Topic Overview

The overuse or misuse of alcohol (alcoholism) or other drugs is called a substance use problem. It can cause or worsen many medical problems and can destroy families and lives.

Alcohol

Alcohol misuse causes over 100,000 deaths in the United States and Canada each year. It is the drug most commonly used by children ages 12 to 17. Alcohol-related car crashes are the leading cause of death in teenagers. People who drink alcohol are more likely to engage in high-risk sexual behavior, have poor grades or job performance, use tobacco products, and experiment with illegal drugs. Alcohol and drug use may be an unconscious attempt at self-treatment for another problem, such as depression.

You have an alcohol problem if your use of alcohol interferes with your health or daily living. You develop alcoholism if you physically or emotionally depend on alcohol to get you through your day.

Long-term heavy drinking damages the liver, nervous system, heart, and brain. It can lead to high blood pressure, stomach problems, medicine interactions, sexual problems, osteoporosis, and cancer. Alcohol misuse can also lead to violence, accidents, social isolation, jail or prison time, and problems at work and home.

Symptoms of an alcohol problem include personality changes, blackouts, drinking more and more for the same "high," and denial of the problem. A person with an alcohol problem may gulp or sneak drinks, drink alone or early in the morning, and suffer from the shakes. He or she may also have family, school, or work problems or get in trouble with the law because of drinking.

The use of alcohol with medicines or illegal drugs may increase the effects of each.

Alcohol misuse patterns vary. Some people drink and may be intoxicated (drunk) every day. Other people drink large amounts of alcohol at specific times, such as on the weekend. It is common for someone with an alcohol or drug problem to call in sick for work on Monday or Friday. He or she may complain of having a virus or the flu. Others may be sober for long periods and then go on a drinking binge that lasts for weeks or months.

Someone with alcohol dependence may suffer serious withdrawal symptoms, such as trembling, delusions, hallucinations, and sweating, if he or she stops drinking suddenly ("cold turkey"). After alcohol dependence develops, it becomes very hard to stop drinking without outside help. Medical detoxification may be needed.

Drugs

Drug misuse includes the use of illegal drugs—such as marijuana, methamphetamines, cocaine, heroin, or other "street drugs"—and the misuse of legal prescription and nonprescription drugs. Some people use drugs to get a "high" or to relieve stress and emotional problems.

Drugs like ecstasy (MDMA), ketamine, GHB, Rohypnol, and LSD, which are known as "club drugs," may be found at all-night dances, raves, trances, or clubs. The use of club drugs accounts for increasing numbers of drug overdoses and emergency room visits. Inhalants like nitrous oxide may also be used at these clubs. Drugs come in different forms and can be used in different ways. They can be smoked, snorted, inhaled, taken as pills, put in liquids or food, put in the rectum or the vagina, or injected with a needle. Teens and young adults may be at risk for becoming victims of sexual assault or violent behavior in situations where these drugs are used.

Prescription medicines that may be misused include opioids (morphine and codeine), diazepam (Valium), hydrocodone and acetaminophen (Norco), methylphenidate (Ritalin), and oxycodone (OxyContin).

Some nonprescription medicines, such as cold medicines that have dextromethorphan as an ingredient, are being misused by teens and young adults as a way to get a "high." Glue, shoe polish, cleaning fluids, and aerosols, are common household products with ingredients that can also be used to get a "high."

In the United States and Canada, approximately 40% of adults will use an illegal drug at some time during their lives. This does not include the use of alcohol or prescription medicines. Many people use more than one illegal substance at a time.

Drug dependence or addiction occurs when you develop a physical or emotional "need" for a drug. You are unable to control your use of a drug despite the negative impact it has on your life. You may not be aware that you have become dependent on a drug until you try to stop taking it. Drug withdrawal can cause uncomfortable and sometimes dangerous symptoms. The usual treatment is to gradually reduce the dose of the drug until you can completely stop using it.

High-risk groups

Some groups of people are more likely than others to have problems related to alcohol or drug use. These groups include:

• Teenagers and young adults. Approximately one-half of all high school seniors in the U.S. admit to having used alcohol or an illegal drug. Substance use in this age group increases the risk of involvement in crime, high-risk sexual behavior, accidents, and injuries. Teens that use alcohol and drugs are more likely to have poor school performance and have higher dropout rates. For more information, see the topic Teen Alcohol and Drug Use.
• Women.
  • Although women are less likely than men to misuse alcohol, they are more likely to have alcohol-related health problems, such as liver disease.
  • Women are more likely to have problems with prescription medicines. More than two-thirds of all tranquilizers are prescribed for women. Tranquilizers, sedatives, pain medicines, and amphetamines are misused most often by women.
  • Alcohol and drug misuse in women increases the risk of developing other health problems, such as osteoporosis or depression.
  • Women who misuse alcohol and drugs attempt suicide four times more frequently than those who do not.
• Adults older than age 65. Drug misuse in this age group is a problem because of the high number of prescription medicines and the lack of coordination between doctors. Signs of alcohol or drug misuse may be mistaken for other disease problems or simply overlooked as a symptom of "aging." Many older adults "self-medicate" with alcohol to help relieve sleep problems, depression, and other problems. Alcohol misuse is more common than drug misuse in older adults. Alcohol contributes to car crashes and other types of severe injury in this group of people. For more information, see the topic Substance Use Problems in Older Adults.
• Low-income populations. Drug and alcohol use is a problem for many minorities, including disabled adults, the homeless, and minority populations.
• Babies. Drug and alcohol use during pregnancy can cause birth defects and increase the risk of infant death. Babies are more likely to have learning disabilities and social and behavioral problems when their mothers use alcohol or drugs during pregnancy. Babies with mothers who use alcohol are at risk for problems from fetal alcohol syndrome.
• Children. Studies show that children who are exposed to drug misuse in the home, especially methamphetamine, have higher rates of depression, anxiety, post-traumatic stress, anger, and alcohol and drug misuse. They also are more likely to have learning problems and do poorly in school.

Recognizing a problem

Alcohol is part of many people's lives and may have a place in cultural and family traditions. It can sometimes be hard to know when you begin to drink too much.

There is a strong connection between the use of drugs and alcohol and high-risk sexual behaviors. This increases a person's chance of getting sexually transmitted infections (STIs), hepatitis B, and human immunodeficiency virus (HIV).