Substance abuse or drug abuse refers to the overindulgence on a drug or substance that can cause physical and mental problems to the person using it and others. This is not limited to the use of drugs that alter the mood or are considered psycho active. Even an activity may be categorized as drug abuse when it is not used in the proper way. For instance, the use of steroids by athletes to enhance their performance can be classified under substance abuse. In simple terms, the use of substances, prescription drugs or over-the-counter medications for purposes other than what they are indicated for and in a manner and amounts not specified can be termed as drug abuse.
An unhealthy pattern of using any substance can lead to one or many of the following problems:
• The person will not be in a position to carry out his/her responsibilities at home, work or school/college.
• It may prove dangerous if a person drives his/her vehicle under the influence of the substance or drug.
• Using drugs in public places or disorderly conduct after using a substance can cause repeated legal problems.
• Continued use of substances, despite being aware of the problems that it can cause, creates distress to others as well.
The distinction between substance abuse and substance dependence is always a matter of debate. In general, substance abuse is defined in terms of the social consequences that the inappropriate use of a substance can lead to, while substance dependence is defined in terms of physiological and behavioral symptoms that substance abuse causes. It is possible that substance abuse may lead to substance dependence or addiction.
In medical terms, a person is said to have substance dependence only if he/she develops withdrawal symptoms when not using the substance. Addiction is different from both abuse and dependence. A person is said to be addicted to a substance if he/she has a compulsion to use the substance despite being aware of the negative consequences of using it. Addiction may or may not involve chemical dependency.
Substance dependence mostly implies abuse. However, abuse can happen without dependence, especially when a person starts using a substance or in the initial stages of use. Substance abuse almost always involves a complex interaction between the person, substance and society.
Typically, when people talk about substance abuse they are actually referring to drug abuse. According to professionals working in the field of prevention of drug abuse, use of drugs that are not legal can be termed as abuse. It is true that some may be of the opinion that use of drugs like marijuana for recreational purposes is not abuse on the presumption that it is not addictive. However, research studies have shown that those who use marijuana can become psychologically dependent and hence can be addicted to its use.
It is not true that only the use of illegal drugs can lead to abuse. Use of alcohol, prescription drugs, OTC drugs, solvents, inhalants, coffee and cigarettes can be used in excess and result in substance abuse. In fact, some people become polysubstance abusers, meaning they involve in inappropriate usage of at least three substances though they may not favor the use of one substance over the other. While caffeine and nicotine are excluded from the list, marijuana, cocaine, heroin and pain killers are substances that are included. To meet the diagnostic criteria, this behavior must last for at least a year.
The signs and symptoms of substance abuse become evident when the users start facing problems such as health and social issues, injuries, motor vehicle accidents, etc. The rate of suicide is very high among alcoholics and drug users as it causes distortion to the brain chemistry. Drug abuse, both alcohol and prescription drugs, is seen to induce symptomatology that resembles mental illness. This can happen when the person is in the intoxicated state or at the time of withdrawal. Sustained alcohol abuse is known to cause severe anxiety and depression in users. Substance abuse affects the central nervous system, causing mood changes and alteration to the levels of awareness or perception and sensations.
It has been observed that initiation into drug and alcohol use generally happens during adolescence, though some people get involved in substance use in late teens. According to a study conducted in the US, as much as 48% of the 12th graders reported that they have used an illegal drug at some point in their lives. However, most adolescents wean themselves out of the drugs before they start facing problems. Therefore, the percentage of adolescents who satisfy the criteria of substance abuse is significantly low, though the overall use rates are very high. The United Nations has estimated that there are 50 million people who regularly use morphine diacetate, synthetic drugs and cocaine.
For many people involved in substance abuse treatment is essential. Substance abuse is considered as a relapsing disease like heart disease or diabetes. Most often a substance abuser has to be convinced to submit to any kind of treatment. The treatments may involve behavioral interventions and medications. Some of the treatment methods that have evolved include behavioral marital therapy, pharmacological therapy, exposure therapy, community reinforcement approach, etc., among many others. The approved medications for the treatment of substance abuse include:
• Buprenorphine and methadone as replacement therapies,
• Disulfiram and naltrexone in both short and long acting forms as antagonist medications,
• Bupropion, Modafinil, etc., used in other contexts have also shown to be effective.
Some of those who practice the nursing profession have indicated that stopping substance abuse can go a long way in reducing the risk of dying early. Further, it is also seen to significantly reduce the risk of heart and lung disease and strokes. In children and adolescents, cognitive behavioral and family therapies have been found to be effective and are supported by research evidence. Social skills training as part of inpatient treatment for alcohol dependence is seen to effective. Many a time the involvement of support groups such as alcoholics, marijuana or narcotics anonymous is also sought in addition to intensive counseling.