Topic 6 Assessment

Title:

Authors:

Source:

Document Type:

Subject Terms:

Abstract:

Full Text Word Count:

Accession Number:

Database:

Record: 1

Substance abuse.

Wulffson, Robin L., MD

Salem Press Encyclopedia of Health, 2022. 3p.

Article

Drug abuse treatment Substance abuse Tobacco use

According to the 2020 National Survey on Drug Use and Health (NSDUH), conducted by the US Department of Health and Human Services' Substance Abuse and Mental Health Services Administration (SAMHSA), an estimated 59.3 million Americans aged twelve years and older (21.4 percent of the population) had used illicit drugs within thirty days of the survey. This total includes psychoactive prescription drugs used for nonmedical reasons.

2979

94415561

Research Starters

Substance abuse

Also known as: Drug abuse

Definition: Substance abuse is the ingestion, inhalation, or injection of a product that is harmful to one’s health, usually for psychoactive (mood-altering) purposes. Legal substances that are commonly abused include alcohol, tobacco, prescription drugs, and over-the-counter medications. Illegal substances of abuse include cocaine, marijuana, hallucinogens, methamphetamine, and heroin. Other substances of abuse include inhalants, solvents, and anabolic steroids.

Overview

According to the 2020 National Survey on Drug Use and Health (NSDUH), conducted by the US Department of Health and Human Services' Substance Abuse and Mental Health Services Administration (SAMHSA), an estimated 59.3 million Americans aged twelve years and older (21.4 percent of the population) had used illicit drugs within thirty days of the survey. This total includes psychoactive prescription drugs used for nonmedical reasons.

5/19/24, 9:11 PM GCU Library Resources - All Subjects

https://eds-p-ebscohost-com.lopes.idm.oclc.org/eds/delivery?sid=47ec5b33-4b1e-4fd8-9b7e-51a5d5e4c7a1%40redis&vid=2&ReturnUrl=https%3a%2… 1/8

Alcohol and tobacco are substances of abuse. By Ivan2010 (Own work) [CC-BY- SA-3.0 (http://creativecommons.org/licens sa/3.0)], via Wikimedia Commons

Vicodin is an example of a commonly abused prescription drug. By see below [Public domain], via Wikimedia Commons

Marijuana was the most commonly used illicit drug in 2020 by a significant margin, with 49.6 million users ages twelve and older in the month before the survey; in comparison, the second-most commonly used illicit drug was misused prescription psychotherapeutics (including pain relievers, tranquilizers, stimulants, and sedatives), with 9.3 million users in the past month. Drug abusers may be of any age. Many abused substances have addictive properties; the user becomes dependent on the regular use of the substance and experiences withdrawal symptoms when use is discontinued. Symptoms of withdrawal range from depression and anxiety to seizures, depending on the substance of abuse and the length of use.

Society has determined that the use of illegal substances is harmful; thus, laws are applied to protect both the individual and society from the harmful consequences of their use.

Abuse of Legal Substances

Tobacco

Tobacco can be smoked or chewed. Nicotine, contained in tobacco, is highly addictive; it is a psychoactive substance that produces temporary physical and mood-altering effects in the brain. Nicotine also is a vasoconstrictor (blood vessel constrictor); thus, it increases the risk of cardiovascular disease.

Tobacco also is a well-known carcinogen, and tobacco’s use is the leading cause of preventable illness and death in the United States. There are a number of known tobacco-related cancers. In addition to lung, throat, and mouth cancer, tobacco has been associated with cancers of the nasal cavity, esophagus, stomach, pancreas, breast, kidney, bladder, and cervix. The smoking of tobacco results in lost time at work either because of smoking breaks or because of respiratory illnesses, which are more common in smokers.

According to the American Cancer Society and the Centers for Disease Control and Prevention (CDC):

• Cigarette smoking causes an estimated 480,000 deaths each year, including approximately 41,000 deaths from exposure to secondhand smoke (CDC 2022).

5/19/24, 9:11 PM GCU Library Resources - All Subjects

https://eds-p-ebscohost-com.lopes.idm.oclc.org/eds/delivery?sid=47ec5b33-4b1e-4fd8-9b7e-51a5d5e4c7a1%40redis&vid=2&ReturnUrl=https%3a%2… 2/8

• Lung cancer is the leading cause of cancer death among both men and women in the United States. About 80 percent of all lung cancer deaths in the United States are caused by tobacco smoking (American Cancer Society 2022).

• Persons who smoke are up to six times more likely than nonsmokers to have a heart attack, and the risk increases with the number of cigarettes smoked. Smoking also causes most cases of chronic lung disease, including chronic obstructive pulmonary disease (COPD).

• In 2020, approximately 12.5 percent of adults in the United States (14.1 percent of men and 11 percent of women) were cigarette smokers. (CDC 2022).

• In 2022, 2 percent of high school students reported having smoked cigarettes in the past thirty days. However, 14.1 percent reported the use of electronic cigarettes. (CDC 2022).

Alcohol

Alcohol consumption involves the ingestion of ethanol (C H OH), which is a component of alcoholic beverages (beer, wine, and hard liquor). Alcoholism is a chronic condition in which a person is dependent upon regular ingestion of alcoholic beverages. Alcoholics are unable to control their drinking and continue to drink even though doing so interferes with their health, interpersonal relationships, or work.

Alcohol abuse refers to excessive drinking—enough to cause problems in daily life—without complete dependence upon the substance. The combination of alcohol abuse and tobacco use markedly increases the risk of cancers of the oral cavity. Approximately 50 percent of cancers of the mouth, pharynx (throat), and larynx (voice box) are associated with heavy drinking. Even in nonsmokers, a strong association exists between alcohol abuse and cancers of the upper digestive tract, including the esophagus, the mouth, the pharynx, and the larynx.

Prescription Medication

Prescription drug abuse involves the ingestion of medication that has been obtained without a prescription or that is used inappropriately (that is, not according to prescription instructions). According to the 2020 National Survey on Drug Use and Health, approximately 2.1 million Americans age twelve and older misused prescription pain relievers for the first time within the past year, while about 2.1 million misused prescription prescription pain reliever for the first time.

Not infrequently, prescription drug abusers take medication with alcohol or combine stimulants and depressants. These combinations increase the risk of permanent damage to the user’s health or death. Commonly abused types of prescription medications include opioids such as hydrocodone (Vicodin), oxycodone (OxyContin, Percocet), and morphine; central nervous system depressants, including benzodiazepines such as alprazolam (Xanax) and diazepam (Valium), barbiturates such as phenobarbital (Luminal Soduim and pentobarbital (Nembutal), and non-benzodiazepine sleep medications such as zolpidem (Ambien) and eszopiclone (Lunesta); and stimulants such as dextroamphetamine (Dexedrine) and methylphenidate (Ritalin). Narcotics and central nervous system depressants cause drowsiness and respiratory depression; stimulants can cause seizures, irregular heartbeat, paranoia, and dangerously elevated body temperatures.

2 5

5/19/24, 9:11 PM GCU Library Resources - All Subjects

https://eds-p-ebscohost-com.lopes.idm.oclc.org/eds/delivery?sid=47ec5b33-4b1e-4fd8-9b7e-51a5d5e4c7a1%40redis&vid=2&ReturnUrl=https%3a%2… 3/8

In some cases, a prescription may be obtained from a health care professional by feigning symptoms such as pain; however, most health care professionals are adept at spotting a drug abuser. Most abused prescription medication is purchased from a drug trafficker or stolen by the user.

Abuse of Illegal Substances

Illegal substances have the added risk of containing contaminants, which can increase the health risk. For example, marijuana may be mixed with phencyclidine (PCP). PCP was developed as an anesthetic, but its medical use was discontinued a few years after its introduction because of its harmful effects on the brain. It is not uncommon for an abuser of illegal substances to combine a drug with other illegal substances, prescription drugs, or alcohol.

Marijuana

Smoked marijuana and smoked tobacco are chemically similar; thus, like cigarettes, the greatest health hazard of marijuana is from smoking the substance. The psychoactive component of marijuana leaves is delta-9- tetrahydrocannabinol (THC), which is a relatively safe drug. However, smoked marijuana is a health risk. Scientific analyses have identified a minimum of six thousand of the same chemicals in marijuana smoke that are present in tobacco. The chief difference between the two plants is that marijuana contains THC and tobacco contains nicotine. Moreover, one of the most potent carcinogens in tobacco smoke, Benzo[a]pyrene, is present in larger quantities in marijuana smoke.

Another factor increasing the carcinogenic risk is in the way it is inhaled. Marijuana smokers frequently inhale and hold the smoke in their lungs for an extended time to increase the drug’s effects; this practice increases the amount of tar deposited in the respiratory tract by about a factor of four.

Cocaine and Crack Cocaine

Cocaine is the most abused central nervous system stimulant in the United States and is a frequent cause of emergency room visits. Ingestion of cocaine can produce seizures, strokes, or heart attacks. Some users claim that it is not addictive because it does not produce physical withdrawal symptoms, which do occur with alcohol or heroin addiction. However, cocaine has powerful psychological addictive properties. Users will often go to extraordinary lengths to obtain the drug.

Methamphetamine

Methamphetamine is a highly addictive street drug that can be readily and inexpensively manufactured from the ingredients of common household products. Psychological effects of the substance include agitation, depression, euphoria, mood disturbances, psychosis, and violent behavior. In addition to being less expensive than cocaine, its effects are longer lasting.

The use of methamphetamine can result in permanent injury to the brain, heart, and lungs. Furthermore, the volatile substances used in its manufacture can lead to fires and explosions.

Heroin

5/19/24, 9:11 PM GCU Library Resources - All Subjects

https://eds-p-ebscohost-com.lopes.idm.oclc.org/eds/delivery?sid=47ec5b33-4b1e-4fd8-9b7e-51a5d5e4c7a1%40redis&vid=2&ReturnUrl=https%3a%2… 4/8

Heroin (diacetylmorphine) is a potent analgesic (painkiller). It is abused for the intense euphoria it produces. It is highly addictive, as tolerance to the drug develops quickly. As a result, users need more of the drug to achieve the same effects. When injected intravenously, heroin produces a greater degree of euphoria than other opiates, such as morphine.

Treatment

Many substance abusers either deny that they have a problem or simply state that the pleasure derived from the substance outweighs the negative impact on their life; thus, treatment is often initiated by a triggering event or by the urging of another person.

A triggering event may be conviction for driving under the influence, a health condition (such as pancreatitis or cirrhosis of the liver), a threat of divorce, a threat of a job loss, or a threat of loss of child custody. A spouse, relative, coworker, or boss may be influential in initiating treatment. However, some substance abusers ignore a triggering event or advice from others and continue to abuse substances.

A number of treatment options are available to substance abusers. These vary markedly by the type of substances and by individual circumstances. In some cases, a brief intervention by a health care professional may be sufficient. Other cases require enrollment in an outpatient program, which includes counseling. More severe cases require an inpatient program.

The following steps are involved in treatment for persons requiring inpatient or intensive outpatient treatment:

Detoxification. For most drug addictions, detoxification (also called detox) is necessary. Sedatives are often necessary to reduce withdrawal symptoms, which may include shaking, confusion, or hallucinations. Withdrawal may last one or two weeks and may require inpatient care at a hospital or a treatment center.

Reprogramming. A recovering substance abuser, with the help of professionals skilled in substance abuse treatment, learns new skills and formulates a treatment plan. The plan should include behavior-modification techniques, counseling, goal setting, and use of self-help manuals or Internet resources.

Psychological counseling. Counseling on an individual or a group basis is an essential treatment component. Group therapy is particularly valuable because it allows interaction with other substance abusers. It promotes the idea that one’s problems are not unique. Therapy may include the presence of a spouse or other family members. Family support is a significant component of the recovery process.

Medication. Following medication for detox, long-term pharmaceutical treatment may be used in some cases. Oral medications such as disulfiram, acamprosate, and naltrexone are used for the treatment of alcoholism. These medications produce unpleasant physical reactions such as flushing, headaches, nausea, and vomiting. Methadone is commonly used in the treatment of heroin addiction; however, its use is controversial. Critics claim that treating recovering addicts with methadone is simply substituting one addictive drug for another. Despite this opinion, many former addicts claim that they never could have ended their heroin habit without help from methadone.

Follow-up support. Aftercare programs and support groups are essential for the recovering substance abuser. These programs help the abuser to avoid (or manage) relapses and deal with the necessary lifestyle changes to maintain a drug-free existence. For alcoholics, regular attendance at a support group such as Alcoholics

5/19/24, 9:11 PM GCU Library Resources - All Subjects

https://eds-p-ebscohost-com.lopes.idm.oclc.org/eds/delivery?sid=47ec5b33-4b1e-4fd8-9b7e-51a5d5e4c7a1%40redis&vid=2&ReturnUrl=https%3a%2… 5/8

Anonymous (AA) is often an important component of follow-up care. Follow-up often includes psychological and medical care.

Substance abuse commonly is a component of other mental health disorders. For persons with mental health issues, psychological counseling or psychotherapy may be recommended. Substance abusers also can have medical conditions that require treatment. These conditions include hypertension (high blood pressure), diabetes, heart disease, and liver disease (such as cirrhosis of the liver). If a substance abuser remains drug- free, some medical conditions may decrease in severity or may resolve. Treatment for depression or anxiety also may be a part of follow-up.

Beyond counseling and medication, other modalities may be helpful. For example, in September 2010, researchers at the University of California, Los Angeles, released the results of a clinical trial involving a unique new therapy that applies electrical stimulation to a major nerve emanating from the brain. The technique, trigeminal nerve stimulation, achieved an average of a 70 percent reduction in depression in the eight-week study period.

Inpatient treatment. For persons with a serious substance abuse problem, inpatient care is often necessary. These programs include detox followed by counseling, group therapy, and medical treatment. A benefit of an inpatient program is that it greatly reduces the risk of a patient gaining access to harmful substances. Regular outpatient follow-up also is essential.

Many medical centers include treatment for substance abuse. Stand-alone facilities also are present throughout the United States and other developed nations. Some provide care in a basic, clinical setting while others function in a resort-like setting. One well-known facility is the Betty Ford Center in Rancho Mirage, California, which was founded by former US First Lady Betty Ford. The nonprofit residential facility offers inpatient, outpatient, and day treatment for recovering substance abusers and addicts. It also provides prevention and education programs for family members (including children) of substance abusers and addicts.

Support groups. A variety of support groups are available to a substance abuser who admits he or she has a problem. Treatment centers may have their own support groups or may refer patients to outside programs they deem suitable. A recovering alcoholic may have to try a variety of resources before finding the best fit.

Religious support. Churches and synagogues often sponsor support for recovering alcoholics. Members can use available services, which are often integrated with other organizations and social services in the community. Although nonsectarian and nondenominational, AA is a faith-based organization as exemplified by its twelve-steps program, which includes the acknowledgement of the existence of a "higher power."

Genetic Factors

Significant evidence exists that genetic factors are involved in the development of substance abuse and addiction, particularly alcoholism. The interaction of genes and environmental factors that influence substance dependence is a complex scientific topic.

Since 1989, the US-government-funded Collaborative Studies on the Genetics of Alcoholism (COGA) has been tracking alcoholism in families. COGA researchers have interviewed more than fourteen thousand people and sampled the DNA of at least three hundred extended families. They have found evidence for the existence of

5/19/24, 9:11 PM GCU Library Resources - All Subjects

https://eds-p-ebscohost-com.lopes.idm.oclc.org/eds/delivery?sid=47ec5b33-4b1e-4fd8-9b7e-51a5d5e4c7a1%40redis&vid=2&ReturnUrl=https%3a%2… 6/8

several alcohol-related genes. COGA researchers are increasingly convinced that different types of alcoholics are representative of a number of genetic variations.

Social Implications

Substance abuse has a tremendous impact on society. For example, many people are injured or killed by substance abusers who drive under the influence of one or more psychoactive substances. Family members of substance abusers suffer from the emotional and financial burden placed on them by a substance abuser. Furthermore, substance abusers accrue countless hours of lost and unproductive work.

All developed nations have extensive legislation regarding substance abuse and age limits for legal substances. For example, in the United States the legal drinking age is twenty-one years and the legal smoking age is eighteen years. However, some nations have more lenient restrictions. Some substances deemed illegal by one government are considered legal by another.

An example of a substance with varying degrees of legality is marijuana. The substance is deemed illegal by the US federal government; however, according to state laws, the recreational use of marijuana is legal in Colorado, Washington, Oregon, Nevada, California, Maine, Alaska, and Massachusetts The use of medical marijuana remains a contentious topic. As of 2017, medical marijuana has been legalized in twenty-nine US states, plus the District of Columbia, Guam, and Puerto Rico, to allow usage for legitimate medical reasons, such as for glaucoma or for pain relief from cancer. However, there is a concern that the substance will be dispensed for frivolous, nonmedical reasons or diverted for illegal use.

Bibliography

Fisher, Gary L., and Thomas C. Harrison. Substance Abuse: Information for School Counselors, Social Workers, Therapists, and Counselors. 5th ed., Pearson, 2013.

Ketcham, Katherine, and William F. Asbury. Beyond the Influence: Understanding and Defeating Alcoholism. With Mel Schulstad and Arthur P. Ciaramicoli, Bantam Books, 2000.

Liptak, John J., and Ester A. Leutenberg. The Substance Abuse & Recovery Workbook. Whole Person, 2008.

"Lung Cancer Prevention." National Cancer Institute, National Institutes of Health, US Dept. of Health and Human Services, 4 Nov. 2015, www.cancer.gov/types/lung/patient/lung-prevention-pdq#section/‗12. Accessed 11 Oct. 2017.

Marion, Nancy E., and Willard M. Oliver, editors. Drugs in American Society: An Encyclopedia of History, Politics, Culture, and the Law. ABC-CLIO, 2015.

Miller, William R., and Kathleen M. Carroll, editors. Rethinking Substance Abuse: What the Science Shows, and What We Should Do about It. Guilford Press, 2006.

Seixas, Judith S., and Geraldine Youcha. Children of Alcoholism: A Survivor’s Manual. Crown Publishers, 1985.

"Fast Facts and Fact Sheets." Centers for Disease Control and Prevention, 22 Aug. 2022, www.cdc.gov/tobacco/data‗statistics/fact‗sheets/fast‗facts/index.htm. Accessed 1 Dec. 2022.

5/19/24, 9:11 PM GCU Library Resources - All Subjects

https://eds-p-ebscohost-com.lopes.idm.oclc.org/eds/delivery?sid=47ec5b33-4b1e-4fd8-9b7e-51a5d5e4c7a1%40redis&vid=2&ReturnUrl=https%3a%2… 7/8

"Highlights for the 2020 National Survey on Drug Use and Health." Substance Abuse and Mental Health Services Administration, www.samhsa.gov/data/sites/default/files/2021-10/2020‗NSDUH‗Highlights.pdf. Accessed 1 Dec. 2022.

"Smoking & Tobacco Use: Youth and Tobacco Use." Centers for Disease Control and Prevention, US Dept. of Health and Human Services, 20 Sept. 2017, www.cdc.gov/tobacco/data‗statistics/fact‗sheets/youth‗data/tobacco‗use/index.htm. Accessed 11 Oct. 2017.

United States, Department of Health and Human Services, Substance Abuse and Mental Health Services Administration. Key Substance Use and Mental Health Indicators in the United States: Results from the 2016 National Survey on Drug Use and Health. HHS Publication No. SMA 17-5044, NSDUH Series H-52, Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, 2017. SAMHSA, www.samhsa.gov/data/sites/default/files/NSDUH-FFR1-2016/NSDUH-FFR1-2016.pdf. Accessed 11 Oct. 2017.

Copyright of Salem Press Encyclopedia of Health is the property of Salem Press. The copyright in an individual article may be maintained by the author in certain cases. Content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. Source: Salem Press Encyclopedia of Health, 2022, 3p Item: 94415561

5/19/24, 9:11 PM GCU Library Resources - All Subjects

https://eds-p-ebscohost-com.lopes.idm.oclc.org/eds/delivery?sid=47ec5b33-4b1e-4fd8-9b7e-51a5d5e4c7a1%40redis&vid=2&ReturnUrl=https%3a%2… 8/8