Drug Abuse and Addiction

OTC and Prescription Drug Abuse Slideshow Pictures Health Risks of Alcohol Abuse Slideshow Pictures Medical Author: Roxanne Dryden-Edwards, MD Medical Editor: Melissa Conrad Stppler, MD

What is drug abuse? What is drug addiction? What types of drugs are commonly abused? What are the physical and psychological effects of drug abuse and addiction? What causes drug abuse and addiction? What are symptoms and signs of drug abuse and addiction? What happens to your brain when you take drugs? How is drug addiction diagnosed? What is the treatment for drug addiction? What is the prognosis of drug addiction? Can drug abuse and addiction be prevented? Drug Abuse and Addiction At A Glance Patient Discussions: Drug Abuse - Treatments Find a local Psychiatrist in your town

Prescription Drug Abuse, an Alarming Trend

Medical Author: Melissa Conrad Stppler, MD Medical Editor: Barbara K. Hecht, PhD In 2009, 16 million Americans 12 years of age and older had taken a prescription pain reliever, tranquilizer, stimulant, or sedative for nonmedical purposes at least once in the year prior to being surveyed, according to the National Survey on Drug Use and Health (Substance Abuse and Mental Health Administration). Although any type of medication has the potential to be abused, certain groups of prescription drugs are most commonly abused. Although any type of medication has the potential to be abused, certain groups of prescription drugs are most commonly abused. Painkillers: Opioids such as codeine and morphine are narcotics prescribed to treat pain. Other drugs in this class include oxycodone (OxyContin), hydrocodone (Vicodin), meperidine (Demerol), hydromorphone (Dilaudid), and propoxyphene (Darvon).

CNS depressants: Drugs in the benzodiazepine class are central nervous system (CNS) depressants used to treat anxiety disorders and sometimes for the short-term treatment of insomnia. Examples include alprazolam (Xanax), diazepam (Valium), and triazolam (Halcion). Barbiturates: Barbiturates are also CNS depressants. They include phenobarbital (Luminal), pentobarbital (Nembutal), and mephobarbital (Mebaral). Barbiturates are prescribed to treat insomnia, tension, and anxiety. Stimulants: Stimulants are sometimes prescribed to treat obesity and attention-deficit hyperactivity disorder. Examples include methylphenidate (Ritalin) and dextroamphetamine (Dexedrine). Some of these preparations can be found in over-the-counter diet pills. Dextromethorphan (DMX): DMX is the active cough suppressant found in cough and cold medications. Read more about risk factors, treatment, and prevention of prescription drug abuse

Top Searched Drug Abuse and Addiction Terms:

signs, cause, teens, prevent, symptoms, treatment, alcoholism, narcotics, cocaine, heroin, marijuana, crack, inhalants, effects, MDMA, ecstasy, opiates, anabolic steroids, cigarette, hallucinogens, prognosis, anxiety

What is drug abuse?

Drug abuse, also called substance abuse or chemical abuse, is a disorder that is characterized by a destructive pattern of using a substance that leads to significant problems or distress. It affects more than 7% of people at some point in their lives. Teens are increasingly engaging in prescription drug abuse, particularly narcotics (which are prescribed to relieve severe pain), and stimulant medications, which treat conditions like attention deficit disorder.

What is drug addiction?

Drug addiction, also called substance dependence or chemical dependency, is a disease that is characterized by a destructive pattern of drug abuse that leads to significant problems involving tolerance to or withdrawal from the substance, as well as other problems that use of the substance can cause for the sufferer, either socially or in terms of their work or school performance. More than 2.6% of people suffer from drug addiction at some time in their life. The term dual diagnosis refers to the presence of both a drug-abuse or dependence issue in addition to a serious mental-health problem in an individual. Substance abuse or dependence unfortunately occurs quite commonly in people who also have severe mental illness. This is important given that people with a serious mental illness are far more at risk of engaging in

violence, being incarcerated, or contracting infection with the human immunodeficiency virus (HIV). Individuals with dual diagnosis are also at higher risk of being noncompliant with treatment.

What types of drugs are commonly abused?

Virtually any substance whose ingestion can result in a euphoric ("high") feeling can be abused. While many are aware of the abuse of legal substances like alcohol or illegal drugs like marijuana (in most states) and cocaine, less well known is the fact that inhalants like household cleaners are some of the most commonly abused substances. The following are many of the drugs and types of drugs that are commonly abused and/or result in dependence:

Alcohol: Although legal, alcohol is a toxic substance, particularly to a developing fetus when a mother consumes this drug during pregnancy.

Amphetamines: This group of drugs comes in many forms, from prescription medications like methylphenidate (Ritalin, Concerta) and dextroamphetamine and amphetamine (Adderall) to illegally manufactured drugs like methamphetamine ("meth"). Overdose of any of these substances can result in seizure and death.

Anabolic steroids: A group of substances abused by bodybuilders and other athletes, this group of drugs can lead to terrible psychological effects like aggression and paranoia, as well as devastating long-term physical effects like infertility and organ failure.

Caffeine: While it is consumed by many, coffee, tea and soda drinkers, when consumed in excess this substance can produce palpitations, insomnia, tremors and significant anxiety.

Cannabis: More commonly called marijuana, the scientific name for cannabis is tetrahydrocannabinol (THC). In addition to the negative effects the drug itself can produce (for example, infertility, paranoia, lack of motivation), the fact that it is commonly mixed ("cut") with other substances so drug dealers can make more money selling the diluted substance or expose the user to more addictive drugs exposes the marijuana user to the dangers associated with those added substances. Examples of ingredients that marijuana is commonly cut with include baby powder, oregano, embalming fluid, PCP, opiates, and cocaine.

Cocaine: A drug that tends to stimulate the nervous system, cocaine can be snorted in powder form, smoked when in the form of rocks (crack cocaine), or injected when made into a liquid.

Ecstasy: Also called MDMA to denote its chemical composition (methylenedioxymethamphetamine), this drug tends to create a sense of euphoria and an expansive love or desire to nurture others. In overdose, it can increase body temperature to the point of being fatal.

Hallucinogens: Examples include LSD and mescaline, as well as so-called naturally occurring hallucinogens like certain mushrooms, these drugs can be dangerous in their ability to alter the perceptions of the user. For example, a person who is intoxicated with a hallucinogen may perceive danger where there is none and to think that situations that are truly dangerous are not. Those misperceptions can result in dangerous behaviors (like jumping out of a window because the individual thinks they are riding on an elephant that can fly).

Inhalants: One of the most commonly abused group of substances due to its accessibility, inhalants are usually contained in household cleaners, like ammonia, bleach, and other substances that emit fumes. Brain damage, even to the point of death, can result from using an inhalant just once or over the course of time, depending on the individual.

Nicotine: The addictive substance found in cigarettes, nicotine is actually one of the most habit-forming substances that exists. In fact, nicotine addiction is often compared to the intense addictiveness associated with opiates like heroin.

Opiates: This group is also called narcotics and includes drugs like heroine, codeine, Vicodin, Percocet, and Percodan. This group of substances sharply decrease the functioning of the nervous system. The lethality of opiates is often the result of the abuser having to use increasingly higher amounts to achieve the same level of intoxication, ultimately to the point that the dose needed to get high is the same as the dose that is lethal for that individual by halting the person's breathing (respiratory arrest).

Phencyclidine: Commonly referred to as PCP, this drug can cause the user to feel extremely paranoid, become quite aggressive and to have an unusual amount of physical strength. This can make the individual quite dangerous to others.

Sedative, hypnotic, or antianxiety drugs: As these substances quell or depress the nervous system, they can cause death by respiratory arrest of the person who either uses these drugs in overdose or who mixes one or more of these drugs with another nervous system depressant drug (like alcohol or an opiate).

What are the physical and psychological effects of drug abuse and addiction?
While the specific physical and psychological effects of drug abuse and addiction tend to vary based on the particular substance involved, the general effects of abuse or addiction to any drug can be devastating. Psychologically, intoxication with or withdrawal from a substance can cause everything from euphoria as with alcohol, Ecstasy, or inhalant intoxication to paranoia with marijuana or steroid intoxication, to severe depression or suicidal thoughts with cocaine or amphetamine withdrawal.

What causes drug abuse and addiction?

Like the majority of other mental-health problems, drug abuse and addiction have no single cause. However, there are a number of biological, psychological, and social factors, called risk factors, that can increase a person's likelihood of developing a chemical-abuse or chemicaldependency disorder. The frequency to which substance-abuse disorders occur within some families seems to be higher than could be explained by an addictive environment of the family. Therefore, most substance-abuse professionals recognize a genetic aspect to the risk of drug addiction. Psychological associations with substance abuse or addiction include mood disorders like depression, anxiety, or bipolar disorder, as well as personality disorders like antisocial personality disorder. Social risk factors for drug abuse and addiction include male gender, being between 18 and 44 years of age, Native-American heritage, unmarried marital status, and lower socioeconomic status. According to statistics by state, people residing in the West tend to be at higher risk for chemical abuse or dependency. While men are more at risk for developing a chemical dependency like alcoholism, women seem to be more vulnerable to becoming addicted to alcohol at much lower amounts of alcohol consumption.

What are symptoms and signs of drug abuse and addiction?

In order to be diagnosed with drug abuse, an individual must exhibit a destructive pattern of drug abuse that leads to significant problems or stress but not enough to qualify as being addicted to a drug. This pattern is manifested by at least one of the following signs or symptoms in the same one-year period:

Recurrent drug use that results in a lack of meeting important obligations at work, school, or home

Recurrent drug use in situations that can be dangerous

Recurrent legal problems as a result of drug use

Continued drug use despite continued or repeated social or relationship problems as a result of the drug's effects

In order to be diagnosed with a drug addiction, an individual must exhibit a destructive pattern of drug abuse that leads to significant problems as manifested by at least three of the following signs or symptoms in the same one-year period:

Tolerance is either a markedly decreased effect of the substance or a need to significantly increase the amount of the substance used in order to achieve the same high or other desired effects.

Withdrawal is either physical or psychological signs or symptoms consistent with withdrawal from a specific drug, or taking that drug or one chemically close to that drug in order to avoid developing symptoms of withdrawal.

Larger amounts of the drug are taken or for longer than intended.

The individual experiences a persistent desire to take the drug or has unsuccessful attempts to decrease or control the substance use.

Significant amounts of time are spent either getting, using, or recovering from the effects of the substance.,

The individual significantly reduces or stops participating in important social, recreational, work, or school activities as a result of using the substance.

The individual continues to use the substance despite being aware that he or she suffers from ongoing or recurring physical or psychological problems that are caused or worsened by the use of the drug.
Font Size A A A

Previous 1 2 3 4 5 6 7 Next Drug Abuse Index Glossary Find a Local Doctor

Drug Abuse (cont.)

OTC and Prescription Drug Abuse Slideshow Pictures Health Risks of Alcohol Abuse Slideshow Pictures Medical Author: Roxanne Dryden-Edwards, MD

Roxanne Dryden-Edwards, MD

Dr. Roxanne Dryden-Edwards is an adult, child, and adolescent psychiatrist. She is a former Chair of the Committee on Developmental Disabilities for the American Psychiatric Association, Assistant Professor of Psychiatry at Johns Hopkins Hospital in Baltimore, Maryland, and Medical Director of the National Center for Children and Families in Bethesda, Maryland.
View Full Profile Medical Editor: Melissa Conrad Stppler, MD

Melissa Conrad Stppler, MD

Melissa Conrad Stppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
View Full Profile In this Article

What is drug abuse? What is drug addiction? What types of drugs are commonly abused? What are the physical and psychological effects of drug abuse and addiction? What causes drug abuse and addiction? What are symptoms and signs of drug abuse and addiction? What happens to your brain when you take drugs? How is drug addiction diagnosed? What is the treatment for drug addiction? What is the prognosis of drug addiction? Can drug abuse and addiction be prevented? Drug Abuse and Addiction At A Glance

Drug Abuse Glossary Drug Abuse Index Find a local Psychiatrist in your town

What happens to your brain when you take drugs?

While the specific effects of drugs on the brain can vary somewhat depending on the drug that is being used, virtually every drug that is abused has an effect on what professionals often call the executive functioning areas of the brain. The functions of those areas can be remembered by thinking about the tasks of the chief executive officer in any company: planning, organizing, acting when it is time to act, as well as delaying or preventing action (inhibitory functions) when appropriate. The parts of the brain that tend to harbor the executive brain functions are the frontmost parts of the brain, called the frontal cortex and prefrontal cortex. When a person takes drugs, the inhibitory functions of the brain are particularly impaired, resulting in the person using drugs and having trouble stopping him or herself from acting on impulses that the brain would otherwise delay or prevent. This disinhibition can result in the substance abuser engaging in aggressive, sexual, criminal, or other activities that can have devastating consequences for the addicted person or those around him or her.

How is drug addiction diagnosed?

As is true with virtually any mental-health diagnosis, there is no one test that definitively indicates that someone has chemical abuse or addiction. Therefore, health-care practitioners diagnose these disorders by gathering comprehensive medical, family, and mental-health information. The practitioner will also either perform a physical examination or request that the individual's primary-care doctor perform one. The medical examination will usually include lab tests to evaluate the person's general health and to explore whether or not the individual has a medical condition that might have mental-health symptoms. In asking questions about mental-health symptoms, mental-health professionals are often exploring if the individual suffers from depression and/or manic symptoms but also anxiety, hallucinations, or delusions, as well as some behavioral disorders. Practitioners may provide the people they evaluate with a quiz or self-test as a screening tool for substance abuse or dependence. Since some of the symptoms of drug misuse and dependence can also occur in other mental illnesses, the mental-health screening is to determine if the individual suffers from bipolar disorder, an anxiety disorder, schizophrenia, schizoaffective disorder and other psychotic disorders, or a personality or behavior disorder like antisocial personality disorder or attention deficit hyperactivity disorder (ADHD), respectively. Any disorder that is associated with sudden changes in behavior, mood, or thinking, like bipolar disorder, a psychotic disorder, borderline personality disorder, or dissociative identity disorder (DID) may be particularly challenging to distinguish from some symptoms of drug abuse or dependence. In order to assess the person's current emotional state, health-care providers perform a mental-status examination as well. In addition to providing treatment that is appropriate to the diagnosis, determining the presence

of mental illnesses that may co-occur (be co-morbid) with substance abuse or dependence is important in promoting the best possible outcome for the person. As previously described, the dual diagnosis of substance abusing or addicted individuals dictates the need for treatment that addresses both issues in a coordinated way by professionals who are trained and experienced with helping this specific population.
Font Size A A A

Previous 1 2 3 4 5 6 7 Next Drug Abuse Index Glossary Find a Local Doctor

Drug Abuse (cont.)

OTC and Prescription Drug Abuse Slideshow Pictures Health Risks of Alcohol Abuse Slideshow Pictures Medical Author: Roxanne Dryden-Edwards, MD

Roxanne Dryden-Edwards, MD

Dr. Roxanne Dryden-Edwards is an adult, child, and adolescent psychiatrist. She is a former Chair of the Committee on Developmental Disabilities for the American Psychiatric Association, Assistant Professor of Psychiatry at Johns Hopkins Hospital in Baltimore, Maryland, and Medical Director of the National Center for Children and Families in Bethesda, Maryland.
View Full Profile Medical Editor: Melissa Conrad Stppler, MD

Melissa Conrad Stppler, MD

Melissa Conrad Stppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
View Full Profile In this Article

What is drug abuse? What is drug addiction? What types of drugs are commonly abused? What are the physical and psychological effects of drug abuse and addiction? What causes drug abuse and addiction? What are symptoms and signs of drug abuse and addiction? What happens to your brain when you take drugs? How is drug addiction diagnosed? What is the treatment for drug addiction? What is the prognosis of drug addiction? Can drug abuse and addiction be prevented? Drug Abuse and Addiction At A Glance Drug Abuse Glossary Drug Abuse Index Find a local Psychiatrist in your town

What is the treatment for drug addiction?

An unfortunate fact about the treatment of drug addiction is that it remains largely unutilized by most sufferers of this condition. Facts about the use of drug treatment include that less than 10% of people with a substance-abuse disorder and less than 40% of those with a substancedependence disorder seek treatment. Those statistics do not seem to be associated with socioeconomic or other demographic traits but do seem to be associated with the presence of other mental-health problems (co-morbidity). The primary goals of drug-abuse or addiction treatment (also called recovery) are abstinence, relapse prevention, and rehabilitation. During the initial stage of abstinence, an individual who suffers from chemical dependency may need help avoiding or lessening the effects of withdrawal. That process is called detoxification or "detox." That aspect of treatment is usually performed in a hospital or other inpatient setting, where medications used to lessen withdrawal symptoms and frequent medical monitoring can be provided. The medications used for detox are determined by the substance the individual is dependent upon. For example, people with alcohol dependence might receive medications like anti-anxiety or blood pressure medications to decrease palpitations and blood pressure, or seizure medications to prevent possible seizures during the detoxification process. For many drugs of abuse, the detox process is the most difficult aspect of coping with the physical symptoms of addiction and tends to last days to a few weeks. Medications that are sometimes used to help addicted individuals abstain from drug use long term also depends on the specific drug of addiction. For example, individuals who are addicted to narcotics like aspirin and oxycodone hydrochloride (Percodan), heroin, or hydrocodone/acetaminophen (Vicodin, Vicodin ES, Anexsia, Lorcet, Lorcet Plus, Norco) often benefit from receiving longer-acting, less addictive narcotic-like substances like methadone (Methadose). Disulfiram (Antabuse) produces nausea, stomach cramping, and vomiting when mixed with alcohol. Often, much more challenging and time consuming than recovery from the physical aspects of addiction is psychological addiction. For people who may have less severe drug dependency, the symptoms of psychological addiction may be able to be managed in an outpatient treatment program. However, those who have a more severe addiction, have relapsed after participation in outpatient programs, or who also suffer from a severe mental illness might need the higher structure, support, and monitoring provided in an inpatient drug treatment center, sometimes called "rehab." Following such inpatient treatment, many people with this level of addiction can benefit from living in a sober living community, that is, a group-home setting where counselors provide continued sobriety support and structure on a daily basis. Also important in the treatment of addiction is helping the parents, other family members, and friends of the addicted person refrain from supporting addictive behaviors (codependency). Whether providing financial support, making excuses or failing to acknowledge the addictive behaviors of the addict, discouraging such codependency of loved ones is a key component to the recovery of the affected individual. A focus on the addicted person's role in the family becomes perhaps even more acute when that person is a child or teenager, given that minors come within the context of a family in nearly every instance. Chemical dependency treatment for children and

adolescents is further different from that in adults by the younger addict's tendency to need help completing their education and achieving higher education or job training compared to addicts who may have completed those parts of their lives before developing the addiction. The treatment of dual diagnosis seems to be less effective when treatment of their mental illness is separate from the treatment of the individual's chemical dependency. More successful are integrated treatment programs that include interventions for both disorders. Such interventions are all the more improved by the inclusion of assessment, intensive case management, motivational interventions, behavior interventions, family treatment as well as services for housing, rehabilitation, and medication treatment.
Font Size A A A

Previous 1 2 3 4 5 6 7 Next Drug Abuse Index Glossary Find a Local Doctor

Drug Abuse (cont.)

OTC and Prescription Drug Abuse Slideshow Pictures Health Risks of Alcohol Abuse Slideshow Pictures Medical Author:

Roxanne Dryden-Edwards, MD Medical Editor: Melissa Conrad Stppler, MD In this Article

What is drug abuse? What is drug addiction? What types of drugs are commonly abused? What are the physical and psychological effects of drug abuse and addiction? What causes drug abuse and addiction? What are symptoms and signs of drug abuse and addiction? What happens to your brain when you take drugs? How is drug addiction diagnosed? What is the treatment for drug addiction? What is the prognosis of drug addiction? Can drug abuse and addiction be prevented? Drug Abuse and Addiction At A Glance Drug Abuse Glossary Drug Abuse Index Find a local Psychiatrist in your town

What is the prognosis of drug addiction?

Drug addiction increases the risk of a number of negative life stressors and conditions. Individuals who are addicted to drugs are at increased risk for domestic violence, particularly if cocaine dependence or binge drinking is involved. If treated, the prognosis of alcoholism and other drug addictions improves but is not without challenges. Recovery from substance abuse is usually characterized by episodes of remission (abstinence from drug use) and relapse.

Can drug abuse and addiction be prevented?

A number of different prevention approaches have been found to be effective in decreasing the risk of drug abuse and addiction. Simple lifestyle changes, like increased physical activity, are thought to help prevent drug abuse and dependence in teens. More formal programs have also been found to be helpful. For example, the Raising Healthy Children program, which includes interventions for teachers, parents, and students, has been found to help prevent substance abuse and addiction in elementary school children when the program goes on for 18 months or more. The prevalence of easier access to technology has led to the development of computer-based prevention programs. Such programs have been found to be very promising in how they compare to more traditional prevention programs, as well as how many more people can be reached through technology.

Where can people get help for drug abuse or addiction?

Al-Anon-Alateen: 888-4AL-ANON

Alcoholics Anonymous World Services: 212-870-3400

American Council on Alcoholism treatment referral line: 800-527-5344

Kids Against Drugs: http://www.kidsagainstdrugs.com

Mothers Against Drunk Driving: 800-GET-MADD

Narconon: http://www.narconon.org/

Narcotics Anonymous: http://www.na.org

National Clearinghouse for Alcoholism and Drug Information: 800-729-6686

National Council on Alcoholism and Drug Dependence: 800-NCA-CALL

National Institute on Alcohol Abuse and Alcoholism: 301-443-3860

National Institute on Drug Abuse: http://www.nida.nih.gov

National Resource Center: 866-870-4979

Drug Abuse and Addiction At A Glance

Drug abuse is a disorder that is characterized by a destructive pattern of using a substance that leads to significant problems or distress. Drug addiction is a disease that is characterized by a destructive pattern of drug abuse that leads to significant problems involving tolerance to or withdrawal from the substance, as well as other problems use of the substance can cause for the sufferer. Drug abuse and addiction are unfortunately quite common, affecting 7% and more than 2% of people at some point in their lives, respectively. Dual diagnosis refers to the presence of both a drug-abuse or dependence issue in addition to a serious mental-health problem in an individual. Virtually any substance whose ingestion can result in a euphoric ("high") feeling can be abused. Inhalants like household cleaners are some of the most commonly abused substances. While the specific physical and psychological effects of drug abuse and addiction tend to vary based on the particular substance involved, the general effects of abuse or addiction to any drug can be devastating. Although drug abuse and addiction have no single cause, there are a number of biological, psychological, and social risk factors that can increase a person's likelihood of developing a chemical abuse or chemical dependency disorder. Symptoms of drug abuse include recurrent drug use that results in legal problems, occurs in potentially dangerous situations, interferes with important obligations, or results in social or relationship problems. Symptoms of drug dependence include tolerance, withdrawal, using a lot of the drug or for a long period of time, persistent desire to use the drug, unsuccessful efforts to stop using the drug, neglecting other aspects of life because of their drug use, and spending inordinate amounts of time or energy getting, using, or recovering from the effects of the drug. While the specific effects of drugs on the brain can somewhat vary depending on the drug that is being used, virtually every drug that is abused has an effect on the executive functioning areas of the brain. Drugs particularly affect the brain's ability to inhibit actions that the person would otherwise delay or prevent. Since there is no one test that definitively indicates that someone has chemical abuse or addiction, health-care practitioners diagnose these disorders by gathering comprehensive medical, family, and mental-health information, as well as securing a physical examination and lab tests to assess the sufferer's medical state. Treatment services for drug abuse and addiction remain largely unutilized by most sufferers of these conditions. The primary goals of recovery are abstinence, relapse prevention, and rehabilitation. During the initial stage of abstinence, an individual who suffers from chemical dependency may need detoxification treatment to help avoid or lessen the effects of withdrawal. Often, much more challenging and time consuming than recovery from the physical aspects of addiction is psychological addiction. The treatment of dual diagnosis seems to be more effective when treatment of the sufferer's mental illness is integrated with the treatment of the individual's chemical dependency. Drug addiction increases the risk of a number of negative life stressors and conditions,

particularly if left untreated. Recovery from substance abuse is usually characterized by episodes of remission and relapse.