Substance Abuse and Dependence Health Article

Definition

Substance abuse is a pattern of behavior that displays many adverse results from continual use of a substance. Substance dependence is a group of behavioral and physiological symptoms that indicate the continual, compulsive use of a substance in self-administered doses despite the problems related to the use of the substance.

Description

The characteristics of abuse are a failure to carry out obligations at home or work, continual use under circumstances that present a hazard (such as driving a car), and legal problems such as arrests. Use of the drug is persistent despite personal problems caused by the effects of the substance on the self or others. In substance dependence, as the patient's tolerance for the drug increases, increased amounts of a substance are needed to achieve the desired effect or level of intoxication. Withdrawal is a physiological and psychological change that occurs when the body's concentration of the substance declines in a person who has been a heavy user.

Substance abuse and dependence cuts across all lines of race, culture, educational, and socioeconomic status, leaving no group untouched by its devastating effects. An estimated 13 million Americans abuse or are dependent on an illegal substance. 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, substance abuse is considered to be 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. An estimated 20 percent of the total yearly cost of health care in the United States is spent on the effects of drug and alcohol abuse.

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

• opioids, including such prescription pain killers as morphine and demerol, as well as illegal substances such 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
• cannabinoid drugs obtained from the hemp plant, including marijuana and hashish
• cocaine-based drugs, including cocaine and "crack"
• hallucinogenic or psychedelic drugs, including lysergic acid diethylamide (LSD) or "acid," phencyclidine (PCP) or "angel dust," 3-4 methylenedioxymethamphetamine (MDMA) or "ecstasy," 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
• alcoholic drinks
• cigarettes, cigars, and other tobacco products

Those substances of abuse that are actually prescription medications may have been obtained on the street by fraudulent means or may have been a legal, medically indicated prescription that a person begins to use without regard to the directions of his or her physician.

A number of important terms must be defined in order to have a complete discussion of substance abuse. Drug tolerance refers to a person's body being accustomed to the symptoms produced by a specific quantity of a substance. When a person first begins taking a substance, he or she will note various mental or physical reactions brought on by the drug (some of which are the very changes in consciousness that the individual is seeking through substance use). Over time with repeated use, the same dosage of the substance produces fewer of the desired feelings. In order to continue to feel the desired effect of the substance, progressively higher drug doses must be taken.