Abuse potential of a drug is related to its capacity to produce immediate satisfaction, which may be a feature of the drug itself (amfetamine and heroin give rapid effect while tricyclic antidepressants do not) and its route of administration in descending order: inhalation/i.v.; i.m./s.c.; oral.
Drug abuse2 implies excessive (in terms of social norms) nonmedical or social drug use.
Nonmedical drug use, i.e. all drug use that is not on generally accepted medical grounds, may be a term preferred to 'abuse'. Nonmedical use means the continuous or occasional use of drugs by individuals, whether of their own 'free' choice or under feelings of compulsion, to achieve their own wellbeing, or what they conceive as their own wellbeing (see motives below).
Drugs used for nonmedical purposes are often divided into two groups, hard and soft.
Hard drugs are those that are liable seriously to disable the individual as a functioning member of society by inducing severe psychological and, in the case of cerebral depressants, physical, dependence. The group includes heroin and cocaine.
2 The World Health Organization adopts the definition of the United Nations Convention on Psychotropic Drugs (1971). Drug abuse means the use of psychotropic substances in a way that would 'constitute a public health and social problem'.
may be psychological dependence, but there is little or no physical dependence except with heavy doses of depressants (alcohol). The group includes sedatives and tranquillisers, amphetamines, cannabis, hallucinogens, alcohol, tobacco and caffeine.
This classification fails to recognise individual variation in drug use. Alcohol can be used in heavy doses that are gravely disabling and induce severe physical dependence with convulsions on sudden withdrawal; i.e. for the individual the drug is 'hard'. But there are many people mildly psychologically dependent on it who retain their position in home and society.
Hard-use where the drug is central in the user's life and soft-use where it is merely incidental, are terms of assistance in making this distinction, i.e. what is classified is not the drug but the effect it has on, or the way it is used by, the individual.
Drug dependence (see p. 168).
Addiction. The term 'addict' or 'addiction' has not been completely abandoned in this book because it remains convenient. It refers to the most severe forms of dependence where compulsive craving dominates the subject's daily life. Such cases pose problems as grave as dependence on tea-drinking is trivial. But the use of the term drug dependence is welcome, because it renders irrelevant arguments about whether some drugs are addictive or merely habit-forming. Nonmedical drug use has two principal forms:
• Continuous use, when there is a true dependence, e.g. opioids, alcohol, benzodiazepines.
• Intermittent or occasional use to obtain a recreational experience, e.g. 'ecstasy' (tenamfetamine), LSD, cocaine, cannabis, solvents, or to relieve stress, e.g. alcohol.
Both uses commonly occur in the same subject, and some drugs, e.g. alcohol, are used in both ways, but others, e.g. 'ecstasy', LSD, cannabis, are virtually confined to the second use.
Drives to nonmedical (or nonprescription) drug use are:
• Relief of anxiety, tension and depression; escape from personal psychological problems; detachment from harsh reality; ease of social intercourse.
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