Support for Addiction and Prevention in Africa
Substances of Abuse
What is alcohol?
We don’t think of alcohol as a drug, but it is. Alcohol is often thought of as a stimulant, because it lowers inhibitions, which may mean that you take chances you wouldn’t otherwise take. However, alcohol actually acts as a depressant on your central nervous system, slowing down brain functioning.
There are two kinds of alcohol in common use. Ethyl alcohol is the kind present in beer, wine, spirits and liqueurs. Methyl alcohol is completely different and is found in solvents, paint removers, antifreeze and other household and industrial products. It is a poison and should never be consumed. For those drinking in the local Chang'aa dens, be careful as some brewers fortify the Chang'aa with methyl alcohol causing death and other servious medical/physiological complications.
Ethyl or beverage alcohol is the most popular drug in Africa. About 60% of people over the age of 15 drink to some extent. Whether they drink beer, wine or spirits, the basic ingredient, ethyl alcohol, is the same. A 12-ounce (340 mL) bottle of beer, a five-ounce (140 mL) glass of wine or a standard shot (1.5 ounces) of spirits such as whiskey or rum all have the same amount of alcohol. For those who drink "Chang'aa", a locally brewed beverage, the content of alcohol is not precise and could be 60% to 80% alcohol making a cup of the substance five to ten standard drinks.
A common effect of drinking alcohol is a sense of well-being. This feeling could be accompanied by drowsiness, dizziness and flushing. After one or two drinks, you may not appear drunk, but you have already lost some of your coordination skills. Drinking more alcohol will affect your speech, balance and vision.
When a person drinks too much, they often wake up with a hangover. Beginning eight to 12 hours after you stop drinking, a headache accompanied by shakiness and nausea may result.A hangover is caused by the dehydrating effect of alcohol and by causing increased urine production, which causes headaches, dry mouth, and lethargy. Dehydration also causes fluids in the brain to be less plentiful. The nausea can be attributed to alcohol's effect on the stomach lining. Another contributing factor is the presence of products from the breakdown of ethanol by liver enzymes. Ethanol is converted to acetaldehyde by the enzyme alcohol dehydrogenase, and then from acetaldehyde to acetic acid by the enzyme acetaldehyde dehydrogenase. Acetaldehyde (ethanal) is between 10 and 30 times more toxic than alcohol itself. Remember, alcohol is not safe to use when you’re taking other drugs. Even a small amount of alcohol can change the effect of another drug. And remember because no safe level of drinking during pregnancy has been established, experts recommend no alcohol during pregnancy or while breastfeeding.
Drinking heavily over a long period of time can lead to serious health problems such as stomach ulcers, sexual problems, liver disease, brain damage, and many kinds of cancer. Excessive drinking is often responsible for financial, legal and family problems.
Most people are able to drink alcohol in a responsible and safe way. They are referred to as social drinkers. However, some people are problem drinkers. They may be physically addicted to alcohol and not able to function without the drug in their systems. Other people are able to go days or weeks without alcohol, but drink a great deal at one time (for men this is defined as four or more drinks on one occasion and for women, it is defined as three or more drinks on one occasion). This pattern of drinking is commonly referred to as binge drinking. Binge drinking increases the risk of injuries from accidents, impaired driving and health problems (such as seizures, stroke and kidney failure) and is the most common form of abusive drinking in Kenya.
Alcohol and Addiction
People who use alcohol may find that they need more and more to get the same effect. Regular users of alcohol may not appear to be drunk, but that doesn’t mean it’s safe for them to drive a car or to do other tasks. If you do require more to get the desired effect you have developed Tolerance. Tolerance can be a symptom of physiological addiction.Another physiological symptom of addiction to alcohol is withdrawal. This is experienced when you suddenly stop using alcohol and experience a variety of symptoms including some or all of the following: insomnia, jumpiness and sweating to more severe symptoms such as tremors, hallucinations, and convulsions.
Additionally the DSM IV TR identifies five additional symptoms you may experience if you are in fact additicted.
The cannabis "high" comes from the chemical THC (delta-9-tetrahydro-cannabinol). In recent years, new growing methods have produced stronger marijuana. Hashish usually is stronger than marijuana, and hash oil is even stronger.
Using cannabis will probably make you feel more relaxed, free and open. Colours will seem brighter, sounds and smells more distinct. Some users feel happy and start talking a lot; others get quiet and withdrawn. Minutes can seem like hours, and ordinary objects seem to have special meaning. If you smoke cannabis, you will probably feel the "high" quickly, and it will last two to four hours. If you eat it, the high happens later, and you feel it for a longer time. Cannabis makes you clumsier and slow to react. Driving and operating machinery while stoned is not safe, especially if you combine cannabis with other drugs, including alcohol. While high on cannabis, you lose some of your ability to learn. You can forget things, and have trouble concentrating—a serious problem for students. Some users feel severe anxiety and high doses can cause panic attacks, fearful suspicious feelings (paranoia) and temporary psychosis. These effects usually disappear within hours. After very high doses, you might hallucinate, but this is unusual. Marijuana can be taken to decrease nausea caused by anti-cancer drugs and increase appetite in people with AIDS. In Canada, it is generally illegal to use marijuana for medical treatment.
In Africa it appears that for some reason we have significant numbers of cannibis smokers that are developing cannibis induced psychotic disorders and schizophrenia. We are not sure of the cause but beleive that it may be related to growers curing the cannibis in petrol or some other form of solvent. It is also common for people to add other substances to the cannibis to make it more powerful, i.e. herioin, cocaine, mescaline, etc. The combination of these substances is unpredictable at best.
Effects of Long-term Use
Using cannabis heavily for a long time can have serious side effects.
Cannabis smoke contains cancer-producing chemicals. Smoking cannabis damages the lungs and can lead to chronic coughing and lung infections. People who smoke both marijuana and tobacco may develop lung, neck and head cancers at a younger age than those who smoke only tobacco. Many people who use cannabis heavily for a long time have problems with short-term memory, concentration and abstract thinking. Most of these problems disappear after a few weeks without drugs, but some last for years. Some heavy cannabis users appear less active and ambitious than other people. We cannot say that cannabis causes this. However, frequent use can make people even less motivated.
Cannabis and Pregnancy
Women who use cannabis during pregnancy are more likely to have premature or underweight babies. As the children grow up, they may have some learning and behaviour problems.
Cannabis and Addiction
People who use cannabis often may find that they need more and more to get the same effect. Heavy users can become mentally and physically dependent, or addicted to how it makes them feel. They can't stop using cannabis even when it causes serious problems.
Dependent users who quit may feel mild withdrawal symptoms like troubled sleep, irritability, anxiety, nausea, sweating and loss of appetite. These symptoms usually last less than a week, but craving can last longer.
Khat is currently legal in Kenya and most of sub-Saharan Africa, though two of the chemicals that are released when the plant is chewed, cathinone and cathine, are classified as Class C drugs. It is a crop for export from Kenya with approximately 6 tons of khat being sent to the UK per week alone, mostly by air from Kenya. This is but one destination for the export of this product and the bulk of this is in transit for supply to the United States of America. The UK is a base for khat distribution to many countries, including the US, where the plant is illegal.
Evidence of khat use can be found in Arab journals dating from the 13th centuryThe use of Khat is an established cultural tradition for many social situations in the main cultivation areas of : East Africa and the Arabian Peninsula.More recently khat use has risen in Europe including the UK, particularly among emigrants and refugees from countries such as Somalia, the Yemen and Ethiopia.
Khat degrades with time so it must be consumed within 36 hours of harvesting. The effects from chewing khat can be felt within 30minutes, though it may take two hours to take full effect (effects may last up to 20 hours)Khat consumption induces mild euphoria and excitementKhat induced manic behaviors, hyperactivity, and hallucinations Dilated pupilsAlthough khat is a stimulant some users may experience a calming effect if used over a few hours.
Pesticide (dimethoate) residue has been found on khat leaves produced in Yemen. Chronic dimethoate poisoning can lead to weakness, fatigue, slurred speech and lack of co-ordination.
Worsening of existing or latent psychiatric disordersThere is evidence that chewing khat is a risk factor for the development of oral cancersInsomniaHigh blood pressureImpotenceIn men there is some evidence that using khat is associated with lower sperm countAnxiety and aggressionLethargyNightmares and tremorsMay cause depression, though this is unprovenLoss of touch with reality Permanent tooth darkening (of a greenish tinge)There is some evidence that khat affects the reproductive health of both sexes. In women it may be associated with delivery of low birth weight babies (as with smoking cigarettes), although the evidence for this is not strong.Khat use may cause inflammation of the liver, though this is unproven.
Dependence and treatment
Psychological dependence can result from regular use