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 behavior occurs when the person is
under the influence of a drug, and long term personality changes in individuals may occur as well. [2] 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. [3]
Drugs most often associated with this term
include: alcohol, barbiturates, benzodiazepines, cannabis, cocaine, methaqualone,opioids and substituted
amphetamines. The exact cause of substance abuse is not clear, with theories including one of two: either
a genetic disposition which is learned from others, or a habit which if addiction develops, it manifests itself
as a chronic debilitating disease.[4]
In 2010 about 5% of people (230 million) used an illicit substance. [5] 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 or puts them at risk of those dangers. [5][6] In 2013 drug use disorders resulted in 127,000
deaths up from 53,000 in 1990.[7] The highest number of deaths are from opioid use disorders at 51,000.
[7]
Cocaine use disorder resulted in 4,300 deaths and amphetamine use disorder resulted in 3,800 deaths.
[7]
Alcohol use disorders resulted in an additional 139,000 deaths. [7]
Contents
[hide]

1Classification
o

1.1Public health definitions

1.2Medical definitions

1.3Drug misuse

1.4As a value judgment

2Signs and symptoms

o

2.1Impulsivity

2.2Screening and assessment

3Treatment
o

3.1Psychological

3.2Medication

3.3Dual diagnosis

4Epidemiology

5History

5.1APA, AMA, and NCDA

5.2DSM

6Society and culture

o

6.1Legal approaches

6.2Cost

7Special populations
o

7.1Immigrants and refugees

7.2Street children

7.3Musicians

8See also

9References

10Further reading

11External links

Classification[edit]
Public health definitions[edit]
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". This model explicitly recognizes a spectrum of use, ranging
from beneficial use to chronic dependence

Medical definitions[edit]
'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
and ICRIS Medical organization Related Health Problems (ICD)
Substance abuse[8] has been adopted by the DSM as a blanket term to include 10 separate classes of
drugs, including alcohol; caffeine; cannabis; hallucinogens; inhalants; opioids; sedatives, hypnotics, and
anxiolytics; stimulants; tobacco; and other substances. [9] The ICD uses the term Harmful use to cover
physical or psychological harm to the user from use.

Physical dependence, abuse of, and withdrawal from drugs and other miscellaneous substances is
outlined in the DSM a:
When an individual persists in use of alcohol or other drugs despite problems related to use of the
substance, substance dependence may be diagnosed. Compulsive and repetitive use may result in
tolerance to the effect of the drug and withdrawal symptoms when use is reduced or stopped. [8]
However, other definitions differ; they may entail psychological or physical dependence,[8] and may focus
on treatment and prevention in terms of the social consequences of substance uses.

Drug misuse[edit]

Legal drugs are not necessarily safer. A 2010 study asked drug-harm experts to rank various illegal and legal drugs. Alcohol
was found to be the overall most dangerous drug.

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 have serious adverse effects. It often 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.[10][11] Chronic use leads to a change in the central nervous system which means the patient has
developed tolerance to the medicine that more of the substance is needed in order to produce desired
effects.When this happens, any effort to stop or reduce the use of this substance would cause withdrawal
symptoms to occur.[12]
The rate of prescription drug abuse is fast overtaking illegal drug abuse 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, prescription drug misuse is now second only to cannabis.[13] "Nearly 1 in 12
high school seniors reported nonmedical use of Vicodin; 1 in 20 reported abuse of OxyContin." [14] Both of
these drugs contain opioids.
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. [15]

As a value judgment[edit]

Correlations between drugs usage. Correlations between 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). Links indicate correlations with
absolute values of Pearson correlation coefficient r above 0.4. Medium, strong, and very strong correlations are indicated by
the colour of link.[16]

Philip Jenkins claims 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.[17] 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.[16] 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), methadone
(r>0.45), and strongly correlated with crack (r>0.5)[16]

Signs and symptoms[edit]

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 orpsychological addiction.[18]
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. [19] In the USA 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.[20]

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 thewithdrawal 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. 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.[21] 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.[22][23] 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.[24]
Drug abuse makes central nervous system (CNS) effects, which produce changes in mood, levels of
awareness or perceptions and sensations. Most of these drugs also alter systems other than the CNS.
Some of these are often thought of as being abused. Some drugs appear to be more likely to lead to
uncontrolled use than others.[25]

Impulsivity[edit]
Impulsivity is characterized by actions based on sudden desires, whims, or inclinations rather than careful
thought.[26] Individuals with substance abuse have higher levels of impulsivity,[27] and individuals who use
multiple drugs tend to be more impulsive.[27] 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.[28] 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.
[29]
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.[30] 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.[31]

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.

Treatment[edit]
Psychological[edit]
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[32][33]
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. [34]
In children and adolescents, cognitive behavioral therapy (CBT)[35] and family therapy[36] 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.[37] These treatments can be administered in a
variety of different formats, each of which has varying levels of research support [38] A few
integrated[39] treatment models, which combines parts from various types of treatment, have also been
seen as both well-established or probably effective.[37] 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.[39] Additionally, brief school-based interventions have been found to be
effective in reducing adolescent alcohol and cannabis use and abuse. [40] Motivational interviewing can also
be effective in treating substance use disorder in adolescents. [41][42]
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. [43]
Social skills are 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.[44]It has been suggested that social
skills training adjunctive to inpatient treatment of alcohol dependence is probably efficacious, [45] including
managing the social environment.

Medication[edit]
Pharmacological therapy - A number of medications have been approved for the treatment of substance
abuse.[46] These include replacement therapies such as buprenorphineand 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.[47] These drugs are used as
substitutes for other opioids and still cause withdrawal symptoms.
Antipsychotic medications have not been found to be useful. [48]
Acamprostate[49] 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. [50] 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.[51]
Individuals who have a comorbid psychological disorder often have a poor prognosis if either disorder is
untreated.[50] Historically most individuals with dual diagnosis either received treatment only for one of their
disorders or they didnt 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.[51]

Epidemiology[edit]

Disability-adjusted life year for drug use disorders per 100,000 inhabitants in 2004.
no data
<40
4080
80120

120160
160200
200240
240280
280320
320360
360400
400440
>440

Total recorded alcohol per capita consumption (15+), in litres of pure alcohol [52]

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. [53] 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.[53] In 2009 in the United States about 21% of high school students have taken
prescription drugs without a prescription.[54] 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.[55]
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%). [56]According to BBC, "Worldwide, the UN
estimates there are more than 50 million regular users of morphine diacetate (heroin), cocaine and
synthetic drugs."[57]

History[edit]
APA, AMA, and NCDA[edit]
In 1932, the American Psychiatric Association created a definition that used legality, social acceptability,
and cultural familiarity as qualifying factors:
as a general rule, we reserve the term drug abuse to apply to the illegal, nonmedical use of a limited
number of substances, most of them drugs, which have properties of altering the mental state in ways
that are considered by social norms and defined by statute to be inappropriate, undesirable, harmful,
threatening, or, at minimum, culture-alien." [58]
In 1966, the American Medical Association's Committee on Alcoholism and Addiction defined abuse of
stimulants (amphetamines, primarily) in terms of 'medical supervision':
'use' refers to the proper place of stimulants in medical practice; 'misuse' applies to the physician's role
in initiating a potentially dangerous course of therapy; and 'abuse' refers to self-administration of these

drugs without medical supervision and particularly in large doses that may lead to psychological
dependency, tolerance and abnormal behavior.
In 1973, the National Commission on Marijuana and Drug Abuse stated:
...drug abuse may refer to any type of drug or chemical without regard to its pharmacologic actions. It is
an eclectic concept having only one uniform connotation: societal disapproval. ... The Commission
believes that the term drug abuse must be deleted from official pronouncements and public policy
dialogue. The term has no functional utility and has become no more than an arbitrary codeword for that
drug use which is presently considered wrong.[59]

DSM[edit]
The first edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental
Disorders (published in 1952) grouped alcohol and drug abuse under Sociopathic Personality
Disturbances, which were thought to be symptoms of deeper psychological disorders or moral weakness.
[60]

The third edition, published in 1980, was the first to recognize substance abuse (including drug abuse)
and substance dependence as conditions separate from substance abuse alone, bringing in social and
cultural factors. The definition of dependence emphasised tolerance to drugs, and withdrawal from them
as key components to diagnosis, whereas abuse was defined as "problematic use with social or
occupational impairment" but without withdrawal or tolerance.
In 1987, the DSM-IIIR category "psychoactive substance abuse," which includes former concepts of drug
abuse is defined as "a maladaptive pattern of use indicated by...continued use despite knowledge of
having a persistent or recurrent social, occupational, psychological or physical problem that is caused or
exacerbated by the use (or by) recurrent use in situations in which it is physically hazardous." It is a
residual category, with dependence taking precedence when applicable. It was the first definition to give
equal weight to behavioural and physiological factors in diagnosis.
By 1988, the DSM-IV defines substance dependence as "a syndrome involving compulsive use, with or
without tolerance and withdrawal"; whereas substance abuse is "problematic use without compulsive use,
significant tolerance, or withdrawal." Substance abuse can be harmful to your health and may even be
deadly in certain scenarios
By 1994, The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) issued by
the American Psychiatric Association, the DSM-IV-TR, defines substance dependence as "when an
individual persists in use of alcohol or other drugs despite problems related to use of the
substance, substance dependence may be diagnosed." followed by criteria for the diagnose [8]
DSM-IV-TR defines substance abuse as:[61]

A. A maladaptive pattern of substance use leading to clinically significant impairment or

distress, as manifested by one (or more) of the following, occurring within a 12-month period:
1. Recurrent substance use resulting in a failure to fulfill major role obligations at work,
school, or home (e.g., repeated absences or poor work performance related to
substance use; substance-related absences, suspensions or expulsions from school;
neglect of children or household)
2. Recurrent substance use in situations in which it is physically hazardous (e.g., driving an
automobile or operating a machine when impaired by substance use)
3. Recurrent substance-related legal problems (e.g., arrests for substance-related
disorderly conduct)

4. Continued substance use despite having persistent or recurrent social or interpersonal

problems caused or exacerbated by the effects of the substance (e.g., arguments with
spouse about consequences of intoxication, physical fights)

B. The symptoms have never met the criteria for Substance Dependence for this class of
substance.

The fifth edition of the DSM (DSM-5), planned for release in 2013, is likely to have this terminology
revisited yet again. Under consideration is a transition from the abuse/dependence terminology. At
the moment, abuse is seen as an early form or less hazardous form of the disease characterized with
the dependence criteria. However, the APA's 'dependence' term, as noted above, does not mean that
physiologic dependence is present but rather means that a disease state is present, one that most
would likely refer to as an addicted state. Many involved recognize that the terminology has often led
to confusion, both within the medical community and with the general public. The American
Psychiatric Association requests input as to how the terminology of this illness should be altered as it
moves forward with DSM-5 discussion.[62]

Society and culture[edit]

Legal approaches[edit]
Related articles: Drug control law, Prohibition (drugs), Arguments for and against drug
prohibition, Harm reduction
Most governments have designed legislation to criminalize certain types of drug use. These
drugs are often called "illegal drugs" but generally what is illegal is their unlicensedproduction,
distribution, and possession. These drugs are also called "controlled substances". Even for
simple possession, legal punishment can be quite severe (including thedeath penalty in some
countries). Laws vary across countries, and even within them, and have fluctuated widely
throughout history.
Attempts by government-sponsored drug control policy to interdict drug supply and eliminate
drug abuse have been largely unsuccessful. In spite of the huge efforts by the U.S., drug supply
and purity has reached an all-time high, with the vast majority of resources spent on interdiction
and law enforcement instead of public health.[63][64] In the United States, the number of nonviolent
drug offenders in prison exceeds by 100,000 the total incarcerated population in the EU, despite
the fact that the EU has 100 million more citizens. [65]
Despite drug legislation (or perhaps because of it), large, organized criminal drug cartels operate
worldwide. Advocates of decriminalization argue that drug prohibition makes drug dealing a
lucrative business, leading to much of the associated criminal activity.

Cost[edit]
Policymakers try to understand the relative costs of drug-related interventions. An appropriate
drug policy relies on the assessment of drug-related public expenditure based on a classification
system where costs are properly identified.
Labelled drug-related expenditures are defined as the direct planned spending that reflects the
voluntary engagement of the state in the field of illicit drugs. Direct public expenditures explicitly
labeled as drug-related can be easily traced back by exhaustively reviewing official accountancy
documents such as national budgets and year-end reports. Unlabelled expenditure refers to
unplanned spending and is estimated through modeling techniques, based on a top-down
budgetary procedure. Starting from overall aggregated expenditures, this procedure estimates
the proportion causally attributable to substance abuse (Unlabelled Drug-related Expenditure =
Overall Expenditure Attributable Proportion). For example, to estimate the prison drug-related
expenditures in a given country, two elements would be necessary: the overall prison
expenditures in the country for a given period, and the attributable proportion of inmates due to

drug-related issues. The product of the two will give a rough estimate that can be compared
across different countries.[66]
Europe[edit]
As part of the reporting exercise corresponding to 2005, the European Monitoring Centre for
Drugs and Drug Addiction's network of national focal points set up in the 27 European Union
(EU) Member States, Norway, and the candidates countries to the EU, were requested to identify
labeled drug-related public expenditure, at the country level. [66]
This was reported by 10 countries categorized according to the functions of government,
amounting to a total of EUR 2.17 billion. Overall, the highest proportion of this total came within
the government functions of Health (66%) (e.g. medical services), and Public Order and Safety
(POS) (20%) (e.g. police services, law courts, prisons). By country, the average share of GDP
was 0.023% for Health, and 0.013% for POS. However, these shares varied considerably across
countries, ranging from 0.00033% in Slovakia, up to 0.053% of GDP in Ireland in the case of
Health, and from 0.003% in Portugal, to 0.02% in the UK, in the case of POS; almost a 161-fold
difference between the highest and the lowest countries for Health, and a 6-fold difference for
POS. Why do Ireland and the UK spend so much in Health and POS, or Slovakia and Portugal
so little, in GDP terms?
To respond to this question and to make a comprehensive assessment of drug-related public
expenditure across countries, this study compared Health and POS spending and GDP in the 10
reporting countries. Results found suggest GDP to be a major determinant of the Health and
POS drug-related public expenditures of a country. Labelled drug-related public expenditure
showed a positive association with the GDP across the countries considered: r = 0.81 in the case
of Health, and r = 0.91 for POS. The percentage change in Health and POS expenditures due to
a one percent increase in GDP (the income elasticity of demand) was estimated to be 1.78% and
1.23% respectively.
Being highly income elastic, Health and POS expenditures can be considered luxury goods; as a
nation becomes wealthier it openly spends proportionately more on drug-related health and
public order and safety interventions.[66]
UK[edit]
The UK Home Office estimated that the social and economic cost of drug abuse [67] to the UK
economy in terms of crime, absenteeism and sickness is in excess of 20 billion a year.
[68]
However, the UK Home Office does not estimate what portion of those crimes are unintended
consequences of drug prohibition (crimes to sustain expensive drug consumption, risky
production and dangerous distribution), nor what is the cost of enforcement. Those aspects are
necessary for a full analysis of the economics of prohibition. [69]
United States[edit]
Year

Cost
(billions of dollars)[70]

1992

107

1993

111

1994

117

1995

125

1996

130

1997

134

1998

140

1999

151

2000

161

2001

170

2002

181

These figures represent overall economic costs, which can be divided in three major
components: health costs, productivity losses and non-health direct expenditures.

Health-related costs were projected to total $16 billion in 2002.

Productivity losses were estimated at $128.6 billion. In contrast to the other costs of drug
abuse (which involve direct expenditures for goods and services), this value reflects a loss of
potential resources: work in the labor market and in household production that was never
performed, but could reasonably be expected to have been performed absent the impact of
drug abuse.
Included are estimated productivity losses due to premature death ($24.6 billion), drug abuserelated illness ($33.4 billion), incarceration ($39.0 billion), crime careers ($27.6 billion) and
productivity losses of victims of crime ($1.8 billion).

The non-health direct expenditures primarily concern costs associated with the criminal
justice system and crime victim costs, but also include a modest level of expenses for
administration of the social welfare system. The total for 2002 was estimated at $36.4
billion. The largest detailed component of these costs is for state and federal corrections
at $14.2 billion, which is primarily for the operation of prisons. Another $9.8 billion was
spent on state and local police protection, followed by $6.2 billion for federal supply
reduction initiatives.

According to a report from the Agency for Healthcare Research and Quality (AHRQ),
Medicaid was billed for a significantly higher number of hospitals stays for Opioid drug
overuse than Medicare or private insurance in 1993. By 2012, the differences were

diminished. Over the same time, Medicare had the most rapid growth in number of hospital
stays.[71]

Special populations[edit]
Immigrants and refugees[edit]
Immigrant and refugees have often been under great stress, [72] physical trauma and
depression and anxiety due to separation from loved ones often characterize the premigration and transit phases, followed by "cultural dissonance," language barriers, racism,
discrimination, economic adversity, overcrowding, social isolation, and loss of status and
difficulty obtaining work and fears of deportation are common. Refugees frequently
experience concerns about the health and safety of loved ones left behind and uncertainty
regarding the possibility of returning to their country of origin. [73][74] For some, substance abuse
functions as a coping mechanism to attempt to deal with these stressors. [74]
Immigrants and refugees may bring the substance use and abuse patterns and behaviors of
their country of origin,[74] or adopt the attitudes, behaviors, and norms regarding substance
use and abuse that exist within the dominant culture into which they are entering. [74][75]

Street children[edit]
Street children in many developing countries are a high risk group for substance misuse, in
particular solvent abuse.[76] Drawing on research in Kenya, Cottrell-Boyce argues that "drug
use amongst street children is primarily functional dulling the senses against the hardships
of life on the street but can also provide a link to the support structure of the street family
peer group as a potent symbol of shared experience." [77]

Musicians[edit]
In order to maintain high-quality performance, some musicians take chemical substances.
[78]
As a group they have a higher rate of substance abuse. [78] The most common chemical
substance which is abused by pop musicians is cocaine,[78] because of its neurological
effects. Stimulants like cocaine increase alertness and cause feelings of euphoria, and can
therefore make the performer feel as though they in some ways own the stage.
Another way in which substance abuse is harmful for a performer (musicians especially) is if
the substance being abused is aspirated. The lungs are an important organ used by singers,
and addiction to cigarettes may seriously harm the quality of their performance. [78] Smoking
causes harm to alveoli, which are responsible for absorbing oxygen.

See also[edit]

Different Types of Substance Abuse

by HAZEL THORNSTEIN Last Updated: Jun 01, 2015

A man is sitting with his head down by a bottle of alcohol. Photo Credit KatarzynaBialasiewicz/iStock/Getty Images

Substance abuse is characterized by a pattern of use that causes significant impairment or distress, in addition to any
one of these additional diagnostic criteria: using substances in situations where it endangers the user; a failure to
fulfill major obligations at work, school or home; having multiple drug-related legal problems; or continuing to use
substances regardless of the problems it causes in the user's life. The different types of substance abuse have
various features depending on the type of drug abused.

Stimulant Abuse
Stimulants include illegal drugs such as cocaine and methamphetamine, as well as legal substances such as nicotine, caffeine and
over-the-counter stimulants. According to Darryl S. Inaba and William E. Cohen, authors of "Uppers, Downers, All-Arounders:
Physical and Mental Effects of Psychoactive Drugs," stimulant use causes the release of the neurotransmitters dopamine and
norepinephrine, stimulating the brain's reward and pleasure center. This stimulation reinforces the drugs' abuse, as users attempt
to feel good through increases of dopamine and norepinephrine and to avoid the "crash," medically known as dysphoria, that
occurs after stimulant use depletes the levels of these neurotransmitters in the brain. Abuse of stimulants depletes energy and
creates intense drug cravings and withdrawal symptoms. It can also induce paranoia, irritability, restlessness, insomnia,
aggression, violence and psychosis. Stimulant abuse and addiction develop quickly.

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Effects of Teenage Substance Abuse on the Family

Treatment for Addictive Personality Disorder

Depressant Abuse
Depressants include opiates such as heroin, morphine and opium, as well as sedative-hypnotic medications such as Xanax, Ativan
and Valium. Depressants slow down the central nervous system, diminish inhibitions, create relaxation and decrease pain. Opiate
abuse carries a high risk of overdose and addiction, as well as health problems. Abuse of sedative-hypnotic drugs easily creates
psychological and physical dependence as well. Abuse of these drugs in combination with alcohol can be lethal. Indeed, multiple
drug abuse is common with abusers of this class of drug, as users combine various depressants throughout a day or week to try to
achieve an optimal psychological and physiological state, notes "Uppers, Downers, All-Arounders."

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Psychedelic Abuse
Psychedelic abuse includes using indole psychedelics such as LSD and psilocybin mushrooms; phenylalkylamine psychedelics
including mescaline; and other types of psychedelics such as ketamine, or "Special K," and PCP, notes "Uppers, Downers, AllArounders." (MDMA, or ecstasy, acts both as a psychedelic and as a stimulant, according to the National Institute on Drug

Abuse.) Psychedelics, called hallucinogens in the medical literature, distort the user's perceptions, thoughts and sensations.
Abusers who have underlying mental health issues face particular risks as these substances can trigger latent mental health
problems.
These drugs vary dramatically in potency. Because they are less well researched than other substances, the effects of abuse are
less well known. MDMA abuse may cause lasting damage to the serotonin-producing neurons in the brain, in addition to
depression and serious health risks. Ketamine abuse can lead to convulsions and coma. LSD abuse causes such impaired
judgment and reasoning that serious injury and death can result even at low doses. Acute anxiety reactions can also occur.

Marijuana Abuse
The most commonly abused illegal drug, marijuana induces short-term euphoria, physical relaxation, distorted perception and
thought, increased appetite, and impairment of memory and physical coordination. According to the National Institute on Drug
Abuse, users of more potent marijuana may experience giddiness, illusions and hallucinations. Because of the impairment in
coordination and thinking, driving and other activities while under the influence pose a risk. Tolerance quickly develops so that
those abusing marijuana need higher doses to achieve the same high. Long-term marijuana abuse may cause respiratory problems
and immune system suppression. According to Inaba and Cohen, longer-term abuse may also stunt emotional maturity and
learning, and it can increase anxiety and even cause temporary psychosis.

Alcohol Abuse
Alcohol affects every organ in the body, and it is the oldest and most widely used psychoactive substance, notes the National
Institute on Drug Abuse. Alcohol abuse includes binge drinking and other problematic patterns of drinking which fall short of
addiction but meet the criteria for abuse. Alcohol abuse is linked to increases in aggression, impaired judgment, diminished
inhibitions, mood problems such as depression and anxiety, health problems, sexual dysfunction and relationship problems.
Alcohol abuse differs from alcoholism primarily in the lack of withdrawal symptoms when an alcohol abuser stops drinking.
However, alcohol abuse creates significant distress or impairment in the abuser's life.

Addiction Basics

From teenagers in the inner city to the elderly living in rural America, there is no one in this country
immune to the dangers of drug addiction. That is because drug addiction does not discriminate. It
impacts the lives of men and women of all races, religions and socioeconomic groups. Understanding
drug addiction is an important part of helping a loved one who is suffering from the disease. The
following information is presented to help those who are living in silence with a drug addiction, or
those want to reach out and help another person who is suffering from addiction.

Most Common Types of Drug Addiction

Currently there are a number of different types of drug addiction making the rounds at treatment
centers (and unfortunately, emergency rooms) around the United States. These conditions include:

Cocaine addiction

Heroin addiction

Prescription drug addiction, including addictions to Vicodin and OxyContin

Crystal meth addiction

Percocet addiction

Marijuana addiction

Signs and Symptoms of Drug Addiction

Just as there a number of different drugs in the word, there are also numerous signs and symptoms of
drug addiction. According to Medline Plus, the following list represents some of the most common
symptoms of drug addiction.

Physical signs and symptoms of drug addiction include:

Chills

Sweats

Flu-like symptoms

Excess amounts of physical energy

The psychological symptoms of drug addiction include:

Nervousness

Anxiety

Delusions of grandeur

Mood swings

Euphoria

In addition to these physical and psychological symptoms, there are also a number of societal
behaviors that tend to be exhibited by those suffering from addiction. These include:

Engaging in reckless behavior, such as driving while intoxicated and unprotected sex with
multiple partners

?Stealing money and engaging in other criminal activity to support a drug habit

?Stealing or borrowing money from friends and family to support ones drug addiction

?Disappearing for long stretches of time without explanation

?Sudden poor performance at work or school

If you or someone you love is exhibiting one or more of these behaviors due to drug use, it is time to
contact a professional interventionist or a drug rehab facility immediately. Contact us today for more
information.

Getting Help for Someone Else

The insidious thing about drug addiction is that individuals who are suffering from the condition rarely
seek treatment help on their own. Simply put, most men and women are unable or unwilling to admit
that they have a problem and need help. Many will also feel ashamed about their addiction and
therefore suffer in silence as they fall deeper and deeper into the negative spiral of drug dependence.
Therefore, it often falls to family and friends to help those in need of treatment. Once the signs and
symptoms of drug addiction have been identified, the next step is to talk to the individual, openly and
honestly, about their condition.
If, after talking, their addiction continues, it is recommended that you hold an intervention. An
intervention is a meeting in which family and friends confront their loved one about their condition, in
a loving manner, showing them how it has impacted the lives of those around them.
The object of an intervention is two-fold: to get the individual to admit that they have a problem with
drugs, and to get that person into drug rehab immediately.

Treating Addiction at a Drug Rehab Center

From the moment an individual sets foot inside a drug rehab center, the healing process begins. It
starts with detox a cleansing process that gives all the harmful toxins associated with drug use time
to leave the body. During detox, the individual may experience withdrawal symptoms but once
completed, it means that they have overcome their physical addiction to drugs. Some addictions, such
as those to opiates, require medication help during detox. For these addictions, individuals may
continue to take the maintenance medication for a long period of time. Medical professionals will
assess each individuals situation and determine the best treatment plan.

Counseling and therapy constitute the next phase of treatment. More than simply putting a bandage
on the problem, drug addiction counseling helps the individual change their behavior for their better.
The objective of therapy is to locate each individuals triggers for drug use these are the
circumstances that tempt them to use drugs and then help them find a healthier way to respond to
these situations.
There are three primary types of drug addiction counseling: individual, group and family. All types help
to address the reasons behind addiction and to develop coping mechanisms to avoid future drug use.

Individual counseling. This involves one-on-one meetings with a therapist to discuss the
root causes of addiction and develop life strategies for sobriety.

Group counseling. This therapy involves meetings with other recovering addicts in the
program where people share stories and support one another through understanding and compassion.

Family counseling. Family members often feel the most negative impact when a loved one is
addicted to drugs. These sessions help clear the air and rebuild the broken bonds that hold a family
together.
The final phase of drug rehab is aftercare. Through aftercare, the individual learns how to cope in their
daily lives without the use of drugs. There are many different types of aftercare, including:

12-step meetings. Groups such as Narcotics Anonymous help the individual get regular
support from other recovering addicts in the weeks, months and years following treatment. These
meetings help those in need feel as if there is always someone there to support them.

Sober living. A sober living home is a place where recovering addicts can gently transition
back into life. They live among other recovering addicts and share responsibilities all while in a safe,
productive environment that is focused on healing.

Follow-up counseling and therapy. Sometimes, recovering addicts are in need of a life
tune-up following treatment. These counseling programs help insure that the individual is putting the
lessons learned during rehab to good use. Many addicts continue with individual counseling for years
after they exit a formal treatment program.

Find Treatment Help Today

Most drug addiction treatment programs last between a month and a full year, depending on the
severity of the individuals addiction. There are two primary types of drug rehab program: residential

(where the individual lives at the facility full time) and outpatient (the recovering addict attends
treatment during the day and then returns home in the evening). Choosing the right form of drug
rehab depends upon the individuals lifestyle, responsibilities and specific addiction. Regardless of the
specific drug of addiction, rest assured that the addict will be in good hands in high-quality, evidencebased drug rehab programs.

Addiction is a form of disease, and it can pose a series of negative consequences on a persons
well-being, physical health and professional life. There are many forms of addiction, and each one
poses its own series of risks.
While drug and alcohol use often begin as voluntary behaviors, addiction prompts chemical
alterations in the brain that affect memory, behavior and the perception of pleasure and pain.
Conscious decisions turn into compulsive actions, and major health, financial and social
consequences often follow.
Click on one of the tabs below to learn about one of the following topics related to addiction,
including the worst-case scenarios for each.
Health Consequences
Physical Consequences
Social Consequences
Consequences for Adolescents

Health
Legal
Social
Adolescents

Health Effects of Substance Abuse

Compulsive cravings combined with prolonged substance abuse can prompt physical consequences
throughout the body. Most substances will cause strain on the organs, as well as the venous and
respiratory system after prolonged use. Many forms of addiction alter the users physical make-up,
sometimes even just after a few weeks of use.

Physical Effects of Substance Abuse Include:


Organ damage

Hormone imbalance

Cancer (caused by nicotine or steroid use)

Prenatal and fertility issues

Gastrointestinal disease

HIV/AIDS
In addition to the above medical concerns, chronic use of certain substances can lead to long-term
neurological impairment, such as exacerbating or giving rise to mental health problems.

Neurological and Emotional Effects of Substance Abuse Include the Following

Mental Health Conditions:

Depression
Anxiety
Memory loss
Aggression
Mood swings
Paranoia
Psychosis

What is drug addiction?

Drug addiction is a chronic disease characterized by compulsive, or uncontrollable, drug
seeking and use despite harmful consequences and changes in the brain, which can be long
lasting. These changes in the brain can lead to the harmful behaviors seen in people who
use drugs. Drug addiction is also a relapsing disease. Relapse is the return to drug use after
an attempt to stop.

iStock/Evgeny Sergeev

The path to drug addiction begins with the voluntary act of taking drugs. But over time, a
person's ability to choose not to do so becomes compromised. Seeking and taking the drug
becomes compulsive. This is mostly due to the effects of long-term drug exposure on brain
function. Addiction affects parts of the brain involved in reward and motivation, learning and
memory, and control over behavior.

Addiction is a disease that affects both the brain and behavior.

Can drug addiction be treated?

Yes, but its not simple. Because addiction is a chronic disease, people cant simply stop
using drugs for a few days and be cured. Most patients need long-term or repeated care to
stop using completely and recover their lives.

Addiction treatment must help the person do the following:

stop using drugs

stay drug-free

be productive in the family, at work, and in society

Principles of Effective Treatment

Based on scientific research since the mid-1970s, the following key principles should form
the basis of any effective treatment program:

Addiction is a complex but treatable disease that affects brain function and behavior.

No single treatment is right for everyone.

People need to have quick access to treatment.

Effective treatment addresses all of the patients needs, not just his or her drug use.

Staying in treatment long enough is critical.

Counseling and other behavioral therapies are the most commonly used forms of
treatment.

Medications are often an important part of treatment, especially when combined with
behavioral therapies.

Treatment plans must be reviewed often and modified to fit the patients changing
needs.

Treatment should address other possible mental disorders.

Medically assisted detoxification is only the first stage of treatment.

Treatment doesn't need to be voluntary to be effective.

Drug use during treatment must be monitored continuously.

Treatment programs should test patients for HIV/AIDS, hepatitis B and C, tuberculosis,
and other infectious diseases as well as teach them about steps they can take to reduce
their risk of these illnesses.

How is drug addiction treated?

Successful treatment has several steps:

detoxification (the process by which the body rids itself of a drug)

behavioral counseling

medication (for opioid, tobacco, or alcohol addiction)

evaluation and treatment for co-occurring mental health issues such as depression
and anxiety

long-term follow-up to prevent relapse

A range of care with a tailored treatment program and follow-up options can be crucial to
success. Treatment should include both medical and mental health services as needed.
Follow-up care may include community- or family-based recovery support systems.

How are medications used in drug addiction

treatment?
Medications can be used to manage withdrawal symptoms, prevent relapse, and treat cooccurring conditions.

Withdrawal. Medications help suppress withdrawal symptoms during detoxification.

Detoxification is not in itself "treatment," but only the first step in the process. Patients who
do not receive any further treatment after detoxification usually resume their drug use. One
study of treatment facilities found that medications were used in almost 80 percent of
detoxifications (SAMHSA, 2014).
Relapse prevention. Patients can use medications to help re-establish normal brain
function and decrease cravings. Medications are available for treatment of opioid (heroin,
prescription pain relievers), tobacco (nicotine), and alcohol addiction. Scientists are
developing other medications to treat stimulant (cocaine, methamphetamine) and cannabis
(marijuana) addiction. People who use more than one drug, which is very common, need
treatment for all of the substances they use.

Opioids: Methadone (Dolophine, Methadose), buprenorphine (Suboxone,

Subutex, Probuphine), and naltrexone (Vivitrol) are used to treat opioid addiction.
Acting on the same targets in the brain as heroin and morphine, methadone and
buprenorphine suppress withdrawal symptoms and relieve cravings. Naltrexone blocks
the effects of opioids at their receptor sites in the brain and should be used only in
patients who have already been detoxified. All medications help patients reduce drug
seeking and related criminal behavior and help them become more open to behavioral
treatments.

Tobacco: Nicotine replacement therapies have several forms, including the patch,
spray, gum, and lozenges. These products are available over the counter. The U.S. Food
and Drug Administration (FDA) has approved two prescription medications for nicotine
addiction: bupropion (Zyban) and varenicline (Chantix). They work differently in the
brain, but both help prevent relapse in people trying to quit. The medications are more
effective when combined with behavioral treatments, such as group and individual
therapy as well as telephone quitlines.

Alcohol: Three medications have been FDA-approved for treating alcohol addiction
and a fourth, topiramate, has shown promise in clinical trials (large-scale studies with
people). The three approved medications are as follows:

Naltrexone blocks opioid receptors that are involved in the rewarding effects
of drinking and in the craving for alcohol. It reduces relapse to heavy drinking and is
highly effective in some patients. Genetic differences may affect how well the drug
works in certain patients.

Acamprosate (Campral) may reduce symptoms of long-lasting withdrawal,

such as insomnia, anxiety, restlessness, and dysphoria (generally feeling unwell or
unhappy). It may be more effective in patients with severe addiction.

Disulfiram (Antabuse) interferes with the breakdown of alcohol.

Acetaldehyde builds up in the body, leading to unpleasant reactions that include
flushing (warmth and redness in the face), nausea, and irregular heartbeat if the
patient drinks alcohol. Compliance (taking the drug as prescribed) can be a problem,
but it may help patients who are highly motivated to quit drinking.

Co-occuring conditions: Other medications are available to treat possible mental

health conditions, such as depression or anxiety, that may be contributing to the
persons addiction.

How are behavioral therapies used to treat drug

addiction?
Behavioral therapies help patients:

modify their attitudes and behaviors related to drug use

increase healthy life skills

persist with other forms of treatment, such as medication

Patients can receive treatment in many different settings with various approaches.

Outpatient behavioral treatment includes a wide variety of programs for patients who
visit a behavioral health counselor on a regular schedule. Most of the programs involve
individual or group drug counseling, or both. These programs typically offer forms of
behavioral therapy such as:

cognitive-behavioral therapy, which helps patients recognize, avoid, and cope with
the situations in which they are most likely to use drugs

multidimensional family therapydeveloped for adolescents with drug abuse

problems as well as their familieswhich addresses a range of influences on their drug
abuse patterns and is designed to improve overall family functioning

motivational interviewing, which makes the most of people's readiness to change

their behavior and enter treatment

motivational incentives (contingency management), which uses positive

reinforcement to encourage abstinence from drugs

Treatment is sometimes intensive at first, where patients attend multiple outpatient sessions
each week. After completing intensive treatment, patients transition to regular outpatient
treatment, which meets less often and for fewer hours per week to help sustain their
recovery.

Inpatient or residential treatment can also be very effective, especially for those with
more severe problems (including co-occurring disorders). Licensed residential treatment
facilities offer 24-hour structured and intensive care, including safe housing and medical
attention. Residential treatment facilities may use a variety of therapeutic approaches, and
they are generally aimed at helping the patient live a drug-free, crime-free lifestyle after
treatment. Examples of residential treatment settings include:

Therapeutic communities, which are highly structured programs in which patients

remain at a residence, typically for 6 to 12 months. The entire community, including
treatment staff and those in recovery, act as key agents of change, influencing the

patients attitudes, understanding, and behaviors associated with drug use. Read more
about therapeutic communities in the Therapeutic Communities Research
Report athttps://www.drugabuse.gov/publications/research-reports/therapeuticcommunities.

Shorter-term residential treatment, which typically focuses on detoxification as well

as providing initial intensive counseling and preparation for treatment in a communitybased setting.

Recovery housing, which provides supervised, short-term housing for patients, often
following other types of inpatient or residential treatment. Recovery housing can help
people make the transition to an independent lifefor example, helping them learn how
to manage finances or seek employment, as well as connecting them to support services
in the community.

Is treatment different for criminal justice

populations?
Scientific research since the mid-1970s shows that drug abuse treatment can help many
drug-using offenders change their attitudes, beliefs, and behaviors towards drug abuse;
avoid relapse; and successfully remove themselves from a life of substance abuse and
crime. Many of the principles of treating drug addiction are similar for people within the
criminal justice system as for those in the general population. However, many offenders
dont have access to the types of services they need. Treatment that is of poor quality or is
not well suited to the needs of offenders may not be effective at reducing drug use and
criminal behavior.

In addition to the general principles of treatment, some considerations specific to offenders

include the following:

Treatment should include development of specific cognitive skills to help the offender
adjust attitudes and beliefs that lead to drug abuse and crime, such as feeling entitled to
have things ones own way or not understanding the consequences of ones behavior.
This includes skills related to thinking, understanding, learning, and remembering.

Treatment planning should include tailored services within the correctional facility as
well as transition to community-based treatment after release.

Ongoing coordination between treatment providers and courts or parole and

probation officers is important in addressing the complex needs of offenders re-entering
society.

Challenges of Re-entry
Drug abuse changes the function of the brain, and many things can "trigger" drug cravings
within the brain. Its critical for those in treatment, especially those treated at an inpatient
facility or prison, to learn how to recognize, avoid, and cope with triggers they are likely to
be exposed to after treatment.

How many people get treatment for drug

addiction?
According to SAMHSA's National Survey on Drug Use and Health, 22.5 million people (8.5
percent of the U.S. population) aged 12 or older needed treatment for an illicit* drug or
alcohol use problem in 2014. Only 4.2 million (18.5 percent of those who needed treatment)
received any substance use treatment in the same year. Of these, about 2.6 million people
received treatment at specialty treatment programs (CBHSQ, 2015).

*The term "illicit" refers to the use of illegal drugs, including marijuana according to federal
law, and misuse of prescription medications.

Points to Remember

Drug addiction can be treated, but its not simple. Addiction treatment must help the
person do the following:

stop using drugs

stay drug-free

be productive in the family, at work, and in society

Successful treatment has several steps:

detoxification

behavioral counseling

medication (for opioid, tobacco, or alcohol addiction)

evaluation and treatment for co-occurring mental health issues such as

depression and anxiety

long-term follow-up to prevent relapse

Medications can be used to manage withdrawal symptoms, prevent relapse, and treat

co-occurring conditions.

Behavioral therapies help patients:

modify their attitudes and behaviors related to drug use

increase healthy life skills

persist with other forms of treatment, such as medication

People within the criminal justice system may need additional treatment services to

treat drug use disorders effectively. However, many offenders dont have access to the
types of services they need.

Learn More
For more information about drug addiction treatment, visit:
www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guidethird-edition/acknowledgments
For information about drug addiction treatment in the criminal justice system, visit:
www.drugabuse.gov/publications/principles-drug-abuse-treatment-criminal-justicepopulations/principles
For step-by-step guides for people who think they or a loved one may need treatment, visit:
www.drugabuse.gov/related-topics/treatment

References
Center for Behavioral Health Statistics and Quality (CBSHQ).2014 National Survey on Drug
Use and Health: Detailed Tables.Rockville, MD: Substance Abuse and Mental Health Services
Administration; 2015.
Substance Abuse and Mental Health Services Administration (SAMHSA). National Survey of
Substance Abuse Treatment Services (N-SSATS): 2013. Data on Substance Abuse Treatment
Facilities. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2014.
HHS Publication No. (SMA) 14-489. BHSIS Series S-73.