Drug abuse and dependence

Alternative names:

drug addiction

Definition:

Use of any drug for purposes other than those for which it is normally intended, or in a manner or in quantities other than directed; drug dependence is the compulsion to continue taking a drug to produce desired effects, or to prevent the onset of ill effects that occur when it is not taken. See also drug abuse and drug abuse first aid.

Causes, incidence, and risk factors:

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.