Substance Use in The Philippines

BETWEEN THE LINES:
What You Need to Know About Substance

use
Pamela P. Bandelaria, MD
Division of Addiction Medicine
UP-Philippine General Hospital
ADDICTION MEDICINE SERVICE
Objectives
• To present an overview of substance use among Filipinos,

particularly youth and young adults (alcohol, cigarette
smoking/vaping, marijuana, methamphetamine)
• To show the neurobiology and psychology behind the use of these
substances
• To discuss the short- and long-term effects of these substances on a
person’s health
• To know how we can prevent adverse effects of substance use to the
individual, the family and the community.
What is Substance Use?
“Refers to the use of selected substances, including alcohol,
tobacco products, drugs... and other substances that can be
consumed, inhaled, injected, or otherwise absorbed into the
body with possible dependence and other detrimental
effects.”
Centers for Disease Control US National Health Statistics 2023

What is the situation?
Adolescent drinking before the pandemic
Survey among college students in Metro Manila (2013)

• 81.6% were ever drinkers
• Drinking before 13 years old: 15.6% beer, 22.5% wine, 11.4%
distilled spirits
• Current drinkers: 30.2% beer, 18.7% wine, 30.8% distilled spirits
• 29.1% got drunk
• 28.9% drove any motor vehicle after drinking
• 31% tried to quit drinking in the past 12 months
• 7.5% felt they have a drinking problem
Pagkatipunan, 2017
Adolescent smoking before the pandemic
Global Youth Tobacco Survey (2019)

• 12.5% currently smoke (smoked any time in the past 30 days)
• 26.8% ever smoked (smoke even just one or two puffs)
Adolescent smoking before the pandemic

Survey among Adolescents in a Tertiary
public hospital (2018)
• 85% never smoked
• 11.8% tried smoking
• 3.6% were current smokers
• More smokers tried e-cigarettes than
regular cigarettes
• Most current and past smokers
started at age 12 to 13
• Friends are the most common
influence
• 13.5% do not know the effects of
smoking
Prevalence of cigarette and electronic cigarette smoking among adolescents surveyed in a
tertiary public hospital between August and October 2018 (n = 170).
Esteban-Ipac and Torres-Ticzon, 2022

• 45% drank less during

the pandemic
• 65% want to stop
drinking
Percent of Filipino youth currently drinking alcohol: 1994-2001

• 41% smoked fewer

sticks during the
pandemic (average
of 5 per day)
• 75% want to stop
smoking
• 16% have tried
vaping
Percent of Filipino youth currently smoking cigarettes: 1994-2001

Dangerous Drugs Board 2021

• Youngest admission to rehabilitation treatment centers was 13 years old
• The age of first use was 15 to 19 years old (41.25%).
• The leading drug of abuse: Methamphetamine Hydrochloride, or “Shabu”
(91.80%), followed by Cannabis (Marijuana) (26.29%).
Other Studies (Cheng & Tabora Subido; 1982)

• Marijuana is the introduction to other potentially dangerous drugs
• Most common influence for trying: curiosity, friends
2004 Action Research (Drug Use Among

Working Children)
• most used methamphetamine (shabu)
followed by marijuana
• age of first use ranged from 12-15
years old
• reasons for drug use: curiosity,
escape problems/family problems,
peer pressure
• influences: friends, parents
What does these data mean?
• Most youth involved with substance use start at a young age

• Influenced by people around them (mostly friends and sometimes family)
• Substance use occurs out of curiosity, escape problems, and peer pressure (Self-
soothing, validation/acceptance from friends)
• There are decreasing trends of substance use especially for alcohol and tobacco. this
means that not a lot of people are doing it unlike what most adolescents might think
(“Everybody does It“ is not actually the case)
• Most of them do not know the effects of these substances
What happens when using substances?
NIDA, 2023
The Brain & Behavior Research Foundation , 2023


REWARD
DEPRESSION ADDICTION


NIDA, 2023
Ashley Addiction Treatment, 2023

Ashley Addiction Treatment, 2023

• The use of substances (alcohol, smoking, drugs) targets the reward center of the
brain, leading to an exaggerated response
• Substance use feels good --> but only at the start
• The use of substances leads to physical changes in the brain
• The use of substances involves the reward center becoming intensely linked to
substance use (EQUATE substance use with REWARD)
• Difficult to find enjoyment in other activities and weakens the ability to control the
impulse to use substances
• The use of substances leads to dependence (relying on the substance) and addiction
which are mental health illnesses
Is addiction the only effect of
substance use?
Effect of alcohol on the brain

• Alcohol is a central
nervous system depressant
• Lower blood levels of
alcohol: disinhibition
• Higher levels: sedative
effect
• Long-term intake of
alcohol alters the brain’s
reward and stress circuits
Effect of nicotine on the brain

• Nicotine is a stimulant and mood
modulator PREFRONTAL CORTEX:
• May TEMPORARILY improve -decision making
alertness and reaction time -judgment
• May promote arousal during fatigue, -planning
relaxation during anxiety, and relief
from stress and hunger
• Nicotine impairs the development of
the prefrontal cortex
• Nicotine use is continued by the need
to prevent the effects of nicotine
withdrawal
• Detrimental effect when exposed at
younger ages
Wang Q, Du W, Wang H, Geng P, Sun Y, Zhang J, Wang W, Jin X. Nicotine's effect on cognition, a friend or foe? Prog Neuropsychopharmacol Biol Psychiatry. 2023 Jun 8;124:110723. doi: 10.1016/j.pnpbp.2023.110723. Epub 2023 Feb 1. PMID:
36736944.
Effect of THC on the brain

• Tetrohydrocannabinol is the
psychoactive component of
cannabis or marijuana
(“high”)
• Its effects include euphoria,
enhancement of sensory
perception, antinociception
(sensation of blocking pain)
• Lead to difficulties in
concentration and
impairment of memory.
Ameri A. The effects of cannabinoids on the brain. Prog Neurobiol. 1999 Jul;58(4):315-48. doi: 10.1016/s0301-0082(98)00087-2. PMID: 10368032.
Effect of methamphetamine on the brain

• Methamphetamine is a
central nervous system
stimulant
• Short-term effects: elevates
mood, alertness, energy
levels, and concentration.
• Long-term effects:
psychosis, depression,
delusions, and violent
behavior.
Prakash MD, Tangalakis K, Antonipillai J, Stojanovska L, Nurgali K, Apostolopoulos V. Methamphetamine: Effects on the brain, gut and immune system. Pharmacol Res. 2017 Jun;120:60-67. doi: 10.1016/j.phrs.2017.03.009. Epub 2017 Mar 14.
PMID: 28302577.
Why is it Important to Discuss Effects of
Substances in the Young Brain?
• The brain continues to develop until the

age of 25
⚬ During adolescence, parts of the
brain involved in decision-making
and impulse control are not yet fully
developed
⚬ Adolescents are more sensitive to
stressors
⚬ Substance use in adolescence
interferes with brain development
• Young people have a higher chance of
taking risks with their health and safety,
including the use of nicotine and other
drugs.
• Youth and young adults are also at high
risk for long-term, long-lasting effects of
exposing their developing brains to
substances.
Arain M, Haque M, Johal L, Mathur P, Nel W, Rais A, Sandhu R, Sharma S. Maturation of the adolescent brain. Neuropsychiatr Dis Treat. 2013;9:449-61. doi: 10.2147/NDT.S39776. Epub 2013 Apr 3. PMID: 23579318; PMCID: PMC3621648.
https://www.sexualhealthtayside.org/lessons/the-adolescent-brain/
Any Other Health Effects of Substances?
How does
alcohol affect
driving?
https://healthblog.uofmhealth.org/wellness-prevention/how-alcohol-impairs-your-ability-to-drive
https://www.niaaa.nih.gov/alcohols-effects-health/alcohols-effects-body
Way, G.W.; Jackson, K.G.; Muscu, S.R.; Zhou, H. Key Signaling in Alcohol-Associated Liver Disease: The Role of Bile Acids. Cells 2022, 11,
1374. https://doi.org/10.3390/cells11081374
All forms of tobacco are

harmful.
There is no safe level of

exposure to tobacco.
What happens after a person stops smoking?
• Stopping smoking has benefits for those who smoke at any age
• There is an immediate decrease in the risk of cardiovascular disease
or death
• The reduced risk of death among former smokers begins shortly after
quitting and continues for at least 10-15 years
• After 10-15 years of not smoking, the risk of death from any cause
returns to almost that of a person who never smoked
Rigotti NA, Kruse GR, Livingstone-Banks J, Hartmann-Boyce J. Treatment of Tobacco Smoking: A Review. JAMA. 2022 Feb 8;327(6):566-577. doi: 10.1001/jama.2022.0395. PMID: 35133411.
What about vaping?

• Marketed particularly towards the youth, with
the inclusion of various flavors
• Its long-term effects are yet to be studied
• Vape still contains nicotine, and may even
deliver more nicotine than regular cigarettes
• Vaping - higher ADHD symptoms, increase
stress levels, intensify symptoms of depression
and anxiety
• The liquid contained in vape (“e-juice”) can
contain other harmful substances (ex:
carcinogens, benzene, heavy metals)
• Current limited evidence shows that vaping is
ineffective to use in quitting smoking – may
result in “dual use”
• May even serve as the “gateway drug” for
smoking
Healthline 2023
• Substance use causes physical changes in the brain

• Substance use also causes changes in other organ systems.
• Because substances act on the reward center, they initially give a feeling of pleasure
(feel good) but this only occurs in the beginning
• Long term effects of substance use is potentially fatal
• Risks of substance use OUTWEIGH the good feeling it provides at the start
• Myth: Addiction is a choice

⚬ Fact: Addiction is not simply a choice, it involves complex changes in the brain that
affect decision-making and self-control.
• Myth: Addiction only affects certain people/ It cannot happen to me
⚬ Fact: Addiction can affect anyone, it is a health condition
⚬ Young people are more susceptible to addiction and Substance Use due to their
developing brains.
• Myth: Substance use is harmless when done short-term
⚬ Fact: Some substances can have immediate and lasting effects on physical and mental
health.
• Myth: You can easily get out of Addiction
⚬ Fact: Overcoming addiction is a complex process. It’s not as simple as deciding to
stop.
• Myth: Addiction only involves illegal drugs
⚬ Fact: Addiction can involve legal substances and prescription medications
• Myth: Addiction has a specific “look”
⚬ Fact: Addiction can be hidden
• Myth: There is no hope for addiction
⚬ Fact: Addiction can be treated
Why do young people engage in
smoking, drinking or drugs?
• Their peers and/or family

members also do
• Depiction in media
• They can afford it
• To express feelings
• To cope with stress
• They may have an
underlying mental health
issue or psychiatric disorder
What can we do?
• Educate Yourself
(education is empowering
yourself)
• Establish clear boundaries
• Communicate and be
assertive
• Surround yourself with
like-minded friends
• Participate in
positive and healthy
activities
• Know your triggers
• Seek Help if
Needed
• Help us Spread the
Word
Key Points
• Exposure to substance use occurs at a young age
• Substances can lead to physical changes in the brain and can affect
the brain in ways that can lead to their continued use
• Young people are more vulnerable to developing addiction
• Personal and social factors lead to one’s decision to use substances
• Drinking and smoking are contributory to most of the top
preventable causes of death
• Substance use can be preventable
• It is important to seek help when being pressured and affected by
substance use
• It is important to educate on both the positive and the negative
effects of substance use
References
• Centers for Disease Control and Prevention US National Health Statistics 2020-2021 (2023).
Retrieved from WWW: https://www.cdc.gov/nchs/hus/sources-definitions/substance-use.htm#:~:
text=Refers%20to%20the %20use%20of, dependence%20and%20other%20detrimental
%20effects.
• Pagkatipunan PMN. (2017). Accessibility and consumption of alcoholic drinks in Metro Manila
colleges and universities. Acta Medica Philippina 51(2):116-20.
• Dangerous Drugs Board Statistical Analysis 2021. Retrieved from WWW :
https://ddb.gov.ph/2021-statistical-analysis/
• Esteban-Ipac NAR and Torres-Ticzon VM. (2022). Adolescent smoking: a cross-sectional study
on the knowledge, attitude, and practices of Filipino adolescents in a tertiary hospital. Acta
Medica Philippina 56(9):9-17
• University of the Philippines Population Institute press release, 14 Oct 2022. “Filipino youth are
turning away from vices, UPPI study shows.”
https://www.uppi.upd.edu.ph/sites/default/files/pdf/YAFS5_Press%20Release_Non-sexual
%20risk%20behaviors.pdf
• Herron AJ and Brennan TK. (2020). The ASAM Essentials of Addiction Medicine, 3ʳᵈ edition.
Wolters Kluwer.

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BETWEEN THE LINES:

What You Need to Know About Substance

• To present an overview of substance use among Filipinos,

Centers for Disease Control US National Health Statistics 2023

Adolescent drinking before the pandemic

Survey among college students in Metro Manila (2013)

Adolescent smoking before the pandemic

Global Youth Tobacco Survey (2019)

Adolescent smoking before the pandemic

Esteban-Ipac and Torres-Ticzon, 2022

• 45% drank less during

Percent of Filipino youth currently drinking alcohol: 1994-2001

• 41% smoked fewer

Percent of Filipino youth currently smoking cigarettes: 1994-2001

Dangerous Drugs Board 2021

Other Studies (Cheng & Tabora Subido; 1982)

2004 Action Research (Drug Use Among

• Most youth involved with substance use start at a young age

The Brain & Behavior Research Foundation , 2023

The Brain & Behavior Research Foundation , 2023

The Brain & Behavior Research Foundation , 2023

The Brain & Behavior Research Foundation , 2023

Ashley Addiction Treatment, 2023

Ashley Addiction Treatment, 2023

Effect of alcohol on the brain

Effect of nicotine on the brain

Effect of THC on the brain

Effect of methamphetamine on the brain

• The brain continues to develop until the

All forms of tobacco are

There is no safe level of

What happens after a person stops smoking?

What about vaping?

• Substance use causes physical changes in the brain

• Myth: Addiction is a choice

• Their peers and/or family

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