Every year, on 26 June, we mark World Drug Day globally. Since its adoption by the United Nations General Assembly in 1987, this day has served as a unifying call for coordinated responses in prevention, treatment, policy reform, and community-based care.
As new psychoactive substances emerge and patterns of use evolve across regions, the urgency for data-driven strategies and public-private collaboration has never been more.
Substance abuse: The African context
Globally, the United Nations Office on Drugs and Crime (UNODC) World Drug Report estimates that 1 in 17 people used drugs in 2021, with over 39.5 million suffering from drug use disorders. In Nigeria, the National Drug Use Survey (2018) revealed that 14.4 per cent of the population aged 15–64 (approximately 14 million people) used drugs in the past year.
This figure is nearly three (3) times the global average.Cannabis remains the most commonly used substance, followed by pharmaceutical opioids (notably tramadol and codeine), cocaine, and amphetamines. Alarmingly, these substances are no longer confined to specific age groups or geographic settings. Increasing reports indicate use among secondary school students, rural women, artisans, and even professionals.
This is a health crisis; we are witnessing a public health emergency with consequences that ripple across health systems, law enforcement, families, and economies.
Understanding terminologies
Effective prevention, diagnosis, and treatment of substance use disorders (SUDs) require an understanding of the core concepts that define the clinical spectrum of substance-related challenges. Here’s a breakdown of four essential but often misunderstood terms:
- Dependence
Dependence is a physiological state that develops when the body adapts to the continued presence of a substance. Over time, the brain and body function normally only in the presence of the drug. When use is reduced or stopped, withdrawal symptoms emerge as the body attempts to regain homeostasis.
Dependence can occur with prolonged use of certain medications (e.g., opioids for chronic pain) even when taken as prescribed, and does not necessarily indicate addiction.
- Addiction
Addiction is a chronic, relapsing disorder characterised by compulsive drug-seeking and use, despite harmful consequences. It involves not only physical dependence but also behavioural and psychological elements, such as craving, impaired control, and continued use in the face of social, occupational, or health consequences.
Addiction affects the brain’s reward, motivation, memory, and impulse control systems, thus, recovery is challenging without structured intervention.
- Tolerance
Tolerance refers to the body’s reduced response to a drug after repeated use. As tolerance builds, the individual must consume larger amounts of the substance to achieve the same effect.
This is a biological adaptation of the central nervous system and can develop rapidly or over time depending on the substance, dosage, and individual factors.
Tolerance can increase the risk of overdose, especially with substances like opioids, alcohol, or benzodiazepines. When someone stops using for a period and then resumes previous doses, the body may no longer be able to handle it, leading to life-threatening outcomes.
Withdrawal symptoms
Withdrawal is the cluster of physical and psychological symptoms that occur when a substance is reduced or discontinued after dependence has developed. Symptoms vary by substance and severity of use, ranging from mild anxiety and irritability to seizures, hallucinations, and cardiovascular collapse.
For example:
Alcohol withdrawal can escalate to delirium tremens (DTs), requiring immediate medical intervention.
Benzodiazepine withdrawal, if unmanaged, can lead to seizures and psychosis.
Why these distinctions matter
Each of these terms represents a different point along the continuum of substance interaction and has implications for how clinicians assess risk, plan interventions, and support long-term recovery.
For instance:
A patient physically dependent on pain medication may not exhibit addictive behaviour.
Someone with tolerance and mild withdrawal symptoms may still function in daily life but could be on the verge of a more severe substance use disorder.
Individuals experiencing addiction often require integrated care, addressing both physiological and behavioural components.
Prevention: Addressing protective factors and structural gaps
Among healthcare providers and public health experts, there is a general consensus that: early prevention and risk reduction remain the most cost-effective and sustainable approaches to reducing substance use burdens.
What has worked?
School and community-based programmes that build resilience, self-efficacy, and awareness, rather than rely solely on scare tactics.
Parental involvement and youth mentoring, which improve emotional regulation, decision-making, and life skills in adolescents, particularly in high-risk environments.
Cross-sectoral collaboration, including educators, social workers, religious leaders, and law enforcement agencies, to ensure consistent messaging and systemic support.
Media literacy and digital behaviour interventions, especially in an age where drug glamorisation on social platforms influences youth behaviour.
For public health systems, it’s also critical to address underlying social determinants, such as poverty, unemployment, trauma, and urban marginalisation, that often coexist with substance use vulnerabilities.
By Pharm. (Dr) Onyinye Bridget Chiekwe, PharmD, MScPH, ABMP
pharmbree25@gmail.com
