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Introduction
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Alcohol-related disorders
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Stimulant drugs
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Hallucinogenic drugs
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Narcotic analgesics
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Cannabis
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Inhalants
Introduction
Substance abuse is the use of a drug or other substance for a non-medical use, with the aim of producing some type of 'mind-altering' effect in the user. This includes both the use of illegally produced substances, and the abuse of legal drugs, in a use for which the substance was not intended. Often this involves use of the substance in excessive quantities.
Addiction is a state of physical or psychological dependence on a substance. Physical addiction includes the development of
tolerance (needing more and more of the drug to achieve the same effect) and
withdrawal symptoms that appear when the user stops taking the drug, and disappear when more of the drug is taken.
Many different types of drugs can be abused: not only illegal drugs such as heroin, cannabis, cocaine or ecstasy, but also prescription drugs such as
tranquillizers, analgesics (painkillers), and sleeping pills. Even medicines that can be bought off the supermarket shelf can be abused (such as cough mixtures or herbal remedies) and the abuse of alcohol is a major area of concern.
Some of the risks associated with drug abuse include:
Drug dependency is also a common cause of financial problems and difficulties at work or school. People may lie or steal in order to continue using the drug, as a result, and may lose the trust of their friends and family. They may feel shame and guilt, due to repeated failures in trying to control their drug intake. Despite all these difficulties, people who are dependent on drugs will often deny that they have a problem. A person may deny a problem even though they
realize they do and get upset by the effect that their drug abuse is causing to themselves, their family and friends. Despite these negative effects, they are compelled to keep using the drug, and so their response is to deny that they have a drug problem, or to deny that it is harmful to themselves or to others. Alternatively, they may actually believe that they do not have a problem; this subconscious denial is one of the effects of dependency drug.
People abuse drugs and alcohol for many reasons, and understanding the person's motivation helps to explain why that person is abusing. What causes drug abuse and addiction will depend on the nature of the drug being abused, the person taking the drug and the circumstances under which it is taken.
Certain medications such as sleeping pills or painkillers are
physically addictive. This means that they bring about changes in the body, which mean that the person eventually needs to continue taking the drug to function normally (tolerance). If the drug is not taken, unpleasant withdrawal symptoms will occur, and the only way to avoid this is to take more drugs. People often need to take increasing amounts of the drug simply to avoid these unpleasant symptoms. Other drugs may lead to
psychological addiction if people have a craving for the desired effect of the drug. The person comes to rely on the drug to supply good feelings, such as relaxation, self-confidence, self esteem, freedom from anxiety etc. The need for the drug is then not just a casual desire, but rather is a powerful compulsion.
Some evidence that certain people may be at more risk of drug abuse and addiction than others - they may inherit a predisposition to addiction from their parents. However, social pressures and other external factors (stress, poverty, other illnesses) are also extremely important. Peer pressure, emotional distress and low self-esteem can all lead individuals to abuse drugs. Ease of access to drugs is another important influence.
If a person abuses a drug to feel better or to cope with their problems, then it is possible that they will come to consistently rely on drink or drugs as a way of avoiding difficult feelings or situations. They may lose, or never learn, the skills that are necessary for them to cope with life.
People who abuse drugs (or alcohol) occasionally never intend to become dependent on them, but for some people, casual drug abuse can develop into drug dependence. They may first take the drug for a number of reasons (e.g., curiosity, peer pressure, a need to cope with an emotional crisis). They may find the effect of the drug helpful or enjoyable. It may make them feel self confident, relaxed, or powerful. Having had a good experience, they take the drug again, to try to repeat the effect, and may continue to take the drug more and more often. At some stage they become either physically or psychologically dependent on the drug. This means that they are unable to stop or reduce their drug taking by themselves. They have no choice but to keep taking the drug to feel normal. They may
realize that they are drinking or using more than they used to, and may try to reduce their use by cutting down the amount taken each time, only drinking/using on certain days or switching to another drug. However, it is very common for their efforts to end in total failure. The realisation that they are unable to reduce their drinking or drug use can often be very confusing and distressing for the person concerned.
Many different people are affected by drug dependence, in many different ways. The problem is not simply one that affects destitute heroin addicts or alcoholics on the street. For example, some people may need a drink or drug to feel confident in meeting people socially. They may have to take a drink or drug every day to avoid withdrawal symptoms. Some use drink or drugs to forget personal problems, others to cope with the stress of day-to-day living. Even though they may not recognise their problem, anyone who feels an absolute need to keep using a substance in order to feel better is actually dependent on that substance.
Substance abuse by teenagers and young adults
The abuse of drugs and alcohol by young people is very common, and can have serious consequences. A large proportion of deaths (from accidents, homicides, suicides) in people aged between 15 and 24 involve alcohol or drug abuse. Use of drugs and alcohol also contributes to violent criminal acts, such as assault or rape.
Repeated and regular recreational drug use can lead to other problems, like anxiety and depression. Some teenagers regularly use drugs or alcohol to compensate for anxiety, depression, or a lack of positive social skills. The use of tobacco and alcohol by teenagers can sometimes be a first step towards the use of other drugs, such as marijuana, cocaine, hallucinogens, inhalants, and heroin. A combination of curiosity, risk taking
behavior, and social pressure can sometimes make it very difficult for a teenager young person to say no.
A teenager with a family history of alcohol or drug abuse, and a lack of social skills can move rapidly from experimentation to patterns of serious abuse or dependency, although those with no family history are also at risk. Teenagers with a family history of alcohol or drug abuse should be particularly advised to abstain and not experiment. No one can predict for sure who will abuse or become dependent on drugs, except that the non-user never will.
Warning signs of teenage drug or alcohol abuse may include:
There may also be physical signs, such as red eyes, a persistent cough, and change in eating and sleeping habits. Alcohol or drug dependency may include blackouts, withdrawal symptoms, and more severe problems at home, school, or work.
Treatment of abuse and addiction
The first step in treatment is recognition by the individual that they have a problem. The family physician will be able to advise on treatment for drug addiction. He or she may suggest that the person should visit a doctor with special training in addiction problems.
People who have become physically or psychologically dependent to some degree on a drug often
realize that they are drinking or using more than they used to. They may then try to reduce their drug intake. This could involve cutting down the amount taken each time; only drinking/using on certain days; switching to another drug (e.g. whiskey to beer, cannabis to alcohol, heroin to methadone) etc. Sometimes attempts to cut down may involve a life change (moving home, changing jobs). However, it is very common for such efforts to end in total failure, to the astonishment and dismay of the individual. They then have to face the fact that their drug abuse is beyond their control, and that they now need help to deal this problem.
Treatment should be suited to the needs of the individual, and there is no one treatment that is used in all cases. The choice of treatment will also depend on which drug is being abused. Treatments include psychological therapies, such as
behavior therapy, and medication to help the individual with withdrawal symptoms. Specific areas that may be given attention during treatment include:
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