Substance Abuse Generally, when most people talk about substance abuse, they are referring to the use

of illegal drugs. Most professionals in the field of drug abuse prevention argue that any use of illegal drugs is by definition abuse. Those drugs got to be illegal in the first place because they are potentially addictive or can cause severe negative health effects; therefore, any use of illegal substances is dangerous and abusive. Substance abuse refers to the harmful or hazardous use of psychoactive substances, including alcohol and illicit drugs. Psychoactive substance use can lead to dependence syndrome - a cluster of behavioural, cognitive, and physiological phenomena that develop after repeated substance use and that typically include a strong desire to take the drug, difficulties in controlling its use, persisting in its use despite harmful consequences, a higher priority given to drug use than to other activities and obligations, increased tolerance, and sometimes a physical withdrawal state. 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 physica ltrauma. 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. . Abused substances produce some form of intoxication that alters judgment, perception, attention, or physical control. Many substances can bring on withdrawal-an effect caused by cessation or reduction in the amount of the substance used. Withdrawal can range from mildanxiety 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. Tobacco: People cite many reasons for using tobacco, including pleasure, improved performance and vigilance, relief of depression, curbing hunger, and weight control. o 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. o 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 can cause heart enlargement and cancer of the esophagus,pancreas, and stomach. o In addition to its direct health effects, officials associate alcohol abusewith 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. o 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. o Effects of heroin intoxication include drowsiness, pleasure, and slowedbreathing. 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 triggerother 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 asensation 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 longterm effects include paranoia, hallucinations, weight loss, destruction of teeth, and heart damage. 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 isa stimulant andhallucinogen used to improve mood and to maintain energy, often for all-night 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 include low 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 (also known as angel dust, hog, love boat): PCP isa 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.

Inhalants are a broad range of drugs whose volatile vapors are taken in via
the nose and trachea.While some inhalant drugs are used for medical purposes, as in the case of nitrous oxide (a dental anaesthetic), this article focuses on inhalant abuse as recreational drugs that are used for their intoxicating effect.\

Prescription drugs~ substance abuse is on the rise and affects teens as well as adults. Prescription drugs are usually found by the addict initially in the home.

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:

Giving up past activities such as sports, homework, or hanging out with new friends Declining grades 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

Substance Abuse Causes

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. Factors within a family that influence a child's early development have been shown to be related to increased risk of drug abuse. o Chaotic home environment

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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 n Perception of approval of drug use behaviour

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: 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 If any of the following occur, call 911 or go to a hospital's emergency departmentimmediately: 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

Substance Abuse Treatment

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

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. There are a variety of evidence-based approaches to treating addiction. Drug treatment can include behavioral therapy (such as individual or group counseling, cognitive therapy, or contingency management), medications, or their combination. The specific type of treatment or combination of treatments will vary depending on the patient's individual needs and, often, on the types of drugs they use. The severity of addiction and previous efforts to stop using drugs can also influence a treatment approach. Finally, people who are addicted to drugs often suffer from other health (including other mental health), occupational, legal, familial, and social problems that should be addressed concurrently. The best programs provide a combination of therapies and other services to meet an individual patient's needs. Specific needs may relate to age, race, culture, sexual orientation, gender, pregnancy, other drug use, comorbid conditions (e.g., depression, HIV), parenting, housing, and employment, as well as physical and sexual abuse history. Treatment medications, such as methadone, buprenorphine, and naltrexone, are available for individuals addicted to opioids, while nicotine preparations (patches, gum, lozenges, and nasal spray) and the medications varenicline and bupropion are available for individuals addicted to tobacco. Disulfiram, acamprosate, naltrexone, and topiramate are medications used for treating alcohol dependence, which commonly co-occurs with other drug addictions. In fact, most people with severe addiction are polydrug users and

require treatment for all substances abused. Even combined alcohol and tobacco use has proven amenable to concurrent treatment for both substances. Psychoactive medications, such as antidepressants, antianxiety agents, mood stabilizers, and antipsychotic medications, may be critical for treatment success when patients have co-occurring mental disorders, such as depression, anxiety disorders (including posttraumatic stress disorder), bipolar disorder, or schizophrenia. Behavioral therapies can help motivate people to participate in drug treatment; offer strategies for coping with drug cravings; teach ways to avoid drugs and prevent relapse; and help individuals deal with relapse if it occurs. Behavioral therapies can also help people improve communication, relationship, and parenting skills, as well as family dynamics. Many treatment programs employ both individual and group therapies. Group therapy can provide social reinforcement and help enforce behavioral contingencies that promote abstinence and a non-drug-using lifestyle. Some of the more established behavioral treatments, such as contingency management and cognitive-behavioral therapy, are also being adapted for group settings to improve efficiency and cost-effectiveness. However, particularly in adolescents, there can also be a danger of iatrogenic, or inadvertent, effects of group treatment; thus, trained counselors should be aware and monitor for such effects.

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. 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.