(BQ) Part 2 book “ABC of mental health” has contents: Mental health problems in old age, mental health problems of children and adolescents, mental health problems in people with intellectual disability, mental health in a multiethnic society, drug treatments in mental health, and other contents. | CHAPTER 13 Addiction and Dependence: Illicit Drugs Clare Gerada and Mark Ashworth OVER VI EW • Illicit drug misuse is most common in teenage and its prevalence decreases in older people; cannabis is the most abused drug Several clinical conditions are recognised as arising from misuse of drugs (Box ). Their clinical features are similar regardless of the drug misused • Clinical conditions associated with drug misuse are similar for all drugs: acute intoxication, harmful use, dependence, withdrawal and psychosis Why use drugs? • Social and personality factors tend to determine whether someone will misuse drugs; biological effects of the drug, especially euphoria, tend to determine if that person develops dependence • Medical complications may arise from the biological effects of the drug, its route of administration or the associated lifestyle • Management of established drug misuse involves general measures to minimise risk of complications, and specific interventions to withdraw the drug or prevent dose escalation What determines whether drug use becomes continuous and problematic includes: • Sociocultural factors such as cost, availability and legal status of the drug • Controls and sanctions on its use • Age (people in their teens to their 20s are most at risk) and gender (male) • Peer group of the person taking the drug. Size of the problem Box Clinical conditions associated with drug misuse More than a quarter of the UK population has used an illicit drug in their lifetime, with highest rates found in 16–19-year-olds (46%) and 20–29-year-olds (41%). Use decreases in higher age groups to 12% at 50–59 years. Cannabis is the most commonly used illicit drug and is likely to be taken frequently, with at least 9% of all users reporting daily use. About 100,000 people misuse heroin and an unknown but increasing number use other drugs such as ecstasy and amphetamines. The numbers using crackcocaine have been increasing since the 1990s and around
