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Substance Abuse

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Substance abuse is the use of a drug or other substance for a non-medical purpose, to produce a mind altering stated in the user. Substance abuse refers to the abuse of illegally produced substances, as well as the use of legal medications for a different purpose to the one the medication is meant for. In most cases, the substance in question is used in excessive quantities.

Addiction is a state of physical and/or psychological dependence on a substance. Physical addiction causes tolerance to the substance. This means that larger quantities of the drug or medication need to be used to achieve the same affect. As a result of addiction and tolerance, withdrawal symptoms emerge when the user stops taking the drug. These symptoms disappear when the user resumes taking the drug or the amount is increased.

Drug abuse does not only involve illegal drugs such as: heroin, cannabis, cocaine or ecstasy, but also prescription medication such as tranquillisers, analgesics, or painkillers, and sleeping pills. Even medicines that can be bought over the counter or off the shelf are resorted to, including cough mixtures or herbal remedies. Alcohol can also be abused and alcoholism or the addiction to alcohol is becoming an increasing area of concern for healthcare professionals.

Drug abuse has a significant number of associated risks. Some of these include:

  • Risk to personal safety (danger of death or injury as a result of an overdose, accident or aggression).
  • Damage to health (including brain damage, liver failure, mental problems etc.).
  • Problems with the law (risk of imprisonment, fines and criminal record).
  • Destructive behaviour (self-harm and harm to family and friends).

Drug dependency is a common cause of financial problems and difficulties at work or school. Often addicts resort to lying or stealing in order to feed their habit. As a result they can end up losing the support of friends and family. Addicts may experience a sense of shame and guilt, which stems from repeated failures to control their drug habit. Yet, despite all these difficulties, people who are addicted to drugs frequently deny they have a problem.

Despite all the negative effects, people who abuse drugs or alcohol are driven to their addiction and tend to deny that they have a drug problem, or that drugs are harmful to themselves or others. Some even believe that they do not really have a problem at all. This subconscious denial is one of the effects of dependency or addiction.

People abuse drugs and alcohol for many reasons. Understanding the person's motivation may help to explain why that person is abusing drugs. The causes of drug abuse and addiction depend on the type of drug that is being abused, the person abusing the drug and the circumstances in which the drug is taken.

People suffering from mental disorders such as Bipolar Disorder, Schizophrenia, or adults with ADHD also are at increased risk and often abuse alcohol or drugs. Therefore, it is important when treating patients abusing substances, to treat the underlying condition. Of course, it remains key to take care of the alcohol abuse at the same time.

Certain medications such as sleeping pills or painkillers cause physical addiction. They provoke changes in the body, which result a need for the drug to be able to function normally. This phenomenon is called tolerance. Not taking the drug will lead to unpleasant withdrawal symptoms and the only way to avoid this is to take more drugs.

Other drugs may result in psychological addiction. In this case the person craves the drug and starts to rely on the feelings the drug produces. Good feelings, including: relaxation, self-confidence, self-esteem, freedom from anxiety, etc drive people to taking more drugs. The need for the drug is then not just a casual desire, but a powerful compulsion.

Scientific evidence indicates that certain people may be an increased risk of drug abuse and addiction. These people have inherited a predisposition to addiction from their parents. However, social pressures and other external factors such as: stress, poverty, other illnesses can also play a very significant role. Peer pressure, emotional distress and low self-esteem can lead people to drug abuse. Having easy access to drugs may also be a contributory factor.

If a person abuses a drug to feel better or to cope with a problem, he or she is very likely to start relying 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.

Most people intend to use drugs or alcohol casually or for recreational purposes. But what initially may seem like controlled enjoyable use, soon takes on very different proportions and the initial positive experience soon starts feeding an addiction.

Having had a good experience, users resort to keep on taking the drug to try to repeat the effect, and gradually may start taking the drug more and more often. At some stage the user will become either physically or psychologically dependent on the drug and will not be able to stop or reduce the drug taking habit. The user then has no choice but to keep taking the drug to feel well.

Drug addiction or substance abuse affects different people in different ways. Some people may need a drink or a drug to feel confident in meeting people socially. They may have to take a drink or a 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, these people are relying on their favoured substance in order to feel better and cope. They become dependent and turn into addicts.

Substance abuse in teenagers and young adults

Drug and alcohol abuse is very common in young people, and can have serious consequences. A large proportion of deaths in youngsters between the ages of 15 and 24, due to accidents, homicide or suicide are often a direct result of alcohol or drug abuse. Substance abuse also can contribute to violent crimes, such as assault or rape.

Repeated and regular recreational drug use can lead to other problems, such as 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 using other drugs, such as: marijuana, cocaine, hallucinogens, inhalants, and heroin. A combination of curiosity, the thrill of risk, and social pressure can sometimes make it very difficult for an adolescent to say no to drugs.

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. However, adolescents with no family history are also at risk. Teenagers with a family history of alcohol or drug abuse should be advised to refrain from taking drugs and not to experiment. No one can predict who will abuse or become dependent on drugs. Only the non-user will ever do so.

Warning signs of teenage drug or alcohol abuse include:

  • a drop in school performance,
  • a change in groups of friends,
  • delinquent behaviour,
  • deteriorating family relationships.

Physical signs may also be present. These include:

  • red eyes,
  • persistent cough,
  • persistent sniffing as if suffering from a cold,
  • change in eating and sleeping habits.

Alcohol or drug dependency may include blackouts, withdrawal symptoms, and more severe problems at home, school, or work.

Treating abuse and addiction

The first step in treatment is recognition by the individual that there is a problem. Also exclude underlying mental diseases. The family doctor or general practitioner will be able to advise on treatment for drug addiction. He or she may suggest a specialist doctor or healthcare professional.

People who have become physically or psychologically dependent on drugs or alcohol often realise that they are drinking or using more than they used to. They may then try to reduce their drug intake. This can involve cutting down the amount taken or switching to another drug. For example they may only drink or use on certain days or switch to another drug (e.g. whiskey to beer, cannabis to alcohol, heroin to methadone) etc.

In some cases attempting to cut down, involves a life change such as moving home or changing jobs. However, it is very common for these efforts to result in failure, to the astonishment and dismay of the individual. Users then have to face the fact that their drug abuse is beyond their control, and that they require help to deal their problem.

Treatment should be suited to the needs of the individual. No one treatment fits all. The choice of treatment will depend on the drug that is being abused as well as the person who is suffering from addiction. Treatments include psychological therapies, such as behaviour therapy, and medication to help the individual with withdrawal symptoms. Areas that are focussed on during treatment include:

  • detoxification (the process of stopping the drug while coping with physical addiction),
  • preventing relapse,
  • coping with relapse,
  • longer-term rehabilitation.