Understanding alcohol and other drugs misuse

We can categorise drugs by how they affect our bodies and minds:

Depressants	Depress the function of the central nervous system.
Hallucinogens	It affects the senses and changes how a user sees, hears, tastes, smells or feels things.
Stimulants	Stimulate the function of the central nervous system.

Some substances affect the body in several ways and can be placed in more than one category. For example, cannabis appears in all categories.

Drugs are also grouped by how or where they are commonly used:

Analgesics	Also known as painkillers, analgesics are legitimately used to relieve thesymptoms of pain, but they are also misused.
Inhalants	Inhalants are gases or fumes that can be breathed in through the nose (sniffing) or mouth.
Opioids	Also called opiates or narcotics, opioids are a type of painkiller made from poppy plants or produced synthetically.
Party drugs	These drugs are a group of stimulants and hallucinogens used to enhance the party experience.
Performance and image-enhancing drugs	These substances are used by individuals who want to alter their physical appearance or increased sporting ability.
Prescription drugs	Also known as pharmaceuticals, prescription drugs are prescribed by a doctor but are misused in a way that can cause short- and long-term harm.
Psychoactive drugs	These are psychoactive substances developed to get around drug laws and give similar effects to illegal drugs.
Synthetic drugs	These affect how an individual thinks, feels and behaves.

Watch

Watch the following video to learn about substance use disorders: ‘Substance Use Disorders | Processing the Environment | MCAT’ by Khanacademymedicine on YouTube.

Depressants

Depressants reduce stimulation and arousal, as they slow the speed of messages sent between the brain and the body through the nervous system (they do not necessarily cause you to be depressed). By affecting the central nervous system, they reduce an individual’s ability to:

• Concentrate and coordinate body functions
• Respond to what is happening around them.

Depressants include:

• Alcohol
• Benzodiazepines (minor tranquillisers, such as Valium)
• Cannabis
• Gamma-hydroxybutyrate (GHB)
• Ketamine
• Opioids (e.g. heroin, morphine, codeine).

Small doses of depressants will make a person feel relaxed and reduce inhibition. However, large amounts of depressants may cause sleepiness, vomiting and nausea, unconsciousness and death.

Depressants affect people differently depending on:

• The individual’s size, weight and health
• Whether their system is acclimatised to the drug
• Whether they are taking other drugs at the same time
• How much of the drug they take
• The strength of the drug—illegally produced drugs can vary in strength from batch to batch.

The onset and effects of depressants can also vary depending on the specific drug and its variants. Some depressants, such as inhalants, can work instantly, with effects lasting for a short time, while others can act more slowly on an individual’s system, and the effects may last longer.

When an individual takes low doses of depressants, they can experience:	If an individual takes high doses of depressants, they might experience:
Reduced inhibitions Enhanced mood Reduced anxiety Slowed reaction time Impaired judgement Slowed breathing Increased risk of accident or injury from lack of coordination.	Impaired judgement and coordination Vomiting Irregular or shallow breathing Blackouts and memory loss Unconsciousness Coma Death

If an individual uses depressants with other drugs, the effects on their health can be more severe—such as consuming alcohol with benzodiazepines, which decreases heart rate and breathing—and an overdose is much more likely. If an individual takes benzodiazepines with opiates (such as heroin), they can have breathing diffculties and an increased risk of overdose and death.

Using depressants has increased dangers, particularly when:

• Taken in combination with alcohol or other drugs
• The user is driving or operating heavy machinery
• Judgement or motor coordination is required
• Used when alone because medical assistance may be needed if they have adverse reactions or overdose.

NOTE:

Individuals who use depressants on a regular basis are likely to develop dependence and tolerance. Tolerance means that they require more significant doses of the substance to get the same effect, and dependence on depressants can be both psychological and physical.

For some, using depressants can grow to be more important than anything else in their lives, and cravings make it very hard to stop using the substances. If an individual is psychologically dependent on depressants, they may feel the urge to use when in specific surroundings or when socialising.

When an individual’s body adapts and acclimatises to functioning with the depressant present, that is referred to as a ‘physical dependence’.

Watch

The following video takes a closer look at psychoactive drugs: ‘Psychoactive Drugs: Depressants and Opiates | Processing the Environment | MCAT’ by khanacademymedicine on YouTube

Hallucinogens

Hallucinogens are also known as ‘psychedelics’. They are psychoactive substances, which means they change an individual’s perception, mood and cognitive processes.

Hallucinogens affect perception and alter an individual’s thinking, sense of time and emotions. They also cause hallucinations, meaning that the individual might see, taste, smell or hear things that do not exist or are distorted.

There are many types of hallucinogens—some occur naturally, in plants and fungi, while others are manufactured in laboratories.

Common hallucinogens include:

LSD	This is a synthetic chemical made from a substance found in ergot fungus.
Psilocybin	Also known as ‘magic mushrooms’, psilocybin is naturally occurring, and in Australia, the most common types are golden tops, blue meanies and liberty caps.
Ayahuasca	This is a plant-based hallucinogen that is most commonly derived from a decoction made by lengthy heating or boiling of Banisteriopsis caapi (a large vine) with the leaves of the Psychotria viridis (a flowering shrub).
N-methoxybenzyl	This is a class of synthetic psychedelics and is also what is referred to as a new psychoactive substance (NPS).
Other hallucinogens available in Australia include:	N, N-Dimethyltryptamine (DMT) 2.5-Dimethoxy-4-methylamphetamine (DOM) 4-Bromo-2,5-dimethoxyphenethylamine (2C-B) Peyote NBOMe

Naturally occurring hallucinogens have been used for sacred purposes by First Nations people across many cultures for thousands of years because the effects they have on perception can create spiritual/mystical experiences.

Some modern users of naturally occurring hallucinogens think they are safer than manufactured hallucinogens because they are natural, but there is no safe level of drug use, and all drugs carry some form of risk to the user.

One of the main problems with hallucinogens, naturally occurring or manufactured, is that the user never knows how strong each batch may be or what other substances may have been added. Hallucinogens affect individual users differently depending on:

• The individual’s size, weight and health
• Whether they are used to taking the drug
• Whether they are taking other drugs at the same time
• How much of the drug they take
• The strength of the drug, can vary from batch to batch.

Note:
Most hallucinogens produce rapid tolerance, and psychological dependence can arise in some individuals. Research does not support the development of physical dependence, and there are no withdrawal symptoms even after prolonged use.

How the drug acts for the user depends on the type of hallucinogen taken. The effects can last for several hours and vary widely from user to user. The experience of hallucinogens can include:

• Vomiting
• Blurred vision
• Rapid breathing
• Clumsiness
• Confusion, trouble concentrating
• Dizziness
• Fast or irregular heartbeat
• Feelings of euphoria
• Numbness
• Seeing and hearing things that are not there
• Sense of relaxation and wellbeing
• Sweating and chills

Some users can experience ‘bad trips’: frightening and disturbing hallucinations that can lead to panic and unpredictable behaviour, including self-harm. Individuals with mental health conditions or a family history of mental health issues should avoid using hallucinogens because of the intense effect on the mind and brain chemistry.

Long-term effects of hallucinogens can include ‘flashbacks’. Flashbacks happen when the user reexperiences the initial effects of the drug, and these events can occur at any time, even years after use.

Most commonly, the individual experiences visual hallucinations, which may last for a minute or two. Flashbacks may be sparked by stress, fatigue, physical exercise or using another drug and can range in severity from creating a mildly pleasant feeling to severe anxiety and panic.

Using drugs like alcohol or cannabis can change the experience of hallucinogen use. Mixing hallucinogens with depressants can create an additional decrease in coordination and can increase the likelihood of the user vomiting. Alcohol can decrease the effects of the psychedelic, making the user want to take more.

Combining hallucinogens with stimulant drugs increases the effects of the stimulant and increases heart rate even more, which puts the body under dangerous stress. Stimulants may increase a user’s anxiety levels, which can increase the chances of them having a ‘bad trip’.

Using hallucinogens is more dangerous when:

• Taken in combination with alcohol or stimulants, such as crystal methamphetamine or ecstasy, and other drugs
• The user is driving or operating heavy machinery
• Judgement or motor coordination is required
• Used when alone because medical assistance may be needed if they have adverse reactions or overdose
• The user has a mental health condition or a family history of mental health conditions.

Watch

Watch this video for more information about how hallucinogens affect the mind and body, particularly the sensations that they cause for the user: ‘Psychoactive Drugs: Hallucinogens | Processing the Environment | MCAT’ by khanacademymedicine on YouTube

Stimulants

Stimulants increase the speed of the nerve messages between the brain and the body. They may cause the individual using them to feel more awake, alert, confident or energetic. Stimulants include caffeine, nicotine, amphetamines and cocaine.

Some stimulants are legitimately prescribed for some medical disorders, while others are illegally created in dangerous criminal conditions. Large doses of stimulants can cause overstimulation and result in the user experiencing anxiety, panic, seizures, headaches, stomach cramps, aggression and paranoia. Long-term use of strong stimulants can have several adverse effects.

Commonly used stimulants include:

Amphetamines	Some amphetamines are prescribed by doctors to treat conditions such as attention deficit hyperactivity disorder. (ADHD), narcolepsy and Parkinson’s disease. Other amphetamines, such as speed, are illegally produced and sold and used as performance-enhancement drugs. Crystal methamphetamine– Also known as ‘ice’, this is a powerful illegal amphetamine, and it is more addictive and harmful than the powder form of methamphetamine (speed). The effects of ice can last for up to 12 hours.
Cocaine	Cocaine is produced from the leaves of the coca bush (Erythroxylum coca), a plant native to South America. The leaf extract is processed to produce three different forms of cocaine: Cocaine hydrochloride Freebase cocaine Crack cocaine.
Khat	The buds and leaves of the khat plant (Catha edulis) are chewed for stimulant and euphoric effects. Khat has traditionally been used for medicinal purposes and used recreationally in some social traditions in the Middle East and Eastern Africa.
Betel nut	Betel nut is the seed of the fruit of the areca palm (Chrysalidocarpus lutescens). Common names, preparations and certain ingredients used in preparations differ across the cultural groups and people who use it. Betel nut chewing is a cultural practice in certain areas from South Asia across to the Asia-Pacific. It plays an important traditional role in social customs, religious practices and cultural rituals.
Other stimulants include:	Nicotine Caffeine Methylphenidate (prescribed) Pseudoephedrine

How different stimulants affect users depends on a variety of factors, including:

• The individual’s size, weight and health
• Whether they are used to taking the drug
• Whether they are taking other drugs at the same time
• How much of the drug they take
• The strength of the drug— illegally produced drugs can vary in strength from batch to batch.

Generally, when taken in small to low doses, stimulants may have the following effects:

• Euphoria
• Heightened feelings of wellbeing
• Increased heart rate and blood pressure
• Increased alertness
• Talkativeness
• Reduced appetite.

When an individual consumes stimulants with other drugs, such as over-the-counter and prescribed medications, the effects can be dangerous and unpredictable.

When amphetamines are consumed with certain types of antidepressants, the results can include elevated blood pressure, irregular heartbeat, heart failure and stroke.

Amphetamines taken with depressants, such as alcohol, cannabis or benzodiazepines, can put the body into a highly stressed situation as it deals with the conflicting effects of each drug and can cause an overdose.

Crystal meth taken with speed or ecstasy can create a huge strain on the heart and other parts of the body and lead to the user having a stroke. Crystal meth taken with alcohol, cannabis or benzodiazepines also puts an immense strain on the body, and users can overdose because the stimulant effects of crystal meth can mask the calming effects of depressants.

Watch

The following video discusses how stimulants affect the user’s body, including withdrawal, addiction and overdose:‘Psychoactive Drugs: Stimulants | Processing the Environment | MCAT’ by khanacademymedicine on YouTube

New Psychoactive Substances

New psychoactive substances are substances designed to imitate established illegal drugs, such as cannabis, cocaine, 3,4-Methylenedioxymethamphetamine (MDMA) and LSD. NPS arrived in the recreational drug markets in Australia in the mid-2000s.

The makers of these drugs create new chemicals to substitute banned drugs, and the chemical structures of the drugs are always changing in efforts to stay ahead of attempts to ban them. Because new drugs are rapidly emerging, you cannot always know the effects of these drugs on the body or mind or what sort of dose can cause what kinds of effects. Not every batch will be the same, and it is possible to get a very different product from each new batch, even if the packaging and name are the same.NPS are comparatively new, and there is limited information available about their effects on users.

However, synthetic cannabinoids, one type of NPS, have been around for a while, so we have evidence that they have more serious side effects than naturally derived cannabis. Synthetic cannabinoids were initially designed to produce similar effects to cannabis and have been available online for at least 20 years. Some of the newer substances claiming to be synthetic cannabis have effects nothing like delta-9 tetrahydrocannabinol (THC), the active ingredient in cannabis.

Phenethylamines are a group of psychoactive drugs that also have stimulant effects. This group includes amphetamines, MDMA, the 2C series, NBOMes, paramethoxyamphetamine (PMA) andparamethoxymethamphetamine (PMMA), and benzodifurans (Bromo-DragonFLY).

MDMA	MDMA is commonly known as ‘ecstasy’, but a lot of pills that are sold as ecstasy have only a tiny quantity of MDMA, or none at all. These pills may include ingredients such as amphetamines, PMA, PMMA, ketamine, NBOMe, methylone or other substances. MDMA is also an empathogen, meaning that it increases a user’s feelings of empathy and compassion towards others.
Piperazines	These have stimulant properties and are often sold as MDMA. They were originally developed by pharmaceutical companies as potential antidepressant drugs, but because they have properties similar to amphetamines, they became a risk for illegal abuse. Some commonly used piperazines are 1-benzylpiperazine (BZP) and trifluoromethylphenylpiperazine (TFMPP), which, when mixed, have similar effects to MDMA.
PMA and PMMA	These drugs are empathogens with effects similar to MDMA. In fact, most people who take PMA or PMMA believe that they are getting MDMA. PMA and PMMA have a more toxic effect and create less euphoria than MDMA. They also take a longer time to create these effects in a user, and many people take another pill believing that the first dose has not worked, which can result in an overdose.
Novel benzodiazepines	These are substances that were created and tested legally by legitimate drug research companies but never approved for use, and they are also illicitly manufactured substances that have different chemical structures from existing benzodiazepines. Several new benzodiazepines have emerged on the illegal drug market and are reportedly sold under the names ‘legal benzodiazepines’, ‘designer benzodiazepines’ or ‘research chemicals’.
Synthetic cathinone	These are a category of drugs related to the khat plant. More than 81 synthetic cathinone derivatives have been reported to the European Union early warning System on NPS, which monitors the emergence of new and dangerous drugs.
Tryptamines	Tryptamines are psychedelic drugs mostly found in plants, fungi and animals, and some are similar to natural neurotransmitters such as serotonin and melatonin. New synthetically produced tryptamine hallucinogens, such as alpha-methyltryptamine (AMT) and 5-methoxy-N, N-dimethyltryptamine (5-MeO-DMT) appeared in the recreational drug market as next-generation designer ‘legal’ drugs and as an alternative to LSD. Tryptamine derivatives are accessible via the internet from companies that sell them as ‘research chemicals’.

Substance use has identifiable stages prior to an addiction. Understanding the stages of substance use and being able to identify patterns is crucial when supporting those suffering from substance abuse. These stages are broadly outlined as experimental, regular use, risky use, dependence and finally, addiction. Some patterns of substance abuse include:

• patterns of recurring use
• risky behaviours
• increased tolerance and dependence isolation
• emotional and physical alterations
• a lack of motivation, manipulation, and unpredictability.

Cryptomarkets

Cryptomarkets, also known as ‘darknet markets’, are anonymous online trading platforms that enable the purchase of illicit goods and services through multiple sellers. A recent study of crypto markets reported by the National Drug & Alcohol Research Centre showed that the illicit drugs most commonly listed for sale to Australia in 2019–20 were cannabis (30%), MDMA (13%), cocaine (9%) and methamphetamines (6%).

Over the period studied, the listings of illicit drugs on the different darknet sites increased by 121%. The report can be downloaded at the following link: Trends in the Availability and Type of Drugs Sold on the Internet via Cryptomarkets, May 2019 - May 2020 by the National Drug & Alcohol Research Centre.

Trends in AOD Use

The National Drug Strategy Household Survey 2019: In Brief (the survey) presents the key findings from the survey report and delves into how tobacco, alcohol and illicit drugs are used by Australians aged 14 and over.

The information from the survey has been compared to the survey previously published in 2016. It shows that, in the population surveyed, the use of alcohol and tobacco is, in general, on the decline, but rolling your own cigarette and vaping is on the rise.

The use of opioids and painkillers is also down, as is the use of new and emerging psychoactive substances.

The use of methamphetamine has remained unchanged since 2016, but the use of inhalants, marijuana, cocaine, ecstasy, hallucinogens and ketamine have all risen. Cannabis is the most used illicit drug in Australia. Cocaine use across all age groups (apart from people aged 14 to 19) has shown the largest increase.

According to the Survey, in 2019, more than 43% of people surveyed had illicitly used a drug at some point in their lifetime, and 16.4% had used a drug in the last 12 months. It also found that 69% of people said they tried illicit drugs out of curiosity, and 71% said they continue to use drugs because they enjoy them.

Frequency of Illicit Drugs

Risky Drinking

The revised Australian Guidelines to Reduce Health Risks From Drinking Alcohol, published in 2020, describe ways in which Australians can best reduce the harms that can occur from drinking alcohol.

Demographics

Age of Users
According to the Survey, patterns of use of alcohol, tobacco and illicit drugs have changed across all age groups during the past 20 years.

In the early 2000s, people aged 20 to 29 were the age group most likely to have used an illicit drug in their lifetime. By 2019, this had shifted to people aged in their 40s. While the use of illicit drugs increased in the older populations surveyed during this period, the proportion of users stabilised for those in their 30s and fell for people aged under 30.

People aged 20 to 29 in the early 2000s were the most likely age group to smoke every day (26%). By 2019 it was people aged 40 to 60 who were most likely to smoke every day (22%). By 2019, only 10.7% of people aged 20 to 29 were likely to smoke.

In the early 2000s, 51% of people in their 20s were likely to engage in risky drinking behaviour. By 2019, it was people in their 40s, 50s and 60s who were most likely to drink alcohol daily, with the highest proportions among people aged over 70. People aged 40 to 50 were the most likely group to engage in behaviours considered risky by the lifetime risk guidelines—in fact, more than 1 in 5 people in this demographic were drinking at unsafe levels. While the amount of single-occurring risky drinking remains highest among people aged 18–24, this did decrease between 2001 and 2019 from 57% to 41%.

Over the same period, the same behaviour rose for people in their 50s and 60s.The number of young adults (aged 18–29) who do not drink at all increased by more than double between 2001 and 2019. However, the number of people aged 70 and over abstaining has declined.

AOD Use in First Nations Populations

While First Nations people in Australia are more likely to engage in daily smoking and risky drinking than nonindigenous people, the statistics show that there have been improvements between 2010 and 2019.

• In 2010, 34% of First Nations people surveyed smoked daily. In the 2019 survey, this dropped to 27%.
• In 2019, the proportion of First Nations people who drank daily dropped to 20% from 30% in 2010.
• In 2010, 39% of First Nations people drank at risk levels on single occasions at least monthly. This dropped to 35% by 2019.

Read the following factsheet for a summary of statistics relating to Aboriginal and Torres Strait Islander people: ‘Alcohol, Tobacco and Other Drugs in Australia: Aboriginal and Torres Strait Islander People’ from the AIHW

LGBTIQ People and Drug Use

People in the LGBTIQ community are more likely to engage in substance use than those who identify as heterosexual.

Between 2010 and 2019, the number of LGBTIQ people who smoked every day and drank at risky levels decreased.

However, a comparable number continue to use illicit drugs.

LGBTIQ people surveyed demonstrated different usage patterns of illicit drugs than heterosexual people in the 12 months previous to the survey in 2019.

Hetrosexual	Percentage	LGBTIQ	Percentage
Cannabis	26%	Cannabis	11.6%
Cocaine	4.2%	Cocaine	8%
Ecstasy	2.9%	Ecstasy	7.4%
Pain killers & opioids (non-medical)	2.5%	Inhalants (amyl nitrate & other nitrates)	9.9%
Tranquilisers/sleeping pills (non-medical)	1.7%	Methamphetamines (non-medical)	5.1%

Watch

Chemsex is a practice among some gay men where the use of stimulants and hallucinogens are used to enhance sexual experiences. Watch the following video for a personal insight into the practice: ‘Be-Longing for It: Finlay’s Story’ by Thorne Harbour Health on YouTube

People With Mental Health Issues

According to the 2019 Survey, people aged 18 and over who have been diagnosed with, or treated for, a mental health condition in the previous year were 1.7 times as likely to have used an illicit drug as people without a mental health condition. They were also two times more likely to smoke daily.

Having a mental illness can make some people more likely to use AOD, for example, in self-medicating for symptomatic relief. For some people, using drugs may produce the initial symptoms of an underlying mental illness.

Certain drugs may cause drug-induced psychosis in some users, but it usually passes after a few days. However, for someone who has a predisposition to a psychotic illness, such as schizophrenia, using illicit drugs could trigger the first episode in a lifelong mental illness. Drug use can interact with mental illness in ways that could produce serious adverse effects on many areas of the user’s life, including their relationships, work, health and safety.

It is important to understand that the survey states that, by themselves, these findings do not indicate a causal link between mental illness and drug use. Mental health conditions can precede drug use or vice versa.

Polydrug Use

Taking a drug while under the influence of another drug or mixing drugs is known as polydrug use. Using two or more drugs in combination is common among people who use drugs, who often use one drug to counteract the effects or the aftereffects of another or who use different drugs at different times over a short period of days or weeks.

Using more than one drug at a time significantly increases the risks of addiction, overdose, and medical problems, such as heart attacks and liver failure. According to the Survey, there seems to be an increase in the proportion of drug users who take multiple drugs at the same time.

Alcohol is the most commonly used substance used with other drugs—at least 8 out of 10 people who use cannabis, cocaine, ecstasy or meth/amphetamines are likely to use alcohol at the same time. Among cannabis users, the number of people who also use alcohol, tranquillisers, hallucinogens, cocaine or ecstasy at the same time increased in 2019, and there was an increase in the proportion of ecstasy and meth/amphetamines users reporting using cocaine at the same time.