Alcoholism

Alcoholism is a broad term for problems with alcohol, and is generally used to mean compulsive
and uncontrolled consumption of alcoholic beverages, usually to the detriment of the drinker's
health, personal relationships, and social standing. It is medically considered a disease,
specifically an addictive illness, and in psychiatry several other terms are used, specifically
"alcohol abuse" and "alcohol dependence," which have slightly different definitions.[1] In 1979
an expert World Health Organization committee discouraged the use of "alcoholism" in
medicine, preferring the category of "alcohol dependence syndrome".[2] In the 19th and early
20th centuries, alcohol dependence in general was called dipsomania, but that term now has a
much more specific meaning.[3] People suffering from alcoholism are often called "alcoholics".
Many other terms, some of them insulting or informal, have been used throughout history. The
World Health Organization estimates that there are 140 million people with alcoholism
worldwide.[4][5]
The American Medical Association supports a dual classification of alcoholism to include both
physical and mental components.[6] The biological mechanisms that cause alcoholism are not
well understood. Social environment, stress,[7] mental health, family history, age, ethnic group,
and gender all influence the risk for the condition.[8][9] Significant alcohol intake produces
changes in the brain's structure and chemistry, though some alterations occur with minimal use
of alcohol over a short term period, such as tolerance and physical dependence. These changes
maintain the person with alcoholism's compulsive inability to stop drinking and result in alcohol
withdrawal syndrome if the person stops.[10] Alcohol damages almost every organ in the body,
including the brain. The cumulative toxic effects of chronic alcohol abuse can cause both
medical and psychiatric problems.[11]
Identifying alcoholism is difficult for the individual afflicted because of the social stigma
associated with the disease that causes people with alcoholism to avoid diagnosis and treatment
for fear of shame or social consequences. The evaluation responses to a group of standardized
questioning is a common method for diagnosing alcoholism. These can be used to identify
harmful drinking patterns, including alcoholism.[12] In general, problem drinking is considered
alcoholism when the person continues to drink despite experiencing social or health problems
caused by drinking.[13]
Treatment of alcoholism takes several steps. Because of the medical problems that can be caused
by withdrawal, alcohol detoxification is carefully controlled and may involve medications such
as benzodiazepines such as diazepam (Valium).[14] People with alcoholism also sometimes have
other addictions, including addictions to benzodiazepines, which may complicate this step.[15]
After detoxification, other support such as group therapy or self-help groups are used to help the
person remain sober.[16][17] Thombs (1999) states according to behavioural sciences alcoholism is
described as a maladaptive behaviour. He explains this must not be confused with
misbehaviour. Behavioural scientists explain that addicts have a behaviour pattern that may
lead to destructive consequences for themselves, their families and society. This does not label
addicts as bad or irresponsible.[18] Compared with men, women are more sensitive to alcohol's
harmful physical, cerebral, and mental effects.[19]

Signs and symptoms

Long-term misuse
Main article: Long-term effects of alcohol

Some of the possible long-term effects of ethanol an individual may develop. Additionally, in
pregnant women, alcohol can cause fetal alcohol syndrome.
Alcoholism is characterised by an increased tolerance of and physical dependence on alcohol,
affecting an individual's ability to control alcohol consumption safely. These characteristics are
believed to play a role in impeding an alcoholic's ability to stop drinking.[10] Alcoholism can
have adverse effects on mental health, causing psychiatric disorders and increasing the risk of
suicide. The onset of depression is a common symptom.[20][21]
Physical
Long-term alcohol abuse can cause a number of physical symptoms, including cirrhosis of the
liver, pancreatitis, epilepsy, polyneuropathy, alcoholic dementia, heart disease, nutritional
deficiencies, peptic ulcers[22] and sexual dysfunction, and can eventually be fatal. Other physical
effects include an increased risk of developing cardiovascular disease, malabsorption, alcoholic
liver disease, and cancer. Damage to the central nervous system and peripheral nervous system
can occur from sustained alcohol consumption.[23][24] A wide range of immunologic defects can
result and there may be a generalized skeletal fragility, in addition to a recognized tendency to
accidental injury, resulting a propensity to bone fractures.[25]

Women develop long-term complications of alcohol dependence more rapidly than do men.
Additionally, women have a higher mortality rate from alcoholism than men.[26] Examples of
long-term complications include brain, heart, and liver damage[27] and an increased risk of breast
cancer. Additionally, heavy drinking over time has been found to have a negative effect on
reproductive functioning in women. This results in reproductive dysfunction such as anovulation,
decreased ovarian mass, problems or irregularity of the menstrual cycle, and early menopause.[26]
Alcoholic ketoacidosis can occur in individuals who chronically abuse alcohol and have a recent
history of binge drinking.[28][29]
Even though alcoholism can increase the risk of liver cancer, studies have shown that a moderate
consumption of alcohol (1 serving/day for women and 2 servings/day for men) does not affect
diabetes Type II greatly.
Psychiatric
Long-term misuse of alcohol can cause a wide range of mental health problems. Severe cognitive
problems are common; approximately 10 percent of all dementia cases are related to alcohol
consumption, making it the second leading cause of dementia.[30] Excessive alcohol use causes
damage to brain function, and psychological health can be increasingly affected over time.[31]
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. The social skills
that are impaired by alcohol abuse include impairments in perceiving facial emotions, prosody
perception problems and theory of mind deficits; the ability to understand humour is also
impaired in alcohol abusers.[32]
Psychiatric disorders are common in alcoholics, with as many as 25 percent suffering severe
psychiatric disturbances. The most prevalent psychiatric symptoms are anxiety and depression
disorders. Psychiatric symptoms usually initially worsen during alcohol withdrawal, but typically
improve or disappear with continued abstinence.[33] Psychosis, confusion, and organic brain
syndrome may be caused by alcohol misuse, which can lead to a misdiagnosis such as
schizophrenia.[34] Panic disorder can develop or worsen as a direct result of long-term alcohol
misuse.[35][36]
The co-occurrence of major depressive disorder and alcoholism is well documented.[37][38][39]
Among those with comorbid occurrences, a distinction is commonly made between depressive
episodes that remit with alcohol abstinence ("substance-induced"), and depressive episodes that
are primary and do not remit with abstinence ("independent" episodes).[40][41][42] Additional use
of other drugs may increase the risk of depression.[43]
Psychiatric disorders differ depending on gender. Women who have alcohol-use disorders often
have a co-occurring psychiatric diagnosis such as major depression, anxiety, panic disorder,
bulimia, post-traumatic stress disorder (PTSD), or borderline personality disorder. Men with
alcohol-use disorders more often have a co-occurring diagnosis of narcissistic or antisocial
personality disorder, bipolar disorder, schizophrenia, impulse disorders or attention
deficit/hyperactivity disorder.[44] Women with alcoholism are more likely to have a history of

physical or sexual assault, abuse and domestic violence than those in the general population,[44]
which can lead to higher instances of psychiatric disorders and greater dependence on alcohol.
Social effects
The social problems arising from alcoholism are serious, caused by the pathological changes in
the brain and the intoxicating effects of alcohol.[30][45] Alcohol abuse is associated with an
increased risk of committing criminal offences, including child abuse, domestic violence, rape,
burglary and assault.[46] Alcoholism is associated with loss of employment,[47] which can lead to
financial problems. Drinking at inappropriate times, and behavior caused by reduced judgment,
can lead to legal consequences, such as criminal charges for drunk driving[48] or public disorder,
or civil penalties for tortious behavior, and may lead to a criminal sentence.
An alcoholic's behavior and mental impairment, while drunk, can profoundly affect those
surrounding them and lead to isolation from family and friends. This isolation can lead to marital
conflict and divorce, or contribute to domestic violence. Alcoholism can also lead to child
neglect, with subsequent lasting damage to the emotional development of the alcoholic's
children.[49] For this reason, children of alcoholic parents can develop a number of emotional
problems. For example, they can become afraid of their parents, because of their unstable mood
behaviors. In addition, they can develop considerable amount of shame over their inadequacy to
liberate their parents from alcoholism. As a result of this failure, they develop wretched selfimages, which can lead to depression.[50]

Alcohol withdrawal
As with similar substances with a sedative-hypnotic mechanism, such as barbiturates and
benzodiazepines, withdrawal from alcohol dependence can be fatal if it is not properly
managed.[45][51] Alcohol's primary effect is the increase in stimulation of the GABAA receptor,
promoting central nervous system depression. With repeated heavy consumption of alcohol,
these receptors are desensitized and reduced in number, resulting in tolerance and physical
dependence. When alcohol consumption is stopped too abruptly, the person's nervous system
suffers from uncontrolled synapse firing. This can result in symptoms that include anxiety, life
threatening seizures, delirium tremens, hallucinations, shakes and possible heart failure.[52][53]
Other neurotransmitter systems are also involved, especially dopamine, NMDA and
glutamate.[10][54]
Severe acute withdrawal symptoms such as delerium tremens and seizures rarely occur after 1
week post cessation of alcohol. The acute withdrawal phase can be defined as lasting between
one to three weeks. In the period of 3 6 weeks following cessation increased anxiety,
depression as well as sleep disturbance is common;[55] fatigue and tension can persist for up to 5
weeks as part of the post-acute withdrawal syndrome; about a quarter of alcoholics experience
anxiety and depression for up to 2 years. These post-acute withdrawal symptoms have also been
demonstrated in animal models of alcohol dependence and withdrawal.[56] A kindling effect also
occurs in alcoholics whereby each subsequent withdrawal syndrome is more severe than the
previous withdrawal episode; this is due to neuroadaptations which occur as a result of periods of
abstinence followed by re-exposure to alcohol. Individuals who have had multiple withdrawal

episodes are more likely to develop seizures and experience more severe anxiety during
withdrawal from alcohol than alcohol dependent individuals without a history of past alcohol
withdrawal episodes. The kindling effect leads to persistent functional changes in brain neural
circuits as well as to gene expression.[57] Kindling also results in psychological symptoms of
alcohol withdrawal becoming more intensified.[55]

Causes
A complex mixture of genetic and environmental factors influences the risk of the development
of alcoholism.[58] Genes that influence the metabolism of alcohol also influence the risk of
alcoholism, and may be indicated by a family history of alcoholism.[59] One paper has found that
alcohol use at an early age may influence the expression of genes which increase the risk of
alcohol dependence.[60] Individuals who have a genetic disposition to alcoholism are also more
likely to begin drinking at an earlier age than average.[61]
Also, a younger age of onset of drinking is associated with an increased risk of the development
of alcoholism,[61] and about 40 percent of alcoholics will drink excessively by their late
adolescence. It is not entirely clear whether this association is causal, and some researchers have
been known to disagree with this view.[62] A high testosterone concentration during pregnancy
may be a risk factor for later development of alcohol dependence.[63]
Severe childhood trauma is also associated with a general increase in the risk of drug
dependency.[58] Lack of peer and family support is associated with an increased risk of
alcoholism developing.[58] Genetics and adolescence are associated with an increased sensitivity
to the neurotoxic effects of chronic alcohol abuse. Cortical degeneration due to the neurotoxic
effects increases impulsive behaviour, which may contribute to the development, persistence and
severity of alcohol use disorders. There is evidence that with abstinence, there is a reversal of at
least some of the alcohol induced central nervous system damage.[64]

Genetic variation
Genetic differences exist between different racial groups which affect the risk of developing
alcohol dependence. For example, there are differences between African, East Asian and Indoracial groups in how they metabolize alcohol. These genetic factors are believed to, in part,
explain the differing rates of alcohol dependence among racial groups.[65][66] The alcohol
dehydrogenase allele ADH1 B*3 causes a more rapid metabolism of alcohol. The allele ADH1
B*3 is only found in those of African descent and certain Native American tribes. African
Americans and Native Americans with this allele have a reduced risk of developing
alcoholism.[67] Native Americans however, have a significantly higher rate of alcoholism than
average; it is unclear why this is the case.[68] Other risk factors such as cultural environmental
effects e.g. trauma have been proposed to explain the higher rates of alcoholism among Native
Americans compared to alcoholism levels in caucasians.[69][70]

Smoking

Couple lighting each others cigarettes, The Netherlands, 1932.

Smoking is a practice in which a substance, most commonly tobacco or cannabis, is burned and
the smoke is tasted or inhaled. This is primarily practised as a route of administration for
recreational drug use, as combustion releases the active substances in drugs such as nicotine and
makes them available for absorption through the lungs. It can also be done as a part of rituals, to
induce trances and spiritual enlightenment.
The most common method of smoking today is through cigarettes, primarily industrially
manufactured but also hand-rolled from loose tobacco and rolling paper. Other smoking
implements include pipes, cigars, bidis, hookahs, vaporizers, and bongs. It has been suggested
that smoking-related disease kills one half of all long term smokers but these diseases may also
be contracted by non-smokers. A 2007 report states that about 4.9 million people worldwide each
year die as a result of smoking.[1]
Smoking is one of the most common forms of recreational drug use. Tobacco smoking is today
by far the most popular form of smoking and is practiced by over one billion people in the
majority of all human societies. Less common drugs for smoking include cannabis and opium.
Some of the substances are classified as hard narcotics, like heroin, but the use of these is very
limited as they are often not commercially available.
The history of smoking can be dated to as early as 5000 BC, and has been recorded in many
different cultures across the world. Early smoking evolved in association with religious
ceremonies; as offerings to deities, in cleansing rituals or to allow shamans and priests to alter
their minds for purposes of divination or spiritual enlightenment. After the European exploration
and conquest of the Americans, the practice of smoking tobacco quickly spread to the rest of the
world. In regions like India and Subsaharan Africa, it merged with existing practices of smoking
(mostly of cannabis). In Europe, it introduced a new type of social activity and a form of drug
intake which previously had been unknown.

Perception surrounding smoking has varied over time and from one place to another; holy and
sinful, sophisticated and vulgar, a panacea and deadly health hazard. Only relatively recently,
and primarily in industrialized Western countries, has smoking come to be viewed in a decidedly
negative light. Today medical studies have proven that smoking tobacco is among the leading
causes of many diseases such as lung cancer, heart attacks, COPD, erectile dysfunction and can
also lead to birth defects. The inherent health hazards of smoking have caused many countries to
institute high taxes on tobacco products and anti-smoking campaigns are launched every year in
an attempt to curb tobacco smoking.

Health effects

Smoking can damage every part of the body

Some of the toxic components in smoke

Smoking is one of the leading causes of preventable death globally. In the United States about
500,000 deaths per year are attributed to smoking-related diseases and a recent study estimated
that as much as 1/3 of China's male population will have significantly shortened life-spans due to
smoking.[37] Male and female smokers lose an average of 13.2 and 14.5 years of life,
respectively.[38] At least half of all lifelong smokers die earlier as a result of smoking.[39][40] The
risk of dying from lung cancer before age 85 is 22.1% for a male smoker and 11.9% for a female
current smoker, in the absence of competing causes of death. The corresponding estimates for
lifelong nonsmokers are a 1.1% probability of dying from lung cancer before age 85 for a man of
European descent, and a 0.8% probability for a woman.[41] Smoking one cigarette a day results in
a risk of heart disease that is halfway between that of a smoker and a non-smoker. The non-linear
dose response relationship is explained by smoking's effect on platelet aggregation.[42]
Among the diseases that can be caused by smoking are vascular stenosis, lung cancer,[43] heart
attacks[44] and chronic obstructive pulmonary disease.[45] Smoking during pregnancy may cause
ADHD to a fetus.[46]
Many governments are trying to deter people from smoking with anti-smoking campaigns in
mass media stressing the harmful long-term effects of smoking. Passive smoking, or secondhand
smoking, which affects people in the immediate vicinity of smokers, is a major reason for the
enforcement of smoking bans. This is a law enforced to stop individuals smoking in indoor
public places, such as bars, pubs and restaurants. The idea behind this is to discourage smoking

by making it more inconvenient, and to stop harmful smoke being present in enclosed public
spaces. A common concern among legislators is to discourage smoking among minors and many
states have passed laws against selling tobacco products to underage customers. Many
developing countries have not adopted anti-smoking policies, leading some to call for antismoking campaigns and further education to explain the negative effects of ETS (Environmental
Tobacco Smoke) in developing countries.[citation needed]
Despite the many bans, European countries still hold 18 of the top 20 spots, and according to the
ERC, a market research company, the heaviest smokers are from Greece, averaging 3,000
cigarettes per person in 2007.[47] Rates of smoking have leveled off or declined in the developed
world but continue to rise in developing countries. Smoking rates in the United States have
dropped by half from 1965 to 2006, falling from 42% to 20.8% in adults.[48]
The effects of addiction on society vary considerably between different substances that can be
smoked and the indirect social problems that they cause, in great part because of the differences
in legislation and the enforcement of narcotics legislation around the world. Though nicotine is a
highly addictive drug, its effects on cognition are not as intense or noticeable as other drugs such
as, cocaine, amphetamines or any of the opiates (including heroin and morphine).[citation needed]
Smoking is a risk factor in Alzheimer's Disease.[49] While smoking more than 15 cigarettes per
day has been shown to worsen the symptoms of Crohn's Disease,[50] smoking has been shown to
actually lower the prevalence of ulcerative colitis.[51][52]

Physiology

A graph that shows the efficiency of smoking as a way to absorb nicotine compared to other
forms of intake.
Inhaling the vaporized gas form of substances into the lungs is a quick and very effective way of
delivering drugs into the bloodstream (as the gas diffuses directly into the pulmonary vein, then

into the heart and from there to the brain) and affects the user within less than a second of the
first inhalation. The lungs consist of several million tiny bulbs called alveoli that altogether have
an area of over 70 m (about the area of a tennis court). This can be used to administer useful
medical as well as recreational drugs such as aerosols, consisting of tiny droplets of a
medication, or as gas produced by burning plant material with a psychoactive substance or pure
forms of the substance itself. Not all drugs can be smoked, for example the sulphate derivative
that is most commonly inhaled through the nose, though purer free base forms of substances can,
but often require considerable skill in administering the drug properly. The method is also
somewhat inefficient since not all of the smoke will be inhaled.[53] The inhaled substances trigger
chemical reactions in nerve endings in the brain due to being similar to naturally occurring
substances such as endorphins and dopamine, which are associated with sensations of pleasure.
The result is what is usually referred to as a "high" that ranges between the mild stimulus caused
by nicotine to the intense euphoria caused by heroin, cocaine and methamphetamines.[54]
Inhaling smoke into the lungs, no matter the substance, has adverse effects on one's health.[citation
needed]
The incomplete combustion produced by burning plant material, like tobacco or cannabis,
produces carbon monoxide, which impairs the ability of blood to carry oxygen when inhaled into
the lungs. There are several other toxic compounds in tobacco that constitute serious health
hazards to long-term smokers from a whole range of causes; vascular abnormalities such as
stenosis, lung cancer, heart attacks, strokes, impotence, low birth weight of infants born by
smoking mothers. 8% of long-term smokers develop the characteristic set of facial changes
known to doctors as smoker's face.[citation needed]

Psychology

Sigmund Freud, whose doctor assisted his suicide because of oral cancer caused by smoking[55]
Most tobacco smokers begin during adolescence or early adulthood. Smoking has elements of
risk-taking and rebellion, which often appeal to young people. The presence of high-status
models and peers may also encourage smoking. Because teenagers are influenced more by their
peers than by adults,[56] attempts by parents, schools, and health professionals at preventing
people from trying cigarettes are often unsuccessful.

Smokers often report that cigarettes help relieve feelings of stress. However, the stress levels of
adult smokers are slightly higher than those of nonsmokers. Adolescent smokers report
increasing levels of stress as they develop regular patterns of smoking, and smoking cessation
leads to reduced stress. Far from acting as an aid for mood control, nicotine dependency seems to
exacerbate stress. This is confirmed in the daily mood patterns described by smokers, with
normal moods during smoking and worsening moods between cigarettes. Thus, the apparent
relaxant effect of smoking only reflects the reversal of the tension and irritability that develop
during nicotine depletion. Dependent smokers need nicotine to remain feeling normal.[57]
In the mid-20th century psychologists such as Hans Eysenck developed a personality profile for
the typical smoker of that period; extraversion was associated with smoking, and smokers tended
to be sociable, impulsive, risk taking, and excitement-seeking individuals.[58] Although
personality and social factors may make people likely to smoke, the actual habit is a function of
operant conditioning. During the early stages, smoking provides pleasurable sensations (because
of its action on the dopamine system) and thus serves as a source of positive reinforcement. After
an individual has smoked for many years, the avoidance of withdrawal symptoms and negative
reinforcement become the key motivations. Like all addictive substances, the amount of
exposure required to become dependent on nicotine can vary from person to person.

Prevalence

Smoking any tobacco product, %, Males[59]

Smoking, primarily of tobacco, is an activity that is practiced by some 1.1 billion people, and up
to 1/3 of the adult population.[60] The image of the smoker can vary considerably, but is very
often associated, especially in fiction, with individuality and aloofness. Even so, smoking of both
tobacco and cannabis can be a social activity which serves as a reinforcement of social structures
and is part of the cultural rituals of many and diverse social and ethnic groups. Many smokers
begin smoking in social settings and the offering and sharing of a cigarette is often an important
rite of initiation or simply a good excuse to start a conversation with strangers in many settings;
in bars, night clubs, at work or on the street. Lighting a cigarette is often seen as an effective way
of avoiding the appearance of idleness or mere loitering. For adolescents, it can function as a first
step out of childhood or as an act of rebellion against the adult world. Also, smoking can be seen
as a sort of camaraderie. It has been shown that even opening a packet of cigarettes, or offering a
cigarette to other people, can increase the level of dopamine (the "happy feeling") in the brain,
and it is doubtless that people who smoke form relationships with fellow smokers, in a way that
only proliferates the habit, particularly in countries where smoking inside public places has been
made illegal.[citation needed] Other than recreational drug use, it can be used to construct identity and

a development of self-image by associating it with personal experiences connected with

smoking. The rise of the modern anti-smoking movement in the late 19th century did more than
create awareness of the hazards of smoking; it provoked reactions of smokers against what was,
and often still is, perceived as an assault on personal freedom and has created an identity among
smokers as rebels or outcasts, apart from non-smokers:

There is a new Marlboro land, not of lonesome cowboys, but of social-spirited

urbanites, united against the perceived strictures of public health.[61]

The importance of tobacco to soldiers was early on recognized as something that could not be
ignored by commanders. By the 17th century allowances of tobacco were a standard part of the
naval rations of many nations and by World War I cigarette manufacturers and governments
collaborated in securing tobacco and cigarette allowances to soldiers in the field. It was asserted
that regular use of tobacco while under duress would not only calm the soldiers, but allow them
to withstand greater hardship.[62] Until the mid-20th century, the majority of the adult population
in many Western nations were smokers and the claims of anti-smoking activists were met with
much skepticism, if not outright contempt. Today the movement has considerably more weight
and evidence of its claims, but a considerable proportion of the population remains steadfast
smokers.[63]

Society and culture

Smoking has been accepted into culture, in various art forms, and has developed many distinct,
and often conflicting or mutually exclusive, meanings depending on time, place and the
practitioners of smoking. Pipe smoking, until recently one of the most common forms of
smoking, is today often associated with solemn contemplation, old age and is often considered
quaint and archaic. Cigarette smoking, which did not begin to become widespread until the late
19th century, has more associations of modernity and the faster pace of the industrialized world.
Cigars have been, and still are, associated with masculinity, power and is an iconic image
associated with the stereotypical capitalist. In fact, some evidence suggests that men with higher
than average testosterone levels, are more likely to smoke.[64] Smoking in public has for a long
time been something reserved for men and when done by women has been associated with
promiscuity. In Japan during the Edo period, prostitutes and their clients would often approach
one another under the guise of offering a smoke and the same was true for 19th century
Europe.[14]

Substance abuse
Substance abuse, also known as drug abuse, is a patterned use of a substance (drug) in which
the user consumes the substance in amounts or with methods neither approved nor supervised by
medical professionals. Substance abuse/drug abuse is not limited to mood-altering or psychoactive drugs. If an activity is performed using the objects against the rules and policies of the
matter (as in steroids for performance enhancement in sports), it is also called substance abuse.
Therefore, mood-altering and psychoactive substances are not the only types of drug abuse.

Using illicit drugs narcotics, stimulants, depressants (sedatives), hallucinogens, cannabis, even
glues and paints, are also considered to be classified as drug/substance abuse.[2] Substance abuse
often includes problems with impulse control and impulsive behaviour.
The term "drug abuse" does not exclude dependency, but is otherwise used in a similar manner in
nonmedical contexts. The terms have a huge range of definitions related to taking a psychoactive
drug or performance enhancing drug for a non-therapeutic or non-medical effect. All of these
definitions imply a negative judgment of the drug use in question (compare with the term
responsible drug use for alternative views). Some of the drugs most often associated with this
term include alcohol, amphetamines, barbiturates, benzodiazepines (particularly temazepam,
nimetazepam, and flunitrazepam), cocaine, methaqualone, and opioids. Use of these drugs may
lead to criminal penalty in addition to possible physical, social, and psychological harm, both
strongly depending on local jurisdiction.[3] There are many cases in which criminal or antisocial
behavior occur when the person is under the influence of a drug. Long term personality changes
in individuals may occur as well.[4] Other definitions of drug abuse fall into four main categories:
public health definitions, mass communication and vernacular usage, medical definitions, and
political and criminal justice definitions. Substance abuse is prevalent with an estimated 120
million users of hard drugs such as cocaine, heroin and other synthetic drugs.
Substance abuse is a form of substance-related disorder.

classification
Medical definitions
In the modern medical profession, the three most used diagnostic tools in the world, the
American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders
(DSM),the World Health Organization's International Statistical Classification of Diseases and
ICRIS Medical organization Related Health Problems (ICD), no longer recognize 'drug abuse' as
a current medical diagnosis. Instead, DSM has adopted substance abuse[5] as a blanket term to
include drug abuse and other things. ICD refrains from using either substance abuse or drug
abuse, instead using 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 Diagnostic and Statistical Manual of Mental Disorders (DSM-IVTR) ). Its section Substance dependence begins with:
Substance dependence 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. These, along with Substance Abuse are considered Substance
Use Disorders

However, other definitions differ; they may entail psychological or physical dependence,[5] and
may focus on treatment and prevention in terms of the social consequences of substance uses.

Drug misuse
Drug misuse is a term used commonly for prescription medications with clinical efficacy but
abuse potential and known adverse effects linked to improper use, such as psychiatric
medications with sedative, anxiolytic, analgesic, or stimulant properties. Prescription misuse has
been variably and inconsistently defined based on drug prescription status, the uses that occur
without a prescription, intentional use to achieve intoxicating effects, route of administration, coingestion with alcohol, and the presence or absence of abuse or dependence symptoms.[6][7]
Tolerance relates to the pharmacological property of substances in which chronic use leads to a
change in the central nervous system, meaning that more of the substance is needed in order to
produce desired effects. Stopping or reducing the use of this substance would cause withdrawal
symptoms to occur.[8]
The rate of prescription drug abuse is fast overtaking illegal drug abuse 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, prescription drug misuse is now second
only to cannabis.[citation needed] "Nearly 1 in 12 high school seniors reported nonmedical use of
Vicodin; 1 in 20 reported abuse of OxyContin."[9]
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.[10]

Treatment
Treatment for substance abuse is critical for many around the world. Often a formal intervention
is necessary to convince the substance abuser to submit to any form of treatment. Behavioral
interventions and medications exist that have helped many people reduce, or discontinue, their
substance abuse. 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[34][35]

Pharmacological therapy - A number of medications have been approved for the

treatment of substance abuse.[citation needed] 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 (under the brand name
Vivitrol). Several other medications, often ones originally used in other contexts, have
also been shown to be effective including bupropion (Zyban or Wellbutrin), Modafinil
(Provigil) and more.

According to some nurse practitioners, stopping substance abuse can reduce the risk of dying
early and also reduce some health risks like heart disease, lung disease, and strokes.[36]
In children and adolescents, cognitive behavioral therapy (CBT)[37] and family therapy[38]
currently have the most research evidence for the treatment of substance abuse problems. These
treatments can be administered in a variety of different formats, each of which has varying levels
of research support[39]
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.[40] It has been
suggested that social skills training adjunctive to inpatient treatment of alcohol dependence is
probably efficacious,[41] including managing the social environment.