The Different Types of Substance Misuse

Substance abuse differs from addiction. Many people with substance abuse problems are able to quit or can change their unhealthy behaviour. Addiction, on the other hand, is a disease, meaning people are physically or psychologically addicted and can’t stop using even when the condition causes harm, unless they have support and the decease is being treated, and even then, there is a danger that they may relapse.

What is Substance Abuse?

Substance abuse usually suggests the misuse of a range of mind-altering substances such as alcohol, which is the most common form of substance misuse, and illegal drugs such as Ecstasy, cocaine or cannabis/marijuana.

However, people can also misuse other substances such as prescription and over-the-counter (OTC) medicines, and even misuse solvents, caffeine, tobacco and food. Someone can use legal substances and not be addicted or even have a substance use disorder; however, “abuse” can result because they are using a substance in a way that is not intended or recommended, or because they are using more than the prescribed or recommended amount.

Most forms of substance abuse may give people a temporary feeling of well-being or of being in control, but all of them if continuously misused, can ultimately damage a person’s physical and/or mental health, work, social situation, relationships and responsibilities.

Commonly Abused Substances

Both legal and illegal substances contain chemicals that can change how the body and mind work. They can give people a pleasurable “high”, ease their stress, or help them avoid problems in their life.

Alcohol

Alcohol is one of the most widely used (and abused) drugs in our society. Alcohol abuse means using this substance in a dangerous manner; drinking too much alcohol too often. How much is too much and what is too often? Alcohol intake is measured in units.

One unit is roughly equal to half a pint of normal strength beer/lager/cider, a small glass of wine or a pub measure of spirits such as gin, vodka, whisky or brandy. One unit equals 10ml or 8g of pure alcohol, which is around the amount of alcohol the average adult body can process in an hour.

The NHS recommends that:

• Men and women should not to drink more than 14 units a week on a regular basis.
• Men and women should spread their drinking over 3 or more days if they regularly drink as much as 14 units a week.

Regularly drinking more than 14 units of alcohol a week risks damaging both your physical health and your mental health. If you drink less than 14 units a week, this is considered low-risk drinking. It is called “low risk” rather than “safe” because there is no safe drinking level. If you drink enough to get frequent hangovers, miss work or often drink more than you intended to, your alcohol use is probably at the abuse level.

The type of illnesses you can develop after 10 to 20 years of regularly drinking more than 14 units a week include:

• Cancers of the mouth, throat and breast.
• Stroke.
• Heart disease.
• Liver disease.
• Brain damage.
• Damage to the nervous system.

There is also evidence that regular drinking at high-risk levels (over 14 units a week) can make your mental health worse. Research has also found strong links between alcohol misuse and self-harming, including suicide. The effects of alcohol on your health will depend on how much you drink. The less you drink, the lower the health risks.

Alcohol abuse can affect all aspects of your life and can cause numerous problems, which include:

• Addiction – Not all alcohol abusers become alcoholics, but it is a big risk factor; if you’re a binge drinker or you drink every day, the risks of developing alcoholism are greater.
• Neglecting your responsibilities – Performing poorly at work, neglecting your family and friends, or avoiding commitments because you are hungover.
• Using alcohol in situations where it’s physically dangerous – Drinking and driving, operating machinery whilst intoxicated, or mixing alcohol with prescription medication against doctor’s orders.
• Negative behaviours – Such as being aggressive, being more promiscuous, particularly unintentionally because your judgement is impaired.
• Financial problems – Neglecting financial responsibilities; using limited funds on alcohol rather than bills, food, everyday necessities; accumulating fines for drunken behaviour.
• Alcohol poisoning – Consuming too much alcohol, too quickly, can slow your breathing and heart rate, lower your body temperature, and cause confusion, vomiting, seizures, unconsciousness, and even death.

Alcohol and UK Culture

Nearly 30 million UK adults say they drink alcohol, an indication of alcohol’s ubiquity and presence in so many areas of British society today. The UK’s drinking culture is a big part of socialising with family and friends, doing business and even networking.

It is not coincidental that British soap operas have a pub as the main meeting place for the community, and alcohol is often used to celebrate achievements, birthdays and special occasions. As many young people in the UK grow up in households where parents regularly drink alcohol, drinking alcohol is seen as the norm.

Compared to other countries in Europe, the UK is near the average in terms of overall alcohol consumption. However, it is consistently among the highest for binge drinking, that is drinking lots of alcohol in a short space of time or drinking to get drunk. This reflects the fact that, on average, drinking in the UK tends to involve more drunkenness than elsewhere in Europe.

Alcohol Abuse and the Student Population

Whilst drinking alcohol is decreasing amongst young people – the ONS stated that Generation Z, that is, students born between 1996 and 2010, are in fact less likely to drink than any other age group – harmful drinking amongst the student population is still a significant public health issue.

There is a strong association of university life being linked with excessive alcohol consumption. The National Union of Students found that 76% of students said that there’s an expectation for students to drink to get drunk and 79% agreed that drinking and getting drunk is part of university culture.

No university is immune from a binge-drinking culture and it is no surprise that new students away from home for the first time, might want to use alcohol to help overcome those transition nerves.

As well as the physical and mental health issues that binge drinking causes, Liverpool John Moore’s University reported that they also found increased incidences of sexual harassment/assault related to alcohol use.

Alcohol Abuse and the Older Generation

Older people tend to drink less alcohol than younger people, but even so 1 in 5 older men and 1 in 10 older women are abusing alcohol. As we get older, our bodies change. On the outside we notice lines, wrinkles, greying hair, our skin is perhaps not quite as strong or flexible as it used to be.

On the inside we lose muscle and gain fat, which leads us to break down alcohol more slowly. This means that we become more sensitive to the effects of alcohol. We also react more slowly and tend to lose our sense of balance. So, even if we drink the same amount of alcohol as we did in our younger days, as we get older it is likely to affect us more than it does younger people.

Bereavement, physical ill health, difficulty getting around and social isolation can lead to boredom and depression and it can be tempting to use alcohol to make these difficulties more bearable. It may then become part of the daily routine and difficult to give up.

There may be less pressure for an older person to give up drinking than for a younger person, fewer family responsibilities, and no pressure to go to work each day. Older people tend not to talk about their drinking, and the effects of alcohol can be mistaken for a physical or mental health problem, so the real problem is not always obvious.

It is often easier to treat drink problems in older people than it is in younger adults by helping them with the problem that made them start drinking in the first place. This could be anxiety, depression, physical problems or just not seeing other people very much.

Getting Help

Living with alcohol abuse will continue to be a struggle if you do not recognise that you need help. If you’re ready to admit you have a drinking problem, you have already taken the first step. Talking to your GP can be a good starting point.

Other support services include:

• Drinkaware an independent UK-wide alcohol education charity.
• NHS Drinkline is the national alcohol helpline. Call 0300 123 1110.
• Alcoholics Anonymous is a free self-help group.
• Smart Recovery helps individuals recover from any addictive behaviour.
• Alcohol Change is a leading UK alcohol charity.
• Help me Stop.
• Age UK.

Helping Someone You Know

Start by talking honestly and openly with the friend or family member who is drinking too much. But always remember that you can’t force someone to give up alcohol. The choice is up to them. You can suggest that they contact any of the support services listed above. You may also benefit from joining a group such as Al-Anon, a free peer support group for families affected by someone else’s drinking.

Illegal Recreational Drugs

The use of illegal substances is by definition illegal, and therefore any use is categorised as misuse.

In the UK there are three drugs that are commonly used for “recreational” purposes. These drugs are:

• Ecstasy.
• Powder cocaine.
• Cannabis/marijuana.

Cannabis is the most commonly used “recreational” drug and powder cocaine is the second most used.

There are many reasons people try “recreational” drugs. These include:

• Their friends are doing it, and they don’t want to feel left out.
• They get pressurised into trying it.
• They are interested in experimenting with the effects, and seeing what happens when they take drugs.
• They may feel drugs give them new experiences or perspectives.
• They may feel drugs make them more relaxed, or more confident when relating to others.
• They may feel drugs help them forget their worries or problems.
• They may feel drugs make them feel happier.
• They want to be rebellious.
• They enjoy the effects.

All drugs can have dangerous effects and many can be unpredictable and variable. There are numerous problems which the use of drugs can cause. These include:

• Addiction – Most drugs can become addictive, and the person can be dependent on having them regularly.
• Health – Illegal drugs can impact both physical and mental health causing nervousness, anxiety and temporary feelings of paranoia. They increase blood pressure, heart rate, breathing rate, and body temperature, which could lead to heart attacks, strokes and respiratory failure.
• Finding it hard to sleep, think, reason, remember and solve problems.
• Social problems – People regularly using drugs may behave in different ways. This may cause problems with their relationships or work, even causing them to lose their job.
• Family problems – Partners and children of people who use drugs can be adversely affected.
• Accidents are more likely (at home, in a car, or at work).
• Possibility of committing a sexual assault or other violent act.
• Vulnerability to sexual assault or engaging in unprotected sex. Either of these could lead to pregnancy and sexually transmitted infections.
• Cost – A regular drug habit is expensive; obtaining the money for it can lead to crime, especially when the person is addicted and cannot stop.
• Illegal drugs are often not pure, and people don’t always know what they are taking.
• Accidental overdose and possible death.

A person might begin to use “recreational” drugs without thinking about any harm to their body. They might think drugs won’t become a problem because they are only a casual user.

However, casual users can easily become abusers as the more they take a drug, the more likely they are to build up a tolerance to its effects. This can lead to the need to take larger doses or more regularly to obtain the effects of the drug. It is important to remember that there is no safe level of drug use.

“Recreational” Drugs and UK Culture

The UK has a growing “recreational drugs” culture, so much so that more UK employers have begun to implement workplace drug and alcohol use policies and are introducing workplace testing in order to keep staff safe and allay fears of workplace accidents.

This is because the workplace is becoming a major part of a society where drug use is a daily reality. Drug taking does not just start at 5pm on a Friday, and whilst people are not necessarily taking drugs in the workplace, they are increasingly reporting for work with drugs in their systems which has implications for Health and Safety at work.

Under 30s account for 61% of all users of “recreational” drugs, with Ecstasy being used most, whilst use of powder cocaine and cannabis are more likely to persist in the over 30s. Cannabis use is more prevalent among those with an annual earned income of less than £10,000, whilst powder cocaine use is most prevalent among those on annual household incomes above £50,000.

Men account for 67% of all drug users, being approximately twice as likely as women to use every main type of recreational drug. However, the large majority of people who use “recreational” drugs each year are occasional users.

Getting Help

There are lots of different ways of getting help either for yourself or for someone you know. Sometimes it is helpful to talk to the people close to you or to your GP, for example, and don’t be scared of telling people about your drug problem.

They are likely to be relieved you want to do something to stop. There are several organisations that help people wanting to stop taking drugs or who want advice because someone they know may be abusing drugs.

• FRANK provides confidential drug advice; their advice line is available 24 hours a day, 7 days a week on 0300 1236600.
• MIND provides information and support for people using recreational drugs.
• Drugwise.
• NHS Choices.

The Misuse of Other Substances

Substances such as prescription and over-the-counter (OTC) medicines and even solvents, caffeine, tobacco and food can all be misused and cause issues for people’s physical and mental well-being.

Prescription Drugs

Taking these drugs without medical need and medical supervision can endanger people’s quality of life, health, or safety of themselves and others. Anabolic steroids are probably the most commonly misused drugs in this group.

Others include:

• Diuretics.
• Erythropoietin and darbepoetin.
• Growth hormone.
• Ipecac syrup.
• Laxatives.

These drugs are usually taken inappropriately for other than their prescribed purposes for losing weight or enhancing athletic performance.

Over-the-Counter Medicines (OTC)

OTC drugs have various medical uses and effects, from treating mild pain to motion sickness. Some people abuse OTC drugs to self-medicate for mental illnesses like anxiety and depression. Abusing these medications can give users a euphoric “high” or hallucinations.

Any use outside of what is recommended is considered abuse. OTC drugs include:

• Cough medicines (dextromethorphan, or DXM).
• Cold medicines (pseudoephedrine).
• Motion sickness pills (dimenhydrinate).

Recreational OTC drug use can also change the brain’s chemistry over time. Eventually the user builds a tolerance to the drugs, needing more of the substance to get the previous effects. Those addicted to OTC drugs may also develop withdrawal symptoms when they stop using.

Solvent Abuse

Solvent abuse (or “volatile substance abuse”) is the deliberate inhalation of volatile chemicals for the purpose of getting intoxicated or “high”. The fumes and gases inhaled are found in everyday products such as cigarette lighter refills and aerosols.

The products associated with solvent abuse are legal, accessible and inexpensive, so they offer the possibility of a fast-acting “high” which usually passes off quickly without a hangover. This can also make solvent abuse difficult to detect. Many young people who experiment with volatile substances do so out of curiosity. Some people might use volatile substances alongside other drugs or as a substitute if a preferred drug is unobtainable.

Tobacco, Caffeine, Food

These substances can give people “legal highs” but can also be misused, particularly when people are feeling low or under pressure.

Smoking, eating or drinking caffeine too much can have a negative impact on people’s health and can lead to:

• Lung disease.
• Cancer.
• Weight gain, leading to obesity.
• Eating disorders.
• Increased blood pressure.
• Heart rhythm changes.
• Sleep problems.

For many legal substances, the line between use and abuse is not clear. Is smoking a pack of cigarettes a day substance abuse? Is drinking two pots of coffee in the morning, use or abuse? Is treating yourself to chocolate or cake use or abuse? Generally, in these situations, only the individual themselves can determine where use ends and abuse begins. The question to ask yourself is, “Is this causing me harm?”

Statistics

According to Drugs Information UK alcohol and drug abuse cost the UK £21 billion and £15 billion respectively annually, and with 70% of all substance abusers being in full-time employment most of this cost is due to missed work days and loss of productivity.

Substance abuse accounts for 40% of industrial accidents and 60% of incidents of poor performance. Every year, workplace hangovers are estimated to cost the UK economy between £1.2 billion and £1.4 billion (The Institute of Alcohol Studies).

A 2018/19 Home Office report found that around 1 in 11 (9.4%) adults aged 16 to 59 had taken a drug in the last year. This equated to around 3.2 million people. Whilst the latest estimate was not significantly higher than the previous year’s (9.0% in the 2017/18 survey), there had been an upward trend since the 2015/16 survey (8.3%).

The NHS reports that in 2019/2020, there were 7,027 hospital admissions for drug-related mental and behavioural disorders, and 16,994 hospital admissions for poisoning by drug misuse.

The Office for National Statistics (ONS) latest figures show that among male registered deaths, there were 104.7 drug poisoning deaths registered per million in 2019 (2,968 deaths), and the female rate was 49.1 deaths per million (1,425 deaths); neither rates were statistically significantly different to those in 2018.

The NHS also reported that in 2019, there were 876,000 hospital admissions where obesity was a factor – an increase of 23% on the previous period.