Drug abuse" redirects here. For the Dice album, see Drug Abuse (album).

Substance abuse

A 2007 assessment of harm from recreational drug use

(mean physical harm and mean dependence liability)[1]

Specialty Psychiatry

Frequency 27 million[2][3]

Deaths 307,400 (2015)[4]

Substance abuse, also known as drug abuse, is a patterned use of a drug in which the user
consumes the substance in amounts or with methods which are harmful to themselves or others,
and is a form of substance-related disorder. Widely differing definitions of drug abuse are used in
public health, medical and criminal justice contexts. In some cases criminal or anti-social
behaviour occurs when the person is under the influence of a drug, and long term personality
changes in individuals may occur as well.[5] In addition to possible physical, social, and psychological
harm, use of some drugs may also lead to criminal penalties, although these vary widely depending
on the local jurisdiction.[6]
Drugs most often associated with this term
include: alcohol, cannabis, barbiturates, benzodiazepines, cocaine, methaqualone, opioids and
some substituted amphetamines like methamphetamine and MDMA. The exact cause of substance
abuse is not clear, with the two predominant theories being: either a genetic disposition which is
learned from others, or a habit which if addiction develops, manifests itself as a chronic debilitating
disease.[7]
In 2010 about 5% of people (230 million) used an illicit substance.[2] Of these 27 million have high-
risk drug use otherwise known as recurrent drug use causing harm to their health, psychological
problems, or social problems that put them at risk of those dangers.[2][3] In 2015 substance use
disorders resulted in 307,400 deaths, up from 165,000 deaths in 1990.[4][8] Of these, the highest
numbers are from alcohol use disorders at 137,500, opioid use disorders at 122,100
deaths, amphetamine use disordersat 12,200 deaths, and cocaine use disorders at 11,100.[4]

Classification[
Public health definitions[

A drug user receiving an injection of the opiate heroin

Public health practitioners have attempted to look at substance use from a broader perspective than
the individual, emphasizing the role of society, culture, and availability. Some health professionals
choose to avoid the terms alcohol or drug "abuse" in favor of language they consider more objective,
such as "substance and alcohol type problems" or "harmful/problematic use" of drugs. The Health
Officers Council of British Columbia — in their 2005 policy discussion paper, A Public Health
Approach to Drug Control in Canada — has adopted a public health model of psychoactive
substance use that challenges the simplistic black-and-white construction of the binary (or
complementary) antonyms "use" vs. "abuse".[9] This model explicitly recognizes a spectrum of use,
ranging from beneficial use to chronic dependence.

Medical definitions[edit]

A 2010 study ranking various illegal and legal drugs based on statements by drug-harm experts. Alcohol was
found to be the overall most dangerous drug.[10]
'Drug abuse' is no longer a current medical diagnosis in either of the most used diagnostic tools in
the world, the American Psychiatric Association's Diagnostic and Statistical Manual of Mental
Disorders (DSM), and the World Health Organization's International Statistical Classification of
Diseases (ICD).

Value judgment[edit]

This diagram depicts the correlations among the usage of 18 legal and illegal drugs: alcohol, amphetamines,
amyl nitrite, benzodiazepine, cannabis, chocolate, cocaine, caffeine, crack, ecstasy, heroin, ketamine, legal
highs, LSD, methadone, magic mushrooms (MMushrooms), nicotine and volatile substance abuse (VSA).
Usage is defined as having used the drug at least once during years 2005–2015. The colored links between
drugs indicate the correlations with |r|>0.4, where |r| is the absolute valueof the Pearson correlation
coefficient.[11]

Philip Jenkins suggests that there are two issues with the term "drug abuse". First, what constitutes
a "drug" is debatable. For instance, GHB, a naturally occurring substance in the central nervous
system is considered a drug, and is illegal in many countries, while nicotine is not officially
considered a drug in most countries.
Second, the word "abuse" implies a recognized standard of use for any substance. Drinking an
occasional glass of wine is considered acceptable in most Western countries, while drinking several
bottles is seen as an abuse. Strict temperance advocates, who may or may not be religiously
motivated, would see drinking even one glass as an abuse. Some groups even
condemn caffeine use in any quantity. Similarly, adopting the view that any (recreational) use
of cannabis or substituted amphetamines constitutes drug abuse implies a decision made that the
substance is harmful, even in minute quantities.[12] In the U.S., drugs have been legally classified into
five categories, schedule I, II, III, IV, or V in the Controlled Substances Act. The drugs are classified
on their deemed potential for abuse. Usage of some drugs is strongly correlated.[11] For example, the
consumption of seven illicit drugs (amphetamines, cannabis, cocaine, ecstasy, legal highs, LSD, and
magic mushrooms) is correlated and the Pearson correlation coefficient r>0.4 in every pair of them;
consumption of cannabis is strongly correlated (r>0.5) with usage of nicotine (tobacco), heroin is
correlated with cocaine (r>0.4) and methadone (r>0.45), and is strongly correlated with crack
(r>0.5)[11]

Drug misuse[edit]
Drug misuse is a term used commonly when prescription
medication with sedative, anxiolytic, analgesic, or stimulantproperties are used for mood alteration or
intoxication ignoring the fact that overdose of such medicines can sometimes have serious adverse
effects. It sometimes involves drug diversion from the individual for whom it was prescribed.
Prescription misuse has been defined differently and rather inconsistently based on status of drug
prescription, the uses without a prescription, intentional use to achieve intoxicating effects, route of
administration, co-ingestion with alcohol, and the presence or absence of dependence
symptoms.[13][14] Chronic use of certain substances leads to a change in the central nervous system
known as a 'tolerance' to the medicine such that more of the substance is needed in order to
produce desired effects. With some substances, stopping or reducing use can cause withdrawal
symptoms to occur,[15] but this is highly dependent on the specific substance in question.
The rate of prescription drug use is fast overtaking illegal drug use in the United States. According to
the National Institute of Drug Abuse, 7 million people were taking prescription drugs for nonmedical
use in 2010. Among 12th graders, nonmedical prescription drug use is now second only
to cannabis.[16] In 2011, "Nearly 1 in 12 high school seniors reported nonmedical use of Vicodin; 1 in
20 reported such use of OxyContin."[17] Both of these drugs contain opioids. A 2017 survey of 12th
graders in the United States, found misuse of oxycontin of 2.7 percent, compared to 5.5 percent at
its peak in 2005.[18] Misuse of the combination hydrocodone/paracetamol was at its lowest since a
peak of 10.5 percent in 2003.[18] This decrease may be related to public health initiatives and
decreased availability.[18]
Avenues of obtaining prescription drugs for misuse are varied: sharing between family and friends,
illegally buying medications at school or work, and often "doctor shopping" to find multiple physicians
to prescribe the same medication, without knowledge of other prescribers.
Increasingly, law enforcement is holding physicians responsible for prescribing controlled
substances without fully establishing patient controls, such as a patient "drug contract". Concerned
physicians are educating themselves on how to identify medication-seeking behavior in their
patients, and are becoming familiar with "red flags" that would alert them to potential prescription
drug abuse.[19]
Depending on the actual compound, drug abuse including alcohol may lead to health
problems, social problems, morbidity, injuries, unprotected sex, violence, deaths, motor vehicle
accidents, homicides, suicides, physical dependence or psychological addiction.[20]
There is a high rate of suicide in alcoholics and other drug abusers. The reasons believed to cause
the increased risk of suicide include the long-term abuse of alcohol and other drugs causing
physiological distortion of brain chemistry as well as the social isolation. Another factor is the acute
intoxicating effects of the drugs may make suicide more likely to occur. Suicide is also very common
in adolescent alcohol abusers, with 1 in 4 suicides in adolescents being related to alcohol
abuse.[21] In the US, approximately 30% of suicides are related to alcohol abuse. Alcohol abuse is
also associated with increased risks of committing criminal offences including child abuse, domestic
violence, rapes, burglaries and assaults.[22]
Drug abuse, including alcohol and prescription drugs, can induce symptomatology which resembles
mental illness. This can occur both in the intoxicated state and also during the withdrawal state. In
some cases these substance induced psychiatric disorders can persist long after detoxification, such
as prolonged psychosis or depression after amphetamine or cocaine abuse. A protracted withdrawal
syndrome can also occur with symptoms persisting for months after cessation of
use. Benzodiazepines are the most notable drug for inducing prolonged withdrawal effects with
symptoms sometimes persisting for years after cessation of use. Both alcohol, barbiturate as well as
benzodiazepine withdrawal can potentially be fatal. Abuse of hallucinogens can trigger delusional
and other psychotic phenomena long after cessation of use.
Cannabis may trigger panic attacks during intoxication and with continued use, it may cause a state
similar to dysthymia.[23] Researchers have found that daily cannabis use and the use of high-potency
cannabis are independently associated with a higher chance of developing schizophrenia and
other psychotic disorders.[24][25]
Severe anxiety and depression are commonly induced by sustained alcohol abuse, which in most
cases abates with prolonged abstinence. Even sustained moderate alcohol use may increase
anxiety and depression levels in some individuals. In most cases these drug induced psychiatric
disorders fade away with prolonged abstinence.[26]

Impulsivity]
Impulsivity is characterized by actions based on sudden desires, whims, or inclinations rather than
careful thought.[27] Individuals with substance abuse have higher levels of impulsivity,[28] and
individuals who use multiple drugs tend to be more impulsive.[28] A number of studies using the Iowa
gambling task as a measure for impulsive behavior found that drug using populations made more
risky choices compared to healthy controls.[29] There is a hypothesis that the loss of impulse control
may be due to impaired inhibitory control resulting from drug induced changes that take place in the
frontal cortex.[30] The neurodevelopmental and hormonal changes that happen
during adolescence may modulate impulse control that could possibly lead to the experimentation
with drugs and may lead to the road of addiction.[31] Impulsivity is thought to be a facet trait in the
neuroticism personality domain (overindulgence/negative urgency) which is prospectively associated
with the development of substance abuse.[32]

Screening and assessment[edit]

There are several different screening tools that have been validated for use with adolescents such
as the CRAFFT Screening Test and in adults the CAGE questionnaire.
Some recommendations for screening tools for substance misuse in pregnancy include that they
take less than 10 minutes, should be used routinely, include an educational component. Tools
suitable for pregnant women include i.a. 4Ps, T-ACE, TWEAK, TQDH (Ten-Question Drinking
History), and AUDIT.[33]

Treatment[
Psychological
From the applied behavior analysis literature, behavioral psychology, and from randomized clinical
trials, several evidenced based interventions have emerged: behavioral marital therapy, motivational
Interviewing, community reinforcement approach, exposure therapy, contingency
management[34][35] They help suppress cravings and mental anxiety, improve focus on treatment and
new learning behavioral skills, ease withdrawal symptoms and reduce the chances of relapse.[36]
In children and adolescents, cognitive behavioral therapy (CBT)[37] and family therapy[38] currently has
the most research evidence for the treatment of substance abuse problems. Well-established
studies also include ecological family-based treatment and group CBT.[39] These treatments can be
administered in a variety of different formats, each of which has varying levels of research
support[40] Research has shown that what makes group CBT most effective is that it promotes the
development of social skills, developmentally appropriate emotional regulatory skills and other
interpersonal skills.[41] A few integrated[42] treatment models, which combines parts from various types
of treatment, have also been seen as both well-established or probably effective.[39] A study on
maternal alcohol and drug use has shown that integrated treatment programs have produced
significant results, resulting in higher negative results on toxicology screens.[42] Additionally, brief
school-based interventions have been found to be effective in reducing adolescent alcohol and
cannabis use and abuse.[43] Motivational interviewing can also be effective in treating substance use
disorder in adolescents.[44][45]
Alcoholics Anonymous and Narcotics Anonymous are one of the most widely known self-help
organizations in which members support each other not to use alcohol.[46] Social skillsare significantly
impaired in people suffering from alcoholism due to the neurotoxic effects of alcohol on the brain,
especially the prefrontal cortex area of the brain.[47] It has been suggested that social skills training
adjunctive to inpatient treatment of alcohol dependence is probably efficacious,[48] including
managing the social environment.

Medication[edit]
A number of medications have been approved for the treatment of substance abuse.[49] These
include replacement therapies such as buprenorphine and methadone as well as antagonist
medications like disulfiram and naltrexone in either short acting, or the newer long acting form.
Several other medications, often ones originally used in other contexts, have also been shown to be
effective including bupropion and modafinil. Methadone and buprenorphine are sometimes used to
treat opiate addiction.[50] These drugs are used as substitutes for other opioids and still cause
withdrawal symptoms.
Antipsychotic medications have not been found to be useful.[51] Acamprostate[52] is a glutamatergic
NMDA antagonist, which helps with alcohol withdrawal symptoms because alcohol withdrawal is
associated with a hyperglutamatergic system.

Dual diagnosis[edit]
Main article: Dual diagnosis
It is common for individuals with drugs use disorder to have other psychological problems.[53] The
terms “dual diagnosis” or “co-occurring disorders,” refer to having a mental health and substance
use disorder at the same time. According to the British Association for Psychopharmacology (BAP),
“symptoms of psychiatric disorders such as depression, anxiety and psychosis are the rule rather
than the exception in patients misusing drugs and/or alcohol.”[54]
Individuals who have a comorbid psychological disorder often have a poor prognosis if either
disorder is untreated.[53] Historically most individuals with dual diagnosis either received treatment
only for one of their disorders or they didn’t receive any treatment all. However, since the 1980s,
there has been a push towards integrating mental health and addiction treatment. In this method,
neither condition is considered primary and both are treated simultaneously by the same provider.[54]

Epidemiology[edit]

Disability-adjusted life year for drug use disorders per 100,000 inhabitants in 2004.
no data
<40
40–80
80–120
120–160
160–200
200–240
 240–280
280–320
320–360
360–400
400–440
>440

The initiation of drug and alcohol use is most likely to occur during adolescence, and some
experimentation with substances by older adolescents is common. For example, results from
2010 Monitoring the Future survey, a nationwide study on rates of substance use in the United
States, show that 48.2% of 12th graders report having used an illicit drug at some point in their
lives.[55] In the 30 days prior to the survey, 41.2% of 12th graders had consumed alcohol and 19.2%
of 12th graders had smoked tobacco cigarettes.[55] In 2009 in the United States about 21% of high
school students have taken prescription drugs without a prescription.[56] And earlier in 2002, the
World Health Organization estimated that around 140 million people were alcohol dependent and
another 400 million with alcohol-related problems.[57]
Studies have shown that the large majority of adolescents will phase out of drug use before it
becomes problematic. Thus, although rates of overall use are high, the percentage of adolescents
who meet criteria for substance abuse is significantly lower (close to 5%).[58] According to BBC,
"Worldwide, the UN estimates there are more than 50 million regular users of morphine diacetate
(heroin), cocaine and synthetic drugs."[59]
More than 70,200 Americans died from drug overdoses in 2017.[60] Among these, the sharpest
increase occurred among deaths related to fentanyl and synthetic opioids (28,466 deaths).[60] See
charts below.

Drug use is higher in countries with high economic inequality

 

Total recorded alcohol per capita consumption (15+), in litres of pure alcohol[61]

Total yearly U.S. drug deaths.[60]

US yearly overdose deaths, and the drugs involved.[60]