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 1996 National Household Survey on Drug Abuse estimated the number of users of illicit drugs in the United States to be about 13 million. In addition, the survey estimated that 10% of Americans abuse or are dependent on alcohol, and 25% of Americans smoke cigarettes.
Abused substances produce some form of intoxication that alters judgment, perception, attention, or physical control.
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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.
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. 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 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 is the most common cause of liver failure in the US. 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.
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.
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): In 1997, an estimated 1.5 million people 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 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.
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.
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 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 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 includelow 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 (al 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.
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
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
Aggressiveness and irritability
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 "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 following symptoms:
Mild tremors or an alcohol withdrawal seizure not accompanied by hallucinations or confusion
Jaundice (yellow skin and eyes)
Increasing abdominal girth
Cough that won't go away
Continuing feelings of sadness or depression
Pain at an injection site
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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:
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
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. Your doctor 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.
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
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In 1992, officials estimated that alcohol and drug abuse in the US cost $246 billion. That figure did not include the health care costs related to tobacco.
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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