Drugsfenomenen kopie.pdf

## Introduction to Drug Policy and Psychopharmacology This study guide provides a comprehensive overview of drug phenomena, encompassing drug policy, psychopharmacology, the demand and supply sides of drug markets, drug-related crime, and the political and societal debate surrounding psychoactive substances. It draws from lectures by various professors, offering insights into the multifaceted nature of drug use and its societal implications. ## Understanding Belgian Drug Policy The Belgian drug policy has evolved significantly over time, moving from a foundational drug law in 1921 to a more integrated and comprehensive approach. Key developments include: * **1921 Drug Law:** Established the initial legal framework, primarily focused on prohibition. * **Federal Action Plan Toxicomania:** A 10-point plan focusing on drug prevention and aid [1995](#page=1995). * **Parliamentary Working Group Drugs (1996-1997):** Advocated for a broader discussion on drugs, recognizing the need for differentiation in policy and moving away from a purely punitive approach towards users. * **Federal Policy Paper Drugs:** Outlined a three-pronged approach: prevention, care (including risk reduction and reintegration), and repression (targeting producers and dealers). It emphasized the need for an integral (all-encompassing) and integrated (collaboration of actors) drug policy [2001](#page=2001). * **Cooperation Agreement for a Global and Integrated Drug Policy:** Led to the establishment of the Thematic Meeting on Drugs (TVD) within the Interministerial Conference on Public Health and the General Drug Policy Unit (ACD) in 2008, which monthly discusses drug policy and aims for consensus [2002](#page=2002). * **Common Statement of the Interministerial Conference on Drugs:** Introduced a new strategy with continued focus on repression, prevention, and care [2010](#page=2010). * **Royal Decree 2017 (Generic Legislation):** Introduced generic legislation to cover entire groups of psychoactive substances, making new psychoactive substances (NPS) illegal by default, not just specific listed substances. * **Interfederal Strategy for a Global and Integrated Drug Policy (2024-2025):** Aims to protect and strengthen a healthy and safe society by promoting responsible drug use and incorporating an evidence-informed approach through an advisory panel. **Key Principle:** The drug policy aims for responsible drug use and the protection of a healthy and safe society for everyone. **Distinction between Legislation and Policy:** Legislation defines what is illegal, while policy outlines how to address the issue, including how to interact with those involved with drugs. **New Psychoactive Substances (NPS):** These are often chemically altered versions of known illegal drugs, created to circumvent existing laws. Belgium has responded with generic legislation to cover entire classes of substances. ### Core Ideas of Drug Policy The Belgian drug policy is built on several core principles: * Reducing demand and supply. * Prioritizing public health. * Promoting health. * Implementing a non-stigmatizing care policy. * Focusing on vulnerable groups. * Protecting society from drug-related organized crime. **"War on Drugs":** The concept of a "war on drugs" is examined in terms of who the target is. While drug laws may criminalize use, the policy aims to focus on aid and assistance rather than solely on punishment for users. ## Psychopharmacology: Understanding Drug Effects This section delves into the pharmacological aspects of various drugs, their mechanisms of action, effects, and associated risks. ### Classification of Psychoactive Substances Psychoactive substances are broadly classified based on their effects on the central nervous system: 1. **Psycholeptics:** Depress the central nervous system. * **Opiates:** Historically important painkillers derived from opium. * **Products:** Opium, morphine (the active compound), heroin (diacetylmorphine, a synthetic derivative of morphine). * **Modes of Administration:** Oral, snorting, inhalation, subcutaneous/intramuscular injection, intravenous injection (most rapid and intense effects). * **Synthetic Opiates:** Narcotic analgesics like fentanyl and oxycodone, known for their potency and addictive potential. Methadone is a synthetic opiate used in substitution therapy to manage withdrawal symptoms and cravings. * **Effects:** Euphoria, sedation, pain relief, respiratory depression. * **Addiction:** Characterized by tolerance, physical and psychological dependence, and compulsive drug-seeking behavior. The 3-M model (Middel, Mens, Milieu) explains addiction development. * **Inhalants:** Volatile substances like gases, solvents, and aerosols. * **Examples:** Nitrous oxide (laughing gas), volatile solvents (glue, nail polish remover). * **Effects:** Depressant, causing intoxication, euphoria, perceptual distortions. * **Risks:** Cryogenic injuries (from nitrous oxide), oxygen deprivation, cardiovascular issues, neurological damage, liver and kidney damage. 2. **Psychoanaleptics:** Stimulate the central nervous system. * **Cocaine:** A stimulant derived from the coca plant. * **Modes of Administration:** Snorting, injection, smoking (crack). * **Effects:** Euphoria, increased energy, alertness, reduced fatigue. * **Risks:** Psychological dependence (craving), paranoia, cardiovascular issues, nasal septum damage. * **Amphetamines:** Synthetic stimulants originally developed as medication. * **Examples:** Amphetamine, methamphetamine (ice, crystal meth). * **Effects:** Increased alertness, energy, euphoria, reduced appetite. * **Risks:** Psychological dependence, psychosis, cardiovascular problems, neurotoxicity. * **Designer Drugs (NPS):** Chemically modified substances designed to mimic known drugs while evading detection and legal restrictions. * **Other Stimulants:** Khat, known for its stimulating effects. 3. **Psychodysleptics (Psychedelics):** Alter perception, mood, and cognitive processes. * **The Psychedelic Experience:** Characterized by perceptual changes (synesthesia), altered sense of time and space, and profound alterations in consciousness and self-perception. * **Applications (Types):** * **Mescaline:** Derived from peyote cactus, used in religious rituals. * **Methoxy-amphetamines:** Chemical variants of mescaline, like MDMA (Ecstasy/XTC). * **Magic Mushrooms (Psilocybin):** Contain psilocin and psilocybin, inducing psychedelic effects. * **Lysergic Acid Diethylamide (LSD):** A potent psychedelic substance, synthesized from ergot. * **Effects:** Hallucinations, altered sensory perception, intensified emotions, altered sense of self. * **Risks:** Psychological distress (bad trips), anxiety, paranoia, potential for long-term psychological effects (HPPD), though generally low physical dependence. * **Specific Risks for XTC (MDMA):** Hyperthermia, bruxism (teeth grinding), potential for water intoxication (hyponatremia). 4. **Cannabinoids:** Derived from the cannabis plant. * **Active Compound:** Δ9-THC is the primary psychoactive component. * **Products:** Marihuana (leaves and buds), Hashish (resin), Hash Oil (concentrated resin). * **Modes of Administration:** Primarily smoking, but also oral (edibles). * **Effects:** Euphoria, relaxation, altered perception of time and space, increased appetite. * **Risks:** Impaired motor skills and cognition, potential for anxiety and paranoia, respiratory issues from smoking, psychological dependence. * **Cannabis and Addiction:** While generally considered to have lower physical dependence than some other drugs, psychological dependence and problematic use are increasing, particularly with higher potency strains. ### Party Drugs, Legal Highs, and NPS This category encompasses a diverse group of substances often used in recreational settings. * **Party Drugs:** Often include NPS and stimulants like MDMA, amphetamines, and GHB, used to enhance experiences at parties and clubs. * **Legal Highs:** Intoxicating substances that are (currently) legal but may be illegal under different regulations (e.g., medicine laws). They are often NPS designed to evade drug laws. * **New Psychoactive Substances (NPS):** A broad category of novel psychoactive substances that emerge rapidly on the market, often by modifying the chemical structure of known illicit drugs. **Examples:** * **Alcohol:** A legal psycholeptic with widespread social acceptance, yet significant health and social risks, including alcohol dependence and long-term organ damage. * **Mephedrone (4-MCC):** A stimulant designed to mimic cocaine or XTC, often found as powder or pills. Illegally controlled in most of the EU since 2010. * **Flakka:** A potent stimulant derived from Khat, known for causing extreme hyperstimulation, paranoia, and aggressive, zombie-like behavior. * **Synthetic Cannabinoids (e.g., Spice):** Chemically manufactured variants of THC, often much stronger than natural cannabis, with unpredictable and severe side effects. They may not be detected by standard drug tests. * **Ketamine:** Originally an anesthetic, it has dissociative and hallucinogenic effects. Used recreationally, it can increase heart and respiratory rates, but carries risks of psychosis and cardiac arrest. * **GHB (Gamma-Hydroxybutyrate):** A central nervous system depressant with a very narrow therapeutic-to-toxic ratio, making it highly dangerous. Known as a "date rape drug" due to its amnesic properties and ease of administration. * **Nouveau Riche Drugs:** Emerging as a trend, these are often NPS or combinations of NPS, marketed to convey an elite or high-status image. "Pink Cocaine" (often a mix of MDMA, ketamine, and caffeine) is an example. ## The Demand Side: Interventions and Behavior Change Professor Favril's lectures focus on the demand side of drug use, emphasizing interventions and the psychology of behavior change. ### Perspectives on Drug Use Different perspectives shape our understanding and response to drug use: 1. **Medical-Psychiatric:** Views addiction as a disease or disorder requiring medical treatment, often pharmacological. 2. **Behavioral:** Sees drug use as learned behavior that can be unlearned through therapy. 3. **Biological-Genetic:** Attributes addiction to inherent vulnerabilities, often with a genetic component. The chosen perspective influences the type of prevention and intervention strategies employed. ### The Continuum of Drug Use Drug use exists on a spectrum from experimental to addictive, influenced by: * **Quantity:** Amount used per occasion. * **Frequency:** How often the drug is used. * **Duration:** How long someone has been using. * **Consequences:** Impact on life domains (work, relationships, health). Interventions are tailored to an individual's position on this continuum. The DSM-5 recognizes substance-related disorders as a spectrum of control loss, social problems, risky use, and physical dependence. ### The 3-M Model (Zinberg) This model explains varying responses to drugs based on three key factors: * **Mens (Person):** Individual characteristics like personality, genetics, and psychological state. * **Middel (Drug):** The pharmacological properties of the substance and its use pattern. * **Milieu (Environment):** The social, cultural, and physical context of drug use. ### Stages of Behavior Change (Transtheoretical Model) Understanding an individual's stage in the behavior change process is crucial for effective intervention: 1. **Precontemplation:** Lack of awareness or denial of a problem. 2. **Contemplation:** Awareness of the problem but ambivalence about change. 3. **Preparation/Decision:** Committing to change and planning action. 4. **Action:** Actively modifying behavior. 5. **Maintenance/Consolidation:** Sustaining the change over time. 6. **(Relapse):** A potential part of the recovery process, not necessarily an end to progress. ### Types of Interventions Drug-related interventions are typically categorized into: 1. **Prevention:** Aimed at stopping drug use before it starts or before problems emerge. * **Universal:** For the general population. * **Selective:** For at-risk groups. * **Indicated:** For individuals showing early signs of problematic use. 2. **Early Intervention:** Identifying and addressing risky or problematic use early on, often through screening and brief interventions. 3. **Treatment/Help Services:** Comprehensive and long-term support for individuals with substance use disorders, including aftercare and relapse prevention. 4. **Harm Reduction:** Strategies to minimize the negative consequences of drug use for individuals and society, without necessarily requiring abstinence. ### Prevention Strategies * **Sensitization:** Raising awareness and attention, often through media campaigns, but effectiveness can be limited if not combined with other strategies. * **Information:** Providing factual data about drugs, with "cautionary" approaches impacting emotions and "objective" information primarily increasing knowledge. * **Skill Development:** Teaching personal and social skills (e.g., coping with peer pressure, managing emotions) to empower individuals to resist drug use. ### Early Intervention * **Early Detection:** Identifying risky or problematic use through screening and assessment. * **Early Help:** Offering motivational interviewing and brief interventions to encourage behavior change. * **Effectiveness:** Short interventions like motivational interviewing show promise in reducing use and relapse, particularly for alcohol and cannabis. ### Help Services (Treatment) * **Trends and Barriers:** A significant treatment gap exists, with many not seeking or finding help due to factors like stigma, cost, and accessibility. * **Strategies:** Comprehensive, individualized care that addresses all life domains is crucial. This includes various modalities like substitution therapy, cognitive behavioral therapy (CBT), contingency management, therapeutic communities, and self-help groups. * **Effectiveness:** Dependent on retention in treatment and adequate aftercare. * **Harm Reduction:** Strategies like needle exchange, substitution therapy (e.g., methadone), supervised consumption sites, and take-home naloxone kits are vital for reducing the harms associated with drug use, particularly for injecting populations. ## The Supply Side: Drug Markets and Criminality Professor Colman's lectures focus on the supply side, analyzing drug markets, production, trafficking, and their societal impact. ### The Illegal Drug Market The illegal drug market is a significant driver of organized crime, characterized by: * **Profit Maximization:** Criminal groups aim to generate substantial profits, often reinvesting them in legal economies (money laundering). * **Polycriminality:** Involvement in multiple illicit activities (e.g., weapons trafficking, human trafficking). * **Price Escalation:** The price of drugs increases with the distance from the production country to the consumer market. * **Corruption:** Pervasive in ports and transit countries, facilitating drug flow. * **Organizational Structures:** Ranging from hierarchical pyramid structures to more flexible, cell-based networks. * **Adaptability and Resilience:** Drug markets readily adapt to law enforcement efforts and global events. ### Drug Supply Chain: Four Echelons The drug supply chain can be broken down into four key stages: 1. **Production:** Where drugs are manufactured or cultivated (e.g., synthetic drugs in Europe, cocaine in South America, cannabis globally, opium/heroin in the Golden Crescent/Triangle). 2. **Wholesale:** Large-scale import and export of drugs, often involving transit countries like Belgium and the Netherlands. 3. **Intermediate Trade:** Bridging wholesale and retail, involving repackaging, cutting, and distribution to smaller dealers. This includes deal houses and drug runners. 4. **Retail:** The final stage of selling drugs to consumers, characterized by street-level dealing and increasingly by delivery services and online markets. ### Online Drug Markets The internet, particularly the darknet, has revolutionized drug markets by: * **Shortening the Chain:** Reducing the number of intermediaries. * **Enhancing Anonymity:** Facilitating transactions through encryption and digital currencies. * **Expanding Reach:** Accessing global markets and new customer bases. * **Key Characteristics:** Wide product range (especially NPS on the clearnet), competitive pricing, quality control through reviews, anonymity, global shipping, and evolving market dynamics. ### Drug Production in Belgium Belgium plays a significant role as a production hub for synthetic drugs (XTC, amphetamines) and a transit country for others. * **Synthetic Drugs:** Often produced in large-scale, sophisticated laboratories, sometimes co-located with legitimate agricultural activities. Production involves precursors, essential chemicals, and specialized hardware. * **Cannabis:** While global production is diverse, Belgium sees both domestic cultivation (increasingly sophisticated indoor operations) and significant imports, often linked to legal markets elsewhere. * **Waste Dumping:** The clandestine production of synthetic drugs generates hazardous chemical waste, posing environmental and public health risks and creating significant cleanup challenges and costs for local authorities. ### Drug Trafficking and Organized Crime * **Antwerp Port:** A critical gateway for cocaine and other drugs into Europe, characterized by extensive infrastructure and a constant battle against sophisticated smuggling methods. * **Modus Operandi:** Smugglers employ various techniques like "rip-offs" (hiding drugs in legitimate cargo), "sleep-overs" or "trojans" (hiding individuals within containers), "switch methods" (swapping containers to evade detection), and impregnating materials with drugs. * **Criminal Networks:** Diverse groups, including Dutch-Belgian, Albanian, and Turkish-Dutch networks, operate in Belgium and the Netherlands, often competing for market share, leading to increased drug-related violence. * **Involvement of Youth:** Young people are often recruited as drug couriers and runners, exploited through grooming, debt bondage, and the allure of financial gain and status. ### Retail-Level Drug Markets * **Market Types:** Characterized by open markets (accessible to all), semi-open markets (requiring knowledge of selling points), and closed markets (based on trust and connections). * **Evolution:** A shift from demand seeking supply to supply meeting demand through "delivery dealing," call centers, and online platforms, facilitated by technology. ## Drug Theories and Discourses Professor Decorte's lectures explore various theoretical frameworks and societal discourses surrounding drug use. ### The Set, Setting, and Drug Interaction The impact of a drug is not solely determined by its pharmacological properties but is significantly influenced by the individual's internal state (set) and the external environment (setting). * **Set:** Includes an individual's personality, expectations, psychological state, and previous experiences with drugs. * **Setting:** Encompasses the physical environment, social context, cultural norms, and legal framework. ### Controlled Drug Use Research suggests that some individuals can use drugs, including those typically considered high-risk like heroin or cocaine, in a controlled manner without developing problematic use or addiction. This is often facilitated by: * **Informal Control Mechanisms:** Individuals developing strategies to regulate their intake based on context, social environment, personal priorities, and emotional state. * **Maturing Out/Drifting Out:** Spontaneous cessation or reduction of drug use and related criminal activity as individuals age, gain responsibilities, or their life circumstances change. ### Critiquing Drug Policy * **"War on Drugs" Impact:** The prohibitionist approach to drugs, particularly in the US, has been criticized for disproportionately affecting minority groups and for its limited effectiveness in reducing drug use and associated harms, while contributing to mass incarceration. * **Legality of Alcohol:** The social acceptance and widespread use of alcohol, a highly harmful substance, highlight the inconsistencies and potential irrationality of current drug policies. * **Regulation vs. Prohibition:** The debate around legalizing and regulating cannabis, for example, involves complex considerations of public health, economic interests, and societal values. Historical lessons from the tobacco and alcohol industries offer insights into potential pitfalls of commercialization. * **Evidence-Based Policy:** There is a call for drug policies to be more evidence-based, critically evaluating the effectiveness of repressive measures versus public health-oriented approaches like prevention, treatment, and harm reduction. ### Drug-Related Criminality * **Drug Use and Crime Link:** Drug use and criminal behavior are often interconnected, with theories explaining this link through: * **Pharmacological Effects:** Crimes committed under the influence of drugs (e.g., violence associated with stimulants). * **Economic Compulsion:** Crimes committed to fund drug use (e.g., theft). * **Systemic Crime:** Crimes related to the drug market itself (e.g., dealing, violence between trafficking groups). * **Shared Causes:** Drug use and crime stemming from common underlying risk factors (e.g., socioeconomic disadvantage, psychological distress). * **Approach to Drug-Related Crime:** Policies differentiate between those involved in the supply side (dealers, producers) who are often targeted with repressive measures, and those on the demand side (users) who may benefit more from prevention, treatment, and harm reduction strategies. * **Desistance and Recovery:** Understanding the processes by which individuals stop both drug use and criminal activity is crucial, highlighting the role of personal agency, social support, and a shift in life priorities. ### Drug Use and Migration in Europe Research on substance use among migrants and ethnic minorities (MEM) in Europe reveals: * **Data Limitations:** Reliable and representative data on drug use prevalence and treatment needs among MEM is scarce, making it difficult to develop targeted interventions. * **Healthy Migrant Effect:** Migrants often show lower substance use rates upon arrival compared to the host population, but this can change over time due to post-migration factors like stress, discrimination, and limited access to services. * **Barriers to Treatment:** MEM face significant barriers in accessing drug treatment, including language barriers, discrimination, lack of culturally sensitive services, distrust in the system, and complex migratory statuses. * **Ecosocial Perspective:** Understanding drug use requires considering micro (individual), meso (community/organizational), and macro (societal/political) factors, recognizing how systemic inequalities contribute to individual risk. * **Equitable Care:** Ensuring equal access to quality drug treatment for all populations, regardless of background, is a critical challenge, requiring tailored approaches and improved data collection. ## Key Themes and Examination Focus * **Holistic Understanding:** Recognize the interplay of drug type, individual factors (set), and environmental context (setting). * **Policy Evolution:** Understand the historical development of drug policy in Belgium. * **Harm Reduction:** Grasp the principles and strategies of harm reduction as a public health approach. * **Drug Markets:** Analyze the structure, functioning, and evolution of illegal drug markets, including the impact of technology. * **Intervention Strategies:** Differentiate between prevention, early intervention, treatment, and harm reduction, and understand their application across different user groups. * **Stigma and Social Exclusion:** Recognize the role of stigma in hindering recovery and reintegration. * **Evidence-Based Practice:** Emphasize the importance of scientific evidence in shaping drug policy and interventions. * **Critical Evaluation:** Approach drug policies and common discourses with a critical eye, considering alternative strategies and their potential implications. **Note on the Exam:** Expect questions covering the breadth of topics discussed, including definitions, comparisons of drug classes, policy developments, market dynamics, intervention strategies, theoretical models, and the impact of social and environmental factors on drug use. Pay attention to specific examples and case studies cited in the lectures.

# Glossary | Term | Definition | | :---------------------------------------- | :----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | | **Psychoactive substances** | Substances that affect the central nervous system, altering perception, mood, consciousness, cognition, and behavior. | | **Psycholeptics** | Substances that depress or slow down the central nervous system, leading to reduced activity and reactivity. Examples include opiates and sedatives. | | **Psychoanaleptics** | Substances that stimulate the central nervous system, leading to increased activity, alertness, and elevated mood. Examples include cocaine and amphetamines. | | **Psychodysleptics** | Substances that disrupt or alter the central nervous system, causing perceptual and cognitive disturbances. Examples include LSD, psilocybin (magic mushrooms), and mescaline. | | **Designer drugs (NPS)** | Synthetically created substances that mimic the effects of known illegal drugs but are chemically altered to evade current legislation. They are often developed in laboratories to bypass drug laws. | | **Harm Reduction** | A set of public health strategies and practices aimed at reducing the negative health, social, and economic consequences associated with drug use, without necessarily eliminating drug use itself. | | **Stepping-stone theory** | A theory suggesting that the use of certain "softer" drugs can lead to the use of "harder" or more potent drugs, proposing a sequential pattern of drug escalation. | | **Desistance** | The process by which individuals stop engaging in criminal behavior, often studied in the context of drug-related offenses. | | **Recovery** | A process of positive change in an individual's health, functioning, societal participation, and personal development, often applied in the context of addiction treatment. | | **Set** | Refers to the internal context of drug use, encompassing the individual's psychological, physiological, and personality factors, as well as their expectations and mental state. | | **Setting** | Refers to the external context of drug use, encompassing the physical environment, social influences, cultural norms, and legal framework within which the drug is consumed. | | **Informal control mechanisms** | Socially learned behaviors and strategies individuals develop to manage their drug use, often influenced by their environment and personal experiences, leading to controlled or regulated consumption. | | **Precursor chemicals** | The basic chemical compounds used as starting materials in the synthesis of illicit drugs. Control over these chemicals is a key strategy in preventing drug production. | | **Polydrug use** | The simultaneous or sequential use of multiple drugs, which can increase the complexity of effects, risks, and treatment challenges. | | **Drug-related criminal behavior** | A broad term encompassing various illegal activities associated with drugs, including dealing, theft to fund drug use, violent offenses under the influence, and violations of drug laws. | | **Equitable substance use treatment for Migrants and Ethnic Minorities (MEM)** | Treatment approaches that aim to provide fair and just access to substance use services for individuals from diverse ethnic and migratory backgrounds, addressing systemic barriers. |