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Assessing the severity of a drug problem

Abuse means that a substance is being used either in a way other than intended or in a way which may result in harm. At one extreme is the so-called 'recreational' drug user who uses a drug infrequently, for example the intermittent marijuana smoker who uses the drug once or twice per month on a social basis. The opposite to this is the severely addicted user who, for example, requires the intravenous injection of two to three 'caps' (full capsules) of heroin every day, possibly engaging in constant criminal activity to support the cost of this habit.

The route of administration of the drug into the body is significant. First-time users may inhale the drug into either the lungs (smoking) or the nasal cavity (snorting). Many drugs are absorbed into the body by ingestion (for example alcohol or standard pharmaceutical tablets). Amphetamines or heroin may also be used this way. As the frequency and volume of drug use increases, the body develops a tolerance to the drug, just as alcohol abusers require increasing amounts of alcohol to achieve the same level of intoxication. As a result of tolerance, increasing amounts and increasingly direct routes of introducing the drug into the body are sought. Smoking of a drug may be followed by snorting, which in turn may be followed by direct injection into the veins. There is, however, no fixed pattern to this development.

The need to use drugs on a once-daily or even more frequent basis, for a prolonged period of time, is indicative of drug dependency. Tolerance results in drug withdrawal symptoms if the drug is not regularly administered into the body (see page 36, 'examples of drug withdrawal'). As this condition is very unpleasant, addicts will go to significant lengths to avoid it. Many rely on prescription-only tranquillising medications such as the 'pams', which can be obtained on the black market.

Generally, there will exist a significant relationship between the socioeconomic status of the drug dependent person and the extent of the drug problem. The more heavily addicted person will have poor accommodation or be regularly homeless, will be self-neglectful, and will lack social or family supports. Other health related problems may be seen with the more severely affected, for example weight loss, signs of liver problems, including , and the results of physical trauma (signs of coincidental injuries etc.). Hepatitis C infection is very common in long-term drug users.

A person who is judged as having a severe addiction is not necessarily less likely to benefit from assistance or to be interested in such help. A cry for help from a severely addicted person may represent a valuable opportunity for helpful intervention.