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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 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.
Alcohol Abuse
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.
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.
- 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.
- Recent 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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