Substance Abuse

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.
  • The National Institute on Drug Abuse estimated the number of users of illicit drugs in 2014 in the United States ages 12 and over to be about 7 million. In addition, the survey estimated that 6.4% of Americans (roughly 17 million adults) abuse or are dependent on alcohol.

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.

Many substances, such as alcohol, tranquilizers, opiates, and stimulants, over time 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.

  • Tobacco: People cite many reasons for using tobacco, including pleasure, improved performance and vigilance, relief of depression, curbing hunger, and weight control.
  • 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.
    • 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 can cause heart enlargement and increase the risk for cancer of the esophagus and stomach. It can also cause chronic inflammation of the pancreas (chronic pancreatitis) and cirrhosis of the liver, which are both considered to be risk factors for pancreatic cancer.
    • 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.
  • 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 plant produces delta-9-tetrahydrocannabinol (THC), the active ingredient associated with intoxication. Marijuana resin, called hashish, contains an even higher concentration of THC. In 2014, there were 22.2 million Americans age 12 and over who reported using marijuana in the past month, up from 14.4 million (5.8 percent) in 2007. 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): Cocaine use has gone down in the last few years; from 2007 to 2012, the number of current users in the U.S. ages 12 or older dropped from 2.1 million to 1.7 million. In 2014, the number of adults (ages 12 and older) that reported using cocaine in the previous month was 0.10 percent.
    • 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. According to the National Survey on Drug Use and Health (NSDUH), in 2012 about 669,000 Americans reported using heroin in the past year, a number that has been on the rise since 2007. The biggest increases are among users ages 18 to 25.
    • 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 respiratory arrest (stopping 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.
  • Methamphetamine (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.
  • 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, or 3,4-methylenedioxy-methamphetamine, as well as Adam, STP): This is a 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 body temperature, sleep, pain, memory, and emotions.
    • GHB (gamma hydroxybutyrate; 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, 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," psychosis (hallucinations, delusions, paranoia), and mood disturbances.
    • PCP (also known as angel dust, hog, 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. Usually, tobacco or marijuana cigarettes are dipped into PCP and then smoked.

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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.
  • Chaotic home environment
  • Genetic risks (drug or alcohol abuse sometimes can run in families)
  • Lack of nurturing and parental attachment
  • Factors related to a child’s socialization outside the family may also increase risk of drug abuse.
  • 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 help reduce 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 following symptoms:

  • 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

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When to Go to the Hospital

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 abuse 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 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. Your doctor may prescribe medications, such as nicotine patches and methadone, naltrexone or Suboxone, to control withdrawal symptoms and certain 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.

Next Steps

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.

Outlook

Costs to society

In 2002, drug abuse in the U.S. cost around $180 billion in direct health costs, lost productivity, and law enforcement costs. Alcohol abuse in 2003 cost $223 billion in health care expenses, lost workplace productivity, and law enforcement costs.

  • 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.

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For More Information

Web Links

The National Institute on Drug Abuse (NIDA) part of the National Institutes of Health (NIH) offers several reports on substance abuse.

Substance Abuse and Mental Health Services Administration.

CDC.

Heroin Abuse and Addiction: Research Report.

Cocaine Abuse and Addiction: Research Report.

Methamphetamine Abuse and Addiction: Research Report.

Nicotine Addiction: Research Report.

Preventing Drug Use Among Children and Adolescents: A Research Based Guide.

Principles of Drug Addiction Treatment: A Research Based Guide.

The Center for Health Communication of the Harvard School of Public Health offers "A Guide for Teens: Does Your Friend Have An Alcohol or Other Drug Problem?"

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

WebMD Medical Reference from eMedicineHealth Reviewed by Joseph Goldberg, MD on April 23, 2016

Sources

Authors and Editors

Author: Kevin P Daly, MD, Staff, Emergency Dept., California Emergency Physicians.



Coauthor(s): John Richards, MD, Assistant Professor, Department of Internal Medicine, Division of Emergency Medicine, University of California at Davis Medical Center.



Editors: Scott H Plantz, MD, FAAEM, Research Director, Assistant Professor, Department of Emergency Medicine, Mount Sinai School of Medicine; Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine; Jeter (Jay) Pritchard Taylor III, MD, Vice-Chief, Compliance Officer, Attending Physician Emergency Medicine Residency, Department of Emergency Medicine, Palmetto Richland Memorial Hospital, University of South Carolina.

 

Substance Abuse from eMedicineHealth

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