Drug abuse
is a disease characterized by continued misuse of drugs even when faced with drug-related job, legal, health, or family difficulties. Problems associated with drug abuse must have existed a minimum of 12 months to meet the diagnosis.
Drug dependence
refers to long-term, compulsive drug use, perhaps with attempts to stop but repeatedly returning to drugs. Drug dependence also means that your body has begun to require the drug in higher doses to avoid withdrawal symptoms.
Drug abuse and drug dependence are not terms that should be used to describe people who are taking appropriate dosages of prescribed drugs (pain medication, for example) and who have become physically dependent on them. Diagnosis of both drug abuse and drug dependence requires the presence of specific behavioral symptoms.
Some of the most commonly abused substances include:
Cocaine
Heroin
Morphine
LSD
Marijuana
Sedatives
Speed (methamphetamine, “crystal meth”)
PCP
Ecstasy
GHB
Ketamine
Steroids
Inhalants
Legal drugs that are used improperly or without a prescription, such as:
The cause of drug abuse and dependence is unknown, although there are a variety of theories. One theory holds that there may be a genetic component that predisposes a person toward using and abusing drugs. Another theory is that drug abuse is a learned behavior and that people begin to use drugs by copying the behavior of those around them. Medical professionals have not been able to target a specific cause.
Brain chemicals may alter the user's perception of the drug's effects. Long-term drug use changes brain function and may reinforce the desire to keep using drugs regardless of the consequences.
Denial that a drug problem exists is common. Drug abuse can occur without physical dependence.
To definitively diagnose drug abuse, the symptoms must have lasted for at least 12 months.
Symptoms include:
Repeated work, school, or home problems due to drug use
Continued use of drugs even though it means risking physical safety
Recurring trouble with the law related to drug use, including impaired driving
Continuing to use drugs despite drug-related problems in personal relationships
Drug abuse often progresses to drug dependence. Symptoms of drug dependence include at least three of the following:
Craving for the substance
Inability to stop or limit drug use
Tolerance, taking greater amounts to feel the same effect
Withdrawal symptoms that occur when the drug is stopped
Significant amounts of time trying to acquire drugs and recover from their effects
Giving up activities to use drugs or recover from the effects
Drug use continues even when it causes or worsens health and/or psychological problems
Diagnosis
The doctor will ask about:
Drug use
How often you use drugs
Which drugs you use
What amount and if you have increased the amount to receive the same desired effect
Emotional problems that may have occurred while using drugs
Problems with a job, your family, or the law
Tests may include:
Blood and urine tests to check for the presence of drugs
Treatment
There is no cure for drug abuse or drug dependence.
There are three main treatment goals:
To help patients stop using drugs
To decrease the toxic effects of the drugs being used and to aid in symptoms of drug withdrawal (“detoxification”)
To prevent relapse
Successful treatment depends on the drug user's recognition of the problem and desire to change. Recovery takes a long time and is not an easy process. Patients may need multiple courses of treatment.
Therapies include:
Medications
Drugs may help alleviate symptoms of withdrawal. In some cases, medication may be ordered to prevent relapse. Heroin addicts may be given
methadone
to help taper them off. Methadone may also be given on a long-term basis to improve the chance the addict will stay in treatment. Methadone is a narcotic drug that blocks cravings as well as the pleasurable effects of heroin and other opiates.
Other drugs that are used in addictions treatment are
naltrexone
(eg, ReVia, which blocks the effect of opiates, such as heroin) and
buprenorphine
(eg, Subutex, which is similar to methadone).
Counseling
Therapy raises awareness of underlying issues and lifestyles that promote drug use. It works to improve coping and problem-solving skills and to develop other ways of dealing with stress or pain. Through counseling, a person can learn how to handle situations associated with drug use and replace drug-using activities with other meaningful activities. Family support is encouraged.
Self-help Organizations
There are numerous organizations dedicated to helping people to stop using drugs. Two examples are Narcotics Anonymous and Cocaine Anonymous. These are 12-step programs and members of these organizations meet regularly to talk about their drug-related troubles. They provide a network of support for each other.
Prevention
Drug education programs may be helpful. Suggested strategies to lower the risk of drug abuse or dependence include:
Learn about risks related to drug use.
Do not spend time with people who are using illegal drugs.
Learn ways to handle peer pressure.
Seek counseling for anxiety, depression, and other mental health problems.
RESOURCES:
Cocaine Anonymous http://www.ca.org
Narcotics Anonymous http://www.na.org
National Institute on Drug Abuse http://www.nida.nih.gov
CANADIAN RESOURCES:
Centre for Addiction and Mental Health http://www.camh.net/about_camh/
Drug Rehab Centers Canada http://www.drug-rehab.ca/
References:
American Psychiatric Association.
Diagnostic and Statistical Manual of Mental Disorders
.
4th ed. Text Revision. Washington, DC: American Psychiatric Association; 2000.
Cami J, Farre M. Drug addiction.
N Engl J Med
. 2003; 349:975-986.
Cecil Textbook of Medicine
. 23rd ed. WB Saunders; 2007.
Griffith's 5-Minute Clinical Consult.
Lippincott Williams and Wilkins; 2006.
National Institute on Drug Abuse website. Available at:
http://www.nida.nih.gov/
.
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
