4.1 Introduction

one single shot of heroin and you're hooked for life. A life which won't last long anyway... Fall for smack and you can count on an early grave. Look at Sid Vicious. But it does not have to be like that. Keith Richards, the guitar player of the Rolling Stones bought his heroin by the kilogram. He sniffed and shot up for 25 years but kept going all the time. Strange? Not really. A person who uses safely or injects with clean needles and doesn't use too much at a time, can get very old on heroin. The most notorious drug of all in reality is far less harmful than the most commonly accepted drug: Alcohol. Pure heroin does not damage tissue or organs. It does not cause cirrhosis of the liver, nor Korsakow's syndrome (a serious brain disorder resulting from long and excessive alcohol use). Heroin's reputation as a 'killer' therefore has other reasons. The danger lies in its heavily sedating effect, the manner it is used and the real risk of an overdose - especially with combined use. A person who takes Valium and

heroin together risks a 'knock-out' in slow motion. A cold might not be noticed because of the numbing effect which can lead to neglect of health - or worse Pneumonia. And finally, someone who uses other people's gear for shooting up risks an infection with the deadly HIV. All are indirect health risks which are not connected to the substance as such,

Addiction consists of multiple factors 
And yet, it is above all heroin which is loathed by many people. Not because it regularly creates victims (so does traffic) but because the opiate is highly addictive. One fix of smack and you're lost: First the gutter, then the grave. In stark contrast to this notion is the user who can easily postpone his 'rush' to the following weekend and so can hardly be called 'heavily addicted'. Further, there are accounts of people who tried withdrawal several times without luck, but the moment they fell in love with someone from outside the I scene' had no problem stopping their heroin use at all. Question: When does drug use turn into addiction - or less normative: Dependence? Is it the drug itself or are other factors involved?

An addiction consists of multiple factors. Individuals are never addicted to the substance alone but also to the I scene' and the manner the drug is used. I he world of a real 'needle freak', for instance, only revolves around preparing the fix. The injection ritual finds its way even into his dream - especially during withdrawal. But 'mainliners' also enjoy discussing the 'rush' of fixing with others. The same applies to people who snort, 'pot heads', and 'acid freaks'. In the drug world everyone likes to mingle with his/her own group and exchange drug stories or talk about drug experiences. Someone who does not use (anymore) will soon feel excluded. More so, ex-users often are not welcomed back with open arms. They more likely are approached with scepticism and suspicion. A person who finds this hard to deal with and has no social contacts outside of the 'drug world' can easily relapse.

There is another factor: The social status of a user is also an important factor. Statistically speaking, children from working-class families are more likely to turn into addicts than the honour student son or daughter of a lawyer. Still, the number of users with both a degree and a bag of smack in their pocket should not be underestimated. The big difference is: 'Classy users' do not have to dirty their hands to get their drug. They have, after all, all the money they need and, therefore, are not on a collision course with society nor get into trouble with the law as much as lowincome users.

Next question: Just when is someone addicted? Already if he lights up the ceremonial 'after dinner cigarette' every evening or only when everything including one's own self-esteem - takes second place to the drug? In short: How do we define addiction? In the theory of addiction, we roughly differentiate between three diverse views. The 'moralistic' view sees addiction as something reprehensible and blames the addict above all for a lack of willpower. The second view, which regards addiction as an illness, is more likely to be sympathetic towards the addict. As viruses destroy their hosts, so drugs destroy their users. But who's to blame? The question then is, to what extent the user loses all control of himself when 'on drugs'.

In the modern outlook on addiction the user is no longer reviled or patronised but addressed as a rightminded individ ual who cares about his/her own health. In practice it appears that users manage to do much better for themselves than .the other two standpoints might suggest. So, even in spite of that first shot or toke the situation often isn't that hopeless after all. In the Netherlands where these matters were studied extensively, it was found that two-thirds of the individuals whose drug use once was problematic had not come into contact with the law and were properly integrated in society ten years later. One-half of them, i.e., one-third of the total group had stopped using drugs altogether. (SOURCE' Zelf controle en ontwenning van harddrugs', 1 A. S. M. Cramer and (I. M. Schippers, 1994).

This chapter deals with the risks of drug use. We shall discuss the health risks of each substance for the short, mediu and long term. Short-term effects arise immediately after use, such as an overdose or a 'shake', (sudden high fever attack). Medium effects only occur after frequent use and often are temporary, such as weight loss in cocaine use. Longterm effects are mostly irreversible, like lung cancer in heavy smokers and Korsakow's syndrome in alcoholics. We also address the addiction potential ofdifferent substances because an addiction which is too intense can result in an unhealthy life-style, (bad  eating habits, little sleep, social isolation, etc.). But also, the manner in which drugs are used carries certain health risks. So can prolonged sniffing (snorting) lead to infections of the nasal membranes, Injecting can lead to abscesses and freebasing can damage the airways. 

Drug use and aggression

Drugs which induce a 'high' like heroin, will rarely cause aggressive behaviour. More dangerous are 'uppers' (cocaine and speed), combined use, and certain pills. If you find a box of Rohypnol, then watch out. This sleeping pill is notorious for temporarily 'incapacitating' someone's consciousness if large amounts are used. It can lead to uncontrolled aggression while the user does not remember a thing afterwards. Alcohol too, can cause aggression, particularly after excessive use and in combination with other drugs. The 'high' turns into a row. The row into a fight.

Drugs and pregnancy

Just as with alcohol and tobacco, it is advisable to stop using drugs during pregnancy. This also applies to the period in which the baby is breast-fed. The active substances can be passed on to the baby. This is why babies of 'heroin mothers' may display withdrawal symptoms.

What is addiction?

There is a difference between physical and psychological addiction. Someone who craves for a substance and does not feel well without it, is psychologically dependant. Someone who displays withdrawal symptoms (sweating, cold shivers, diarrhoea, etc.) after having stopped drug use, is physically dependant. We speak of 'tolerance' (also called habituation) when the body needs more and more of a certain substance to maintain the same effect. The body quickly adapts to heroin, sleeping medicines and alcohol. Of these substances, a steadily increasing dosage is needed. Certain drugs produce both a physical and psychological addiction. If, in addition, withdrawal symptoms occur when the drug is stopped, the way back can be very difficult.