Clinical Review

ABC of mental health: Addiction and dependence—I: Illicit drugs

BMJ 1997; 315 doi: (Published 02 August 1997) Cite this as: BMJ 1997;315:297

This article has a correction. Please see:

  1. Claire Gerada,
  2. Mark Ashworth

    Size of the problem

    About 30% of adults in Britain have used illicit drugs at some time in their lives, but misuse of prescription drugs (such as benzodiazepines and barbiturates) is probably even more widespread. Cannabis is the most commonly used illicit drug. About 100 000 people misuse heroin (diamorphine), and an unknown but increasing number use other drugs such as ecstasy and amphetamines.

    Numbers of drug addicts notified to the Home Office during 1982-92

    While the number of new drug users continues to rise, the number who inject drugs is falling, possibly as a result of health education about risks of HIV transmission. The highest number of addicts are found in London and the north west of England.

    Why misuse drugs?

    What determines whether drug use becomes continuous and problematic includes

    • Sociocultural factors such as cost and availability of the drug

    • Controls and sanctions on its use

    • Age (people in their teens to their 20s are most at risk) and sex (male)

    • Peer group of the person taking the drug.

    Personality factors determine how a person copes once addicted and the mechanisms he or she may use to seek help.

    Factors influencing misuse of drugs

    Commonly misused drugs

    Common drugs of misuse tend to cause dependence and euphoria.

    Snorting heroin (picture reproduced with subject's permission)


    This is the largest category of drug misuse. The most commonly misused drugs, temazepam and diazepam, usually originate from legal prescriptions or thefts from pharmacies. They may be taken alone as the drug of choice, to supplement opioids, or as a last resort when supply of opioids fails. Tolerance to benzodiazepines can occur, with daily doses escalating to 50-100 mg of diazepam. Intravenous injection of the viscous gel within temazepam capsules can cause catastrophic embolic damage to limbs and digits: temazepam is now a controlled drug.

    A withdrawal syndrome can occur after only three …

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