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Table of Contents


Volume 6, Issue 2 2022


Volume 6, Issue 2, 2022

Substance misuse: alcohol and drugs.

Manuela Callari PhD, Freelance science writer

Substance misuse is a worldwide burden, with over two per cent of the world population having alcohol or illicit drug addiction. In some countries, it’s even more common. In the USA and several Eastern European countries, more than one in 20 people suffer a dependence, with twice more men than women misusing alcohol or drugs. 

Figure 1: In some countries more than one in 20 people have an alcohol or illicit drug addiction.

Mood-altering substances can be legal – alcohol and prescription medicines – or illegal – cannabis, ice or amphetamines. Some substances are highly addictive, so you often need more of the substance to experience the same effects. You might have cravings and urges to use the substance and experience withdrawal symptoms when not using it.

People use alcohol and drugs for many reasons – to relax, have fun, dull emotional or physical pain, or get away from problems or difficulties experienced in life. But inappropriate or excessive use of alcohol and drugs may lead to dependence and serious long-term consequences on health and wellbeing.

Figure 2: People use drugs and alcohol for many different reasons, often to dull emotional pain.

Risks of substance abuse: disease and death.

The misuse of alcohol and drugs, legal or illegal, is associated with many risks, including death. The use of drugs can lead to accidental overdose and death and increase suicidality risk. People under the influence of alcohol or drugs have impaired judgment and loss of normal inhibition and may act impulsively, increasing their risk of causing fatal accidents.

How many people die from substance misuse each year?

According to The Global Burden of Disease, a major global study on the causes and risk factors for death and disease published in the medical journal The Lancet in 2017, substance misuse can lead to death through two pathways. Direct deaths are those caused by an overdose of a substance. Indirect deaths result from the increased risk of premature death from related diseases, such as liver disease, hepatitis, HIV, cancers or heart disease, and injuries, including accidents and suicide.

The Global Burden of Disease study estimated that substance use was responsible for 11.8 million deaths in 2017 globally. Overall, indirect deaths from substance use vastly outnumber direct deaths from overdoses, with deaths caused by smoking being the most significant contributor.

Smoking is associated with an increased risk of various cancers, heart disease, stroke and diabetes, while misuse of alcohol and illicit drugs increases the risk of hepatitis and liver diseases.

Drugs and the brain

Using drugs as a teenager can profoundly affect the way your brain develops. Some changes drugs cause to your developing brain can be irreversible and potentially impact the rest of your life.

The brain circuits that coordinate feelings, thoughts and actions are formed by billions of neurons – nerve cells – connected. These connections are called synapses, and messages are sent across them when we think or do something.

In healthy brain development, synapses that are used repeatedly become stronger. Those that aren’t utilised much get weaker and are eventually trimmed in a process called synaptic pruning. 

Fewer connections between brain cells mean less grey matter, but the left connections are more efficient. You will lose about 1% of your grey matter every year during your teenage years and until your early twenties.

Figure 3: Drugs can profoundly affect the developing brain during adolescence.

The experiences you live and the choices during your teenage years can profoundly affect the pruning process and shape your brain. This plasticity of the brain helps teens learn new concepts and develop skills. But it can also reinforce thinking and behaviour that are not helpful. That is why the earlier someone begins using substances, the more likely they will develop an addiction.

Even “light” drugs can cause serious problems: cannabis use.

Recreational cannabis is often seen as a “light” drug and one that does not cause addiction or severe effects on the body. But increasing evidence suggests that cannabis use in young people might have intense and lasting physical, mental and behavioural effects. 

In a study published in the American Journal of Psychiatry in 2018, researchers followed over 3,000 high school students in Montreal, Canada, for four years to monitor their drug and alcohol use and measure its impact on their brains. 

The researchers found that regular cannabis use can affect teens’ inhibitory behaviour impairing their ability to control impulses. This could indirectly lead to risky behaviour, other drug issues and bad habits later on. The regular use of recreational cannabis can also impact a teen’s ability to think, remember and perform at school.

Both low and high use of cannabis is associated with an increased risk of schizophrenia in young people.

Many studies suggesting a link between smoking marijuana and developing schizophrenia have looked at frequent and high dosages. But a systematic review published recently in the Journal of Clinical Psychology revealed no difference in the risk of developing schizophrenia between high and low frequency.

The researchers analysed all the literature published between 2010 and 2020 that focused on adolescents aged 12 and 18 years old. They found that whether the teenagers used cannabis twice weekly or daily, they were up to six times more likely to develop schizophrenia than those who had never used cannabis. 

The effect of a global pandemic on substance use.

The uncertainty of the COVID-19 pandemic has led to an increased demand for mental health and drug use services. Periods of isolation due to lockdowns and restrictions in many countries to stop the spread of the virus have caused an escalation in substance misuse. 

According to the Centre for Disease Control and Prevention, 13% of Americans reported starting or increasing substance use to cope with stress or emotions related to COVID-19 in 2020. 

Since the beginning of the pandemic, overdoses have also spiked. Last December, the American Medical Association reported that most US states had seen an increase in opioid-related mortality (opioids are prescription medicines for pain relief such as morphine) and the number of people with substance use disorders.

In Australia, one in five people reported drinking more alcohol during the pandemic, with women more likely to increase alcohol consumption than men.

The pandemic presented unique challenges for people with a substance use disorder and those in recovery. On the one hand, they experienced barriers in accessing help centres and support groups, while the isolation from friends and family might have exacerbated their need to resort to substances. On the other hand, people who regularly misuse substances are at increased risk for poor COVID-19 outcomes.

Figure 4: Isolation caused by lockdowns during the pandemic led to greater substance abuse.

Signs of addiction

Some behaviours can signal if a person is abusing substances and might need help.

  • Engaging in risky behaviours such as drinking and driving.
  • Engaging in criminal behaviour such as purchasing illegal drugs, stealing, and causing physical harm to others.
  • Disengaging from pleasurable activities such as hobbies, sports or spending time with family and friends.
  • Neglecting responsibilities, including school, work and family.
  • Finding difficulties in maintaining relationships, having conflicts with a loving partner, family and friends.
  • Developing tolerance to a substance and increasing doses to experience the same effects.
  • Experiencing withdrawal symptoms when unable to use the substance.
  • Experiencing mental issues such as depression, anxiety, paranoia and suicidal thoughts.
  • Feeling unable to go on with daily routines.

Drugs affect your whole life

Drugs are never safe, but they can have even more dangerous effects on young people. Misuse of alcohol and drugs affect your health, social life, work, school, friends and family.

General health. Substances can have severe effects on the nervous system and damage your brain, and they can cause memory and learning problems and make it hard to control impulses. The misuse of alcohol and drugs can lead to long-term illnesses, such as cancers, heart disease, diabetes and liver disease, injuries, and premature death.

Mental health. Studies show that drug use increases the risk of mental health issues such as anxiety, depression, psychosis, paranoia and schizophrenia.

Social life. Because drugs can change behaviour, they can affect your relationships with family and friends, and they can cause conflicts, loss of friendships and isolation.

Legal issues. Many drugs are illegal and can result in a fine or imprisonment for possessing them. Conviction of a drug offence could lead to a criminal record, making it harder to get a job, apply for a loan, or travel overseas.

In addition, because some drugs can be costly, people who are addicted might be driven to steal to provide for their needs.

Getting help

If you are struggling with substance use or know someone who might be, it is essential to seek support as soon as possible. 

Asking for help from teachers, family or someone you trust might be the first step to receiving appropriate support.

In Australia, every State and Territory offers support through online and in-person services. You can also speak with your GP, pointing out the best service available in your area and for your circumstances.

Figure 5: There are various forms of support for people with substance addiction, including group therapy.

Student activities

  1. What are mood-altering substances, and why do some people choose to misuse them?

  2. How can misuse of these substances lead to death?

  3. What are the main risks of misusing substances?

  4. How do substances affect your brain?

  5. In groups, discuss some of the signs of substance addiction.

  6. In groups, discuss how misusing substances can affect your life.

  7. How has the pandemic impacted people with substance misuse problems?

  8. How does recreational cannabis affect your physical and mental health?

  9. Where can you find help?

References and resources

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