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Substance Abuse and Addiction
   Wednesday, August 31 2005

Addiction is a serious illness. Health, finances, relationships, careers - all can be ruined. The abuse of drugs and alcohol is by far the leading cause of preventable illnesses and premature death in our society. The importance of substance abuse treatment cannot be overstated, and fortunately many effective treatments are available. The road to recovery, however, begins with recognition.

Consequences of Use


People often drink alcohol during social occasions; it tends to loosen inhibitions. Unfortunately, the recklessness often resulting from excessive drinking is a leading cause of serious injuries and accidental deaths. In addition, alcohol is the most common cause of preventable birth defects, including fetal alcohol syndrome. Of course, excessive drinking can also lead to alcoholism, an illness that tends to run in families and is often associated with depression. Alcoholism can have devastating effects on health, including serious liver damage, greater risk of heart disease, impotence, infertility, and premature aging.


The most widespread and frequently used illicit drug, marijuana is associated with the following consequences:

  • Short-term memory loss
  • Accelerated heartbeat
  • Increased blood pressure
  • Difficulty with concentrating and information processing
  • Lapses in judgment
  • Problems with perception and motor skills
In addition, years of marijuana use can lead to a loss of ambition and an inability to carry out long-term plans or to function effectively.


Stimulants (for example, cocaine, "crack," amphetamines) give a temporary illusion of enhanced power and energy. As the initial elevation of mood fades, however, a depression emerges. Stimulant abuse can lead to serious medical problems:

  • Heart attacks - even in young people with healthy hearts
  • Seizures
  • Strokes
  • Violent, erratic, anxious, or paranoid behavior
Cocaine use during pregnancy may result in miscarriages, stillbirths, or low-birth-weight babies who may be physically dependent on the drug and later may develop behavioral or learning difficulties. Excessive crack use can lead to a permanent vegetative, or zombie-like, state. Long-term amphetamine abuse can result in psychotic effects, such as paranoid delusions and hallucinations.


Heroin, which can be smoked, eaten, sniffed, or injected, produces an intense - but fleeting - feeling of pleasure. Serious withdrawal symptoms begin, however, after 4 to 6 hours:

  • Chills
  • Sweating
  • Runny nose and eyes
  • Abdominal cramps
  • Muscle pains
  • Insomnia
  • Nausea
  • Diarrhea
Heroin use during pregnancy may result in miscarriages, stillbirths, or premature deliveries of babies born physically dependent on the drug. Those who inject heroin are introducing unsterile substances into their bloodstream, which can result in severe damage to the heart, lungs, and brain. In addition, sharing needles is one of the fastest ways to spread diseases; it is currently the leading cause of all new HIV and hepatitis B cases.


Hallucinogens are drugs such as LSD ("acid") or the new "designer" drugs (for example, "ecstasy") that are taken orally and cause hallucinations and feelings of euphoria. Dangers from LSD include stressful "flashbacks" - reexperiencing the hallucinations despite not having taken the drug again, sometimes even years later. Excessive use of ecstasy, combined with strenuous physical activity, can lead to death from dehydration or an exceptionally high fever.


Inhalants are breathable chemicals - for example, glue, paint thinner, or lighter fluid. They are commonly abused by teenagers because they are easy to obtain and because they produce mind-altering effects when "sniffed" or "huffed." These chemicals reach the lungs and bloodstream very quickly and can be deadly. High concentrations of inhalant fumes can cause heart failure or suffocation. Long-term abuse of inhalants can cause permanent damage to the nervous system.


Sedatives are highly effective medications prescribed by physicians to relieve anxiety and to promote sleep. Unfortunately, harmful effects can occur when they are taken in excess of the prescribed dose or without a physician's supervision, such as when they are obtained illegally. Combining sedatives with alcohol or other drugs greatly increases the likelihood of death by overdose. Women who abuse sedatives during pregnancy may deliver babies with birth defects (for example, cleft palate) who may also be physically dependent on the drugs.


The U.S. Surgeon General has confirmed that nicotine in tobacco products has addictive properties similar in severity to those of heroin. Quitting is difficult because of the unpleasantness of withdrawal, which involves feelings of irritability, frustration, anger, anxiety, insomnia, and depression. However, continued smoking may lead to far more dire circumstances:

  • Lung cancer
  • Heart attacks
  • Emphysema
  • High blood pressure
  • Ulcers


The first step on the road to recovery is recognition of the problem, but often this process is complicated by a lack of understanding about substance abuse and addiction or, worse, denial. In these cases, what often prompts treatment are interventions by concerned friends and family. Many health centers and other institutions offer screenings free of charge for various disorders throughout the year. For example, screening tests for alcohol abuse are usually offered in early April.

Because substance abuse affects many aspects of a person's life, multiple forms of treatment are often required. For most, a combination of medication and individual or group therapy is most effective. Medications are used to control the drug cravings and relieve the severe symptoms of withdrawal. Therapy can help addicted individuals understand their behavior and motivations, develop higher self-esteem, and cope with stress. Other treatment methods that may be used as part of the rehabilitative process include

  • Hospitalization
  • Therapeutic communities - highly controlled, drug-free environments
  • Outpatient programs, including methadone maintenance for heroin addiction

Finally, in addition to treatment, self-help groups for substance-abusing individuals (Alcoholics Anonymous, Narcotics Anonymous) as well as their family members (Al-Anon or Nar-Anon Family Groups) are useful in providing support and reinforcing messages learned in treatment. These organizations can be found in your local telephone directory and below.

A comprehensive review of treatments for substance abuse and addiction can be found in the APA Practice Guideline for the Treatment of Patients With Substance Use Disorders, available from American Psychiatric Press for $22.95 plus shipping and handling. Also available for those wishing to quit smoking is the Practice Guideline for the Treatment of Patients With Nicotine Dependence. Call 1-800-368-5777 for more information or to order.

Other Sources of Information:

Al-Anon Family Group
National Referral Hotline

Alcoholics Anonymous (AA)-Worldwide
475 Riverside Drive
New York, NY 10115

American Academy of Addiction Psychiatry
7301 Mission Road, Suite 252
Prairie Village, KS 66208

American Society of Addiction Medicine
4601 North Park Avenue
Suite 101, Upper Arcade
Chevy Chase, MD 20815

Drug Abuse Information and Treatment Referral Line
800-662-HELP; Spanish 800-66-AYUDA

Narcotics Anonymous and Nar-Anon Family Group
Nationwide referral line: 202-399-5316

National Alcohol Screening Day
(Project Headquarters)

National Clearinghouse for Alcohol and Drug Information
P.O. Box 2345
Rockville, MD 20847-2345

National Council on Alcoholism and Drug Dependence
12 West 21st Street
New York, NY 10010
800-622-2255 or 800-475-4673

National Institute on Drug Abuse
5600 Fishers Lane, Room 10-05
Rockville, MD 20857

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