Substance Abuse

Substance abuse without treatment takes a heavy toll on a person's health, family, and society.

People abuse substances such as alcohol, tobacco, and other drugs 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 both 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
in recent years, use of other drugs such as heroin, crystal methamphetamine, and "club drugs"
has increased.

 Finding effective treatment for and prevention of substance abuse and substance
dependence, now both included under the diagnosis of substance use disorder, has been
difficult. Through research, we now have a better understanding of this behavior. Studies
have made it clear that drug education and prevention aimed at children and adolescents
offers the best chance to curb drug abuse nationally.
 The 2014 National Household Survey on Drug Abuse estimated that more than 16% of
respondents in the United States have used illicit drugs in the past year. Other statistics
from the survey include that more than 22% of Americans over 18 years of age have
engaged in binge drinking in the past year, and more than 20% of Americans have
smoked cigarettes in the past month. Same survey reveals that 21.5 million people over
12 years of age in the United States have had some form of substance use disorder in the
past year.

Abused substances produce some form of intoxication that alters judgment, perception, attention,
or physical control.

Many substances can bring on withdrawal effects caused by cessation or reduction in the amount
of the substance used. Withdrawal symptoms can range from mild anxiety to seizures and
hallucinations. Drug overdose may also cause death.

Nearly all drugs of abuse can also produce a phenomenon known as tolerance, in which one must
use a larger amount of the drug to produce the same level of intoxication. Commonly abused
drugs include the following:

 Inhalants: This group of substances includes solvents that emit vapors, causing
intoxication when breathed in (inhaled). Individuals who abuse inhalants intentionally
breathe in the vapors, either directly from a container, from a bag in which such a
substance is in, or from a rag soaked with the substance and then placed over the mouth
or nose. Inhalant intoxication happens quickly and doesn't last long.
 Abuse of inhalants is also called "huffing." Approximately 58% of inhalant users
report first using it by the end of ninth grade. Teens who started using inhalants
before 15 years of age were up to six times more likely as those who had started
later to develop dependence on these substances.
  Symptoms of inhalant intoxication are very similar to those seen with intoxication
with alcohol, including dizziness, clumsiness, slurred speech, elation, tiredness,
slowed reflexes, thinking and movement, shaking, blurred vision, stupor or coma,
and/or weakness. It can also result in chemical and temperature burns, as well as
withdrawal symptoms, chronic mental illness, and even sudden death.
 Long-term damage associated with inhalant use includes brain and nerve damage
as well as heart, liver, or kidney failure.
 Tobacco: People cite many reasons for using tobacco, including pleasure, improved
performance and vigilance, relief of depression, curbing hunger, and weight control.
 The primary addicting substance in cigarettes is nicotine. But cigarette smoke
contains thousands of other chemicals that also damage health both to the smoker
and to those around them. 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. Tobacco use
costs the nation an estimated $100 billion a year, mainly in direct and indirect
health-care costs.
 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 prolonged use may lead to alcoholism.
 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
abuse is the most common cause of liver failure in the U.S. 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. In 1992, the total economic cost of
alcohol abuse was estimated at $150 billion.

What Are Commonly Abused Drugs?

 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 United States. The active
ingredient in the plant, delta-9-tetrahydrocannabinol (THC), is associated with
intoxication. Marijuana resin, called hashish, contains an even higher concentration of
THC.
 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 the use of more powerful and dangerous drugs such as cocaine
and heroin. The risk for progressing to cocaine use is 104 times higher if you have
smoked marijuana at least once than if you never smoked marijuana.
 Synthetic (man-made) forms of marijuana (often called K2, Spice, Black Mamba,
Blaze and Red X) can be smoked or otherwise inhaled. It is an increasing health
 risk, in that it can produce the same impairment in judgment, addiction, and
inability to function as marijuana and go undetected by conventional drug testing.
Some preparations of synthetic marijuana are much more potent than traditional
marijuana, leading to a higher occurrence of becoming delirious, having seizures,
or a stroke.
 Cocaine (also known as crack, coke, snow, blow, rock): In 2010, an estimated 1.5 million
people over 12 years of age abused cocaine in the United States.
 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 have been associated with damage to the heart, the brain, the lung, and
the kidneys.
 Heroin (also known as dope, smack, horse): A 2010 National Household Survey on Drug
Abuse indicated that the average age when Americans use this drug for the first time is
about 21 years of age, including 140,000 who reported using it for the first time in the
year prior to the time the survey was taken.
 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 decreased breathing to the point of stopped breathing and
death. Because heroin is usually injected, often with dirty needles, use of the drug
can trigger other health complications including destruction of your heart valves,
tetanus, and botulism, and infections like HIV/AIDS or hepatitis.
 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.
 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.
 Anabolic steroids:
 This group of drugs includes testosterone, which is the natural male hormone. It
also includes a number of other synthetic forms of testosterone. Steroids are often
abused by bodybuilders or other athletes to increase muscle mass or improve
performance.
 These types of substances seem to be associated with a number of mental-health
effects, like dependence on the substance, mood problems, and developing other
kinds of drug abuse.
 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. The
following are the most popular club drugs:
  Ecstasy (also called MDMA, E, X, E pills, Adam, STP): This is a stimulant and
hallucinogen used to improve mood and to maintain energy, often for all-night
dance parties. Even onetime use can cause high fevers to the point of inducing a
seizure. 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 has been 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, 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, lovie, love boat): PCP is a 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 when under its effects. Usually, tobacco or marijuana
cigarettes are dipped into PCP and then smoked.

What Are the Causes and Risk Factors of Substance Abuse?

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 of abusing substances.

 Family history factors that influence a child's early development have been shown to be
related to an increased risk of drug abuse, such as
 Chaotic home environment,
 Ineffective parenting,
 Lack of nurturing and parental attachment,
 Parental drug use or addiction.
 Other risk factors for substance abuse are related to the substance abuse sufferer him- or
herself, like
 Male gender,
 Childhood Attention Deficit Hyperactivity Disorder (ADHD),
 History of anxiety or other mood disorders,
 Conduct disorder or antisocial personality disorder.
  Factors related to a child's socialization outside the family may also increase the risk of
drug abuse, including
 inappropriately aggressive or shy behavior in the classroom,
 poor social coping skills,
 poor school performance,
 association with a deviant peer group or isolating oneself from peers altogether,
 perception of approval of drug-use behavior.

What Are the Symptoms and Signs of Substance Abuse?

Friends and family may be among the first to recognize the signs of substance abuse. Early
recognition increases the 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
 A significant change in mood or behavior
 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
 Physical problems with unclear cause (for example, red eyes and slurred speech)
 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, and 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 or other problems at school or in the workplace for an alcohol- or drug-
related incident

When to Seek Medical Care

If you recognize that someone has a substance abuse problem and wants to quit, a doctor can
refer him/her to community resources where he/she may receive formal diagnosis and treatment
of a substance-abuse problem. A doctor also may prescribe medications to control cravings and
withdrawal or help manage medical complications resulting from substance abuse. Let a doctor
know what drugs are being used and how they are taken. Any of the following symptoms
warrant a call to the doctor:

 Mild tremors or an alcohol withdrawal seizure not accompanied by hallucinations or

confusion
 Jaundice (yellow skin and eyes)
 Increasing abdominal girth
 Leg swelling
 A cough, congestion, or sniffles that won't go away
 Continuing feelings of sadness or depression
 Pain at an injection site
 Fever

If any of the following occur, call for help 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 of being sexually assaulted while under the influence

Screening and Assessment for Substance Abuse

While there is no one test that establishes the diagnosis of a substance use disorder with
certainty, there are screening tools, including online tests, that may help identify people who are
at risk for having a substance use problem. Therefore, health-care professionals assess this group
of illnesses by gathering thorough mental-health, medical, and family information. The
practitioner will also likely ask that the individual's primary-care doctor perform a physical
exam, including lab tests to assess the person's medical health and to explore whether or not the
individual has a medical condition that can produce the same symptoms as a mental-health
problem.

Exploring the presence of mental-health symptoms includes determining if the person has a
substance use disorder, a mood disorder like depression and/or mania or anxiety, or if he or she
suffers from the hallucinations or delusions associated with schizophrenia, schizoaffective
disorder, or other psychotic disorders. The possible presence of a personality or behavior
disorders like attention deficit hyperactivity disorder (ADHD) is also usually explored.
Practitioners may use a quiz or self-test as a screening tool for substance-use disorders.

What Is the Treatment for Substance Abuse?

Most substance abusers believe they can stop using drugs on their own, but the majority who try
do not succeed. Before treatment for the addictive behavior can be directly addressed, the
substance abuse sufferer might need help in lessening physical withdrawal from alcohol or other
drugs they have been using. That initial phase of treatment is called detoxification or "detox." It
often requires inpatient hospital treatment.

Research shows that long-term drug use alters brain function and strengthens compulsions to use
drugs. This craving continues even after drug use stops.

Because of these ongoing cravings, the most important component of treatment, also called
recovery, is preventing relapse. Treating substance abuse often requires treatment in a
rehabilitation (rehab) program and depends on both the person and the substance being used. In
behavioral treatment, a counselor (like a social worker, psychologist, psychiatrist, psychiatric
nurse, or nurse practitioner) provides strategies to cope with drug cravings and ways to avoid
relapse. Treatment often includes individual and group therapy.

Once they have performed a thorough assessment of someone's condition, a doctor or nurse
practitioner may prescribe medications, such as nicotine patches and methadone, to control
withdrawal symptoms and drug cravings. Random drug testing is often an integral part of
encouraging the person with substance abuse problems to refrain from further drug use. Drug-
abuse hotlines can be an invaluable resource for people to initiate treatment and prevent relapse.

Often, a drug user has an underlying behavioral disorder or other mental illness, one that
increases the risk of substance abuse. When an individual suffers from a substance use disorder
in addition to another mental-health disorder, he or she is referred to as having a dual diagnosis.
Such disorders must be treated medically and through counseling along with treatment of the
drug abuse.

How Can You Prevent Substance Abuse?

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 provide information in order
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 of drug use from children's peers and families.

What Is the Prognosis for Substance Abuse?

Individuals who suffer from substance abuse tend to be more successful in recovery when they
are highly motivated to be in treatment, are actively engaged in their own recovery, and receive
intensive treatment services. Prognosis for substance abuse recovery is further improved by
being able to easily access community-based social supports.

Dr. williams for Medical Awareness International

Credits to emedicinehealth.com