Definition

     Drug dependence (addiction) is compulsive use of a substance despite negative consequences which can be severe; drug abuse is simply excessive use of a drug or use of a drug for purposes for which it was not medically intended.

     Physical dependence on a substance (needing a drug to function) is not necessary or sufficient to define addiction. There are some substances that don't cause addiction but do cause physical dependence (for example, some blood pressure medications) and substances that cause addiction but not classic physical dependence (cocaine withdrawal, for example, doesn't have symptoms like vomiting and chills; it is mainly characterized by depression).

Causes

     The exact cause of drug abuse and dependence is not known. However, the genetic make-up of the individual, the pharmacology of the particular drug, peer pressure, emotional distress, anxiety, depression, and environmental stress are all factors which seem to be involved.

     Peer pressure may lead to use or abuse, but at least half of those who go on to addiction 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.

Symptoms 

     OPIATES AND NARCOTICS:

     Symptoms of use:

• needle marks on the skin in some cases (called "tracks")

• scars from skin abscesses

• rapid heart rate

• constricted pupils (pinpoint)

• relaxed and/or euphoric state ("nodding")

• coma, respiratory depression leading to coma and death in high doses

     Symptoms of withdrawal:

• anxiety and difficulty sleeping

• sweating

• goose bumps (piloerection)

• runny nose (rhinorrhea)

• stomach cramps or diarrhea

• dilated pupils

• nausea and vomiting

• excessive sweating

• increase in blood pressure, pulse, and temperature

     CENTRAL NERVOUS SYSTEM STIMULANTS

     Symptoms of cocaine use:

• euphoria (exaggerated feeling of well-being)

• dilated pupils

• rapid heart rate

• restlessness and hyperactivity

     Symptoms of cocaine withdrawal:

• fatigue and malaise

• depression

• vivid 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

• tremors

• seizures

• increase in blood pressure, pulse, and temperature

• delirium

     HALLUCINOGENS

     Symptoms of LSD use:

• anxiety

• frightening hallucinations

• paranoid delusions

• blurred vision

• dilated pupils

• tremor

Screening and Diagnostics

     Toxicology screens (drug testing) done on blood and urine specimens can reveal the presence of many chemicals and drugs in the body. The sensitivity depends upon the substance itself, when the substance was taken, and the testing laboratory. Blood tests are more likely to detect the presence of an abused substance than urine tests, however, urine drug screens are more frequently done.

     Opiates and narcotics are usually present in the urine 12 to 36 hours after the last use, depending on the amount used and the frequency.

     CNS stimulants such as cocaine can be detected in urine anywhere between 1 to 12 days, again depending in frequency of use.

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

     Most hallucinogens are also detectable in the urine up to 7 days after the last use. However, cannabis can be detected up to 28 days in regular users.

Treatment

     Treatment for the person with drug abuse or dependence begins with the recognition of the problem. Though previously "denial" was considered a symptom of addiction, recent research has shown that this symptom can be dramatically reduced if addicts are treated with empathy and respect, rather than told what to do or "confronted."

     Treatment of drug dependency involves detoxification, support and abstinence. Emergency treatment may be indicated for acute intoxication or drug overdose. Often, there may be a loss of consciousness and the person may need to be on a mechanical respirator (breathing machine) temporarily. The specific treatment depends on the drug.

     Detoxification is the gradual withdrawal of an abused substance in a controlled environment. Sometimes a drug with a similar action is substituted during the withdrawal process to reduce the unpleasant symptoms and risks associated with withdrawal. The process can be managed on an inpatient or outpatient basis.

     If depression or other mood disorder exists, it should be treated appropriately. Very often drug abuse develops from efforts to self-treat mental illness.

Prognosis

     Drug abuse and dependence may lead to a fatal drug overdose. Relapses from drug abstinence may occur and lead to recurrent dependence.

Complications   

• depression

• relapse of drug abuse

• drug overdose

• bacterial endocarditis, hepatitis, thrombophlebitis, pulmonary emboli, malnutrition, or respiratory infections, caused by intravenous drug abuse

• Infection with HIV through shared needles

• Drug-induced loss of inhibitions may lead to 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 associated with nicotine use, mouth and stomach cancer are associated with alcohol abuse and dependence

• Problems with memory and concentration are seen with hallucinogen use, including marijuana (THC)

Prevention  

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