Health Encyclopedia

Drug abuse and dependence

Definition

Drug addiction (dependence) is compulsively using a substance, despite its negative and sometimes dangerous effects. Drug abuse is using a drug excessively, or for purposes for which it was not medically intended.

A physical dependence on a substance (needing the drug to function) is not always part of the definition of addiction. Some drugs (for example, some blood pressure medications) don't cause addiction but do cause physical dependence. Other drugs cause addiction without physical dependence (cocaine withdrawal, for example, doesn't have symptoms like vomiting and chills; it mainly involves depression).

Alternative Names

Drug addiction; Addiction - drug

Causes, incidence, and risk factors

Drug abuse can lead to drug dependence or addiction. People who use drugs for pain relief may become dependent, although this is rare in those who don't have a history of addiction.

The exact cause of drug abuse and dependence is not known. However, the person's genes, the action of the drug, peer pressure, emotional distress, anxiety, depression, and environmental stress all can be factors.

Peer pressure can lead to drug use or abuse, but at least half of those who become addicted have depression, attention deficit disorder, post-traumatic stress disorder, or another psychological problem.

Children who grow up in an environment of illicit drug use may first see their parents using drugs. This may put them at a higher risk for developing an addiction later in life for both environmental and genetic reasons.

Signs of drug use in children include but are not limited to:

A change in the child's friends
Withdrawn behavior
Long unexplained periods away from home
Lying
Stealing
Involvement with the law
Problems with family relations
Acting drunk or high (intoxicated), confused, impossible to understand, or unconscious
Distinct changes in behavior and normal attitude
Decreased school performance

Commonly abused substances include:

Opiates and narcotics are powerful painkillers that cause drowsiness (sedation) and feelings of euphoria. These include heroin, opium, codeine, meperidine (Demerol), hydromorphone (Dilaudid), and Oxycontin.
Central nervous system stimulants include amphetamines, cocaine, dextroamphetamine, methamphetamine, and methylphenidate (Ritalin). Caffeine and nicotine are the most commonly used stimulants. These drugs have a stimulating effect, and people can start needing higher amounts of these drugs to feel the same effect (tolerance).
Central nervous system depressants include barbiturates (amobarbital, pentobarbital, secobarbital), benzodiazepine (Valium, Ativan, Xanax), chloral hydrate, and paraldehyde. The most commonly used, by far, is alcohol. These substances produce a soothing sedative and anxiety-reducing effect and can lead to dependence.
Hallucinogens include LSD, mescaline, psilocybin ("mushrooms"), and phencyclidine (PCP or "Angel Dust"). They can cause people to see things that aren't there (hallucinations) and can lead to psychological dependence.
Tetrahydrocannabinol (THC) is the active ingredient found in marijuana (cannabis) and hashish. Although used for their relaxing properties, THC-derived drugs can also lead to paranoia and anxiety.

People may become high on drugs or overdose by accident or on purpose. Drug withdrawal symptoms can occur when a person stops or reduces their use of a substance. Withdrawal symptoms vary, depending on the abused substance. When withdrawal symptoms begin depends on the length of time the drug normally stays within the body. Drug intoxication, overdose, and withdrawal can sometimes be life-threatening.

Symptoms

OPIATES AND NARCOTICS

Symptoms of opiate and narcotic use:

Needle marks on the skin in some cases (called "tracks")
Scars from skin abscesses
Rapid heart rate
Small pupils (pinpoint)
Relaxed and/or euphoric state ("nodding")
Coma, respiratory depression leading to coma, and death in high doses

Symptoms of opiate and narcotic withdrawal:

Anxiety and difficulty sleeping
Sweating
Goose bumps (piloerection)
Runny nose (rhinorrhea)
Stomach cramps or diarrhea
Enlarged (dilated) pupils
Nausea and vomiting
Excessive sweating
Increase in blood pressure, pulse, and temperature

CENTRAL NERVOUS SYSTEMSTIMULANTS

Symptoms of cocaine use:

Exaggerated feeling of well-being (euphoria)
Dilated pupils
Fast heart rate
Restlessness and hyperactivity

Symptoms of cocaine withdrawal:

Fatigue and malaise
Depression
Very clear and unpleasant dreams

CENTRAL NERVOUS SYSTEM DEPRESSANTS

Symptoms of alcohol use:

Slurred speech
Lack of coordination
Decreased attention span
Impaired judgment

Symptoms of alcohol withdrawal:

Anxiety
Shaking (tremors)
Seizures
Increased blood pressure, pulse, and temperature
Delirium

HALLUCINOGENS

Symptoms of LSD use:

Anxiety
Frightening images of things that aren't there (hallucinations)
Paranoid delusions
Blurred vision
Dilated pupils
Tremors

Signs and tests

Drug tests (toxicology screens) on blood and urine samples can show many chemicals and drugs in the body. How sensitive the test is depends upon the drug itself, when the drug was taken, and the testing laboratory. Blood tests are more likely to find a drug than urine tests; however, urine drug screens are done more often.

Opiates and narcotics are usually in the urine 12 to 36 hours after the last use, depending on the amount used and how often the drug was used.

CNS stimulants such as cocaine can be found in urine for 1 to 12 days, again depending on how often the drog was used.

CNS depressants such as Valium and Xanax are found up to 7 days after the last day of use, mostly depending on the substance used and how quickly the body removes it (its half-life).

Most hallucinogens also can be found in the urine up to 7 days after the last use. However, marijuana can be found for up to 28 days in regular users.

Treatment

Treatment for drug abuse or dependence begins with recognizing the problem. Though "denial" used to be considered a symptom of addiction, recent research has shown that people who are addicted have far less denial if they are treated with empathy and respect, rather than told what to do or "confronted."

Treatment of drug dependency involves weaning off the drug gradually (detoxification), support, and stopping the drug (abstinence). People with acute intoxication or drug overdose may need emergency treatment. Sometimes, the person loses consciousness and might need to be on a breathing machine (mechanical respirator) temporarily. The treatment depends on the drug being used.

Detoxification is the gradual withdrawal of an abused substance in a controlled environment. Sometimes a drug with a similar action is taken instead, to reduce the side effects and risks of withdrawal. Detoxification can be done on an inpatient or outpatient basis.

If the person also has depression or another mood disorder, it should be treated. Very often, people start abusing drugs in their effort to self-treat mental illness.

For narcotic dependence, some people are treated with methadone or similar drugs to prevent withdrawal and abuse. The goal is to enable the person to live as normal a life as possible.

Support Groups

Many support groups are available in the community. They include Narcotics Anonymous (NA), Ala-Teen, and Al-Anon. Most of these groups follow the 12-Step program used in Alcoholics Anonymous (AA). SMART Recovery and LifeRing Recovery are programs that do not use the 12-step approach. You can find support groups in your phone book.

Expectations (prognosis)

Drug abuse and dependence may lead to a fatal drug overdose. Some people relapse after they have stopped using drugs. Relapses can lead to continued dependence.

Complications

The complications of drug abuse and dependence include:

Depression
Relapse of drug abuse
Drug overdose
Bacterial endocarditis, hepatitis, thrombophlebitis, pulmonary emboli, malnutrition, or respiratory infections, caused by drug use through a vein (intravenous)
Infection with HIV through shared needles
Unsafe sexual practices, which may result in unwanted pregnancies, sexually transmitted diseases, HIV, or hepatitis.
Problems with the law
Increase in various cancer rates, for example, lung and pharynx cancer are linked to nicotine use, mouth and stomach cancer are associated with alcohol abuse and dependence
Problems with memory and concentration, for example with hallucinogen use, including marijuana (THC)

Calling your health care 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 if you have been cut off from your drug supply and are at risk of withdrawal. Most employers also offer referral services for their employees with substance abuse problems.

Prevention

Drug education programs may be helpful though none has proved effective in the long term.

Review Date:7/27/2007
Reviewed By:Benjamin W. Van Voorhees, MD, MPH, Assistant Professor of Medicine, Pediatrics and Psychiatry, The University of Chicago, Chicago, IL. Review provided by VeriMed Healthcare Network.

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