In this article we examine the behavioral, physical and psychological signs and symptoms of substance abuse and addiction.
America has an undeniable substance abuse problem. Whether it be alcohol, prescription drugs, heroin, cocaine or another substance, use, abuse and addiction rates in America have never been higher. 2014 was a record year for overdose deaths in this country, and the 2013 National Survey on Drug Use and Health found that nearly 10 percent of the U.S. adult population were current illicit drug users.
Over 50 Americans die per day from prescription pill overdoses.
10% of adults in the US are Drug Users.- Centers for Disease Control and Prevention (CDC)
Alcohol and illicit drug use costs to U.S.- National Center for Chronic Disease Prevention and Health Promotion
Drug and alcohol abuse destroys lives, ruins families and costs the nation billions in legal and medical costs. The National Center for Chronic Disease and Health Promotion estimates that alcohol and illicit drug abuse costs our nation $417 billion annually. When added to the country’s rampant prescription drug abuse, it’s clear that a deadly epidemic exists. In 2013, over 50 Americans per day died from prescription pill overdoses, and 6.5 million people over age 11 used them for non-medical reasons.
Substance abuse and addiction often comes to the forefront of public awareness following the drug or alcohol-related death of a beloved celebrity. When household names like Michael Jackson, Phillip Seymour Hoffman, and Prince die of overdoses, shock hits society at large. Hidden addictions revealed, the fatal consequences of drug abuse and dependence become all too real to communities of fans and the general public alike: a constant, familiar figure is suddenly no more. However, famous musicians and actors aren’t the only victims worth discussing. American families are fighting against substance abuse and addiction on a daily basis. By developing an awareness of the risks of drug use, an ability to identify when drug use puts oneself in danger and when use becomes abuse, the life of a loved one may be saved. Still, understanding the difference between recreational, pharmaceutical, abusive and dependent drug use is no easy task. To make an already difficult problem even more complex, families also need to know about all the different types of synthetic street drugs that have become very popular and readily available.
The Difference between Substance Abuse and Dependence
One of the reasons substance abuse often leads to dependence is because it can be very difficult to draw the line between the two. Friends may be willing to look the other way on illicit drug use that only seems to happen at parties, for example, even when these abusive tendencies may indicate addictive dependencies.
Prescription pill abuse can sometimes be more straightforward to identify. If a loved one progressively increases his or her intake of a medical drug and justifies this increased, unprescribed dosage as a means of treating continued symptoms of illness and pain, there may be cause for concern. But how does one tell when recreational substance use has crossed over into abuse and then dependence?
People use substances for a variety of reasons. It becomes drug abuse when people use illegal drugs or use legal drugs inappropriately. This includes the repeated use of drugs to produce pleasure, alleviate stress, and/or alter or avoid reality.
The Slippery Path from Abuse to Dependence
The initial decision to use and abuse drugs or alcohol begins with a conscious decision. But somewhere in between the first exposure and the onset of addiction, the user loses control of his or her ability to limit, reduce or cease usage. This change occurs as the body and brain become accustomed to the effects of the drug, develop tolerance and then need continuingly increasing amounts to achieve the same results.
Most drugs of abuse target the brain’s reward system, whether directly or indirectly. These substances flood the reward system with dopamine, a neurotransmitter in the brain that regulates movement, emotion, motivation and feelings of pleasure. Dopamine is naturally activated during exercise, when a person smells good food, during sexual activities and other pleasurable events.
How Drugs and Alcohol Interact with Dopamine
When dopamine is artificially overstimulated through drug and alcohol abuse, it produces euphoric effects.
These strongly reinforce the behavior of abuse, and make the user more inclined to use again.
Alters the brain stem’s neuro-chemical activity that regulates breathing and beating of the heart
Modifies the limbic system’s control over emotions and feelings
Hinders pain signals generated by the spinal cord
Substance Abuse/Risky Behavior
Negative life consequences begin impacting substance abusers at this stage. Noticeable drops in performance at work and/or school are often very apparent. Additionally, friendships and family relationships may become strained as a result of the abuser’s obsession with substance abuse. When the abuser understands the detrimental effects of drug abuse on his or her life but continues this risky behavior despite such knowledge, this becomes a serious issue.
Uncontrollable cravings and debilitating withdrawal symptoms are common characteristics of the final stage of substance abuse. The abuser’s body and brain have become dependent on the substance of choice, and the addicted individual will often do whatever is necessary to feed that dependence. At this stage, individuals with substance use disorders believe that obtaining and using the substance is critical to their wellbeing.
Common Myths about Substance Abuse and Addiction
Though substance abuse and/or addiction are widespread problems experienced by many, numerous myths and misconceptions surround these issues. For people not suffering from an addiction, it can be difficult to understand why a person can’t simply stop using. Drugs and alcohol interact differently with each person based on a variety of factors, including family history, mental health, physical health and environment.
These varied elements diversify the experience of abuse and addiction, but sustained misunderstandings about these issues ignore these differences in attempt to fit the abuser into a convenient and often alienating narrative.
It’s important that these myths be debunked because people with addictions need to be helped, not outcast. When the public is accurately educated about substance abuse and addiction, it is easier to make informed decisions and provide support and compassion to loved ones who need help.
Chronic substance abuse can impact anyoneMYTH OR REALITY
As several celebrity recovering alcoholics and other substance abusers can attest, addiction does not discriminate. Most people who are addicted to drugs or alcohol have jobs, families, have not had legal problems and are flying under the radar as a result. A person struggling with addiction can come from any background.
You have to hitMYTH OR REALITY
This is a myth perpetuated by movies and television that is actually very far from the truth. A person can benefit from substance abuse treatment during any of the stages mentioned previously.
People with addictions should be punishedMYTH OR REALITY
Thankfully, this is a myth that is beginning to become exposed as false. The fact is that the philosophy of “incarceration over rehabilitation” that dominated the 70s, 80s and 90s did not result in anything other than higher levels of addiction. Addiction cannot be incarcerated out of an individual any more than asthma, diabetes or some other chronic disease.
Worried About A Loved One?
Learn about the warning signs of addiction
The Scourge of Heroin
What draws more and more people towards heroin? Stronger regulations and restrictions on prescription opioids, such as oxycodone, have guided the pathway to heroin as a cheaper and easier-to-access alternative. Whether smoked, snorted or injected, heroin is entering and damaging more bodies in the U. S. every day. Numerous surveys taken by reputable organizations have indicated a correlation between the prescription drug abuse epidemic and the rise in heroin use.
The amount of people who met the DSM-V criteria for heroin use disorder was roughly 586,000 individuals. As the heroin abuse epidemic continues to grow, no one is safe. Families from the most densely populated states to those in the wide open countryside are all equally prone to succumbing to abuse and addiction.
The rise of fentanyl laced heroin has intensified the dangers of use and abuse. Fentanyl is a synthetic opioid that is up to 50 times stronger than heroin and has been linked to drug overdoses across the nation, including in the passing of musical legend Prince. Fentanyl has also been found in prescription drugs such as Xanax and OxyContin, putting users unknowingly at an increased risk of overdose.
Common street names for heroin:
Increase in heroin overdose deaths
from 2002 - 2013
Not Just Trash
The tell-tale signs of heroin may not be noticeable to the casual observer. Needles and/or syringes lying around when there is not a known medical condition that would warrant this equipment would be indicators of a problem.
Warning Signs and Symptoms of Heroin Abuse
The effects from heroin abuse depend on various factors, including the amount used, purity level and length of drug use. These elements inform how long it takes for the opioid to bind to receptors in the brain, how it goes about doing so, and how the body will react. The signs can be subdivided into categories: immediate, delayed and long-term.
- Dry Mouth
- Feeling drowsy and sleepy for several hours
- Having a foggy mental state
- Slowed breathing
- Slowed heart rate
- “Nodding,” where the user will alternate between periods of being awake and asleep
- Needle marks and bruising on the injection sites
- Skin problems, such as abscesses and infections
- Heart problems
- Disease in organs including the liver and kidneys
A Hopeful Beginning Dissolved – America and Opioids
Twenty years ago, Purdue Pharma introduced the highly effective painkiller oxycodone hydrochloride, commonly known as OxyContin, for the treatment of moderate to severe chronic pain.
This synthetic drug was initially marketed as a controlled-release tablet with strength ranging from 10 to 80 milligrams. When taken properly, OxyContin is slowly released into the blood stream over a twelve-hour period. Due to the quantity and purity of the drug, patients are able to function normally and nearly pain-free. However, with the wide-spread overprescription of these pain pills and the rising rates of prescription opioid abuse, the hope attached to these drugs has begun to dissolve.
In 2014, there were 19,000 deaths in the U.S. involving prescription opioids, approximately 52 per day.- Centers for Disease Control and Prevention
80 percent new heroin users in the U.S. started off misusing prescription painkillers- National Center for Health Statistics Data Brief. 2015
prescriptions written for opioids - Centers for Disease Control and Prevention
in the U.S. (2012)
Prescription drugs are being abused at an alarming rate in this country.
- Physicians issued almost a quarter of a billion opioid prescriptions in 2013.
- Health care providers in Alabama (highest prescribing state) wrote more than three times the number of prescriptions per individual than providers in Hawaii (lowest prescribing state).
- In 2014, nearly 2 million Americans either abused or were dependent on prescription opioid pain relievers.
- The most common drugs involved in prescription opioid overdose deaths are:
- Oxycodone (i.e. OxyContin, etc.)
- Hydrocodone (i.e. Vicodin, etc.)
Governmental Attempts to Intervene
Recently, the Centers for Disease Control and Prevention (CDC) introduced new guidelines for prescribing pain medication, such as OxyContin and Vicodin. While these are not federally mandated, some of the recommendations include:
- Prescribing painkillers only after non-addictive pain relievers, physical therapy, behavior changes and other options
- Prescribing the lowest effective dosage
- Utilizing immediate-release opioids, instead of extended-release or long-acting
- Limiting opioid use to three days of treatment, whenever possible
Benzodiazepine Abuse Remains Rampant
Benzodiazepines, otherwise known as benzos, are pharmaceutical drugs that are typically prescribed to treat severe anxiety, panic attacks, insomnia, alcohol withdrawal and seizure disorders. Popular brands of benzos include Xanax, Ativan and Valium. Although they are perfectly legal when administered by doctors, these drugs are often sold on the streets and have led to an increase in emergency room visits and drug-related deaths.
Benzos are being prescribed at an alarming rate in the United States. Opioid pain relievers and benzodiazepine sedatives are both frequently prescribed and are often even given together to a single patient during treatment.
Overprescribing Leads to Death
In a 2016 paper published in the American Journal of Public Health, the number of adults filling prescriptions for benzodiazepine increased 67 percent from approximately 8.1 million in 1996 to 13.5 million in 2013. This corresponded to a total quantity of the drug that more than tripled during this period. The results also indicated a four-fold increase in benzodiazepine-related overdose deaths. In 2013, the drug accounted for almost a third of the deaths from prescription drugs in the United States.
Other studies resulted in similar findings. According to the Centers for Disease Control and Prevention (CDC), benzodiazepines were involved in 31 percent of the opioid-analgesic poisoning deaths in 2011, which is up from the 13 percent of such deaths in 1999. Between 2006 and 2011, these poisoning deaths increased an average of 14 percent per year. The National Center for Health Statistics (NCHS) reported a five-fold increase in the number of overdose deaths from benzodiazepines from 2001 to 2014.
Warning Signs and Symptoms of Benzodiazepine Abuse
Medical prescriptions are typically the initial and primary source for individuals who abuse benzodiazepines. The early signs of a problem might include visits to different doctors to obtain multiple prescriptions, taking the medication longer and more often than recommended and forging prescriptions.
Abuse of benzodiazepines can occur when a patient uses the drug in ways that are not prescribed by a physician. The signs and symptoms of abuse depend on the length of time and the amount of abuse. It not only affects behavior, but significant physical and cognitive effects are often displayed. Some of the most common signs of abuse include:
- Increased respiratory infections
- Physical dependence
- Double vision
- Muscle weakness
- Changes in eating and sleeping patterns
- Memory impairment
- Anterograde amnesia
- Increased confusion
- Slowed thinking
- Abated reaction time
- Increased anxiety
- Irritability and hostility
- Mood swings
Signs and Symptoms of OxyContin Abuse
When taking the prescription opioid OxyContin under a physician's instruction, a patient should experience the elimination and/or suppression of pain.
However, the euphoria and overall peaceful feeling that accompanies taking the drug can lead a patient to take more than is medically necessary, often resulting in abuse of this opioid.
Abuse of OxyContin occurs when its controlled-release property is eliminated by crushing and snorting the tablet, chewing it or dissolving it in water and injecting the solution. Without the time-release features, OxyContin produces an almost immediate high that is similar to the one obtained with heroin.
The drug is often used interchangeably with heroin because of the similar euphoric effect. However, since it is significantly less expensive and easier to obtain, an addiction to heroin is often the outcome for many OxyContin abusers.
Warning Signs of Overdose
Cold and clammy skin
Bluish appearance to skin, fingernails, lips or around the mouth (cyanotic)
Loss of consciousness
Periods of excessive sleepiness
Cocaine Abuse Still an Ever-Present Danger
Cocaine is a highly addictive, powerful stimulant that is most often taken by snorting, although it can also be smoked or injected. The drug is derived from the coca plant of South America and produces short-term euphoria, energy and talkativeness in users. It also produces dangerous side-effects, such as elevated blood pressure and raised heart rate.
Crack is a form of cocaine that has been processed into a rock crystal formation, also known as free-base cocaine. This form of cocaine is smoked and absorbed into the bloodstream through the lungs, causing an intense, rapid and short-lived high. The impact of cocaine use and abuse depends on the amount being taken and the way it is administered.
The 2013 National Survey on Drug Use and Health reported that 855,000 Americans over age 11 were dependent on cocaine. Among people ages 15 – 34, an estimated 7.5 million have used the drug at least once in their lives, while 3.5 million have used in the past year and 1.5 million in the past month.
Common street names for cocaine:
1.5 million cocaine users are living in the U.S. (2014)- National Survey on Drug Use and Health
The Problem of Increasing Doses
Unfortunately, abusers often use cocaine in binge patterns in order to maintain their highs. This causes them to do increasingly large amounts in very short periods of time, potentially leading to overdose and addiction.
Cocaine, which acts as a strong central nervous system stimulant, floods the brain with dopamine, the body’s pleasure hormone. Long-term use can impair the brain’s reward system, which may lead to difficulty in experiencing enjoyable feelings in any other way.
Long-term Effects of Cocaine Abuse
Some of the long-term adverse effects of cocaine abuse includes inflammation of the heart muscle, rupture to the aorta and severe declines in cardiac function. Abuse can also lead to a loss of the sense of smell, cardiac arrest and damage to the nasal membrane. According to the United Nations Office on Drugs and Crime (UNODC) World Drug Report, as many as 21 million people around the world were abusing cocaine in 2012.
Crystal Meth Abuse Afflicting U.S. and World
Crystal meth is the rock-like crystal form of methamphetamine: a legal, highly addictive stimulant used to treat obesity and ADHD when prescribed. Crystal meth is a purer form of methamphetamine that is always illegal and has no other purpose than for abuse.
Users are often drawn to crystal meth (also known as ice or glass) because of its immediate and long-lasting euphoric effects. These desired effects are highly insignificant, however, when compared to its undesirable, even disturbing consequences to the mind and body.
Common street names for crystal meth:
Desired Effects of Crystal Meth
Initial 30-minute rush
Higher motivation to accomplish goals
Increased self confidence
Enhanced sexual performance and feeling
Identifying Meth Abuse
Long-term abuse of crystal meth can cause outward signs of accelerated aging in users. The drug destroys blood vessels and impedes the body’s ability to heal, leading to the development of acne and damaged skin. An abuser’s skin may appear dull and lacking elasticity. Additionally, meth use may cause an abuser’s teeth to crack and decay, leading to what is known as "meth mouth."
Other Warning Signs of Abuse:
Physical indications of meth abuse include sudden weight loss, uncontrollable twitching, dry and cracked skin (especially lips and fingertips), bad breath, dilated pupils, and chronic nasal problems.
The Dangers of Club Drugs
Club drugs, also known as designer drugs, have grown in popularity in the United States since entering the drug market in the 1980s. They include a wide variety of drugs that are often associated with parties, all-night raves, nightclubs and concerts. Club drug abuse can damage brain neurons and impair judgement, memory and coordination. The effects on the body include loss of motor control, blurred vision and seizures.
Part of the additional dangers associated with club drug use is the uncertainty of their ingredients. They are manmade illegally in makeshift home laboratories, making it impossible for users to truly know what they are putting into their bodies.