Encyclopedia of Health and Medicine

SUBSTANCE ABUSE
Substance abuse is the use of any DRUG, including ALCOHOL, or other psychoactive substances in ways that are harmful
to a person or others whom the person’s actions may affect. Health-care practitioners who provide care for people who
have substance abuse problems, alcohol or drug DEPENDENCE, and ADDICTION may be physicians (MDs or DOs), psychiatrists
(physicians who specialize in psychiatric disorders), psychologists (PhDs), social workers (LSWs), and clinical
registered nurse practitioners (CRNPs). Practitioners may be certified substance abuse professionals (SAPs), designating
that they have additional education and experience in treating substance abuse (including ALCOHOLISM).
This section, “Substance Abuse,” presents an
overview discussion of the health implications of
substance abuse and alcoholism and entries about
substances of abuse, health risks related to substance
abuse, and treatment for substance abuse.
From Tonic to Toxin: Opium’s Odyssey
Many substances currently restricted because of
their high potential for abuse were once in common
use. For centuries cultures around the world
used opium, the dried sap from the poppy plant,
Papaver somniferum, to relieve PAIN, induce sleep,
and provide INTOXICATION. In 1805 a young pharmacist’s
assistant, Freidrich Wilhelm Adam Serturner
(1783–1841), isolated morphine, opium’s
most potent ingredient, from opium; 90 years
later chemists at the Bayer Company created
HEROIN from morphine. For the next decade the
most common use of heroin was to treat morphine
addiction—clearly a circumstance, in retrospect,
of leaping from the frying pan into the fire.
By 1913 the Bayer Company stopped producing
heroin, and in the 1920s opium and heroin
became illegal in the United States. Federal law
regulated the manufacture, sale, and possession of
morphine and other medicinal OPIATES. Nonetheless
heroin continued to make its way into the
United States, and in 1970 its abuse peaked with
more than 750,000 Americans addicted. Perhaps
not so coincidentally the US Congress passed the
Controlled Substances Act, the first comprehensive
classification and enforcement legislation for
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drugs, in the same year. Through concerted legal,
social, and medical efforts heroin abuse declined
significantly over the following 30 years, and in
2004 the US Substance Abuse and Mental Health
Administration (SAMHA) estimated 166,000 people
actively using heroin.
Opiates, and in particular morphine and its
direct derivatives, remain the mainstay of analgesia
(pain relief) in medical treatment though
under tight regulatory control. Tens of millions of
Americans use opiates for effective pain management.
However, PRESCRIPTION DRUG ABUSE of opiate
NARCOTICS such as hydromorphone, hydrocodone,
oxycodone, and codeine becomes problematic for
about four million of them.
Health Implications of Substance Abuse
Addiction is a condition that develops over time,
regardless of the substance or behavior that is the
source of the addiction. Social factors compound
the health issues of addiction; many people are
afraid or reluctant to acknowledge a possible addiction
for fear of repercussions in all areas of their
lives. Despite advances in understanding addiction
in recent years, the perception remains that addiction
is a matter of insufficient willpower. However,
addiction arising from substance abuse (whether
alcohol, NICOTINE, illicit drugs, or prescription
drugs) represents a complex entanglement of physiologic,
psychologic, and social factors. Many people
abuse multiple substances though have a
primary substance of abuse.