Substance Use Disorders
Any pattern of substance use causing significant physical, mental, or social dysfunction
- Substances of abuse include:
- Prescription medications
- Opioids and morphine derivatives (buprenorphine, codeine, fentanyl, hydrocodone, hydromorphone, meperidine, methadone, morphine, oxycodone, oxymorphone)
- CNS depressants (barbiturates, benzodiazepines, hypnotics)
- Stimulants (amphetamines, methylphenidate)
- Dextromethorphan (“Robo-tripping”)
- Cannabis (marijuana, hashish, cannabis oil, and extracts); also 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, carfentanil, desomorphine [Krokodil], U-47700 [Pink])
- Dissociative drugs (ketamine, phencyclidine [PCP], tenocyclidine [TCP])
- Hallucinogens (lysergic acid diethylamide [LSD], salvia, ayahuasca, N,N-dimethyltryptamine [DMT])
- Synthetic cathinones (bath salts, α-PVP [Flakka])
- Inhalants (glue, paint thinners, nitrous oxide)
- Synonym(s): drug abuse; drug dependence; substance abuse
- Alcohol is the most commonly abused substance, and abuse often goes unrecognized.
- Higher potential for drug interactions
Substance abuse may cause fetal abnormalities, morbidity, and fetal or maternal death.
- Predominant age: 18 to 25 years
- Predominant sex: male > female
- 57.2 million Americans (20.8%) reported illicit drug use in the past year in 2019.
- 17.2% of 12- to 17-year-olds; 39.1% of 18- to 25-year-olds
- 1 in 3 (35.4%) young adults were past year users of marijuana.
- 70.6% of drug overdose deaths in 2019 were opioid related.
Etiology and Pathophysiology
Multifactorial, including genetic, environmental
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.
- Male gender, young adult
- Depression, anxiety
- Family history
- Peer or family use or approval; family dysfunction or trauma
- Low socioeconomic status; unemployment
- Accessibility of substances of abuse
- Antisocial personality disorder
- Academic problems, school dropout
- Criminal involvement
- 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; bipolar affective disorder
- Personality disordersALERT
Prescription narcotic overdose is the leading cause of accidental death in patients between the ages of 23 and 45 years in the United States.
- Many states require naloxone to be prescribed or offered when issuing a prescription of opioids to patients at increased risk of overdose, such as those receiving ≥50 morphine milligram equivalents per day of an opioid, those taking both opioids and benzodiazepines, and those with a history of substance abuse.
There's more to see -- the rest of this topic is available only to subscribers.