Tobacco, Drug and Alcohol (TDA) Abuse

Tobacco, Drug and Alcohol (TDA) Abuse

Beyond infectious disease, this chapter also surveys a very different but equally serious threat to human welfare: the misuse of tobacco, alcohol and psychoactive drugs, collectively referred to as TDA (Tobacco, Drug and Alcohol) abuse.

Tobacco and its effects on the respiratory system

Tobacco, whether smoked (as cigarettes, bidis or cigars) or used in smokeless forms, delivers nicotine along with thousands of other harmful chemicals and tar deep into the respiratory tract. Chronic tobacco smoke exposure damages the delicate lining of the airways and alveoli: it paralyses and eventually destroys the protective cilia of the respiratory tract that normally sweep out mucus and trapped particles, leading to chronic cough and repeated respiratory infections; it causes chronic bronchitis (persistent inflammation and mucus over-production in the bronchi); it destroys alveolar walls, producing emphysema and a permanent reduction in the lungs' capacity to exchange oxygen and carbon dioxide; and the carcinogens in tobacco tar are a leading cause of lung cancer as well as cancers of the mouth and throat. Chronic obstructive pulmonary disease (COPD) caused by long-term tobacco use is one of the leading preventable causes of death and disability in India.

What is meant by drug abuse

Drug abuse is defined as the self-administration of a chemical substance, at a dose and frequency not warranted by any genuine medical need, purely for its mood-altering or pleasurable psychological effects, in a way that harms the user's physical health, mental health or social functioning. It is distinguished from legitimate medicinal use of the same substances under medical supervision.

Sources of commonly abused drugs

• Smack (crude heroin) is derived from the opium poppy plant, Papaver somniferum — it is a chemically processed (acetylated) derivative of morphine, itself extracted from opium latex.
• Cocaine (coke) is obtained from the leaves of the coca plant, Erythroxylum coca, a shrub native to South America; the leaf extract is refined into the white crystalline powder known on the street as coke.

Hallucinogenic plants

Certain plants naturally produce chemicals that alter perception, mood and consciousness, and are abused for their hallucinogenic effects. Familiar examples referenced in this context include Cannabis sativa (the source of marijuana/charas/ganja/hashish-type products, containing psychoactive cannabinoids), the opium poppy Papaver somniferum (source of morphine-type opioids), and the coca plant Erythroxylum coca (source of cocaine) — the same plant sources that give rise to some of the most heavily abused drugs described above.

Substances banned in competitive sports

Sportspersons are prohibited from using certain performance-influencing substances because they provide an unfair advantage or endanger health. Two major banned categories are:

• Cannabinoids (derived from Cannabis), which are banned because of their psychoactive and performance-impairing/altering effects.
• Anabolic steroids, synthetic derivatives of the male hormone testosterone, which are abused by some athletes to artificially build muscle mass and strength, and are banned because they give an unfair competitive edge and carry serious long-term health risks (including hormonal imbalance and organ damage).

Medicinally valuable drugs that are also abused

Several drug classes are genuinely valuable in medicine when used correctly, but are also widely abused: opioids (morphine-type painkillers, medically indispensable for severe pain relief, but highly addictive when abused), cannabinoids (with some recognised medical applications, but abused for their psychoactive effect), and cocaine (once used as a local anaesthetic, now almost entirely known instead as a dangerously addictive stimulant of abuse).

Adolescent vulnerability and the difference between addiction and dependence

Adolescence — the transitional period between childhood and adulthood — is a stage of particular vulnerability to TDA abuse because of curiosity, peer pressure, the desire for novel or thrilling experience, stress related to academic or personal expectations, and, in some cases, easy availability of these substances combined with a still-developing capacity for judgement and impulse control. …