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Substance Use Disorders

Substance Use Disorders is a topic covered in the 5-Minute Clinical Consult.

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Basics

Description

Any pattern of substance use causing significant physical, mental, or social dysfunction

  • Substances of abuse include:
    • Alcohol
    • Tobacco
    • Prescription medications
      • CNS depressants (barbiturates, benzodiazepines, hypnotics)
      • Opioids and morphine derivatives (codeine, fentanyl, hydrocodone, hydromorphone, oxymorphone [Opana], meperidine, methadone, morphine, oxycodone)
      • Stimulants (amphetamines, methylphenidate)
      • Dextromethorphan (“Robotripping”)
    • Cannabis (marijuana, hashish, cannabis oil, and extracts); increasingly sold as highly concentrated extracts (up to 90% THC) for use in vaporizers
    • Synthetic cannabinoids (Spice, K2, fake weed); often much more potent than marijuana; may be smoked, brewed in tea, or vaporized
    • Stimulants (cocaine, amphetamines, methamphetamines, Khat)
    • “Club drugs” (MDMA [ecstasy, Molly], PMMA [Superman], flunitrazepam, γ-hydroxybutyrate [GHB])
    • Opioids (heroin, opium, kratom, desomorphine [Krokodil])
    • Dissociative drugs (ketamine, phencyclidine [PCP])
    • Hallucinogens (lysergic acid diethylamide [LSD], salvia, ayahuasca, N,N-dimethyltryptamine [DMT])
    • Synthetic cathinones (bath salts, α-PVP [Flakka])
    • Inhalants (glue, paint thinners, nitrous oxide)
    • Anabolic steroids
  • See Also:
    • www.drugabuse.gov/drugs-abuse.
  • System(s) affected: cardiovascular, endocrine/metabolic, CNS
  • Synonym(s): drug abuse; drug dependence; substance abuse
Geriatric Considerations
  • Alcohol is the most commonly abused substance, and abuse often goes unrecognized.
  • Higher potential for drug interactions

Pregnancy Considerations
Substance abuse may cause fetal abnormalities, morbidity, and fetal or maternal death.

Alert
The prevalence of opioid use in pregnancy and associated neonatal abstinence syndrome have increased significantly in recent years. Screen for substance use at the first prenatal visit with a brief intervention, and refer for treatment to improve maternal and neonatal outcomes.

Epidemiology

Incidence
  • Predominant age: 18 to 25 years
  • Predominant sex: male > female

Prevalence

Etiology and Pathophysiology

Multifactorial, including genetic, environmental

Genetics
Substances of abuse affect dopamine, acetylcholine, γ-aminobutyric acid, norepinephrine, opioid, and serotonin receptors. Variant alleles may account for differences in susceptibility to misuse of different substances.

Risk Factors

  • Male gender, young adult
  • Depression, anxiety
  • Other substance use disorders
  • Family history
  • Peer or family use or approval
  • Low socioeconomic status
  • Unemployment
  • Accessibility of substances of abuse
  • Family dysfunction or trauma
  • Antisocial personality disorder
  • Academic problems, school dropout
  • Criminal involvement

General Prevention

  • Early identification and aggressive early intervention improve outcomes.
  • Universal school-based interventions are modestly effective for preventing drug use among adolescents.

Commonly Associated Conditions

  • Depression
  • Personality disorders
  • Bipolar affective disorder

ALERT
Prescription narcotic overdose is the leading cause of accidental death in patients between the ages of 25 and 44 years in the United States (http://www.cdc.gov/injury/wisqars/leading_causes_death.html).

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Citation

Stephens, Mark B., et al., editors. "Substance Use Disorders." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116577/3.4/Substance_Use_Disorders.
Substance Use Disorders. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116577/3.4/Substance_Use_Disorders. Accessed June 27, 2019.
Substance Use Disorders. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116577/3.4/Substance_Use_Disorders
Substance Use Disorders [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 June 27]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116577/3.4/Substance_Use_Disorders.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Substance Use Disorders ID - 116577 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116577/3.4/Substance_Use_Disorders PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -