SUBSTANCE ABUSE

also known as drug abuse, refers to a maladaptive pattern of use of a substance

that is not considered dependent.The term "drug abuse" does not exclude depende
ncy,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 perfor
mance enhancing drug for a non-therapeutic or non-medical effect. All of these d
efinitions imply a negative judgment of the drug use in question (compare with t
he term responsible drug use for alternative views). Some of the drugs most ofte
n associated with this term include alcohol, amphetamines, barbiturates, benzodi
azepines, cocaine, methaqualone, and opioids. Use of these drugs may lead to cri
minal penalty in addition to possible physical, social, and psychological harm,
both strongly depending on local jurisdiction. Other definitions of drug abuse f
all into four main categories: public health definitions, mass communication and
vernacular usage, medical definitions, and political and criminal justice defin
itions.
Worldwide, the UN estimates there are more than 50 million regular users of hero
in, cocaine and synthetic drugs.
Substance abuse is a form of substance-related disorder.
-substance-related disorder
is an umbrella term used to describe several different conditions (such as intox
ication, harmful use/abuse, dependence, withdrawal, and psychoses or amnesia ass
ociated with the use of the substance) associated with several different substan
ces (such as alcohol or opiods.)
Substance-related disorders can be subcategorized into "substance use disorders"
(SUD) and "substance-induced disorders"
Though DSM-IV makes a firm distinction between the two, SIDs often occur in the
context of SUDs.
-public health definitions
Public health practitioners have attempted to look at drug abuse from a broader
perspective than the individual, emphasizing the role of society, culture and av
ailability. Rather than accepting the loaded terms alcohol or drug "abuse," many
public health professionals have adopted phrases such as "substance and alcohol
type problems" or "harmful/problematic use" of drugs.
The Health Officers Council of British Columbia in their 2005 policy discussion
paper, A Public Health Approach to Drug Control in Canada has adopted a public h
ealth model of psychoactive substance use that challenges the simplistic black-a
nd-white construction of the binary (or complementary) antonyms "use" vs. "abuse
". This model explicitly recognizes a spectrum of use, ranging from beneficial u
se to chronic dependence.
-Medical definitions
In the modern medical profession, the two most used diagnostic tools in the worl
d, the American Psychiatric Association's Diagnostic and Statistical Manual of M
ental Disorders (DSM) and the World Health Organization's International Statisti
cal Classification of Diseases and Related Health Problems (ICD), no longer reco
gnize 'drug abuse' as a current medical diagnosis. Instead, DSM has adopted subs
tance abuse as a blanket term to include drug abuse and other things. ICD refrai
ns 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. Physi
cal dependence, abuse of, and withdrawal from drugs and other miscellaneous subs
tances is outlined in the Diagnostic and Statistical Manual of Mental Disorders
(DSM-IV-TR) ). 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 dependenc
e 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 dep
endence, and may focus on treatment and prevention in terms of the social conseq
uences of substance uses.
-Drug misuse
Drug misuse is a term used commonly for prescription medications with clinical e
fficacy but abuse potential and known adverse effects linked to improper use, su
ch as psychiatric medications with sedative, anxiolytic, analgesic, or stimulant
properties. Prescription misuse has been variably and inconsistently defined ba
sed on drug prescription status, the uses that occur without a prescription, int
entional use to achieve intoxicating effects, route of administration, co-ingest
ion with alcohol, and the presence or absence of abuse or dependence symptoms.
-Signs and symptoms
Depending on the actual compound, drug abuse including alcohol may lead to healt
h problems, social problems, morbidity, injuries, unprotected sex, violence, dea
ths, motor vehicle accidents, homicides, suicides, physical dependence or psycho
logical addiction.
There is a high rate of suicide in alcoholics and drug abusers. The reasons beli
eved to cause the increased risk of suicide include the long-term abuse of alcoh
ol and drugs causing physiological distortion of brain chemistry as well as the
social isolation. Another factor is the acute intoxicating effects of the drugs
may make suicide more likely to occur. Suicide is also very common in adolescent
alcohol abusers, with 1 in 4 suicides in adolescents being related to alcohol a
buse. In the USA approximately 30 percent of suicides are related to alcohol abu
se. Alcohol abuse is also associated with increased risks of committing criminal
offences including child abuse, domestic violence, rapes, burglaries and assaul
ts.
Drug abuse, including alcohol and prescription drugs can induce symptomatology w
hich resembles mental illness. This can occur both in the intoxicated state and
also during the withdrawal state. In some cases these substance induced psychiat
ric disorders can persist long after detoxification, such as prolonged psychosis
or depression after amphetamine or cocaine abuse. A protracted withdrawal syndr
ome can also occur with symptoms persisting for months after cessation of use. B
enzodiazepines are the most notable drug for inducing prolonged withdrawal effec
ts with symptoms sometimes persisting for years after cessation of use. Abuse of
hallucinogens can trigger delusional and other psychotic phenomena long after c
essation of use and cannabis may trigger panic attacks during intoxication and w
ith use it may cause a state similar to dysthymia. Severe anxiety and depression
are commonly induced by sustained alcohol abuse which in most cases abates with
prolonged abstinence. Even moderate alcohol sustained use may increase anxiety
and depression levels in some individuals. In most cases these drug induced psyc
hiatric disorders fade away with prolonged abstinence.
Drug abuse makes central nervous system (CNS) effects, which produce changes in
mood, levels of awareness or perceptions and sensations. Most of these drugs als
o alter systems other than the CNS. Some of these are often thought of as being
abused. Some drugs appear to be more likely to lead to uncontrolled use than oth
ers.
Traditionally, new pharmacotherapy's are quickly adopted in primary care setting
s, however; drugs for substance abuse treatment have faced many barriers. Naltre
xone, a drug originally marketed under the name "ReVia," and now marketed in int
ramuscular formulation as "Vivitrol" or in oral formulation as a generic, is a m
edication approved for the treatment of alcohol dependence. This drug has reache
d very few patients. This may be due to a number of factors, including resistanc
e by Addiction Medicine specialists and lack of resources.
The ability to recognize the signs of drug use or the symptoms of drug use in fa
mily members by parents and spouses has been affected significantly by the emerg
ence of home drug test technology which helps identify recent use of common stre
et and prescription drugs with near lab quality accuracy.
-Prevention
The declaration from UN's Commission of Narcotic Drugs Fifty-second session in V
ienna, 11 20 March 2009, with participation from 130 member countries, state that
"We are determined to tackle the world drug problem and to actively promote a so
ciety free of drug abuse..." The concept drug abuse is used five times in the de
claration. Most physicians and pharmacists advise patients to securely lock up t
heir medications, hoping to prevent access to prescription medications by toddle
rs and teenagers. 1 in 5 teenagers report having abused a prescription medicatio
n and over 2500 teenagers a day experiment with prescription medications taken f
rom the home. The Massachusetts legislature just enacted a law that requires all
Pharmacy's located within the Commonwealth to display, and offer for sale, medi
cal lock boxes for home use and to place those products within 50 feet of the ph
armacy counter. Products such as the RxDrugSAFE, a fingerprint recognition home
medical safe, combats unauthorized access to prescription medications at home, t
hereby preventing abuse. This new law is the first such law enacted within the U
nited States.
HISTORY
APA, AMA, and NCDA
In 1932, the American Psychiatric Association created a definition that used leg
ality, social acceptability, and cultural familiarity as qualifying factors:
as a general rule, we reserve the term drug abuse to apply to the illegal,
nonmedical use of a limited number of substances, most of them drugs, whi
ch have properties of altering the mental state in ways that are consider
ed by social norms and defined by statute to be inappropriate, undesirable, harm
ful, threatening, or, at minimum, culture-alien."
In 1966, the American Medical Association's Committee on Alcoholism and Addictio
n defined abuse of stimulants (amphetamines, primarily) in terms of 'medical sup
ervision':
'use' refers to the proper place of stimulants in medical practice; 'misuse'
applies to the physician's role in initiating a potentially dangerous
course of therapy; and 'abuse' refers to self-administration of these drugs
without medical supervision and particularly in large doses that may lea
d to psychological dependency, tolerance and abnormal behavior.
In 1973 the National Commission on Marihuana and Drug Abuse stated:
...drug abuse may refer to any type of drug or chemical without regard to i
ts pharmacologic actions. It is an eclectic concept having only one uniform
connotation: societal disapproval. ... The Commission believes that the te
rm drug abuse must be deleted from official pronouncements and public policy dia
logue. The term has no functional utility and has become no more than an ar
bitrary codeword for that drug use which is presently considered wrong.
DSM
In the first edition of the American Psychiatric Association's Diagnostic and St
atistical Manual of Mental Disorders (published in 1952) grouped alcohol and dru
g abuse under Sociopathic Personality Disturbances, which were thought to be sym
ptoms of deeper psychological disorders or moral weakness.
The third edition, published in 1980, was the first to recognize substance abuse
 (including drug abuse) and substance dependence as conditions separate from sub
stance abuse alone, bringing in social and cultural factors. The definition of d
ependence emphasised tolerance to drugs, and withdrawal from them as key compone
nts to diagnosis, whereas abuse was defined as "problematic use with social or o
ccupational impairment" but without withdrawal or tolerance.
In 1987 the DSM-IIIR category "psychoactive substance abuse", which includes for
mer concepts of drug abuse is defined as "a maladaptive pattern of use indicated
by...continued use despite knowledge of having a persistent or recurrent social
, occupational, psychological or physical problem that is caused or exacerbated
by the use (or by) recurrent use in situations in which it is physically hazardo
us". It is a residual category, with dependence taking precedence when applicabl
e. It was the first definition to give equal weight to behavioural and physiolog
ical factors in diagnosis.
By 1988, the DSM-IV defines substance dependence as "a syndrome involving compu
lsive use, with or without tolerance and withdrawal"; whereas substance abuse is
"problematic use without compulsive use, significant tolerance, or withdrawal".
Substance abuse can be harmful to your health and may even be deadly in certain
scenarios
By 1994, The fourth edition of the Diagnostic and Statistical Manual of Mental D
isorders (DSM) issued by the American Psychiatric Association ,the DSM-IV-TR, de
fines substance dependence as "when an individual persists in use of alcohol or
other drugs despite problems related to use of the substance, substance dependen
ce may be diagnosed." followed by criteria for the diagnose
DSM-IV-TR defines substance abuse as:
*A. A maladaptive pattern of substance use leading to clinically signific
ant impairment or distress, as manifested by one (or more) of the followi
ng, occurring within a 12-month period:
1.Recurrent substance use resulting in a failure to fulfill ma
jor role obligations at work, school, or home (e.g., repeate
d absences or poor work performance related to substance use; substance-related
absences, suspensions or expulsions from school; neglec
t of children or household)
2. Recurrent substance use in situations in which it is physic
ally hazardous (e.g., driving an automobile or operating a
machine when impaired by substance use)
3.Recurrent substance-related legal problems (e.g., arrests fo
r substance-related disorderly conduct)
4.Continued substance use despite having persistent or recurre
nt social or interpersonal problems caused or exacerbated b
y the effects of the substance (e.g., arguments with spouse about
consequences of intoxication, physical fights)
*B. The symptoms have never met the criteria for Substance Dependence f
or this class of substance.
The fifth edition of the DSM (DSM-5), planned for release in 2013, is likely to
have this terminology revisited yet again. Under consideration is a transition f
rom the abuse/dependence terminology. At the moment, abuse is seen as an early f
orm or less hazardous form of the disease characterized with the dependence crit
eria. However, the APA's 'dependence' term, as noted above, does not mean that p
hysiologic dependence is present but rather means that a disease state is presen
t, one that most would likely refer to as an addicted state. Many involved recog
nize that the terminology has often led to confusion, both within the medical co
mmunity and with the general public. The American Psychiatric Association reques
ts input as to how the terminology of this illness should be altered as it moves
forward with DSM-5 discuss
SOCIETY AND CULTURE
-Legal approaches
Related articles: Drug control law, Prohibition (drugs), Arguments for and
against drug prohibition
Most governments have designed legislation to criminalize certain types of drug
use. These drugs are often called "illegal drugs" but generally what is illegal
is their unlicensed production, distribution, and possession. These drugs are al
so called "controlled substances". Even for simple possession, legal punishment
can be quite severe (including the death penalty in some countries). Laws vary a
cross countries, and even within them, and have fluctuated widely throughout his
tory.
Attempts by government-sponsored drug control policy to interdict drug supply an
d eliminate drug abuse have been largely unsuccessful. In spite of the huge effo
rts by the U.S., drug supply and purity has reached an all time high, with the v
ast majority of resources spent on interdiction and law enforcement instead of p
ublic health.In the United States, the number of nonviolent drug offenders in pr
ison exceeds by 100,000 the total incarcerated population in the EU, despite the
fact that the EU has 100 million more citizens.
Despite drug legislation (or perhaps because of it), large, organized criminal d
rug cartels operate worldwide. Advocates of decriminalization argue that drug pr
ohibition makes drug dealing a lucrative business, leading to much of the associ
ated criminal activity.
-Cost
The UK Home Office estimated that the social and economic cost of drug abuse[23]
to the UK economy in terms of crime, absenteeism and sickness is in excess of £20
billion a year.
However, it does not estimate what portion of those crimes are unintended conseq
uences of drug prohibition (crimes to sustain expensive drug consumption, risky
production and dangerous distribution), nor what is the cost of enforcement. Tho
se aspects are necessary for a full analysis of the economics of prohibition.
The Home Office has a recent history of taking a hard line on controlled drugs,
including those with no known fatalities and even medical benefits, in direct op
position to the scientific community.
-Treatment
Treatment for binge drinking and other forms of substance abuse is critical for
many around the world. Behavior interventions do exist that have helped people t
o restore some sanity to their lives. From the applied behavior analysis literat
ure and the behavioral psychology literature several evidenced based interventio
n programs have emerged:
*behavioral maritial therapy;
*community reinforcement approach;
*cue exposure therapy;
*contingency management strategies.
In addition, the same author suggest that social skills training adjunctive to i
npatient treatment of alcohol dependence is probably efficacious. However, these
programs are not wide spread amongst addiction counselors. Recent trends by NID
A has been to help deploy these intervention techniques. Several successful prog
rams are underway.