Over view of Substance Abuse

Substance Abuse is a major problem and this problem is growing day by day.  Increasing rates of substance abuse has increased burden on public health especially in lower and middle income countries like Pakistan. Evidence suggests that misuse of legal and illicit drugs is increasing 7% annually in Pakistani population especially in younger population.

PILL Contribution

Pakistan Institute of Living & Learning (PILL) has started awareness programs for community regarding risk and harm reduction of substance abuse. PILL has also took initiative for trainings and workshops of students, teachers and health professional to enhance their knowledge, understanding and expertise for treatment of people with substance abuse.

Recent Initiatives

Workshop on Addictive Behavior in Global Perspective

The Pakistan Institute of Living and Learning organized a one-day workshop on Additive Behavior in the Global Perspective at the Centre for Clinical Psychology, University of the Punjab, Lahore.

Dr. Iqbal Naeem, consultant psychiatrist and SAS trainer, was specially invited from the UK as the key resource person for the workshop and he delivered a presentation that focused on addictive behavior with a focus on the commonalities in the behaviors of people with substance abuse.

Substance Abuse in Pakistan

  • Cannabis is the most commonly used drug in Pakistan. About 3.6 percent of the adult population or four million people are listed as cannabis users.
  • The use of opiates is higher than the global estimates in Pakistan. Among opiates, heroine and opium are used by one percent of drug users.
  • 8 percent Adults or 4.6 million people use drugs in 2013 in Pakistan.
  • According to an estimate, about 8.9 million people in Pakistan are drug dependent and only 30,000 individuals receive treatment due to short supply of treatment and special interventions.
  • Nationwide, there is a high prevalence of non-medical use of prescribed medicines (opioid-based painkillers, and to a lesser extent tranquillizers and sedatives) particularly among women.


Addiction is not a personality or character problem; it is a health related problem.  Addiction refers to a chronic and relapsing brain disease in which an individual continues the use of substance despite its harmful consequences and spends most of the time seeking the substance. When the desired substance is not available, the individual starts having some signs and symptoms of craving and withdrawal that is a clear indication of dependence. Addiction causes metabolic changes in the brain. Genetic factors, environmental factors and life styles are important etiological factors of addiction

Psychoactive substance

Any chemical substance can produce a physical or psychological reaction. Similarly, psychoactive substances affect our central nervous system (CNS) and alter the perception, mood, cognition, behavior, thinking process and motor functions of the user.

CNS is a part of nervous system that is consists of Brain and Spinal Cord.  Our brain is covered with a protective membrane called Blood Brain Barrier. Only specific chemical substances that have small molecules can cross this membrane. Psychoactive substances can easily cross the blood brain barrier and therefore these substances directly affect the brain.  These effects might be positive or negative and it depends on the type and use of substance. These substances can also alter the metabolism and chemical processes of the body.

Psychoactive substances include licit and illicit substances and some medicines. Medicines are used to cure diseases but psychoactive substances can lead to dependence and some harmful effects. These substances have short term and long term effects that can damage organs of the body. The use of psycho active substances often results in consequences central to individual, familial and community level.

 Commonly used methods of substance abuse

The specific effects of any substance depend on the method and amount of use of the choose substance. Commonly used methods of using substances are:

  • The study of different methods of substance use is important as different methods have different speed of action.
  • Smoking is the most common and fastest route of substance administration as it takes 7 to 10 second to reach to the receptors in brain. Taking psychoactive drugs through smoking can cause damage to heart and throat and can also cause cancer.
  • Intravenous injecting takes 5 to 3 seconds and intramuscular or subcutaneous injecting takes 3 to 5 minutes to directly reach the blood stream. It is one of the dangerous routes of administration. Individuals who take drugs through injecting are at greater risk of addiction as the substance directly reaches to blood stream and delivers a greater amount of substance uses to the brain in a very short time period.
  • Swallowing is the simplest and safest route of taking drugs as by this way the drug slowly gets absorbed in the stomach lining and then slowly reaches the blood stream that makes it less dangerous.
  • Snorting enter the bloodstream through the mucus membrane in the nose. The rest is then swallowed and moves down to the stomach where it finally reaches the blood. In general, the high is experienced within about 15 minutes from the time of snorting.
  • One of the riskier methods of drug intake is the use of suppositories where the substance is absorbed through the mucus membrane in the rectum. This is not a typical method of drug administration, though some drugs like ecstasy and cocaine are taken in this way. This is very risky method as drug can burn the lining of rectum that can result in a number of conditions and even it can cause death.
  • Classifications of Drugs


Depressants Stimulants Opioids Hallucinogens Others





Amphetamine Heroin Lysergic Acid Diethyl Amide (LSD) Inhalants
Alcohol Cocaine Codeine Peyote Aerosol
Cannabis Methamphetamine


Opium Magic Mushrooms Propellants
Synthetic Cannabinoids





Morphine Ecstacy Solvents (Gasoline, Glues)




Effects of Drugs

Category of Drugs Possible Pleasant Effects Short-term Side Effects Long-term Side Effects
Depressants Feels good

Reduced restlessness

Get pleasure

Reduced tension

Feeling of relaxation

Muscle relaxation



Muscle weakness

Poor concentration


Slurred speech

Poor problem solving

Poor coordination





Sexual problems

Sleep problems

High blood sugar

Weight gain



Stimulants Increased sensation


Increased sexual desire

Feeling of happiness



Increased heart rate



Increased violence


Tactile stimulation


Increased body temperature



Running nose

Dry mouth

Teeth deterioration


Kidney problems

Liver dysfunction


Heart attack


Increased body temperature


Increased blood pressure

Opioids Euphoria

Pain relief




Blurred vision


Slow breathing

Skin rash and allergy





Dry mouth

Poor memory

Liver or kidney disease

Muscle weakness

Low blood pressure

Slow heart beat

Trouble breathing


Heart problems



Hallucinogens Happiness

Extreme joy

Change in perception of time and place

Extreme emotions

Change in self-perception

Dreamy state

Change in perception

Increased sensation




Increased body temperature

Increased blood pressure

Increased heart rate

Dilated pupil

Dry mouth

Problem in concentration

Poor judgment

Flash backs

Mood disturbances

Disorganized thinking

Visual distortions

Persistent psychosis




Others/ Inhalants Giddiness

Reduced restlessness





Negative thinking

Poor concentration

Blood oxygen depletion

Kidney and liver dysfunction




Risk factors of Drug Addiction


Addiction: Addiction refers to a chronic and relapsing brain disease in which an individual continues the use of substance despite its harmful consequences and spends most of the time seeking the substance.

Substance Use: Self-administration of any substance that can have certain effects and can alters the functioning of brain. Substance use may not always but can lead to abuse or addiction.

Substance Misuse: Taking substance without prescription or to use substance for the purpose other than it is prepared for.

Substance Abuse: Chronic and repeated exceeding of the recommended use of a substance to get high or without prescription despite its harmful consequences

Tolerance: Tolerance refers to an increase in the dose of substance to have the same effects originally produces by lower dose that usually occurs with continued use

Dependence: A severe form of drug use (compulsive use) characterized by marked tolerance, withdrawal symptoms when not using the substance, spending most of the time obtaining and using substance without its harmful consequences

Withdrawal: Physical and behavioral symptoms that appear when there is a sudden decrease or cessation of use of psychoactive substance one is dependent on such as nausea, watery eyes, shaking, insomnia.

Compulsion: Repetitive and persistent act without its consequences

Craving: Having strong urge or desire to use substance

Relapse: A return to the earlier condition after a successful abstinence or Recurrence of symptoms after a period of cessation of substance misuse

Blood Brain Barrier: A protective layer of central nervous system that is comprised of a network of blood vessels and separates the brain and circulatory system from each other and restricts the passage of certain substances and enable the passage of certain substances.

Lapse: A brief or one time return to an earlier state or condition of substance misuse

Central Nervous System (CNS):  A part of nervous system that is comprised of brain and spinal cord regulating most of the body function including voluntary and involuntary processes.

Stimulants: Category of psychoactive substances that act on the central nervous system and results in wakefulness, excitation and alertness.

Depressants: Category of psychoactive substances that slows down the effect of central nervous system and due to their effect on CNS, depressants is also known as Downers.

Hallucinogens: Category of psychoactive substances that alters the function of CNS, cause perceptual abnormalities and changes in thoughts and mood.

Recovery: A process of change through which a person achieves abstinence from substance use and strives to live a better healthy life.

Psychoactive Substance: Any chemical substance can produce a physical or psychological reaction. Similarly, psychoactive substances affect our central nervous system (CNS) and alter the perception, mood, cognition, behavior, thinking process and motor functions of the user.

Harmful Use: The use of psychoactive substances in a way that leads towards health damage both physical and mental damage.

Hazardous Use: The use of psychoactive substances in a way that can lead towards an increased risk of harmful consequences

Chronic Use: Continuous, frequent and long term use of a substance that lead towards serious health consequences

Swallowing: Taking substance by mouth which absorbs into the lining of stomach and then into blood stream.

Snorting: Taking substance through nose where it is absorbed in the nasal lining and release the substance directly into the blood stream.

Smoking: Taking substance through smoke which is breathed in, absorbed in the lining of lungs and reaches the blood stream

Intravenous injecting: The substance is directly injected into the veins that put it directly to the blood stream

Intramuscular or subcutaneous injecting: The substance is directly injected into the muscle or soft tissue that puts it directly to the blood stream

Suppositories: A psychoactive substance entering in the body through suppositories is absorbed in the blood stream through the mucus lining of rectum.