Introduction
Motor vehicle accidents are the leading cause of death among people aged 15–44 (Ricci, Majori, Mantovani, Zappatera & Rocca, 2008). It is well documented that psychoactive substances, such as amphetamines, medicinal drugs and alcohol also increase the risk of motor vehicle accidents and injuries. These substances impair driving performance by diminishing perception and response to external stimuli (Ramaekers, 2008).
Psychoactive substances are chemical substances that changes brain functions and results in alterations in perception, mood, or consciousness. These substances may be used to alter one’s consciousness, or augmenting the mind. Some categories of psychoactive drugs, which are prescription medicines, have medical therapeutic utility for the treatment of neuro-psychiatric disorders and some stimulant medications used in some sleep disorders (Petridou & Moustaki, 2010).
Benzodiazepines and alcohol are common psychoactive substances that have been shown to impair driving responses in a manner equivalent to a blood alcohol level of 50 mg/dl (Barbone, 2014). Many studies have suggested a causal link between psychotropic drugs and motor vehicle accidents. Moreover, a combination of two or more psychoactive drugs or psychoactive drugs with alcohol further increases the risk of having an accident. In the opinion of Neuter (2005), fatal and nonfatal motor vehicle accidents have both been a burden on the health care system, therefore, all means of preventing motor vehicle accidents are important to society.
In spite of the above stated influence of psychoactive substance and their roles in motor vehicle accidents, Skegg, Richard and Doll (2009) traced the continuous usage of these psychoactive substances to countless factors that influence their professional practice, among which the intake of psychoactive substances is used for reducing sleepiness during the trips and increasing willingness for work and socialisation. However, the use of these substances may cause harmful effects to the individual and to society. Amphetamines, when used to aid in sleepiness reduction, may cause agitation, tachycardia, vertigo and hallucinations, besides altering the body’s perceptions and reactions, thus raising the risk of traffic accidents.
Conceptual framework
A psychoactive substance also called psychopharmaceutical, or psychotropic is a chemical substance that changes brain function and results in alterations in perception, mood, or consciousness (Nelson, 2005). These substances may be used recreationally, to purposefully alter one’s consciousness, or as entheogens, for ritual, spiritual, or shamanic purposes, as a tool for studying or augmenting the mind.
According to Weil (2014), some categories of psychoactive substances, which are prescription medicines, have medical therapeutic utility, such as anaesthetics, analgesics, hormonal preparations, anticonvulsant and antiparkinsonian drugs or for the treatment of neuro-psychiatric disorders, as hypnotic drugs, anxiolytic and some stimulant medications used in Attention Deficit Hyperactivity Disorder (ADHD) and some sleep disorders. There are also some psychoactive substances used in the detoxification and rehabilitation programs for psychoactive drug users.
In the opinion of Siegel (2009), psychoactive substances often bring about subjective (although these may be objectively observed) changes in consciousness and mood that the user may find rewarding and pleasant (e.g. euphoria) or advantageous (e.g. increased alertness) and are thus reinforcing. Substances which are both rewarding and positively reinforcing have the potential to induce a state of addiction – compulsive drug use despite negative consequences – when used consistently in excess. In addition, sustained use of some substances may produce a physical dependence or psychological dependence syndrome associated with somatic or psychological-emotional withdrawal states respectively.
Drug rehabilitation aims to break this cycle of dependency, through a combination of psychotherapy, support groups, maintenance and even other psychoactive substances. However, the reverse is also true in some cases, that certain experiences on drugs may be so unfriendly and uncomforting that the user may never want to try the substance again. This is especially true of the deliriants (e.g. Jimson weed) and powerful dissociatives (e.g. Salvia divinorum). “Psychedelic amphetamines” or empathogen-entactogens may produce an additional stimulant or euphoriant effect, and thus have an addiction potential.
Historical background on the use of psychoactive substances
The use of psychoactive substances can be traced to prehistory. There is archaeological evidence of the use of psychoactive substances (mostly plants) dating back at least 10,000 years, and historical evidence of cultural use over the past 5,000 years (Merlin, 2013). The chewing of coca leaves, for example, dates back over 8000 years ago in Peruvian society (British Broadcasting Corporation, 2010).
Medicinal use is one important facet of psychoactive substance usage. However, some have postulated that the urge to alter one’s consciousness is as primary as the drive to satiate thirst, hunger or sexual desire (Siegel, 2005). Supporters of this belief contend that the history of drug use and even children’s desire for spinning, swinging, or sliding indicate that the drive to alter one’s state of mind is universal (Weil, 2014). During the 20th century, many governments across the world initially responded to the use of recreational drugs by banning them and making their use, supply, or trade a criminal offense. A notable example of this was Prohibition in the United States, where alcohol was made illegal for 13 years. However, many governments, government officials and persons in law enforcement have concluded that illicit drug use cannot be sufficiently stopped through criminalization.
Most common purpose for psychoactive substances use in Nigeria
In Nigeria, psychoactive substances are used for various purposes. The following according to Li and Pearce (2007) are some of the common uses of psychoactive substances:
· Anaesthesia
· Pain management
· Mental disorders
· Recreation
· Ritual and spiritual
· Military
Anaesthesia
General anaesthetics are a class of psychoactive substances used on people to block physical pain and other sensations. Most anaesthetics induce unconsciousness, allowing the person to undergo medical procedures like surgery without the feelings of physical pain or emotional trauma. To induce unconsciousness, anaesthetics affect the gamma-aminobutyric acid (GABA) and 3,4-methylenedioxy-methamphetamine (NMDA) systems. For example, halothane is a GABA agonist, and ketamine is an NMDA receptor antagonist (Li & Pearce, 2007).
Pain management
Psychoactive substances are often prescribed to manage pain. The subjective experience of pain is primarily regulated by endogenous opioid peptides. Thus, pain can often be managed using psychoactives that operate on this neurotransmitter system, also known as opioid receptor agonists. This class of drugs can be highly addictive, and includes opiate narcotics, like morphine and codeine. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen, are also analgesics. These agents also reduce eicosanoid-mediated inflammation by inhibiting the enzyme cyclooxygenase (Quiding, 2008).
Mental disorders
Psychiatric medications are psychoactive substances prescribed for the management of mental and emotional disorders, or to aid in overcoming challenging behaviour (Matson & Neal, 2009). There are six major classes of psychiatric medications:
- Antidepressants treat disparate disorders such as clinical depression, dysthymia, anxiety, eating disorders and borderline personality disorder.
- Stimulants, which are used to treat disorders such as attention deficit disorder and narcolepsy and to suppress the appetite.
- Antipsychotics, which are used to treat psychotic symptoms, such as those associated with schizophrenia or severe mania.
- Mood stabilizers, which are used to treat bipolar disorder and schizoaffective disorder.
- Anxiolytics, which are used to treat anxiety disorders.
- Depressants, which are used as hypnotics, sedatives, and anaesthetics, depending upon dosage.
In addition, several psychoactive substances are currently employed to treat various addictions. These include acamprosate or naltrexone in the treatment of alcoholism, or methadone or buprenorphine maintenance therapy in the case of opioid addiction. Exposure to psychoactive substances can cause changes to the brain that counteract or augment some of their effects; these changes may be beneficial or harmful. However, there is a significant amount of evidence that relapse rate of mental disorders negatively corresponds with length of properly followed treatment regimens (that is, relapse rate substantially declines over time), and to a much greater degree than placebo (Hirschfeld, 2011).
Recreation
Many psychoactive substances are used for their mood and perception altering effects, including those with accepted uses in medicine and psychiatry. Examples of psychoactive substances include caffeine, alcohol, cocaine, Lysergic acid diethylamide (LSD), and cannabis. Classes of drugs frequently used recreationally according to Bullis (2010) include:
- Stimulants, which activate the central nervous system. These are used recreationally for their euphoric
- Hallucinogens (psychedelics, dissociatives and deliriants), which induce perceptual and cognitive alterations.
- Hypnotics, which depress the central nervous system.
- Opioid analgesics, which also depress the central nervous system. These are used recreationally because of their euphoric effects.
- Inhalants, in the forms of gas aerosols, or solvents, which are inhaled as a vapour because of their stupefying effects. Many inhalants also fall into the above categories (such as nitrous oxide which is also an analgesic).
Ritual and spiritual
Certain psychoactives, particularly hallucinogens, have been used for religious purposes since prehistoric times. Native Americans have used peyote cacti containing mescaline for religious ceremonies for as long as 5700 years. The muscimol-containing Amanita muscaria mushroom was used for ritual purposes throughout prehistoric Europe. Various other hallucinogens, including jimsonweed, psilocybin mushrooms, and cannabis, have been used in religious ceremonies for millennia. The use of entheogens for religious purposes resurfaced in the West during the counterculture movements of the 1960s and 70s. However, the genuine religious use of peyote, regardless of one’s personal ancestry, is protected in Colorado, Arizona, New Mexico, Nevada, and Oregon (Vetulani, 2008).
Military
Psychoactive substances have been used in military applications as non-lethal weapons. In World War II, between 1939 and 1945, 60 million amphetamine pills were made for use by soldiers. Brown-brown, a form of cocaine adulterated with gunpowder, has been used in the Sierra Leone Civil War by child soldiers. Both military and civilian American intelligence officials are known to have used psychoactive drugs while interrogating captives apprehended in its War on Terror. In July 2012, Jason Leopold and Jeffrey Kaye, psychologists and human rights workers, had a Freedom of Information Act request fulfilled that confirmed that the use of psychoactive drugs during interrogation was a long-standing practice. Captives and former captives had been reporting medical staff collaborating with interrogators to drug captives with powerful psychoactive drugs prior to interrogation since the very first captives’ release. In May 2003, recently released Pakistani captive Sha Mohammed Alikhel described the routine use of psychoactive drugs. He said that Jihan Wali, a captive kept in a nearby cell, was rendered catatonic through the use of these drugs (Haroon, 2003).
Prevalence of the use of psychoactive substances
Tobacco, alcohol, marijuana and other drug use are prevalent in Nigeria. According to Oshodi, Aina and Onajole (2010), in a-30 research work among people living in urban setting in Ibadan revealed prevalence of psychoactive substances as 34% for alcohol, 8.5% for tobacco smoking, 2.7% for cannabis, 0.2% for glue and 0.1% for drugs such as diazepam. Other similar research studies have shown that adolescent and young adult period are particular moments of vulnerability because it is tempting to experiment with drugs. This finding is significant in terms of the development of health related behaviours because adolescence is a time when many new behaviours are explored, some of which may become established and continue through to adulthood (Flanagan, Bedford, Farrell & Howell, 2013).
The prevalence rate of psychoactive substance use has been reported among Nigerian youth between 11 and 20 years in one study, however another study reported a lifetime prevalence of 66% for psychoactive substance usage among Nigerian. In South Africa, it is reported that 49.1% of adult had consumed one or more psychoactive substance in their lifetime and 31.8% had consumed one or more in the previous month. In Ghana, lifetime prevalence of psychoactive substance use varied from 25.1% (Fatoye, Oyebanjo & Ogunro, 2006).
Cannabis is also commonly used among people in Africa. In South Africa 12.8% of adults reported ever using cannabis and 9.1% had used cannabis on one or more days in the past month. The lifetime prevalence for cannabis use was found to be 18.3% in South Africa, 10.9% in Kenya 4.4% among Nigerians and 2.6% among Ghanaian (Adu-Mireku, 2009). Tobacco use by young people is also of major concern in Africa. According to Reddy, Panday, Swart, Jinabhai, Amosun and James (2012), 30.5% of South African had smoked cigarettes in their lifetime while 21.1% acknowledged consuming tobacco during the past 30 days. The lifetime prevalence for tobacco use was reported to be 20% in Nigeria, 34.7% in Kenya, and 7.5% in Ghana.
Reasons behind the use psychoactive substances
Psychoactive substances are used by humans for a number of different purposes to achieve a specific end. These uses vary widely between cultures. Some substances may have controlled or illegal uses while others may have shamanic purposes, and still others are used medicinally. Other examples would be social drinking, nootropic, or sleep aids. Caffeine is the world’s most widely consumed psychoactive substance, but unlike many others, it is legal and unregulated in nearly all jurisdictions (Lovett, 2005).
Psychoactive drugs are divided into different groups according to their pharmacological effects. Commonly used psychoactive drugs and groups:
- Anxiolytics for example, Benzodiazepine
- Euphoriants for example (3,4-methylenedioxy-methamphetamine) (MDMA).
- Stimulants: This category comprises substances that wake one up, stimulate the mind, and may even cause euphoria, but do not affect perception. For examples, amphetamine, caffeine, cocaine, nicotine
- Depressants (“downers”), including sedatives, hypnotics, and narcotics. This category includes all of the calmative, sleep-inducing, anxiety-reducing, anesthetizing substances, which sometimes induce perceptual changes, such as dream images, and also often evoke feelings of euphoria. For examples: ethanol (alcoholic beverages), opioids, barbiturates, benzodiazepines.
- Hallucinogens, including psychedelics, dissociatives and deliriants. This category encompasses all those substances that produce distinct alterations in perception, sensation of space and time, and emotional states, for examples: psilocybin, LSD, Salvia divinorum and nitrous oxide.
Consequences of the use of psychoactive substances
Psychoactive substances operate by temporarily affecting a person’s neurochemistry, which in turn causes changes in a person’s mood, cognition, perception and behaviour. There are many ways in which psychoactive substances can affect the brain. Each psychoactive substance has a specific action on one or more neurotransmitter or neuroreceptor in the brain (Nutt & King, 2007).
Psychoactive substances that increase activity in particular neurotransmitter systems are called agonists. They act by increasing the synthesis of one or more neurotransmitters, by reducing its reuptake from the synapses, or by mimicking the action by binding directly to the postsynaptic receptor. Substances that reduce neurotransmitter activity are called antagonists, and operate by interfering with synthesis or blocking postsynaptic receptors so that neurotransmitters cannot bind to them (Seligma, 2014).
Exposure to a psychoactive substance can cause changes in the structure and functioning of neurons, as the nervous system tries to re-establish the homeostasis disrupted by the presence of the substance. Exposure to antagonists for a particular neurotransmitter can increase the number of receptors for that neurotransmitter or the receptors themselves may become more responsive to neurotransmitters; this is called sensitization. Conversely, overstimulation of receptors for a particular neurotransmitter may cause a decrease in both number and sensitivity of these receptors, a process called desensitization or tolerance. Sensitization and desensitization are more likely to occur with long-term exposure, although they may occur after only a single exposure. These processes are thought to play a role in substance dependence and addiction. Physical dependence on antidepressants or anxiolytics may result in worse depression or anxiety, respectively, as withdrawal symptoms (Malenka, Nestler & Hyman, 2009).
Measures to reduce the use of psychoactive substances
Preventing the use of psychoactive substance is a critical, national public health goal. The simplest and most cost-effective way to lower the human and societal costs of psychoactive substance abuse is to prevent it in the first place. The following measures are highlight by Dworkin (2006) to reduce the use of psychoactive substances:
Role of parents
During the early age of the child especially during adolescent age when which is usually the onset of the use of psychoactive substances, the role of the parent is very importance in reducing or preventing it. Parents who wait to guide their children away from drugs until older ages when youngsters are more readily influenced by peers or may have started using alcohol, tobacco, and other drugs, decrease their ability to positively influence children.
Children whose parents abuse alcohol or other drugs face heightened risks of developing substance-abuse problems themselves. Nevertheless, specially crafted prevention messages can break through the levels of denial inherent in these families. Teachers, coaches, youth workers in all areas of life from faith communities to scouts, and extended family members also provide youth with important protection from drug abuse and support for positive parental training by modelling, teaching, and reinforcing positive behaviour. Adult addiction can have a devastating impact on children. By taking small steps, adult mentors can make a permanent difference in the course of a child’s life.
National anti-drug media campaign
This goal includes preventing drug abuse and encouraging current users to quit. The campaign should focus on primary prevention, which means preventing drug use before it starts. First, primary prevention targets the underlying causes of drug use and therefore has the greatest potential to reduce the scope of the problem. Second, over time a primary prevention campaign will lessen the need for drug treatment, which is in short supply. Third, a media campaign has greater potential to affirm the anti-drug attitudes of people who are not involved with drugs than to persuade experienced drug users to change their behaviour.
The media have come to play an increasingly important role in public health campaigns due to their wide reach and ability to influence behaviour. There is significant evidence that carefully planned mass media campaigns can reduce substance abuse by countering false perceptions that drug use is normative and influencing personal beliefs that motivate drug use. Media campaigns have been used to prevent or reduce consumption of illegal drugs and smoking along with risky behaviour like driving under the influence of alcohol or without seat belts. For all their power to inform and persuade, the media alone are unlikely to bring about large, sustained changes in drug use. The anti-drug campaign will be truly successful only if media efforts are coordinated with initiatives that reinforce one another in homes, schools, and communities.
This method should include the use of media outlets, paid advertisements with public-service time for advertisements and pro-bono programming content. Public-service advertising space generated by the paid campaign is being dedicated to messages that target underage drinking and smoking, as well as other messages related to the campaign’s communications objectives.
Safe and drug-free schools and communities
This will require schools to adopt effective drug and violence policies and programs, annual safety and drug use report cards, links to after school programs, and efforts to involve parents. This should include community leaders, state education agencies, local education agencies, institutions of higher education, and community organizations, adopt programs, policies and practices that are based on research and evaluation.
Mentoring initiative
There should be a national mentoring program to focus on some of the problems people face, including alcohol and drug abuse. Adult mentors should be recruited and trained to reach at-risk people through demonstration programs. This initiative will help communities adopt effective, science-based programs to strengthen tutoring and mentoring, both of which enhance youth resiliency and reduce psychosocial factors that put families at risk.
Substance abuse prevention initiative
There should be initiative that is designed to reduce psychoactive substance usage. Major components of this initiative should include provision of states and communities technical assistance and information about research-based prevention and encourage collaboration with private and community-based organizations.
References
Barbone, F. (2014). Association of road traffic accidents with benzodiazepine use. Lancet, 352, 1331-1336.
British Broadcasting Corporation (2010). Coca leaves first chewed 8,000 years ago, says research. BBC News. December 2, 2010.
Bullis, R. K. (2010). Swallowing the scroll: legal implications of the recent Supreme Court peyote cases. Journal of Psychoactive Drugs, 22 (3), 325–32.
Dworkin, R. (2006). Artificial happiness. New York: Carroll & Graf
Fatoye, F. O., Oyebanjo, A. O. & Ogunro, A. S. (2006). Psychological characteristics as correlates of emotional burden in incarcerated offenders in Nigeria. East African Medical Journal, 83, 545-52.
Flanagan, E., Bedford, D., Farrell, A. & Howell, F. (2013). Smoking, alcohol and drug use among young people. Navan: North Eastern Health Board.
Hirschfeld, R. (2011). Clinical importance of long-term antidepressant treatment”. The British Journal of Psychiatry, 179 (s42), s4–s8.
Haroon, R. (2003). Pakistani relives Guantanamo ordeal. BBC News, January 13, 2003.
Li, X. & Pearce, R. A. (2007). Effects of halothane on GABA(A) receptor kinetics: evidence for slowed agonist unbinding. The Journal of Neuroscience, 20 (3), 899–907.
Lovett, R. (2005). Coffee: The demon drink? New Scientist, 2, 5-18.
Malenka, R. C., Nestler, E. J. & Hyman, S. E. (2009). Molecular neuropharmacology: a foundation for clinical neuroscience (2nd ed.). New York: McGraw-Hill Medical.
Matson, J. & Neal, D. (2009). Psychotropic medication use for challenging behaviours in persons with intellectual disabilities: An overview. Research in Developmental Disabilities, 30 (3), 572.
Merlin, M. D. (2003). Archaeological evidence for the tradition of psychoactive plant use in the old world. Economic Botany, 57 (3), 295–323.
Nelson, M. (2005). The barbarian’s beverage: a history of beer in ancient Europe. Abingdon, Oxon: Routledge.
Neuter, C. I. (2005). Risk of traffic accident after a prescription for benzodiazepine. Annals of Epidemiology, 5, 239-244.
Nutt, D & King, L. (2007). Development of a rational scale to assess the harm of drugs of potential misuse. The Lancet, 369 (9566), 1047–1053.
Oshodi, O. Y., Aina, O. F. & Onajole, A. T. (2010). Substance use among people living in an ueban setting in Nigeria: prevalence and associated factors. African Psychiatry, 13, 52-57.
Petridou, E. & Moustaki, M. (2010). Human factor in the causation of road traffic crashes. European Journal of Epidemiology, 16, 819-826.
Quiding, H. (2008). Analgesic effect and plasma concentrations of codeine and morphine after two dose levels of codeine following oral surgery. European Journal of Clinical Pharmacology, 44 (4), 319–23.
Ramaekers, J. G. (2008). Behavioural toxicity of medicinal drugs. Practical consequences, incidence, management and avoidance. Drug Safety: An International Journal of Medicaine Toxicology and Drug Experience, 18, 189-208
Reddy, S.P., Panday, S., Swart, D., Jinabhai, C.C. Amosun, S. L. & James, S. (2012). The South African youth risk behaviour survey 2012. Cape Town: South African Medical Research Council.
Ricci, G., Majori, S., Mantovani,W., Zappatera, A. & Rocca, G. (2008). Prevalence of alcohol and drugs in urine of patients involved in road accidents. Journal of Preventive Medicine and Hygiene, 49, 89-95.
Seligma, M. (2014). Abnormal psychology. New York: W. W. Norton & Company.
Shields, P. & Rangarjan, N. (2013). A playbook for research methods: integrating conceptual frameworks and project management. . Stillwater, OK: New Forums Press.
Siegel, R. K (2005). Intoxication: the universal drive for mind-altering substances. Rochester, Vermont: Park Street Press.
Skegg, D. C., Richard, S. M. & Doll, R. (2009). Minor tranquillizer and road accidents. British Medical Journal, 1,917-919.
Vetulani, J. (2008). Drug addiction. part I. psychoactive substances in the past and presence. Polish Journal of Pharmacology, 53 (3), 201–14.
Weil, A. (2014). The natural mind: a revolutionary approach to the drug problem (revised edition). New York: Houghton Mifflin.
