Doctor's Notes on Substance Abuse
Substance abuse, or drug abuse, is when people take illegal drugs or they misuse legal drugs such as alcohol, tobacco, or prescription medications. Abused substances often produce some form of intoxication that alters judgment, perception, attention, or physical control.
Signs and symptoms of substance abuse may include
- giving up past activities a person used to enjoy,
- hanging out with new friends,
- declining grades,
- significant changes in mood or behavior,
- disappearing money or valuables,
- feeling rundown,
- hopelessness, depression,
- suicidal thoughts or actions,
- use of room deodorizers and incense,
- presence of drug 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 (especially about how much alcohol or other drugs are being used),
- avoiding friends or family in order to get drunk or high,
- planning drinking in advance,
- hiding alcohol,
- 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 happened the night before,
- constantly talking about drinking or using other drugs,
- the trouble with the law, drinking, and driving, and
- suspension or other problems at school or in the workplace for alcohol- or drug-related incidents.
What Is the Treatment for Substance Abuse?
Substance abuse requires a comprehensive treatment plan, including the active participation of the patient. Slowly decreasing the use of substances (tapering) and eventually stopping use, or drug substitution to either a less addictive medication or another drug class are mainstays of treatment. High-risk patients with long-term addiction or substance abuse may do better with inpatient residential rehab treatment or intensive inpatient addiction services.
Because substance abuse and addiction are chronic diseases, people can’t simply stop using drugs for a few days and be cured. Most patients need long-term or repeated care to stop using completely and recover their lives.
Substance abuse treatment must help the person do the following:
- Stop using the addicting substances
- Stay clean and clear of the substance
- Be productive in the family, at work, and in society
Strategies for treatment of substance abuse may include:
- Behavioral counseling
- Tapering of amount and dose until abstinence
- Lower and lower dose with less frequency until the medication is no longer needed
- Antiseizure medication substitution
- Used with tapering the dose or drug substitution, is shown to be more effective than either approach separately
- Evaluation and treatment for co-occurring mental health issues such as depression and anxiety
- Maintenance therapy
- Some patients cannot get off certain drugs and need to be on low-dose chronic medication therapy supervised by their healthcare provider
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Barbiturate AbuseBarbiturates are a group of drugs in the class of drugs known as sedative-hypnotics, which generally describes their sleep-inducing and anxiety-decreasing effects.
Cocaine Abuse (Addiction)Cocaine is one of the most commonly abused drugs in the U.S. Symptoms of cocaine abuse include dilated pupils, recurrent nosebleeds, and hallucinations. Medical professionals diagnose cocaine abuse by looking for signs and symptoms such as cocaine-induced headaches and cocaine-induced seizures; psychiatric complications like anxiety, hallucinations, and psychoses; nasal and throat complications like nosebleed and perforated nasal septum; pulmonary conditions like asthma and pneumonia; cardiovascular complications; and infectious complications.
Drug Dependence and AbuseDrug dependence is the physical need for a certain substance. Drug abuse and dependence comprise a huge public health problem with no easy treatment available.
Drug OverdoseOverdoses of drugs or chemicals can be either accidental or intentional. Drug overdoses occur when a person takes more than the medically recommended dose. Overdose is often a cause of death, coma, or other injury with heroin and other drugs commonly abused.
Narcotic AbuseNarcotic abuse is when people use narcotics for reasons apart from the narcotic's pain-relief purpose. Signs and symptoms of narcotic abuse include euphoria, shallow breathing, small pupils, nausea, vomiting, slurred speech, confusion, and needle marks on the skin. Treatment involves addressing the long-term psychological dependence associated with narcotic abuse and administering medications such as buprenorphine, clonidine, and naltrexone to alleviate withdrawal symptoms.
Opioid Abuse and AddictionOpioids are a form of pain relief medicine. These painkillers are very addictive. Symptoms of opioid addiction include chronic constipation, nausea, vomiting, sleepiness, and insomnia. Treatment of opioid addiction may include medications such as naltrexone, buprenorphine, methadone, and/or lofexidine, in addition to behavioral therapy and counseling.
What Is the Difference Between Addiction and Substance Abuse Disorder?Substance abuse disorder is focused on using substance(s) such as alcohol, tobacco, or illicit drugs, to such an extreme that makes the person unable to perform daily functions. Addictions are the most severe form of substance use disorder, which leaves people who are addicted often aware of their problem but are unable to stop, even if they want to.
Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.