Drug abuse and dependence

Causes and Risks:
Drug abuse and dependence occurs with both legal prescription and nonprescription medications, as well as illegal substances. Drug abuse can lead to drug dependence or addiction. This may occur through the progression from experimentation with drugs to their occasional use and then to the development of tolerance and physical dependence. The exact cause of drug abuse and dependence is not known, however, the make-up of the individual, the addictiveness of the drug, peer pressure, emotional distress, anxiety , depression , low self-esteem, and environmental stress are all factors that may play a causative role. Drug dependence may follow the use of drugs for physical pain relief.

Risk factors that predispose people to drug abuse are a lack of mental or emotional resources against stress, a low tolerance for frustration, and the need for immediate relief of tension or distress. Health care professionals are at risk of drug abuse and dependence because of increased access to drugs.

Junior high and high school students often begin using drugs as a result of peer pressure. Lack of adequate family support, failure or parental supervision, excess unsupervised free time, and a more tolerant societal attitude have contributed to increased drug use among adolescents. Younger children (toddler through grade school) may first see drugs used by their parents or their friends parents. These children often grow up in an environment of illicit drug use .

There is also an attitude fostered by television, radio, and magazine advertising, and even somewhat by the medical profession, that medications are available for every problem to make a person feel better. The attitude, unfortunately, is extended by younger people to include illegal drugs.

Signs of school age children on drugs may include any of the following:

1. A change in the child's friends, a new group
2. Seclusive behavior
3. Long unexplained periods away from home
4. Lying
5. Stealing
6. Involvement with the law
7. Deteriorating family relations
8. Obvious toxic state: drunk, delirious, incoherent, unconscious
9. Changes in behavior and normal attitude
10. Decreased school performance

Commonly abused substances include:
  • Opioids or narcotics include heroin , opium, codeine, meperidine, (Demerol), hydromorphone (Dilaudid), methadone, and others. These drugs have a sedative effect, but also cause euphoria-like states and produce a physical and psychological dependence.
  • Central nervous system stimulants include amphetamines, cocaine , dextroamphetamine, and methamphetamine. These drugs have a stimulating effect and produce tolerance and psychological dependence.
  • Central nervous system depressants include barbiturates such as amobarbital, pentobarbital, secobarbital; Benzodiazepine; chloral hydrate; and paraldehyde. They produce a depressant and sedative effect as well as physical and psychological dependence.
  • Cannabis includes marijuana , hashish, and THC (tetrahydrocannabinol), and produces psychological but not physical dependence.
  • Hallucinogens include LSD , mescaline, psilocybin, and phencyclidine (PCP). They have hallucinogenic properties and can produce psychological dependence.

Acute drug intoxication and drug overdose may be accidental or intentional. Drug withdrawal symptoms can occur when use of a substance is stopped or reduced. Withdrawal symptoms vary, depending on the abused substance. The onset of withdrawal symptoms depends on the length of time the drug normally stays within the body. Benzodiazepine (Valium and similar drugs) withdrawal will occur 5 to 7 days after the drug is reduced or stopped. Opiate withdrawal starts between 6 to 12 hours after the last use. Drug intoxication, overdose, and withdrawal can be life-threatening situations.

The incidence of drug abuse and dependence is widespread and affects all levels of society, causing a major public health problem.

Prevention:
Drug education programs have a preventive role for some children and teenagers who are able to resist peer pressure. At present, drug prevention education is not widespread, and the long-term success of these programs is not known.

Symptoms:
OPIOID SYMPTOMS:

CENTRAL NERVOUS SYSTEM STIMULANT SYMPTOMS

CENTRAL NERVOUS SYSTEM DEPRESSANT SYMPTOMS

CANNABIS SYMPTOMS

  • panic and paranoid reactions

HALLUCINOGEN SYMPTOMS

Note: Symptoms vary depending upon the abused substance.

High blood pressure may also be associated with drug abuse .

Signs and Tests:
Toxicology screens (drug testing) done on blood and urine specimens can reveal the presence of many chemicals and drugs in the body. The sensitivity depends upon the substance itself, when the substance was taken, and the testing laboratory.

Treatment:
Treatment for the person with drug abuse or dependence begins with the recognition of the problem. Drug dependence is associated with denial, allowing the person to believe there is no need for treatment. Most people with drug dependence enter treatment under pressure from others rather than a voluntary acceptance of the need for treatment.

Treatment of drug dependency involves detoxification, long-term rehabilitation, and a lifetime of abstinence. Emergency treatment may be indicated for acute intoxication or drug overdose and is symptomatic . Often, support of the respiratory system is needed as there may be a loss of consciousness . The specific treatment depends on the drug.

Detoxification is the gradual withdrawal of an abused substance under controlled circumstances. Sometimes a drug with a similar action is substituted during the withdrawal process to reduce the unpleasant symptoms and risks associated with withdrawal. The process is managed on an inpatient or outpatient basis, depending on the substance.

Rehabilitation is the process that occurs after detoxification and is needed to prevent the recurrence of drug abuse . Inpatient and outpatient programs are available. Individual, group, or family therapy is usually part of this process, which may continue for a month or longer. Information/support may also be sought from local 12 step groups (i.e., Alcoholics Anonymous (AA), Narcotics Anonymous (NA), Ala-teen, Alanon) which you can locate through your phone directory. See chemical dependence - support group .

If a depression or other mood disorder exists, that should be treated appropriately. Often drug abuse develops from efforts to self-treat an illness of which the individual is unaware.

Aftercare involves life-long abstinence from drug abuse. Self-help groups such as Narcotics Anonymous can offer support.

Prognosis:
Drug abuse and dependence may lead to a fatal drug overdose. Relapses from drug abstinence may occur and lead to recurrent dependence.

Complications:



Call Your Healthcare Provider:
Call for an appointment with your health care provider if you are addicted to drugs and would like to get off of them or you have been cut off from your drug supply and are at risk of withdrawal.