Substance Use Disorders
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Any pattern of substance use causing significant physical, mental, or social dysfunction
- Substances of abuse include:
- 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 (“Robo-tripping”)
- Cannabinoids (marijuana)
- Synthetic cannabinoids (Spice, K2, others); note: Increasingly, these are sold as liquid in eyedropper bottles for use with vaporizing devices (e-cigarettes/vape pens).
- 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:
- System(s) affected: cardiovascular, endocrine/metabolic, CNS
- 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.
The prevalence of opioid use in pregnancy and associated neonatal abstinence syndrome have increased significantly in recent years. Screening for substance use at the first prenatal visit with a brief intervention, and referral for treatment can improve maternal and neonatal outcomes.
- Predominant age: 16 to 25 years
- Predominant sex: male > female
- 27 million Americans reported illicit drug use in 2015.
- 9% of 12 to 17 year-olds; 22% of 18 to 25 year-olds
- 1 in 5 young adults currently use marijuana.
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
- Other substance use disorders
- Family history
- Peer or family use or approval
- Low socioeconomic status
- Accessibility of substances of abuse
- Family dysfunction or trauma
- 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
- Personality disorders
- Bipolar affective disorder
Prescription narcotic overdose is the leading cause of accidental death in patients between the ages of 25 and 65 years in the United States; this correlates with increased prescribing of long-acting oxycodone (see http://www.cdc.gov/injury/wisqars/leading_causes_death.html).