Dr. Sayeed Ahmad D. I. Hom. (London)
Drug abuse is the non medical use of a drug that interferes with a healthy and productive life. Drug abuse occurs at all economic levels of society, from the wealthy to the impoverished, and among young people as well as adults. Any drug may be abused, including alcohol, medications, and substances that give off intoxicating fumes. Drug abuse is often called substance abuse.
After continued use of certain drugs, some people develop a condition called drug dependence. It can be psychological, physical, or both. A person with a psychological dependence craves a drug for the feeling of well-being it might provide. A physically dependent person continues drug use chiefly to avoid the physical illness that results when use stops. A danger of any type of dependence is that the need for a drug may grow so overpowering that nothing matters except getting more.
Many people begin and continue to use drugs because they want a pleasurable change in their state of mind. Unfortunately, drugs only change the brain's perception of difficulties and problems. When a drug wears off, the user's real problems nearly always remain.
Many harmful effects often accompany drug use. These effects include failure to achieve goals, undesirable personality changes, physical illness, and death.
Besides the personal damage the drug user suffers, a person's drug use can have a devastating effect on others. Many drug users turn to crime, such as robbery or prostitution, to support their habit. Each year, thousands of traffic deaths and injuries are caused by people under the influence of alcohol or other drugs. Drug abuse also damages families and other personal relationships.
Types of drug abuse
Some of the most commonly abused drugs in the United States and Canada can be purchased legally. They include (1) alcoholic beverages, (2) tobacco, (3) inhalants, and (4) prescription drugs.
Alcoholic beverages are made chiefly from grains or fruits and contain ethyl alcohol, one of the most commonly abused drugs in the world. Alcohol is a depressant--that is, it lowers the activity of the central nervous system. It also interferes with thinking, concentration, and movement. Heavy use of alcohol can lead to death. Even a single episode of excessive drinking can cause coma and death. Some people develop a physical dependence on alcohol, and overcoming that dependence may be extremely difficult.
Tobacco is a plant native to North and South America, whose leaves are made into smoking tobacco, chewing tobacco, and snuff. Tobacco contains a substance called nicotine. Nicotine is a stimulant, a drug that raises activity of the central nervous system. In addition to nicotine, tobacco smoke contains carbon monoxide and substances called tars, which can cause lung cancer. Tobacco use contributes to heart disease and other health problems. It can become a habit that many users have difficulty breaking.
Inhalants are substances that give off fumes inhaled for their intoxicating effects. They include certain glues, nail polish, gasoline, and aerosol sprays. In some instances, the effect of these substances results from their fumes' taking the place of oxygen in the lungs. The reduced flow of oxygen to the brain creates an intoxicating effect. Inhalants can make the user relaxed, restless, uncoordinated, and sometimes delirious. Some fumes result in lung damage, brain damage, and coma. Some also can cause death when they coat the lungs' surface and prevent the absorption of oxygen.
Prescription drugs can only be obtained legally with a physician's prescription. Commonly abused prescription drugs include tranquilizers, barbiturates, stimulants called amphetamines, and analgesics (pain relievers). Many prescription drugs are powerful, and some create physical dependence.
Steroids are a special type of prescription drug used medically for a variety of purposes. Some athletes take anabolic steroids because, in certain cases, the drugs help increase muscle size and strength. Some doctors believe anabolic steroids may cause aggressive behavior and lead to liver damage.
Abuse of illegal drugs.
Many abused drugs are illegal--that is, under most circumstances, their possession and sale are forbidden by law. Illegal drugs include (1) cocaine, (2) marijuana, (3) heroin and other opiates, (4) hallucinogenic drugs, and (5) designer drugs. Some of these drugs can be obtained legally with a prescription, but they are most often sold and used illegally.
Cocaine is a powerful stimulant made from the leaves of the coca shrub, a plant native to the Andean region of South America. Most users eat or snort (sniff) a powdered form of the drug, or inject a solution of cocaine and water. Some people also smoke a form of cocaine called crack. Crack produces stronger, briefer effects than other forms of cocaine because the body absorbs it faster. People easily develop a compulsive desire for cocaine, and many have great difficulty stopping use.
Marijuana is the common name for hemp, a tall plant that grows easily in most parts of the world. It contains a potent drug called tetrahydrocannabinol (THC). People usually smoke the dried leaves and flowers of the plant in cigarettes or pipes. Some may mix marijuana with food and beverages. The thick, sticky resin of the plant, called hashish, can be eaten or smoked.
Heroin and other opiates are made from the sap of the opium poppy. Opium, the dried sap of the poppy's seed pods, contains a potent narcotic called morphine. Some people smoke or eat opium, seeking pleasant effects from morphine. Physicians use morphine to relieve severe pain in patients. Codeine, a less potent opiate, relieves coughs and mild pain. Heroin is a highly addictive drug made from morphine. People use heroin by eating or snorting it, or by injecting it.
Hallucinogenic drugs include such naturally occurring drugs as mescaline, produced within the peyote cactus, and such substances as LSD (lysergic acid diethylamide), manufactured in laboratories. Hallucinogenic drugs affect the senses, emotions, and reasoning, often producing delusions or visions. PCP (phencyclidine), a hallucinogenic drug once used as an anesthetic for animals, may cause violent outbursts.
Designer drugs, created in laboratories, are variations on existing illegal drugs. Originally, they were "designed" to vary slightly in chemical composition from the definition of existing illegal drugs so that they could be considered legal substances. Today, however, all substances that are chemically similar to defined illegal drugs are illegal.
Many designer drugs are of poor quality, and they sometimes contain dangerous chemicals that cause severe brain damage in some users. A designer drug called MDMA, commonly known as Ecstasy, has an effect similar to that of amphetamines. Research suggests that it can permanently damage brain cells.
Why people abuse drugs
Young people begin using drugs for various reasons. Some experiment with drugs because their friends use them. Many young people find it difficult to resist peer pressure (the influence of people their own age). Also, young people often have a sense of invulnerability--that is, that death or other severe consequences of drug use will not affect them personally. Users of tobacco and alcohol may be attempting to appear grown-up by imitating their parents or other adults who smoke or drink.
Adults may begin using drugs for some of the same reasons as young people. In addition, the stress of life, job, and family pressures may lead people to seek relief in drugs. People also may use drugs for a surge of energy or to help them relax. Others may use drugs out of curiosity, for a thrill, or to rebel. Regardless of why drug use begins, many people continue the practice because they become dependent on the drug.
Effects of drug abuse
Effects on the individual. Both legal and illegal drugs have a range of potentially harmful effects. For example, alcohol can damage the liver, brain, and heart. Cocaine can cause high blood pressure, leading to a burst blood vessel in the brain and a stroke. Injecting drugs into the body with contaminated needles can lead to blood poisoning, which may destroy the heart valves and result in death. Sharing needles and syringes with a person who has hepatitis or AIDS can give a user those diseases. Constant drug use also causes malnutrition, particularly in heavy drinkers, who tend to miss meals and suffer from lack of vitamins. Use of illegal drugs may lead to overdose or death because their strength is unknown, and some contain toxic impurities.
Frequent drug users may turn to crime to meet the increasing expense of their habit. Criminal activity may lead to loss of a driver's license, expulsions from school, loss of a job, arrest, fines, or even a prison term.
Continued drug use may cause personality changes. The user may become hyperactive or withdrawn. Some users lose interest in school or work, or have difficulty meeting the responsibilities of a job or family.
Associated with many drugs are two effects known as tolerance and withdrawal that often contribute to continued drug use. Tolerance is a state of resistance to the effects of a drug. A person who develops a tolerance must take more and more of a drug to achieve its original effect. In this way, occasional drug users can become frequent users. Withdrawal is the reaction of the body when regular drug use is stopped. The symptoms of withdrawal can range from headaches and muscle cramps lasting a few days to death, depending on the drug and the extent of use. Some people continue to use drugs only to prevent the pain of withdrawal.
The warning signs of drug abuse are varied. Most abused drugs strongly influence a person's behavior. For example, excessive use of alcohol or sleeping pills causes slurred speech and drowsiness. People who use cocaine become restless and talkative. Parents may notice money and household items disappearing as their children seek money to buy drugs. Employers might find workers functioning poorly.
Effects on family, friends, and work.
Some users spend so much time under the influence of drugs or thinking about getting drugs that they neglect their family, friends, and work. In some cases, their actions harm the people closest to them. Pregnant women who take drugs can cause harm to their unborn children. All drug users risk injury or death to themselves and others if they drive a vehicle under the influence of a drug.
Some people help conceal and make up for a user's destructive actions. They pay a user's debits, supply money that can be used for drugs, and in other ways make it possible for drug use to continue. These people are called codependents. Some codependents do not realize they are supporting the habit. Others may say they oppose drug use, but they find themselves unable to stop assisting the user's drug habit. Some codependents fear losing the user's affections. Others may fear the legal consequences of refusing the user. For example, if rent goes unpaid, a user might be evicted.
Effects on society. Drug users may resort to theft, prostitution, or selling drugs to pay for their drug habits. Drug users in the transportation industry, such as bus drivers and air traffic controllers, risk endangering the public. Factory and office workers using drugs perform inefficiently and make mistakes. These inefficiencies and errors result in higher costs for products.
Public concern about the drug problem has led to a demand for greater law enforcement efforts. The police have responded by making more arrests for drug possession and sales. As a result, drug offenders have crowded courtrooms, jails, and prisons, creating a burden on the criminal justice system.
The federal government estimates that people in the United States spend about $40 billion to $50 billion a year on illegal drugs. But the estimated total expense of drug abuse is far higher. The problem of alcohol and drug abuse costs an additional $143 billion annually in the United States and more than $12 billion ($16 billion in Canadian dollars) in Canada. These totals include the price of hospitalization, property damage, time lost from work, and law enforcement efforts.
Treatment of drug abuse
Some physicians use medication to treat drug dependence. Such medication relieves craving or blocks the effect of habit-forming drugs. Doctors often use methadone, a drug with effects similar to opiates, to relieve an addict's craving for heroin during withdrawal. Although methadone is addictive, many doctors believe its use in the treatment of opiate addicts can be beneficial. Disulfiram, also known as Antabuse, is a drug used to treat alcoholism. It makes the user suffer flulike symptoms for several hours whenever alcohol is consumed. Nicotine skin patches, available by prescription, can relieve a smoker's craving for cigarettes.
Many professionals who treat drug dependence believe that users can profit from treatment in groups of drug users. In such groups, drug abusers share experiences and learn from one another.
Detoxification is a treatment used to eliminate a person's physical dependence on a drug by eliminating the drug from the body. Some programs involve decreasing the daily dose of a drug gradually over a period of weeks to reduce the severity of withdrawal illness. Effective detoxification programs include counseling and other support to help users fight craving and solve the problems that first led them to drugs.
A drug user can obtain treatment in a medical clinic, a doctor's office, or a hospital. Unfortunately, many people in need of immediate treatment must rely on public drug treatment centers with long waiting lists. Waiting periods of up to several months discourage many people from seeking treatment. Some drug users die before they receive treatment.
Treatment for drug abuse is not always successful. Some people must fight strong cravings for years after they stop using drugs. The success of the treatment often depends on the person's desire for cure. Pressure from the family and employer often motivates the user to seek treatment and stay off drugs.
Contributor: David F. Musto, M. D., Professor of Child Psychiatry and History of Medicine, Yale University. (World Book 2003).
Copyright with Dr. Sayeed Ahmad 2004