Understanding Drug Use Among Young People: Causes, Consequences, and Prevention Strategies, Quizzes of Health sciences

Download Understanding Drug Use Among Young People: Causes, Consequences, and Prevention Strategies and more Quizzes Health sciences in PDF only on Docsity! [si =" TEST BANK Drugs and Substances Use DRUG USE ZN AVON: Bijan ease tye: CTSA G Trams ois <p — GUARANTEED SAFE CHECKOUT — wise BGS =a ae 9 2. Module 6 Drugs and Substance Use wipe Coe a wey ste aes Sess) Sep fa, > « ayy wt 2 , Aah ee & Module 6: Drugs and Substance Use 6-3 the approach of “Harm Reduction”. Harm Reduction can be viewed as the prevention of adverse consequences of licit and illicit drug use without necessarily reducing their consumption. A broad range of programs have been implemented to foster harm reduction principles and to prevent HIV infection among IDUs. These include:  The provision of information programs to inform IDUs of the risks.  The establishment of d rug treatment substitution programs, such as methadone for opiate dependent persons.  Outreach education using peer educators.  Sterile needle/ syringe exchange, distribution and disposal programmes.  Over the counter sales of injecting equipment.  Counselling and testing for HIV among IDUs.  Increasing access to primary health care.  Removing the barriers to safer injecting, including laws and police practices.  Targeting special groups and circumstances. All of these programs aim to change behaviour and thereby reduce the risks of HIV infection among IDUs. The injecting of illicit drugs exists in most countries, and in at least 80 countries there are epidemics of HIV infection among IDUs. The majority of these infections result from sharing contaminated needles and syringes, which happens for many reasons. Such epidemics can occur with explosive rapidity, and, having occurred, can form a core group for further sexual and vertical transmission. It is therefore very important to include effective prevention measure s against HIV transmission among IDUs in any comprehensive AIDS strategy. IDUs are a hidden and stigmatized group because of their illegal behaviour; often they also engage in other risk behaviour for HIV, such as commercial sex work or paid blood donation because of the cycle of poverty and the cost of the drugs. The strategies, which have been demonstrated to be effective, in both the developed and the developing world, are those based on the principles of harm reduction. The primary aim of harm reduction for IDUs is to reduce the harm associated with the injecting of drugs, especially the transmission of HIV and other blood borne viruses, without necessarily diminishing the amount of drug use. This is an approach entirely compatible with sensible demand and supply reduction approaches, and sees drug use as a public health rather than a land order issue. As with all effective community responses, it acknowledges the humanity and worth of the IDU, and creates a partnership with the IDU and his or her community to protect their common health. In the context of injecting drug use and HIV infection, the following points need to be highlighted:  Illicit drugs are injected in many parts of the world.  The reuse of contaminated needles and syringes by different persons is common in many settings where injecting drug use takes place.  HIV is efficiently transmitted by this sharing of injecting equipment.  The reasons for sharing are various - poverty, lack of availability or access to needle and syringes, cultural factors and ignorance.  Aspects of enforcement of prohibition of illicit drugs promoted conditions for transmission of HIV among IDUs.  HIV spreads from IDUs to their sexual partners and children. Module 6: Drugs and Substance Use 6-4 The scale of HIV spread among IDUs, their sexual partners and their children depends on a wide variety of factors. These include the following:  The drugs injected and the frequency of injecting.  The social organization of drug injecting, especially the existence of “shooting galleries” or professional injectors.  Know ledge on the part of IDUs of HIV/ AIDS, hepatitis viruses and other infections that can be associated with unsterile injecting.  The availability of sterile injecting equipment or of the means to sterilize equipment.  The availability and accessibility of drug treatment programs.  The availability and accessibility of welfare and health programs for IDUs. An action plan responding to HIV among IDUs should include:  A situation assessment using both qualitative and quantitative approaches among the at -risk popul ations. Essential questions include:  Why are the IDUs injecting/ using drugs?  What drugs are being injected?  What is the prevalence of HIV/ AIDS among IDUs?  What is the level of knowledge about HIV/ AIDS and its transmission?  Where do IDUs go to inject or buy drugs?  How much sharing of injecting equipment is there?  Why do the IDUs share their equipment?  What kind of health care and drug treatments are available? Where?  What are the legal and logistical barriers to behaviour change? Research and education per formed in collaboration with the affected community is the most effective. IDUs are as varied as the community they come from; many are not in treatment or prison, so outreach is very important. Peer education is the most effective form of education. Iden tification and removal of legal and policing barriers to behaviour change, such as laws related to the sale and purchase of injecting equipment or punitive policing of IDUs, which do not decrease drug use but often increase sharing of needles/ syringes. Development of national and local policies, which achieve a balance between attempts to reduce supply and use of illicit drugs with the reduction of unsafe use – recognition of the role of law and the police in reducing spread of HIV. The basic elements of an effective response programme for IDUs are:  Education, especially peer education.  Promotion of the use of sterile injecting equipment for every injection: increasing availability of equipment, removing barriers to access and use of sterile equipment.  Increasing drug treatment availability, accessibility and options.  Increasing access to and appropriateness of primary health care. Behaviour, which put IDUs at risk of HIV infection, is not random; they result from the social, political and cultural context . Module 6: Drugs and Substance Use 6-5 IDUs in prisons, among ethnic minorities, sex workers and women are at an increased risk of HIV infection. Much of what follows is adapted from the ESCAP HRD Course on Drug Use and its Relationships with Sexual Abuse and Sexual Exploitation of Children and Youth, (ESCAP, 2000). III Some Critical Concepts a) What are ‘drugs’? The word “drug” refers to any substance or product that affects the way people feel, think, see, taste, smell, hear, or behave. The World Health Organisation (WHO) defines “a drug” as “any substance, solid, liquid or gas that changes the function or structure of the body in some way”. Often, the term “substance use” is preferred, so that all things that affect the way a person feels, thinks, sees, tastes, smells, hears and behaves are included. Thus, glue is a substance used by many street children and methamphetamines are substances used by many young people who go to discos and bars. Sometimes we use the phrase “psychoactive substance" for drugs to emphasize the fact that the substance produces a change in mental processes. A drug can be a medicine, such as morphine, or it can be an industrial product, such as glue. Some drugs are legally available, such as approved medicines and cigarettes, while others are illegal, such as heroin and cocaine. Each country has its own laws regarding drugs and their legality. The use of drugs may have a little or a large effect on a person's life and health. The extent of the effect depends on the person, the type of substance, the amount used, the method of using it, and the general situation of the person. b) Why do young people use drugs? People, including young people, take drugs for their immediate and short-term effects. Usually many young people use drugs because they either add something to their lives or help them to feel that they have solved their problems, however fleeting this feeling might be. Drug use may also be influenced by a number of factors, such as: The individual: Adolescence is a time of immense physical and emotional change. Young people often feel awkward and self -conscious. They may feel caught between conformity and the urge to be different or the urge to fit in with the peer group. Often, young people do not have the skills necessary to deal with the stress an d pressures of life, and drugs may be seen as a way of dealing with them. Family and friends: Young people may learn about drugs and their uses from their family and friends. Often, children living in families where smoking, drinking alcohol and taking prescription drugs, or any other stimulant, is considered a part of Module 6: Drugs and Substance Use 6-8 which the use of a psychoactive drug (or drugs) takes on high priority, more than other behaviours that once had value”. Dependence may be defined as:  A strong desire or sense of compulsion to take the drug;  Difficulties in controlling drug -taking behaviour;  A physiological withdrawal state when drug use has ceased or been reduced;  Evidence of tolerance, i.e., increased doses required to achieve effects originally produced by lower doses;  Progressive neglect of alternative pleasure or interests due to substance use, increased amount of time needed to obtain or take the substance or to recover from its effects;  Persisting with substance use, despite clear evidence of harmful consequences (e.g., liver damage, depression, and impaired cognitive functioning). f) What is detoxification and withdrawal? If a person has been using a drug heavily or for a long time, the user might experience a difficult period of transition when he or she stops using or reduces the amount of use. The person may have psychological and/ or physical problems until adjustment to the absence of the drug is complete. This transitional process is called detoxification and the adjustment problems are called withdrawal symptoms. Unless they have been using large amounts of drugs for a long time, young people rarely need medical help to detoxify. More typically, young drug users need to be in a safe place where they can be assessed with their full cooperation. The most dangerous withdrawals ar e from alcohol and hypnosedatives, which may trigger convulsions and delirium tremors. g) Are there any major patterns of drug use among the youth? Patterns of drug use vary greatly among youth, and may change over time. Some develop a regular pattern of use while others may be quite haphazard and opportunistic. Just because a young person starts to use one drug does not mean that he or she will automatically progress to using other drugs or to more intensive use. While recognizing the variability of drug use by the youth, it can be useful to try to classify their use according to the level of use and risks or problems experienced. It has been suggested that there are 5 kinds of drug use: Experimental use: Young people go through a period of development that involves experimentation, exploration, curiosity and identity search. Part of such a quest usually involves some risk taking, which can include experimenting with drugs. They are curious about drugs and want to experience new feelings and sensations. It is important to note that, following some experimentation, most young people stop using drugs. Module 6: Drugs and Substance Use 6-9 Functional use: For the majority of young people, drug use is not mindless or pathological, but functional. Drugs have a specific purpose in their lives, such as recreation, providing relief from anxiety or boredom, to keep awake or to get to sleep, to relieve hunger and pain, to feel good and to dream. Such use is often controlled and limited to specific circumstances and situations. Young people may vary the type of drug they use, depending on the situation, to achieve the desired effect. They are sometimes experienced users and know what, when and how to use drugs. If their drug use is not causing serious problems for them, there is little motivation for these functional users to stop using drugs. Dysfunctional use: Dysfunctional use is drug use that leads to impaired psychological or social functioning. Typically, such use affects personal relationships. As a result of their drug use, some young people may become involved in fights or arguments with others or family members. It may interfere with his or her education or work. S/ he may not be able to accomplish important survival tasks, such as finding adequate food and avoiding violence. This behaviour may cause further alienation, including rejection by other members of the peer group or family. Because of these increasing difficulties, there may be some motivation to think about quitting drugs. However, the benefits they perceive in using drugs may make it difficult for them to break the habit. Harmful use: In harmful use, drugs cause damage to physical or mental health. These harms include traumatic injuries from accidents and violence, overdose and poisoning, suffocation, burns and seizures. Other harms result from the way in which the drug is used. Injecting drugs is particularly dangerous because of the risk of hepatitis, HIV and other infections from contaminated needles and syringes, along with collapsed veins and overdose. Smoking drugs can result in disorders of the respiratory system and burns. Some drugs are particularly toxic and can cause health damage in even small amounts. Such drugs include leaded petrol, benzene and coca paste. Although health damage is more likely to occur in individuals who use drugs regularly and intensively, it can also occur in experimental and occasional users, usually as a result of intoxication. As most young people have not been using drugs for long enough, it is unusual to see them with such disorders as alcohol-related liver disease or smoking - related lung cancer, which tend to occur late in life. Dependent use: Drug dependence is the name given to the most intensive type of drug use. Users who are dependent on drugs often have poor control over their intake. They may continue to use drugs despite very serious consequences. In addition, they may spend more and more of their day in activities related with drugs; earning money or trading sex for them, purchasing them, using them, recovering from them, and planning to get more of them. Dependent users may develop a tolerance for certain drugs, that is, their bodies may adjust to the drugs so that the same amount of the drugs no longer produce the same effect and they require more of the drug to get the effect previously experienced. A dependent user may also experience withdrawal symptoms, if s/ he goes too long without the drugs. Module 6: Drugs and Substance Use 6-10 The young people who are dependent on drugs will need a lot of support to change their behaviour. Establishing good links with local health agencies that deal with drug users is important. If workers are in isolated areas and there are few health resources in the local community, links will need to be formed with helpful professionals in other locations. Being dependent on drugs can be like being very dependent on other people, food or exercise. The drug can be like a reliable friend who usually gives what a person wants or needs. Giving up the drug can be like losing a best friend. Grief and loss issues need to be dealt with. h) What are the names and types of substances commonly used by young people? There is an enormous number of substances that can be used. The generic name of a drug is standard and used throughout the world. However, most drugs are marketed under various trade names and also have many street names. Trade names usually begin with a capital letter. For example, a commonly used drug to reduce anxiety is diazepam (generic name) and is sold in some countries as Valium (trade name). Another example is diacetylmorphine, which is the generic name for Heroin, and has the street names, "brown sugar" in India, and "smack" in the USA and Australia. It is also common for street names to change regularly. The three main types of drugs, classified by their effects on the central nervous system are:  Depressants.  Hallucinogens.  Stimulants. Depressants slow down, or depress, the central nervous system. They do not necessarily make the user feel depressed. Depressant drugs include:  Alcohol  Opiates and opioids including her oin,morphine, codeine, methadone, and pethidine  Cannabis including marijuana, hashish and hash oil  Tranquillisers and hypnotics, including Rohypnol, Valium, Serepax, Mogadon, and Euhypnos  Barbiturates, including Seconal, Tuinal and Amytal  Solvents and in halants including petrol, glue, paint thinners and lighter fluid In moderate doses, depressants can make users feel relaxed. Some depressants cause euphoria and a sense of calm and well -being. They may be used to wind down or to reduce anxiety, stress or inhibition. Because they slow the nervous system down, depressants affect coordination, concentration and judgment. In larger doses, depressants can cause unconsciousness by reducing breathing and heart rate. Speech may become slurred and movements sluggish or uncoordinated. Other effects of larger doses include nausea, vomiting and, in extreme cases, death. When taken in combination, depressants increase their effects and the danger of overdose. Module 6: Drugs and Substance Use 6-13 While marijuana -intoxicated, a user shows many indications of impaired psychological functioning, including effects on memory, thinking, speaking, various kind of problem solving, and concept formation. Most of these effects seem to share in common an impairment of short -term memory the leads to fragmented speech, disjointed thinking and a tendency to lose one's train of thought. While the drug is active in the body, driving a vehicle or operating machinery puts the user and others at increased risk of accident. Some new users, particularly adolescents and people who use a lot regularly, can experience psychosis. People with schizophrenia or those with a family history of psychosis are at increased risk. Long-term heavy cannabis use is likely to have a negative effect on your health. These effects include:  Respiratory diseases such as bronchitis and cancers commonly associated with smokers.  Some loss of memory and mental capacity.  Potential risk to children when women use cannabis during pregnancy. Users can become dependent on cannabis and have great difficulty controlling their use of the drug. Cocaine mainly comes in a white powder called cocaine hydrochloride. Cocaine in this form is usually snorted or injected. Cocaine is often mixed with other substances, such as, mannitol or some other sugar to increase the profitability of a deal. Effects of cocaine, which can last for minutes or hours, happen very quickly and can include an extreme feeling of well -being, increased heart rate, agitation, sexual stimulation, alertness, energy, unpredictability and aggressive behaviour. The inside of the nose can be severely damaged if you regularly in hale cocaine through the nose. Cocaine or coke is highly dependency creating and, as with other stimulants, reduces hunger, thirst and natural needs for rest, food and water. Death can occur as a result of overdose or an accident. Ecstasy: the chemical M ethylenedioxymethamphetamine (MDMA) is a drug that can cause users to see things that are not seen by other people and produces a feeling of tranquillity, increased confidence and feeling close to people, which is why it's also known as the love drug. User s can also experience jaw clenching, teeth grinding, dry mouth and throat, nausea and loss of appetite, anxiety, paranoia and confusion. Ecstasy is regarded as a dangerous drug for people with heart or breathing conditions or with depression or psychological disorders. The next day, a severe hangover may leave the user feeling “burnt out”. Symptoms include: loss of appetite, sleep problems, aching and confusion. Overdose can occur resulting in very high blood pressure, increased heartbeat and body tempe rature. Many people take ecstasy at dance or rave parties. Ecstasy can raise the body temperature to dangerous levels. Not much is known about the long - tern effects of ecstasy, but there is some suggestion that it may damage some types of brain cells. Few people seem to use ecstasy for long periods. Ecstasy is one of a growing number of “designer drugs” and many new variations are already available. Gamma -hydroxybutyrate (GHB) , also known as liquid ecstasy, is a depressant drug, which works by slowing dow n the activity of the brain and central nervous system. Module 6: Drugs and Substance Use 6-14 That is, they slow down the messages going to, and from the brain. GHB commonly exists as a colourless, odourless liquid usually sold in small bottles. It has also has been seen in powder and capsule form. It is mostly taken orally. However, it can be injected. People have reported the following effects after taking GHB: euphoria, drowsiness, nausea, increased confidence, and dizziness. With increased doses, the initial euphoria is replaced by powerful sedative effects, which can include: confusion, agitation, hallucinations, seizures, vomiting/ nausea, stiffening of muscles, disorientation, convulsions, unconsciousness / coma, and respiratory collapse. Users can become both physically and psychologically dependent on GHB. Prolonged use of high doses of GHB may lead to withdrawal symptoms. Some people have experienced agitation/ anxiety, insomnia and tremors after stopping regular use of GHB. Withdrawal symptoms are usually experienced for three to twelve days. Heroin is derived from the opium poppy and usually comes in a rock or powdered form that is generally white or pink/ beige in colour. The purity of heroin sold on the street can vary enormously from as low as 25 -30 per cent to 85 -90 per cent dep ending on fluctuations in the unpredictable illegal drug market. It is a powerful painkiller that is widely used by doctors to treat pain in cancer and heart attack patients. Used medically, pure heroin is a relatively safe drug. Pure heroin is a white powder. Street names include “skag”, “smack”, “H”, “horse”, “harry”, “junk”, “henry”, and “brown sugar”. Heroin can be smoked, sniffed or injected. It is rarely swallowed, as this method is relatively ineffective. When heroin is heated over a candle or a match on a piece of tin foil or a spoon, the smoke generated is inhaled, often through a small tube (known as “chasing the dragon”). Injection directly into the veins gives an immediate short -lived pleasurable sensation (known as a “rush”). Heroin is the most commonly injected illegal drug. Users say heroin, in the beginning, makes them feel warm, loved and safe. Heroin provides an extremely intense rush and a high that usually lasts for 6 -10 hours. In its pure form, in controlled clinical conditions heroin is relatively non -toxic to the body, causing little damage to body tissue and other organs. However, regular users are very likely to become dependent upon it. Some long-term effects include constipation, menstrual irregularity and loss of sex drive. Impure street heroin is usually a mixture of pure heroin and other substances, such as sugar. Sometimes other drugs like speed or sedatives are also mixed in. This is very poisonous. Impure heroin causes collapsed veins, tetanus, abscesses and damage to the heart, lungs, liver and brain. Because the user usually doesn't know the strength of the heroin s/ he is using, it is easy to accidentally overdose and die. Complications associated with heroin use can include tolerance, which means that the user needs more quantity to get the same effect. Using heroin can result in both psychological and physical dependence on the drug. Heroin dependence is extremely expensive and is a major reason for many crimes, as the dependent heroin Module 6: Drugs and Substance Use 6-15 user needs more money to support the “habit” and just feel normal. Life can become an endless circle of finding money, obtaining the drug and usage. Inhalants: Some drugs turn to gas in the air and when the fumes are inhaled can cause the user to feel high. These are inhalants. Many household products are used as inhalants such as glue, aerosol spray cans, lighter fluid, paint thinner, chrome based paint or petrol. After a high the drug slows down the central nervous system or the messages going to and from the brain to the body. Most effects pass within an hour of use. Using many times may make users pass out, get bad cramps, not know what's going on or even die. The drug in some of these products can cause heart failure particularly if the user is stressed or does heavy exercise. S ome users have been known to pass out and suffocate in the plastic bag they inhale from. Like most street drugs, use of inhalants can lead to dependence, although almost all who try inhalants only use them once or twice. LSD (Lysergic Acid and Diethylami de), the best known of the hallucinogens. As a synthetic drug, it is one of the most potent mind -altering chemicals. LSD is most commonly seen in tablet form or the tablet incorporated into some other dose form, such as, a capsule or occasionally confectionery. LSD appears to cause little or no physical dependence with no withdrawal symptoms having been observed, even after long periods of use. However, users can develop psychological dependence. Methamphetamine is an ATS. The use of methamphetamine produces similar, but mostly stronger behavioural and physiological effects to cocaine and other stimulants. These effects include euphoria, increased alertness, the perception of improved self -esteem and self -confidence, impaired judgment, and impulsiveness. Acute and chronic use of methamphetamine typically results in nervousness, irritability, restlessness, and insomnia. The major difference between cocaine and methamphetamine is duration of action. The half-life for cocaine's euphoric effects is less than 45 minutes, for methamphetamine it is three to six hours. Therefore, the period of stimulant -induced euphoria may be much longer in methamphetamine users, and likewise, the period of impaired judgment will be longer. Permanent neurological changes and deficit can result from chronic methamphetamine use. i) Are there any connections between drugs and sex, sexual exploitation and sexual abuse? The connections between drugs and sex, sexual exploitation and sexual abuse are well established. Due to this n exus many young people find themselves vulnerable to HIV infection as well. Some examples of this are as follows:  Some young people may run away from their home or village due to the drug use of family members and/ or other adults who may become violent when intoxicated (some of this violence may be in the form of sexual abuse) or neglect their needs.  Some young people are sold by their parents for money to buy drugs. Module 6: Drugs and Substance Use 6-18 Life skills applied to drug/ substance use prevention are supposed to facilitate the practice and reinforcement of psychosocial skills that contribute to the promotion of personal and social development such self awareness, empathy, communication skills, interpersonal skills, creative thinking, critical thinking, coping with emotions and coping with stress. In drug/ substance use prevention, which should also be part of treatment programmes, this means imparting skills in drug/ substance resistance/ refusal and critical thinking, social competence and communication skills to explain and reinforce personal anti -drug commitments. Module 6: Drugs and Substance Use 6-19 Note for the Facilitator The definition for the term is given in the question answer section at the beginning of this section. You can p resent that definition after the two groups have made their presentation. After facilitating the group discussion you can make a short presentation on the status of drug/ substance use among the youth in your country/ region or locality. Emphasize that drug/ substance use is also linked to another emerging health concern among the young people – namely HIV/ AIDS. Point to the fact that HIV/ AIDS is a real threat for young people who inject drugs, as HIV/ AIDS is transmitted through contaminated needles. HIV/ AIDS is also transmitted through unprotected sex and from infected mother to child. Session 6.1 Substance Use – Our Understanding Expected Outcomes Participants will know what constitutes substance use. Participants will know the affects of substance use on their lives. Exploring Substance Use Objective To develop a common understanding on drug/ substance use. Materials Flip charts, markers, tape. Time 30 to 40 minutes. Process Invite the participants to sit in a circle. Explain that the use of drugs/ substance among youth is an emerging concern. Ask the participants to divide into 2 groups. Ask the 2 group members to pick up a chart each and some markers. Ask both groups to discuss within their group and come up with a definition of the term “drug”. This definition should be based on their common understanding and knowledge. Allow 15 minutes to do this exercise. Invite both groups to display their respective definitions and ask them to present. You could use the following questions to facilitate a discussion after the groups have made their presentation:  Have you heard the term “drug use”?  When did you first hear the term, and from whom did you hear it?  If you think someone you know is abusing drugs, what would you do?  Why do we prefer the term “substance dependence” to “addiction”? Module 6: Drugs and Substance Use 6-20 Session 6.2 Beliefs and the Reality of Drugs Expected Outcomes Peer educator will know the level of knowledge and beliefs that the participants have on the subject of drugs. Participants will learn to distinguish between myths and facts regarding drugs. Participants will know some basic facts about drugs. Myths And Facts About Drugs Objective To provide correct information about drugs. To enable the participants to analyze the information they already have about drugs. Materials "Myth and fact statements" and information/ answer key for myth and fact statements, flipchart paper, markers, cloth bag or a small box. Time 30 to 40 minutes. Process Invite the participant s to sit in a circle. Explain that they will be learning some facts about drugs through a game. Create the mood by asking some questions for example: Do you know of anyone who uses drugs? Why do young people experiment with drugs? Have you ever thought of experimenting with drugs? Now ask the participants to divide into two teams and sit facing each other on the floor or chairs. Place the bag or box with the myth and fact statements in the middle of the two teams. Explain that each team will draw a statement from the bag alternatively. The team that draws and answers correctly will get 10 points. If the team draws and fails to give the correct answer, they will get 0 points. If the team draws and passes, then the other team will get 20 bonus points on a correct answer. If both teams fail to give the correct answer, you will provide the answer. Put a flip chart up to keep scores. Ask for a volunteer to help you if required. Allow the teams to discuss their answer for 1 minute or so. After each round encourage discussion by asking the teams to give reasons for their answers. Module 6: Drugs and Substance Use 6-23 Anyone using oral contraceptive (birth control pill) has to be careful about prescription medicines. Fact: Girls and women who are using oral contraceptives to prevent pregnancy need to tell their doctor if s/he prescribes antibiotics. Some medications make oral contraceptives ineffective and pregnancy could result. Cigarette smoking can be harmful for the pregnant woman but not for the child in her womb. Myth: smoking is equally harmful for the child in the womb. Alcohol is a sexual stimulant. Myth: Alcohol can actually depress a person's sexual response. The drug may lessen inhibition with a sexual partner, but it causes problems such as lack of erection, loss of sexual feeling or inability to have an orgasm. In addition, alcohol or drugs may cause a person to do something sexually that he or she would not do when sober. Cannabis/Marijuana is used legally to treat severe pain (in cancer and other chronic illnesses). True: In most countries cannabis/ marijuana is against the law. However, in some countries cannabis preparations are being trialled for wasting conditions (where a person in final stages of cancer or HIV -related illness become very thin from not eating or being unable to eat) and glaucoma. Heroin use ca n cause dependence, but not cannabis/ marijuana. Myth: Experts believe that long-term use of cannabis/marijuana is potentially dangerous and may lead to a decrease in motivation, memory loss, and damage to coordination, impaired judgment, damage to the reproductive system and throat, lung irritation and mental health problems. Experimenting with drugs is a part of growing up. Myth: drugs are a matter of choice and have nothing to do with the growing up process. Drug dependence can lead to homelessness and loss of life. Fact: Many drug users loose their social and economic status and can loose their life to overdose and other complications. Taking amphetamines or methamphetamines only once can cause problems. Myth: Any drug use can cause difficulties for new and regular users. Much of what is sold as amphetamine or methamphetamine (e.g., ya ba) is a combination of many chemicals, mostly mixed in illegal laboratories. Users may never really be sure of what they are buying or taking. The mix can be toxic. Drugs like alcohol, cannabis/marijuana and ecstasy shouldn’t be a problem for young people Myth: Drugs can interrupt normal growth and development for youth, be associated with problems in relationships and result in unintended pregnancies of STD/HIV because their use can lead to risk taking. HIV infection among young injecting drug users is on the rise. Fact: research shows that HIV infection rates are high and increasing among young IDUs. Module 6: Drugs and Substance Use 6-24 Session 6.3 Smoking and Health Concerns Expected Outcomes Participants will know the health affects of smoking. Participants will start thinking about the harm of smoking and eventually quit smoking. I Am Choking! Objective The participants will analyze ways in which smoking, or the use of tobacco, interferes with health, general well -being and achieving personal goals. Materials Straws covered with wrappers, small narrow straws, white paper. Time 45 minutes. Process Invite the participants to sit in a circle. Explain that they will be doing an interesting exercise to experience some of the effects of smoking. Participants who are asthmatic or prone to breathlessness should not take part in the exercise. Ask the participants to take a deep breath and exhale. Ask them to repeat this three times. Give a straw (wrapped in its cover) to each participant. After the participants have their straws, ask them to remove the wrapping. Ask them to pinch their nostrils closed so that they cannot inhale or exhale through their nose. Ask each participant to place a straw in his/ her mouth. Each participant is to keep his/ her nostrils pinched closed while inhaling and exhaling through the straw. Explain that, if they have any difficulty exists with breathing they can stop the activity at any time. Participants are to breathe through the straw for one minute. Request the participants to describe what it was like to breathe through the straw. Most likely, they will explain that it was difficult. In order to inhale the same amount of air that they normally inhale each minute, they needed to inhale more often. This raised the heart beat rate and became tiring. Explain that this is what happens when a person smokes cigarettes. Provide each participant with a smaller narrower straw. Repeat the strategy. Ask the participants to pinch their nostrils closed so that they cannot inhale or exhale through their nose. Ask each participant to place the small narrower straw in his/ her mouth. Each participant is to keep his/ her nostrils pinched closed while inhaling and exhaling Module 6: Drugs and Substance Use 6-25 Note for the Facilitator Often young people have the impression that the harmful consequences from smoking cigarettes a re experienced only after many years of smoking. Explain that smoking cigarettes can interfere with short -term goals. For example, the effects of though a straw. Explain that if any difficulty exists with breathing, they can stop the activity at any time. Participants are to breathe through the narrow straw for one minute. Explain that the long -term effects of smoking cigarettes are very serious. They have just experienced what it is like to have chronic obstructive lung disease, which is characterized by progressive limitation of the flow of air into and out of the lungs. Emphysema and chronic bronchitis are two examples of chronic obstructive lung diseases. Pass out a small sheet of white paper to each participant and have him or her think of five reasons why it is harmful to use tobacco products. Have them roll their papers in the shape of a cigarette. Collect the paper cigarettes. Distribute them to the participants, giving each participant a paper cigarette other than his/ her own. Have the participants take turns reading what is written on their cigarettes. Explain that we never know what problems may occur from our actions but, if we know that problems are likely to occur, we should use prevention tactics to keep them from happening. Further explain that cigarette smoking has also been linked to lung cancer, laryngeal cancer, coronary heart disease, atherosclerotic peripheral vascular disease, oral cancer, esophageal cancer intrauterine growth retardation, low birth weight babies, leukaemia, unsuccessful pregnancies, increased infant mortality, peptic ulcer cancer of the bladder, cancer of the pancreas, cancer of the kidney, and cancer of the stomach. Smokeless tobacco use increases the frequency of localized gum recession and oral cancer. After the exercise, use the following questions to facilitate a group discussion:  Is it easy for you to take deep breaths?  How did you feel after taking deep breaths?  What was it like to breathe through the large straw? Was it easier or more difficult than deep breathing?  What was it like to breathe through the small straw? Was it easier or more difficult than breathing through the large straw?  How did you f eel after breathing through the small straw?  What are some things that may prevent you from taking deep breaths? (Pollution, sickness, etc.)  Do you know someone who cannot breathe easily? Why can't they breathe easily?  If you cannot breathe easily, what are some of the activities that you may not be able to do? How do you think you would feel if you could no longer do these activities? Module 6: Drugs and Substance Use 6-28 Session 6.4 Effects of Alcohol on a Person’s Abilities Expected Outcomes Participants will know the effect alcohol can have on their physical and mental health. I Feel Woozy! Objective To demonstrate how alcohol can affect a person's ability to function. Materials Pencils, paper. Time 30 minutes. Process Ask the participants to sit in a circle. Explain that they will be doing a short exercise to understand the effect of alcohol and other substance use. Ask the participants to take one marker and one sheet of paper. Ask them to write their names on the sheet of paper. Then, ask them to once again write their names using the other hand (one not normally used by the participants). Thus, a person who usually writes with his/ her left hand will write with his/ her right hand and vice versa. After the participants have the opportunity to do this activity, have them analyze what occurred. Have them compare their writi ng samples with each other. Explain that what the participants experienced was an experiment in which their hand muscles did not work as they usually do. By writing with the opposite hand, they could not function as they normally would. If alcohol were inside a person's body, that person would not be able to use his/ her body muscles the way they usually work in a smooth and coordinated manner. That is, it would be similar to writing their name with their left hand, if they normally wrote with their right hand and vice versa. You may want to link this experiment with wider issue of substance use. The following questions may be used for discussion:  With which hand did it take you longer to write your name?  Are the letters of your name as clear as the letters you write with the hand you normally use?  What are some of the activities you would not be able to do if you were drunk or under the influence of drugs?  Imagine one activity that you like doing and would not be able to do if you were drunk or under the influence of drugs. Module 6: Drugs and Substance Use 6-29  What would the consequences for your family and dear ones be, if you become drunk or begin taking drugs? Look Where You Are Going! Objective To demonstrate how alcohol can affect a person's ability to function. Materials Old pairs of sunglasses, Vaseline, two balls made of a sheet of crumpled paper. Time 20 minutes. Process Invite the participants to sit in a circle. Explain that they will be doing a short exercise to understand the effect of alcohol on their ability to see and coordinate. Ask the participants to call out some effects of alcohol consumption. Record these responses on a flip chart. Ask for 3 volunteers to stand in the centre of the circle. Give two of the volunteers sunglasses with a layer of Vaseline on the lenses. Ask them to wear the sunglasses. Ask the third volunteer to stand 1 meter or so away (s/ he should be visible but not clearly) from the 2 volunteers wearing sunglasses. Give him/ her the 2 paper bal ls. Ask the volunteer with the ball to throw the balls to the two volunteers with sunglasses. The volunteer to whom the ball is thrown must try and catch the ball. Repeat the throw and catch process a few times. Invite more participants to try out the experiment. Then, return to the circle for discussion. You may want to use the following questions for the discussion:  How did you feel wearing the sunglasses with Vaseline?  Were you able to see the ball thrown at you? How easy or difficult was it? Why?  Do you think alcohol has a similar effect on your ability to see and coordinate? Why/ Why not?  Have you ever thought about the effects of alcohol use on your ability to drive? Module 6: Drugs and Substance Use 6-30  Do you know of any other stimulant that may produce similar effects?  Have you ever had a bad experience due to being drunk? Would you like to share it with the group? Revert to the flip chart with participants’ responses on effects of alcohol consumption and summarize the discussion. Point out that alcohol use results in uncoordinated movements, blurred vision and mental lethargy. These effects are somewhat similar to those experienced by the participants when they tried to catch a ball wearing glasses smeared with Vaseline. Module 6: Drugs and Substance Use 6-33 Helpline for the peer educator Some reasons why young people use drugs are as follows:  Pressure from commercials/advertisements (alcohol/tobacco)  Influence of role models (film stars or singers who smoke or drink alcohol)  Curiosity (a typical trait of youth)  To relax (alcohol, other drugs)  Have fun (most drugs)  To avoid physical pain or psychological problems (heroin, opium)  To stimulate, to make one energetic (caffeine, cocaine, amphetamines, methamphetamines)  To reinforce physical power (steroids)  Stay awake (amphetamines)  Possible effects of using drugs are as follows:  Dependence on the drug  Loss of job or interruptions in education  Debt burden, due to mounting cost of drug use  Problems with law enforcement agencies for procuring illegal substances and stealing  Loss of social status and friends and family  Loss of good health  Depression, loneliness and suicidal tendencies  Indiscriminate sexual activity; i.e., sex for money  Make sex better (cocaine and Ecstasy)  High risk of HIV infection  Memory loss or loss of decision making capacity  Heightened emotions and mood swings  Enhanced enjoyment of music and dancing (ecstasy and methamphetamine)  Feelings of shame and guilt The World Health Organisation (WHO) analyzed research on risk and protective factors from more than 50 countries and concluded the following for Asia (WHO, 2001): Risk factors for adolescent drug/substance use Protective factors for adolescent drug/substance use  Conflict in the family  A positive relationship with parents  Friends who drugs/ substance use (family)  Parents provide structure and boundaries (family)  A positive school environment (community)  Having spiritual beliefs (individual) Module 6: Drugs and Substance Use 6-34 Risk and Protective Factors Exist on Several Levels At an individual level, life experiences play a more significant role in substance/ drug use than genetic traits. Important factors are the level of support and care from a parent or other adult at an early age and the quality of a child’s school experience. In addition, personal and social competence, such as, feeling in control and feelings about the future are important factors. Also, personal beliefs play an import ant role. At the peer level, the selection of peers and nature of peer support is crucial. Factors arising from the family level include a history of substance use or lack of effectiveness of family management including communication and discipline, structure of coping strategies, the level of attachment parents and children, nature of rules and parental expectations, and the strength of extended family network. Adolescents who have a positive relationship with their parents and whose parents provide struc ture and boundaries are less likely to use drugs/ substance. However, adolescents in families where there is conflict are more likely to use substance/ drugs. At societal and community levels, factors include the prevailing social norms and attitudes toward s substance/ drug use. Social competency skills, communication and resistance skills also play an important role. At the school level, adolescents who have a positive relationship with teachers, who attend school regularly and who do well in school, are less likely to use substance/ drugs. (Source: Global Youth Network, 2002; NIDA 1997; WHO, 2001) Module 6: Drugs and Substance Use 6-35 Session 6.6 Consequences of Drug/ Substance Use Expected Outcomes Participants will understand the various ways in which drug/ substance use can affect a per son’s life. Participants will know that there is a link between drug/ substance use and HIV infection. Story Of Woo Objectives The participants will become aware of the consequences of drug use. The participants will become aware of the risk of HIV infection related to drug use. Materials Flipchart paper, markers. Time 30 minutes. Process Ask the participants to divide into 4 groups. Explain that each group will work on the same case study but will answer different questions. All of the groups will make a presentation on their work and the discussion that occurred within the group. They should use flip charts and markers to make the presentation. Hand out the case studies and allow 20 minutes to do the exercise. Invite all of the groups to di splay their outputs and present their work one by one. Encourage the groups to question each other and discuss. Facilitate the discussion by asking relevant and open -ended questions. Base your questions on the answers given by the 4 groups based on the case study. The following case study can be used for this exercise. The peer educator can also prepare another case study for use, if so desired. Case of Woo Woo is a 17-year old Chinese Buddhist girl who was born in Lushai. She is the youngest in her family, and her parents are alive and live in Lushai. Her father was a rebel but has changed his ways. Her mother is a nurse. Woo worked in a department store in Mandarine and lived with her aunt. While living with her aunt Woo made new friends and started enjoying the nightlife offered by the city. She would often go to bars with her friends after work hours. One night, one of her friends offered her some amphetamine tablets. Her friend told her that they would make her energetic and lively and that she would be able to enjoy Module 6: Drugs and Substance Use 6-38 The following scenarios can be used for this exercise. The peer educator can also make new scenarios based on his/ her awareness and socio-cultural realities of young people in his/ her area/ country region. Scenario 1 A friend invites you to a disco where it is rumoured that (meth)amphetamines and other drugs are widely available. What might be happen if (a) you accept the invitation, or (b) you refuse the invitation? Scenario 2 You meet an old friend whom you haven't seen for some time. She/ he lights a marijuana cigarette (a “joint”) and offers it to you? Scenario 3 You go out with some friends and someone offers you a tablet. They insist that it will make you feel great, that everybody is taking them and that, surely, you do not want to be left out. What should you do? What would you say? Scenario 4 You are with your friends. Someone offers you some alcohol and some capsules, which someone suggests will take away the effects of the alcohol. How would you respond? Scenario 5 One of your friends is becoming increasingly involved with another group. You have heard that this group regularly uses solvents and amphetamines. What do you do? Scenario 6 A friend has been spending a lot of time (and money) at the local video game arcade (store). She/ he asks to borrow some money from you. What would you do? Module 6: Drugs and Substance Use 6-39 Session 6.8 Learning To Make Sensible Choices Expected Outcomes Participants will know how and when to use negotiation and refusal skills. Participants will apply negotiation and refusal skills to protect themselves from negatives influences and situations. No Thank You Objective The participants will learn and practice negotiation and refusal skills. The participants will be able to analyze the method and appropriate time to protect themselves from the influence of others. Materials Flipchart paper, markers, plain paper, pencils. Time 1 hour. Process Invite the participants to sit in a circle. Explain that they will be doing an exercise to learn negotiation and refusal skills. Ask the participants to help write the following messages on flipchart paper and post them around the room. Just one more for the road. Real men drink to the bottom! What are you afraid of? Only sissies, goody-goodies and nerds don’t drink. Drinking is better than worrying about something. No alcohol, no fun. All your friends smoke. Why don’t you? Just have one for my sake. Discos and drugs go together. Just try this pill and you will be on top of the world. Don’t be a goody -goody. There is no harm in smoking If you don’t take this tablet, I will marijuana, once in a while. think that you don’t love me. Would I give you something harmful? I am your best friend. You are my friend only if you prove it by smoking this joint. Arrange small groups of 4-5 persons each. Each group must select one of the messages above. Allow the groups 15 minutes to prepare a role -play on the message they choose. The role-plays should focus on responses to the messages they choose. The group should be able to display multiple ways of handling the situation. Module 6: Drugs and Substance Use 6-40 When the groups are ready, invite them to present their role -plays to the other groups. After each group has presented its role -play, the observers must state the message that the role -play is in reference to and the method the group used to solve the problem. Do they think the method was appropriate? What would they suggest? You may want to use the following questions for discussion and summarization:  How did you feel about the role -plays? Why?  If you faced similar situations would you be able to refuse? Why/Why not?  Why is it so difficult to refuse friends?  How can you counter peer pressure and make your own choices?  What do you think are the consequences of drinking alcohol or using drugs?  Do you think that the problem solving methods that your friends presented are appropriate for you? Why? Do you have any other methods?  If there is no way that you can refuse your friends, what can you do to help yourself?  What skills did you build or strengthen from this activity?