Chapter 2 REVIEW OF RELATED LITERATURE AND STUDIES In this chapter, literature and studies relating to the factors that

can contribute to drug abuse and its effects on health will be discussed. Related Literature Physiological Effects of Drug Abuse According to Mehra et. al (2006), drugs are limited not only to psychological effects but also can be detrimental to the body. The damage caused by drug abuse can be widespread and possibly long-term. In some instances, the relation between drug intake and physiological effects are not clear but as a precautionary note, it is not advisable to dismiss drug abuse as safe, according to the research. Moreover, Tetrault et. al (2007) stated that smoking marijuana affects preliminaries for cancer in the human body, such as changes in cellular activity. Thus, people are advised to abstain from smoking marijuana to avoid lung cancer until the research is more definitive. They also claimed that smoking affects the lungs in terms of increased coughing, increased mucous production, and wheezing. These effects were found to be related specifically to marijuana, although co-occurring tobacco use was present. Drugs are known to negatively affect the heart. For example, cocaine can cause damage to the large coronary arteries and create a toxic

12

environment for muscle tissue within the heart, according to Dattilo et. al (2008). Psychological Effects of Drug Abuse Mcnair (2010) stated that addiction can have profound effects on a person's thoughts, feelings and behaviour. It usually disturbs perceptions and attitudes, and can significantly disrupt someone's personality. Linsaum (2004) implied that depression is one known effect. This isn't just because the substances involved - such as alcohol, nicotine, cocaine, heroin and valium - interfere with the natural chemistry of the brain. The experience of addiction itself also has an effect on how a person thinks, feels and behaves. However, the amount of psychological disruption from an addiction varies hugely. Repraul (2006) stated that an addiction such as smoking, for example, doesn't have the same harmful social consequences as an addiction to a substance such as heroin might, and the psychological impact isn't so marked. How severely people are affected psychologically depends on their mental health before becoming addicted and the ongoing circumstances of their lives. If you're unemployed, homeless and physically unwell, for example, your psychological health is likely to suffer more than if you have a home, job and supportive family. If the drug, such as alcohol, is particularly damaging to the brain, it may add to the long-term psychological harm. Such

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brain damage may be irreversible. Not everyone who becomes addicted has the same experience. There are certain psychological symptoms that most addicted people suffer sooner or later, either all at once or in clusters. People may begin to look for treatment when these start to become severe, often because of the growing impact of the addiction's harmful consequences in their lives. The psychological effects of addiction can be divided into those that relate to feeling and those that relate to thinking. These thoughts and feelings are tied closely to addictive behaviours that can result from, and/or lead to, the thoughts and feelings, leading to a vicious circle. For instance, an addicted person may avoid others, leading to a feeling of isolation. They may also feel ashamed of their addiction and inability to cope. To deal with these feelings, they take more of the drug. Their relationship with the drug excludes people, who avoid that person. The result is increased isolation (Sinclair, 2011).

Social Effects Dependence to any substance is damaging to the individual as well to society (Butcher, 2004). Substance abuse does not only affect the individual, it also affects the family, friends, teachers at school and other members of the community. Adolescents abusing substances may become withdrawn, moody, irritable or

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aggressive. That often leads to a deterioration in family, peer group, and school relationships (Parrott, 2004). The substance, and obtaining it, become the center of the abusers existence, governing all activities and social relationships. The effect of these substances on the general inhibition of impulses, social judgment is often distorted. Involvement in other social problems such as impulsive violence, casual or exploitative sex, racial and other forms of intolerance or abuse may result. It is believed that over half of all murderers are committed under the influence of substances are rape, assault and family violence (Davison, 2004). Factors that contribute to Drug Abuse Age Adolescence is a time of growth, exploration and increased risk taking. Many adolescents engage in substance use activities which they perceive as acceptable within their peer groups. As a result, risk behaviors including substance abuse during the adolescent years are of major concern because they are associated with the increased risk of injury, interpersonal violence, crime, high-risk sexual behavior, suicide, academic difficulties and school drop-out. Consequently, substance abuse can have a major impact on the lives of adolescents (Berk, 2007).

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Younger people most often abuse illicit substances (e.g., marijuana or cocaine), older adults tend to become dependent on over-the-counter and prescription drugs (Colliver, 2006). Alcohol and drug use tends to begin in mid-to-late adolescence, though it is greater among individuals who experience early puberty (O'Connell, 2009). The above statements implies that adolescents are the ones who are most prone to committing drug abuse Gender Women are less likely than men to use illicit drugs and to develop drug-related problems (Greenfield, 2003). Recent research shows that womens and mens substance use patterns have become more similar in the past few years (McPherson, 2004) There are differences in why each gender took the path in which they did. Not all teens get addicted. Some teens (more prominently male) use substance abuse as a tool to gain other personal rewards that they are seeking, such as sexual encounters (Jasper, 2003). The above statement implies that women are less prone to committing drug abuse than men. Psychological Factors Persons with a history of at least one major depressive episode within a past year were significantly more likely to use abuse drug compared to

16

those persons without a major depressive episode (Journal of opioid management, 2007). Lack of meaningful relationships has been observed in those who abuse drugs. Evidence suggests that loneliness is a risk factor that the prevention of loneliness may be helpful in the prevention and treatment of drug abuse (Smith et. al, 2006). Long-lasting stressful periods, experience of early severe stress and/or traumatic life events in childhood can affect an individuals personal development resulting in an enhanced risk for drug use (Andersen et. al, 2009). The above statements implies that stress, mental health problems and lack of meaningful relationships can be a factor for committing drug abuse. Behavioral Factors The identity confusion could result in an identity foreclosure or negative identity. Identity foreclosure means that the identity crisis is resolved by making a series of premature decisions about ones identity, based on others expectations of what one should be. This happens when external demands or role expectations pose a threat to adolescents identity development. In their confusion, adolescents tend to fulfill roles simply to meet the expectations of others, without truly identifying with these roles, so they develop a negative identity. Negative identity means that adolescents form an identity contrary to

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the cultural values and expectations of society, for example, adolescents who abuse drugs and juvenile delinquents (Burger, 2008). Reasons for adolescents abuse of substances include coping with stress, peer group pressure and following the example set by adults (Lesly, 2008). Associating with drug or alcohol-using peers, or being rejected by peers, can create problem behaviors and influence attitudes and norms related to substance use (O'Connell, 2009). Furthermore, having delinquent peers or peers expressing antisocial attitudes is also associated with increased risk of drug use for the individual (Kokkevi, 2007). The above statements implies that peer influence is a great factor for committing drug abuse.

Social Factors Living in a deprived neighborhood, with high crime rate and other social problems, is also found to be related to substance use (Daniel, 2009). In addition, the school environment and school management are also linked to substance use, where poor school situations increase the risk of using substances such as illicit drugs (Frischer, 2007). In addition, according to Henry (2005), low perception of harm towards alcohol and drug use is a risk factor for use.

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Furthermore, Rice et. al (2008) stated that another reason for trying substances is to have fun or sensual pleasure. Users seek and exciting experience. According to Davison (2004), substance use is therefore reinforcing, either by enhancing positive mood states or by diminishing negative ones. Teenagers who drink alcohol are firstly exposed to parents who themselves drink and their peers who act as models for heavy consumption. The parents not only show inappropriate behavior such as antisocial tendencies and the rejection of their children. When such children loosen their parental ties, they tend to be strongly influenced by peers who are also heavy drinkers (Papalia, 2004). Adolescents relationships with their parents, as with gender identity and peer relationships, have been repeatedly linked to adolescent substance use (Fisher, 2006). Example of risk factor associated with the individuals family is adverse childhood experiences, mostly due to a destructive and negative family environment (Barrett et. al, 2005). Studies have also found that siblings can have a major impact on whether a person will use substances or not (Stergar, 2007). Moreover, children of parents with substance use problems have an increased risk of developing their own substance-related problems later in life, compared to children of parents without such problems. Also, the presence of

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mental health problems within the family is shown to be associated with the development of substance-related problems (Heiman, 2007). Additionally, the adolescents family structure, e.g. single-parent families, can be a factor influencing the risk of problematic substance use. Also, parental divorce has shown to be related to substance use (Hemovich et. al, 2009). Another individual risk factor associated with adolescents substance use is the occurrence of parents with substance use problems. Studies have found associations between having parents with substance use and an increased risk of developing ones own substance-related problems (Kendler, 2012). The above statements implies that living in an environment where there are social problems and having a low perception of harm to drugs is also a factor for committing drug abuse. Common Drugs Abused in the Philippines According to the Drug and Alcohol Rehab Asia (2005) the most commonly abused drugs in the Philippines include: Alcohol, Tobacco, Marijuana or Cannabis, and Methamphetamine (locally known as Shabu). Alcohol is a central nervous system depressant with effects similar to those of sleeping pills or. Larger doses of alcohol distort vision, impair motor coordination and slur speech. Other common physiological changes include damage to the endocrine glands and pancreas, heart failure, erectile

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dysfunction, hypertension and stroke, which are responsible for the swelling and redness in the face, and especially the nose, of chronic alcohol abusers. Short term abuse of alcohol may affect cognitive performance of alcohol abusing students (Rice et. al, 2008). Moreover, Haylix (2012) stated that alcohol is a stimulant as it can give people feelings of confidence and fearlessness. However, alcohol is actually classified as a 'depressant drug', which basically means that it slows down the actions of the central nervous system in your body. If you feel confident or fearless when you drink alcohol, its because the alcohol impacts on your brains warning system which helps you monitor your behaviour. Alcohol's classification as a depressant has a lot to do with how your body reacts to the drug. One effect of alcohol is that it lowers your heart and breathing rates. It also slows down the time it takes for a person to respond to things, which often results in being uncoordinated, having slower reflexes and making poor decisions.

Tobacco is smoked, chewed or ground into small pieces and inhaled as snuff. Nicotine is the addicting agent of tobacco. The most probable harmful components in the smoke from burning tobacco are nicotine, carbon monoxide and tar. Cigarettes can discolor teeth, affect skin color and makes breath, body and clothes smell unpleasant. In addition to that, smoking increases heart rate, constricts blood vessels, irritates the throat and deposits

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foreign matter in sensitive lung tissues, thus limiting lung capacity. Years of smoking can lead to premature heart attacks, lung and throat cancer, emphysema, and other respiratory diseases. Even moderate smoking shortens a persons life by an average of 7 years (Shaiya, 2007). According to National Institute on Drug Abuse (2010), Cigarettes and other forms of tobaccoincluding cigars, pipe tobacco, snuff, and chewing tobaccocontain the addictive drug nicotine. Nicotine is readily absorbed into the bloodstream when a tobacco product is chewed, inhaled, or smoked. A typical smoker will take 10 puffs on a cigarette over a period of 5 minutes that the cigarette is lit. Thus, a person who smokes about 1 pack (30 cigarettes) daily gets 300 hits of nicotine each day. Upon entering the bloodstream, nicotine immediately stimulates the adrenal glands to release the hormone epinephrine (adrenaline). Epinephrine stimulates the central nervous system and increases blood pressure, respiration, and heart rate (Niaura, 2003). Furthermore, Belluzi (2007) stated that like cocaine, heroin, and marijuana, nicotine increases levels of the neurotransmitter dopamine, which affects the brain pathways that control reward and pleasure. For many tobacco users, long-term brain changes induced by continued nicotine exposure result in addiction, a condition of compulsive drug seeking and use, even in the face of negative consequences. Studies suggest that additional

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compounds in tobacco smoke, such as acetaldehyde, may enhance nicotines effects on the brain. Cannabis is made from the dried and crushed leaves and flowering tops of the hemp plants Cannabis sativa. It is most often smoked, but it may be chewed, prepared as tea, or eaten in baked goods. The intoxicating effects of cannabis, like those of most substances, depend in part on its potency and the size of the dose. Smokers of cannabis find it makes them feel relaxed and sociable. The short term somatic effects include blood shot and itchy eyes, dry mouth and throat, reduced pressure within the eye and somewhat raised blood pressure (Kring, 2007). Moreover, Erickson (2003) stated that Cannabis is a psychoactive agent, primarily used to produce euphoria and that the effect of the drug may produce relaxation, loss of coordination, impaired memory, concentration and knowledge retention, and loss of appetite. More potent doses can cause disoriented behavior, psychosis, fragmented thoughts and mood swings. To add, Welsh (2013), stated that the active ingredient in marijuana acts in the part of the brain called the hippocampus to alter the way information is processed and how memories are formed. Animal studies have shown that this is particularly true while the brain is still developing specifically why the legal smoking age is 21 in the states that have legalized it. This blockage of memory formation can cause cognitive impairment in adulthood if use happens during adolescence.

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Methamphetamine is often referred to as crystal meth or ice. Methamphetamine can be taken orally or intravenously. It can also be taken intranasal, that is snorting. Craving for methamphetamine is particularly strong, often lasting several years after use. Several studies conducted indicated that chronic use of amphetamine causes damage to the brain, affecting both dopamine and serotonin system (Shaiya, 2007).

To add, Bliss (2004) stated that Methamphetamine is a very potent central nervous system stimulant. The drug works directly on the brain and spinal cord by interfering with normal neurotransmission. Neurotransmitters are chemical substances naturally produced within nerve cells used to communicate with each other and send messages to influence and regulate our thinking and all other systems throughout the body.

Moreover, Tekosu (2007) stated that the main neurotransmitter affected by methamphetamine is dopamine. Dopamine is involved with our natural reward system. For example, feeling good about a job well done, getting pleasure from our family or social interactions, feeling content and that our lives are meaningful and count for something, all rely on dopamine transmission.

Methamphetamine may be inhaled, smoked, or injected. When someone starts using methamphetamine, they have increased energy,

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feelings of euphoria, decreased appetite, and decreased need for sleep. They also experience increased heart rate, blood pressure, sweating, restlessness, and anxiety. Although some of these effects sound positive, they are far outweighed by the bad effects and risks of using methamphetamine. The euphoria, increased energy, and grandiosity often lead to impulsive risktaking behaviors such as violence and sexual promiscuity. The effects of the drug can easily last 12 or more hours so insomnia is quite common, but coming down causes depression and fatigue. Attempting to avoid depression and fatigue as well as a desire to regain the euphoria originally experienced, individuals are likely to turn to the drug again making it even harder to withdraw from it in the future (Johaner, 2009).

One of the consequences of regular methamphetamine use, not typically seen with other drugs, is the very long recovery period where the former user experiences depression and little or no pleasure in life. Even things they use to enjoy are no longer satisfying. This inability to get pleasure from life and the environment typically lasts 2-3 years after stopping use. However, some persons never recover and remain unsatisfied due to permanent brain damage (Niele, 2003).

There are at least two ways this brain damage may occur. Through dopamine depletion, over time, cells that replenish this essential

neurotransmitter are destroyed. Brain damage may also occur due to

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increased blood pressure and heart rate which can cause stroke and death of brain tissue. An irregular heartbeat may also lead to heart attack and even death. And autopsy results of methamphetamine users document thousands of mini-strokes at the ends of microscopic blood vessels in the brain typically resulting in premature aging, and in some cases, premature senility (Princeton, 2003).

Related Studies

Physiological Effects of Drug Abuse Drugs, particularly methamphetamine abuse, can lead to stroke according to Shanner et. al (2006). They also noted that methamphetamine abusers are more likely to contract HIV and hepatitis B and C through unsafe sexual and needle sharing practices while under the influence. The immune system is responsible for protecting the body and fighting off illness and disease, according to the National Drug and Alcohol Research Centre (2005), people who use drugs run the risk for a compromised immune system. For example, those who used ecstasy or marijuana had a greater chance of incurring mild infections such as the common cold, mild urine infections and infection of the sinuses.

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Extensive dental decay is common among methamphetamine users. This condition is commonly referred to as "meth mouth," as stated by Shanner et. al (2006)

Psychological Effects of Drug Abuse It's important to realize that the psychological effects of addiction aren't only experienced by the person who misuses alcohol and/or drugs, but also by those who are personally involved with them, such as families, friends and colleagues (Halford, 2004). Frances (2005) explained that drugs of abuse are thought to act on a brain circuit called the limbic system. This pathway pairs activities that are crucial to individual or species survival, such as eating or sex, with pleasant feelings of reward. The feelings of reward are meant to reinforce or motivate the individual to partake in the activity again. Biochemically, the pleasant feelings are the result of dopamine release in a part of the brain called the nucleus accumbens. He also stated that that when a drug is abused over a long period of time, the nervous system and body must adjust so that the organs can continue to function normally. The adjustments made by the cells and tissues in response to chronic drug use lead to physical dependence. Because normal function is now dependent on the presence of the drug, the body responds with uncomfortable withdrawal symptoms when the drug is

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discontinued. Many people who abuse drugs continue to do so in order to avoid withdrawal symptoms. To add, the National Institute on Drug Abuse (2010) stated that chronic drug abuse changes the way brain cells respond to the activity of dopamine. This requires drug abusers to increase their dosage of a drug in order to experience euphoric and pleasurable feelings. The cycle continues until the brain is so desensitized to dopamine that the user feels flat and lifeless, unable to experience any pleasure at all. Social Effects Reports of disturbed family life related to drugs are frequent in the literature. It was found that disrupted family life appears to be a major risk factor for drug abuse among some young persons, and that as many as 10 percent of the young people between 15 and 20 years of age (Miraol, 2006). When teenagers depend on alcohol and other substances to deal with daily stresses, they fail to learn responsible decision-making skills and alternative coping mechanisms. These young people show serious

adjustment problems, including chronic anxiety, depression and antisocial behavior that are both the cause and consequences of taking drugs (Berk, 2007). Factors that contribute to Drug Abuse Age

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Data from around the world suggest that substance abuse starts between the ages of 15 and 20. A large number of adolescents experiment with legal and illegal substances out of curiosity (Visser et. al, 2007). The above statements implies that adolescents are the ones who are most prone to committing drug abuse Gender Several studies have linked gender identity to the susceptibility of adolescent females to use drugs (Nieri et. al, 2008). Adolescents relationships with their parents, as with gender identity and peer relationships, have been repeatedly linked to adolescent substance use (Koruky, 2006). The above statements implies that gender identity is a problem that can drive someone to do drug abuse. Psychological Factors Long-lasting stressful periods, experience of early severe stress and/or traumatic life events in childhood can affect an individuals personal development resulting in an enhanced risk for drug use (Andersen et. al, 2009). Occurrence of mental health problems is another factor often associated with use of substances. Thus, psychiatric disorders such as anxiety problems and different types of personality disorders may increase the likelihood of using drugs (Rao, 2008).

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The above statement implies that experience of traumatic events can be a factor for committing drug abuse. Behavioral Factors Associating with drug or alcohol-using peers, or being rejected by peers, can create problem behaviors and influence attitudes and norms related to substance use (O'Connell, 2009). Peer influence can be constructive, resulting in increased selfconfidence and autonomy. It can, however, also be destructive, promoting for example deviant behaviour such as excessive alcohol consumption and use of illicit drugs (Steinberg, 2005). There is also a relationship between adolescents illicit drug use and having peers who express positive attitudes to drug use, although the peers have never used illicit drugs (Steinberg, 2005). The above statements implies that peer influence is a great factor for committing drug abuse. Social Factors Although families have a powerful influence on shaping the attitudes, values and behavioural patterns of children and thus preventing substance abuse, peer groups often prove to have an even stronger influence. The negative influence of peers appears to increase when parents abdicate their traditional supervisory roles. Family factors thought to lead to, or intensify, drug abuse include prolonged or traumatic parental absence, harsh discipline,

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failure to communicate on an emotional level and parental use of drugs (Saiyuno, 2007). Linder (2004) stated that lack of household stability triggered by low and irregular income and unemployment may increase the stress on the family and its vulnerability to drug abuse. This opens a wide field for possible government action to reduce such vulnerability. Substance use is therefore reinforcing, either by enhancing positive mood states or by diminishing negative ones (Davison, 2004). The above statement implies that living in an environment where there are social problems is also a factor for committing drug abuse. Common Drugs Abused in the Philippines Alcohol dependence often go hand in hand. Research shows that people who are dependent on alcohol are much more likely than the general population to use drugs, and people with drug dependence are much more likely to drink alcohol (Alcohol Research and Health, 2005). For example, Staines et. al (2005) found that, of 248 alcoholics seeking treatment, 64 percent met the criteria for a drug use disorder at some point in their lifetime. Persons with co-occurring alcohol and other drug use disorders also are likely to have more severe dependence-related problems than those without combined disorders, that is, they meet a higher number of diagnostic criteria for each disorder (Hiller, 2010).

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People with co-occurring alcohol and other drug use disorders are more likely to have psychiatric disorders such as personality, mood, and anxiety disorders; they are more likely to attempt suicide and to suffer health problems (Verheul, 2005). Cigarette smoking accounts for about one-third of all cancers, including 90 percent of lung cancer cases. Smokeless tobacco (such as chewing tobacco and snuff) also increases the risk of cancer, especially oral cancers. In addition to cancer, smoking causes lung diseases such as chronic bronchitis and emphysema, and increases the risk of heart disease, including stroke, heart attack, vascular disease, and aneurysm. Smoking has also been linked to leukemia, cataracts, and pneumonia. On average, adults who smoke die 14 years earlier than nonsmokers. (Shennassa, 2003). Marijuana comes from the cannabis sativa plant, and is the dried and shredded leaves, stems seeds and flowers. The high you get from marijuana comes from a chemical called Tetrahydrocannabinol, also known as THC. Some strains contain more or less THC, making them more or less potent. Most of THC's effects happen in the brain, where the chemical interacts with receptors on brain cells called cannibinoid receptors. Our bodies actually make chemicals very similar to THC, which are used in normal brain function and development. THC co-opts these natural pathways to produce most of its effects (Spector, 2013)

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According to the 2012 National Survey on Drug Use and Health (2012), approximately 1.2 million people reported using methamphetamine in the past year, and 440,000 (0.2 percent) reported using it in the past month. This represents a decrease from previous years: In 2006 731,000 (0.3 percent) reported past-month use. In 2012, there were 133,000 new users of methamphetamine age 12 or older the same as the previous year but continuing a general downward trend across the past decade. The average age of new methamphetamine users in 2012 was 19.7 years old.