and ketamine are mediated by the binding to specific sites in the channel of the NMDA
glutamate receptor, where they act as noncompetitive NMDA antagonists. PCP is selfadministered directly into the NAc, where its reinforcing effects are believed to result from
the blockade of excitatory glutamatergic input to the same medium spiny NAc neurons
inhibited by opioids, and also by increases in extracellular dopamine. In contrast,
hallucinogens, such as LSD, act at 5-HT2 serotonin receptors. [18]
1.14 Effects of Drug on body
Drugs are chemicals that tap into the brain's communication system and disrupt the
way nerve cells normally send, receive, and process information. There are at least two ways
that drugs are able to do this: (1) by imitating the brain's natural chemical messengers, and/or
(2) by over stimulating the "reward circuit" of the brain. Some drugs, such as marijuana and
heroin, have similar structures to chemical messengers, called neurotransmitters, which are
naturally produced by the brain. Because of this similarity, these drugs are able to "fool" the
brain's receptors and activate nerve cells to send abnormal messages. Other drugs, such as
cocaine or methamphetamine, can cause the nerve cells to release abnormally large amounts
of natural neurotransmitters, or prevent the normal recycling of these brain chemicals, which
is needed to shut off the signal between neurons. This disruption produces a greatly amplified
message that ultimately disrupts normal communication patterns. [19]
Nearly all drugs, directly or indirectly, target the brain's reward system by flooding
the circuit with dopamine. Dopamine is a neurotransmitter present in regions of the brain that
control movement, emotion, motivation, and feelings of pleasure. The overstimulation of this
system, which normally responds to natural behaviors that are linked to survival (eating,
spending time with loved ones, etc), produces euphoric effects in response to the drugs. This
reaction sets in motion a pattern that "teaches" people to repeat the behavior of abusing drugs.
[20]

As a person continues to abuse drugs, the brain adapts to the overwhelming surges in
dopamine by producing less dopamine or by reducing the number of dopamine receptors in
the reward circuit. As a result, dopamine's impact on the reward circuit is lessened, reducing
the abuser's ability to enjoy the drugs and the things that previously brought pleasure. This

decrease compels those addicted to drugs to keep abusing drugs in order to attempt to bring
their dopamine function back to normal. And, they may now require larger amounts of the
drug than they first did to achieve the dopamine high an effect known as tolerance. [20]
Long-term abuse causes changes in other brain chemical systems and circuits as well.
Glutamate is a neurotransmitter that influences the reward circuit and the ability to learn.
When the optimal concentration of glutamate is altered by drug abuse, the brain attempts to
compensate, which can impair cognitive function. Drugs of abuse facilitate nonconscious
(conditioned) learning, which leads the user to experience uncontrollable cravings when they
see a place or person they associate with the drug experience, even when the drug itself is not
available. Brain imaging studies of drug-addicted individuals show changes in areas of the
brain that are critical to judgment, decisionmaking, learning and memory, and behavior
control. Together, these changes can drive an abuser to seek out and take drugs compulsively
despite adverse consequences in other words, to become addicted to drugs. [20]
1.15 Myths about Drug Addiction and Substance Abuse
MYTH 1: Overcoming addiction is a simply a matter of willpower. You can stop
using drugs if you really want to. Prolonged exposure to drugs alters the brain in ways that
result in powerful cravings and a compulsion to use. These brain changes make it extremely
difficult to quit by sheer force of will. [20]
MYTH 2: Addiction is a disease; theres nothing you can do about it. Most experts
agree that addiction is a brain disease, but that doesnt mean youre a helpless victim. The
brain changes associated with addiction can be treated and reversed through therapy,
medication, exercise, and other treatments. [20]
MYTH 3: Addicts have to hit rock bottom before they can get better. Recovery can
begin at any point in the addiction processand the earlier, the better. The longer drug abuse
continues, the stronger the addiction becomes and the harder it is to treat. Dont wait to
intervene until the addict has lost it all. [20]
MYTH 4: You cant force someone into treatment; they have to want help. Treatment
doesnt have to be voluntary to be successful. People who are pressured into treatment by
their family, employer, or the legal system are just as likely to benefit as those who choose to
enter treatment on their own. As they sober up and their thinking clears, many formerly
resistant addicts decide they want to change. [20]
MYTH 5: Treatment didnt work before, so theres no point trying again; some cases
are hopeless. Recovery from drug addiction is a long process that often involves setbacks.
Relapse doesnt mean that treatment has failed or that youre a lost cause. Rather, its a signal
to get back on track, either by going back to treatment or adjusting the treatment approach. [20]
1.16 Stages of addiction

Addiction has some stages

1.16.1 Initial stage (starting)
This is the first stage of drug addiction. At first, a person starts to take drug without
concerning his body. At the early stage he takes it just normally, and gets the ordinary
happiness, which makes him feel better. Sometimes, he wants to touch heavenly excitement
and dreams himself as a floating constituent in the sky. This is the first stage of drug abusing.
Amateurs are in this group. They take drug once or twice a week with their friends or seniors
in their locality, who are already addicted. He collects it and processes it to take. [3]
1.16.2 Pre-mature stage (the real test of drug)
In this stage, drugs become a habit, and the abuser wants more. Feeling better, s/he
tries to increase the dosage drugs. It is taken at least 4-5 times a week. This is the primary
stage for abusers in becoming addicted. At the initial stage they can easily manage or collect
the money for purchasing. They collect money from their family, and sometimes from other
sources. They take drugs with their friends. After a few days they need to take more and
become dependent on it both mentally and physically. The sudden need for excess money,
involves them in criminal acts like hijacking, and they feel thrilled to do it. [3]
1.16.3 Mature stage
After the pre-mature stage, abusers become seriously addicted. They have to take it
every day, after a certain period. In maximum of cases, it is taken from evening to night time.
For that, they are busy all day long in collecting the expenditure of drug. They need much
more money for it and sometimes they turn against the law. Many discontinue their education
after failing to concentrate on any kind of discipline. They forget social protocol, always
remain bad tempered and feel they are always in the right. They do not want to hear any
advice and count themselves as very aware and competent. Sometimes they feel frustrated
and even lose the will to live. [3]
1.16.4 Decaying stage
After mature stage, most of the abusers stay on the verge of decaying. It means
gradually their lives crumble. They can realize how imbalanced they are. They lose taste for
food. At this stage they become fully dependent on drug, gradually after a few hours they
have to take it, otherwise their body system stops. In that situation the abuser loses human
characteristics and behaves like a monster. They have no sense to evaluate good or bad, to
enjoy anything; they lose interest in normal male/female yeaning. Finally, one day they fully
surrender to drugs, which lead them to their graves. [3]
1.17 Causes of addiction
People abuse drugs for a number of different reasons. The most common reason why
people abuse drugs is to "get high." Adolescents and preadolescents can become involved in

experimentation with drugs. However, only a small percentage of people who experiment
with drugs become drug abusers. The desire to get high may be from an underlying disease
such as depression. It may also come from the pressures of coping with school, work, or
family tensions. Drug abuse by pregnant women results in the developing fetus (baby) being
exposed to these same drugs. The baby may develop birth defects. The baby may be born
with an addiction and go into withdrawal. The baby may be born with a disease associated
with drug abuse such as HIV/AIDS. People with specific medical conditions, such as chronic
pain from cancer, can become dependent on certain drugs but not addicted in the sense they
would steal a stereo to pay for the drugs. Many psychiatric diseases can be complicated by
substance abuse. Similarly, drug abuse may be a sign of a more serious mental health
problem. [22]
Athletes have abused a variety of agents, such as steroids, to enhance muscle mass or
improve athletic ability. Athletes have also abused amphetamines to make them feel more
powerful and to mask pain so they can continue to play even with injuries. Drug testing
programs have reduced this problem to some extent, but drug use among athletes is still a
problem worldwide. [21]
1.18 Drug Dependence & Abuse Symptoms
The signs and symptoms displayed by a person depend on what substances the person
has abused. A person who has not abused drugs extensively may experience unpleasant
symptoms and may seek help from family members and friends. Chronic drug abusers
generally know what to expect from their drug use and rarely seek help for themselves. Most
agents cause a change in level of consciousnessusually a decrease in responsiveness. A
person using drugs may be hard to awaken or may act bizarrely. Suppression of brain activity
can be so severe that the person may stop breathing, which can cause death. Alternatively, the
person may be agitated, anxious, and unable to sleep. Hallucinations are possible. Abnormal
vital signs (temperature, pulse rate, respiratory rate, blood pressure) are possible and can be
life threatening. Vital sign readings can be increased, decreased, or absent completely.[22]
Sleepiness, confusion, and coma are common. Because of this decline in alertness, the
drug abuser is at risk for assault or rape, robbery, and accidental death. Skin can be cool and
sweaty, or hot and dry. Chest pain is possible and can be caused by heart or lung damage
from drug abuse. Abdominal pain, nausea, vomiting, and diarrhea are possible. Vomiting
blood, or blood in bowel movements, can be life threatening. Withdrawal syndromes are
variable depending on the agent but can be life threatening. Sharing IV needles among people

can transmit infectious diseases, including HIV (the virus that causes AIDS) and hepatitis
types B and C. [24]
Many common household drugs and chemicals can be abused. Gasoline and other
hydrocarbons are frequently abused by adolescents and preadolescents. Over-the-counter
drugs, such as cold medications, are commonly taken in excessive doses by adolescents and
young adults to get high. Prescription medications are additional examples of drugs that are
abused and that can be obtained illegally (without a prescription). Amphetamines and cocaine
cause impotence in men. Cocaine and amphetamine users to counteract impotence have used
Sildenafil (Viagra). Because Viagra is generally prescribed for middle-aged and older men, a
younger person must be questioned as to why he has a need for Viagra. [25]
1.19 Ways of taking substance as a drug
Substances can be taken into the body in several ways:
1.20 Drug Dependence & Abuse Treatment
Self-Care at Home
If a drug has been ingested inappropriately, contact a local chapter of the American
Association of Poison Control Centers. Visiting an emergency department is usually
appropriate to obtain proper treatment. Home care is not appropriate if the drug of abuse
cannot be identified. People who have ingested unknown drugs should be taken to the
emergency department. People with severe symptoms should not be treated at home. They
should be taken directly to the emergency department. The key to treatment is stopping the
abuse of the drugs or substances. Agitated or violent people need physical restraint and may
need sedating medications in the emergency department until the effects of the drugs wear
off. This can be disturbing for the person to experience and for family members to witness.
Medical professionals go to great lengths to use as little force and as few medications as
possible. [25]
It is important to remember that whatever the medical staff does, it is to protect the
person. Very few antidotes are available for drug intoxications. In most cases, the only way to
eliminate a drug is for the body to metabolize itin other words, let it run its course. In some
acute intoxications, the doctor may administer certain agents to help prevent absorption in the
stomach or to help speed metabolism of the drug. The dose of some agents (for example,
benzodiazepines and barbiturates) must be reduced slowly to prevent withdrawal. Withdrawal
from some drugs can cause significant problems, and stopping these drugs should only be
done under the supervision of an appropriate health care provider. [25]

Withdrawal from other agents, such as narcotics, is uncomfortable but generally not
harmful and unpleasant effects can be lessened with prescription medications. These
prescriptions must be combined with a specific plan for stopping drug abuse. The use of the
prescription medication combined with continued drug abuse may cause life-threatening
complications.
People who are acutely intoxicated may need hospitalization for detoxification. Some
cities have detoxification centers for sobering from drug and alcohol intoxication. Counseling
programs may be suggested. Programs similar to Alcoholics Anonymous, such as those listed
through the Web of Addictions, are helpful for some. [27]
Follow-up
The initial evaluation by a doctor is just the first step in battling drug abuse. Followthrough in drug avoidance is essential to successful treatment. It will generally be necessary
to discharge the person from the emergency department into the care of a sober adult.
Activities that require skill and judgment, such as driving, high-speed activities (bicycling,
skateboarding), operating machinery, and swimming (even bathtub use) should not be
undertaken until all the effects of the drug have worn off. Joining support groups like
Alcoholics Anonymous or Narcotics Anonymous can be intimidating, but such groups are
very helpful for some people. A social worker at the hospital can advise on local resources
available. [27]
Prevention
Prevention involves avoiding places frequented by drug abusers and not associating
with known drug abusers. Knowledge about drug use and abuse is key to preventing abuse in
the first place and avoiding relapse among those who are recovering. [27]
Outlook
Treatment of drug dependence and abuse requires a long-term outlook. A person who
has abused drugs in the past must be constantly vigilant never to use them again. Relapses are
common. Family and friends must provide support with a caring attitude during these
relapses. [27]
1.21 Some Findings from other survey
1.
Opinion on how the respondents were drug abused
2.
Reasons for being addicted to drugs
3.
Sources of money for buying drugs
4.
Where from respondents collect drugs/the nearest drug spots
5.
Persons involved in drug business/smuggling: Respondents opinion
6.
Causes why respondents change drugs one after another
7.
Negative effects due to drug abusing: Respondents view
8.
Suggestions of respondents to get rid of drug addiction
9.
Changes in social behavior according to the respondents

1.22. Addictive behaviors

Any activity, substance, object, or behavior that has become the major focus of a
person's life to the exclusion of other activities, or that has begun to harm the individual or
others physically, mentally, or socially is considered an addictive behavior. A person can
become addicted, dependent, or compulsively obsessed with anything. Some researchers
imply that there are similarities between physical addiction to various chemicals, such as
alcohol and heroin, and psychological dependence to activities such as compulsive gambling,
sex, work, running, shopping, or eating disorders. [25]
It is thought that these behavior activities may produce beta-endorphins in the brain,
which makes the person feel "high." Some experts suggest that if a person continues to
engage in the activity to achieve this feeling of well-being and euphoria, he/she may get into
an addictive cycle. In so doing, he/she becomes physically addicted to his/her own brain
chemicals, thus leading to continuation of the behavior even though it may have negative
health or social consequences. Others feel that these are just bad habits. [28]
Most physical addictions to substances such as alcohol, heroin, or barbiturates also have a
psychological component. For example, an alcoholic who has not used alcohol for years may
still crave a drink. Thus some researchers feel that we need to look at both physical and
psychological dependencies upon a variety of substances, activities, and behaviors as an
addictive process and as addictive behaviors. They suggest that all of these behaviors have a
host of commonalities that make them more similar to that different from each other and that
they should not be divided into separate diseases, categories, or problems. [29]
1.22.1 Common Characteristics among Addictive Behaviors
There are many common characteristics among the various addictive behaviors:
1. The person becomes obsessed (constantly thinks of) the object, activity, or substance.
2. They will seek it out, or engage in the behavior even though it is causing harm (physical
problems, poor work or study performance, problems with friends, family, fellow workers).
3. The person will compulsively engage in the activity, that is, do the activity over and
over even if he/she does not want to and find it difficult to stop.
4. Upon cessation of the activity, withdrawal symptoms often occur. These can include
irritability, craving, restlessness or depression.
5. The person does not appear to have control as to when, how long, or how much he or
she will continue the behavior (loss of control). (They drink 6 beers when they only wanted
one, buy 8 pairs of shoes when they only needed a belt, ate the whole box of cookies, etc).
6. He/she often denies problems resulting from his/her engagement in the behavior, even
though others can see the negative effects.

7. Person hides the behavior after family or close friends have mentioned their concern.
(Hides food under beds, alcohol bottles in closets, doesn't show spouse credit card bills, etc).
8. Many individuals with addictive behaviors report a blackout for the time they were
engaging in the behavior (don't remember how much or what they bought, how much the lost
gambling, how many miles they ran on a sore foot, what they did at the party when drinking)
9. Depression is common in individuals with addictive behaviors. That is why it is
important to make an appointment with a physician to find out what is going on.
10. Individuals with addictive behaviors often have low self esteem, feel anxious if they do
not have control over their environment, and come from psychologically or physically
abusive families. [27]
The behavior of addicted people is the most visible part of addiction and thus the
easiest to focus attention on. Addictive behavior such as addictively overspending,
compulsively going to pornographic bookstores, and bingeing on and purging food regularly
occurs only after the development of the addictive personality. These behaviors are all signs
that the person is out of control on an internal level. As the addiction develops, the person
also becomes out of control on a behavioral level. In the early stages of addiction, the
addicted person is able to contain addiction to the degree that there are few episodes of being
behaviorally out of control. Gradually these episodes become more and more frequent, as the
person becomes much more preoccupied with the object or event. It is in this stage that others
start to notice that something is wrong or abnormal. Others start to see the presence of the
Addict. [25]
At first, the addict was able to behave largely within socially acceptable limits. The
addictive gambler gambled mostly within acceptable limits; the food addict ate mostly within
normal limits; the alcoholic drank socially most of the time. But inside all of these people,
there starts to develop a deep and totally consuming mental dependency. In the development
of the behavioral dependency, a person starts to act out their addictive belief system in a
ritualistic manner, and the peoples behavior becomes more and more out of control. [27]
Once an addictive personality has established control emotionally and mentally, the
person becomes dependent on the addictive personality, not on the mood change or the object
or event. The addictive belief system itself becomes the addict's foundation, and it develops
into a lifestyle. It is in this stage of the addictive cycle that addicts start to arrange their lives
and relationships using addictive logic to guide them. Their behavioral commitment to the
addictive process becomes all-encompassing. [27]
There are many ways a personal behavior adapts to the addictive process, bringing
about an addictive lifestyle. Betrayal of Self and others becomes a regular occurrence. The
person starts to lie to others, even when it is easier to tell the truth. The person starts to blame

others, knowing others are not to blame. The person starts to ritualize his or her behavior. The
person starts to withdraw from others. Not only will the person have a secret world to
withdraw to emotionally and mentally, but also a physical secret world in which he or she
lives out an addictive lifestyle. [29]
It is in this stage that food addicts may start hiding or starving themselves. It is in this
stage that sex addicts may start going to prostitutes or having multiple affairs. It is in this
stage that addictive gamblers may open secret bank accounts or get secret jobs. It is in this
stage that alcoholics may begin to have a couple of quick shots and a few breath mints before
going home. [27]
Each of these examples shows a behavioral commitment to the addictive process.
Each time people act out in these ways, they are depending more on the addictive process and
its logic and less on themselves and others who love them. Addicts must make sense of this to
themselves, and they do so by denying the fear and pain caused by their inappropriate
behavior. This is where the addict turns to denial, repression, lies, rationalizations, and other
defenses to help cope with what is happening. [27]
Thus, whenever addicts act out and then explain their actions away, they
unintentionally deepen their commitment to addiction. Whenever addicts act out, they must
emotionally and mentally withdraw into the addictive personality to receive support for
acting out. This inward motion isolates them from the world and others around them, causing
them to lose more of their humanity. This creates loneliness and a longing to reach out and
connect, which internally becomes another signal to act out. [29]
This addictive process has the power and ability to create a need for itself. Through
repeated acting out combined with mental obsession, another form of commitment to the
Addict will now steadily establish more and more control. The behavioral loss of control is an
expression of the internal loss of control by the Self to the Addict. [29]
1.22.2 What Causes Addictive Behaviors
There is no consensus as to the etiology (cause), prevention, and treatment of
addictive disorders. A United States government publication, "Theories on Drug Abuse:
Selected Contemporary Perspectives," came up with no less than forty-three theories of
chemical addiction and at least fifteen methods of treatment .As an example of this confusion,
many people consider addictive behaviors such as gambling and alcoholism as "diseases," but
others consider them to be behaviors learned in response to the complex interplay between
heredity and environmental factors. Still others argue for a genetic cause. [29]
Some researchers point out that, unlike most common diseases such as tuberculosis,
which has a definite cause (a microbe) and a definite treatment model to which everyone

agrees, there is no conclusive cause or definite treatment method to which everyone agrees
for most of the addictive behaviors. This lack of agreement among experts causes problems
with prevention and treatment approaches for many addictive behaviors. Professionals debate
whether total abstinence or controlled and moderate use of a substance (such as alcohol) or
activity (such as gambling) is effective. [29]
Others debate whether or not a medication is a desirable treatment method. In the area
of addiction to food or exercise, of course, few advocate total abstinence as a solution.
Though the theories for the causes of addictive behaviors and their treatment are numerous,
various types of therapy can help a person who has an addictive behavior. If you think you,
or a family member, might be addicted to a substance, activity, object, or behavior, please talk
to your family physician, clergy person, counselor, or seek out a support group for the
problem. [30]
1.24 Perception of addicted people
While most people are aware of the disease model of addiction, many of them claim
to recognize it as a disease but harbor deep rooted prejudice beneath the surface. What they
say they believe and what they actually believe are often two different things. Addicts are
suffering from a disease that affects the part of their body they use to make decisions so in
actuality it is hitting them twice. The part of their body that they would need in order to get
themselves some help is the very part of them that is being afflicted. It is a double edged
sword. [29]
On top of the fact that diseased thinking is so difficult to break through, there is this
social stigma that is attached to addiction. In the same way that there is still a stigma attached
to mental illness which, lets face it, is pretty much what were talking about here there is
some level of blame that gets attached to addiction and in the back of our minds we think
Well, its your own fault. It is no more an addicts fault that they are an addict than it is a
diabetics fault that they have diabetes. Its a sickness, pure and simple. And yet there is some
sense of judgment that gets attached somewhere along the way. Addicts do some crazy stuff
along the way and it can be difficult to separate the behavior from the person. [29]
However, until we start treating addiction as a disease, it is going to be an uphill
battle for addicts to seek out help. We need to stop treating addiction as though it is a
character flaw and start acknowledging it as a legitimate illness. Society holds many different
views on alcohol and substance addiction. Some people, often those working in the field of
drug and alcohol treatment, see addiction as a disease for which people need intervention.
Others, often those with the addiction, do not see it as a problem but rather as a behavior that
brings them some satisfaction, albeit short-lived. But, it seems that the majority of people,

even some professionals in the field and some addicts themselves, view addiction as a result
of moral weakness. [30]
Holding the view that addiction is a matter of moral infirmity causes problems, not
just for addicts, but for our society as a whole. People typically come to inaccurate
conclusions like this one because they want a simple answer to a baffling phenomenon, and
they also want to protect themselves from the idea that this type of thing could happen to
them. Seeing addicts as bad people allows non-addicts to feel good about themselves. They
use this splitting of good versus bad to protect themselves from bad feelings. We do this all
the time with many different things, such as the good child versus the bad child, the good
political party versus the bad political party, etc. [30]
The problem with this splitting is that it does not allow people to own certain parts
of themselves. They shut off aspects of their own beings by splitting them off from their selfconcept and seeing them as something not of them. However, the truth is that we all have
our struggles. We all have our good and bad parts, the different sides of our strengths, our
weaknesses and ourselves. [30]
Seeing people who are struggling with addiction as morally weak seems to serve as a
natural defense for us. We do not want to identify with them so we say that they are weak,
and we are strong because we have resisted the temptations of alcohol and drugs. Addiction
to alcohol and drugs is a rampant problem in our society. For anyone who has ever watched
the show Intervention, it is easy to see that it doesnt take long for an addiction to ruin a
persons life and leave his or her relationships in shambles. The important lesson to learn
here, however, is that those with addictions do not need people to turn away from them,
writing them off as bad or weak people. [29]
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