Difference between drug use and abuse

 “During Easter, one of the sermons touched on the subject of drugs and alcohol abuse and I have to say, I was confused. The priest seemed to confuse the use and abuse of alcohol and seems to use the terms interchangeably. His conclusion was that all drugs and alcohol are bad at all times and that all people of God must preach this gospel. What is the medical view on the subject of alcohol and drugs in general?"

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The first and perhaps most important point that I have to make from a medical point of view is that we respect all religions and indeed we know that spirituality is often a key component in the journey to recovery of all diseases and in particular that of addiction.

For this reason, even though the person on the pulpit that day might have overdone himself with the enthusiasm of the word, we still respect him/her even as we hold a different view on the matter.

A good place to start might be with some definitions as understood by the medical profession.

Drug abuse is for example, on the one hand, understood to be the use of illegal drugs. This means that all drugs that are illegal cannot be used without the person being an abuser. (Alcohol is legal but can also be abused).

The other component of drug abuse is the use of prescription or over-the-counter drugs for purposes other than they have been registered. In this regard, many people use the drug piriton to induce sleep.

This is a sign of drug abuse because this drug is to be used as an antihistamine to treat say a running nose or some form of allergy! You are an abuser if you take them to sleep.

The other component of abuse and this is where the medical profession and your priest part ways is when there is excessive use of a substance. Again, alcohol is a good example.

Her Royal Highness the Queen mother died at the age of 101 years. It is not a secret that she enjoyed a gin with Dubonnet almost every single day of her adult life. Small amounts of alcohol daily in her case were not considered to amount to abuse. Many young men who binge drink, although not daily drinkers can be considered to be abusing alcohol.

When one uses a drug (alcohol included) and it leads to any physical, emotional or social harm, such problems at work or in the family, then that person is abusing alcohol. So, for example a mother who uses money meant for milk to buy alcohol is as problematic as her daughter who skips her university class because she has a hangover.

For the removal of doubt, any use of bhang (cannabis) or heroin is drug abuse because these substances are illegal in Kenya. The World Health Organisation (WHO) has issued guidelines on safe drinking limits (which your priest either disagrees with or worse is unaware of) that state that an equivalent of 14 units of alcohol a week is safe for men and rather less than that for women.

This translates to about seven glasses of wine per week. Put another way one drink a day for women and two for men is the safe limit. Anything beyond that whether it is the Queen mother or your husband/wife is a case of abuse. This is the current medical position.

There is no safe limit for heroin or cannabis or for that matter any drug that is illegal.

The other term your priest could have used is addiction. This is sometimes confused with the term drug abuse. Again at the risk of upsetting your priest, let me point out that addiction or substance use disorder refers to the medical disease of addiction.

Simply defined, this is a condition in which the patient has the physical or psychological inability to stop consuming a chemical, drug, activity or substance though it is causing psychological or physical harm.

The person who is addicted is aware of the harm say the use of alcohol is doing to the family or to his body but the urge to drink is greater than the harm the alcohol is doing. Simply telling off a husband for his bad behaviour or even the threat of hell upon death are simply not enough to cure the disease! Prayers and threats are important but often are inadequate.

A number of referrals to psychiatrists now come from the clergy and other spiritual providers who are now acutely aware of the need to approach the disease of addiction from both the spiritual and medical angles. There is reason to remain in hope.