Definitions, categories and legal status of substances

Aim of this resource

The aim of this resource is to provide an introduction to the main health and social issues associated with substance misuse in the UK today by:

• Identifying definitions of misuse.

• Outlining the main models of misuse & categories of substances.

So, what is ‘misuse’?

• Addictive behaviour – binge drinking?

• Substance use – alcohol, caffeine, heroin, tobacco, aspirin?

• Drug dependence – physical, psychological, sociological?

• It all depends who you ask – what perspective you take.

World health organization guidelines (definition of ‘misuse’):

• Unsanctioned use– Not approved by society.

• Hazardous use– Leading to harm or dysfunction.

• Dysfunctional use– Leading to impaired psychological or

social functioning.

• Harmful use– Known to cause tissue damage or

psychiatric disorders.

Addictive behaviour - six main components (Griffiths 1995)

• SALIENCE - drug seeking/taking behaviour takes over a wide range of life activities – friends, partner, job etc.

• EUPHORIA - experience from behaviour – high, buzz, rush chill. • TOLERANCE - need to increase behaviour/amount to gain same

experience.

• WITHDRAWAL - unpleasant feelings when deprived.

• CONFLICT - conflicts with others who don’t share same salience – partner, family, employers, law, society. Also inner conflict from guilty conscience.

• RELAPSE - hard to give up addictive behaviour, but easy to take up again.

Progress made, challenges ahead

In a report entitled Drug Treatment 2012: Progress Made, Challenges Ahead, Public Health England (2013) set out some of the key statistics about the number of people using drugs and entering treatment.

It reported that:

• drug use is declining, more drug users are recovering. • the original pool of people with problematic heroin and crack use is

shrinking.

This was reinforced further by data from subsequent years....

NTA (2013) why invest?

• NTA (2013) why invest?

Public Health England reports fewer heroin and crack users in England...

NTA (2013) why invest?Shorter waiting times for treatment....

NTA (2013) why invest?

More successful treatment completions....

NTA (2013) why invest?

And fewer young people needing treatment for hard drugs.

Alcohol

• Alcohol is a regulated legal substance in the UK

• This means it is governed by laws regarding its supply, quality and use.

• For instance, it cannot be sold to people under 18. It must be labelled correctly. Advertising of alcohol is strictly limited.

• Despite being legal, it is responsible for most harm in the UK among all substances used (Nutt, 2009).

• Alcohol-related deaths in the UK peaked in 2008 to over 9000. • Scotland has the largest death rate in the UK at over double that of

England for men and women (Institute of Alcohol Studies, 2015).

Alcohol (cont.)• 9 million adults drink at levels that increase the risk of harm to their health.

• 1.6 million adults show some signs of alcohol dependence.

• Overall, alcohol is the third biggest risk factor for illness and death.

• 15,479 people died from alcohol-related causes in 2010, up 30% since 2001

• 27% of social care serious case reviews mention alcohol misuse.

• There are recognised physical, psychological and behavioural problems for children of parents with alcohol problems.

• 16% of road fatalities are due to alcohol intoxication.

Sources: NTA (2013); The Alcohol Strategy (2012); Drug Strategy – Home Office, (2010); Drug Strategy Annual Review (2013)

Categorising substances

regulatedillegallegal

Substances can be divided into different legal statuses.

• ‘Legal’ includes coffee, herbal remedies

• ‘Regulated’ includes alcohol, solvents and cigarettes, prescription-only & over the counter medication.

• ‘Illegal’ includes substances used outside the regulations, i.e. cannabis, heroin, cocaine.

Misuse of Drugs Act 1971Substances are legally divided into schedules 1-5.

• Schedule 1 - no known medical use so totally banned, like LSD.

• Schedule 2 – controlled drugs like morphine.

• Schedule 3 - as above but less control like temazepam.

• Schedule 4 - typically, most prescription only drugs.

• Schedule 5 – typically, over the counter drugs.

Misuse of Drugs Act 1971 (cont.)• Drug classes govern the legal ‘tariff’ for using illegally. i.e. The

possession or, supply of drugs.

• There are three classes, A – C.

• Class A drugs have the highest tariffs, class C the lowest.

• Drug classes change so you need to keep alert for changes. However, heroin and cocaine are likely to remain as Class A drugs.

• Go to the UK Government’s website for the main drug classification list. Be aware that it can change to accommodate new substances and policies. https://www.gov.uk/penalties-drug-possession-dealing

Types of drug by effect

stimulantshallucinogensdepressants

Substances commonly misused can be divided into three types according to the effect they have on the nervous system.

These three types are:1. Depressants2. Stimulants3. Hallucinogens.

Typical drug types are:• Depressants (they slow down the nervous system)

– Heroin, methadone, alcohol, benzodiazepines , some solvents

• Stimulants (they speed up the nervous system)– Cocaine, crack, amphetamines, ecstasy, crystal meth, many ‘legal

highs’ (new psychoactive substances)

• Hallucinogens (typically, change perception)– LSD, cannabis* & synthetic cannabinoids*, magic mushrooms

*these drugs can fit into a number of categories dependent on the type and use

References• Griffiths E (2000) Alcohol, the Ambiguous Molecule. Harmondsworth, Penguin Books. • HM Govt. (2012) The Government’s Alcohol Strategy. Available at:

https://www.gov.uk/government/publications/alcohol-strategy • Home Office (2015) Drug Strategy Annual Review 2014-2015. Available at:

https://www.gov.uk/government/publications/drug-strategy-annual-review-2014-to-2015

• Institute of Alcohol Studies (2015) Alcohol related mortality rates. http://www.ias.org.uk/Alcohol-knowledge-centre/Health-impacts/Factsheets/Alcohol-related-mortality-rates.aspx

• NTA (2013) Why Invest? National Treatment Agency. Available at: http://www.nta.nhs.uk/uploads/why-invest-2014-alcohol-and-drugs.pdf

• NTA (2012) Drug Treatment: Progress Made, Challenges Ahead. London. National Treatment Agency.

• Nutt, D. (2009). Estimating drug harms: a risky business. London: Centre for Crime and Justice Studies.