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Common Issues

Alcoholism

Definition

Alcoholism is drinking alcoholic beverages at a level that interferes with physical health, mental health, and social, family, or job responsibilities.

Alternative Names

Alcohol dependence; Alcohol abuse

Causes

Alcoholism is a type of drug addiction. There is both physical and mental dependence on alcohol.

Alcoholism is divided into 2 categories: dependence and abuse. People who are dependent on alcohol spend a great deal of time drinking alcohol, and getting it.

Physical dependence involves:

  • A need for increasing amounts of alcohol to get drunk or achieve the desired effect (tolerance)
  • Alcohol-related illnesses
  • Memory lapses (blackouts) after drinking episodes
  • Withdrawal symptoms when alcohol use is stopped

The most severe drinking behavior includes long drinking binges that lead to mental or physical problems. Some people are able to gain control over their dependence in earlier phases before they totally lose control. But no one knows which heavy drinkers will be able to regain control and which will not.

There is no known common cause of alcoholism. However, several factors may play a role in its development. A person who has an alcoholic parent is more likely to become an alcoholic than a person without alcoholism in the immediate family.

Research suggests that certain genes may increase the risk of alcoholism, but which genes or how they work is not known.

Psychological factors may include:

  • A need for anxiety relief
  • Conflict in relationships
  • Depression
  • Low self-esteem

Social factors include:

  • Ease of getting alcohol
  • Peer pressure
  • Social acceptance of alcohol use
  • Stressful lifestyle

The incidence of alcohol intake and related problems is rising. Data indicate that about 15% of people in the United States are problem drinkers, and about 5% to 10% of male drinkers and 3% to 5% of female drinkers could be diagnosed as alcohol dependent.

Symptoms

Alcohol affects the central nervous system as a depressant. This leads to a decrease in:

  • Activity
  • Anxiety
  • Inhibitions
  • Tension

Even a few drinks can change behavior, slow motor skills, and decrease the ability to think clearly. It can impair concentration and judgment. Drinking a lot of alcohol can cause drunkenness (intoxication).

Some of the symptoms of alcoholism include:

  • Abdominal pain
  • Confusion
  • Drinking alone
  • Episodes of violence with drinking
  • Hostility when confronted about drinking
  • Lack of control over drinking -- being unable to stop or reduce alcohol intake
  • Making excuses to drink
  • Nausea and vomiting
  • Need for daily or regular alcohol use to function
  • Neglecting to eat
  • Not caring for physical appearance
  • Numbness and tingling
  • Secretive behavior to hide alcohol use
  • Shaking in the morning

Alcohol withdrawal develops because the brain adapts to the alcohol and cannot function well without the drug. Symptoms of withdrawal may include:

  • Anxiety
  • Confusion or seeing and hearing things that aren't there (hallucinations)
  • Death (rarely)
  • Increased blood pressure
  • Loss of appetite, nausea, or vomiting
  • Psychosis
  • Raised temperature
  • Rapid heart rate
  • Restlessness or nervousness
  • Seizures
  • Tremors

Exams and Tests

Men who have 15 or more drinks a week, women who have 12 or more drinks a week, or anyone who has 5 or more drinks per occasion at least once a week are all at risk for developing alcoholism. (One drink is defined as a 12-ounce bottle of beer, a 5-ounce glass of wine, or a 1 1/2-ounce shot of liquor).

All doctors should ask their patients about their drinking. The health care provider can get a history from the family if the affected person is unwilling or unable to answer questions. A physical examination is done to identify physical problems related to alcohol use.

The following questions are used by the National Institute on Alcohol Abuse and Alcoholism to screen for alcohol abuse or dependence:

  • Do you ever drive when you have been drinking?
  • Do you have to drink more than before to get drunk or feel the desired effect?
  • Have you felt that you should cut down on your drinking?
  • Have you ever had any blackouts after drinking?
  • Have you ever missed work or lost a job because of drinking?
  • Is someone in your family worried about your drinking?

Tests for alcohol abuse include:

  • A toxicology screen or blood alcohol level (this can tell whether someone has recently been drinking alcohol, but it does not necessarily confirm alcoholism)
  • Complete blood count (CBC)
  • Folate tests
  • Liver function tests
  • Serum magnesium
  • Total protein
  • Uric acid

Treatment

Those who are dependent need to stop drinking alcohol (abstinence). Those who are problem drinkers may be successful with moderation. Because many people refuse to believe that their drinking is out of control, trying moderation can often be an effective way to deal with the problem. If it succeeds, the problem is solved. If not, the person is usually ready to try abstinence.

Three general steps are involved in treatment once the disorder has been diagnosed:

  • Intervention
  • Detoxification
  • Rehabilitation

INTERVENTION

Many people with alcohol problems don't recognize when their drinking gets out of hand. In the past, treatment providers believed that alcoholics should be confronted about their drinking problems, but now research has shown that compassion and empathy are more effective.

Studies find that more people enter treatment if their family members or employers are honest with them about their concerns, and try to help them to see that drinking is preventing them from reaching their goals.

DETOXIFICATION

Withdrawal from alcohol is done in a controlled, supervised setting in which medications relieve symptoms. Detoxification usually takes 4 to 7 days.

Examination for other medical problems is necessary. For example, liver and blood clotting problems are common.

A balanced diet with vitamin supplements is important. Complications can occur with alcohol withdrawal, such as delirium tremens (DT's), which could be fatal. Depression or other mood disorders should be evaluated and treated. Often, alcohol abuse develops from efforts to self-treat an illness.

REHABILITATION

After detoxification, alcohol recovery or rehabilitation programs can help people stay off alcohol. These programs usually offer counseling, psychological support, nursing, and medical care. Therapy involves education about alcoholism and its effects.

Many of the staff members at rehabilitation centers are recovering alcoholics who serve as role models. Programs can be either inpatient, where patients live in the facility during the treatment, or outpatient, where patients attend the program while they live at home.

Medications are sometimes prescribed to prevent relapses.

  • Acamprosate is a new drug that has been shown to lower relapse rates in those who are alcohol dependent.
  • Disulfiram (Antabuse) produces very unpleasant side effects if you drink even a small amount of alcohol within 2 weeks after taking the drug.
  • Naltrexone (Vivitrol) decreases alcohol cravings. It is available in an injected form.

You cannot take these medications if you are pregnant or have certain medical conditions. Long-term treatment with counseling or support groups is often necessary. The effectiveness of medication and counseling varies.

Support Groups

Support groups are available to help people who are dealing with alcoholism. Alcoholics Anonymous is a self-help group of recovering alcoholics that offers emotional support and a model of abstinence for people recovering from alcohol dependence. There are local chapters throughout the United States.

Members of AA:

  • Are given a model of recovery by seeing the accomplishments of sober members of the group
  • Have help available 24 hours a day
  • Learn that it is possible to participate in social functions without drinking

Because alcoholism can also affect those around the person with the alcohol problem, family members often need counseling. Al-Anon is a support group for spouses and others who are affected by someone else's alcoholism. Alateen provides support for teenage children of alcoholics.

If you don't like the 12-step approach, there are several other support groups available. It is important to know about these other groups because in the past, those who did not find AA helpful or were troubled by its involvement of a "Higher Power" had no alternatives.

SMART recovery uses cognitive methods to help people with alcoholism recover. LifeRing recovery and SOS are two other non-religious programs. Women For Sobriety is a self-help group just for women - many women with alcohol problems have different concerns than men. Moderation Management is a program for problem drinkers who want to moderate their drinking. It recommends abstinence for people who fail at moderation.

See also: Alcoholism - support group

Outlook (Prognosis)

Only 15% of people with alcohol dependence seek treatment for this disease. Starting drinking again after treatment is common, so it is important to maintain support systems in order to cope with any slips and ensure that they don't turn into complete reversals.

Treatment programs have varying success rates, but many people with alcohol dependency make a full recovery.

Possible Complications

  • Brain degeneration
  • Cancers of the larynx, esophagus, liver, and colon
  • Cirrhosis of the liver
  • Delirium tremens (DTs)
  • Depression
  • Esophageal bleeding
  • Heart muscle damage
  • High blood pressure
  • Insomnia
  • Liver disease (alcoholic hepatitis)
  • Nausea, vomiting
  • Nerve damage
  • Pancreatitis
  • Poor nutrition because vitamins aren't absorbed properly
  • Problems getting an erection in men
  • Severe memory loss
  • Stopping of the period (menstruation) in women
  • Suicide
  • Wernicke-Korsakoff syndrome

Alcohol consumption during pregnancy can cause severe birth defects. The most serious is fetal alcohol syndrome, which may lead to mental retardation and behavior problems. A milder form of the condition that can still cause lifelong problems is called fetal alcohol affects.

People who are dependent on or who abuse alcohol continue to drink it despite physical or mental problems. They may have problems with binge drinking (drinking 6 or more drinks at one sitting). Those with dependence have more severe problems and a greater need to drink.

Alcoholism is a major social, economic, and public health problem. Alcohol is involved in more than half of all accidental deaths and almost half of all traffic deaths. A high percentage of suicides involve the use of alcohol along with other substances.

People who abuse or are dependent on alcohol are more likely to be unemployed, involved in domestic violence, and have problems with the law (such as drinking and driving).

When to Contact a Medical Professional

If you or someone you know has alcohol dependence and develops severe confusion, seizures, bleeding, or other health problems, go to the emergency room or call the local emergency number such as 911.

Prevention

Educational programs and medical advice about alcohol abuse can help decrease alcohol abuse and its problems. Alcohol dependency needs more intensive management.

The National Institute on Alcohol Abuse and Alcoholism recommends that women have no more than 1 drink per day and men no more than 2 drinks per day. One drink is defined as a 12-ounce bottle of beer, a 5-ounce glass of wine, or a 1 1/2-ounce shot of liquor.

References

Goldman L, Ausiello D. Cecil Textbook of Medicine. 22nd ed. Philadelphia, Pa: WB Saunders; 2004:79-80.

Pettinati HM, O'Brien CP, Rabinowitz AR, Wortman SP, Oslin DW, Kampman KM, Dackis CA. The status of naltrexone in the treatment of alcohol dependence: specific effects on heavy drinking. J Clin Psychopharmacol, 2006;26:610-625.

Assanangkornchai S, Srisurapanont M. The treatment of alcohol dependence. Curr Opin Psychiatry, 2007;20:222-227.

Laaksonen E, Koski-Jännes A, Salaspuro M, Ahtinen H, Alho H. A randomized, multicentre, open-label, comparative trial of disulfiram, naltrexone and acamprosate in the treatment of alcohol dependence. Alcohol Alcohol, 2008;43:53-61.

Review Date: 2/6/2008
Reviewed By: Christos Ballas, MD, Attending Psychiatrist, Hospital of the University of Pennsylvania, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- 2008 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
adam.com

Cocaine Withdrawal

Definition

Cocaine withdrawal occurs when a heavy cocaine user cuts down or quits taking the drug.

Causes

Cocaine produces a sense of extreme joy by causing the brain to release higher than normal amounts of some biochemicals. However, cocaine's effects on the body can be very serious or even deadly.

When cocaine use is stopped or when a binge ends, a crash follows almost immediately. This crash accompanied by a strong craving for more cocaine. Additional symptoms include fatigue, lack of pleasure, anxiety, irritability, sleepiness, and sometimes agitation or extreme suspicion.

Cocaine withdrawal often has no visible physical symptoms like the vomiting and shaking that accompanies the withdrawal from heroin or alcohol.

In the past, people underestimated the addictive properties of cocaine. However, cocaine is addictive when addiction is defined as a desire for more of the drug, despite negative consequences.

The level of craving, lack of pleasure, and depression produced by cocaine withdrawal rivals or exceeds that felt with other withdrawal symptoms.

See also:

  • Drug abuse
  • Drug abuse and dependence
  • Stroke secondary to cocaine

Symptoms

Primary symptoms may include:

  • Depressed mood
  • Fatigue
  • Generalized malaise
  • Vivid and unpleasant dreams
  • Agitation and restless behavior
  • Slowing of activity
  • Increased appetite

The craving and depression can last for months following cessation of long-term heavy use(particularly daily). Withdrawal symptoms can also be associated with suicidal thoughts in some people.

During withdrawal, there can be powerful, intense cravings for cocaine. However, the "high" associated with ongoing use becomes less and less pleasant, and can produce fear and extreme suspicion rather than joy. Just the same, the cravings may remain powerful.

Exams and Tests

A physical examination and history of cocaine use are sufficient to diagnose this condition.

Treatment

The withdrawal from cocaine may not be as unstable as withdrawal from alcohol. However, the withdrawal from any chronic substance abuse is very serious. There is a risk of suicide or overdose.

Symptoms usually disappear completely over time. People experiencing cocaine withdrawal often attempt to self-medicate with alcohol, sedatives, hypnotics, or antianxiety medications, such as diazepam (Valium). Self-medication or replacement is not advised, because each simply shifts addiction from one substance to another.

Because at least 50% of people addicted to cocaine have a co-existing mental disorder (particularly depression and attention-deficit disorder), these conditions must be considered and treated aggressively.

Relapse rates are dramatically reduced when these conditions are treated appropriately. All prescription drugs should be monitored carefully in patients who abuse substances.

Support Groups

The 12-step support groups, such as Cocaine Anonymous or Narcotics Anonymous, have helped many people addicted to cocaine. Alternative groups such as SMART recovery should be recommended for those who do not like the 12-step approach.

Outlook (Prognosis)

Cocaine addiction is difficult to treat, and relapse can occur. However, the rates of achieving stabilization are as good as those for other chronic illnesses like diabetes and asthma.

Treatment should start with the least restrictive option and move up if necessary. Outpatient care is as effective as inpatient for most people addicted to cocaine, according to the research.

Presently there are no effective medications for reducing craving, though some are being tested. Some studies have reported that medications such as amantadine and bromocriptine may help to reduce patient's craving, increase energy, and normalize sleep, particularly among those with the most serious problems.

Possible Complications

  • Depression
  • Craving and overdose
  • Suicide

Because many users will abuse more than one drug, other withdrawal syndromes - such as alcohol withdrawal - need to be ruled out.

When to Contact a Medical Professional

Call your health care provider if you use cocaine and need help to stop using it.

Prevention

Avoid cocaine use. If you have previously used cocaine and wish to stop, try to avoid people, places, and things you associate with the drug. If you find yourself considering the extreme joy produced by cocaine, force yourself to think of the negative consequences that follow use. Seek support if you find it helpful.

Review Date: 1/22/2008
Reviewed By: Eric Perez, MD, Department of Emergency Medicine, St. Luke's-Roosevelt Hospital Center, New York, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- 2008 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
adam.com

Drug Abuse

Definition

Drug abuse is the use of illegal drugs, or the misuse of prescription or over-the-counter drugs.

See also:

  • Drug abuse and dependence
  • Drug abuse first aid

Alternative Names

Substance abuse; Illicit drug abuse; Narcotic abuse; Hallucinogen abuse

Information

MARIJUANA (also called "grass," "pot," "reefer," "joint," "hashish," "cannabis," "weed," and "Mary Jane")

About 2 in 5 Americans have used marijuana at least once. About 10% of the population uses it on a regular basis.

The source of marijuana is the hemp plant (cannabis sativa). The active ingredients are THC (delta-9-tetrahydrocannabinol) and other cannabinoids, which are found in the leaves and flowering shoots of the plant.

Hashish is a substance taken from the tops of female plants. It contains the highest amount of THC.

The drug dose in marijuana varies greatly depending on how it is prepared.

You may feel the effects of marijuana within seconds to several minutes after breathing in the smoke (from a joint or a pipe), or within 30 - 60 minutes after eating foods containing marijuana, such as "hash brownies."

Because you can feel the effects almost right away, you can stop breathing in at any time to reduce the effect. In contrast, eating marijuana produces effects more slowly. These effects add up and last longer, making unpleasant reactions more likely.

The main effects of marijuana are on behavior, because the drug affects the central nervous system (CNS). Marijuana became popular because it gives people a feeling of joy (euphoria), relaxation, and increased sight, hearing, and taste with low-to-moderate doses. Most users also report an increase in their appetite ("the munchies").

Unpleasant effects that may occur include trouble telling oneself from others, changed body image, lack of orientation, and acute panic reactions or severe paranoia.

Some cases of severe delirium, seeing or hearing things that aren't there (hallucinations), and violence have also been reported. In such cases, marijuana may have been laced with another drug, such as PCP.

Marijuana has specific effects that may decrease your ability to perform tasks that require a lot of coordination (such as driving a car). It affects visual tracking and prolongs the sense of time.

The drug can affect learning because it can reduce your ability to concentrate and pay attention. Studies have shown that learning may become "state-dependent," meaning that information learned while under the influence of marijuana is best remembered in the same state of drug influence.

Other marijuana effects may include:

  • Airway (bronchial) irritation leading to narrowing of the airways (bronchoconstriction) or airway spasms (bronchospasm)
  • Bloodshot eyes
  • Increased heart rate and blood pressure
  • Pharyngitis, sinusitis, bronchitis, and asthma in heavy users
  • Possible serious effects on the immune system
  • Widening of the airways (bronchodilatation)

Regular users, when they stop marijuana use, may have withdrawal effects. These may include:

  • Agitation
  • Anxiety
  • Insomnia
  • Irritability

Because the substance formed when the body breaks down marijuana may be stored in the body's fat tissue, heavy users may show evidence of marijuana in urine tests for up to 1 month after stopping the drug.

The active substance in cannabis is believed to have medical properties. Many people believe that it can help treat nausea caused by chemotherapy in cancer patients.

Others claim that cannabis stimulates appetite in patients with AIDS, or is useful for treating glaucoma. While the active ingredient in marijuana has been approved as a medication (dronabinol) by the Food and Drug Administration for these purposes, the use of whole marijuana remains very controversial. Currently, cannabis is illegal even for medical use.

PHENCYCLIDINE (PCP, "angel dust")

It is difficult to estimate the current use of phencyclidine in the United States, because many people do not know that they have taken it. Other illegal substances (such as marijuana) can be laced with PCP without the user being aware of it.

A 1986 National Institute of Drug Abuse survey of high school seniors revealed that more than 12% of the students had used substances that cause hallucinations (hallucinogens), and that many of these drugs probably contained PCP.

PCP use in the U.S. dates back to 1967 when it was sold as the "Peace Pill" in the Haight-Ashbury district of San Francisco. It never became very popular because it had a reputation for causing "bad trips."

PCP use grew during the mid-1970s, mainly because of different packaging (sprinkling on leaves that are smoked) and marketing strategies. During the 1980s it became the most commonly used hallucinogen, especially among users aged 15 - 25.

Although phencyclidine was first created by a drug company searching for a new pain reliever (anesthetic), it was not good for human use because of its mind-altering (psychotropic) side effects.

PCP is no longer produced for legitimate, legal purposes. Unfortunately it can be made rather easily and cheaply by anyone who knows organic chemistry. This makes it a prime drug for the illegal drug industry. It is available illegally as a white powder that can be dissolved in either alcohol or water.

PCP may be taken in different ways. How fast it affects the user depends on how it is taken. If dissolved, PCP may be taken through a vein ("shot up") and its effects begin within seconds.

Sprinkled over dried parsley, oregano, or marijuana leaves, it can be smoked. The effects begin within 2 - 5 minutes, peaking at 15 - 30 minutes. Taken by mouth, in pill form, or mixed with food or drinks, PCP's effects usually start within 30 minutes. The effects tend to peak in about 2 - 5 hours.

Lower doses of PCP typically produce feelings of joy (euphoria) and less inhibition, similar to being drunk. Higher doses cause numbness throughout the body, and perception changes that may lead to extreme anxiety and violence.

Large doses may produce paranoia, "hearing voices" (auditory hallucinations), and psychosis similar to schizophrenia. Massive doses, usually from taking the drug by mouth, may cause:

  • Acute kidney failure
  • Cardiac arrhythmias
  • Death
  • Muscle rigidity
  • Seizures

Because of the pain-killing ( analgesic) properties of PCP, users who get seriously injured may not feel any pain.

Ketamine, a substance related to PCP, has become more popular in recent years. It is commonly called "Special K."

HALLUCINOGENS

In addition to PCP, other commonly abused hallucinogens include LSD (lysergic acid diethylamide), psilocybin (mushrooms, "shrooms"), and peyote (a cactus plant containing the active ingredient mescaline).

Some people have used naturally occurring hallucinogens, especially for religious rites, for centuries. The native people of Mexico used mushrooms containing psilocybin, and peyote use was common among southwestern Native Americans.

In contrast, LSD is an artificial substance, first developed by a drug company in 1938. Today, most hallucinogens are used experimentally rather than on a regular basis. Most users report only one or a few uses per year.

LSD is a very strong hallucinogen. Only tiny doses are needed to produce effects. Compared to LSD, psilocybin is 100 - 200 times weaker, and mescaline (peyote) is about 4,000 times weaker.

Hallucinogens can lead to extreme anxiety and lack of reality at the height of the drug experience ("bad trips"). These experiences can come back as a "flashback," even without using the drug again. Such experiences typically occur during times of increased stress, and tend to occur less often and intensely after stopping the drugs.

STIMULANTS ("speed," "crack," "coke," "snow," "crank," "go," "speedball," "crystal," "cross-tops," "yellow jackets")

Cocaine

The abuse of cocaine increased dramatically in the late 1980s and early 1990s, but is now on the decline.

Cocaine may be breathed in through the nose ("snorting"), or dissolved in water and taken through a vein (intravenously). When mixed with heroin for IV use, the combination is called a "speedball."

Through a simple chemical procedure, cocaine may be changed into a smokeable form known as freebase or crack. Smoking produces an instant and intense sense of joy (euphoria), which is attractive to abusers. Other effects include:

  • Feelings of increased confidence and energy
  • Less inhibition
  • Local numbness
  • Powerful stimulation of the central nervous system

Increased use of and addiction to cocaine probably occur because it produces a very pleasurable high that is very short lived. This encourages the user to use the drug more often or regularly to get the desired effects.

Both the need to use larger amounts of the drugs to get the same effect (tolerance) and dependence may occur with regular cocaine use. Regular users may have:

  • Depression
  • Loss of interest in school, work, family, and friends
  • Memory loss
  • Mood swings
  • Sleep problems
  • Social withdrawal

Because heavy use may cause paranoia, cocaine users may become violent.

AMPHETAMINES

During the 1950s and 1960s, amphetamines were often prescribed for conditions such as fatigue, obesity, and mild depression. Such use has stopped because the drugs are very addictive, and are now considered controlled substances.

Over-the-counter (OTC) amphetamine look-alike drugs are often abused. These drugs typically contain caffeine and other stimulants, and are sold as appetite suppressants or stay-awake/stay-alert aids.

If taken in high doses, these OTC drugs may cause the same high and other effects that occur with amphetamines. Regular users may have:

  • Dilated pupils
  • Irritability
  • Restlessness
  • Skin flushing
  • Sleep disturbances
  • Tremors
  • Weight loss

INHALANTS

Inhalant use became popular with young teens in the 1960s with "glue sniffing." Since then, a greater variety of inhalants have become popular. Inhalant use typically involves younger teens or school age children. Groups of children will use inhalants usually as an experiment.

Commonly abused inhalants include:

  • Aerosols for deodorants or hair sprays
  • Cleaning fluids
  • Gasoline
  • Liquid typewriter correction fluid
  • Model glue
  • Spray paints

The chemicals are poured into a plastic bag or soaked into rags, then breathed in. The drugs are absorbed through the respiratory tract and cause an altered mental state within 5 - 15 minutes.

Negative effects of inhalant abuse include:

  • Brain damage
  • Convulsions
  • Liver or kidney damage
  • Nerve damage ( peripheral neuropathy)
  • Sudden death

Most inhalant use occurs among teens or preteens who do not have access to illegal drugs or alcohol.

OPIATES, OPIOIDS, AND NARCOTICS

Opiates come from opium poppies. These drugs include morphine and codeine. Opioids are artificial substances that have the same effect as morphine or codeine.

Opiates and opioids include:

  • Heroin
  • Hydromorphone
  • Oxycodone
  • Meperidine
  • Methadone
  • Propoxyphene

All of these substances, natural or man-made, are considered narcotics. Used as painkillers, these drugs:

  • Change perception of painful stimuli
  • Decrease anxiety
  • Promote a relaxed state (sedation)

Because heroin is commonly injected into a vein (used intravenously), there are health concerns about sharing contaminated needles among IV drug users. Complications of sharing contaminated needles include hepatitis, HIV infection, and AIDS.

STAGES OF JUVENILE DRUG USE

There are several stages of drug use. Young people seem to move more quickly through the stages than do adults.

  • Experimental use -- typically involves peers, done for recreational use; the user may enjoy defying parents or other authority figures.
  • Regular use -- the user misses more and more school or work; worries about losing drug source; uses drugs to "fix" negative feelings; begins to stay away from friends and family; may change friends to those who are regular users; shows increased tolerance and ability to "handle" the drug.
  • Daily preoccupation -- the user loses any motivation; does not care about school and work; behavior changes become obvious; thinking about drug use is more important than all other interests, including relationships; the user becomes secretive; may begin dealing drugs to help support habit; use of other, harder drugs may increase; legal problems may increase.
  • Dependence -- cannot face daily life without drugs; denies problem; physical condition gets worse; loss of "control" over use; may become suicidal; financial and legal problems get worse; may have broken ties with family members or friends by this time.

TREATMENT OVERVIEW

As with any other area of medicine, the least intensive treatment should be the starting point.

Residential treatment programs monitor and address possible withdrawal symptoms and behaviors. These programs use behavior modification techniques, which are designed to get users to recognize their behaviors.

Treatment programs include counseling both for the person (and perhaps family), and in group settings. Drug abuse treatment programs have a long after-care part (when the user is released from the medical facility), and provide peer support.

Drug addiction is a serious and complicated health condition that requires both physical and psychological treatment and support. It is important to be evaluated by a trained professional to determine the best care.

CALL YOUR HEALTH CARE PROVIDER

  • If you are concerned about the possibility of getting addicted to any prescribed medications
  • If you are concerned about possible drug abuse by yourself or a family member
  • If you are interested in getting more information on drug abuse
  • If you are seeking treatment of drug abuse for yourself or a family member

Also seek out information and support from local 12-step support groups, such as:

  • Al-anon/Alateen
  • Alcoholics Anonymous (AA)
  • Narcotics Anonymous (NA)

Other support groups include:

  • LifeRing Recovery
  • Moderation Management
  • SMART Recovery

See also:

  • Alcoholism - support group
  • Chemical dependence - support group

References

National Institutes of Health. Principles of Drug Addiction Treatment: A Research Based Guide. NIH Publication No. 00-4180, printed October 1999, reprinted July 2000.

Kleber HD, Weiss RD, Anton RF, George TP, Greenfield SF, Kosten TR, et al. Work Group on Substance Use Disorders. Treatment of patients with substance use disorders, second edition. Am J Psychiatry, 2007;164:5-123.

Review Date: 2/6/2008
Reviewed By: Christos Ballas, M.D., Attending Psychiatrist, Hospital of the University of Pennsylvania, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- 2008 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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Drug Dependence

Definition

Drug addiction (dependence) is compulsively using a substance, despite its negative and sometimes dangerous effects. Drug abuse is using a drug excessively, or for purposes for which it was not medically intended.

A physical dependence on a substance (needing the drug to function) is not always part of the definition of addiction. Some drugs (for example, some blood pressure medications) don't cause addiction but do cause physical dependence. Other drugs cause addiction without physical dependence (cocaine withdrawal, for example, doesn't have symptoms like vomiting and chills; it mainly involves depression).

See also:

  • Drug abuse
  • Drug abuse first aid

Alternative Names

Drug addiction; Addiction - drug

Causes

Drug abuse can lead to drug dependence or addiction. People who use drugs for pain relief may become dependent, although this is rare in those who don't have a history of addiction.

The exact cause of drug abuse and dependence is not known. However, the person's genes, the action of the drug, peer pressure, emotional distress, anxiety, depression, and environmental stress all can be factors.

Peer pressure can lead to drug use or abuse, but at least half of those who become addicted have depression, attention deficit disorder, post-traumatic stress disorder, or another psychological problem.

Children who grow up in an environment of illicit drug use may first see their parents using drugs. This may put them at a higher risk for developing an addiction later in life for both environmental and genetic reasons.

Signs of drug use in children include but are not limited to:

  • A change in the child's friends
  • Withdrawn behavior
  • Long unexplained periods away from home
  • Lying
  • Stealing
  • Involvement with the law
  • Problems with family relations
  • Acting drunk or high (intoxicated), confused, impossible to understand, or unconscious
  • Distinct changes in behavior and normal attitude
  • Decreased school performance

Commonly abused substances include:

  • Opiates and narcotics are powerful painkillers that cause drowsiness (sedation) and feelings of euphoria. These include heroin, opium, codeine, meperidine (Demerol), hydromorphone (Dilaudid), and Oxycontin.
  • Central nervous system stimulants include amphetamines, cocaine, dextroamphetamine, methamphetamine, and methylphenidate (Ritalin). Caffeine and nicotine are the most commonly used stimulants. These drugs have a stimulating effect, and people can start needing higher amounts of these drugs to feel the same effect (tolerance).
  • Central nervous system depressants include barbiturates (amobarbital, pentobarbital, secobarbital), benzodiazepine (Valium, Ativan, Xanax), chloral hydrate, and paraldehyde. The most commonly used, by far, is alcohol. These substances produce a soothing sedative and anxiety-reducing effect and can lead to dependence.
  • Hallucinogens include LSD, mescaline, psilocybin ("mushrooms"), and phencyclidine (PCP or "Angel Dust"). They can cause people to see things that aren't there (hallucinations) and can lead to psychological dependence.
  • Tetrahydrocannabinol (THC) is the active ingredient found in marijuana (cannabis) and hashish. Although used for their relaxing properties, THC-derived drugs can also lead to paranoia and anxiety.

People may become high on drugs or overdose by accident or on purpose. Drug withdrawal symptoms can occur when a person stops or reduces their use of a substance. Withdrawal symptoms vary, depending on the abused substance. When withdrawal symptoms begin depends on the length of time the drug normally stays within the body. Drug intoxication, overdose, and withdrawal can sometimes be life-threatening.

Symptoms

OPIATES AND NARCOTICS

Symptoms of opiate and narcotic use:

  • Needle marks on the skin in some cases (called "tracks")
  • Scars from skin abscesses
  • Rapid heart rate
  • Small pupils (pinpoint)
  • Relaxed and/or euphoric state ("nodding")
  • Coma, respiratory depression leading to coma, and death in high doses

Symptoms of opiate and narcotic withdrawal:

  • Anxiety and difficulty sleeping
  • Sweating
  • Goose bumps (piloerection)
  • Runny nose (rhinorrhea)
  • Stomach cramps or diarrhea
  • Enlarged (dilated) pupils
  • Nausea and vomiting
  • Excessive sweating
  • Increase in blood pressure, pulse, and temperature

CENTRAL NERVOUS SYSTEMSTIMULANTS

Symptoms of cocaine use:

  • Exaggerated feeling of well-being (euphoria)
  • Dilated pupils
  • Fast heart rate
  • Restlessness and hyperactivity

Symptoms of cocaine withdrawal:

  • Fatigue and malaise
  • Depression
  • Very clear and unpleasant dreams

CENTRAL NERVOUS SYSTEM DEPRESSANTS

Symptoms of alcohol use:

  • Slurred speech
  • Lack of coordination
  • Decreased attention span
  • Impaired judgment

Symptoms of alcohol withdrawal:

  • Anxiety
  • Shaking (tremors)
  • Seizures
  • Increased blood pressure, pulse, and temperature
  • Delirium

HALLUCINOGENS

Symptoms of LSD use:

  • Anxiety
  • Frightening images of things that aren't there (hallucinations)
  • Paranoid delusions
  • Blurred vision
  • Dilated pupils
  • Tremors

Exams and Tests

Drug tests (toxicology screens) on blood and urine samples can show many chemicals and drugs in the body. How sensitive the test is depends upon the drug itself, when the drug was taken, and the testing laboratory. Blood tests are more likely to find a drug than urine tests; however, urine drug screens are done more often.

Opiates and narcotics are usually in the urine 12 to 36 hours after the last use, depending on the amount used and how often the drug was used.

CNS stimulants such as cocaine can be found in urine for 1 to 12 days, again depending on how often the drog was used.

CNS depressants such as Valium and Xanax are found up to 7 days after the last day of use, mostly depending on the substance used and how quickly the body removes it (its half-life).

Most hallucinogens also can be found in the urine up to 7 days after the last use. However, marijuana can be found for up to 28 days in regular users.

Treatment

Treatment for drug abuse or dependence begins with recognizing the problem. Though "denial" used to be considered a symptom of addiction, recent research has shown that people who are addicted have far less denial if they are treated with empathy and respect, rather than told what to do or "confronted."

Treatment of drug dependency involves weaning off the drug gradually (detoxification), support, and stopping the drug (abstinence). People with acute intoxication or drug overdose may need emergency treatment. Sometimes, the person loses consciousness and might need to be on a breathing machine (mechanical respirator) temporarily. The treatment depends on the drug being used.

Detoxification is the gradual withdrawal of an abused substance in a controlled environment. Sometimes a drug with a similar action is taken instead, to reduce the side effects and risks of withdrawal. Detoxification can be done on an inpatient or outpatient basis.

If the person also has depression or another mood disorder, it should be treated. Very often, people start abusing drugs in their effort to self-treat mental illness.

For narcotic dependence, some people are treated with methadone or similar drugs to prevent withdrawal and abuse. The goal is to enable the person to live as normal a life as possible.

Support Groups

Many support groups are available in the community. They include Narcotics Anonymous (NA), Ala-Teen, and Al-Anon. Most of these groups follow the 12-Step program used in Alcoholics Anonymous (AA). SMART Recovery and LifeRing Recovery are programs that do not use the 12-step approach. You can find support groups in your phone book.

Outlook (Prognosis)

Drug abuse and dependence may lead to a fatal drug overdose. Some people relapse after they have stopped using drugs. Relapses can lead to continued dependence.

Possible Complications

The complications of drug abuse and dependence include:

  • Depression
  • Relapse of drug abuse
  • Drug overdose
  • Bacterial endocarditis, hepatitis, thrombophlebitis, pulmonary emboli, malnutrition, or respiratory infections, caused by drug use through a vein (intravenous)
  • Infection with HIV through shared needles
  • Unsafe sexual practices, which may result in unwanted pregnancies, sexually transmitted diseases, HIV, or hepatitis.
  • Problems with the law
  • Increase in various cancer rates, for example, lung and pharynx cancer are linked to nicotine use, mouth and stomach cancer are associated with alcohol abuse and dependence
  • Problems with memory and concentration, for example with hallucinogen use, including marijuana (THC)

When to Contact a Medical Professional

Call for an appointment with your health care provider if you are addicted to drugs and would like to get off of them, or if you have been cut off from your drug supply and are at risk of withdrawal. Most employers also offer referral services for their employees with substance abuse problems.

Prevention

Drug education programs may be helpful though none has proved effective in the long term.

Review Date: 7/27/2007
Reviewed By: Benjamin W. Van Voorhees, MD, MPH, Assistant Professor of Medicine, Pediatrics and Psychiatry, The University of Chicago, Chicago, IL. Review provided by VeriMed Healthcare Network.
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- 2008 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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Heroin Overdose

Definition

Heroin is an illegal street drug that is is very addictive. This article discusses overdose due to heroin. An overdose is when you take more than the normal or recommended amount of something, usually a drug. An overdose may result in serious, harmful symptoms or death.

Alternative Names

Acetomorphine overdose; Diacetylmorphine overdose

Poisonous Ingredient

  • Heroin

Where Found

Heroin is made from morphine. Morphine is a powerful drug, and it naturally occurs in the seedpods of Asian (opium) poppy plants. Street names for heroin include "junk," "smack," and "skag."

See also: Morphine overdose

Symptoms

  • Airways and lungs
    • Shallow breathing
    • Slow and difficult breathing
  • Eyes, ears, nose, and throat
    • Dry mouth
    • Extremely small pupils, sometimes as small as the head of a pin ("pinpoint pupils")
    • Tongue discoloration
  • Heart and blood
    • Low blood pressure
    • Weak pulse
  • Skin
    • Bluish-colored fingernails and lips
  • Stomach and intestines
    • Constipation
    • Spasms of the stomach and intestinal tract
  • Nervous system
    • Coma
    • Delirium
    • Disorientation
    • Drowsiness
    • Muscle spasticity

Home Care

Seek immediate medical help. DO NOT make a person throw up unless told to do so by Poison Control or a health care professional.

Before Calling Emergency

Determine the following information:

  • The patient's age, weight, and condition
  • The name of the product (ingredients and strengths if known)

Poison Control

The National Poison Control Center (1-800-222-1222) can be called from anywhere in the United States. This national hotline number will let you talk to experts in poisoning. They will give you further instructions.

This is a free and confidential service. All local poison control centers in the United States use this national number. You should call if you have any questions about poisoning or poison prevention. It does NOT need to be an emergency. You can call for any reason, 24 hours a day, 7 days a week.

See: Poison control center - emergency number

What to Expect at the Emergency Room

The health care provider will measure and monitor the patient's vital signs, including temperature, pulse, breathing rate, and blood pressure. Symptoms will be treated as appropriate. The patient may receive:

  • Breathing support
  • Fluids by IV
  • Laxative
  • Medicine, called a narcotic antagonist, to counteract the effects of the heroin (multiple doses, if needed)

Outlook (Prognosis)

If an antidote can be given, recovery from an acute overdose occurs within 24 - 48 hours.

Because heroin is commonly injected into a vein, there are health concerns related to sharing contaminated needles. Sharing contaminated needles can lead to hepatitis, HIV infection, and AIDs.

References

NIDA Research Report - Heroin Abuse and Addiction: NIH Publication No. 05-4165, Revised May 2005.

Review Date: 10/24/2007
Reviewed By: Stephen C. Acosta, MD, Department of Emergency Medicine, Portland VA Medical Center, Portland, OR. Review provided by VeriMed Healthcare Network.
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- 2008 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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Toxicology Screen

Definition

A toxicology screen refers to various tests to determine the type and approximate amount of legal and illegal drugs a person has taken.

Alternative Names

Barbiturates - screen; Benzodiazepines - screen; Amphetamines - screen; Analgesics - screen; Antidepressants - screen; Narcotics - screen; Phenothiazines - screen; Drug abuse screen; Blood alcohol test

How the Test is Performed

Toxicology screening is most often done using a blood or urine sample. However, it may be done soon after swallowing the medication using stomach contents, which are obstained through gastric lavage or after vomiting.

For information on giving a blood sample from a vein see venipuncture.

For information providing a urine sample, see clean catch urine sample. In some circumstances, you may need to provide the urine sample in the presence of the nurse or technician to verify that the urine sample came from you and was not tampered with.

How to Prepare for the Test

No special preparation is needed. If able, tell your health care provider what drugs (including over-the-counter medications) you have taken, including when and how much.

This test is sometimes part of an investigation for drug use or abuse. Special consents, handling and labeling of specimens, or other special procedures may be required.

How the Test Will Feel

Blood test:

When the needle is inserted to draw blood, some people feel moderate pain, while others feel only a prick or stinging sensation. Afterward, there may be some throbbing.

Urine test:

A urine test involves normal urination. There is no discomfort.

Why the Test is Performed

This test is often done in emergency medical situations. It can be used to evaluate possible accidental or intentional overdose or poisoning. It may help determine the cause of acute drug toxicity, to monitor drug dependency, and to determine the presence of substances in the body for medical or legal purposes.

Additional reasons the test may be performed:

  • Alcoholism
  • Alcohol withdrawal state
  • Altered mental state
  • Analgesic nephropathy
  • Complicated alcohol abstinence (delirium tremens)
  • Delirium
  • Dementia
  • Drug abuse monitoring
  • Fetal alcohol syndrome
  • Intentional overdose
  • Stroke secondary to cocaine
  • Unconscious patient

If the test is used as a drug screen, it must be done during a certain time period after the drug is taken or while forms of the drug can still be detected in the body. Examples are below:

  • Alcohol: 3 to 10 hours
  • Amphetamines: 24 to 48 hours
  • Barbiturates: up to 6 weeks
  • Benzodiazepines: up to 6 weeks with high level use
  • Cocaine: 2 to 4 days; up to 10 to 22 days with heavy use
  • Codeine: 1 to 2 days
  • Heroin: 1 to 2 days
  • Hydromorphone: 1 to 2 days
  • Methadone: 2 to 3 days
  • Morphine: 1 to 2 days
  • Phencyclidine (PCP): 1 to 8 days
  • Propoxyphene: 6 to 48 hours
  • Tetrahydrocannabinol (THC): 6 to 11 weeks with heavy use

Normal Results

Normal value ranges may vary slightly among different laboratories. Talk to your doctor about the meaning of your specific test results.

A normal value usually means that alcohol, prescription medications that are not prescribed, and illegal drugs are not found.

A blood toxicology screen can determine the presence and level (amount) of a drug in your body.

Urine sample results are usually reported as positive (substance is found) or negative (no substance is found).

What Abnormal Results Mean

Elevated levels of alcohol or prescription drugs can be a sign of intentional or accidental intoxication or overdose.

The presence of illegal drugs or drugs not prescribed for the person indicates illicit drug use.

Risks

Veins and arteries vary in size from one patient to another and from one side of the body to the other. Obtaining a blood sample from some people may be more difficult than from others.

Other risks associated with having blood drawn are slight but may include:

  • Excessive bleeding
  • Fainting or feeling light-headed
  • Hematoma (blood accumulating under the skin)
  • Infection (a slight risk any time the skin is broken)

Considerations

Commonly found substances on a toxicology screen include:

  • Alcohol (ethanol) -- "drinking" alcohol
  • Amphetamines
  • Antidepressants
  • Barbiturates and hypnotics
  • Benzodiazepines
  • Cocaine
  • Marijuana
  • Narcotics
  • Non-narcotic pain medicines including acetaminophen and anti-inflammatory drugs
  • PCP
  • Phenothiazines (antipsychotic or tranquilizing medications)
  • Prescription medications, any type
Review Date: 10/29/2007
Reviewed By: Eric Perez, MD, Department of Emergency Medicine, St. Luke's-Roosevelt Hospital Center, New York, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- 2008 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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