DRUG ABUSE — SteemCN

Substance abuse, also known as drug abuse, is a patterned use of a drug in which the user consumes the substance in amounts or with methods which are harmful to themselves or others, and is a form of substance-related disorder. Widely differing definitions of drug abuse are used in public health, medical and criminal justice contexts. In some cases criminal or anti-social behavior occurs when the person is under the influence of a drug, and long term personality changes in individuals may occur as well.[5] In addition to possible physical, social, and psychological harm, use of some drugs may also lead to criminal penalties, although these vary widely depending on the local jurisdiction.[6]

Substance abuse
Rational scale to assess the harm of drugs (mean physical harm and mean dependence).svg
A 2007 assessment of harm from recreational drug use (mean physical harm and mean dependence liability)[1]
Specialty
Psychiatry
Frequency
27 million[2][3]
Deaths
307,400 (2015)[4]
[edit on Wikidata]
Drugs most often associated with this term include: alcohol, cannabis, barbiturates, benzodiazepines, cocaine, methaqualone, opioids and some substituted amphetamines. The exact cause of substance abuse is not clear, with the two predominant theories being: either a genetic disposition which is learned from others, or a habit which if addiction develops, manifests itself as a chronic debilitating disease.[7]

In 2010 about 5% of people (230 million) used an illicit substance.[2] Of these 27 million have high-risk drug use otherwise known as recurrent drug use causing harm to their health, psychological problems, or social problems or puts them at risk of those dangers.[2][3] In 2015 substance use disorders resulted in 307,400 deaths, up from 165,000 deaths in 1990.[4][8] Of these, the highest numbers are from alcohol use disorders at 137,500, opioid use disorders at 122,100 deaths, amphetamine use disorders at 12,200 deaths, and cocaine use disorders at 11,100.[4]https://en.m.wikipedia.org/wiki/File:Rational_scale_to_assess_the_harm_of_drugs_(mean_physical_harm_and_mean_dependence).svgRational scale to assess the harm of recreational drug use[1]
Drug Drug class Physical
harm Dependence
liability Social
harm Total
harm
Heroin Opioid 2.78 3.00 2.54 2.77
Cocaine CNS stimulant 2.33 2.39 2.17 2.30
Barbiturates CNS depressant 2.23 2.01 2.00 2.08
Methadone Opioid 1.86 2.08 1.87 1.94
Alcohol CNS depressant 1.40 1.93 2.21 1.85
Ketamine Dissociative anesthetic 2.00 1.54 1.69 1.74
Benzodiazepines Benzodiazepine 1.63 1.83 1.65 1.70
Amphetamine CNS stimulant 1.81 1.67 1.50 1.66
Tobacco Tobacco 1.24 2.21 1.42 1.62
Buprenorphine Opioid 1.60 1.64 1.49 1.58
Cannabis Cannabinoid 0.99 1.51 1.50 1.33
Solvent drugs Inhalant 1.28 1.01 1.52 1.27
4-MTA Designer SSRA 1.44 1.30 1.06 1.27
LSD Psychedelic 1.13 1.23 1.32 1.23
Methylphenidate CNS stimulant 1.32 1.25 0.97 1.18
Anabolic steroids Anabolic steroid 1.45 0.88 1.13 1.15
GHB Neurotransmitter 0.86 1.19 1.30 1.12
Ecstasy Empathogenic stimulant 1.05 1.13 1.09 1.09
Alkyl nitrites Inhalant 0.93 0.87 0.97 0.92
Khat CNS stimulant 0.50 1.04 0.85 0.80
Notes about the harm ratings
The Physical harm, Dependence liability, and Social harm scores were each computed from the average of three distinct ratings.[1] The highest possible harm rating for each rating scale is 3.0.[1]
Physical harm is the average rating of the scores for acute binge use, chronic use, and intravenous use.[1]
Dependence liability is the average rating of the scores for intensity of pleasure, psychological dependence, and physical dependence.[1]
Social harm is the average rating of the scores for drug intoxication, health-care costs, and other social harms.[1]
Total harm was computed as the average of the Physical harm, Dependence liability, and Social harm scores.
Depending on the actual compound, drug abuse including alcohol may lead to health problems, social problems, morbidity, injuries, unprotected sex, violence, deaths, motor vehicle accidents, homicides, suicides, physical dependence or psychological addiction.[21]

There is a high rate of suicide in alcoholics and other drug abusers. The reasons believed to cause the increased risk of suicide include the long-term abuse of alcohol and other drugs causing physiological distortion of brain chemistry as well as the social isolation. Another factor is the acute intoxicating effects of the drugs may make suicide more likely to occur. Suicide is also very common in adolescent alcohol abusers, with 1 in 4 suicides in adolescents being related to alcohol abuse.[22] In the USA approximately 30% of suicides are related to alcohol abuse. Alcohol abuse is also associated with increased risks of committing criminal offences including child abuse, domestic violence, rapes, burglaries and assaults.[23]

Drug abuse, including alcohol and prescription drugs, can induce symptomatology which resembles mental illness. This can occur both in the intoxicated state and also during the withdrawal state. In some cases these substance induced psychiatric disorders can persist long after detoxification, such as prolonged psychosis or depression after amphetamine or cocaine abuse. A protracted withdrawal syndrome can also occur with symptoms persisting for months after cessation of use. Benzodiazepines are the most notable drug for inducing prolonged withdrawal effects with symptoms sometimes persisting for years after cessation of use. Abuse of hallucinogens can trigger delusional and other psychotic phenomena long after cessation of use.

Cannabis may trigger panic attacks during intoxication and with continued use, it may cause a state similar to dysthymia.[24] Researchers have found that daily cannabis use and the use of high-potency cannabis are independently associated with a higher chance of developing schizophrenia and other psychotic disorders.[25][26]
SIGNS AND SYMTOMS
Severe anxiety and depression are commonly induced by sustained alcohol abuse, which in most cases abates with prolonged abstinence. Even sustained moderate alcohol use may increase anxiety and depression levels in some individuals. In most cases these drug induced psychiatric disorders fade away with prolonged abstinence.[27]

Impulsivity Edit
Impulsivity is characterized by actions based on sudden desires, whims, or inclinations rather than careful thought.[28] Individuals with substance abuse have higher levels of impulsivity,[29] and individuals who use multiple drugs tend to be more impulsive.[29] A number of studies using the Iowa gambling task as a measure for impulsive behavior found that drug using populations made more risky choices compared to healthy controls.[30] There is a hypothesis that the loss of impulse control may be due to impaired inhibitory control resulting from drug induced changes that take place in the frontal cortex.[31] The neurodevelopmental and hormonal changes that happen during adolescence may modulate impulse control that could possibly lead to the experimentation with drugs and may lead to the road of addiction.[32] Impulsivity is thought to be a facet trait in the neuroticism personality domain (overindulgence/negative urgency) which is prospectively associated with the development of substance abuse.[33]
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Substance abuse
See also: Substance use disorder
This article is about Drug abuse. For the Dice album, see Drug Abuse (album).
Substance abuse, also known as drug abuse, is a patterned use of a drug in which the user consumes the substance in amounts or with methods which are harmful to themselves or others, and is a form of substance-related disorder. Widely differing definitions of drug abuse are used in public health, medical and criminal justice contexts. In some cases criminal or anti-social behavior occurs when the person is under the influence of a drug, and long term personality changes in individuals may occur as well.[5] In addition to possible physical, social, and psychological harm, use of some drugs may also lead to criminal penalties, although these vary widely depending on the local jurisdiction.[6]

Classification Edit

Public health definitions Edit

Drug users injecting heroin, an opiate.
Public health practitioners have attempted to look at substance use from a broader perspective than the individual, emphasizing the role of society, culture, and availability. Some health professionals choose to avoid the terms alcohol or drug "abuse" in favor of language they consider more objective, such as "substance and alcohol type problems" or "harmful/problematic use" of drugs. The Health Officers Council of British Columbia — in their 2005 policy discussion paper, A Public Health Approach to Drug Control in Canada] — has adopted a public health model of psychoactive substance use that challenges the simplistic black-and-white construction of the binary (or complementary) antonyms "use" vs. "abuse".[9] This model explicitly recognizes a spectrum of use, ranging from beneficial use to chronic dependence.

Medical definitions Edit

A 2010 study ranking various illegal and legal drugs based on statements by drug-harm experts. Alcohol was found to be the overall most dangerous drug.[10]
'Drug abuse' is no longer a current medical diagnosis in either of the most used diagnostic tools in the world, the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM), and the World Health Organization's International Statistical Classification of Diseases (ICD).

Substance abuse[11] has been adopted by the DSM as a blanket term to include 10 separate classes of drugs, including alcohol; caffeine; cannabis; hallucinogens; inhalants; opioids; sedatives, hypnotics, and anxiolytics; stimulants; tobacco; and other substances.[12] The ICD uses the term Harmful use to cover physical or psychological harm to the user from use.

Physical dependence, abuse of, and withdrawal from drugs and other miscellaneous substances is outlined in the DSM a:

When an individual persists in use of alcohol or other drugs despite problems related to use of the substance, substance dependence may be diagnosed. Compulsive and repetitive use may result in tolerance to the effect of the drug and withdrawal symptoms when use is reduced or stopped.[11]

However, other definitions differ; they may entail psychological or physical dependence,[11] and may focus on treatment and prevention in terms of the social consequences of substance uses.

Value judgment Edit

This diagram depicts the correlations among the usage of 18 legal and illegal drugs: alcohol, amphetamines, amyl nitrite, benzodiazepine, cannabis, chocolate, cocaine, caffeine, crack, ecstasy, heroin, ketamine, legal highs, LSD, methadone, magic mushrooms (MMushrooms), nicotine and volatile substance abuse (VSA). Usage is defined as having used the drug at least once during years 2005–2015. The colored links between drugs indicate the correlations with |r|>0.4, where |r| is the absolute value of the Pearson correlation coefficient.[13]
Philip Jenkins suggests that there are two issues with the term "drug abuse". First, what constitutes a "drug" is debatable. For instance, GHB, a naturally occurring substance in the central nervous system is considered a drug, and is illegal in many countries, while nicotine is not officially considered a drug in most countries.

Second, the word "abuse" implies a recognized standard of use for any substance. Drinking an occasional glass of wine is considered acceptable in most Western countries, while drinking several bottles is seen as an abuse. Strict temperance advocates, who may or may not be religiously motivated, would see drinking even one glass as an abuse. Some groups even condemn caffeine use in any quantity. Similarly, adopting the view that any (recreational) use of cannabis or substituted amphetamines constitutes drug abuse implies a decision made that the substance is harmful, even in minute quantities.[14] In the U.S., drugs have been legally classified into five categories, schedule I, II, III, IV, or V in the Controlled Substances Act. The drugs are classified on their deemed potential for abuse. Usage of some drugs is strongly correlated.[13] For example, the consumption of seven illicit drugs (amphetamines, cannabis, cocaine, ecstasy, legal highs, LSD, and magic mushrooms) is correlated and the Pearson correlation coefficient r>0.4 in every pair of them; consumption of cannabis is strongly correlated (r>0.5) with usage of nicotine (tobacco), heroin is correlated with cocaine (r>0.4), methadone (r>0.45), and strongly correlated with crack (r>0.5)[13]

Drug misuse Edit
Drug misuse is a term used commonly when prescription medication with sedative, anxiolytic, analgesic, or stimulant properties are used for mood alteration or intoxication ignoring the fact that overdose of such medicines can sometimes have serious adverse effects. It sometimes involves drug diversion from the individual for whom it was prescribed.

Prescription misuse has been defined differently and rather inconsistently based on status of drug prescription, the uses without a prescription, intentional use to achieve intoxicating effects, route of administration, co-ingestion with alcohol, and the presence or absence of dependence symptoms.[15][16] Chronic use of certain substances leads to a change in the central nervous system known as a 'tolerance' to the medicine such that more of the substance is needed in order to produce desired effects. With some substances, stopping or reducing use can cause withdrawal symptoms to occur,[17] but this is highly dependent on the specific substance in question.

The rate of prescription drug use is fast overtaking illegal drug use in the United States. According to the National Institute of Drug Abuse, 7 million people were taking prescription drugs for nonmedical use in 2010. Among 12th graders, nonmedical prescription drug use is now second only to cannabis.[18] "Nearly 1 in 12 high school seniors reported nonmedical use of Vicodin; 1 in 20 reported such use of OxyContin."[19] Both of these drugs contain opioids.

Avenues of obtaining prescription drugs for misuse are varied: sharing between family and friends, illegally buying medications at school or work, and often "doctor shopping" to find multiple physicians to prescribe the same medication, without knowledge of other prescribers.

Increasingly, law enforcement is holding physicians responsible for prescribing controlled substances without fully establishing patient controls, such as a patient "drug contract." Concerned physicians are educating themselves on how to identify medication-seeking behavior in their patients, and are becoming familiar with "red flags" that would alert them to potential prescription drug abuse.[20]

Signs and symptoms Edit

Rational scale to assess the harm of recreational drug use[1]
Drug Drug class Physical
harm Dependence
liability Social
harm Total
harm
Heroin Opioid 2.78 3.00 2.54 2.77
Cocaine CNS stimulant 2.33 2.39 2.17 2.30
Barbiturates CNS depressant 2.23 2.01 2.00 2.08
Methadone Opioid 1.86 2.08 1.87 1.94
Alcohol CNS depressant 1.40 1.93 2.21 1.85
Ketamine Dissociative anesthetic 2.00 1.54 1.69 1.74
Benzodiazepines Benzodiazepine 1.63 1.83 1.65 1.70
Amphetamine CNS stimulant 1.81 1.67 1.50 1.66
Tobacco Tobacco 1.24 2.21 1.42 1.62
Buprenorphine Opioid 1.60 1.64 1.49 1.58
Cannabis Cannabinoid 0.99 1.51 1.50 1.33
Solvent drugs Inhalant 1.28 1.01 1.52 1.27
4-MTA Designer SSRA 1.44 1.30 1.06 1.27
LSD Psychedelic 1.13 1.23 1.32 1.23
Methylphenidate CNS stimulant 1.32 1.25 0.97 1.18
Anabolic steroids Anabolic steroid 1.45 0.88 1.13 1.15
GHB Neurotransmitter 0.86 1.19 1.30 1.12
Ecstasy Empathogenic stimulant 1.05 1.13 1.09 1.09
Alkyl nitrites Inhalant 0.93 0.87 0.97 0.92
Khat CNS stimulant 0.50 1.04 0.85 0.80
Notes about the harm ratings
The Physical harm, Dependence liability, and Social harm scores were each computed from the average of three distinct ratings.[1] The highest possible harm rating for each rating scale is 3.0.[1]
Physical harm is the average rating of the scores for acute binge use, chronic use, and intravenous use.[1]
Dependence liability is the average rating of the scores for intensity of pleasure, psychological dependence, and physical dependence.[1]
Social harm is the average rating of the scores for drug intoxication, health-care costs, and other social harms.[1]
Total harm was computed as the average of the Physical harm, Dependence liability, and Social harm scores.
Depending on the actual compound, drug abuse including alcohol may lead to health problems, social problems, morbidity, injuries, unprotected sex, violence, deaths, motor vehicle accidents, homicides, suicides, physical dependence or psychological addiction.[21]

Severe anxiety and depression are commonly induced by sustained alcohol abuse, which in most cases abates with prolonged abstinence. Even sustained moderate alcohol use may increase anxiety and depression levels in some individuals. In most cases these drug induced psychiatric disorders fade away with prolonged abstinence.[27]

Screening and assessment Edit
There are several different screening tools that have been validated for use with adolescents such as the CRAFFT Screening Test and in adults the CAGE questionnaire.

Some recommendations for screening tools for substance misuse in pregnancy include that they take less than 10 minutes, should be used routinely, include an educational component. Tools suitable for pregnant women include i.a. 4Ps, T-ACE, TWEAK, TQDH (Ten-Question Drinking History), and AUDIT.[34]

Treatment Edit

Psychological Edit
From the applied behavior analysis literature, behavioral psychology, and from randomized clinical trials, several evidenced based interventions have emerged: behavioral marital therapy, motivational Interviewing, community reinforcement approach, exposure therapy, contingency management[35][36] They help suppress cravings and mental anxiety, improve focus on treatment and new learning behavioral skills, ease withdrawal symptoms and reduce the chances of relapse.[37]

In children and adolescents, cognitive behavioral therapy (CBT)[38] and family therapy[39] currently has the most research evidence for the treatment of substance abuse problems. Well-established studies also include ecological family-based treatment and group CBT.[40] These treatments can be administered in a variety of different formats, each of which has varying levels of research support[41] Research has shown that what makes group CBT most effective is that it promotes the development of social skills, developmentally appropriate emotional regulatory skills and other interpersonal skills.[42] A few integrated[43] treatment models, which combines parts from various types of treatment, have also been seen as both well-established or probably effective.[40] A study on maternal alcohol and drug use has shown that integrated treatment programs have produced significant results, resulting in higher negative results on toxicology screens.[43] Additionally, brief school-based interventions have been found to be effective in reducing adolescent alcohol and cannabis use and abuse.[44] Motivational interviewing can also be effective in treating substance use disorder in adolescents.[45][46]

Alcoholics Anonymous and Narcotics Anonymous are one of the most widely known self-help organizations in which members support each other not to use alcohol.[47] Social skills are significantly impaired in people suffering from alcoholism due to the neurotoxic effects of alcohol on the brain, especially the prefrontal cortex area of the brain.[48] It has been suggested that social skills training adjunctive to inpatient treatment of alcohol dependence is probably efficacious,[49] including managing the social environment.

Medication Edit
A number of medications have been approved for the treatment of substance abuse.[50] These include replacement therapies such as buprenorphine and methadone as well as antagonist medications like disulfiram and naltrexone in either short acting, or the newer long acting form. Several other medications, often ones originally used in other contexts, have also been shown to be effective including bupropion and modafinil. Methadone and buprenorphine are sometimes used to treat opiate addiction.[51] These drugs are used as substitutes for other opioids and still cause withdrawal symptoms.

Antipsychotic medications have not been found to be useful.[52] Acamprostate[53] is a glutamatergic NMDA antagonist, which helps with alcohol withdrawal symptoms because alcohol withdrawal is associated with a hyperglutamatergic system.

Psychedelics, such as LSD and psilocin, may have anti-addictive properties.[54]

Dual diagnosis Edit
Main article: Dual diagnosis
It is common for individuals with drugs use disorder to have other psychological problems.[55] The terms “dual diagnosis” or “co-occurring disorders,” refer to having a mental health and substance use disorder at the same time. According to the British Association for Psychopharmacology (BAP), “symptoms of psychiatric disorders such as depression, anxiety and psychosis are the rule rather than the exception in patients misusing drugs and/or alcohol.”[56]

Individuals who have a comorbid psychological disorder often have a poor prognosis if either disorder is untreated.[55] Historically most individuals with dual diagnosis either received treatment only for one of their disorders or they didn’t receive any treatment all. However, since the 1980s, there has been a push towards integrating mental health and addiction treatment. In this method, neither condition is considered primary and both are treated simultaneously by the same provider.[56]

Epidemiology

History

Society and culture

Special populations