Substance Use and Abuse Assignment, Research Paper Example

Substance use, abuse and the delicate balance between them compose a multidimensional issue that has been extensively researched because it is associated with a plethora of social, health and psychological problems of national importance. Is the use of drugs which can be harmfully abused justified by their medical effects? How to prevent abuse? These and many other questions are asked by clinicians and pharmaceutists on a daily basis as universal solutions in this case do not seem to exist.  Individuals must also be alert and aware of the possible threats of drug abuse because many find themselves addicted unexpectedly. Parents must be watchful for the signs of abuse in their children. In this respects, any research attempt is valuable as enhances the awareness of the problem.

Since there is hardly a person who has never resorted to the intake of medications during his / her life, substance use is widely viewed as acceptable and necessary. However, many succumb to the temptation of abuse. Many people use drugs for non-medical purposes, but they control their effect and avoid harmful influences on health and functioning. This is not substance abuse, although the drugs in this case are not prescribed by healthcare practitioner. It may be quite challenging to identify the difference between substance use and abuse. Perhaps, the most reliable criterion is the reason for the usage. By definition, substance abuse is the use of mind-altering substances without medical need, in an amount large enough or over a period long enough to threaten the quality of life or health and safety of the user or others. Many specialists disagree about the correlation and usage of the terms abuse, dependence and addiction.

The mind-altering effect is a characteristic feature of many drugs, both legal and not. While some mind-altering drugs affect brain function each time they are used, irrespective of the dose, others only affect brain function when taken in large amounts and used continually. Many drugs affect the brain in the way that makes a person want to return to the emotional and physical state created by the drug, i.e. crave for the drug. This effect is the grounding of addiction.

Another aspect of abuse is overdose of a drug which may lead to unpredictable, harmful and frightening consequences including death.

As has been mentioned above, drugs are an obligatory and irreplaceable part of the routing for many people, including adolescents (the high-risk group in terms of drug abuse).  The legality and social acceptance of a particular drug are often dependent on the method of application – the reason for it, the effects (also in combination with other drugs) and the person who uses it. For example, taking marijuana for achieving a certain emotional state is illegal and widely criticized by the society. However, marijuana is officially used in palliative care to relieve nausea in a patient with advanced cancer and this is viewed as acceptable by many people. The legality and social acceptance of a drug often vary from country to country and from one society to another. Legality and acceptance may also alter within a society or country over time, like in the case of alcohol in the United States.

Practically none of socioeconomic groups is safe from drug abuse. The people involved have most varied backgrounds – they may be highly educated and professional or uneducated and unemployed. The drug abuse statistics for the year 2007 in the USA indicate that more than 7.5 million residents required treatment for illegal drug use. Moreover, 6.2 million residents needed assistance with drug abuse but did not receive treatment. About 70% of abusers made to effort to receive treatment for their dependency or addiction. Overall, 3% of the total population aged 12 or older, which makes 7.5 million US residents, need treatment for drug abuse.

Approximately 50% of teenagers reported that it was “fairly easy” or “very easy” to procure marijuana, which remains the most popular drug. 14.1% also reported it was easy to procure heroin, while 24.5% claimed it was “very easy” to obtain cocaine.

22.3% of children aged 12-17 mentioned they had been involved in a violent drug-related altercation or confrontation.

Many argue that abuse is not restricted to the intake of mind-altering substances and can be defined as the application of drugs without medical need, especially if the drugs endanger the quality of life and health, safety of the user and others and performance.

When people quit abusing non-mind-altering drugs, they do not suffer from withdrawal symptoms, but medical problems may arise if the drug is discontinued abruptly (under medical supervision such problems are easily preventable).

These less traditionally abused substances include first and foremost anabolic steroids which are very similar to the hormone testosterone. They have various physical effects on a person. For example, they enhance muscle growth and increase strength and energy level. Consequently, anabolic steroid abuse is very popular with sportsmen who spur their natural progress by use of the substance. The statistics shows that anabolic steroid users are in the majority male, typically football players, wrestlers, weight lifters and athletes. The side effects that the users risk suffering fall into different categories. Psychologically, a person may experience erratic mood swings, moments of unaccountable behavior, and increased aggressiveness (often referred to as ‘steroic rage’). Physically, anabolic steroids affect the liver and can lead to jaundice. Many experience intense body hair growth and breakouts of acne, the latter commonly being a reason to visit a doctor who must exhibit vigilance and test the patient for anabolic steroids intake (urine analysis).

Another substance often abused by athletes is growth hormone. It is naturally produced by the brain and controls the balance of carbohydrates, protein, and fats so that they contribute to the process of growth. The hormone is also manufactured as a drug for children who have too low levels of the production of growth hormone. The athletes who use it believe it will increase their muscle growth and strength while decreasing their body fat. However, a prolonged use of the hormone without medical need may lead to an increase in fat levels in the blood, diabetes, and an increase in heart size resulting in heart failure. At the moment, laboratory tests to identify the intake of growth hormone are not easily available.

In an attempt to enhance the performance, athletes also use erythropoietin and darbepoietin. Erythropoietin is a hormone normally produced by the kidney. It stimulates the bone marrow to generate red blood cells. Also manufactured as a drug, erythropoietin is routinely given to many people with anemia resulting from kidney failure and to people with several other types of anemia. Darbepoietin is used in the similar way. Drug abuse in this case results from a popular believe that more red cells would carry more oxygen to the muscles which in their turn would perform better. However, the use of the drugs without prescription (and medical need) can damage the regulation of red blood cell production and when erythropoietin and darbepoietin are discontinued, the number of red blood cells may decrease abruptly. Like in the case of the growth hormone, laboratory tests for the intake of these substances are not routinely available.

People with eating disorders such as anorexia nervosa, people suffering from obesity and athletes use diuretics (drugs that speed elamination of salt and water by the kidneys) to lose weight quickly. Normally diuretics are used for the treatment of a variety of diseases such as heart failure, high blood pressure, cystitis etc. Excessive use of diuretics may lead to dehydration, severe deficiency of electrolytes such as potassium and even possible kidney failure.

Ipecac syrup, a drug that provokes vomiting and is given to children who have swallowed some chemicals or poisons, is often abused by people with eating disorders such as anorexia nervosa in hope to lose weight. But used inappropriately, ipecac may cause diarrhea, severe deficiencies of electrolytes, weakness, irregular heart rhythms, and eventually heart failure.

Laxatives, drugs that promote bowel movements and are used in the treatment of constipation, may also be taken by people who maintain a popular misconception that frequent bowel movements mean being healthy. Again, people with eating disorders such as anorexia nervosa sometimes abuse laxatives to order to lose weight. However, the abuse of laxatives may lead to dehydration, and severe deficiencies of electrolytes and damage to the muscle layers of the large intestine resulting in severe constipation. Moreover, regular use of laxatives weakens the effect of other drugs by preventing absorption.

Still, the nucleus of substance abuse is formed by the abuse of mind-altering substances. In this respects, the first group of drugs that are subject to abuse are stimulants such as Ritalin, Adderall, and Dexedrine. Most cases of stimulant abuse are among adolescents and adults who are not being treated with stimulants for AD/HD. Adderall and Dexedrine are preferred by the abusers as they give a high similar to speed. Ritalin is less popular and is abused as a last resort because it does not give the abuser the euphoria he / she craves. Sometimes drug addicts and alcoholics abuse stimulant medications by taking more than prescribed in the course of treatment, grinding them up to inhale or mixing them with water and injecting. Some may pretend having AD/HD in order to obtain stimulants. Aware of the problem, the doctors should closely supervise treatment for AD/HD and avoid giving large prescriptions without ongoing treatment.

Other stimulant drugs have been developed and marketed to replace amphetamines as appetite suppressants. They include benzphetamine (Didrex®), diethylproprion (Tenuate®, Tepanil®), mazindol (Sanorex®, Mazanor®), phendimetrazine (Bontril®, Prelu-27®), and phentermine (Lonamin®, Fastin®, Adipex®). All of them produce amphetamine-like effects, i.e. euphoria longer and more stable than in case of cocaine. Chronic abuse causes a psychosis resembling schizophrenia and characterized by paranoia, picking at the skin, preoccupation with one’s own thoughts, auditory and visual hallucinations. It is also responsible for violent and erratic behavior. The symptoms may persist for a long period after the medication has been quitted because of the lasting neurotoxic effects. The most popular of the diet pills listed above is phentermine, which can be easily found on the illicit market.

The second widely abused group includes sedatives and tranquilizers. In almost every culture, people have long been used special substances to cope with insomnia, relieve stress, and allay anxiety. Apart from traditionally used alcohol, a number of drugs have a depressive effect on the central nervous system. The two oldest pharmaceutically produces depressants that are still popular today are choral hydrate and paraldehyde. Other examples include gluthethimide, methaqualone, and meprobamate. The two major groups of depressants dominating both the licit and illicit markets are barbiturates and benzodiazepines. Barbiturates were extremely popular in the first half of the 20th century. Used appropriately, they make a person feel a state akin to alcohol intoxication, relax and fall asleep. But in case of overdose and frequent use, one can easily develop tolerance, and physical and psychological dependence on barbiturates. The main risk for tolerant abusers is overdose – even the slightest leads to coma or death. The margin of safety between the effective dose and the lethal dose is very narrow. Nowadays less than 10% of all depressant prescriptions in the United States are for barbiturates.

First marketed in the 1960s, benzodiazepines were introduced as a safer alternative to barbiturates because of less addiction potential. Today depressant therapy relies on benzodiazepines for about one out of every five prescriptions. However, they have been found to share most of the negative side effects of the barbiturates. The list includes a number of toxic central nervous system effects resulting in headaches, irritability, confusion, deteriorating memory, and depression, the risk of developing over-sedation, dizziness and confusion. Benzodiazepines cause less respiratory depression than barbiturates. Despite an extensive record of primary abuse, benzodiazepines are often used to enhance the effect of other substances like heroin and cocaine and alter the side effects linked to over-stimulation and narcotic withdrawal.

The third group comprises analgesics, commonly referred to as painkillers. The mind-altering effect of these drugs is clear from the mechanism of their action: they relieve pain either by blocking pain signals going to the brain or by interfering with the brain’s interpretation of the signals, without producing anesthesia or loss of consciousness. There are two basic kinds of analgesics: non-narcotics and narcotics. Narcotic analgesics can be divided into two categories: opiates and opioids (the latter are opiate derivatives). Opiates are based on the alkaloids found in opium (a white liquid extract of unripe seeds of the poppy plant). Opioids can be of four types:

• Endogenous opioid peptides (they are produced in the body: endorphins, dynorphins, enkephalins);
• Opium alkaloids (morphine, codeine, thebaine);
• Semi-synthetic opioids (heroin, oxycodone, hydrocodone, dihydrocodeine, hydromorphone, oxymorphone, nicomorphine);
• Fully synthetic opioids (pethidine or Demerol, methadone, fentanyl, propoxyphene, pentazocine, buprenorphine, butorphanol, tramadol, and more).

Opioids are very strong painkillers and relieve severe or chronic pain. In pain relief, there is no upper limit for the dosage of opioids. Some doses are so high that for a person who does not suffer from pain they would be fatal. However, the dose must be gradually increased to allow for the development of tolerance to adverse effects (like respiratory depression). The side affects and adverse reactions of analgesics include nausea, vomiting, drowsiness, dry mouth, miosis (contraction of pupil), orthostatic hypotension (sudden lowering of blood pressure), urinary retention, and constipation. Less common side effects usually occurring after prolonged use or abuse include confusion, hallucinations, delirium, hives, itch, hypothermia, bradycardia (slow heart rate), tachycardia (rapid heart rate), raised intracranial pressure, uretric or biliary spasm, muscle rigidity, and flushing. Many of the described symptoms are associated with withdrawal from opiates and opioids.

Painkillers are reported to cause more overdoses than cocaine and heroin combined. One in ten teenagers in the United States admits to abusing painkillers, such as Vicodin and Oxycontin. In many cases, addiction starts with using painkillers for legitimate reason – to relieve pain after surgery or childbirth, or to deal with chronic pain. The sense of euphoria and relaxation provided by the drugs builds up and people start craving for doses although they do not longer need them for pain. Painkillers are comparatively easily accessible. An abuser may claim pain to get multiple prescriptions from a doctor, forge prescriptions, order painkillers from websites that do not require prescription or make a trip to Mexico for an excessive supply of drugs. The process of taking painkillers is not as “criminal” as in the case of heroin when a person needs to inject him/herself with a drug risking getting AIDS or overdosing. As to painkillers, an abuser just has to swallow a pill.

As a result, the proportion of people abusing painkillers is the highest in comparison to the abusers of other prescribed drugs.

Cough and cold medicine abuse has been on the rise recently. It is especially popular with teenagers. Nearly 3.1 million individuals aged between 12 and 25 (5.3 percent) admit to have misused cough and cold medications. It was in the 1970s that the U.S. Food and Drug Administration replaced the narcotic codeine with dextromethorphan in over-the-counter cough suppressants. Before that, teenagers used to simply swallow cough syrup to get a quick buzz. However, the Food and Drug Administration’s measure failed to be a solution as teenagers discovered they still could get high by taking a large dose of any over-the-counter medication containing dextromethorphan. Dextromethorphan-containing products — tablets, capsules, gel caps, lozenges, and syrups — are labeled DM, cough suppressant, or Tuss (or contain the part “tuss” in the title). As the access to the medications is perfectly easy, many teenagers believe they are harmless. The situation is made even worse due to the Internet. Not only can teenagers buy cough and cold medicines over the Internet, but they can also read about how to abuse them. As drinking cough syrup in large amounts usually causes nausea, one can buy over the Internet tablets to swallow or powder to snort in which the agent has been concentrated. Moreover, online dosing calculators are available to teach young abusers what dose they need for their weight to get high. Taken in mass quantities, however, dextromethorphan causes hallucinations, loss of motor control, and disassociative (“out-of-body”) sensations.

Among other side effects of dextromethorphan abuse there are confusion, impaired judgment, blurred vision, dizziness, paranoia, excessive sweating, slurred speech, nausea, vomiting, abdominal pain, irregular heartbeat, high blood pressure, headache, lethargy, numbness of fingers and toes, facial redness, dry and itchy skin, loss of consciousness, seizures, brain damage, and even death. The substance may also cause hyperthermia, or high fever, which is especially dangerous if the drug is combined with alcohol or another drug or consumed out of home, e.g. at a discotheque where it is hot and children exert themselves. It is imperative that parents be on the lookout and keep the drugs in a safe place. They must also monitor Internet usage by their children and notice the appearance of strange-looking pills or cough medicines in their teenager’s bedroom. It is also very important to educate children about the effects of cold and cough medicines since many of them believe they are harmless since they are sold openly. Moreover, parents should teach a child to resist suggestions to buy or take the medicine on behalf of the child’s counterparts.

Serious drug abuse, either accidental or intended, is on the rise. It can be explained by a relative accessibility of abused drugs and insufficient understanding of the threats involved in the practice on the part of abusers. After all, drugs, especially the ones sold over-the-counter, are not as negatively connoted as heroine and cocaine and the danger may be hidden from the person who starts abuse without knowing he / she might develop tolerance.

Finally, we cannot but mention the most traditional objects of abuse – alcohol and nicotine. Alcohol and nicotine abuse has various effects from non-life-threatening to long-lasting and ruinous. Abuse most often starts in adolescents. In case of alcohol, there is a number of risk factors determining the likelihood for a person to start drinking. They include genetic and social factors. A person with a family history of alcoholism is susceptible to the abuse. In addition, adolescents are often provoked to start drinking by their peers who deem it quite acceptable and even positive.

Smoking usually starts in adolescents (if a person reaches the age of 18 or 19 without becoming a smoker, it is highly unlikely that he will become a smoker as an adult). Smoking parents and peers as well as low self-esteem and distress are the factors which encourage smoking in a teenager. Moreover, smoking is widely associated with relaxing effect, enhancing thinking, weight control etc. It is also a part of a number of attractive images such as “Hemingway hero” or “femme fatale”. The antidote is informing teenagers about ensuing health and social problems on the part of parents and educators.

In conclusion, it must be admitted that the numerical data on the subject shows that the current situation requires immediate nationwide attention. Both clinicians and pharmaceutists should try to prevent people from exposure to the temptation and threat of substance abuse. It is also the task of legislative and punitive authorities to control illegal drug use. Finally, every individual must be made aware of the negative, often fatal, effects of abuse and possible threats to be able to make an educated choice.

References

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Menninger Clinic. Painkiller Abuse Continues to Grow; New Treatments Offer Hope. Retrieved April 10, 2009, from  http://opioids.com/painkiller/medicine-cabinet.html

Office of Applied Studies, Substance Abuse and Mental Health Services Administration. (1999). National Household Survey on Drug Abuse. Retrived April 10, 2009, from http://www.samhsa.gov/

Richardson W. AD/HD and Stimulant Medication Abuse. Retrieved April 10, 2009, from http://www.add.org/articles/med_abuse.html

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U.S. Drug Enforcement Administration. Stimulants. Retrieved April 10, 2009, from http://www.usdoj.gov/dea/pubs/abuse/5-stim.htm

U.S. Drug Enforcement Administration. Depressants. Retrieved April 10, 2009, from http://www.usdoj.gov/dea/pubs/abuse/6-depress.htm