Substance Abuse Overview
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.
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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.
Did You Know?
Under the Affordable Care Act, many health insurance plans will cover preventive mental health services,
including screening tests for depression and alcohol misuse, at no cost to you. Learn more.
Health Insurance Center
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.
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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
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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.
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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 allnight 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.
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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
Ineffective parenting
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:
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Giving up past activities such as sports, homework, or hanging out with new friends
Declining grades
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Aggressiveness and irritability
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
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 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 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:
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Mild tremors or an alcohol withdrawal seizure not accompanied by hallucinations or confusion
Jaundice (yellow skin and eyes)
Increasing abdominal girth
Leg swelling
Cough that won't go away
Continuing feelings of sadness or depression
Pain at an injection site
Fever
When to Go to the Hospital
If any of the following occur, call 911 or go to a hospital's emergency department immediately:
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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 that you were sexually assaulted while under the influence
Medical Treatment
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.
Next Steps
Prevention
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.
Outlook
Costs to society
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.
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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.