Chapter 13
Substance abuse
By the end of this chapter you should be able to:
a discuss the meaning of the term substance
abuse, with reference to legal and illegal
drugs;
b distinguish between psychological and physical
dependence;
c describe the short-term and long-term
consequences of alcohol consumption on the
nervous system and the liver, with reference to
fatty liver, hepatitis, cirrhosis, cancer, impaired
nervous transmission, demyelination, and
dehydration of the brain cells;
Legal and illegal drugs
A drug can be defined as a substance that alters
the bodys physiology. Drugs may be used to treat
specific health problems, and this is known as
therapeutic drug use. There are also drugs that
people use to change their mood, such as caffeine,
alcohol, nicotine, cannabis and heroin.
Although all of these drugs can have beneficial
effects in some circumstances, most of them also
have the potential to cause enormous problems
for their users and others if they are abused.
Drug (or substance) abuse means using the drug
in a way that causes harm, either to oneself or
to others. Misuse of drugs seriously damages the
physical and mental health of many people in
the Caribbean each year, as well as harming their
families and other members of the society in which
they live and work.
Many of the most harmful drugs are illegal.
However, the fact that a drug is legal does not
mean that it is harmless. Most doctors agree that
alcohol, although it is a legal drug, does more
harm each year than any of the illegal drugs. It
has been suggested that, if alcohol was discovered
for the first time today, it would immediately be
d discuss the social consequences of excessive
alcohol use;
e describe the effects of the components of
cigarette smoke on the respiratory and
cardiovascular systems, including reference to
passive smoking.
banned as being extremely dangerous to health.
In this chapter, we will look in detail at two legal
drugs which, between them, contribute to very
large numbers of deaths and serious illness each
year. These are alcohol and nicotine.
Drug dependency
Many drugs affect what happens at synapses, either
in the brain or elsewhere in the body. Postsynaptic
neurones contain receptors in their plasma
membranes into which the transmitter substance
used at that synapse precisely fits. Drugs that act at
synapses may do so by mimicking the action of the
transmitter substance; that is, they have the same
shape and affect the postsynaptic neurone in the
same way that the transmitter would. They may
prevent the breakdown of the transmitter for
example, by inhibiting the enzyme that normally
does this. Or they may inhibit the action of the
transmitter itself.
If the drug is taken over a period of time, then
the body may adjust to its use. For example, if
the drug blocks particular receptors at synapses,
then new receptors may be produced to make up
for the ones that are no longer in use. This means
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that more drug has to be taken to have the same
effect. This is known as tolerance to the drug. An
increasing tolerance is an indication of increasing
dependence on the drug.
The ways in which people use mood-changing
drugs such as nicotine, heroin and alcohol are
sometimes classified according to how much
control a person has over their drug-taking
behaviour.
Recreational use involves a person taking a drug
occasionally, in such a way that they do not
suffer any health problems as a result, nor does
their use of the drug affect their behaviour in
ways that cause problems for anyone else. For
example, having a glass of wine or beer with
a meal would be classed as recreational use of
alcohol.
Abuse occurs when the drug starts to damage
the health of the person taking it, or of people
around them or in their families. An example of
drug abuse would be a person drinking enough
alcohol to make them aggressive and cause them
to act violently.
Dependency occurs when, as a result of changes
in the brain and other parts of the body, the
person can no longer manage without the drug.
Their life begins to revolve around getting the
drug and using it.
Dependency can be classified as physical or
psychological. This distinction is useful in working
out the best way to help a person to escape from
the hold that the drug has over them. However,
there is no sharp dividing line between these two
types of dependency, and in the end they both
probably result from changes that occur in the
body as a result of taking the drug.
Physical dependency occurs because there have
been changes in the structure and physiology of
neurones in the brain. If the person stops taking
the drug, they suffer from withdrawal symptoms
(abstinence syndrome). Withdrawal from heroin
produces some of the very worst withdrawal
symptoms. The person will feel anxious,
restless and irritable. They will not be able
to sleep. Their eyes water and nose runs, and
they salivate excessively, and may vomit, have
abdominal pain and diarrhoea. The pupils of
270
their eyes dilate and they may feel pain all over
the body. These extremely unpleasant symptoms
start about 8 to 16 hours after withdrawal
begins, and then can last for a week. The person
will feel cravings for the drug for many weeks
afterwards, as well as a general feeling of being
unwell and being unable to relax or sleep.
Psychological dependency is also due to what
is happening in the brain as a result of taking
the drug, but the person does not experience
unpleasant withdrawal symptoms when they
stop taking it. They do, however, constantly
crave the drug. It seems as essential to them
as food or water does to you when you feel
very hungry or very thirsty. They may have
begun taking it to help them to get through a
particular problem in their lives, and if that
situation re-emerges they may start taking it
again. Their drug-taking may also have led them
to experience an environment that they enjoyed
for example, injecting drugs along with others;
they may miss all the paraphernalia associated
with this environment and feel a tremendous
need to go back to it. Indeed, psychological
dependency may be harder to get over than
physical dependency.
Alcohol
Alcohol more correctly ethanol has been used
by humans for thousands of years. It was drunk
in beer, wine and other drinks produced by the
fermentation of substances such as grapes by
yeasts. It was also widely used as a solvent in the
preparation of herbal remedies.
As you will see below, drinking too much
alcohol can cause serious damage to the liver, brain
and other parts of the body. Health professionals
recommend that each person should stay within
daily alcohol limits (DALs) of no more than 2 or 3
units for a woman, and no more than 3 or 4 units
for a man. A unit is explained on page 274.
How alcohol affects the body
Alcohol molecules dissolve very easily in the fatty
acid tails of phospholipids that make up cell
surface membranes. This distorts the proteins that
form channels in the membranes. In particular, it
 Chapter 13: Substance abuse

affects the shape of receptors in the membranes

of neurones in the brain that respond to a
neurotransmitter called GABA, which inhibits the ethanol aldehyde
dehydrogenase dehydrogenase
formation of action potentials. Alcohol increases ethanal ethanoate
ethanol
and prolongs the effects of GABA. (acetaldehyde) (acetate)
Alcohol also affects another, stimulatory, oxidised reduced oxidised reduced
neurotransmitter called glutamate. This is the NAD NAD NAD NAD
commonest neurotransmitter in the brain, and is
responsible for much of the interaction between enters Krebs cycle
neurones. Alcohol blocks the receptors on cell
membranes that glutamate would normally bind to.
So, alcohol increases the effect of the inhibitory Figure 13.1 Detoxification of alcohol in the liver.
neurotransmitter GABA and reduces the effect of
the stimulatory neurotransmitter glutamate. Both deposited in the liver. There is a strong correlation
of these actions reduce or depress the activity of between the amount of alcohol consumed and the
the brain, so alcohol is a depressant. The effects amount of fat deposited in a persons liver. The
are especially great in the cortex of the cerebrum fat is stored in the hepatocytes, and can severely
and in the cerebellum. As the activity of the cortex reduce their efficiency at carrying out their other
is depressed, the person becomes less able to functions. This condition is known as fatty liver
think clearly and logically and to make decisions. (Figure 13.2). (Alcohol consumption is not the
Inhibitions are reduced, and this helps some only cause of fatty liver other risk factors include
people to relax and interact socially. Depression of diabetes and obesity.)
the activity of the cerebellum inhibits coordination Excessive intake of alcohol may also cause the
of movements. liver to become inflamed, a condition known as
If drunk in large amounts, alcohol can kill. hepatitis.
Inhibition of various areas of the brain causes A combination of the excess storage of fat in
drowsiness and eventually unconsciousness. It can the hepatocytes, plus the direct damage done to
cause coma. When the nervous stimulation of the hepatocytes by ethanol, can lead to a condition
muscles used in breathing is inhibited by alcohol, known as cirrhosis. The damaged hepatocytes
breathing movements stop and the person may die. are replaced by fibrous tissue. The structure of
Alcohol is broken down inside the cells
of the liver, the hepatocytes. The enzyme
that catalyses the breakdown of ethanol is
ethanol dehydrogenase, also known as alcohol
dehydrogenase. Ethanol is first converted to
ethanal by this enzyme, and then to ethanoate by
aldehyde dehydrogenase. Ethanoate can enter the
Krebs cycle in mitochondria and be metabolised to
produce ATP (Figure 13.1).
If large quantities of alcohol are consumed on
a regular basis, then the tissues within the liver can
be damaged. You can see, in Figure 13.1, that the
breakdown of ethanol produces reduced NAD.
In its oxidised state, NAD is involved in oxidising
fatty acids in the liver cells. If the NAD has been Figure 13.2 This is an MRI scan of a person
reduced, then it cannot do this. The fatty acids suffering from fatty liver. The fat deposits can be
accumulate and are converted to fats, which are seen as yellow patches in the liver.
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 Chapter 13: Substance abuse
the blood supply is lost, so that some blood that
arrives in the hepatic portal vein simply goes
straight past and into the hepatic vein, without
ever passing through the channels between the
hepatocytes on the way.
A liver affected by hepatitis or cirrhosis cannot
carry out its normal functions. The liver has a
very wide range of roles, involving many different
metabolic reactions, so damage to it has far-
reaching effects on the body. For example, the
hepatocytes can no longer convert ammonia into
urea, so ammonia concentration in the blood
increases and can cause major damage to the
central nervous system. In severe cases, coma and
even death may result.
Long-term alcohol consumption also causes
high blood pressure which in turn increases the risk
of heart attacks and strokes. Alcohol can damage
the lining of the stomach. It increases the loss of
water in urine, so can cause dehydration. Brain
cells are especially susceptible to this. The neurones
in some parts of the brain also tend to lose their
myelin sheaths, a process known as demyelination.
This severely affects brain function.
Alcohol is a major cause of cancer. People who
regularly drink large quantities of alcohol have a
greatly increased risk of developing cancer in the
mouth, oesophagus, liver, breast or bowel.
Some people are able to drink large amounts
of alcohol without becoming dependent on it,
but others run the risk of developing dependency.
It is not understood why some people become
alcoholics (dependent on alcohol) while others do
not. Alcoholics experience unpleasant withdrawal
symptoms if they have to go for any length of
time without drinking it. If they wish to give up
drinking alcohol, they can be helped through these
withdrawal symptoms with the use of drugs such
as diazepam. However, a person who has once
been dependent on alcohol can easily fall back into
the same dependency again, unless they completely
give up drinking alcohol or control their drinking
very rigorously.
272
Social consequences of alcohol abuse
Drinking and driving
Drinking alcohol increases reaction time, and
adversely affects judgment. Both of these effects
mean that a driver who has drunk alcohol is much
less likely to react appropriately and rapidly to
danger. A high proportion of accidents involve
drivers who have been drinking. They often also
involve pedestrians who have been drinking.
Many Caribbean countries have laws that limit
the amount of alcohol that a driver can legally
have in their blood. In the majority, this is 0.08%
that is, 80 mg of alcohol in every 100 cm3 of
blood. In Jamaica, the limit is higher than this, at
0.35%. In Barbados and Cuba, the limit is zero.
How can you judge your blood alcohol
concentration? Just going by how you feel doesnt
work, as people generally greatly underestimate
the effect that alcohol has on them. It helps to
think about units of alcohol. One unit can be
considered to be half a pint of low strength beer,
or just under one half of a regular glass of wine
with an ABV (alcohol by volume) of 13% (Figure
13.3). These each contain 8 g of alcohol.
one unit two units one unit
Figure 13.3 Units of alcohol in some drinks.
To calculate the number of units in a drink,
multiply the volume of the drink in ml by its ABV,
and divide by 1000:
volume of drink ABV
number of units =
1000
On average, each unit increases blood alcohol
concentration by 15 mg per 100 cm3 (though this
may be higher in a small person, and tends always
 Chapter 13: Substance abuse

to be higher in women). The liver breaks down alcohol at all, and gets all of his or her (non-
about one unit each hour. alcoholic) drinks paid for by the rest of the group.
Many people, however, think that the best rule is
not to drink at all if you are going to drive (Figure Violence
13.4). There really is no safe limit for drinking Some people become aggressive and violent when
and driving. Young people on an evening out often they have been drinking alcohol. They may be
appoint a designated driver, who doesnt drink almost unaware of this effect on them, thinking
that they are just behaving normally and like
everyone else. However, this kind of behaviour can
have very severe effects on others who get caught
up in it. Alcohol-fuelled violence happens not only
out in the streets, but also within the home. Family
members may suffer at the hands of a drunken
parent or partner. Each year, many families break
up as a result of aggressive behaviour caused by
drinking alcohol.

Crime
We have seen that drinking alcohol damages
judgment and weakens inhibitions. In some people,
Figure 13.4 The amount of alcohol in the breath this can lead to them committing crimes such as
is directly related to the concentration of alcohol theft, which they would not commit if they were
in the blood. not drunk.

SAQ
1 The graphs show the number of people who b Compare the pattern you have described in a
were admitted to hospital in one part of the with that shown by cannabis.
USA in the year 2000 for drug-related illnesses. c Compare the pattern you have described in
In all cases, the drug was being abused and was a with the pattern of admissions for alcohol
a direct cause of the need for admission. amongst women of different ages.
a Describe the pattern of alcohol abuse that d Explain why these data do not give useful
resulted in hospital admission, amongst men information about the percentage of people
of different ages. who were using these different categories
of drugs.

males females
400 400
Number of admissions / thousands

ages
40+
300 300
3039
200 200 2029
<20
100 100

0 0
alcohol cocaine stimulants alcohol cocaine stimulants
opiates cannabis other opiates cannabis other

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 Chapter 13: Substance abuse
Smoking
Tobacco smoke contains many different chemicals.
These include:
tar a mixture of substances, some of which
can cause cancer;
nicotine the addictive substance in cigarette
smoke; it affects the brain and other parts of
the nervous system, and also the cardiovascular
system;
carbon monoxide a gas, produced by
incomplete oxidation of some of the substances
in tobacco, which reduces the oxygen-carrying
capacity of the blood;
particulates tiny particles, mostly of carbon,
that cause irritation in the lungs and airways.
Each of these substances is potentially harmful
to health. Compounds found in cigarette smoke
are the direct cause of serious lung diseases, and
increase the risk of developing CHD or suffering
a stroke. Even breathing in someone elses
cigarette smoke passive smoking (Figure 13.5)
significantly increases the risk of developing these
health problems.
Figure 13.5 Passive smoking.
274
Lung diseases
Lung diseases are a major cause of illness and
death. They include:
chronic obstructive pulmonary disease (COPD)
this includes many related diseases, such as
emphysema, that prevent the normal flow of air
through the gaseous exchange system;
lung cancer, where cells in the lungs divide
uncontrollably and form a tumour;
illnesses caused by infectious organisms
(pathogens), such as bronchitis.
Chronic obstructive pulmonary disease
COPD is an illness in which the airflow into and
out of the lungs gradually and progressively
becomes more and more obstructed. COPD
happens to everyone to a certain extent as they get
older, but it is hugely accelerated and worsened
by smoking. It is thought that around 600 million
people worldwide suffer from COPD, and that 300
million die from it each year. Somewhere between
80% and 90% of these cases are caused by smoking
cigarettes.
Cigarette smoke contains a wide range of
different chemicals, many of which stimulate
neutrophils a type of white blood cell (Figure
13.6) to come to the scene. Neutrophils
are an important part of the bodys defence
against infectious disease, but here they behave
inappropriately and actually cause illness.
The neutrophils secrete an enzyme called
neutrophil elastase. This enzyme is a protease and,
as its name suggests, it breaks down elastin, which
forms the elastic fibres in the tissues of the airways.
Usually, there are inhibitors present that prevent
this enzyme from doing very much harm. But, in
a smoker, the balance between the concentrations
of the protease enzymes and inhibitors tips too far
in favour of the enzymes. The proteases gradually
break down the elastin tissues in the lungs, causing
irreversible damage.
One of the effects of this tissue damage is that
the walls of many of the alveoli are broken down.
Instead of millions of tiny alveoli, separated from
blood capillaries by exceptionally thin walls, the
lungs become filled with larger spaces, much more
widely separated from the blood capillaries. Whats
 Chapter 13: Substance abuse

make it more difficult for air to move into and out

Inspiration Expiration
of the lungs.
The damage to the airways also involves the
ciliated cells and the goblet (mucus-producing)
cells, which normally help to keep the lungs clear
of dust, bacteria and other foreign particles in the
air that is breathed in. In smokers, the goblet cells
often proliferate, producing much larger numbers
than in a non-smoker. The production of large

a
alveolus
elastin fibre

a Healthy alveoli partially deate when breathing

out due to the recoil of elastin bres.

Inspiration Expiration

b Neutrophils from the blood make pathways through

alveolar walls by digesting elastin and, after many
years of this destruction, the alveoli do not deate
very much.

Figure 13.6 The development of emphysema.

more, many of these capillaries also disappear.

The total surface area for gaseous exchange is
therefore greatly reduced. This condition is called
emphysema (Figure 13.7). Not surprisingly,
someone with emphysema has great difficulty in
getting enough oxygen into their blood.
The progressive damage to the lungs causes
them to lose their elasticity, while damage to the Figure 13.7 a Photomicrograph of lung tissue
airways causes their walls to thicken. This happens from a person with chronic emphysema, showing
because the attempts by the tissue to repair itself large spaces where there should be many tiny
cause it to become fibrous. Both of these changes alveoli, b photomicrograph of normal lung tissue.
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 Chapter 13: Substance abuse
numbers of extra cells is called hyperplasia. As
a result, more mucus is produced, but the cilia
do not beat and so there is nothing to carry the
mucus up and out of the bronchi and trachea.
Instead, mucus accumulates in the airways,
where it provides a breeding ground for bacteria.
People with this condition therefore tend to suffer
from bacterial infections of the bronchi, called
bronchitis. They may have a chronic cough, as they
attempt to clear the mucus from their lungs.
There is not really a great deal that can be done
to help a person who has COPD. Once the tissues
have been damaged, it is very difficult for them to
recover. Usually, the best that can be done is to
prevent the disease from getting any worse.
The first thing that anyone with COPD will be
told to do is to stop smoking. This will almost
immediately produce a reduction in the frequency
and severity of infections, and may also reduce the
cough. Ciliated cells and goblet cells can recover
to a certain extent. But it is unlikely that large
improvements will be made in the breathlessness
that is caused by emphysema. Emphysema appears
to be irreversible.
Many patients may be helped a little by drugs
called beta agonists, which dilate the airways by
causing the smooth muscle in their walls to relax.
As the patient ages, and the symptoms get
worse, they may need to breathe oxygen on a
regular basis. This can be done at home, where the
patient has an oxygen cylinder and breathing mask
that they can use whenever they need to. In the
advanced stages of the disease, even walking a
few steps becomes impossible without getting out
of breath.
Lung cancer
While COPD causes about 15% of smoking-
related deaths, lung cancer causes almost double
that number. Smokers are almost 20 times as likely
to die from lung cancer as are non-smokers. Lung
cancer is one of the most difficult cancers to treat
successfully.
Cigarette smoke contains several chemicals
that are carcinogenic. Carcinogens are substances
that damage the control of cell division. Cells
may begin to divide much more than they should,
276
forming a lump of disorganised cells called a
tumour (Figure 13.8). The tumour can be almost
anywhere in the gas exchange system, but most
frequently grows where the trachea branches into
the two bronchi, or at other branching points.
Figure 13.8 Micrograph showing a tumour
(darker purple) in a human lung (16).
As the tumour grows, it displaces other tissues.
Eventually, this can lead to the blockage of the
airways or other parts of the lungs. The person
may find it difficult to get their breath, and may
have a chronic cough, sometimes bringing up
blood. They may experience pain or tightness in
the chest. As the cancer progresses, they may lose
weight.
Cancerous cells may break away from the
primary (original) tumour and begin to form
secondary tumours in other parts of the body.
If this happens, survival rates are very low.
Some of the carcinogenic substances enter
the bloodstream in the lungs, and are carried
all over the body. It is therefore not surprising
that smoking significantly increases the risk of
developing cancers in almost every part of
the body.
Smoking and the cardiovascular system
Smoking increases the risk of developing CHD.
Nearly everyone who develops CHD in their 30s
or early 40s is a smoker. Smoking can cause high
blood pressure. A smoker with high blood pressure
has a 20 times greater risk of stroke than a non-
smoker who does not have high blood pressure.
 Chapter 13: Substance abuse

Nicotine can sometimes cause problems such as dizziness,

One of the culprits is the nicotine in cigarettes.
Nicotine is a neurotoxin a chemical that damages
the nervous system. It is used as an insecticide.
Nicotine is extremely addictive, and this is the
reason why smokers find it so difficult to give up.
Nicotine molecules are relatively small, and they
easily move out of the blood and into every part of
the body, including the brain. Nicotine increases
the levels of a transmitter substance called
dopamine in the parts of the brain that are known
as reward circuits. Activation of these circuits
gives feelings of pleasure, and this is why people
enjoy smoking.
Nicotine also causes the release of adrenaline
into the blood. Adrenaline increases the rate of
heart beat, blood pressure and breathing rate.
Nicotine is a vasconstrictor it causes the
smooth muscle in the walls of arteries and
arterioles to contract, narrowing the lumen and
therefore making it harder for blood to be pumped
through. This, too, tends to increase blood pressure
and the risk of blood clots forming (page 250).
weakness, headache and joint pain.
Hypertension, CHD and stroke
We have seen that nicotine increases blood
pressure, which can increase the risk of developing
atherosclerosis and CHD (Chapter 12). It is not
only the coronary arteries that are affected
atherosclerosis can develop in any arteries in the
body. Smokers run a higher risk than non-smokers
of atherosclerosis developing in blood vessels that
supply the brain. This greatly increases the risk of
suffering a stroke (page 254).
Smokers tend to have more viscous blood than
non-smokers. This can increase the risk of blood
clots forming inappropriately, which once again
increases the risk of stroke.

Carbon monoxide
Carbon monoxide diffuses from the alveoli into
the blood in the lung capillaries. Here it combines
with haemoglobin, forming a bright red compound
called carboxyhaemoglobin. It holds on tightly;
haemoglobin has a very high affinity for carbon
monoxide. With a proportion of the haemoglobin
tied up in this way, there is less available for the
transport of oxygen. Smoking therefore reduces
the delivery of oxygen to the tissues, including the
heart muscle. Smokers have less energy available to
their muscles when they exercise.
The body may respond to the oxygen shortage
by producing larger numbers of red blood cells.
A hormone called erythropoetin, produced by
the kidneys, is secreted in larger amounts when
the amount of oxygen in the blood is low. This
hormone stimulates the production of red blood
cells by the stem cells in the bone marrow. and
smokers usually have a higher red blood cell
count (the number of red cells per unit volume of
blood). This might seem to be a good thing, but it

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SAQ
2 The chart below is used to work out how likely a b What could each of these people do to reduce
person is to have a heart attack or stroke. their risk of having a heart attack or stroke?
a Use the chart to find the predicted risk for: c Suggest how a risk calculator like this could

a 56-year-old woman who smokes, has a
blood pressure of 160/95 and whose total
be produced.

cholesterol:HDL-cholesterol ratio is 5

a 45-year-old man who does not smoke,
whose blood pressure reading is 160/95 and
whose total cholesterol:HDL-cholesterol
ratio is 8.

Men Women
Non-smoker Smoker Non-smoker Smoker
ratio total chol:HDL-chol ratio total chol:HDL-chol
4 5 6 7 8 4 5 6 7 8 4 5 6 7 8 4 5 6 7 8
180/105
160/95
Age 7079
140/85
120/75
Blood pressure / mm Hg

180/105
160/95
Age 6069
140/85
120/75
180/105
160/95
Age 5059
140/85
120/75
180/105
160/95
Age 4049
140/85
120/75

Notes:
Risk 5 yr cardiovascular fatal Events prevented
1 ratio total chol:HDL-chol is
+ non-fatal events per 100 treated for 5 yrs
the ratio of the total amount of
cholesterol in the blood to the
>30% >10 amount of cholesterol transported
very high 2530% 9 in high density lipoprotein in the
2025% 7.5 blood.
high/moderate 1520% 6
2 A cardiovascular event in
1015% 4
this table is referring to newly
510% 2.5 diagnosed angina, myocardial
mild 2.55% 1.25 infarction, death from CHD or
<2.5% <0.8 stroke.

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Summary

Substance abuse is the misuse of a drug or other substance, so that it causes harm to the user or to
other people.

Although
problems.
alcohol and nicotine (in cigarettes) are legal drugs, their use can cause serious health

Physical dependency on a drug occurs when the structure and physiology of the body is changed
by the drug use, so that withdrawal symptoms are experienced when the drug is no longer taken.
Psychological dependency occurs when the person feels they cannot manage without the drug, even
if no withdrawal symptoms are experienced. There is no sharp dividing line between physical and
psychological dependency.

Intogether
the short-term, alcohol affects the neurotransmitters GABA and glutamate in the brain, which
causes the activity of the brain to slow down. It is therefore a depressant. Inhibitions are
reduced, coordination is lost and nervous transmission is slowed, lengthening reaction time. If so
much alcohol is drunk that the breathing muscles are inhibited, the person may die.

Alcohol is broken down in the liver by the hepatocytes. Long-term excessive consumption of alcohol
often leads to fatty liver, hepatitis and cirrhosis and also greatly increases the risk of developing
many types of cancer.

Alcohol consumption is a causative factor in many vehicle and other accidents, in incidents involving
violence and aggression, and in petty crime.

Smoking cigarettes, and the inhalation of smoke from other peoples cigarettes, causes a very wide
range of serious health problems. These include COPD and lung cancer, CHD and stroke.

Questions
Multiple choice questions
1 Drug abuse is:
A the use of a drug for personal gratification, causing damage to health.
B the compulsion to use a drug on a periodic or continuous basis to avoid discomfort from its
absence.
C the need for increasing quantities of the drug to produce the same effect.
D the occasional use of the drug to lessen pain.
2 Which of the following best describes physical dependence?
A the emotional changes if the drug is withheld
B the need for an increasing dose of the drug to produce the same effect
C when a drug or one of its metabolites has become necessary for the continued functioning
of the body
D a mild form of dependence that does not produce withdrawal symptoms

continued ...

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3 Which of the following is not a consequence of long-term use of alcohol?

A the development of swollen cells with wispy cytoplasm in the liver cells
B the accumulation of fat in the liver cells
C the constriction of blood vessels in the liver
D the development of fibrous tissue in the liver
4 How many grams of absolute (pure) alcohol does one unit of alcohol contain?
A 7
B 8
C 15
D 25
5 Fat accumulates in the liver when alcohol is consumed regularly because:
A fat absorbs alcohol and helps detoxify it.
B alcohol is used to synthesise fat molecules in the liver.
C liver cells use alcohol instead of fat as an energy source.
D alcohol prevents liver cells from secreting fat molecules.
6 Which component of tobacco smoke causes an increased risk of lung cancer?
A nicotine
B carbon dioxide
C carbon monoxide
D tar
7 How does nicotine in cigarette smoke increase the risk of cardiac disease?
A by reducing the diameter of arterioles
B by attaching to haemoglobin
C by stimulating the sino-atrial node directly
D by forming plaque in blood vessels
8 Which of the components of tobacco smoke lowers the capacity of haemoglobin to
transport oxygen?
A carbon monoxide
B nicotine
C tar
D carcinogens

continued ...

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9 The images below are enlarged views of alveoli from a non-smoker and a smoker.

alveoli of a non-smoker alveoli of a smoker

Why may a smoker have to consciously contract his muscles to breathe out?
A increased mucus production by goblet cells
B paralysis of the cilia
C excess tar in the alveoli
D loss of elasticity in the alveolar walls

Structured questions
10 a What do you understand by the following terms?
i drug
ii drug abuse
iii drug dependence
iv drug tolerance
v abstinence syndrome (withdrawal symptoms) [10 marks]
b Distinguish between:
i physical and psychological dependence
ii legal and illegal drugs. [5 marks]
11 The following drinking guidelines have been developed for people over 18 years of age,
based on medical advice.

Men
It is recommended that men drink no
more than 3 to 4 units of alcohol a
4 day day and no more than 21 units over
21 week the course of the week.

Women
It is recommended that women drink
no more than 2 to 3 units of alcohol
a day and no more than 14 units
3 day over the course of the week.
14 week

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a What do you understand by the term unit of alcohol? [1 mark]

b Why are the recommended units given in both units per day as well as units
per week? [2 marks]
c Why are the recommended units per day of alcohol for men and women different? [4 marks]
d Alcohol is absorbed quickly from the gastrointestinal tract into the blood.
What properties of alcohol facilitate the fast absorption rates? [2 marks]
e Recently the Trinidad and Tobago Government introduced breathalyzer testing in
order to reduce road accidents.
i Copy and complete the table below which shows the effects of drinking and
blood alcohol concentrations on driving behaviour.

Blood alcohol Effects of alcohol on

concentration / g100cm3 driving
0.020.05
0.050.08
[4 marks]
ii The legal limit for drinking in Trinidad and Tobago is 0.08g per 100cm3 blood.
Explain why a breathalyzer test can be used to determine whether a driver is
above this limit. [2 marks]
12 a Name three main constituents of cigarette smoke that are harmful to the body. [3 marks]
Diagram a below shows the alveoli of a smoker and non-smoker during expiration,
and image b shows the coronary artery of a smoker.

a b wall of artery
I
II

III

b Identify the alveoli of the smoker and the non-smoker. Give a reason for your answer. [3 marks]
c i Name the disease that is characterised by the alveoli of the smoker. [1 mark]
ii Explain why the smoker would have difficulty in breathing. [2 marks]
d i Identify structure III in image b. [1 mark]
ii Name the disease that is characterised by image b. [1 mark]
iii State four symptoms that might be experienced by a person whose artery has
been narrowed as shown in image b. [2 marks]
iv Explain how cigarette smoking may account for the appearance of the artery. [2 marks]

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 Chapter 13: Substance abuse

Essay questions
13 Explain the following terms using alcohol and the components of cigarette smoke
as examples.
a physical dependence
b psychological dependence
b tolerance
b abstinence syndrome (withdrawal symptoms) [15 marks]
14 Cigarette smoke contains many substances that are harmful to the body and which
cause disease. Explain how the components of cigarette smoke increase the risk of
developing the following diseases.
a coronary heart disease
b lung cancer
c chronic bronchitis
d emphysema
e hypertension
f strokes [15 marks]
15 a Briefly describe the short-term and long-term consequences of alcohol
consumption on:
i the liver
ii the nervous system. [9 marks]
b Discuss the factors which affect blood alcohol level. [3 marks]
c Discuss the social consequences of excessive alcohol consumption. [3 marks]

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