SUBSTANCE ABUSE

Substance abuse, also known as drug abuse, refers to a maladaptive

pattern of use of a substance that is not considered dependent. The term
"drug abuse" does not exclude dependency, but is otherwise used in a
similar manner in nonmedical contexts. Some of the drugs most often
associated with this term include alcohol, amphetamines, barbiturates,
benzodiazepines (particularly temazepam, nimetazepam, and
flunitrazepam), cocaine, methaqualone, and opioids. Use of these drugs may
lead to criminal penalty in addition to possible physical, social, and
psychological harm, both strongly depending on local jurisdiction. Other
definitions of drug abuse are
1.Compulsive, excessive, and self-damaging use of habit forming drugs or
substances, leading to addiction or dependence, serious physiologicalinjury
(such as damage to kidneys, liver, heart) and/or psychologicalharm (such as
dysfunctionalbehaviorpatterns, hallucinations, memoryloss), or death.
"Substance dependencewhen an individual persists in use of alcohol or
other drugs despite problems related to use of the substance,
substancedependence may be diagnosed. Compulsive and repetitive use
may result in tolerance to the effect of the drug and withdrawal symptoms
when use is reduced or stopped
Drug misuse
Drug misuse is a term used commonly for prescriptionmedications with
clinical efficacy but abuse potential and known adverse effects linked to
improper use, such as psychiatric medications with sedative, anxiolytic,
analgesic, or stimulant properties. Prescription misuse has been variably and
inconsistently defined based on drug prescription status, the uses that occur
without a prescription, intentional use to achieve intoxicating effects, route
of administration, co-ingestion with alcohol, and the presence or absence of
abuse or dependence symptoms. Tolerance relates to the pharmacological
property of substances in which chronic use leads to a change in the central
nervous system, meaning that more of the substance is needed in order to
produce desired effects. Stopping or reducing the use of this substance
would cause withdrawal symptoms to occur.

Facts and figures

The bare facts

The harmful use of alcohol results in 2.5 million deaths each year.

320,000 young people between the age of 15 and 29 die from alcoholrelated causes, resulting in 9% of all deaths in that age group.

At least 15.3 million persons have drug use disorders.

Injecting drug use reported in 148 countries, of which 120 report HIV
infection among this population.

Recalling the world health report 2002, which indicated that 4% of the
burden of disease and
3.2% of all deaths globally were attributed to alcohol, and that alcohol was
the foremost risk to health
In low-mortality developing countries and the third in developed countries;
People abuse substances such as drugs, alcohol, and tobacco for varied and
complicated reasons, but it is clear that our society pays a significant cost.
The toll for this abuse can be seen in our hospitals and emergency
departments through direct damage to health by substance abuse and its
link to physical trauma. Jails and prisons tally daily the strong connection
between crime and drug dependence and abuse. Although use of some
drugs such as cocaine has declined, use of other drugs such as heroin and
"club drugs" has increased.

Finding effective treatment for and prevention of substance abuse has

been difficult. Through research, we now have a better understanding of
the behavior. Studies have made it clear that drug education and
prevention aimed at children and adolescents offers the best chance to
curb abuse nationally.
Abused substances produce some form of intoxication that alters judgment,
perception, attention, or physical control.
Many substances can bring on withdrawal-an effect caused by cessation or
reduction in the amount of the substance used. Withdrawal can range from
mild anxiety to seizures and hallucinations. Drug overdose may also cause
death.
Nearly all these drugs also can produce a phenomenon known as tolerance
where you must use a larger amount of the drug to produce the same level
of intoxication.
Drugs of Abuse

Tobacco: People cite many reasons for using tobacco, including

pleasure, improved performance and vigilance, relief of depression,
curbing hunger, and weight control.
o

The primary addicting substance in cigarettes is nicotine. But

cigarette smoke contains thousands of other chemicals that also
damage health. Hazards include heart disease, lung cancer and
emphysema, peptic ulcer disease, and stroke. Withdrawal symptoms of
smoking include anxiety, hunger, sleep disturbances, and depression.
Smoking is responsible for nearly a half million deaths each year

Alcohol: Although many people have a drink as a "pick me up," alcohol

actually depresses the brain. Alcohol lessens your inhibitions, slurs speech,
and decreases muscle control and coordination, and may lead to
alcoholism.
o

Withdrawal from alcohol can cause anxiety, irregular heartbeat,

tremor, seizures, and hallucinations. In its severest form, withdrawal
combined with malnutrition can lead to a life-threatening condition
called delirium tremens (DTs). Alcohol is the most common cause of liver
failure in the world. The drug can cause heart enlargement and cancer
of the esophagus, pancreas, and stomach.
In addition to its direct health effects, officials associate alcohol abuse
with nearly half of all fatal motor vehicle accidents.

Marijuana (also known as grass, pot, weed, herb): Marijuana, which

comes from the plant Cannabis sativa, is the most commonly used illegal
drug in the world. The plant produces delta-9-tetrahydrocannabinol (THC),
the active ingredient associated with intoxication. Marijuana resin, called
hashish, contains an even higher concentration of THC.
o

The drug is usually smoked, but it can also be eaten. Its smoke
irritates your lungs more and contains more cancer-causing chemicals
than tobacco smoke. Common effects of marijuana use include pleasure,
relaxation, and impaired coordination and memory.

Often, the first illegal drug people use, marijuana is associated

with increased risk of progressing to more powerful and dangerous drugs
such as cocaine and heroin. The risk for progressing to cocaine is 104

times higher if you have smoked marijuana at least once than if you
never smoked marijuana.

Cocaine (also known as crack, coke, snow, rock):

o

Derived from the coca plant of South America, cocaine can be

smoked, injected, snorted, or swallowed. The intensity and duration of
the drug's effects depend on how you take it. Desired effects include
pleasure and increased alertness.

Short-term effects also include paranoia, constriction of blood

vessels leading to heart damage or stroke, irregular heartbeat, and
death. Severe depression and reduced energy often accompany
withdrawal.

Both short- and long-term use of cocaine has been associated

with damage to the heart, the brain, the lung, and the kidneys.

Heroin (also known as smack, horse): Heroin use continues to

increase. A 1998 National Household Survey on Drug Abuse indicated 2.4
million Americans used heroin, including 81,000 new users in 1997.
Officials see increased use mainly among people younger than 26 years,
often women. In 1997, 87% of heroin users were younger than 26 years,
compared to 61% in 1992.
o

Effects of heroin intoxication include drowsiness, pleasure, and

slowed breathing. Withdrawal can be intense and can include vomiting,
abdominal cramps, diarrhea, confusion, aches, and sweating.

Overdose may result in death from decreased breathing.

Because heroin is usually injected, often with dirty needles, use of the
drug can trigger other health complications including destruction of your
heart valves, HIV/AIDS, infections, tetanus, and botulism.

Methamphetamines (also known as meth, crank, ice, speed, crystal):

Use of this drug also has increased, especially in the West.
Methamphetamine is a powerful stimulant that increases alertness,
decreases appetite, and gives a sensation of pleasure.
o

The drug can be injected, snorted, smoked, or eaten. It shares

many of the same toxic effects as cocaine-heart attacks, dangerously
high blood pressure, and stroke.

Withdrawal often causes depression, abdominal cramps, and

increased appetite. Other long-term effects include paranoia,
hallucinations, weight loss, destruction of teeth, and heart damage.
Club drugs: The club scene and rave parties have popularized an
assortment of other drugs. Many young people believe these drugs are
harmless or even healthy. These are the more popular club drugs.

Ecstasy (also called MDMA, Adam, STP): This isa stimulant and
hallucinogen used to improve mood and to maintain energy, often for
all-night dance parties. Long-term use may cause damage to the brain's
ability to regulate sleep, pain, memory, and emotions.

GHB (also called Liquid XTC, G, blue nitro): Once sold at health
food stores,GHB's effects are related to dose. Effects range from mild
relaxation to coma or death. GHB is often used as a date-rape drug
because it is tasteless, colorless, and acts as a powerful sedative.

Rohypnol (also called roofies, roche): This is another sedative

that can be used as a date-rape drug. Effects include low blood pressure,
dizziness, abdominal cramps, confusion, and impaired memory.

Ketamine (also called Special K, K): This is an anesthetic that

can be taken orally or injected. Ketamine (Ketalar) can impair memory
and attention. Higher doses can cause amnesia, paranoia and
hallucinations, depression, and difficulty breathing.

LSD (also called acid, microdot) and mushrooms (also called

shrooms, magic mushrooms, peyote, and buttons): Popular in the 1960s,
LSD has been revived in the club scene. LSD and hallucinogenic
mushrooms can cause hallucinations, numbness, nausea, and increased
heart rate. Long-term effects include unwanted "flashbacks" and
psychosis (hallucinations, delusions, paranoia, and mood disturbances).

PCP (also known as angel dust, hog, and love boat): PCP isa
powerful anesthetic used in veterinary medicine. Its effects are similar to
those of ketamine but often stronger. The anesthetic effects are so
strong that you can break your arm but not feel any pain. Usually,
tobacco or marijuana cigarettes are dipped into PCP and then smoked.

Substance Abuse Causes

Use and abuse of substances such as cigarettes, alcohol, and illegal drugs
may begin in childhood or the teen years. Certain risk factors may increase
someone's likelihood to abuse substances.

Factors within a family that influence a child's early development have

been shown to be related to increased risk of drug abuse.
o

Chaotic home environment

Ineffective parenting

Lack of nurturing and parental attachment

Factors related to a child's socialization outside the familymay

alsoincrease risk of drug abuse.
o

Inappropriately aggressive or shy behavior in the classroom

Poor social coping skills

Poor school performance

Association with a deviant peer group

Perception of approval of drug use behavior

Substance Abuse Symptoms

Friends and family may be among the first to recognize the signs of
substance abuse. Early recognition increases chances for successful
treatment. Signs to watch for include the following:
Giving up past activities such as sports, homework, or hanging out
with new friends
Declining grades
Aggressiveness and irritability
Forgetfulness
Disappearing money or valuables
Feeling rundown, hopeless, depressed, or even suicidal
Sounding selfish and not caring about others
Use of room deodorizers and incense

Paraphernalia such as baggies, small boxes, pipes, and rolling paper

Getting drunk or high on drugs on a regular basis
Lying, particularly about how much alcohol or other drugs he or she is
using
Avoiding friends or family in order to get drunk or high
Planning drinking in advance, hiding alcohol, drinking or using other
drugs alone
Having to drink more to get the same high
Believing that in order to have fun you need to drink or use other
drugs
Frequent hangovers
Pressuring others to drink or use other drugs
Taking risks, including sexual risks
Having "blackouts"-forgetting what he or she did the night before
Constantly talking about drinking or using other drugs
Getting in trouble with the law
Drinking and driving
Suspension from school or work for an alcohol or drug-related incident
When to Seek Medical Care
If you recognize you have a substance abuse problem and want to quit, a
doctor can refer you to community resources. A doctor also may prescribe
medications to control cravings and withdrawal or help manage medical
complications resulting from substance abuse. Let your doctor know what
drugs you use and how you take them. Call your doctor if you recognize any
of the followingsymptoms:

Mild tremors or an alcohol withdrawal seizure not accompanied by

hallucinations or confusion
Jaundice (yellow skin and eyes)

Increasing abdominal girth

Leg swelling

Cough that won't go away

Continuing feelings of sadness or depression

Pain at an injection site

Fever
If any of the following occur, call 911 or go to a hospital's emergency
department immediately:

Thoughts of harming yourself or others

Chest pain, rapid heartbeat, difficulty breathing, or lightheadedness

Severe abdominal pain

Confusion or ongoing hallucinations

Severe tremors or recurrent seizures

Difficulty speaking, numbness, weakness, severe headache, visual

changes, or trouble keeping balance

Severe pain at an injection site (may be accompanied by redness,

swelling, discharge, and fever)

Dark, cola-colored urine

Any suspicion that you were sexually assaulted while under the
influence
Substance Abuse Treatment

Medical Treatment
Most substances abusers believe they can stop using drugs on their own, but
a majority who try do not succeed. Research shows that long-term drug use

alters brain function and strengthens compulsions to use drugs. This craving
continues even after your drug use stops.

Because of these ongoing cravings, the most important component of

treatment is preventing relapse. Treating substance abuse depends on both
the person and the substance being used. Behavioral treatment provides you
with strategies to cope with your drug cravings and ways to avoid relapse.
Doctors may prescribe medications, such as nicotine patches and
methadone, to control withdrawal symptoms and drug cravings.

Often, a drug user has an underlying mental disorder, one that increases risk
for substance abuse. Such disorders must be treated medically and through
counseling along with the drug abuse.
Prevention
Substance abuse may start in childhood or adolescence. Abuse prevention
efforts in schools and community settings now focus on school-age groups.
Programs seek to increase communication between parents and their
children, to teach resistance skills, and to correct children's misperceptions
about cigarettes, alcohol, and drugs and the consequences of their use. Most
importantly, officials seek to develop, through education and the media, an
environment of social disapproval from children's peers and families
Costs to society
Crime: More than half the economic cost of alcohol and drugs is due to
crime. A substance abuser is 18 times more likely to be involved in
criminal activity than someone in the general population. Many violent
crimes have been linked to the mind-altering effects of drugs. Substance
abusers often commit thefts to support their drug habits. Drugs and
alcohol have been linked to domestic violence and sexual assault. At
colleges, 75% of date rapes are alcohol-related. Among jailed sex
offenders, 43% say they were under the influence of drugs or alcohol at
the time of their crime.
Disease: Most abused substances have harmful health effects. For
some substances, such as tobacco, effects are caused by long-term use.
For other drugs, a single use can cause significant disease.

Behavior: In addition to their direct effects on health, drugs produce

other indirect effects. Many drugs lessen inhibitions and increase the
likelihood that a person will participate in risky behavior. Studies show that
the use of alcohol and drugs among teenagers increases chances for teen
pregnancy and contracting HIV/AIDS or other sexually transmitted
diseases. Any injected drug is associated with contracting HIV/AIDS and
hepatitis B and C.
Trauma: Up to 75% of injured people treated at emergency
departments test positive for illicit or prescription drugs. Alcohol is strongly
associated with both intentional and unintentional injury. Drug use also
puts people at risk of violence. Nearly half of assault victims are cocaine
users.

Synonyms and Keywords

substance abuse, drug abuse, alcoholism, addiction, drug dependence,
drunkenness, narcotic abuse, drug overdose, cocaine abuse, benzodiazepine
abuse, barbiturate abuse, marijuana, cocaine, heroin, methamphetamine,
club drugs, GHB, Rohypnol, ketamine, LSD, PCP