Substance Abuse and Dependence Health Article

Definition

Substance abuse is the continued compulsive use of mind-altering substances despite personal, social, and/or physical problems caused by the substance use. Abuse may lead to dependence, in which increased amounts are needed to achieve the desired effect or level of intoxication and the patient's tolerance for the drug increases.

Description

Substance abuse and dependence cut across all lines of race, culture, education, and socioeconomic status, leaving no group untouched by their devastating effects. Substance abuse is an enormous public health problem with far-ranging effects throughout society. In addition to the toll substance abuse can take on one's physical

health, it is considered an important factor in a wide variety of social problems, affecting rates of crime, domestic violence, sexually transmitted diseases (including HIV/AIDS), unemployment, homelessness, teen pregnancy, and failure in school. One study estimated that 20% of the total yearly cost of health care in the United States is spent on treating the effects of drug and alcohol abuse.

A wide range of substances can be abused. The most common classes include:

• alcohol
• cocaine-based drugs
• opioids (including such prescription pain killers as morphine and Demerol as well as such illegal substances as heroin)
• benzodiazapines (including prescription drugs used for treating anxiety, such as valium)
• sedatives or "downers" (including prescription barbiturate drugs commonly referred to as tranquilizers)
• stimulants or "speed" (including prescription amphetamine drugs used as weight loss drugs and in the treatment of attention deficit disorder) and Ecstasy (which in 2001 had been tried by more than 12% of teens, up 71% over 1999 figures)
• cannabinoid drugs obtained from the hemp plant (including marijuana and hashish).
• hallucinogenic or "psychedelic" drugs (including LSD, PCP or angel dust, and other PCP-type drugs)

• inhalants (including gaseous drugs used in the medical practice of anesthesia, as well as such common substances as paint thinner, gasoline, and glue). A 2002 study found that inhalant use among youths was even higher than that of Ecstasy

Over time, the same dosage of an abused substance will produce fewer of the desired feelings. This is known as drug tolerance. In order to continue to feel the desired effect of the substance, the person must take progressively higher drug doses.

Substance dependence is a phenomenon whereby a person becomes physically addicted to a substance. A substance-dependent person must have a particular dose or concentration of the substance in his or her bloodstream at any given moment in order to avoid the un-pleasant symptoms associated with withdrawal from that substance. The common substances of abuse tend to exert either a depressive (slowing) or a stimulating (speeding up) effect on such basic bodily functions as respiratory rate, heart rate, and blood pressure. When a drug is stopped abruptly, the person's body will respond by overreacting to the substance's absence. Functions slowed by the abused substance will suddenly speed up, while previously stimulated functions will slow down. This results in very unpleasant effects, known as withdrawal symptoms.

Addiction refers to the mental-state of a person who reaches a point where he/she must have a specific substance, even though the social, physical, and/or legal consequences of substance use are clearly negative (e.g., loss of relationships, employment, housing). Craving refers to an intense hunger for a specific substance, to the point where this need essentially directs the individual's behavior. Craving is usually seen in both dependence and addiction and can be so strong that it over-whelms a person's ability to make any decisions that will possibly deprive him/her of the substance. Drug possession and use becomes the most important goal, and other forces (including the law) have little effect on changing the individual's substance-seeking behavior.