Drug abuse

Overview
Drug abuse is the continued misuse of a substance that leads to negative consequences, even without an intent to harm. Drug abuse can include the misuse of prescription medications, as well as illegal drugs.

Classifications of commonly abused drugs
Commonly abused drugs include:
inhalants, such as aerosol sprays, cleaning fluids and nitrous oxide
hallucinogens, such as marijuana, LSD and PCP
stimulants, such as caffeine, nicotine, methamphetamine and cocaine
narcotics or opiates, such as morphine and heroin
opioids and morphine derivatives, such as methadone
depressants and sedatives, such as alcohol, benzodiazepines, barbiturates and Rohypnol
anabolic steroids
Marijuana is the most commonly used illicit drug in the United States. Other commonly abused drugs include pain relievers for nonmedicinal use, tranquilizers, stimulants and sedatives, as well as cocaine, hallucinogens and inhalants.


Intoxication
Intoxication usually occurs within minutes to hours after a sufficient dose of a particular drug and continues or intensifies with repeated doses. The most common effects involve changes in perception, alertness, attention, thinking, judgment, motor skills and interpersonal behavior. Others may include mood changes and nausea. Of course, intoxication varies depending on the substance used, the dose, the route of administration, the person's tolerance for the substance, the length of time since the last dose, the duration of drug use, the user's expectations about the substance's effects, and the environment or setting in which the substance is taken. Sometimes, symptoms of intoxication last longer than the substance is actually detectable in body fluids. This may be related to the effect the drug has on certain physiological processes. Some neurological changes may be permanent after a single dose of a drug.

Withdrawal
Withdrawal develops with the decline of the substance in the central nervous system. For substances with a short half-life, such as alcohol and heroin, symptoms of withdrawal usually develop a few hours after substance use stops. Withdrawal symptoms may develop several weeks after stopping high doses of substances with a long half-life, such as anxiolytics (drugs that treat anxiety). Symptoms of withdrawal vary depending on the substance used, as well as the dose and duration of drug use. Some prolonged withdrawal symptoms may last several weeks or months. During withdrawal, most people crave the drug to alleviate the symptoms.

Senior-specific information
The most common form of drug abuse among older adults is prescription drug abuse. Older people are prescribed medications three times more frequently than the general population and tend to have poorer compliance with directions for use. Prescription drug abuse is often due to multiple doctors prescribing a large number of medications and failing to communicate with each other, or the older adult giving false impressions or failing to communicate with multiple doctors about medications. Many older people have taken certain medications for years, and don't realize they're addicted. They may believe addiction isn't possible if they've taken the medications as prescribed. Many older adults view their withdrawal symptoms as effects of the underlying condition (anxiety, for example) for which they were prescribed medications in the first place.

Characteristics
A variety of characteristics may develop in response to or as a result of drug abuse. Physically, you may experience muscle spasms, nausea, sweating, diarrhea, disorientation, slurred speech or convulsions. Psychologically, you may worry excessively or develop a sense of hopelessness, mood swings, paranoia or impulsive behavior.
Socially, you may develop promiscuous sexual activity and have difficulty in primary relationships. You may manipulate others. You may engage in thrill-seeking or risk-taking behaviors. You may continue to use drugs despite negative effects. You may develop a drug tolerance, requiring more of the drug to achieve the desired effect.


Coping
If you or someone you know is suicidal or in imminent danger to himself or herself or another person, call 911 immediately. If there is no imminent harm, it's important to consult a medical or mental health care provider promptly for a substance abuse evaluation to help address the drug abuse.
Treatment programs
A variety of drug abuse treatment programs are available. They can all be effective in reducing or eliminating drug use, but the most appropriate treatment must be determined by a qualified health care professional. Substance use disorders may affect many aspects of a person's life and often require multiple modes of treatment.

Short-term

Short-term inpatient treatment lasts about three to six weeks, and short-term outpatient treatment lasts about six months. Short-term programs typically include participation in self-help groups.

Medication may be a short-term treatment option to counteract the effect of alcohol or drugs and relieve withdrawal symptoms and cravings, as well as the symptoms of any associated medical or psychological problems.
Antidepressants may be used to treat depression, which can accompany withdrawal or be part of an underlying problem. Antidepressants may also reduce cravings and help delay or prevent a relapse. Anxiolytics are used to treat anxiety that may accompany treatment or withdrawal. They may also reduce the physiologic effects of withdrawal of alcohol. Antipsychotics are used in treating conditions that may accompany withdrawal or overdose, such as an alcohol- or drug-induced psychosis. Sedatives are used to treat insomnia and similar symptoms that may accompany drug or alcohol withdrawal. Naltrexone is used to treat the withdrawal effects of opioid addiction and also reduce the craving for alcohol. Methadone is often used to treat narcotic withdrawal syndrome. Clonidine is prescribed to reduce the severity of opioid withdrawal symptoms, as is buprenorphine.


Outpatient drug-free therapy is an option for some people. This type of therapy includes individual and group counseling.
Long-term

Methadone maintenance outpatient treatment is primarily used for opiate abusers. A person is given an oral dose of a synthetic opiate -- methadone once a day or levo-alpha-acetyl-methadol (LAAM) three times a week. The purpose of methadone or LAAM is to block the effects of heroin and create a state free from physiological craving. There is a one-year use limit due to the risk of physical dependency. Treatment is most effective when combined with counseling and social services.

Long-term residential treatment, often characterized by a highly structured environment, usually lasts six to 12 months. Long-term treatment is often most effective for people who have long, chronic histories of drug abuse.
Detoxification
Detoxification, or simply detox, is the process in which the abused substance is removed from the body. Detox provides relief for withdrawal symptoms in a safe setting while the body adjusts to a drug-free state. Detox is not intended to be the sole drug abuse treatment, but it can set the stage for further treatment. In fact, detox often provides a crucial window of opportunity to motivate the person to continue with longer-term substance abuse treatment. Detoxification without subsequent treatment is highly ineffective in stopping drug use.

It's important to consult your doctor about what type of detox would be most appropriate for you. Inpatient detox may be indicated if you are withdrawing from sedative drugs, such as alcohol, barbiturates and benzodiazepines, for which withdrawal is potentially fatal, or if you have developed seizures, delirium or psychosis during a previous withdrawal. Another indication for inpatient detox might be if you have a recent history of serious medical problems, such as a stroke, head trauma, acute abdominal pain, liver disease, electrolyte imbalance, pneumonia, sepsis, dehydration, AIDS, heart disease, hypertension or severe respiratory disease. People with a high tolerance for the drug being used or who've had multiple detoxifications in the past may also be good candidates for inpatient detox. Those with no reliable support person or who live alone, pregnant women, or people over 65 years old with a drug abuse problem might also need inpatient detox.

Inpatient detox programs provide a protected setting with restricted access to common substances of abuse. The withdrawal process tends to be safer that in outpatient settings, and detoxification is accomplished faster. For example, benzodiazapine withdrawal can occur in two weeks rather than several weeks or months.

Outpatient detox may be indicated if you are highly motivated, are medically stable to be detoxed in an outpatient setting, or you agree to abstain from alcohol or any drugs other than those prescribed by your doctor. Outpatient detox may also be recommended if you have a sober, responsible and knowledgeable support person who can encourage participation in the program, monitor you for serious withdrawal symptoms, and provide medications on schedule as directed by your doctor.

With outpatient detox programs, daily life is less disrupted and there are no abrupt transitions from the inpatient setting to ordinary home and work settings. Outpatient programs are also less expensive.

Medical model detox programs are directed by a doctor and staffed by health care personnel. These programs focus on medical treatment of withdrawal symptoms and range from hospital-based programs to freestanding residential programs or community facilities. Social model detox programs concentrate on providing psychosocial services, such as individual and family counseling and coordination of care. The emphasis is on nondrug management of withdrawal symptoms. Sometimes a doctor is on call to prescribe detoxification medications if needed. Social model detox programs are generally not recommended for people who need to have medically supervised detoxification.

Support
Several drug abuse recovery groups have developed from the Alcoholics Anonymous movement. Each follows a series of personal activities, known as the Twelve Steps. For example, Narcotics Anonymous members share their common problem and help others recover from abusing drugs. The only requirement is a desire to stop drug use. Nar-Anon is a recovery group for friends, relatives and family members who are concerned about the addiction problem of a loved one. Cocaine Anonymous is open to anyone who wants to stop using cocaine, crack cocaine or other mind-altering substances. Co-Anon is for friends and family members of cocaine addicts. Marijuana Anonymous members share their experience, strength and hope with each other to help solve their common problem and help others recover from marijuana addiction. The only requirement for membership is a desire to stop using marijuana.

If you're abusing drugs, you probably know how difficult it can be to overcome temptation and drug use. In addition to support and professional treatment, it's important to develop an individual self-help plan that takes into account various factors:

Consider the times of the day or part of the week that are most difficult, as well as the people or situations that make it more tempting to use.

Remove yourself from tempting situations by eating, writing in a journal, exercising, reading something inspiring, or taking a walk.

Remember a time when temptation was avoided and how you did it.

Inform your doctors about each other and any medications you're taking.

Call someone supportive if you're having trouble fighting a craving, such as a friend, family member, partner, clergy member, colleague, recovering friend, or Narcotics Anonymous, AA or other sponsor. Have the names and telephone numbers of these supportive people readily available (such as in your wallet or purse).

It's also important to reward yourself for avoiding temptation. Call someone to share your triumph or give yourself a small reward, such as a healthy treat or a small gift.

Summary
If you're abusing drugs, get a substance abuse evaluation as soon as possible. Consult a doctor for a medical exam to address any physical problems that may have developed in response to the drug use. Contact Narcotics Anonymous, Narc-Anon or Nar-Anon to get a temporary sponsor for daily contact. Remember, motivation is a major predictor of success. If you want to stop using drugs, overcoming the addiction is in your power.