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Substance-Use Disorders

Substance Use Disorder is the term used to describe a group of substances that lead to addictive disorders, and are defined as a chronic disease. The disorder occurs when an individual develops more than a dependence, but, rather an uncontrollable addition that results in the unstoppable use of the substance. The results of and the consequences for use have no relevance to the individual as they cannot stop their behaviors and cravings for the substance.

Since 2013, the term substance abuse was obviated, and the DSM-V noted the term substance use disorder to combine (previous DSM-IV categories) substance abuse and substance dependence into a single disorder measured on a continuum from mild to severe. Each specific sub­stance (other than caffeine, which cannot be diagnosed as a substance use disorder) is addressed as a separate use disorder. Almost all of the substances are diagnosed based on the same variables and criteria.

Currently, there is a list of 11 symptoms of which the DSM-V requires 2 – 3 symptoms to qualify a mild substance use disorder.

According to SAMHSA, the most common substance use disorders include:

Alcohol Use Disorder
Alcohol Use Disorder is an individual's excessive use of alcohol, resulting in an increased risk of developing serious health problems, and the uncontrollable intake of alcohol. Excessive drinking, drinking that leads to a disorder, often puts one's safety at risk as well. It has been found that the genetic predisposition for the disorder exists, and plays a significant role in one's chance of developing an addiction to alcohol.

Cannabis (Marijuana) Use Disorder
Marijuana is the most-used drug after alcohol and tobacco in the United States. According to SAMHSA: Marijuana's immediate effects include distorted perception, difficulty with thinking and problem solving, and loss of motor coordination. Long-term use of the drug can contribute to respiratory infection, impaired memory, and exposure to cancer-causing compounds. Heavy marijuana use in youth has also been linked to increased risk for developing mental illness and poorer cognitive functioning. Symptoms of marijuana use disorder include disruptions in functioning due to its use, the development of tolerance, cravings for cannabis, and the development of withdrawal symptoms, such as the inability to sleep, restlessness, nervousness, anger, or depression within a week of ceasing heavy use.

Stimulant Use Disorder (Methamphetamine, Cocaine)
The use of stimulants is on the rise in the United States and having devastating effects on communities nationwide. Stimulants are known to increase alertness, attention, and energy, as well as elevate blood pressure, heart rate, and respiration. In their original form, stimulants were used to treat conditions and illnesses such as obesity, attention deficit hyperactivity disorder and, occasionally, depression. Unfortunately, as with other prescription medications, stimulants have been modified for illegal use. The most commonly abused stimulants are amphetamines, methamphetamine, and cocaine. Stimulants can be synthetic (such as amphetamines) or can be plant-derived (such as cocaine). They are usually taken orally, snorted, or intravenously. The symptoms of using such stimulants include unstoppable craving for the drugs, failure to control use when attempted, continued use despite interference with major obligations or social functioning, use of larger amounts over time, development of tolerance, spending a great deal of time to obtain and use stimulants, and withdrawal symptoms that occur after stopping or reducing use, including fatigue, vivid and unpleasant dreams, sleep problems, increased appetite, or irregular problems in controlling movement.

Hallucinogen Use Disorders
Hallucinogens can be chemically formulated (as with lysergic acid diethylamide or LSD) or are created/derived naturally (as with psilocybin mushrooms, peyote). These drugs can produce visual and auditory hallucinations, feelings of detachment from one's environment and oneself, and distortions in time and perception. Symptoms of hallucinogen use disorder include craving for hallucinogens, the inability to control use when attempted, continued use despite interference with major obligations or social functioning, use of larger amounts over time, use in risky situations like driving, development of tolerance, and spending a great deal of time to obtain and use hallucinogens.

Opioid Use Disorder
Opioids are a drug that help to reduce the perception of pain; however, they also can induce drowsiness, mental confusion, euphoria, nausea, constipation, and, depending upon the amount of drug taken, can depress respiration. Most often, opioid addiction begins with the legal use of a prescription medication. Illegal opioid drugs, such as heroin and legally available pain relievers such as oxycodone and hydrocodone can cause serious health effects in those who misuse them. Some people experience a euphoric response to opioid medications, and it is common that people misusing opioids try to intensify their experience by snorting or injecting them. These methods increase their risk for serious medical complications, including overdose. Other users have switched from prescription opiates to heroin as a result of availability and lower price. The form found on the street offers a dangerous varied purity, and with other chemicals and drugs mixed with heroin on the black market, this also increases risk of overdose. Symptoms of opioid use disorders include the uncontrollable need for continued use, inability to control or reduce use, continued use despite interference with major obligations or social functioning, use of larger amounts over time, development of tolerance, spending a great deal of time to obtain and use opioids, and withdrawal symptoms that occur after stopping or reducing use, such as negative mood, nausea or vomiting, muscle aches, diarrhea, fever, and insomnia.

DSM (Diagnostic and Statistical Manual of Mental Disorders) is the manual used by physicians, clinicians and researchers to diagnose and classify mental disorders, . The American Psychiatric Association (APA) will published the DSM-5 in 2013, culminating a 14-year revision process, to establish common language and standard criteria for the classification of mental disorders.

Alcohol Heroin Cocaine Opiates Methamphetamine Prescription Drugs PCP Marijuana

Alcohol

Alcohol consumption is very common in everyday life. People drink to socialize, celebrate, relax, and de- stress. The Substance Abuse and Mental Health Services Administration's National Survey on Drug Use and Health revealed that more than half of all adults drink alcohol.

This same report showed that in 2013, of the 136.9 million drinkers ages 12 or older, 22.9% were classified as binge drinkers and 6.3% were heavy drinkers. About 17.3 million, or 6.6%, of these individuals met the criteria for an alcohol use disorder.

Alcohol is a central nervous system depressant that can impair brain functioning, resulting in poor judgment, slurred speech, loss of balance, and reduced reaction time. Long-term alcohol consumption produces even graver health problems, such as liver cirrhosis, pancreatitis, cancer, high blood pressure, unintentional injuries, and violence, including homicide and suicide.

The following symptoms may mean you, or a loved one, are suffering from alcohol use disorder or addiction:

  • Failure to manage responsibilities at home, work, or school
  • Legal problems related to alcohol, such as driving under the influence
  • Drinking despite ongoing problems caused, or worsened, by alcohol
  • Strong cravings for alcohol
  • Inability to stop, or limit, drinking

Heroin

In 2010, 12 million American adolescents used prescription pain medication not prescribed for them. The National Institute on Drug Abuse reported that 1 in 15 of these Americans will go on to try heroin within the following 10 years. And, whereas 14% of prescription pain medication abusers develop an addiction, it's 54% for heroin users.

Many heroin users are introduced to this opioid through prescription painkillers, like OxyContin. However, an OxyContin habit is expensive to maintain; therefore, many users turn to this cheaper, easier-to-buy alternative.

Heroin is a white or brown powder extracted from the Asian opium poppy plant. It can be snorted, smoked, or diluted and injected. Either way, heroin is very quickly delivered to the brain, which makes it so addicting.

By binding to opioid receptors in the brain, heroin effects one's perception of pain and stimulates the reward center. Users often report feeling a rush of euphoria after ingesting the drug, then "nodding off," or experiencing a wakeful and drowsy state.

Heroin suppresses the respiratory systems, which is the leading cause of heroin overdose. Users injecting heroin are also at a greater risk of contracting HIV and hepatitis C. Chronic users often report incidences of collapse veins, heart infections and abscesses, gastrointestinal cramping or illnesses, and kidney and liver diseases.

Long-term heroin use leads to tolerance, meaning the user must ingest more of the drug in order to achieve the same euphoric effect felt in the past. Heroin is extremely addicting and alters the brain, leading to a dependence on the substance. When a user goes without heroin, they often experience withdrawal symptoms, such as restlessness, physical pain, insomnia, diarrhea and vomiting, cold flashes, and involuntary kicking movements.

The signs and symptoms of heroin addiction include:

  • The presence of nonmedical needles and syringes
  • Spoons, straws, and/or aluminum foil with burn marks
  • Track or scratch marks on the skin
  • Lying or deceptive behavior
  • Decreasing attention to hygiene and physical appearance
  • Repeatedly borrowing or stealing money or valuables from others
  • Weight loss, runny nose, and scabs or bruises from skin picking

Cocaine

Cocaine is a powerful and highly addictive stimulant. Made from the leaves of South American coca plants, cocaine is often used in a powder form, either snorted through the nose or dissolved in water and injected into the bloodstream.

In 2008, the National Institute on Drug Abuse (NIDA) estimated that 1.9 million Americans were cocaine users, and that adults ages 18 to 25 had a higher rate of cocaine use than any other age group. NIDA also reported that nearly 1.4 million Americans met the criteria for cocaine abuse or addiction. Cocaine is so powerfully addicting due to its effect on the brain's reward system. By increasing the level of dopamine in the brain, cocaine creates a sense of euphoria, as well as feelings of increased energy, confidence, and sexual arousal.

When coming down from the high, users report feeling restlessness, anxiety, irritability, and insomnia. This leads to the desire to use cocaine in larger amounts at more frequent intervals. However, the more users chase the pleasurable effects of cocaine, the more elusive they become. The euphoric effect occurs less often, while feelings of depression and anxiety increase.

There are several signs of cocaine abuse or addiction, including:

  • Increased energy and talkativeness
  • Decreased need or desire for sleep
  • Weight loss or malnutrition
  • Nosebleeds or a chronically runny nose
  • Difficulty swallowing or hoarseness
  • Increasing irritability and paranoia
  • Violent mood swings
  • Stealing or borrowing money

Opiates

Opiates have an unusually high potential for abuse and addiction.

Opiates are a depressant:

  • Opiates are derived from the resin of a poppy plant
  • Morphine, Codeine, and Vicodin are legally prescribed for pain
  • Heroin has no approved medical use in the US.
  • Methods of abuse:
    • Heroin can be injected (mainlining), snorted or smoked
    • Chasing the Dragon - heating heroin on aluminum foil the heroin will boil and vaporize and the user will then inhale the fumes
    • Codeine and Morphine are usually injected or pills

Signs and symptoms of use include:

  • Lethargy
  • Lack of motivation
  • Drowsiness
  • Flushed appearance
  • Shallow breathing
  • Need marks and/or open sores on the body

Physical effects of opiates include:

  • Skin infections
  • Inability to stay awake
  • Irregular heart rate/blood pressure
  • Irregular menstrual cycles in women
  • Depressed: appetite, thirst and reflexes
  • Increase tolerance for pain
  • Decreased sexual pleasure

Mental effects of opiates include:

  • Short lived state of euphoria sometimes called "rush" and can be described as similar to a sexual experience
  • After the "rush," the narcotic kicks in
    • Drowsiness, slurred speech, slowed heart rate, breathing and brain activity
    • The "nod" effect takes place - a condition bordering on passing out

Methamphetamine

Methamphetamine is an illegal drug, similar to cocaine, and other addictive and dangerous street drugs. It has many alternate names use, including meth, crank, chalk or speed being the most common name used.

Crystal meth - a variation of methamphetamine, short for crystal methamphetamine - is used by people of all ages, but is most commonly used as a "club drug," taken while partying in night clubs or at rave parties. Its alternate names, most commonly used on the streets, are ice or glass.

Incredibly addictive, meth in all forms, uses the body's resources resulting in a devastating addiction and chemical dependency that can only be satisfied by taking more of the drug. Crystal meth is known to be concentrated and so powerful that users often get addicted after the first time they try the drug. The dangerous poison and chemicals are known to create very serious health problems such as memory loss, aggression, psychotic behavior and potential heart and brain damage.

Methamphetamine is a white crystalline drug that people take by snorting it (inhaling through the nose), smoking it or injecting it with a needle. Some choose to ingest it; however, all develop a strong desire to continue using it because the drug creates a false sense of happiness and well-being-an intoxicating feeling of confidence, hyperactivity, energy, and decrease in appetite. The drug's effects usually last from six to eight hours, but can last up to twenty-four hours.

Although the first experience typically offers some joy and pleasure; methamphetamine immediately begins to destroy the user's health and life.

Prescription Drugs

America is currently experiencing an unprecedented epidemic of prescription drug overdoses. The Centers for Disease Control and Prevention reports that deaths from prescription drugs have quadrupled over the past two decades.

In 2013, 51.8% of drug overdose deaths in America were related to pharmaceutical drugs. Of these deaths, 71.3% involved opioids (painkillers) and 30.6% involved benzodiazepines (Xanax and other anti- anxiety medications).

Prescription, and even some over-the-counter, drugs are the most commonly abused substances in America, following marijuana. People assume prescription drugs are safer than illicit ones because they are approved for use by the medical community. Many prescription abusers even receive their drugs from family and/or friends for free.

What are the signs that you, or a loved one, may be struggling with prescription drug abuse?

  • Taking a drug for a purpose other than prescribed
  • Taking someone else's prescription to self-medicate
  • Taking a prescription drug to get high

PCP

Phencyclidine, more commonly known as (PCP) was first created as an intravenous anesthetic; however, side effects incliding hallucinations, delirium, and mania led to its discontinued use for human medical use. Ketamine, an anesthetic used in pediatric and veterinary medicine, was then developed and is structurally similar to PCP.1 PCP is listed as a Schedule II drug by the US Drug Enforcement Agency; ketamine is a Schedule III agent.

PCP is an illicit street drug also known as Angel Dust, PeaCe Pill, Hog, Lovely, Wack, Ozone, Dust, , Rocket Fuel. When combined with marijuana, it is also known as Supergrass and Killer Joints.

In its original form, PCP is a white crystalline powder that easily dissolves in water or alcohol, and has a distinctive bitter chemical taste. On the illicit drug market, PCP contains a number of contaminants causing the color to range from a light to darker brown with a powdery to a gummy mass consistency. It is available in a variety of tablets, capsules, and colored powders, which are either taken orally or in the nose. The liquid form of PCP is actually PCP base dissolved most often in ether, a highly flammable solvent. For smoking, PCP is typically sprayed onto leafy material such as mint, parsley, oregano, or marijuana. PCP may also be injected.

PCP is also known as Angel Dust, PeaCe Pill, Hog, Lovely, Wack, Ozone, Dust, , Rocket Fuel. When combined with marijuana, it is also known as Supergrass and Killer Joints.

PCP is quite addictive, and even in a moderate amount of PCP often causes users to feel detached, distant, and estranged from their surroundings. Numbness of the extremities, slurred speech, and loss of coordination may be accompanied by a sense of strength and invulnerability. A blank stare, rapid and involuntary eye movements, and an exaggerated gait are among the more observable effects. Auditory hallucinations, image distortion, severe mood disorders, and amnesia may also occur. In some users, PCP may cause acute anxiety and a feeling of impending doom; in others, paranoia and violent hostility, and in some, it may produce a psychoses indistinguishable from schizophrenia. Many believe PCP to be one of the most dangerous drugs of abuse.

Physiological effects of PCP include a slight increase in breathing rate and a more pronounced rise in blood pressure and pulse rate. Respiration becomes shallow, and flushing and profuse sweating.

At high doses of PCP, there is a drop in blood pressure, pulse rate, and respiration. This may be accompanied by nausea, vomiting, blurred vision, flicking up and down of the eyes, drooling, loss of balance and dizziness. High doses of PCP can also cause seizures, coma, and death (though death more often results from accidental injury or suicide during PCP intoxication). Psychological effects at high doses include illusions and hallucinations.

PCP is addictive and its use often leads to psychological dependence, craving, and compulsive PCP-seeking behavior. Users of PCP report memory loss, difficulties with speech and learning, depression, and weight loss. These symptoms can persist up to a year after cessation of PCP use. PCP has sedative effects, and interactions with other central nervous system http://images.intellitxt.com/ast/adTypes/icon1.png depressants, such as alcohol and benzodiazepines, can lead to coma or accidental overdose. Use of PCP among adolescents may interfere with hormones related to normal growth and development. Many PCP users are brought to emergency rooms because of PCP's unpleasant psychological effects or because of overdoses. In a hospital or detention setting, they often become violent or suicidal, and are very dangerous to themselves and to others. They should be kept in a calm setting and should not be left alone.

Marijuana

Marijuana can be addictive. Marijuana consists of the dried leaves and flowers from the female plant, Cannabis sativa. Marijuana, the most commonly used drug in America, contains a mind-altering chemical called delta-9- tetrahydrocannabinol, or THC.

When marijuana is smoked, this THC finds its way from the lungs into the bloodstream, which then transports the chemical to the brain, acting on the brain's cannabinoid receptors. These receptors are responsible for pleasure, memory, concentration, and sensory perception. When stimulated by THC, the receptors alter one's perceptions, mood, coordination, and memory.

Marijuana smoke is an irritant, meaning smokers can experience the same respiratory problems as those smoking cigarettes. It also affects the heart, raising the average beats per minute by 20-100% its normal rate. According to the National Institute on Drug Abuse (NIDA), this puts users at a 4.8-fold increase for the risk of having a heart attack within the first hour of smoking.

Marijuana's affects aren't just physical-studies have linked chronic marijuana use to mental illnesses such as depression, anxiety, suicidal thoughts, and personality problems. NIDA reports that habitual marijuana smokers have lower life satisfaction, more relationship problems, and less academic and career success than non-smokers.

Contrary to popular belief, marijuana is addicting, and symptoms include:

  • Increased tolerance with more frequent use
  • Feelings of withdrawal from decreased use (such as irritability, sleeplessness, and cravings)
  • Spending more time smoking marijuana and less time with other activities or family and loved ones
  • Avoiding or failing to follow through on daily responsibilities at home, work, or school
  • Smoking to escape reality and cope with the stress of everyday life



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