Alcohol and Drug Problems

Topic Overview

The overuse or abuse of alcohol (alcoholism) or other drugs is called substance abuse. It is common and costly. It can cause or worsen many medical problems and can destroy families and lives.

If you think you may have a problem with drugs or alcohol, take a short quiz to evaluate your symptoms:

Substance abuse self-test (What is a PDF document?)

Alcohol

Alcohol abuse causes over 100,000 deaths in the United States and Canada each year. It is the drug most commonly abused by children ages 12 to 17. Alcohol-related motor vehicle accidents are the leading cause of death in teenagers. People who drink alcohol are more likely to engage in high-risk sexual behavior, have poor grades or job performance, use tobacco products, and experiment with illegal drugs. Alcohol and drug use may be an unconscious attempt at self-treatment for another problem, such as depression.

You have an alcohol problem if your use of alcohol interferes with your health or daily living. You develop alcoholism if you physically or emotionally depend on alcohol to get you through your day.

Long-term heavy drinking damages the liver, nervous system, heart, and brain . It also can lead to high blood pressure, stomach problems, medicine interactions, sexual problems, osteoporosis, and cancer. Alcohol abuse can also lead to violence, accidents, social isolation, jail or prison time, and difficulties at work and home.

Symptoms of an alcohol problem include personality changes, blackouts, drinking more and more for the same "high," and denial of the problem. A person with an alcohol problem may gulp or sneak drinks, drink alone or early in the morning, and suffer from the shakes. He or she may also have family, school, or work problems or get in trouble with the law because of drinking.

The use of alcohol with medicines or illegal drugs may increase the effects of each.

Alcohol abuse patterns vary. Some people get drunk every day; others drink large amounts of alcohol at specific times, such as on the weekend. It is common for someone with an alcohol or drug problem to call in sick for work on Monday or Friday. He or she may complain of having a virus or the flu. Others may be sober for long periods and then go on a drinking binge that lasts for weeks or months.

Someone with alcohol dependence may suffer serious withdrawal symptoms, such as trembling, delusions, hallucinations, and sweating, if he or she stops drinking suddenly ("cold turkey"). Once alcohol dependence develops, it becomes very difficult to stop drinking without outside help. Medical detoxification may be needed.

Drugs

Drug abuse includes the use of illegal drugs—such as marijuana, methamphetamines, cocaine, heroin, or other "street drugs"—and the abuse of legal prescription and nonprescription drugs. Some people use drugs to get a "high" or to relieve stress and emotional problems.

Drugs like ecstasy (MDMA), ketamine, GHB, Rohypnol, and LSD, which are known as "club drugs," may be found at all-night dances, raves, trances, or clubs. Club drug use accounts for increasing numbers of drug overdoses and emergency room visits. Inhalants like nitrous oxide may also be used at these clubs. Drugs come in different forms and can be used in different ways. They can be smoked, snorted, inhaled, taken as pills, put in liquids or food, put in the rectum or the vagina, or injected with a needle. Teens and young adults may be at risk for becoming victims of sexual assault or violent behavior in situations where these drugs are used.

Some nonprescription medicines, such as cold medicines that have dextromethorphan as an ingredient, are being abused by teens and young adults as a way to get a "high."

In the United States and Canada, approximately 40% of adults will use an illegal drug at some time during their lives. This does not include the use of alcohol or prescription medicines. Many people abuse more than one illegal substance at a time.

Drug dependence or addiction occurs when you develop a physical or emotional "need" for a drug. You are unable to control your use of a drug despite the negative impact it has on your life. You may not be aware that you have become dependent on a drug until you try to stop taking it. Drug withdrawal can cause uncomfortable and sometimes dangerous symptoms. The usual treatment is to gradually reduce the dose of the drug until you can completely stop using it.

High-risk groups

Some groups of people are more likely than others to have problems related to alcohol or drug abuse. These groups include:

• Teenagers and young adults. Approximately one-half of all high school seniors in the U.S. admit to having used alcohol or an illegal drug. Substance abuse in this age group increases the risk of involvement in crime, high-risk sexual behavior, accidents, and injuries. Teens that use alcohol and drugs are more likely to have poor school performance and have higher dropout rates.
• Women.
  • Although women are less likely than men to abuse alcohol, they are more likely to have alcohol-related health problems, such as liver disease.
  • Women are more likely to have problems with prescription medicines. More than two-thirds of all tranquilizers are prescribed for women. Tranquilizers, sedatives, pain medicines, and amphetamines are abused most often by women.
  • Alcohol and drug abuse in women increases the risk of developing other health problems, such as osteoporosis or depression.
  • Women who abuse alcohol and drugs attempt suicide four times more frequently than nonabusers.
• Adults older than age 65. Drug abuse in this age group is a problem because of the high number of prescription medicines and the lack of coordination between health professionals. Signs of alcohol or drug abuse may be mistaken for other disease problems or simply overlooked as a symptom of "aging." Many older adults "self-medicate" with alcohol to help relieve sleep problems, depression, and other problems. Alcohol abuse is more common than drug abuse in older adults. Alcohol contributes to automobile accidents and other types of severe injury in this group of people.
• Low-income populations. Drug and alcohol abuse is a problem for many minorities, including disabled adults, the homeless, and minority populations.
• Babies. Drug and alcohol use during pregnancy can cause birth defects and increase the risk of infant mortality. Babies are more likely to have learning disabilities and social and behavioral problems when their mothers use alcohol or drugs during pregnancy. Babies with mothers who use alcohol are at risk for problems from fetal alcohol syndrome.
• Children. Studies show that children who are exposed to drug abuse in the home, especially methamphetamine, have higher rates of depression, anxiety, post-traumatic stress, anger, and alcohol and drug abuse. They also are more likely to have learning problems and do poorly in school.

Recognizing a problem

The CAGE screening questionnaire is used to screen for alcohol abuse and dependence in adults. It is not used to diagnose the disease but only to indicate whether a problem may exist. If you answer "yes" to even 1 of the questions, you may have a problem with alcohol.

The CAGE questionnaire consists of four questions about your use of alcohol:¹

• Have you ever felt you ought to Cut down on your drinking or drug use?
• Do you get Annoyed at criticism of your drinking or drug use?
• Do you ever feel Guilty about your drinking or drug use?
• Do you ever take an Early-morning drink (eye-opener) or use drugs first thing in the morning ("a little hair of the dog that bit you") to get the day started or eliminate the "shakes"?

There is a strong connection between the use of drugs and alcohol and high-risk sexual behaviors. This increases a person's chance of getting sexually transmitted diseases (STDs), hepatitis C, and human immunodeficiency virus (HIV).

If you think you might have a drinking problem, take a short quiz to evaluate your symptoms:

Interactive Tool: Do You Have a Drinking Problem?

Use the Check Your Symptoms section to decide if and when you should see a doctor.

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Author:	Jan Nissl, RN, BS	Last Updated: January 18, 2008
Medical Review:	Adam Husney, MD - Family Medicine Martin Gabica, MD - Family Medicine William M. Green, MD - Emergency Medicine William H. Blahd, Jr., MD, FACEP - Emergency Medicine
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