Substance Abuse and Drug abuse are used interchangeably.
The National Center on Addiction and Substance Abuse boldly claims that “a child who reaches age twenty-one without smoking, abusing alcohol or using drugs is virtually certain never to do so.” Many policy makers and drug abuse professionals do not take the center claim lightly.
In anti-drug campaigns and programs, children and adolescents are repeatedly advised to resist the influences of peer pressure, popular music, and films, and to abstain from underage drinking, smoking, and marijuana use.
Efforts are especially aimed at keeping young people from using marijuana due to the “gateway theory” belief that using marijuana increases one’s likelihood of using harder drugs.
A committee of the American Academy of Pediatrics, for example, claims that “adolescents who use marijuana are 104 times more likely to use cocaine compared with peers who never smoked marijuana,” and that “marijuana’s role as a ‘gateway drug’ for some teenagers must be considered.”
Some suggest that marijuana users go on to try other drugs because they grow tolerant of marijuana’s effects. According to columnist Phyllis Schlafly, “The ‘high’ from pot gradually diminishes and pot smokers often take other drugs to get a kick.”
However, detractors contend that the gateway theory fails to hold up when drug abuse patterns are examined closely. Professors Lynn Zimmer and John P. Morgan state, “Over time, as any particular drug increases or decreases in popularity, its relationship with marijuana changes.
Cocaine became very popular in the early 1980s as marijuana use was declining.” Others suggest that drug abuse is linked more strongly to the traits of the abuser than the use of a gateway drug. “We’ve long known that everyone reacts to drugs differently,” says writer Cynthia Cotts, “and that the risk of addiction is predicted by many factors, such as genetic hard-wiring and social status.” These and other issues are debated in the following chapter, which examines the factors that contribute to drug abuse.
CLASSIFICATION OF SUBSTANCE-RELATED DISORDERS
Under certain conditions, the use of substances that affect mood and behavior is normal, at least as gauged by statistical frequency and social standards. It is normal to start the day with caffeine in the form of coffee or tea, to take wine or coffee with meals, to meet friends for a drink after work, and to end the day with a nightcap.
Many of us take prescription drugs that calm us down or ease our pain. Flooding the bloodstream with nicotine by means of smoking is normal in the sense that about 1 in 5 Americans do it.
However, some psychoactive substances, such as cocaine, marijuana, and heroin, are illegal and are used illicitly. Others, such as anti anxiety drugs (such as Valium and Xanax) and amphetamines (such as Ritalin), are available by prescription for legitimate medical uses.
Still, others such as tobacco (which contains nicotine, a mild stimulant) and alcohol (a depressant), are available without prescription, or over-the-counter. Ironically, the most widely and easily accessible substances tobacco and alcohol cause more deaths through sickness and accidents than all illicit drugs combined.
The classification of substance-related disorders in the DSM system is not based on whether a drug is legal or not, but rather on how drug use impairs the person’s physiological and psychological functioning.
The DSM-IV classifies substance-related disorders into two major categories: substance use disorders and substance-induced disorders.
Substance-induced disorders
These are disorders induced by using psychoactive substances, such as intoxication, withdrawal syndromes, mood disorders, delirium, dementia, amnesia, psychotic disorders, anxiety disorders, sexual dysfunctions, and sleep disorders. Different substances have different effects, so some of these disorders may be induced by one, a few or nearly all substances.
Substance intoxication refers to a state of drunkenness or being “high.” This effect largely reflects the chemical actions of the psychoactive substances.
The particular features of intoxication depend on which drug is ingested, the dose, the user’s biological reactivity, and to some degree the user’s expectations. Signs of intoxication often include confusion, belligerence, impaired judgment, inattention, and impaired motor and spatial skills.
Extreme intoxication from use of alcohol, cocaine, opioids, (narcotics)and PCP can even result in death (yes, you can die from alcohol overdoses),either because of the substance’s biochemical effects or because of behaviour patterns such as suicide that are connected with psychological pain or impaired judgment brought on by use of the drug.
Substance use disorders are patterns of mal-adaptive use of psychoactive substances. These disorders, which include substance abuse and substance dependence, are the major focus of our study.
Substance Abuse and Dependence
Where does substance use end and abuse begin? According to the DSM, substance abuse is a pattern of recurrent use that leads to damaging consequences.
Damaging consequences may involve failure to meet one’s major role responsibilities (e.g., as student, worker, or parent), putting oneself in situations where substance use is physically dangerous (e.g., mixing driving and substance use), encountering repeated problems with the law arising from substance use (e.g., multiple arrests for substance-related behaviour), or having recurring social or interpersonal problems because of substance use (e.g., repeatedly getting into fights when drinking).
When people repeatedly miss school or work because they are drunk or “sleeping it off,” their behaviour may fit the definition of substance abuse. A single incident of excessive drinking at a friend’s wedding would not qualify.
Nor would regular consumption of low to moderate amounts of alcohol be considered abusive so long as it is not connected with any impairment in functioning. Neither the amount nor the type of drug ingested, nor whether the drug is illicit, is the key to defining substance abuse according to the DSM.
Rather, the determining feature of substance abuse is whether a pattern of drug-using behaviour becomes repeatedly linked to damaging consequences.
Substance abuse may continue for a long period of time or progress to substance dependence, a more severe disorder associated with physiological signs of dependence (tolerable come compulsive users lack control over their drug use.
They may be aware of how their drug use is disrupting their lives or damaging their health, but feel helpless or powerless to stop using drugs, even though they may want to. By the time they become dependent on a given drug, they’ve given over much of their lives to obtaining and using it. The cocaine user whose words opened this chapter would certainly fit this definition.
Repeated use of a substance may alter the body’s physiological reactions, leading to the development of tolerance or a physical withdrawal syndrome (see Table 9.1).
Tolerance is a state of physical habituation to a drug, resulting from frequent use, such that higher doses are needed to achieve the same effect.
A withdrawal syndrome (also called an abstinence syndrome) is a cluster of symptoms that occur when a dependent person abruptly stops using a particular substance following heavy, prolonged use. People who experience a withdrawal syndrome often return to using the substance to relieve the discomfort associated with withdrawal, which thus serves to maintain the addictive pattern.
Withdrawal symptoms vary with the particular type of drug. With alcohol dependence, typical withdrawal symptoms include dryness in the mouth, nausea or vomiting, weakness, increased heart rate, anxiety, depression, headaches, insomnia, elevated blood pressure, and fleeting hallucinations.
In some cases of chronic alcoholism, withdrawal produces a state of delirium tremens, or DTs. DTs are usually limited to chronic, heavy users of alcohol who dramatically lower their intake of alcohol after many years of heavy drinking.
DTs involve intense autonomic hyperactivity (profuse sweating and tachycardia) and deliriuma state of mental confusion characterized by incoherent speech, disorientation, and extreme restlessness. Terrifying hallucinations frequently of creepy, crawling animals may also be present.
Substances that may lead to withdrawal syndromes include in addition to Alcohol opioids, cocaine, amphetamines, sedatives and barbiturates, nicotine, etc
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Diagnostic Features of Substance Dependence
Substance dependence is defined as a mal-adaptive pattern of use that results in significant impairment or distress, as shown by the following features occurring within the same year:
- Tolerance for the substance, as shown by either
- the need for increased amounts of the substance to achieve the desired effect or intoxication, or
- marked reduction in the effects of continuing to ingest the same amounts.
- Withdrawal symptoms, as shown by either
- the withdrawal syndrome that is considered characteristic for the substance, or
- the taking of the same substance (or a closely related substance, as when methadone is substituted for heroin) to relieve or to prevent withdrawal symptoms.
- Taking larger amounts of the substance or for longer periods of time than the individual Intended (e.g., person had desired to take only one drink, but after taking the first, continues drinking until severely intoxicated).
- Persistent desire to cut down or control intake of substance or lack of success in trying to exercise self-control.
- Spending a good deal of time in activities directed toward obtaining the substance (e.g., visiting several physicians to obtain prescriptions or engaging in theft), in actually ingesting the substance, or in recovering from its use. In severe cases, the individual’s daily life revolves around substance use.
- The individual has reduced or given up important social, occupational, or recreational activities due to substance use (e.g., person withdraws from family events in order to indulge in drug use).
- Substance use is continued despite evidence of persistent or recurrent psychological or physical problems either caused or exacerbated by its use (e.g., repeated arrests for driving while intoxicated).
Addiction: Impaired control over the use of a chemical substance, accompanied by physiological dependence.
Physiological dependence:
A condition in which the drug user’s body comes to depend on a steady supply of the substance.
Anti-anxiety agents (minor tranquilizers).Marijuana and hallucinogens such as LSD are not recognized as producing a withdrawal syndrome, because abrupt withdrawal from these substances does not produce clinically significant withdrawal effects.
Substance dependence is often, but not always, associated with the development of physiological dependence. It sometimes involves a pattern of compulsive use without physiological or chemical dependence.
For example, people may become compulsive users of marijuana, especially when they rely on the drug to help them cope with the stresses of daily life.
Yet they may not require larger amounts of the substance to get “high” or experience distressing withdrawal symptoms when they cease using it. In most cases, however, substance dependence and physiological features of dependence occur together.
Despite the fact that the DSM considers substance abuse and dependence to be distinct diagnostic categories, the borderline between the two is not always clear. Unfortunately, substance abuse and dependence disorders are common problems in our society.
An estimated 10.3% of adults in the United States develop drug (substance) use disorders on an illicit drug at some point in their lives, with about 7.7% developing a drug abuse disorder and about 2.5% developing a drug dependence disorder. About 8% of adult Americans develop alcohol abuse or dependence disorders .
People with one drug use disorder, such as alcohol dependence disorder, often present with another, such as cocaine dependence disorder.
Addiction and Other Forms of Compulsive Behavior
The DSM uses the terms substance abuse and substance dependence as categories of substance use disorders. It does not use the term addiction to describe these problems. Yet the concept of addiction is widespread among professionals and laypeople alike.
Even some leading professionals believe the word “addiction” should replace the word “dependence” in the diagnostic manual (O’Brien, Volkow, & Li, 2006). But what does the term “addiction” mean? Before we proceed to discuss drugs of abuse, let us define the terms we will be using.
Addiction is thereby a compulsive use of a drug accompanied by signs of physiological dependence. People become compulsive users when they have impaired control over their use of a drug. In effect, they feel compelled to continue using the drug despite the negative consequences that continued use of the drug entails.
By physiological dependence, we mean that a person’s body has changed as a result of the regular use of a psychoactive drug in such a way that it comes to depend on having a steady supply of the substance. The major signs of physiological dependence are the development of tolerance and a withdrawal syndrome.
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Substance Abuse and Dependence
- Psychological dependence
Compulsive use of a substance to meet a psychological need. People can also develop psychological dependence on a drug without becoming physiologically or chemically dependent.
These individuals come to compulsively use a drug to meet psychological needs. We can think of someone who compulsively uses marijuana to cope with daily stress, but is not physiologically dependent on the drug.
On the other hand, a person may become physiologically dependent on a drug but not become a compulsive user. For example, people recuperating from surgery are often given narcotics derived from opium as painkillers. Some develop signs of physiological dependence, such as tolerance and a withdrawal syndrome, but do not develop impaired control over the use of these drugs.
Other forms of compulsive behavior, such as compulsive gambling, shopping, or even Internet use, can be likened to forms of non-chemical addiction. Whether we label such behavioral patterns as addictions depends on how we define the concept of addiction
Racial and Ethnic Differences in Substance Use Disorders
Despite the popular stereotype that drug dependence is more frequent among ethnic minorities, this belief is not supported by evidence.
To the contrary, African Americans and Latinos have comparable or even lower rates of substance use disorders than do European Americans (non-Hispanic Whites) (Breslau et al., 2005; Compton et al., 2005).Moreover, African American adolescents are much less likely than European American adolescents to develop substance abuse or dependence problems .
WAYS TO PREVENT SUBSTANCE ABUSE
While it is practically impossible to prevent anyone and everyone from using substance of abuse, there are things we can do to avoid its abuse. The includes;
Effective deal with peer pressure: The biggest reasons why teens start using drugs is because their friends utilize peer pressure. No one likes to be left out, and teens (and yes, some adults too) find themselves doing things they normally wouldn’t do, just to fit in. in recent cases, you need to either find a better group of friends that won’t pressure you into doing harmful things, or you try to find a good way to say no. Teens should prepare a good excuse or plan ahead of time, to keep from giving into tempting situation.
Deal with life pressure: people today are overworked and overwhelmed, and often feel like a good break or a reward is deserved. But in the end, drugs only make life more stressful and many of us all too often fail to recognise these in the moment. To prevent using drugs as a reward, find other ways to handle stress and unwind. Take up exercising, read a good book, volunteer with the needy, create something. Anything positive and relaxing helps take the mind off than using drugs to relieve stress.
Seek help for mental illness: Mental illness and substance abuse often go hand in hand. Those with a mental illness may turn to drugs as a way to ease the pain. Those suffering from some forms of mental illness, such as anxiety, depression or post-traumatic stress disorders should seek the help of a trained professional for treatment before it leads to substance abuse.
Examine the risk factors: If you are aware of the biological, environmental and physical factors you possess, you are more likely to overcome them. A history of substance abuse in the family, living in a social setting that glorifies drug abuse and / or family life that models drug abuse can be risk factors.
Keep a well-balanced life: People take up drugs when something in their life is not working, or when they are unhappy about their lives or where their lives are going. Look at life’s big picture, and have priorities in order.
SUBSTANCE ABUSE MANAGEMENT / TREATMENT OF SUBSTANCE ABUSE
Drug abuse is a complex disorder that can involve virtually every aspect of an individual’s functioning in the family, at work and school, and in the community.
Because of addiction’s complexity and pervasive consequences, drug addiction treatment typically must involve many components. Some of those components focus directly on the individual’s drug use; others, like employment training, focus on restoring the addicted individual to productive membership in the family and society enabling him or her to experience the rewards associated with abstinence.
Treatment for substance abuse and addiction is delivered in many different settings using a variety of behavioral and pharmacological approaches. In the United States, more than 14,500 specialized drug treatment facilities provide counseling, behavioral therapy, medication, case management, and other types of services to persons with substance use disorders.
Along with specialized drug treatment facilities, drug abuse and addictions are treated in physician offices and mental health clinics by a variety of providers, including counselors, physicians, psychiatrists, psychologists, nurses, and social workers.
Treatment is delivered in outpatient, inpatients and residential settings. Although specific treatment approaches often are associated with particular treatment settings, a variety of therapeutic interventions or services can be included in any given setting.
Because drug abuse and addiction are major public health problems, a large portion of drug treatment is funded by local, State, and Federal governments. Private and employer-subsidized health plans also may provide coverage for treatment of addiction and its medical consequences.
Unfortunately, managed care has resulted in shorter average stays, while a historical lack of or insufficient for substance abuse treatment has curtailed the number of operational programs.