What is substance abuse?

Overview

According to the 2014 US National Survey on Drug Use and Health, an estimated 27.0 million Americans aged twelve years and older (10.2 percent of the population) used illicit drugs within one month of the survey. This total includes psychoactive prescription drugs used for nonmedical reasons.

Marijuana was the most commonly used illegal drug in 2014, followed by the nonmedical use of prescription-type psychotherapeutics (including pain relievers, tranquilizers, stimulants, and sedatives), cocaine, and hallucinogens. Drug abusers comprise all ages. Many abused substances have addictive properties; the user becomes dependent on the regular use of the substance and experiences withdrawal symptoms when use is discontinued. Symptoms of withdrawal range from depression and anxiety to seizures, depending on the substance of abuse and the length of use.

Society has determined that the use of illegal substances is harmful; thus, laws are applied to protect both the individual and society from the harmful consequences of their use.

Abuse of Legal Substances

Tobacco

Tobacco can be smoked or chewed. Nicotine, contained in tobacco, is highly addictive; it is a psychoactive substance that produces temporary physical and mood-altering effects in the brain. Nicotine also is a vasoconstrictor (blood vessel constrictor); thus, it increases the risk of cardiovascular disease.

Tobacco also is a well-known carcinogen, and tobacco’s use is the
leading cause of preventable illness and death in the United States. There are a
number of known tobacco-related cancers. In addition to lung, throat, and
mouth cancer, tobacco has been associated with cancers of the nasal cavity,
esophagus, stomach, pancreas, breast, kidney, bladder, and cervix. The smoking of
tobacco results in lost time at work either because of smoking breaks or because
of respiratory illnesses, which are more common in smokers.

According to the US National Cancer Institute and the Centers for Disease Control and Prevention:

•Cigarette smoking causes an estimated 480,000 deaths each year, including approximately 42,000 deaths from exposure to secondhand smoke (2015).

•Lung
cancer is the leading cause of cancer death among both men
and women in the United States; 90 percent of lung cancer cases are linked to
cigarette smoking in the United States.

•Persons who smoke are up to six times more likely than nonsmokers to have a heart
attack, and the risk increases with the number of cigarettes smoked. Smoking also
causes most cases of chronic lung disease, including chronic obstructive pulmonary
disease (COPD).

•In 2013, approximately 17.8 percent of adults in the United States were cigarette smokers. Approximately 20.5 percent of American men and 15.3 percent of American women were current cigarette smokers in 2013, according to the US Centers for Disease Control and Prevention.

•In 2013, 15.7 percent of high school students were current cigarette smokers, the lowest rate in twenty-two years.

Alcohol

Alcohol consumption involves the ingestion of ethanol (C2H5OH), which is a component of alcoholic beverages (beer, wine, and hard liquor). Alcoholism is a chronic condition in which a person is dependent upon regular ingestion of alcoholic beverages. Alcoholics are unable to control their drinking and continue to drink even though doing so interferes with their health, interpersonal relationships, or work.

Alcohol abuse refers to excessive drinking—enough to cause problems in daily life—without complete dependence upon the substance. The combination of alcohol abuse and tobacco use markedly increases the risk of cancers of the oral cavity. Approximately 50 percent of cancers of the mouth, pharynx (throat), and larynx (voice box) are associated with heavy drinking. Even in nonsmokers, a strong association exists between alcohol abuse and cancers of the upper digestive tract, including the esophagus, the mouth, the pharynx, and the larynx.

Prescription Medication

Prescription drug abuse involves the ingestion of medication that has been obtained without a prescription or that is used inappropriately (that is, not according to prescription instructions). According to the 2010 National Survey on Drug Use and Health, 2.4 million Americans used prescription drugs nonmedically for the first time within the past year, averaging 6,600 initiates per day.

Not infrequently, prescription drug abusers take medication with alcohol or
combine stimulants and depressants. These combinations increase the risk of
permanent damage to the user’s health or death. Commonly abused types of
prescription medications include opioids such as hydrocodone
(Vicodin), oxycodone (OxyContin, Percocet), and morphine;
central nervous system depressants, including benzodiazepines such as alprazolam (Xanax) and diazepam
(Valium), barbiturates such as phenobarbital (Luminal Soduim and
pentobarbital (Nembutal), and non-benzodiazepine sleep medications such as
zolpidem (Ambien) and eszopiclone (Lunesta); and stimulants
such as dextroamphetamine (Dexedrine) and methylphenidate (Ritalin). Narcotics and
central nervous system depressants cause drowsiness and respiratory depression;
stimulants can cause seizures, irregular heartbeat, paranoia, and dangerously
elevated body temperatures.

In some cases, a prescription may be obtained from a health care professional by feigning symptoms such as pain; however, most health care professionals are adept at spotting a drug abuser. Most abused prescription medication is purchased from a drug trafficker or stolen by the user.

Abuse of Illegal Substances

Illegal substances have the added risk of containing contaminants, which can
increase the health risk. For example, marijuana may be mixed with phencyclidine
(PCP). PCP was developed as an anesthetic, but its medical use was discontinued a
few years after its introduction because of its harmful effects on the brain. It
is not uncommon for an abuser of illegal substances to combine a drug with other
illegal substances, prescription drugs, or alcohol.

Marijuana

Smoked marijuana and smoked tobacco are chemically similar; thus, like cigarettes, the greatest health hazard of marijuana is from smoking the substance. The psychoactive component of marijuana leaves is delta-9-tetrahydrocannabinol (THC), which is a relatively safe drug. However, smoked marijuana is a health risk. Scientific analyses have identified a minimum of six thousand of the same chemicals in marijuana smoke that are present in tobacco. The chief difference between the two plants is that marijuana contains THC and tobacco contains nicotine. Moreover, one of the most potent carcinogens in tobacco smoke, Benzo[a]pyrene, is present in larger quantities in marijuana smoke.

Another factor increasing the carcinogenic risk is in the way it is inhaled. Marijuana smokers frequently inhale and hold the smoke in their lungs for an extended time to increase the drug’s effects; this practice increases the amount of tar deposited in the respiratory tract by about a factor of four.

Cocaine and Crack Cocaine

Cocaine is the most abused central
nervous system stimulant in the United States and is a frequent cause of emergency
room visits. Ingestion of cocaine can produce seizures, strokes, or heart attacks.
Some users claim that it is not addictive because it does not produce physical
withdrawal symptoms, which do occur with alcohol or heroin addiction. However,
cocaine has powerful psychological addictive properties. Users will often go to
extraordinary lengths to obtain the drug.

Methamphetamine

Methamphetamine is a highly addictive
street drug that can be readily and inexpensively manufactured from the
ingredients of common household products. Psychological effects of the substance
include agitation, depression, euphoria, mood disturbances, psychosis, and violent
behavior. In addition to being less expensive than cocaine, its effects are longer
lasting.

The use of methamphetamine can result in permanent injury to the brain, heart, and lungs. Furthermore, the volatile substances used in its manufacture can lead to fires and explosions.

Heroin

Heroin (diacetylmorphine) is a potent
analgesic (painkiller). It is abused for the intense euphoria it produces. It is
highly addictive, as tolerance to the drug develops quickly. As a result, users
need more of the drug to achieve the same effects. When injected intravenously,
heroin produces a greater degree of euphoria than other opiates, such as
morphine.

Treatment

Many substance abusers either deny that they have a problem or simply state that
the pleasure derived from the substance outweighs the negative impact on their
life; thus, treatment is often initiated by a triggering event or by the urging of
another person.

A triggering event may be conviction for driving under the influence, a health
condition (such as pancreatitis or cirrhosis of the liver), a threat of
divorce, a threat of a job loss, or a threat of loss of child custody. A spouse,
relative, coworker, or boss may be influential in initiating treatment. However,
some substance abusers ignore a triggering event or advice from others and
continue to abuse substances.

A number of treatment options are available to substance abusers. These vary markedly by the type of substances and by individual circumstances. In some cases, a brief intervention by a health care professional may be sufficient. Other cases require enrollment in an outpatient program, which includes counseling. More severe cases require an inpatient program.

The following steps are involved in treatment for persons requiring inpatient or intensive outpatient treatment:

Detoxification. For most drug addictions, detoxification (also called detox) is necessary. Sedatives
are often necessary to reduce withdrawal symptoms, which may include shaking,
confusion, or hallucinations. Withdrawal may last one or two weeks and may require
inpatient care at a hospital or a treatment center.

Reprogramming. A recovering substance abuser, with the help of
professionals skilled in substance abuse treatment, learns new skills and
formulates a treatment plan. The plan should include behavior-modification
techniques, counseling, goal setting, and use of self-help manuals or Internet
resources.

Psychological counseling. Counseling on an individual or a group
basis is an essential treatment component. Group
therapy is particularly valuable because it allows
interaction with other substance abusers. It promotes the idea that one’s problems
are not unique. Therapy may include the presence of a spouse or other family
members. Family support is a significant component of the recovery process.

Medication. Following medication for detox, long-term
pharmaceutical treatment may be used in some cases. Oral medications such as
disulfiram, acamprosate, and naltrexone are used for the treatment
of alcoholism. These medications produce unpleasant physical reactions such as
flushing, headaches, nausea, and vomiting. Methadone is commonly used in the treatment of heroin
addiction; however, its use is controversial. Critics claim that treating
recovering addicts with methadone is simply substituting one addictive drug for
another. Despite this opinion, many former addicts claim that they never could
have ended their heroin habit without help from methadone.

Follow-up support. Aftercare programs and support groups are
essential for the recovering substance abuser. These programs help the abuser to
avoid (or manage) relapses and deal with the necessary lifestyle changes to
maintain a drug-free existence. For alcoholics, regular attendance at a support
group such as Alcoholics Anonymous (AA) is often an important component of
follow-up care. Follow-up often includes psychological and medical care.

Substance abuse commonly is a component of other mental health disorders. For persons with mental health issues, psychological counseling or psychotherapy may be recommended. Substance abusers also can have medical conditions that require treatment. These conditions include hypertension (high blood pressure), diabetes, heart disease, and liver disease (such as cirrhosis of the liver). If a substance abuser remains drug-free, some medical conditions may decrease in severity or may resolve. Treatment for depression or anxiety also may be a part of follow-up.

Beyond counseling and medication, other modalities may be helpful. For example, in September 2010, researchers at the University of California, Los Angeles, released the results of a clinical trial involving a unique new therapy that applies electrical stimulation to a major nerve emanating from the brain. The technique, trigeminal nerve stimulation, achieved an average of a 70 percent reduction in depression in the eight-week study period.

Inpatient treatment. For persons with a serious substance abuse
problem, inpatient care is often necessary. These programs include detox followed
by counseling, group therapy, and medical treatment. A benefit of an inpatient
program is that it greatly reduces the risk of a patient gaining access to harmful
substances. Regular outpatient follow-up also is essential.

Many medical centers include treatment for substance abuse. Stand-alone facilities
also are present throughout the United States and other developed nations. Some
provide care in a basic, clinical setting while others function in a resort-like
setting. One well-known facility is the Betty Ford Center
in Rancho Mirage, California, which was founded by former US first lady Betty
Ford. The nonprofit residential facility offers inpatient, outpatient, and day
treatment for recovering substance abusers and addicts. It also provides
prevention and education programs for family members (including children) of
substance abusers and addicts.

Support groups. A variety of support groups are available to a
substance abuser who admits he or she has a problem. Treatment centers may have
their own support groups or may refer patients to outside programs they deem
suitable. A recovering alcoholic may have to try a variety of resources before
finding the best fit.

Religious support. Churches and synagogues often sponsor support
for recovering alcoholics. Members can use available services, which are often
integrated with other organizations and social services in the community. Although
nonsectarian and nondenominational, AA is a faith-based organization as
exemplified by its twelve-steps program. The twelve steps include the
acknowledgement of the existence of a supreme being.

Genetic Factors

Significant evidence exists that genetic factors are involved in the development of substance abuse and addiction, particularly alcoholism. The interaction of genes and environmental factors that influence substance dependence is a complex scientific topic.

Since 1989, the US-government-funded Collaborative Studies on the Genetics of
Alcoholism (COGA) has been tracking alcoholism in families. COGA researchers have
interviewed more than 14,000 people and sampled the DNA of 300 extended families.
They have found evidence for the existence of several alcohol-related genes. COGA
researchers are increasingly convinced that different types of alcoholics are
representative of a number of genetic variations.

Social Implications

Substance abuse has a tremendous impact on society. For example, many people are
injured or killed by substance abusers who drive under the influence of one or
more psychoactive substances. Family members of substance abusers suffer from the
emotional and financial burden placed on them by a substance abuser. Furthermore,
substance abusers accrue countless hours of lost and unproductive work.

All developed nations have extensive legislation regarding substance abuse and age limits for legal substances. For example, in the United States the legal drinking age is twenty-one years and the legal smoking age is eighteen years. However, some nations have more lenient restrictions. Some substances deemed illegal by one government are considered legal by another.

An example of a substance with varying degrees of legality is marijuana. The substance is deemed illegal by the US federal government; however, the recreational use of marijuana is legal in Colorado, Washington, Oregon, and Washington, DC. The use of medical marijuana remains a contentious topic. Medical marijuana has been legalized in some US states to allow usage for legitimate medical reasons, such as for glaucoma or for pain relief from cancer. However, there is a concern that the substance will be dispensed for frivolous, nonmedical reasons or diverted for illegal use.

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