Alchoholism and Substance Abuse Dependancy

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1. Become familiar with clinical and statistical information regarding substance abuse history, DSM criteria, types of abuse, demographic characteristics, treatment, and outcomes. 2. Define substance abuse and identify its efftects. 3. Become familiar with the medical aspects of alcohol abuse/dependence and other types of chemical dependency. 4. Apply current theories of the etiology of substance abuse. 5. Recognize the role of persons and systems that support or compound the abuse. 6. Become familiar with the major treatment approaches to alcoholism and chemical dependency. 7. Learn the national legal aspects of substance abuse. 8. Obtain knowledge of certain populations at risk with regard to substance abuse. 9. Access community resources offering assessment, treatment and follow-up for the abuser and family. 10. Learn the process of referring affected persons.

Table of Contents: 1. Definitions 2. History 3. DSM Criteria 4. Types of Substance Abuse 5. Prescription Drug Addiction and Dependence 6. Demographic Characteristics 7. Substance Abuse Treatment and Outcomes 8. References

1. DEFINITIONS

Substance abuse is defined as “the overindulgence in and dependence of a drug or other chemical leading to effects that are detrimental to the individual's physical and mental health, or the welfare of others. It is characterized by a pattern of continued pathological use of a medication, non-medically indicated substance, drug or toxin, that results in repeated adverse social consequences related to drug use, such as failure to meet work, family, or school obligations, interpersonal conflicts, or legal problems. Some controversy exists regarding the precise distinctions between substance abuse and substance dependence. However, the current clinical standard distinguishes between them by defining substance dependence in terms of physiological and behavioral symptoms of substance use, and substance abuse in terms of the social consequences of substance use. Substance abuse may lead to addiction or substance dependence. Dependence requires the development of tolerance leading to withdrawal symptoms. Both abuse and dependence are distinct from addiction which involves a compulsion to continue using the substance despite the negative consequences, and may or may not involve chemical dependency. Dependence almost always implies abuse. However, abuse frequently occurs without dependence. Dependence involves added physiological processes while substance abuse reflects a complex interaction between the individual, the abused substance and society.”

2. HISTORY

Throughout history, in fact for thousands of years, substance abuse has existed. Early Egyptians drank wine while narcotics were used dating back to 4000 B.C. Medicinal use of marijuana has been dated back to 2737 B.C. in China. During the 19th century, the active substances in drugs began to be extracted. At that time, substances including morphine, laudanum, and cocaine were unregulated and prescribed by physicians for a variety of illnesses. During the American Civil War, morphine was commonly used, and wounded veterans returned home with morphine kits and hypodermic needles. Opium dens grew and by the early 1900s there were an estimated 250,000 addicts in the United States (Office of Applied Studies, Substance Abuse and Mental Health Services Administration). The problems of addiction became gradually identified. Legal measures against drug abuse in the United States were first established in 1875, when opium dens were outlawed in San Francisco. The first national drug law was the Pure Food and Drug Act of 1906, which required accurate labeling of patent medicines containing opium and certain other drugs. In 1914 the Harrison Narcotic Act forbade sale of substantial doses of opiates or cocaine except by licensed doctors and pharmacies. Later, heroin was totally banned. Subsequent Supreme Court decisions made it illegal for doctors to prescribe any narcotic to addicts; many doctors who prescribed maintenance doses as part of an addiction treatment plan were jailed, and soon all attempts at treatment were abandoned. Use of narcotics and cocaine diminished by the 1920s. The spirit of temperance led to the prohibition of alcohol by the Eighteenth Amendment to the Constitution in 1919, but Prohibition was repealed in 1933. In the 1930s most states required antidrug education in the schools, but fears that knowledge would lead to experimentation caused it to be abandoned in most places. Soon after the repeal of Prohibition, the U.S. Federal Bureau of Narcotics (now the Drug Enforcement Administration) began a campaign to portray marijuana as a powerful, addicting substance that would lead users into narcotics addiction. In the 1950s, use of marijuana increased again, along with that of amphetamines and tranquilizers. The social upheaval of the 1960s brought with it a dramatic increase in drug use and some increased social acceptance; by the early 1970s some states and localities had decriminalized marijuana and lowered drinking ages. The 1980s brought a decline in the use of most drugs, but cocaine and crack use soared. The military became involved in border patrols for the first time, and troops invaded Panama and brought its de facto leader, Manuel Noriega, to trial for drug trafficking (Office of Applied Studies, Substance Abuse and Mental Health Services Administration). Throughout the years, the public's perception of the dangers of specific substances changed. The surgeon general's warning label on tobacco packaging gradually made people aware of the addictive nature of nicotine. By 1995, the Food and Drug Administration was considering its regulation. The recognition of fetal alcohol syndrome brought warning labels to alcohol products. The addictive nature of prescription drugs such as diazepam (Valium) became known, and caffeine came under scrutiny as well. Drug laws have tried to keep up with the changing perceptions and real dangers of substance abuse. By 1970 over 55 federal drug laws and countless state laws specified a variety of punitive measures, including life imprisonment and
even the death penalty. To clarify the situation, the Comprehensive Drug Abuse Prevention and Control Act of 1970 repealed, replaced, or updated all previous federal laws concerned with narcotics and all other dangerous drugs. While possession was made illegal, the severest penalties were reserved for illicit distribution and manufacture of drugs. The act dealt with prevention and treatment of drug abuse as well as control of drug traffic. The Anti-Drug Abuse Acts of 1986 and 1988 increased funding for treatment and rehabilitation; the 1988 act created the Office of National Drug Control Policy. Its director, often referred to as the drug “czar,” is responsible for coordinating national drug control policy (Office of Applied Studies, Substance Abuse and Mental Health Services Administration).