The document outlines the physical, psychological, and social harms of substance misuse. It describes the major effects and risks of opiates, alcohol, and stimulants. Opiate misuse can lead to overdose, health issues, and social problems like crime and unemployment. Alcohol misuse poses risks of overdose, accidents, withdrawal seizures, and social harms. Stimulants may cause cardiovascular and mental health issues as well as risky behaviors and psychological addiction. All substances discussed can negatively impact users' physical health, mental wellbeing, and social relationships.

1. Effects of problematic
substance use: physical and
psychological harms

2. Outcomes
The aim of this learning resource is to identify the physical, psychological
and social harms associated with the misuse of substances.
Specifically it will:
• Describe the main effects of the major substances.
• Outline the common harms linked to these substances.
• We will look at each category and identify what the substance is, its
main effects, how it is used and what the potential major harms are.
• Go back to the resource ‘Definitions, categories and legal status’ for
more on the categories of substances.

3. Opiates
This group of drugs include heroin, diamorphine, oramorph, pethadine,
morphine, diclofenac,codamol, codeine, tramadol.
Opiates - They link to opiate receptors in brain – the pleasure centre,
they are non-toxic to the body.
Depressant - Opiates switch off arousal system after initial high
therefore they slow the nervous system.
Tolerated - The body adapts quickly by stopping production of natural
opiates (endorphins). Hence the need for sustained supplies.
Type of use - intravenous (IV) use with cut ‘dirt’ in unsterile conditions.
Also associated with polydrug use – users commonly also use alcohol,
cocaine and amphetamines with the opiate. Can be smoked which
carries less risk of infection but still addictive.

4. Risks of opiate misuse
(Webb et al 2003)
Overdose
• Opiates cause stupor, anoxia, respiratory depression, inability to
self-protect such as not lying on your back when asleep or
suffocating.
Health impact
• There is a mortality risk from respiratory depression & choking,
infection, neural damage, brain damage, amputation, poor self-care
– diet, gum disease, lice, etc
Social impact
• Opiate misuse is commonly associated with crime, anti-social
behaviour, social alienation, depression, low self-esteem, poor
parenting, relating, unemployment.

5. Alcohol (ethanol, C2H5OH)
Toxic
• It mimics GABA – a natural anxiolytic – therefore alcohol relaxes the
drinker
Depressant
• Alcohol switches off the neural arousal system (ARAS) so users fall
asleep until the system is clear of alcohol
Use
• Regulated and so used and marketed legally
Overdose/intoxication
• Too much alcohol can lead to death through respiratory failure,
choking or an accident
Withdrawal
• Sudden withdrawal can cause status epilepticus (a seizure) and
death typically from cardiac failure or stroke.

6. Alcohol
Physical harm
• death by overdose is rare but can happen,
especially to younger people. Physical
harm and death is more likely to occur
through accidents.
Social impact
• anti social behaviour, unemployment,
social exclusion, family disruption, poor
parenting, relating, poor self-care,
depression, anxiety, poor self-esteem.

7. Stimulants and hallucinogens
This group of drugs includes crack, cocaine, cannabis, amphetamines,
metamphetamine, new psychoactive substances* (‘legal highs’),
ecstasy, LSD, magic mushrooms) .
Effects
• These speed up the nervous system impacting
on a whole body ‘fight or flight’ response.
Biological impacts
• Stimulants can cause cardiovascular & respiratory problems,
psychosis, flashbacks, depression (crack crash & withdrawal – 96
hrs), anxiety, suicidal thoughts; risk-taking behaviour when high.
Some new psychoactive substances carry a greater risk of acute
toxicity and death (Abdulrahmin 2015).
*NPS could also be classed as depressants depending on their type.

8. Stimulants (uppers)
Behavioural impacts
• Stimulants are not biologically addictive but do create a
‘psychological’ addiction. The drug can become highly important to
the person (salience), leading to compulsive drug-seeking, social
avoidance, lack of motivation, anti-social behaviour. There are strong
cueing effects so being in a drug environment can lead to drug
seeking.
Psychosocial
• They can create a psychological dependency, and can cause
paranoia, social exclusion, social withdrawal, poverty, exploitation,
mental illness.

9. References
• Abdulrahim D & Bowden-Jones O, on behalf of the NEPTUNE Expert Group.
Guidance on the Management of Acute and Chronic Harms of Club Drugs and Novel
Psychoactive Substances. Novel Psychoactive Treatment UK Network (NEPTUNE).
London, 2015.
• NICE (2010) Alcohol-use disorders: preventing the development of hazardous and
harmful drinking. NICE public health guidance 24.
• RSA (2007) Drugs – Facing Facts. RSA Commission on Illegal Drugs, Communities
and Public Policy.
• Webb et al (2003) Cause and manner of death in drug-related fatality: an analysis of
drug-related deaths recorded by coroners in England and Wales in 2000. Drug and
Alcohol Dependence, 72, 67-74.

10. Resources
• National Institute on Drug Abuse (USA)
http://www.drugabuse.gov/publications/drugfacts/drug-related-
hospital-emergency-room-visits
• Talk to Frank – drugs A-Z http://www.talktofrank.com/drugs-a-z