Adel Eldahmy, MD, MBA
          
 Joseph Simpson, MD,PhD
        
 Michael Ferguson, LCSW
          
 Enas Elshiwck, MFT, PsyD
         
 Catherine Speckmann,LCSW

          

 Mary-Louise Henson, LMFT

          

         

949.367.1200


Alcohol and Drug depenence


What are alcohol abuse and alcohol dependence?

 

Alcohol abuse means having unhealthy or dangerous drinking habits, such as drinking every day or drinking too much at a time. Alcohol abuse can harm your relationships, cause you to miss work, and lead to legal problems such as driving while drunk ( intoxicated). When you abuse alcohol, you continue to drink even though you know your drinking is causing problems.

If you continue to abuse alcohol, it can lead to alcohol dependence. Alcohol dependence is also called alcoholism. You are physically or mentally addicted to alcohol. You have a strong need, or craving, to drink. You feel like you must drink just to get by.

You might be dependent on alcohol if you have three or more of the following problems in a year:

  • You cannot quit drinking or control how much you drink.
  • You need to drink more to get the same effect.
  • You have withdrowal symptoms when you stop drinking. These include feeling sick to your stomach, sweating, shakiness, and anxiety.
  • You spend a lot of time drinking and recovering from drinking, or you have given up other activities so you can drink.
  • You have tried to quit drinking or to cut back the amount you drink but haven't been able to.
  • You continue to drink even though it harms your relationships and causes you to develop physical problems.


You might not realize that you have a drinking problem. You might not drink every day, or you might not drink large amounts when you drink. You might go for days or weeks between drinking episodes. You might say you're a "social drinker."

But even if you don't drink very often, it's still possible to be abusing alcohol and to be at risk for becoming addicted to it.

Symptoms of alcohol abuse in children and teens sometimes are different from adult symptoms.

Signs of alcohol abuse

Watch for the following signs of alcohol abuse:

  • You have problems at work or school because of your drinking. These may include being late or absent, being injured at work, and not doing your job or schoolwork as well as you can.
  • You drink in dangerous situations, such as before or while driving a car.
  • You have blakeouts. This means that after a drinking episode you cannot remember what happened while you were drinking.
  • You have legal problems because of your drinking, such as being arrested for harming someone or driving while drunk (intoxicated).
  • You get hurt or you hurt someone else when you are drinking.
  • You continue to drink despite health problems that are caused or made worse by alcohol use, such as liver disease (cirrhosis).
  • Your friends or family members are worried about your drinking.

Signs of alcohol dependence or addiction

Watch for the following signs of alcohol dependence or addiction:

  • You cannot quit drinking or control how much you drink. You drink more often than you want to, or you drink larger amounts than you want to.
  • You need to drink more to get the same effect.
  • You have withdrowal symptoms when you stop drinking. These include feeling sick to your stomach, sweating, shakiness, and anxiety.
  • You spend a lot of time drinking and recovering from drinking, or you have given up other activities so you can drink.
  • You have tried unsuccessfully to quit drinking or to cut back the amount you drink.
  • You continue to drink even though it harms your relationships and causes you to develop physical problems.

Other signs of possible trouble with alcohol include the following:

  • You drink in the morning, are drunk often for long periods of time, or drink alone.
  • You change what you drink, such as switching from beer to wine because you think that doing this will help you drink less or keep you from getting drunk.
  • You feel guilty after drinking.
  • You make excuses for your drinking or do things to hide your drinking, such as buying alcohol at different stores.
  • You worry that you won't get enough alcohol for an evening or weekend.
  • You have physical signs of alcohol dependence, such as weight loss, a sore or upset stomach(gastritis), or redness of the nose and cheeks.

 

What Is a Drug Addiction?

 

Addiction is a chronic, often relapsing brain disease. It causes compulsive drug seeking and use despite harmful consequences to the addicted person as well as the people around that person. The abuse of drugs -- even prescription drugs -- leads to changes in the structure and function of the brain.

For most people, the initial decision to take prescription drugs is voluntary. Over a period of time, however, changes in the brain caused by repeated drug abuse affect a person's self control and ability to make sound decisions. While this is going on, the person continues to experience intense impulses to take more drugs.

 

Which Prescription Drugs Are Commonly Abused?

 

According to the National Institute on Drug Abuse, the three classes of prescription drugs that are often abused include:

  • opioids used to treat pain
  • central nervous system (CNS) depressants used to treat anxiety and sleep disorders
  • stimulants used to treat and narcolepsy (a sleep disorder)

Cocaine Use and Its Effects

 

Cocaine -- a high-priced way of getting high -- has a mystique. Called "the caviar of street drugs," Cocaine is seen as the status-heavy drug of celebrities, fashion models, and Wall Street traders.

The reality of cocaine hits after the high. Cocaine has powerful negative effects on the heart, brain, and emotions. Many cocaine users fall prey to addiction, with long-term and life threatening consequences. Even occasional users run the risk of sudden death with cocaine use. Read on for the not-so-glamorous truth about cocaine use and its effects.

 

Coca, Cocaine, and Crack

Cocaine is a purified extract from the leaves of the Erythroxylum coca bush. This plant grows in the Andes region of South America. Different chemical processes produce the two main forms of cocaine:

  • Powdered cocaine -- commonly known on the street as "coke" or "blow" -- dissolves in water. Users can snort or inject powdered cocaine.
  • Crack cocaine -- commonly known on the street as "crack" or "rock" -- is made by a chemical process that leaves it in its "freebase" form, which can be smoked.

About 14% of U.S. adults have tried cocaine. One in 40 adults has used it in the past year. Young men aged 18 to 25 are the biggest cocaine users, with 8% using it in the previous 12 months.

 

Cocaine: Anatomy of a High

Smoking or injecting cocaine results in nearly instantaneous effects. Rapid absorption through nasal tissues makes snorting cocaine nearly as fast-acting. Whatever the method of taking it in, cocaine quickly enters the bloodstream and travels to the brain.

Deep in the brain, cocaine interferes with the chemical messengers -- neurotransmitters -- that nerves use to communicate with each other. Cocaine blocks norepinephrine, serotonin, dopamine, and other neurotransmitters from being reabsorbed. The resulting chemical buildup between nerves causes euphoria or feeling "high."

What's so great about being high on coke? Cocaine users often describe the euphoric feeling as:

  • an increasing sense of energy and alertness
  • an extremely elevated mood
  • a feeling of supremacy

On the other hand, some people describe other feelings tagging along with the high:

  • irritability
  • paranoia
  • restlessness
  • anxiety

Signs of using cocaine include:

  • dilated pupils
  • high levels of energy and activity
  • excited, exuberant speech

Cocaine's immediate effects wear off in 30 minutes to two hours. Smoking or injecting cocaine results in a faster and shorter high, compared to snorting coke.

 

Physiological Effects of Cocaine

Cocaine produces its powerful high by acting on the brain. But as cocaine travels through the blood, it affects the whole body.

Cocaine is responsible for more U.S. emergency room visits than any other illegal drug. Cocaine harms the brain, heart, blood vessels, and lungs -- and can even cause sudden death. Here's what happens in the body:

  • Heart. Cocaine is bad for the heart. Cocaine increases heart rate and blood pressure while constricting the arteries supplying blood to the heart. The result can be a heart attack, even in young people without heart disease. Cocaine can also trigger a deadly abnormal heart rhythm called arrythmia  killing instantly.
  • Brain. Cocaine can constrict blood vessels in the brain, causing strokes. This can happen even in young people without other risk factors for strokes. Cocaine causes seizures and can lead to bizarre or violent behavior.
  • Lungs and respiratory system. Snorting cocaine damages the nose and sinuses. Regular use can cause nasal perforation. Smoking crack cocaine irritates the lungs and, in some people, causes permanent lung damage.
  • Gastrointestinal tract. Cocaine constricts blood vessels supplying the gut. The resulting oxygen starvation can cause ulcers, or even perforation of the stomach or intestines.
  • Kidneys. Cocaine can cause sudden, overwhelming kidney failure through a process called rhabdomyolysis. In people with high blood pressure, regular cocaine use can accelerate the long-term kidney damage caused by high blood pressure.
  • Sexual function. Although cocaine has a reputation as an aphrodisiac, it actually may make you less able to finish what you start. Chronic cocaine use can impair sexual function in men and women. In men, cocaine can cause delayed or impaired ejaculation.

Benzodiazepine Abuse

 

Benzodiazepines are a type of medication known as tranquilizers. Familiar names include Valium and Xanax. They are some of the most commonly prescribed medications in the United States. When people without prescriptions take these drugs for their sedating effects, then use turns into abuse.

  • Doctors may prescribe a benzodiazepine for the following legitimate medical conditions:
    • Anxiety
    • Insomnia
    • Alcohol withdrawal
    • Seizure control
    • Muscle relaxation
    • Inducing amnesia for uncomfortable procedures
    • Given before an anesthetic (such as before surgery)
  • Benzodiazepines act on the central nervous system, produce sedation and muscle relaxation, and lower anxiety levels.

          They are usually classified by how long their effects last.

  • Ultra-short acting - Midazolam (Versed), triazolam (Halcion)
  • Short-acting - alprazolam (Xanax), lorazopam (Ativan)
  • Long-acting - Chlordiazepoxide (Librium), diazepam (Valium

  • Benzodiazepines are commonly abused. This abuse is partially related to the toxic effects that they produce and also to their widespread availability. They can be chronically abused or, as seen more commonly in hospital emergency departments, intentionally or accidentally taken in overdose. Death and serious illness rarely result from benzodiazepine abuse alone; however, they are frequently taken with either alcohol or other medications. The combination of benzodiazepines and alcohol can be dangerous.

Benzodiazepine Abuse Causes

 

Although some people may have a genetic tendency to become addicted to drugs, there is little doubt that environmental factors also play a significant role. Some of the more common environmental influences are low socioeconomic status, unemployment, and peer pressure.

 

Benzodiazepine Abuse Symptoms

 

At normal or regular doses, benzodiazepines relieve anxiety and insomnia. They are usually well tolerated. Sometimes, people taking benzodiazepines may feel drowsy or dizzy. This side effect can be more pronounced with increased doses.

  • High doses of benzodiazepines can produce more serious side effects. Signs and symptoms of acute toxicity or overdose may include the following:
    • Drowsiness
    • Confusion
    • Dizziness
    • Blurred vision
    • Weakness
    • Slurred speech
    • Lack of coordination
    • Difficulty breathing
    • Coma
  • Signs of chronic drug abuse can be very nonspecific and include changes in appearance and behavior that affect relationships and work performance. Warning signs in children include abrupt changes in mood or deterioration of school performance. Chronic abuse of benzodiazepines can lead to the following symptoms that mimic many of the indications for using them in the first place:
    • Anxiety
    • Insomnia
    • Anorexia
    • Headaches
    • Weakness
  • Despite their many helpful uses, benzodiazepines can lead to physical and psychological dependence. Dependence can result in withdrawal symptoms and even seizures when they are stopped abruptly. Dependence and withdrawal occur in only a very small percentage of people taking normal doses for short periods. The symptoms of withdrawal can be difficult to distinguish from anxiety. Symptoms usually develop at 3-4 days from last use, although they can appear earlier with shorter-acting varieties.

Alcohol dependence, an entity in which an individual uses alcohol despite significant areas of dysfunction, evidence of physical dependence, and/or related hardship.


 

Definition and Diagnosis

In a 12 month period, the patient must satisfy 3 out of 7 of the following:

  • Tolerance
  • Withdrawal symptoms or clinically defined Alcohol Withdrawal Syndrome
  • Use in larger amounts or for longer periods than intended
  • Persistent desire or unsuccessful efforts to cut down on alcohol use
  • Time is spent obtaining alcohol or recovering from effects
  • Social, occupational and recreational pursuits are given up or reduced because of alcohol use
  • Use is continued despite knowledge of alcohol-related harm (physical or psychological)

 


 History and Epidemiology

About 12% of American adults have had an alcohol dependence problem at some time in their life. Alcohol dependence is acknowledged by the American Medical Association as a disease because it has a characteristic set of signs and symptoms and a progressive course.

 


 


Drug abuse has a huge range of definitions related to taking a psychoactive drug or performance enhancing drug for a non-therapeutic or non-medical effect. All of these definitions imply a negative judgment of the drug use in question (compare with the term responsible drug use for alternative views). Some of the drugs most often associated with this term include alcohol, amphetamines, barbiturates, benzodiazepines, cocaine, methaqualone, and opium alkaloids. Use of these drugs may lead to criminal penalty in addition to possible physical, social, and psychological harm, both strongly depending on local jurisdiction. Other definitions of drug abuse fall into four main categories: public health definitions, mass communication and vernacular usage, medical definitions, and political and criminal justice definitions.

Worldwide, the UN estimates there are more than 50 million regular users of heroin, cocaine and synthetic drugs.

 

 

"Substance dependence When an individual persists in use of alcohol or other drugs despite problems related to use of the substance, substance dependence may be diagnosed. Compulsive and repetitive use may result in tolerance to the effect of the drug and withdrawal symptoms when use is reduced or stopped. This, along with Substance Abuse are considered Substance Use Disorders...."

However, other definitions differ; they may entail psychological or physical dependence , and may focus on treatment and prevention in terms of the social consequences of substance uses.

 

 

Signs and symptoms

Depending on the actual compound, drug misuse including alcohol may lead to health problems, social problems, morbidity, injuries, unprotected sex, violence, deats, motor vehicle accidents, homicides, suicides, mortality, physical dependence or psychological addiction.

There is a high rate of suicide in alcoholics and drug abusers. The reasons believed to cause the increased risk of suicide include the long-term abuse of alcohol and drugs causing physiological distortion of brain chemistry as well as the social isolation. Another factor is the acute intoxicating effects of the drugs may make suicide more likely to occur. Suicide is also very common in adolescent alcohol abusers, with 1 in 4 suicides in adolescents being related to alcohol abuse.In the USA approximately 30 percent of suicides are related to alcohol abuse. Alcohol abuse is also associated with increased risks of commiting criminal offences including child abuse, domestic violence, rapes, burglaries and assaults.

Drug abuse, including alcohol and prescription drugs can induce symptomatology which resembles mental illness. This can occur both in the intoxicated state and also during the withdrawal state. In some cases these substance induced psychiatric disorders can persist long after detoxification, such as prolonged psychosis or depression after amphetamine or cocaine abuse. A protracted withdrawal syndrome can also occur with symptoms persisting for months after cessation of use. Benzodiazepines are the most notable drug for inducing prolonged withdrawal effects with symptoms sometimes persisting for years after cessation of use. Abuse of hallucinogens can trigger delusional and other psychotic phenomena long after cessation of use and cannabis may trigger panic attacks during intoxication and with use it may cause a state similar to dysthymia. Severe anxiety and depression are commonly induced by sustained alcohol abuse which in most cases abates with prolonged abstinence. Even moderate alcohol sustained use may increase anxiety and depression levels in some individuals. In most cases these drug induced psychiatric disorders fade away with prolonged abstinence.

Drug abuse makes central nervous system (CNS) effects, which produce changes in mood, levels of awareness or perceptions and sensations. Most of these drugs also alter systems other than the CNS. Some of these are often thought of as being abused. Some drugs appear to be more likely to lead to uncontrolled use than others.