Substance Abuse People abuse substances such as drugs, alcohol, and tobacco for varied and complicated reasons, but it is clear that our society pays a significant cost. The toll for this abuse can be seen in our hospitals and emergency departments through direct damage to health by substance abuse and its link to physical trauma. Jails and prisons tally daily the strong connection between crime and drug dependence and abuse. Although use of some drugs such as cocaine has declined, use of other drugs such as heroin and "club drugs" has increased.

• Finding effective treatment for and prevention of substance abuse has been difficult. Through research, we now have a better understanding of the behavior. Studies have made it clear that drug education and prevention aimed at children and adolescents offers the best chance to curb abuse nationally.
• The 2012 National Household Survey on Drug Abuse estimated the number of users of illicit drugs in the United States ages 12 and over to be about 24 million. In addition, the survey estimated that 6.8% of Americans abuse or are dependent on alcohol (down from 7.7% in 2002), and 22% of Americans smoke cigarettes (down from 26 percent in 2002).

Abused substances produce some form of intoxication that alters judgment, perception, attention, or physical control.

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Many substances can bring on withdrawal, an effect caused by cessation or reduction in the amount of the substance used. Withdrawal can range from mild anxiety to seizures and hallucinations. Drug overdose may also cause death.

Many substances, such as alcohol, tranquilizers, opiates, and stimulants, over time also can produce a phenomenon known as tolerance, where you must use a larger amount of the drug to produce the same level of intoxication.

• Tobacco: People cite many reasons for using tobacco, including pleasure, improved performance and vigilance, relief of depression, curbing hunger, and weight control.
  • The primary addicting substance in cigarettes is nicotine. But cigarette smoke contains thousands of other chemicals that also damage health. Hazards include heart disease, lung cancer and emphysema, peptic ulcer disease, and stroke. Withdrawal symptoms of smoking include anxiety, hunger, sleep disturbances, and depression.
  • Smoking is responsible for nearly a half million deaths each year. Tobacco use costs the nation an estimated $100 billion a year, mainly in direct and indirect health care costs.
• Alcohol: Although many people have a drink as a "pick me up," alcohol actually depresses the brain. Alcohol lessens your inhibitions, slurs speech, and decreases muscle control and coordination, and may lead to alcoholism.
  • Withdrawal from alcohol can cause anxiety, irregular heartbeat, tremor, seizures, and hallucinations. In its severest form, withdrawal combined with malnutrition can lead to a life-threatening condition called delirium tremens (DTs). Alcohol is the most common cause of liver failure in the US. The drug can cause heart enlargement and cancer of the esophagus, pancreas, and stomach.
  • In addition to its direct health effects, officials associate alcohol abuse with nearly half of all fatal motor vehicle accidents. In 1992, the total economic cost of alcohol abuse was estimated at $150 billion.
• Marijuana (also known as grass, pot, weed, herb): Marijuana, which comes from the plant Cannabis sativa, is the most commonly used illegal drug in the United States. The plant produces delta-9-tetrahydrocannabinol (THC), the active ingredient associated with intoxication. Marijuana resin, called hashish, contains an even higher concentration of THC. In 2012, there were 18.9 million Americans age 12 and over who reported using marijuana in the past month, up from 14.4 million (5.8 percent) in 2007. The drug is usually smoked, but it can also be eaten. Its smoke irritates your lungs more and contains more cancer-causing chemicals than tobacco smoke. Common effects of marijuana use include pleasure, relaxation, and impaired coordination and memory.
• • Often, the first illegal drug people use, marijuana is associated with increased risk of progressing to more powerful and dangerous drugs such as cocaine and heroin. The risk for progressing to cocaine is 104 times higher if you have smoked marijuana at least once than if you never smoked marijuana.
• Cocaine (also known as crack, coke, snow, rock): Cocaine use has gone down in the last few years; from 2007 to 2012, the number of current users in the U.S. ages 12 or older dropped from 2.1 million to 1.7 million.
  • Derived from the coca plant of South America, cocaine can be smoked, injected, snorted, or swallowed. The intensity and duration of the drug’s effects depend on how you take it. Desired effects include pleasure and increased alertness.
  • Short-term effects also include paranoia, constriction of blood vessels leading to heart damage or stroke, irregular heartbeat, and death. Severe depression and reduced energy often accompany withdrawal.
  • Both short- and long-term use of cocaine has been associated with damage to the heart, the brain, the lung, and the kidneys.
• Heroin (also known as smack, horse): Heroin use continues to increase. According to the National Survey on Drug Use and Health (NSDUH), in 2012 about 669,000 Americans reported using heroin in the past year, a number that has been on the rise since 2007. The biggest increases are among users ages 18 to 25.
  • Effects of heroin intoxication include drowsiness, pleasure, and slowed breathing. Withdrawal can be intense and can include vomiting, abdominal cramps, diarrhea, confusion, aches, and sweating.
  • Overdose may result in death from respiratory arrest (stopping breathing). Because heroin is usually injected, often with dirty needles, use of the drug can trigger other health complications including destruction of your heart valves, HIV/AIDS, infections, tetanus, and botulism.
• Methamphetamines (also known as meth, crank, ice, speed, crystal): Use of this drug also has increased, especially in the West. Methamphetamine is a powerful stimulant that increases alertness, decreases appetite, and gives a sensation of pleasure. The drug can be injected, snorted, smoked, or eaten. It shares many of the same toxic effects as cocaine-heart attacks, dangerously high blood pressure, and stroke. Withdrawal often causes depression, abdominal cramps, and increased appetite. Other long-term effects include paranoia, hallucinations, weight loss, destruction of teeth, and heart damage.
• Club drugs: The club scene and rave parties have popularized an assortment of other drugs. Many young people believe these drugs are harmless or even healthy. These are the more popular club drugs.
• Ecstasy (also called MDMA, Adam, STP): This is a stimulant and hallucinogen used to improve mood and to maintain energy, often for all-night dance parties. Long-term use may cause damage to the brain’s ability to regulate body temperature, sleep, pain, memory, and emotions.
• GHB (also called Liquid XTC, G, blue nitro): Once sold at health food stores, GHB's effects are related to dose. Effects range from mild relaxation to coma or death. GHB is often used as a date-rape drug because it is tasteless, colorless, and acts as a powerful sedative.
• Rohypnol (also called roofies, roche): This is another sedative that can be used as a date-rape drug. Effects include low blood pressure, dizziness, abdominal cramps, confusion, and impaired memory.
• Ketamine (also called Special K, K): This is an anesthetic that can be taken orally or injected. Ketamine (Ketalar) can impair memory and attention. Higher doses can cause amnesia, paranoia and hallucinations, depression, and difficulty breathing.
• LSD (also called acid, microdot) and mushrooms (also called shrooms, magic mushrooms, peyote, buttons): Popular in the 1960s, LSD has been revived in the club scene. LSD and hallucinogenic mushrooms can cause hallucinations, numbness, nausea, and increased heart rate. Long-term effects include unwanted "flashbacks" and psychosis (hallucinations, delusions, paranoia, and mood disturbances).
• PCP (al known as angel dust, hog, love boat): PCP is a powerful anesthetic used in veterinary medicine. Its effects are similar to those of ketamine but often stronger. The anesthetic effects are so strong that you can break your arm but not feel any pain. Usually, tobacco or marijuana cigarettes are dipped into PCP and then smoked.