Drug Abuse and Addiction

People can abuse almost any substance whose ingestion results in a euphoric feeling.

Drug abuseand addiction, now both grouped as substance ordrug use disorder, is a condition characterized by a self-destructive pattern of using a substance that leads to significant problems and distress, which may include tolerance to or withdrawal from the substance.

• Drug addictiondisorder is unfortunately quite common, affecting more than 8% of people in the United States at some point in their lives.
• Dual diagnosis refers to the presence of both a drug-use issue addition to a seriousmental healthcondition in an individual.
• People can abuse virtually any substance whose ingestion can result in a euphoric ("high") feeling.
• Inhalants like household cleaners are some of the most commonly abused substances.
• While the specific physical and psychological effects of drug use disorder tend to vary based on the particular substance involved, the general effects of a substance use disorder involving any drug can be devastating.
• Although drug use disorders have no single cause, there are a number of biological, psychological, and social risk factors that can predispose a person to develop a chemical use disorder.
• Symptoms of a drug problem include recurrent drug use that results in legal problems, occurs in potentially dangerous situations, interferes with important obligations, results in social or relationship problems, tolerance, withdrawal symptoms, using a lot of the drug or for a long period of time, persistent desire to use the drug, unsuccessful efforts to stop using the drug, neglecting other aspects of life because of their drug use, and spending inordinate amounts of time or energy getting, using, or recovering from the effects of the drug.
• While the specific effects ofdrugson the brain can somewhat vary depending on the drug that is being used, virtually every substance that is abused has an effect on the executive-functioning areas of the brain. Drugs particularly affect the brain's ability to inhibit actions that the person would otherwise delay or prevent.
• Since there is no single test that can definitively diagnose someone with a chemical use disorder, health care professionals assess these disorders by gathering comprehensive medical, family, and mental health information, as well as securing a physical examination and lab tests to assess the sufferer's medical state.
• Treatment options for substance abuse disorders remain largely underutilized by most people who suffer from these conditions.
• The primary goals of recovery are abstinence, relapseprevention, and rehabilitation.
• During the initial stage of abstinence, a person who suffers from chemical dependency may need detoxification treatment to help avoid or lessen the effects of withdrawal.
• Often, much more challenging and time-consuming than recovery from the physical aspects of addiction is psychological addiction.
• The treatment of dual diagnosis is more effective when treatment of the sufferer'smental illnessoccurs in tandem with the treatment of the individual's chemical dependency.
• Drug addiction increases the risk of a number of negative life stressors and conditions, particularly if left untreated.
• Episodes of remaining drug-free (remission) and relapse characterize recovery from a substance use disorder.

Formerly separately called substance or drug abuse and addiction, drug use disorder, also called substance use or chemical use disorder, is an illness characterized by a destructive pattern of using a substance that leads to significant problems or distress, including tolerance to or withdrawal from the substance, as well as other problems that use of the substance can cause for the sufferer, either socially or in terms of their work or school performance. The effects of drug use disorders on society are substantial. The economic cost, including everything from lost wages to medical, legal, and mental health implications is about $215 billion. The cultivation ofmarijuanaand the production of synthetic drugs like methamphetamine have a negative impact on soil and water supplies. Drug law infractions are a highly common reason for arrests in the United States, with more than 1.5 million occurring in 2016.

Teensare increasingly engaging in prescription drug abuse, particularly narcotics, also called opioids (which physicians prescribe to relieve severepain), and stimulant medications, which treat conditions like attention-deficit disorder andnarcolepsy．

双重诊断指的存在both a drug use disorder and a serious mental health problem in a person. Substance use disorders, unfortunately, occur quite commonly in people who also have a severe mental illness. Individuals with dual diagnoses are also at higher risk of being non-compliant with treatment.

Individuals may abuse almost any substance whose ingestion can result in a euphoric ("high") feeling. While many are aware of the abuse of legal substances likealcoholor illegal drugs like marijuana (in most states) andcocaine, less well-known is the fact that inhalants like household cleaners andover-the-countermedications likecoldmedicines are some of the most commonly abused substances. The following are many of the drugs and types of drugs that people commonly abuse and/or result in dependence:

• Alcohol: Although legal, alcohol is a toxic substance, especially for a developing fetus when a mother consumes this drug duringpregnancy．One of the most common addictions,alcoholismcan have devastating effects on the alcoholic individual's physical well-being, as well as his or her ability to function interpersonally and at work.
• Amphetamines: This group of drugs comes in many forms, from prescription medications likemethylphenidate(for example,Ritalin,Concerta,Focalin)nddextroamphetamineand amphetamine (Adderall) to illegally manufactured drugs like methamphetamine ("crystal meth"). Overdose of any of these substances can result inseizuresand death.
• Anabolic steroids: A group of substances that are most often abused by bodybuilders and other athletes, this group of drugs can lead to devastating emotional symptoms likeaggressionandparanoia, as well as severe long-term physical effects likeinfertilityand organ failure.
• Caffeine: While many people consume coffee, tea, and soda, when consumed in excess, this substance can be habit-forming and producepalpitations,insomnia,tremors, irritability, and significantanxiety．
• Cannabis: More usually called marijuana, the scientific name for cannabis is tetrahydrocannabinol (THC). Marijuana is the most commonly used illicit drug, with nearly 14 million people 12 years or older reporting having used this drug in the past year. In addition to the negative effects, the drug itself can produce (for example,infertility, difficulties with sexual performance, paranoia, lack of motivation), the fact that it is commonly mixed (cut) with other substances so drug dealers can make more money selling the diluted substance or expose the user to more addictive drugs exposes the marijuana user to the dangers associated with those added substances. People commonly cut marijuana with ingredients that include baby powder, oregano, embalming fluid, phencyclidine (PCP), opiates, and cocaine.
• Cathinones(bath salts): Chemically unrelated to bath salts that people use to bathe, cathinone are chemically similar to stimulant drugs, like amphetamines, cocaine, and Ecstasy (MDMA). In addition to bath salts, other street names for cathinone include "plant food," "jewelry cleaner," or "phone screen cleaner."
• Cocaine: A drug that tends to stimulate the nervous system, people can snort cocaine in powder form, smoke it when in the form of rocks ("crack" cocaine), or inject it when made into a liquid.
• Ecstasy: Also called MDMA to denote its chemical composition (methylenedioxymethamphetamine), this drug tends to create a sense ofeuphoriaand an expansive love or desire to nurture others. In overdose, it can increase body temperature to the point of causing death.
• Hallucinogens: Examples include LSD and mescaline, as well as so-called naturally occurring hallucinogens like certain mushrooms. These drugs can be dangerous in their ability to alter the perceptions of the user. For example, a person who is intoxicated ("high" on) with ahallucinogenmay perceive danger where there is none and think that situations that are truly dangerous are not. Those misperceptions can result in dangerous behaviors (like jumping out of a window because the person thinks they have wings and can fly).
• Inhalants: One of the most commonly abused groups of substances due to its easy accessibility, inhalants are usually in household cleaners, like ammonia, bleach, and other substances that emit fumes.Brain damage, to the point of death, can result from using aninhalanteven just once or over the course of time, depending on the individual.
• Nicotine:香烟成瘾物质s, nicotine is actually one of the most addictive substances that exist. In fact, people often compare nicotine addiction to the intense addictiveness associated with opiates likeheroin．
• Opiates: People also call this group narcotics or opioids and include drugs like heroin,codeine,hydrocodone, morphine,methadone,Vicodin,OxyContin,Percocet, and Percodan. This group of substances sharply decreases the functioning of the nervous system. The lethality of opioids is often the result of the abuser having to use increasingly higher amounts to achieve the same level of intoxication, ultimately to the point that the dose needed to get high is the same as the dose that is lethal by overdose for that individual by halting the person'sbreathing(呼吸停止)。
• Phencyclidine: Commonly called PCP, this drug can cause the user to feel highly suspicious, become very aggressive, and have an exceptional amount of physical strength. This can make the person quite dangerous to others.
• Sedative, hypnotic, or antianxiety drugs: The second most commonly used group of illicit drugs, these substances quiet or depress the nervous system. They can therefore cause death by stopping the breathing (respiratory arrest) of the individual who either uses these drugs in overdose or who mixes one or more of these drugs with another nervous system depressant (like alcohol, another sedative drug, or an opiate).

While the specific physical and psychological effects of drug abuse and addiction disorders tend to vary based on the particular substance involved, the general effects of addiction to any drug can be devastating.

• Psychologically, intoxication with or withdrawal from a substance can cause everything fromeuphoriaas with alcohol, Ecstasy, or inhalant intoxication, to paranoia with marijuana or steroid intoxication, to severedepressionorsuicidal thoughtswith cocaine or amphetamine withdrawal.
• In terms of effects on the body, intoxication with a drug can cause physical effects that range from marked sleepiness and slowed breathing as with intoxication with heroin or sedative-hypnotic drugs, to the rapidheartrate of cocaine intoxication, or thetremorstoseizuresofalcohol withdrawal．

Like most other mental health problems, drug use disorders have no single cause and are not the result of a lack of discipline or self-control. There are a number of biological, psychological, and social factors, known as risk factors, which can increase an individual's vulnerability to developing a chemical use disorder. The frequency with which substance use disorders occur within some families seems to be higher than could be explained by an addictive environment of the family. Therefore, most substance use professionals recognize a genetic aspect to the risk of drug addiction.

Psychological associations with substance abuse or addictioninclude mood disorders like early aggressive behaviors,depression,anxiety, orbipolar disorder,认为疾病如schizophrenia, as well as personality disorders like anantisocial personality disorder．

Social risk factors for drug abuse and addictioninclude male gender, being between the ages of 18 and 44 Native-American heritage, unmarried marital status, and lower socioeconomic status. According to statistics by state, people residing in the West tend to be at a somewhat higher risk for chemical dependency. While men are more at risk for developing a chemical dependency like alcoholism, women seem to be more vulnerable to becoming addicted to alcohol at much lower amounts of alcohol consumption compared to men.

Adults exposed to negative events as childrenare at higher risk of developing drug abuse and addiction disorders. In addition to poverty, examples of such negative events include lack of parental supervision, the presence of parental substance abuse, witnessingdomestic violence, or being the victim of emotional, physical, or sexual abuse.

While specific symptoms that are used to diagnose drug abuse and addiction disorders are described below, warning signs that you or a loved one suffer from a drug-related problem include the following:

• Havingblackoutsor loss of memory
• Mood problems like irritability, sadness, ormood swings
• Repeated arguments with loved ones
• Repeatedly using drugs to cope with problems
• Physical symptoms when abstaining from drug use
• Physical problems due to drug use
• Repeatedly using more drugs or using drugs for longer than intended
• Spending less time on life obligations due to drug use
• Need more drugs to get high than the one used to

According to theDSM-5(theDiagnostic and Statistical Manual of Mental Disorders, Fifth Edition), the diagnostic reference that is written and endorsed by the American Psychiatric Association, in order to be diagnosed with substance-related use disorder, a person must exhibit a maladaptive pattern of drug use that leads to significant problems orstress, as manifested by at least two of the following signs or symptoms in the same one-year period:

• Recurrent substance use that prevents the sufferer from meeting significant responsibilities at work, school, or home
• Recurrent drug use despite significant resulting drug-related problems in the person's life (for example, in situations that may be physically dangerous, cause recurrent legal problems as a result of drug use; repeated social or relationship problems as a result of or worsened by the drug's effects)
• Recurrent legal problems as a result of drug use
• Continued drug use in spite of continued or repeated social or relationship problems as a result of, or worsened by the drug's effects
• Tolerance, which is either a markedly decreased effect of the drug or a need to significantly increase the amount of the substance used in order to experience the same high or other desired effects
• 撤军的定义是身体或心理logical signs or symptoms consistent with withdrawal from a specific drug or taking that drug or one chemically close to that drug in order to avoid developing symptoms of withdrawal
• Larger amounts of the drug are taken or for longer than intended.
• The person has a persistent urge to take the drug or has unsuccessfully tried to decrease or control the drug use
• A person spends excessive amounts of time either getting, using, or recovering from the effects of the drug
• Cravings/strong urges to use the substance.
• The person significantly lessens or stops engaging in important social, recreational, work, or school activities because of the substance use
• The person engages in negative decision-making, in that he or she continues to use the drug despite knowing that he or she suffers from ongoing or recurring physical or psychological problems caused or worsened by the use of the drug.

While the specific effects of drugs on the brain can vary somewhat depending on the drug that people abuse, virtually every drug that is abused has an effect on what professionals often call the executive functioning areas of the brain. The functions of those areas can be remembered by thinking about the tasks of the chief executive officer in any company: planning, organizing, prioritizing, acting when it is time to act, as well as delaying or preventing action (inhibitory functions) when appropriate.

The parts of the brain that tend to harbor the executive brain functions are the front-most parts of the brain, called the frontal lobes, including the frontal cortex and prefrontal cortex. When a person takes drugs, the inhibitory functions of the brain are particularly impaired, causing the person to have trouble stopping him or herself from acting on impulses that the brain would otherwise delay or prevent. This disinhibition can lead to the substance abuser engaging in aggressive, sexual, criminal, dangerous, or other activities that can have devastating consequences for the addicted person or those around him or her.

• Given that the brain of individuals below about the age of 25 years is in the process of actively and rapidly developing and is therefore not fully mature, drug use that takes place during the childhood or teenage years can have particularly negative effects on the younger person's ability to perform all these essential executive functions.

Similar to many mental health diagnoses, there is no one test that definitively determines that someone has a chemical use disorder. Therefore, health care professionals diagnose these conditions by thoroughly gathering medical, family, and mental health information. The practitioner will also either conduct a physical examination or ask that the person's primary care doctor perform one. The medical assessment will usually include lab tests to evaluate the person's general medical health and to explore whether or not the individual currently has drugs in their system or has a medical problem that might mimic symptoms of drug addiction.

In asking questions about mental health symptoms, specialists are often exploring if the person suffers fromdepressionand/ormanicsymptoms but alsoanxiety,hallucinations, ordelusions, as well as some behavioral problems. Practitioners may provide the people they evaluate with a quiz or self-test as a screening tool for substance use disorders. Since some of the symptoms of chemical dependency can also occur in other mental illnesses, the screening is to determine if the individual suffers frombipolar disorder, ananxiety disorder,schizophrenia,schizoaffective disorder, and otherpsychotic disorders, or a personality or behavior disorder likeantisocial personality disorderorattention deficit hyperactivity disorder(ADHD), respectively. Any condition that is associated with sudden changes in behavior, mood, or thinking, likebipolar disorder, apsychotic disorder,borderline personality disorder, ordissociative identity disorder(DID), may be particularly challenging to separate from some symptoms of drug use disorder. In order to assess the person's current emotional state, health care providers perform a mental-status examination, as well.

In addition to providing treatment that is appropriate to the diagnosis, determining the history or presence of mental illnesses that may co-occur (be co-morbid) with substance abuse or dependence is important in promoting the best possible outcome for the person. As previously described, the dual diagnosis of substance abusing or addicted individuals dictates the need for treatment that addresses both issues in a coordinated way by professionals who are trained and experienced with helping this specific population.

An unfortunate fact about the treatment of drug addiction is that it remains largely underutilized by most sufferers. Facts about the use of drug addiction treatment include that less than 10% of people with a milder substance-use disorder and less than 40% of those with a more entrenched substance-use disorder seek professional help. Those statistics do not seem to be associated with socioeconomic or other demographic traits but do seem to be associated with the presence of other mental health problems (co-morbidity).

The primary goals of drug abuse and addiction disorders treatment (also called recovery) are abstinence, relapse prevention, and rehabilitation.During the initial stage of abstinence, an individual who suffers from chemical dependency may need help avoiding or decreasing the effects of withdrawal.That process is detoxification or "detox." Medical professionals primarily perform that part of drug addiction treatmentin a hospital or other inpatient setting, where medications are used to lessen withdrawal symptoms and close medical monitoring can be performed.The medications used for detox depend on the drug the person is dependent upon. For example, people with alcohol use disorder might receive medications likesedatives(benzodiazepines) or官网地址bwinmedications to decreasepalpitationsand blood pressure, orseizuremedications to prevent seizures during the detoxification process.

For many substances of abuse, the detox process is the most difficult part of dealing with the physical symptoms of addiction and tends to be short-term, lasting days to a few weeks. Physicians sometimes use medications to help addicted individuals abstain from drug use on a long-term basis also depending on the specific drug of addiction. For example,

• individuals who are dependent on opioids like Percodan (a combination ofaspirinandoxycodonehydrochloride) heroin, or Vicodin, Vicodin ES,Anexsia,Lorcet, Lorcet Plus, or Norco (combinations ofhydrocodone and acetaminophen) often benefit from receiving longer-acting, less addictive narcotic-like substances like methadone (Methadose).
• People with alcohol addiction might try to avoid alcohol intake by takingdisulfiram(Antabuse), which producesnausea, stomach cramping, andvomitingin reaction to the person consuming alcohol.

Often, much more difficult and time-consuming than recovery from the physical aspects of drug dependency is psychological addiction. For people who may have less severe drug use disorder, the symptoms of psychological addiction may be able to be managed in an outpatient treatment program. However, those who have a more severe addiction, have relapsed after participation in outpatient programs, or who also suffer from a severe mental health condition might need the elevated level of structure, support, and monitoring provided in an inpatient drug addiction treatment center, often called "rehab．" Following such inpatient treatment, many people with this level of drug use disorder can benefit from living in a sober living community, that is, a group-home setting where counselors provide continued sobriety support, structure, and monitoring on a daily basis.

Self-help groups for people with a drug use disorder, like Alcoholics Anonymous and Narcotics Anonymous, or for loved ones of addicted individuals, like Al-Anon, are important to drug addiction recovery. Specifically, such groups provide an emotionally safe place for people with substance use disorders and their loved ones to share their feelings and experiences, as well as benefit from the experiences of others in their efforts to abstain from using drugs.

Also important in the treatment of drug dependency is helping the parents, other family members, and friends of the addicted person refrain from supporting addictive behaviors (codependency)．Whether providing financial support, making excuses, or failing to acknowledge the drug seeking and other maladaptive behaviors of the drug abuser, discouraging such codependency of loved ones is a key component of recovery. A focus on the addicted person's role in the family becomes perhaps even more significant when that person is a child or teenager, given that minors come within the context of a family in nearly every instance. Drug dependency treatment for children and adolescents is further different from that in adults by the impact of drugs on the developing brain, as well as the younger addict's tendency to need help completing their education and achieving higher education or job training compared to addicts who may have completed those parts of their lives before developing the addiction.

The treatment options for dual diagnosis seem to be less effective when the management of the person's mental disorder is separate from the care for his or her chemical dependency.More successful are integrated treatment approaches that include interventions for both disorders. The inclusion of assessment, intensive case management, motivational interventions, behavior interventions, family treatment, as well as services for housing, rehabilitation, and medication management improve such interventions.

Drug abuse and addiction put sufferers at risk for potentially devastating social, occupational, and medical complications. Effects of chemical dependency on families include increased risk ofdomestic violence．吸毒患者也多less likely to find and keep a job compared to people who are not drug-addicted. Children of parents with a substance use disorder are at higher risk for impaired social, educational, and health functioning, as well as being at higher risk for using drugs themselves.

In addition to the many devastating social and occupational complications of drug addiction, there are many potential medical complications. From respiratory arrest associated with heroin or sedative overdose toheart attackorstrokecaused by cocaine or amphetamine intoxication, death is a highly possible complication of a drug use disorder. People who are dependent on drugs are also vulnerable to developing persistent medical conditions include:

• Liverorheart failureor
• pancreatitis与酗酒有关
• brain damage associated with alcoholism or inhalants

如果治疗,酗酒和其他的预后drug abuse and addiction disorders improves but is not without challenges. Episodes of remission (abstinence from drug use) and relapse characterize recovery from substance dependency.

A number of different prevention approaches are effective in decreasing the risk of drug abuse and addiction disorders. Lifestyle changes, like increased physical activity and using otherstress-reduction techniques, help prevent drug use disorder in teens. Programs that are more formal are also helpful. For example, the Raising Healthy Children program, which includes interventions for teachers, parents, and students, helps prevent drug addiction in elementary school children when the program goes on for 18 months or more. Designing research-based prevention programs to meet the specific needs of children by age and specific community strengths and challenges contributes to the success of those programs. The prevalence of easier access to technology led to the development of computer-based prevention programs. Such programs are very promising in how they compare to more traditional prevention programs, as well as how many more people can be reached through technology.

• Al-Anon-Alateen: 888-4AL-ANON
• Alcoholics Anonymous World Services: 212-870-3400
• American Council on Alcoholism treatment referral line: 800-527-5344
• Kids Against Drugs:http://www.kidsagainstdrugs.com
• Mothers Against Drunk Driving: 800-GET-MADD
• Narconon:http://www.narconon.org/
• Narcotics Anonymous:http://www.na.org
• National Clearinghouse for Alcoholism and Drug Information: 800-729-6686
• National Cocaine Hotline: 800-COCAINE (262-2463)
• National Council on Alcoholism and Drug Dependence: 800-NCA-CALL
• National Drug Information Treatment and Referral Hotline: 800-662-HELP (4357)
• 研究所onAlcohol Abuseand Alcoholism: 301-443-3860
• 国家药物滥用研究所:http://www.nida.nih.gov
• National Resource Center: 866-870-4979