Drug abuse

1. DRUG ABUSE AMONGST MILITARY PERSONNEL
THE WAY FORWARD
SURG SLT LO MAJOLAGBE
MEDICAL OFFICER
NIGERIAN NAVY REFERENCE HOSPITAL OJO
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2. OUTLINE
 Introduction
 Definitions of Terms
 Epidemiology
 Common Drug Abused
 Predisposing Factors of Drug Abuse Amongst Personnel
 Effects/Symptoms of Drug Abuse
 Investigations
 Management
 Way forward
 Recommendations
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3. INTRODUCTION
 It’s important to understand that drug abuse is an extreme
desire to obtain, and use, increasing amounts of one or more
substances.
 In the military, certain substance types tend to be abused
more often than others.
 Reasons for drug abuse in military personnel differ from the
civilians.
 Alcohol and prescription drugs (including sedatives and
opioid painkillers) are more commonly abused than illicit
drugs among armed forces.
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4. DEFINITION OF TERMS (1)
 Drugs: Any substance that enters the human body and can
change either the function or structure of the human
organism.
 Psychoactive drugs: are substances that, when taken in or
administered into one's system, affect mental processes, e.g.
perception, consciousness, cognition or mood and
emotions. [W.H.O]
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5. DEFINITION OF TERMS (2)
 Drug abuse: Drug abuse is the deliberate or unintentional
continuous use of mind-changing chemical substances
(usually for reasons other than legitimate medical purposes)
that results in any degree of physical, mental, emotional, or
social impairment of the user, the user's family, or society
in general.
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6. DEFINITION OF TERMS (3)
 It is simply the use of a drug in amounts or by methods
which are harmful to the individual or others.
 It is also known as substance abuse [ICD. DSM]
 Controversial.
 Illegal or Legal
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7. DEFINITION OF TERMS (4)
 Drug addiction is the inability to stop using the drug in
spite of numerous attempts to stop despite substantial harm
and adverse consequences.
 One can abuse drugs without necessarily being addicted to
drugs.
 Addictive drug – psychoactive substances that with
repeated use are associated with significantly higher rates of
substance use disorders.
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8. DEFINITION OF TERMS (5)
 Withdrawal syndrome: is the group of symptoms that
occur upon the abrupt discontinuation or decrease in the
intake of medicational or recreational drugs.
 Drug dependence: is an adaptive state that develops from
repeated drug administration, and which results
in withdrawal upon cessation of drug use.
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9. DEFINITION OF TERMS (6)
• Physical dependence – dependence that involves persistent
physical–somatic withdrawal symptoms (e.g., fatigue
and delirium tremens).
• Psychological dependence – dependence that involves
emotional–motivational withdrawal symptoms
(e.g., dysphoria and anhedonia).
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10.  Tolerance – the diminishing effect of a drug resulting from
repeated administration at a given dose.
 Drug misuse: Use of a substance for a purpose not
consistent with legal or medical guidelines, as in the non-
medical use of prescription medications. [W.H.O] e.g.
Tramal
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DEFINITION OF TERMS (7)

11. PICTURE SHOWING DRUGS
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12. EPIDEMIOLOGY (1)
 W.H.O World drug report (2019)
 About 270 million people (or about 5.5% of global
population aged 15-64) had used psychoactive drugs in the
previous year.
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13. EPIDEMIOLOGY (2)
 It is estimated that about 0.5 million death annually are
attributable to drug use with about 350,000 male and
150,000 female deaths
 It is estimated that worldwide there are almost 11 million
people who inject drugs, of whom 1.4 million live with HIV
and 5.6 million - with hepatitis C.
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14. EPIDEMIOLOGY (3)
 Cannabis (marijuana) is the most widely abused drugs in
the world.
 Around 141 million people worldwide consume cannabis.
 While among armed forces, alcohol and marijuana take the
lead.
 320,000 young people between the age 15 and 29 years die
of alcohol related deaths resulting in about 9% of death in
that age group.
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15. EPIDEMIOLOGY (4)
 Kareem and Abdukarim (2014)
investigated relationship between depression, paranoid
ideation and substance abuse among Nigerian military
personnel deployed for peace support operation.
 Using a 211 item structured self-report questionnaire, the
research has found that depression and paranoid ideation were
significantly and positively associated with substance abuse.
(Kareem &Abdulkarim. 2014).
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16. EPIDEMIOLOGY (5)
 Alcohol Use Among Military and Paramilitary Personnel
by GE Abikoye 2016; 18.5% of Nigerian
Army personnel abuse one of alcohol, cannabis and
tobacco; and 8.5% abuse at least two of alcohol. cannabis
and tobacco.
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17. DRUG CATEGORY (1)
• Depressants: These cause depression of the brain's
faculties and examples include sleeping pills (barbiturates)
and heroin.
• Hallucinogens: These cause hallucinations and an "out of
this world" feeling of dissociation from oneself.
Hallucinogens may cause distorted sensory perception,
delusion, paranoia and even depression. Examples include
ecstasy, mescaline and LSD.
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18. DRUG CATEGORY (2)
• Stimulants: These cause stimulation of the brain, giving
rise to alertness and increased bursts of activity. A rapid
heart rate, dilated pupils, raised blood pressure, nausea or
vomiting and behavioral changes such as agitation, and
impaired judgment may also result. Examples are cocaine
and amphetamines.
• Alcohol, Tobacco, Opioids, and Marijuana.
• Narcotics, Rubber, Gutter, Gum, Cigarette.
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19. MOST COMMON DRUGS USED BY MILITARY
PERSONNEL
 Marijuana. Easily the most used drug in the military.
Marijuana is a relatively easy for soldiers to obtain. The
drug is used to temporarily escape the stressors provided by
the wartime environment.
 Cocaine and other stimulants. Long stretches of duty lead
many soldiers to turn to stimulants such as amphetamines
or cocaine to stay alert throughout the course of the day.
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20. MOST COMMON DRUGS USED
 Opiates. Vicodin and OxyContin are becoming more
widespread in the military because of the euphoric effects
they provides. Many will have these drugs shipped in from
home, or brought over with incoming military personnel.
They provide escape and self-medication against the horrors
of war.
 Alcohol: military culture.
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21.  Oral
 Injection
 subcutaneous
 intramuscular
 intravenous reaches brain in ~10 secs
 quick response thus dangerous, HIV, Hepatitis Risk
 Inhalation - reaches brain in ~8 secs
 Dermal – absorbed through the skin
 Buccal or nasal membranes
ROUTES OF ADMINISTRATION
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22. PREDISPOSING FACTORS
 Combat exercise: active deployment in a combat zone.
 Those who have multiple deployments may be at an
even higher risk of developing substance abuse issues,
due to cumulative effect in terms of the related stress
and trauma.
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23. PREDISPOSING FACTORS
 Post traumatic stress disorder: vivid flashbacks, intrusive
images, thoughts, nightmares seen in PTSD contribute to
increased substance use as well as depression, and
traumatic brain injury.
 Unfortunately, substance use is a maladaptive coping
method that some turn to in the face of untreated mental
health issues and psychological distress.
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24. PREDISPOSING FACTORS
 Culture of military: For many, drinking is an accepted part
of military culture. Turning to alcohol to unwind or
otherwise cope with the challenges of military life is
common. Alcohol is widely available in some military
bases at a discounted rate, and service members have many
opportunities to partake in established drinking rituals. It
serves as anti-emetics for sailors.
 Examples are regimental dinners nights, mess functions etc.
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25. PREDISPOSING FACTORS
 Increased risk for injury: there is an increased risk of
physical injury.
 Treatment for injuries often involves prescription
opioids, painkilling medications with a high potential
for misuse and abuse. Misuse of prescribed pain
medication may lead to an opioid use disorder
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26. EFFECTS OF DRUG ABUSE
MILITARY DUTIES
FAMILY / SOCIAL
FINANCIAL PROBLEMS
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27. EFFECTS OF DRUG ABUSE
 The subsequent “crash” after using these drugs is
dangerous because it leaves soldiers in a weakened state
during what could be times of emergency.
 Creating the wrong kind of environment. A military unit
functions on order and the chain of command. If conflict
arises, or chaos ensues as a result of drug use, the entire unit
will cease to function properly.
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28. EFFECTS OF DRUG ABUSE
 Putting their comrades in jeopardy. In the military, all
you have to rely on at the end of the day are your comrades
in arms. If an individual’s judgment is impaired because of
drug use, it puts the man or woman next to them in peril as
well.
 Risking one’s own personal safety. Drugs can slow
reaction times, which on the battlefield can mean the
difference between life and death. Taking drugs puts the
soldier at greater risk for being wounded or separated from
their fellow soldiers during battle or troop movements.
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29. EFFECTS OF DRUG ABUSE
 Emotional burden (frustration, worry, depression, shame
and guilt).
 Increased financial burden (financial embarrassment, loss
of job, reliance on others).
 Family instability (tension, conflicts, abuse, violence and
break up).
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30. SIGNS AND SYMPTOMS OF SUBSTANCE ABUSE
 Anxiety
 Blackouts, dizziness
 Depression
 Disorientation
 Mood swings
 Falls, bruises, burns
 Family/Social problems
 Financial problems
 Headaches
 Incontinence
 Increased tolerance
 Aggressive / violent
behavior
 Memory loss
 New problems in decision
making
 Poor hygiene
 Seizures, idiopathic
 Sleep problems
 Social isolation
 Unusual response to
medications
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31. ALCOHOL INTOXICATION
 Drunkenness / Alcohol poisoning
 Mainly absorbed in the stomach, small amount in the small
intestine.
 Alcohol is primarily metabolized by the liver (90%).
 Alcohol has lethal effects on all organs of the body.
 Legally, alcohol intoxication is often defined as a blood
alcohol concentration (BAC) of greater than 5.4–
17.4 mmol/L (25–80 mg/dL).
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32. BLOOD ALCOHOL CONCENTRATION
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33. BREATHALYZER TEST
 A breathalyzer or breathalyser is a device for estimating
blood alcohol content from a breath sample.
 The name is a genericized trademark of the Breathalyzer
brand name of instruments developed by inventor Robert
Frank Borkenstein in the 1950s.
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34. TABLE SHOWING ALCOHOL CONTENT OF
VARIOUS BEVERAGES
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35. ALCOHOL RECOMMENDED LIMITS
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36. ALCOHOL RECOMMENDED LIMITS
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37. ALCOHOL EFFECTS ON BODY ORGANS
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38. STANDARD FIELD SOBRIETY TEST
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39. INVESTIGATIONS OF DRUG ADDICTS
 Random screening e.g. annual medical screening, pre-
enlistment screening.
 Monitor someone with a history of substance abuse.
 To monitor compliance with prescribed medications e.g.
pain medications or addictive drugs.
 To detect and evaluate drug intoxication or overdose for
legal or forensic reasons.
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40. INVESTIGATIONS OF DRUG ADDICTS
Sample Required:
 Random urine; detects drug use from few days to 1 week
 Venous blood; hormones and steroids
 Hair; 2 to 3 months
 Saliva; last 24 hours
 Sweat; collected on an absorbent patch worn for several
days to weeks
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41. INVESTIGATIONS OF DRUG ADDICTS
Urine Drug Tests
• amphetamines.
• methamphetamines.
• benzodiazepines.
• barbiturates.
• marijuana.
• cocaine.
• PCP.
• methadone.
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42. INVESTIGATIONS OF DRUG ADDICTS
 Test Preparation Needed
 Some prescription and over-the-counter drugs may give a
positive screening result; prior to testing, indicate any
medications that you have taken and/or for which you have
prescriptions.
 Vicks nasal spray can test positive for amphetamines;
poppy seeds can produce a false-positive for opiates.
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43. MANAGEMENT OF SUBSTANCE ABUSE
 Seek help: free counseling to service members who are
concerned about their substance use or are dealing with
overwhelming stress, depression, or other concerns, can
access this resource.
 Psychotherapy: Psychiatrists, psychologist and the
counselors.
 Rehabilitation.
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44. MANAGEMENT OF SUBSTANCE ABUSE (CONT)
 Disciplinary committee: While disciplinary action may
result, it’s important to remember that without intervention,
it is likely that the substance abuse issue will continue to
worsen and may end in devastating consequences.
 Random drug test: positive member can go for in-patient
or out-patient detox program.
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45. MANAGEMENT OF SUBSTANCE ABUSE (CONT)
 Focus of treatment: Treatment programs for military
personnel with substance abuse should ideally include a
focus on addressing trauma, include treatment for other
psychiatric disorders, and work to lessen the stigma
associated with substance abuse or mental health disorders
among military members.
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46.  First need to treat acute withdrawal
 With benzodiazepines (diazepam)
 Then follow up with more long-term strategies
 Pharmacotherapies e.g. Disulfiram, Acamprosate
 Join groups like Alcoholics Anonymous
TREATING ALCOHOL DEPENDENCE
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47. PICTURE SHOWING MEMBER OF A THERAPY GROUP
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48.  Opioid based drugs
 heroin, morphine, oxycodone, methadone, etc.
 Treatment often uses substitution therapy
 methadone
 buprenorphine
TREATMENT OF OTHER DRUGS
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49. WAY FORWARD - PREVENTION
 Continuous mandatory random drug testing that would
discourage drug use.
 Avoid lengthy deployments which put service members
under unusual work stress, which may further contribute
to substance abuse issues.
 PTSD: early diagnosis and prompt treatment before they
start using drugs as coping mechanism.
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50. WAY OF PREVENTION (CONT)
 Avoid using drugs with addictive tendencies: Treatment
for injuries often involves prescription opioids, painkilling
medications with a high potential for misuse and
abuse. Misuse of prescribed pain medication may lead to an
opioid use disorder.
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51. DISCIPLINARY ACTION IN MILITARY
Armed Forces Act Chapter A20 Laws of the Federation of
Nigeria 2004:
 64. Drunkenness.
 65. Drugs: wrongful use, possession, etc., of controlled
substances.
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52. CONCLUSION
 Cannabis and opiates use in military personnel have
increased in recent years.
 Alcohol (and pain killers) remains the most commonly
drug abused among military men due to military alcohol
culture (and work related stressful conditions).
 Work stress and PTSD are the leading predisposing
factors in drug abuse amongst personnel.
 Prevention, early detection and prompt treatment
(psychological counselling) are key in moving away
from substance abuse in the military and in the society
at large.
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53. RECOMMENDATIONS
 Compulsory drug testing and psychological counselling for
every personnel that just returned from combat deployment.
 Provide other means of alleviating boredom, like sport,
religious activities as opposed to ritualized drinking and
using alcohol as a way to handle stress, boredom,
loneliness, and other negative feelings.
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54. RECOMMENDATIONS
 Reduction in the availability or increase in price of alcohol
at the military bases.
 A study on substance use abuse amongst Naval personnel in
Nigeria can be done.
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55. REFERENCES
 National Institute on Drug Abuse; National Institutes of Health; U.S.
Department of Health and Human Services.
 Michael’s House residential drug treatment facility
 Serious Mental Illness Treatment Research & Evaluation Center
Department of Veterans Affairs
 Sharbafchi, M. R., & Heydari, M. (2017). Management of Substance Use
Disorder in Military Services: A Comprehensive Approach. Advanced
biomedical research, 6, 122.
 Substance Abuse in the Active Military Personnel Reviewed by Scot Thomas,
MD Last Updated: May 4, 2020
 National Institute on Drug Abuse. (2013). Substance Abuse in the Military.
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56. THANK YOU FOR YOUR RAPT ATTENTION
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