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Substance abuse refers to the consumption of drugs that cause intoxication or hallucinations, stimulate or trigger feelings of happiness. Abuse means using these substances in a way that is not good for health and social behavior.
Marijuana and heroin, alcohol and nicotine
Nicotine and alcohol are also drugs and addiction is also a drug addiction. In official parlance, however, drug addiction characterizes dependence on illegal substances. These include opiates such as opium and heroin, cocaine, extasy, speed, amphetamines and metaamphetamines, halluinogens such as LSD or mescaline and cannabis, i.e. hashish and marijuana.
We become physically dependent on some substances. They superimpose messenger substances in the organism and intervene directly in the biochemical metabolism. If we stop you, this will have serious physical consequences, at least until a chemical balance has been restored in the body.
Opiates, nicotine and alcohol lead to such physical dependence. Other substances such as cannabis or cocaine do not lead to a physical, but to a psychological addiction. If those affected lack the drug, the urge to get it becomes overwhelming.
An addiction is associated with mental disorders, and it is often unclear whether the psychological problems were there first, i.e. the reason why the people affected became dependent in the first place. In particular, psychological addiction to drugs is a major problem for unstable characters.
Opium, morphine and heroin are drugs derived from the opium poppy. The plant (Papaver somniferum) originally comes from Asia, in particular from Afghanistan, Pakistan, the northeast of Iran and the neighboring countries. But it is also grown in Central and South America.
Poppy seed oil can be pressed from the seeds, milk is the basis for raw opium. The almost ripe capsules are scratched with a knife. The milk comes out, dries and can be scraped off. This raw opium has been used as a pain reliever and anesthetic for thousands of years. It contains over 20 alkaloids, the most important of which is morphine - for a long time also the most important narcotic in Europe.
The first civilizations in Sumer and Egypt used opium poppy as a medicinal plant, and its product, opium, was particularly important in China. A culture of opium smoking developed there in the early modern period. This opium made the British East India Company rich; it exported thousands of tons from India to China.
Opium smoking had massive social consequences in China, and the Chinese government took action against imports: in 1839, in the canton of Canton, they destroyed 1,000 tons of opium that the British had illegally imported. The British government therefore waged the so-called opium war (1839-1842). The British now won and forced China to accept not only opium but other goods traded by the British.
The German pharmacist Friedrich Wilhelm Sertürner had already isolated morphine (morphine) from opium in 1806; Morpheus was named after the Greek god of sleep - he referred to the narcotic intoxication that the substance triggers. It had been factory-made since 1828 and injected into the bloodstream since 1853.
Over the next three years, it was used extensively to relieve the pain of wounded German soldiers in the Crimean War, including in the American Civil War of 1861-65 and in the war between Germany and France in 1870/71, quantities of the drug were used. The result was many thousands of soldiers who became addicted to morphine. This physical addiction was given a special name: morphinism.
At the latest the soldiers addicted to morphine showed that this opiate led to a high degree to physical addiction. However, its effects as a pain reliever and sedative were undisputed, and the doctors looked for a replacement that had these positive properties but did not make them dependent.
The irony of history: C.R.A. Wright synthesized diacetylmorphine in 1874. In 1898, Bayer marketed this morphine derivative under the name of heroin. It soon became clear that heroin became addictive even faster than morphine. Of all drugs, apart from perhaps meta-amphetamines (meth) and crack, heroin is the fastest to addict. Bayer therefore stopped heroin production in 1931.
The "Queen of Drugs"
In contrast to other opioids, heroin is no longer used in medicine. However, as an illegal drug, it is a billion dollar business. Drug users refer to heroin as the “queen of drugs”. An injection leads to an euphoric high, the people who experience this as dream with open eyes. This effect is not unlike that of opium, but heroin works faster and more intensely.
But when the morphine level drops, the euphoria turns into depression, the person concerned is extremely irritable and demands a new kick. The psychological addiction starts after just a few injections, then the physical addiction follows.
Heroin puts on the messenger substances that activate feelings of happiness in the brain. If the addicts stop taking the substance, the body will initially lack these transmitters. This has physical consequences: The skin is itchy all over, they have to vomit, have nightmares in which they fear for their lives, vomit in convulsions, and sweat breaks out. This condition lasts for several weeks.
Once the addict's body has gotten used to the heroin, the euphoric effect is absent, more precisely, the person concerned has to take larger amounts to achieve this effect, and the distance from injection to injection is becoming shorter.
Because of the risk of addiction, opiates have been allowed in almost all countries for medical purposes since 1925, and only under strict conditions. On the one hand, opium has been a cultural asset in Afghanistan or Iran for thousands of years, on the other hand, in Afghanistan, where 92% of the world's opium is produced, many thousands of farmers grow it for the drug kings who promise to protect the poppy growers as warlords.
The Bundeswehr protects the opium kings
The piquant thing is that while the Bush administration in Colombia waged a war on drugs against coca farmers, it indirectly promoted opium production in Afghanistan. They control the war leaders of the so-called Northern Alliance, allies of the United States against the Taliban. In Germany, this led to a rapid drop in the price of heroin and the police in Germany to pursue dependent end users and small dealers, while the German Bundeswehr actually provided military protection under which the Afghan drug lords could bring the heroin to Europe.
The heroin business also attracted countless desperados from Islamic countries from Morocco to Malaysia. While al-Qaeda and other jihadists who are up to mischief in Afghanistan are known only from the perspective of religious terror, the pull that drew young men from Arab countries to Afghanistan had practical reasons in particular: to get rich in the opium business. In Afghanistan, however, the farmers who live off the opium poppy have little alternative.
In fact, the persecution of heroin users in western countries is disproportionate to the social consequences that alcohol has. Millions of alcoholics face thousands of heroin addicts; alcohol-related illnesses are one of the main causes of death in Europe; Alcohol plays a role in a high proportion of offenses, and this includes dangerous bodily harm or homicide in the affect.
A clash of cultures?
Critics therefore consider the careless use of alcohol and the criminalization of heroin to be cultural chauvinism: the main areas where opium poppies are grown are Islamic countries, which in turn prohibit alcohol, and opium and hashish are part of the cultural tradition. So is the fight against heroin the fight of one culture against another?
It's true that pure heroin doesn't even begin to damage the body as much as long-term alcohol abuse. It is also right that in Iran or Afghanistan a lot of people smoke opium at times without ending up in social misery, like not everyone who likes to drink a beer in Germany becomes an alcoholic.
However, Iran also has a huge heroin problem. Although the Iranian army has its own war on drugs, militarily combats drug smuggling in the border provinces to Afghanistan like Baluchistan and publicly executes heroin traffickers in Tehran, there are armies of heroin addicts in the Iranian cities.
Sick, not criminals
In the enlightened drug policy, it has long been a matter of course that the persecution of addicts is wrong, because it is not just criminals but sick people. The criminalization of these patients pushes them even more into a spiral of misery.
In order to get the money for the fabric, they sell their bodies on the most dangerous edges of the street, finance themselves through theft, burglary and robbery; they lose their home and job; because they need the money for heroin, they neglect nutrition and hygiene; they suffer from diseases caused by a lack of vitamins and minerals; they get hepatitis and AIDS from infected syringes; they poison themselves with stretched heroin. All of these are expressly not the consequences of heroin itself, but the need to obtain the substance on the illegal market.
Criminalization creates misery
The history of opiates in Europe and the United States confirms that criminalizing addicts creates social consequences. When heroin or the “opium wine” laudanum were legal, opiates spread particularly among intellectuals; Laudanum was considered the hallmark of writers, and some world-class stories were created in the opium frenzy. Many pharmacists around 1900 were just as dependent on opiates as the superstar of American short history, Edgar Allan Poe.
It is important that these people remained dependent on the opiate until their death, but most of them were able to pursue their profession with this dependency and did not fall out of all social grids. Many sufferers today receive methadone, so they remain dependent, but the intoxication is less extreme and the victims are more likely to be able to structure a daily routine. Ideally, they are at a distance from the illegal market and the associated criminal milieu.
In reality, however, most addicts remain attached to this milieu, and many add heroin to methadone. In the meantime there are also projects with synthetic heroin for the severely dependent in large German cities.
Cocaine is a crystalline powder that is chemically produced from the leaves of the coca bush that originally came from South America. Coca leaves of the species Erythroxylum coca and Erythroxylum novogranatense have been an important pain reliever for the indigenous people of the Andean countries for thousands of years.
The coca bush
They use the leaves in everyday life because of their stimulant effects as well as in all types of painful illnesses. Envelopes made from coca leaves help against colds, chills, muscle stiffness and burns, against swollen feet as well as against exhaustion.
Indigenous doctors use boiled coca leaf washes for gastrointestinal complaints and chewed coca leaves for headaches. Colic and gastritis treat the natives with potions from coca. The two types of coca bush are among the most important plants in Andean medicine.
The Spanish conquistadors took advantage of the properties of the plants to better exploit the Indian slaves: with coca they needed less to eat and could work longer.
Coca leaves came to Europe in the 18th century, and the pharmacist Albert Niemann isolated the alkaloid cocaine in 1860. In 1862, the Merck company in Darmstadt manufactured it in a factory. Cocaine was used for local anesthesia during eye surgery, and Sigmund Freund praised it as a means of treating depression; he took it regularly and was probably psychologically dependent.
In 1886, pharmacist John Styth Pemberton invented a cola and coca leaf remedy to help relieve fatigue and headaches. This drink has been called Coca-Cola since 1892. The danger of psychological dependence led to the Coca-Cola Company replacing coca with caffeine in 1903.
Today, several countries in Latin America are demanding the legalization of coca products. Ecuador is the pioneer with the “Coca si, Cocain no” campaign. There are coca shampoos, coca teas, coconut sweets, coca tablets, coca cookies etc. In contrast to the isolated cocaine, the risk of addiction is low with these products.
How does cocaine work?
Cocaine euphoric, uninhibited and users feel like a manic in its heyday: They believe they can do everything, develop brilliant ideas, their self-doubts disappear and they develop an over-sized ego. If the intoxication subsides, a depressive phase follows. Therefore, the cocaine rush is comparable to the clinical picture of bipolar patients.
The change between extreme euphoria and the “black hole” afterwards leads to a high risk of psychological dependency, since those affected fear the low and reach the high with the drug. Cocaine is also considered an "anti-social drug".
Whoever is “on coke” not only feels like the ruler of the world, he often also devalues others; he throws money around that he does not have, he appears arrogant and unscrupulous. Coke (like manicers) regularly destroys close social relationships through their behavior when they consume the drug.
Cocaine stimulates the release of the neurotransmitters dopamine, norepinephrine and serotonin, which increases blood pressure, pulse and respiratory rate. The body receives the signal of higher reading ability and runs at full speed - hyperactivity is also a consequence.
Coke usually sniff the powder in narrow strips, which they absorb through the nose. However, coke can also be boiled with water and baking powder, then the mixture can be burned and inhaled or smoked. We then speak of crack or freebase.
Today "Paco" is widespread in South America. This is the sediment that remains when the coca paste is boiled down to cocaine. This "waste" is significantly cheaper than real cocaine. Since the intoxication lasts only very briefly, the risk of addiction is extreme. The risk of developing permanent psychoses is greater than with any other drug.
Cocaine is the most commonly used illegal drug after cannabis in Europe and America. (Dr. Utz Anhalt)
Author and source information
This text corresponds to the requirements of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
Dr. phil. Utz Anhalt, Barbara Schindewolf-Lensch
- Federal Ministry of Health: Brief report: estimate of opioid addicts in Germany, as of January 2018, bundesgesundheitsministerium.de
- German Center for Addiction Issues: Heroin (accessed: August 6, 2019), dhs.de
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ICD codes for this disease: F11, F14, F19, T40, R78ICD codes are internationally valid encodings for medical diagnoses. You can find e.g. in doctor's letters or on disability certificates.