Substance Abuse

Reviewed on 9/29/2021

Facts on Substance Abuse

Substance abuse without treatment takes a heavy toll on a person's health, family, and society.
Substance abuse without treatment takes a heavy toll on a person's health, family, and society.

People abuse substances such as alcohol, tobacco, and other drugs 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 both 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 in recent years, use of other drugs such as heroin, crystal methamphetamine, and "club drugs" has increased.

  • Finding effective treatment for and prevention of substance abuse and substance dependence, now both included under the diagnosis of substance use disorder, has been difficult. Through research, we now have a better understanding of this behavior. Studies have made it clear that drug education and prevention aimed at children and adolescents offers the best chance to curb drug abuse nationally.
  • The 2014 National Household Survey on Drug Abuse estimated that more than 16% of respondents in the United States have used illicit drugs in the past year. Other statistics from the survey include that more than 22% of Americans over 18 years of age have engaged in binge drinking in the past year, and more than 20% of Americans have smoked cigarettes in the past month. Same survey reveals that 21.5 million people over 12 years of age in the United States have had some form of substance use disorder in the past year.

Abused substances produce some form of intoxication that alters judgment, perception, attention, or physical control.

Many substances can bring on withdrawal effects caused by cessation or reduction in the amount of the substance used. Withdrawal symptoms can range from mild anxiety to seizures and hallucinations. Drug overdose may also cause death.

Nearly all drugs of abuse can also produce a phenomenon known as tolerance, in which one must use a larger amount of the drug to produce the same level of intoxication. Commonly abused drugs include the following:

  • Inhalants: This group of substances includes solvents that emit vapors, causing intoxication when breathed in (inhaled). Individuals who abuse inhalants intentionally breathe in the vapors, either directly from a container, from a bag in which such a substance is in, or from a rag soaked with the substance and then placed over the mouth or nose. Inhalant intoxication happens quickly and doesn't last long.
    • Abuse of inhalants is also called "huffing." Approximately 58% of inhalant users report first using it by the end of ninth grade. Teens who started using inhalants before 15 years of age were up to six times more likely as those who had started later to develop dependence on these substances.
    • Symptoms of inhalant intoxication are very similar to those seen with intoxication with alcohol, including dizziness, clumsiness, slurred speech, elation, tiredness, slowed reflexes, thinking and movement, shaking, blurred vision, stupor or coma, and/or weakness. It can also result in chemical and temperature burns, as well as withdrawal symptoms, chronic mental illness, and even sudden death.
    • Long-term damage associated with inhalant use includes brain and nerve damage as well as heart, liver, or kidney failure.
  • 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 both to the smoker and to those around them. 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 prolonged use 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 abuse is the most common cause of liver failure in the U.S. 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.

What Are Commonly Abused Drugs?

  • 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 active ingredient in the plant, delta-9-tetrahydrocannabinol (THC), is 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 the use of more powerful and dangerous drugs such as cocaine and heroin. The risk for progressing to cocaine use is 104 times higher if you have smoked marijuana at least once than if you never smoked marijuana.
    • Synthetic (man-made) forms of marijuana (often called K2, Spice, Black Mamba, Blaze and Red X) can be smoked or otherwise inhaled. It is an increasing health risk, in that it can produce the same impairment in judgment, addiction, and inability to function as marijuana and go undetected by conventional drug testing. Some preparations of synthetic marijuana are much more potent than traditional marijuana, leading to a higher occurrence of becoming delirious, having seizures, or a stroke.
  • Cocaine (also known as crack, coke, snow, blow, rock): In 2010, an estimated 1.5 million people over 12 years of age 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 have been associated with damage to the heart, the brain, the lung, and the kidneys.
  • Heroin (also known as dope, smack, horse): A 2010 National Household Survey on Drug Abuse indicated that the average age when Americans use this drug for the first time is about 21 years of age, including 140,000 who reported using it for the first time in the year prior to the time the survey was taken.
    • 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 decreased breathing to the point of stopped breathing and death. Because heroin is usually injected, often with dirty needles, use of the drug can trigger other health complications including destruction of your heart valves, tetanus, and botulism, and infections like HIV/AIDS or hepatitis.
  • 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.
  • Anabolic steroids:
    • This group of drugs includes testosterone, which is the natural male hormone. It also includes a number of other synthetic forms of testosterone. Steroids are often abused by bodybuilders or other athletes to increase muscle mass or improve performance.
    • These types of substances seem to be associated with a number of mental-health effects, like dependence on the substance, mood problems, and developing other kinds of drug abuse.
  • 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. The following are the most popular club drugs:
    • Ecstasy (also called MDMA, E, X, E pills, Adam, STP): This is a stimulant and hallucinogen used to improve mood and to maintain energy, often for all-night dance parties. Even onetime use can cause high fevers to the point of inducing a seizure. 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 has been used as a date-rape drug. Effects include low 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 (also known as angel dust, hog, lovie, 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 when under its effects. Usually, tobacco or marijuana cigarettes are dipped into PCP and then smoked.

What Are the Causes and Risk Factors of Substance Abuse?

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 of abusing substances.

  • Family history factors that influence a child's early development have been shown to be related to an increased risk of drug abuse, such as
    • chaotic home environment,
    • ineffective parenting,
    • lack of nurturing and parental attachment,
    • parental drug use or addiction.
  • Other risk factors for substance abuse are related to the substance abuse sufferer him- or herself, like
  • Factors related to a child's socialization outside the family may also increase the risk of drug abuse, including
    • inappropriately aggressive or shy behavior in the classroom,
    • poor social coping skills,
    • poor school performance,
    • association with a deviant peer group or isolating oneself from peers altogether,
    • perception of approval of drug-use behavior.

What Are the Symptoms and Signs of Substance Abuse?

Friends and family may be among the first to recognize the signs of substance abuse. Early recognition increases the 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
  • Declining grades
  • Aggressiveness and irritability
  • A significant change in mood or behavior
  • Forgetfulness
  • 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
  • Physical problems with unclear cause (for example, red eyes and slurred speech)
  • 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, and drinking or using other drugs alone
  • Having to drink more to get the same high
  • Believing that in order to have fun you need to drink or use other drugs
  • Frequent hangovers
  • Pressuring others to drink or use other drugs
  • Taking risks, including sexual risks
  • 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 or other problems at school or in the workplace for an alcohol- or drug-related incident

When to Seek Medical Care

If you recognize that someone has a substance abuse problem and wants to quit, a doctor can refer him/her to community resources where he/she may receive formal diagnosis and treatment of a substance-abuse problem. A doctor also may prescribe medications to control cravings and withdrawal or help manage medical complications resulting from substance abuse. Let a doctor know what drugs are being used and how they are taken. Any of the following symptoms warrant a call to the doctor:

  • Mild tremors or an alcohol withdrawal seizure not accompanied by hallucinations or confusion
  • Jaundice (yellow skin and eyes)
  • Increasing abdominal girth
  • Leg swelling
  • A cough, congestion, or sniffles that won't go away
  • Continuing feelings of sadness or depression
  • Pain at an injection site
  • Fever

If any of the following occur, call 911 or go to a hospital's emergency department immediately:

  • Thoughts of harming yourself or others
  • 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 of being sexually assaulted while under the influence

Screening and Assessment for Substance Abuse

While there is no one test that establishes the diagnosis of a substance use disorder with certainty, there are screening tools, including online tests, that may help identify people who are at risk for having a substance use problem. Therefore, health-care professionals assess this group of illnesses by gathering thorough mental-health, medical, and family information. The practitioner will also likely ask that the individual's primary-care doctor perform a physical exam, including lab tests to assess the person's medical health and to explore whether or not the individual has a medical condition that can produce the same symptoms as a mental-health problem.

Exploring the presence of mental-health symptoms includes determining if the person has a substance use disorder, a mood disorder like depression and/or mania or anxiety, or if he or she suffers from the hallucinations or delusions associated with schizophrenia, schizoaffective disorder, or other psychotic disorders. The possible presence of a personality or behavior disorders like attention deficit hyperactivity disorder (ADHD) is also usually explored. Practitioners may use a quiz or self-test as a screening tool for substance-use disorders.

What Is the Treatment for Substance Abuse?

Most substance abusers believe they can stop using drugs on their own, but the majority who try do not succeed. Before treatment for the addictive behavior can be directly addressed, the substance abuse sufferer might need help in lessening physical withdrawal from alcohol or other drugs they have been using. That initial phase of treatment is called detoxification or "detox." It often requires inpatient hospital treatment.

Research shows that long-term drug use alters brain function and strengthens compulsions to use drugs. This craving continues even after drug use stops.

Because of these ongoing cravings, the most important component of treatment, also called recovery, is preventing relapse. Treating substance abuse often requires treatment in a rehabilitation (rehab) program and depends on both the person and the substance being used. In behavioral treatment, a counselor (like a social worker, psychologist, psychiatrist, psychiatric nurse, or nurse practitioner) provides strategies to cope with drug cravings and ways to avoid relapse. Treatment often includes individual and group therapy.

Once they have performed a thorough assessment of someone's condition, a doctor or nurse practitioner may prescribe medications, such as nicotine patches and methadone, to control withdrawal symptoms and drug cravings. Random drug testing is often an integral part of encouraging the person with substance abuse problems to refrain from further drug use. Drug-abuse hotlines can be an invaluable resource for people to initiate treatment and prevent relapse.

Often, a drug user has an underlying behavioral disorder or other mental illness, one that increases the risk of substance abuse. When an individual suffers from a substance use disorder in addition to another mental-health disorder, he or she is referred to as having a dual diagnosis. Such disorders must be treated medically and through counseling along with treatment of the drug abuse.

How Can You Prevent Substance 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 provide information in order 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 of drug use from children's peers and families.

What Is the Prognosis for Substance Abuse?

Individuals who suffer from substance abuse tend to be more successful in recovery when they are highly motivated to be in treatment, are actively engaged in their own recovery, and receive intensive treatment services. Prognosis for substance abuse recovery is further improved by being able to easily access community-based social supports.

Costs to society

As of 2006, officials estimated that alcohol and drug abuse in the U.S. cost more than $246 billion. Some important facts about the negative impact of drug and alcohol use in the United States are as follows:

  • Crime: More than half of the economic cost of alcohol and other drugs is due to crime. A substance abuser is 18 times more likely to be involved in illegal activity than someone who does not abuse alcohol or other drugs. 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 death, disability, or 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.
What is addiction, dependence, and tolerance?

What Is Addiction?

Definitions of addiction, dependence, and tolerance

Addiction is a term that is often confused with dependence.

  • Addiction is defined as drug craving, seeking, and use, in the face of negative health or social consequences.
  • Dependence is the development of withdrawal symptoms after use of a substance is stopped.
  • Tolerance is when the body becomes less responsive to a specific amount of a substance, thereby causing the person to increase the amount of drug intake to achieve the previous effect.

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Reviewed on 9/29/2021
Medically reviewed by Ashraf Ali, MD; American Board of Psychiatry & Neurology


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