Substance Abuse Overview
Overview of substance abuse and alcoholism. Find out the difference between substance abuse and substance dependence and the characteristics of alcoholism.
What is Substance Abuse?
The use of various substances to modify mood or behavior is generally regarded as normal and acceptable in our society. Many people drink coffee or tea for the stimulant effects of caffeine, or engage in the social drinking of alcohol. On the other hand, there are wide cultural variations. In some groups, even the recreational use of alcohol is frowned upon, whereas in other groups the use of various legal or illegal substances for mood-altering effects has become widely accepted. In addition, certain over-the-counter and prescription medications may be medically recommended to relieve tension or pain or to suppress appetite.
But when regular use of these substances begins to interfere with normal functioning, creating behavioral changes that would be undesirable to people from any cultural background, substance use has turned to substance abuse. As psychiatrists define it, a person has a substance abuse problem when they continue to use a substance--some form of drug, medication or alcohol -- despite the recurring social, occupational, psychological or physical problems such use causes. Such behavior is indicative of a mental disorder which can turn an illegal or a legal substance into a "drug" and which requires psychiatric medical treatment.
Substance abuse, the misuse of alcohol, cigarettes and both illegal and legal drugs and medications and other mood-altering substances is, by far, the predominant cause of premature and preventable illness, disability and death in our society. According to the National Institute of Mental Health, nearly 17 percent of the U.S. population 18 years old and over will fulfill criteria for alcohol or drug or other substance abuse during their lifetimes. When the effects on the families of abusers and people close to those injured or killed by intoxicated drivers are considered, such abuse affects untold millions more.
The annual cost of alcohol abuse is nearly $86 billion for treatment and indirect losses such as reduced worker productivity, early death and property damage resulting from alcohol-related accidents and crime each year. Alcohol intoxication is associated with approximately 50 percent of the nation's traffic fatalities and homicides every year. Drug abuse accounts for $58 billion a year in direct and indirect costs to business and the economy. Cigarette smoking has long been known to cause cancer and emphysema and heart disease, but quitting cigarettes is greatly complicated because most smokers declare that they would like to quit, but they have lost control of the habit. This is especially true of smokers who begin smoking when they are adolescents or young adults. The economic toll of these different forms of substance abuse amounts to over four times that of cancer and nearly a third greater than that of cardiovascular disease, according to a 1984 Research Triangle Institute report.
Among the disorders related to the misuse of these substances, a distinction is made between substance abuse and substance dependence. As related above, those whom psychiatrists and other mental health professionals would classify as "substance abusers" can't control their use of alcohol or other drugs. They become intoxicated on a regular basis--daily, every weekend or in binges--and often need the substance for normal daily functioning. They repeatedly try to stop the use but fail.
Those who are considered to be dependent on a substance suffer all the symptoms of drug abuse, with the addition that they have developed a physical tolerance for it, so that increased amounts are necessary for the desired effects. Opiates (such as heroin), alcohol and amphetamines (such as methamphetamine) also lead to physical dependence in which the person develops withdrawal symptoms when he or she stops use.
While alcohol is considered by psychiatrists to be a "drug," for the purposes of this pamphlet its abuse is being discussed separately from that of other drugs.
The National Council on Alcoholism and Drug Dependence (NCADD) and the American Society of Addiction Medicine (ASAM) define alcoholism as: A primary, chronic disease...characterized by impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and distortions in thinking, most notably denial." NCADD and ASAM further say that by "disease" they mean "involuntary disability," and that the symptoms of alcoholism may be continuous or may occur periodically. Further, the two groups say that the development of alcoholism in a person is influenced by genetic, psychosocial, and environmental factors, and that the disease of alcoholism is often progressive and fatal.
Social stigma has blocked the road to understanding of alcoholism more than with any other disease. Society has long viewed the affliction as a psychological problem alone--the sign of a ravaged soul devoid of discipline or morality. Physicians are inclined to ignore its symptoms and victims deny its existence.
Recent scientific breakthroughs, however, have begun to dramatically alter our views on alcoholism. The myth that alcoholism is a "psychological problem" is yielding under the weight of evidence that the disease has its roots in biological causes. This news holds significant hope for the estimated 15.4 million adult victims of alcohol, as well as the 56 million people directly affected by their alcohol abuse or addiction. Such discoveries may eventually lead to prevention or detection of the disease before its damage becomes irreversible.
continue: Characteristics of Alcoholism
Drinking and Alcoholism Facts
The following characteristics of alcoholism leave little doubt as to the devastating impact of the disease:
- Alcoholism is a progressive disease that generally first appears between the ages of 20 and 40, although children can become alcoholics.
- Drinking patterns vary by age and sex. At all ages, two to five times more males than females are heavy drinkers. For both males and females, drinking prevalence is highest and abstention lowest in the 21 to 34 age range. Among those 65 years and older, abstainers exceed drinkers in both sexes.
- Alcohol dependence tends to cluster in families.
- Alcohol dependence is often associated with depression. Depression typically makes its appearance before the drinking. Studies show that, among the general population, those with diagnosable depression are at a somewhat elevated risk for development of alcoholism. Among women, however, the risk is almost tripled.
- Women seem also to be more sensitive to alcohol than men. When differences in weight are factored out, women still seem to get higher blood levels of alcohol from drinking--a fact that may increase their risk.
- It takes five to 15 years for an adult to become an alcoholic; an adolescent can become an alcoholic, by contrast, in six to 18 months of heavy drinking. Younger alcohol abusers are also more likely to die of alcohol poisoning through hypoglycemia because their livers cannot metabolize the alcohol as efficiently as the adult liver.
Alcohol overdose itself may also be fatal.
Drinking Patterns and Impact of Alcoholism
- Generally, abuse occurs in one of three patterns: regular, daily intoxication; drinking large amounts of alcohol at specific times, such as every weekend; and long periods of sobriety interspersed with binges of heavy daily drinking that last for weeks or months.
- As drinking continues, dependence develops and sobriety brings serious withdrawal symptoms such as delirium tremens (DTs) that include physical trembling, delusions, hallucinations, sweating and high blood pressure.
- Long-term, heavy drinking can cause dementia, in which the individual loses memory and the ability to think abstractly, to recall names of common objects, to use correct words to describe recognized objects or to follow simple instructions.
- Physical complications of chronic alcohol dependence include cirrhosis (liver damage), hepatitis, altered brain-cell functioning, nerve damage, gastritis (inflammation of the stomach), premature aging, impotence and infertility, and a variety of reproductive disorders. Some researchers suspect the hormonal imbalances caused by alcohol dependence actually fool the body into shutting off its supply of natural opiates (endorphins). Chronic alcohol dependence also increases the risk and severity of heart disease, pneumonia, tuberculosis and neurological disorders.
- Many studies have strongly suggested that in pregnant women alcohol abuse has harmful effects on the development of the fetus' brain and other parts of its central nervous system, an effect known as fetal alcohol syndrome (FAS). FAS is the leading preventable cause of mental retardation in children, and studies have shown that 8,000 American babies are born with FAS each year. Researchers are discovering biological markers that could eventually identify many potential alcoholics. Preliminary studies indicate that alcoholics are born with a faulty liver enzyme system that may lead to their addiction, an encouraging twist to the existing knowledge that alcoholics do not metabolize alcohol normally. Still other studies reveal that the majority of alcoholics have abnormal brain waves and memory impairments. This appears to be true of their young children as well, even though the offspring may never have been exposed to alcohol. This and other studies suggest that children of alcoholics are at increased risk themselves for alcoholism and addiction, as well as other psychological problems linked to the addiction's disruptive effect on family life. This makes children of alcoholics important targets for alcohol abuse prevention efforts.
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Sources: 1. American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Washington, DC: American Psychiatric Association. 2. National Council on Alcoholism and Drug Dependence, Definition of Alcoholism Fact Sheet. 3. NIMH, National Institute on Drug Abuse, Substance Abuse Fact Sheet. Updated April 2007.