Drug Dependence and Abuse

Drug abuse (substance abuse) is an intense desire to use increasing amounts of a particular substance or to take illegal drugs or misuse legal substances such as alcohol or prescription medications.

Drug abuse and drug dependence represent different ends of the same disease process.

Drug abuse is an intense desire to use increasing amounts of a particular substance or substances to the exclusion of other activities.

Drug dependence is the body's physical need, or addiction, to a specific agent. There is therefore virtually no difference between dependency and addiction. Over the long term, this dependence results in physical harm, behavior problems, and association with people who also abuse drugs. Stopping the use of the drug can result in a specific withdrawal syndrome.

Drug abuse is a common problem that plagues all ethnic groups and social classes worldwide.

• Control of drug abuse is a top priority of the United States Surgeon General, as outlined in the Healthy People 2010 goals for the nation.
• Different people are affected by drugs in different ways. Some people are more prone to alcoholism and other drug addictions than others.
• Drug abuse and dependence is a disease and not a character defect. A person being treated for this condition should be given the same respect as a person with any other medical condition.
• A person who abuses drugs may not realize that he or she has a problem. Family members often bring the abuse to the attention of a health care professional. Unfortunately, some people who abuse drugs only realize they have a problem after they have been arrested for a drug-related violation of the law.
• A wide variety of substances can be abused. These take the form of illegal drugs (hallucinogens such as phencyclidine known as PCP, LSD, and illicit narcotics like heroin), plant products (such as marijuana or hallucinogenic mushrooms), chemicals (the inhalation of gasoline, for example), or prescription drugs (like Vicodin, Percocet, or Oxycontin). More information can be found at the National Institute on Drug Abuse.
• Substances can be taken into the body in several ways:
  • Oral ingestion (swallowing) as with alcohol or Ecstasy
  • Inhalation (breathing in) or smoking as with tobacco cigarettes or marijuana
  • Injection into the veins (shooting up) as with heroin
  • Depositing onto the mucosa (moist skin) of the mouth or nose (snorting) as with cocaine
• In addition to health care costs from drug abuse, society pays a huge price for the effects of drug addiction.
  • Monetary costs from theft by abusers to support their drug habits
  • Additional tax money to pay for law enforcement agencies, including the U.S. Coast Guard
  • Loss to society of the potential contributions the drug abuser would have made to his or her community had he or she remained sober and productive

While there is no single cause for substance abuse, people abuse drugs for several different reasons.

• The most common reason why people abuse drugs are to "get high." Adolescents and preadolescents can become involved in experimentation with drugs. However, only a small percentage of people who experiment with drugs become drug abusers. The desire to get high may be from an underlying psychological disease such as depression. Other risk factors for drug use also include the pressures of coping with school, work, or family tensions.
• Drug abuse by pregnant women results in the developing fetus (baby) being exposed to these same drugs. The baby may develop birth defects. The baby may be born with an addiction and go into withdrawal. The baby may be born with a disease associated with drug abuse such as HIV/AIDS.
• People with a current or a history of specific medical conditions, such as chronic pain from cancer, can become dependent on certain drugs. Many psychiatric diseases can be complicated by substance abuse. Similarly, drug abuse may be a sign of a more serious mental health problem. Individuals who fit the diagnostic criteria for both a substance abuse and another mental health disorder are often referred to as having a dual diagnosis.
• Athletes have abused a variety of agents, such as steroids, to enhance muscle mass or improve athletic ability. Athletes have also abused amphetamines to make them feel more powerful and to mask the pain so they can continue to play even with injuries. Drug testing programs have reduced this problem to some extent, but drug use among athletes is still an issue worldwide.

The signs and symptoms displayed by a person depending on what substances the person has abused. A person who has not abused drugs extensively may experience unpleasant symptoms and may seek help from family members and friends. Chronic drug abusers generally know what to expect from their drug use and rarely seek help for themselves.

• Most agents cause a change in the level of consciousness -- usually a decrease in responsiveness. A person using drugs may be hard to awaken to or may act bizarrely.
• Suppression of brain activity can be so severe that the person may stop breathing, which can cause death.
• Alternatively, the person may be agitated, angry, anxious, and unable to sleep. Hallucinations are possible.
• Abnormal vital signs (temperature, pulse rate, respiratory rate, blood pressure) are possible and can be life-threatening. Vital sign readings can be increased, decreased, or absent completely.
• Sleepiness, confusion, and coma are common. Because of this decline in alertness, the drug abuser is at risk for assault or rape, robbery, and accidental death.
• Skin can be cool and sweaty or hot and dry.
• Chest pain is possible and can be caused by heart or lung damage from drug abuse.
• Abdominal pain, nausea, vomiting, and diarrhea are possible. Vomiting blood, or blood in bowel movements, can be life-threatening.
• Withdrawal syndromes are variable depending on the agent but can be life-threatening.
• People with drug dependency often develop a tolerance to their drug of choice in that it takes more of the substance over time to achieve the desired effect.
• Sharing IV needles among people can transmit infectious diseases, including HIV (the virus that causes AIDS) and hepatitis types B and C.
• Many common household drugs and chemicals can be abused. Gasoline and other hydrocarbons are frequently abused by adolescents and preadolescents as inhalants. Over-the-counter drugs, such as cold medications, are commonly taken in excessive doses by adolescents and young adults to get high. Prescription medications are additional examples of drugs that are abused and that can be obtained illegally (without a prescription).
• Amphetamines and cocaine cause impotence in men. Sildenafil (Viagra) has been used by users of cocaine, methamphetamine, and other and amphetamines to counteract impotence. Because Viagra is generally prescribed for middle-aged and older men, a younger person must be questioned as to why he has a need for Viagra.

There are thought to be four stages of addiction symptoms that correspond to the increasing severity of the addiction: no symptoms, to wanting, craving, and needing the drug of choice.

Someone who wishes to receive treatment for substance abuse or dependence should see a doctor. Family members should accompany the person with a drug abuse problem to the doctor's appointment to discuss the issue.

• Referral for counseling can be beneficial for some people. One place to start would be at the American Academy of Health Care Providers in the Addictive Disorders.
• Complications from drug abuse need medical evaluation.

A person with an acute drug overdose should be brought to a hospital's emergency department immediately. An emergency department is a frequent place for people who suffer from drug dependence to seek medical care. People who are behavior problems may come to the attention of the emergency medical services system or police. These public service professionals can assist in bringing the person to the hospital.

• Anyone with an alteration of consciousness needs immediate medical evaluation. Such a person may not recognize how ill he or she is or may be a danger to himself or herself or to others. A hallucinating person, for example, may think he can fly and jump off a building, killing himself as well as a person below. Violent behavior is also possible.
• Anyone with abnormal vital signs, severe pain, or any severe or sudden onset of problems needs immediate help.

In order to determine if the diagnosis of substance abuse or dependence is appropriate, the doctor will determine what substances have been abused and will ask what symptoms prompted the person to seek care. The health care professional will assess whether the individual being evaluated meets diagnostic criteria for a specific substance abuse disorder. The doctor will then perform a physical examination to evaluate for possible organ damage.

• Laboratory studies are directed to evaluate for specific organ damage.
• Drug screening tests are readily available for some agents. Other substances can be detected with specialized tests at only a few laboratories in the country. Some agents cannot be detected by laboratory evaluation. Depending upon the circumstances, there may be little benefit from drug testing.

If a drug has been ingested inappropriately, contact a local chapter of the American Association of Poison Control Centers. Visiting an emergency department is usually appropriate to obtain proper treatment.

• Home care is not appropriate if the drug of abuse cannot be identified. People who have ingested unknown drugs should be taken to the emergency department immediately.
• People with severe symptoms should not be treated at home. They should be taken directly to the emergency department.

The key to treatment also called recovery, is stopping the abuse of drugs or substances.

• Agitated or violent people need physical restraint and may need sedating medications in the emergency department until the effects of the drugs wear off. This can be disturbing for the person to experience and for family members to witness. Medical professionals go to great lengths to use as little force and as few medications as possible. It is important to remember that whatever the medical staff does, it is to protect the person.
• Very few antidotes are available for drug intoxications. In most cases, the only way to eliminate a drug is for the body to metabolize it -- in other words, let it run its course. In some acute intoxications, the doctor may administer certain agents to help prevent absorption in the stomach or to help speed the metabolism of the drug.
• The dose of some agents (for example, benzodiazepines and barbiturates) must be reduced slowly to prevent withdrawal. Withdrawal from some drugs can cause significant problems, and stopping these drugs should only be done under the supervision of appropriate health care professionals. Withdrawal from other agents, such as narcotics, can be very uncomfortable but generally not harmful, and unpleasant effects can be lessened with prescription medications. These prescriptions must be combined with a specific plan for stopping drug abuse. The use of prescription medication combined with continued drug abuse may cause life-threatening complications.
• People who are acutely intoxicated may need inpatient treatment, hospitalization, or detoxification. Some cities have detoxification (detox) centers for those sobering from drug and alcohol intoxication.
• Counseling programs may be suggested. Programs similar to Alcoholics Anonymous, such as those listed through the Web of Addictions, are helpful for some people.

The initial evaluation by a doctor is just the first step in battling drug abuse. Follow-through in drug avoidance is essential to successful treatment.

• It will generally be necessary to discharge the person from the emergency department into the care of recovery program or a sober adult. Activities that require skill and judgment, such as driving, high-speed activities (bicycling, skateboarding), operating machinery, and swimming (even bathtub use) should not be undertaken until all the effects of the drug have worn off.
• Joining support groups like Alcoholics Anonymous or Narcotics Anonymous can be intimidating, but such groups are very helpful for some people. A social worker or other counselor at the hospital can advise on local resources available.

To prevent further drug use, avoiding places frequented by drug abusers and not associating with known drug abusers is important.

While knowledge about drug use and abuse can help prevent abuse in the first place and avoid relapse among those who are recovering, research is showing that a more comprehensive physical and emotional approach to a drug-free life and health in general is a more effective approach compared to just what has been called resistance education.

The importance of abstaining from drug use is clear given the devastating, sometimes fatal prognosis of drug abuse and dependence. Drug abuse can affect every major organ system, even after a single-use.

Treatment of drug dependence and abuse requires a long-term outlook. A person who has abused drugs in the past must be constantly vigilant never to use them again.

Relapses are common. Family and friends must provide support with a firm while caring attitude during these relapses.