Substance abuse

a patterned use of a drug in which the user consumes the psychoactive/chemical substance substances in amounts or with methods which are harmful to themselves or others

Substance abuse, or drug abuse, happens when a person uses a drug over and over again, in ways that hurt their health. The person is using the drug to change their mood or to feel better, not for any healthy reason. Sometimes when the person uses the drug for a long time, they will start to act differently. Some of the drugs are illegal to have or use, or can have certain limits that the person does not follow. Someone who thinks that they need a drug is called an addict.

Is it substance abuse?Edit

Substance abuse can have different symptoms in different people. “Drug abuse” is not used in the DSM or ICD. In the DSM, the term “substance abuse” is used instead to mean the misuse of one of ten different types of drugs.  A person can also become dependent on drugs.[1] Repetitive use of a drug can cause dependence as well as tolerance. Tolerance happens when it takes more of a drug to produce the same effect than a previous time.

The term “drug misuse” is sometimes used when the drug being used is a prescription medication that are classified as sedatives (medicines that make someone calm), anxiolytics (medicines that make someone less worried or anxious), analgesics (medicines that reduce pain), or stimulants (medicines that give someone more energy).[2] Someone who abuses there drugs may have to illegally buy them from someone who gets them from a doctor.

Not everyone agrees on the definition of substance abuse. Different countries have different rules for what is a drug and what drugs are illegal. People also do not agree about what is abuse. In most Western countries, one glass of wine is acceptable, but drinking more than one bottle at once is abuse. To some people, any drinking can be seen as abuse. In the United States, any use of marijuana

What causes people to abuse substances?Edit

In many cases, when a person is using drugs, their thinking and behaviors change. Sometimes, they commit crimes while using drugs. They may do things that are not safe, like drive a car while drunk. When people abuse drugs over a longer time, their personalities often change as well. The people who abuse drugs are often addicted. Since many of these drugs are illegal, very often drug users have problems with the law.

There are two major ideas about why people abuse drugs.[3] Many people believe that both can be true for different cases or with different people, which is one reason why different treatments work better or worse for different people.

One idea about why people use drugs is because of their genes. When a person's parents or grandparents have been addicted to drugs, alcohol, cigarettes or even coffee, the same genes that made them become addicted could be passed down to any of their children. When someone is born with the genes that increase addiction, it causes their brain and body to become dependent on drugs very quickly. But even if a person's genes make it easier for them to become addicted to drugs, that person still need to try a drug first, before they can become addicted on it. This idea also means that different people can have harder or easier time stopping drugs after they are already addicted.

The second major idea is that drug use is a habit that becomes harmful. It is always very hard to stop bad habits, but in this idea, drugs are one of the strongest bad habits because drugs cause so many changes in the brain. Each time a person uses drugs, the parts of the brain that think about drugs become stronger and stronger. In this idea, if a person likes drugs, that person starts to plan their day around using drugs. To stop a habit as strong as drug use, many other things about that person's life must also change. This idea also means that, the longer a person takes drugs, the harder it is for them to stop taking drugs.

What kind of drugs are abused?Edit

People abuse drugs in many different ways, including:

Illegal drugsEdit

Some of the most commonly abused illegal drugs are:[4]

Legal drugs and medicinesEdit

Some of the most commonly abused legal drugs and medicines are:[4]

Substance abuse, depression, and suicideEdit

People who abuse drugs have a high rate of suicide. This is because of the changes in the brain caused by drugs, both when they are being used and the changes they cause over time. Another cause is the loss of family and friends because of the drug abuse. In the United States, about 30% of all people who perform suicide have abused alcohol at some point.[5]

This table explains more about how some commonly abused drugs relate to depression and suicide:

Substance abused Effects related to suicide
Alcohol People who misuse alcohol are more likely to have a number of mental health disorders. Alcoholics have a very high suicide rate. Suicide from alcoholism is more common in older adults.[6] If a person drinks 6 or more drinks per day, they are six times more likely to commit suicide.[7][8] Many heavy drinkers have major depressive disorder, and heavy drinking itself can cause major depressive disorder in a lot of alcoholics.[9]
Benzodiazepines People are more likely to be depressed, and have a higher risk of suicide, if they have been abusing benzodiazepines (like Xanax) or using them for a long time.[10] Depressed adolescents who were taking benzodiazepines were much more likely to hurt themselves or kill themselves.[11]
Cigarette smoking Many studies have shown a link between smoking, thinking about suicide, and suicide attempts.[12][13] In studies done with 50,000 nurses and 300,000 male U.S. Army soldiers, the people who smoked between 1 to 24 cigarettes per day had twice the suicide risk, and people who smoked 25 cigarettes or more had 4 times the suicide risk, as compared with those who had never smoked.[14][15]
Cocaine Misuse of drugs such as cocaine often has a link with suicide. When cocaine's effects wear off, people go through cocaine withdrawal. During this time, many people feel very bad. Suicide is most likely to happen during this time in people who use a lot of cocaine or are addicted. In younger adults, suicide more commonly happens when two or more drugs are taken together.
Crystal meth Crystal meth use has a strong link with depression and suicide, as well as a range of other bad effects on physical and mental health.[16]
Heroin 3% to 35% of deaths among heroin users are thought to be from suicide. Overall, heroin users are 14 times more likely than people who do not use heroin to die from suicide.[17]

Treating substance abuseEdit

Treatment of substance abuse can include both therapy and medicine. Therapy for substance abuse helps people not use drugs when they feel they need to. For children and young adults, both the child and the family may have therapy. The child will learn how to not abuse, and the family will learn how to help the child. The organization Alcoholics Anonymous helps people with alcohol abuse.[18]

For some kinds of substance abuse, medicine can be used to help.[19] Some of these medicines, such as methadone, stop the drug from working in the brain. Other medicines can cause people to feel ill if they use the substance that they abuse. Some medicines, like bupropion, makes people stop wanting the drug so much.[20]

Many substances can cause withdrawal. Withdrawal is group of bad feelings that happen when someone stops taking a drug suddenly, if they were regularly taking that drug before. For someone to have withdrawal, they must be dependent on the drug. Different drugs cause different things to happen during withdrawal. They can also cause different amounts of trouble for the person in withdrawal. Withdrawal for some drugs, like heroin and other opiates, can be dangerous or deadly, and should be done with a doctor or nurse taking care of the person in withdrawal.


About 9% of Americans have a substance abuse issue. Young people are the most likely to experiment with and abuse drugs. Drug abuse affects about 5% of adolescents.[21] More men than women have substance abuse disorder, though women are more likely to have an issue with abusing prescription medication. Children who have parents with substance abuse issues are more likely to have a substance abuse issue when they grow up.

Special populationsEdit

Certain groups of people are more likely to develop substance abuse issues. One group is immigrants or other people who have left their home country. They often have issues in their new country, and some use drugs as a way to feel better.[22]  Another group that is at risk is homeless children. They will use drugs to become closer to each other.[23] A third group that is at risk is musicians. They may use stimulants to make themselves more active and happy. Singers can also hurt themselves if they use drugs that are inhaled.[24]


The first official definition for substance abuse was made in 1932 by the American Psychiatric Association. This definition was only used for when the substance was illegal and not being used as medicine.[25] In 1966, the American Medical Association defined abuse as the drug being given by someone to themselves without a doctor.

The first edition of the Diagnos[26]tic and Statistical Manual of Mental Disorders (DSM) had drug abuse as a symptom of other psychological issues. In the third edition, substance abuse was made its own issue. The DSM also has drug abuse as a different issue than drug dependence, which is defined as compulsive use of a drug.

Society and cultureEdit

Most countries have laws that make having or using certain drugs illegal. The rules for these drugs can be different between countries or in different parts of the same country. Many drugs that are illegal in several places are sold to make money for groups known as drug cartels.

Drug abuse can also cause issues in a country’s economy. According to the European Union, about 2.5 billion dollars are lost each year because of people abusing drugs. This loss comes from people not going to work or having to go to the hospital because of side effects of the drug. In the United Kingdom, about 29 billion dollars a year are lost.[27] This number does not include the cost of police or other law enforcement. In the United States, the cost was 181 billion dollars in 2002. This number includes costs because of health issues, loss of work, law enforcement, and welfare programs.

The “Chasing The Dragon” DocumentaryEdit

On February 4, 2016 - in an effort to help raise the awareness of an opioid and prescription drug abuse epidemic - the United States Federal Bureau of Investigation (FBI) and the Drug Enforcement Administration (DEA) released the “Chasing the Dragon: The Life of an Opiate Addict” documentary which focused on the crisis of prescription drugs and outlined the dangerous cycle of opioid and prescription drug abuse - how the problem starts, how the addiction takes hold and how that addiction damages one’s life and body. The 47-minute film, whose title refers to the never-ending pursuit of the original or ultimate high, features stark first-person accounts told by individuals who either themselves have abused opioids or who have children who have abused opioids, in some cases with tragic consequences. The “Chasing the Dragon” documentary is a wrenching but crucial viewing experience, particularly for young people who must contend with mounting peer pressures on a daily basis.

“This film may be difficult to watch,” explained the FBI Director at the time James B. Comey, “but we hope it educates our students and young adults about the tragic consequences that come with abusing these drugs and that it will cause people to think twice before becoming its next victim.”

The Acting DEA Administrator at the time Chuck Rosenberg said, “The numbers are appalling and shocking - tens of thousands of Americans will die this year from drug-related deaths and more than half of these deaths are from heroin and prescription opioid overdoses. You will see in “Chasing the Dragon” opioid abusers that have traveled a remarkably dangerous and self-destructive path. I hope this will be a wakeup call for folks. Please pay close attention to this horrific epidemic.”

The documentary also features interviews with medical and law enforcement professionals discussing a variety of issues including how quickly addiction can set in, how the increasing costs of prescription opioids can lead to the use of heroin as a less expensive alternative, the horrors of withdrawal, the ties between addiction and crime and the fact that, contrary to popular belief, opiate abuse is prevalent in all segments of society.

The quotations from the "Chasing the Dragon" documentary:

“You can be the smartest person in the world - [but] the minute that chemical hits your bloodstream, you lose control of what it does in your body. You can’t control it. Nobody can control it - it’s not controllable.” - Deborah Taylor, President & CEO of Phoenix House Mid-Atlantic.

“A friend offers you something at a party or at home. Or you’re having a bad day and need something to pick you up so somebody hands you a pill and says, “Here this’ll, this’ll help you feel better”. That’s how this problem always starts.

...First time somebody uses an opiate drug, the euphoria that they get is something that they continue to search for and seek for. So, while you could do that in the beginning by just chewing on the drug, over time you can’t get that high anymore, and so now you have to take it up to the next level. And nobody sets out thinking that they are going to end up being a needle user. But every one of those needle users will tell you that they couldn’t get the high anymore doing it the way they were doing.

...How do you know you’re an addict? It’s when you’re doing something that you know is not good for you, that’s harming you, but you can’t help yourself. When your relationships are starting to fall apart around you and you don’t care. And the only thing that’s on your mind is about how to get the substance and how to get to the next high - you’re an addict. You can’t maintain an opiate addiction and a normal life for very long.

...Every generation seems to have their drug of choice. Unfortunately this generation seems to have found prescription opiates as that drug of choice. And even more unfortunately, the consequences of those drugs are far more devastating than anything else we’ve seen in the past. Chemically and physiologically speaking there is very little difference between oxycodone, morphine and heroin. It’s just that one comes in a prescription bottle and another one comes in a plastic bag.” - Dr. Deeni Bassam, M.D., Board Certified Anesthesiologist and Pain specialist.

“I never hesitate to ask them all which drugs they’ve tried. And they’ll typically say, “I tried, started off with marijuana. Tried cocaine. I’ve tried oxycodone.” And I ask them of all the drugs they’ve ever tried what’s the most addictive drug? And without a doubt, 100% of the time they’ll say, “The most addictive drug is oxycodone.

...Best thing that can happen to someone who is addicted to oxycodone is that they can be arrested. That’s the best thing. The best thing [is] that they can be arrested and go to jail. Everything other than that is worse. It’s gonna end in a bad way.” - The FBI Special Agent Andrew Lenhart.

“She was 17 years old and the only way I knew about it is because she was arrested. ...She was pulled over ...and she was a convicted felon at the age of 18.

...She started in gymnastics when she was, like, a toddler and she was a cheerleader through middle schools, high schools, and she was also a competitive cheerleader. She was a very good student, she was in AP classes, AB honor roll.

...I think the new friends had a really big impact on [her], when she got to that fork in the road - you go left or you go right. And I think at that point, the friends helped pick the road that she chose. “This sounds really appealing. I’m gonna try that.” But, I guess what most people and most kids don’t understand is, you know, when you try something you’re not [just] trying it - it’s your new path.

...She stole checks from her grandmother, ...she stole my debit card, ...she spent $800 a week. My daughter, who could have gone anywhere in the world, very book smart, you know, very motivated, worked at a strip club. My little girl degraded herself just to get that. ...[But] you have to understand what you are dealing with is not your child.

...[So] she was seven months clean - eating healthy, getting her rest, no drugs. ...And she came out and just, she was healthy. Everything was great. Everything was great. There were no problems, no fighting, no talking about, “You know mom I’m feeling funny, you know I need to go to a meeting.” Nothing, everything was just that little girl at 16 before all this stuff started.

...And then she asked to go to the store to get a pack of cigarettes. And she came home, said, “Oh, you know, mom, I’m sorry I was late, you know, they didn’t have my cigarettes I had to go to another gas station.” Okay, you know, and things fine, so I’m cooking dinner and I’m like, “You want to help me cook.” She’s like, “No, I don’t want to help you cook.” You know, she, “I’m gonna go in my room and watch TV.” You know, and she was so bubbly, you know, like, like nothing, nothing was wrong. And she went upstairs and it was maybe 40 minutes. I was cooking dinner. Dinner was done. And I’m hollering for the kids. My son and nephew come down, and Cierra doesn’t come down. I’m like, “she fell asleep or something.” So I go upstairs, and I’m knocking, and knocking, and knocking on the door and there is no answer. I open that door, and my little girl is on the floor dead. ...I was in my kitchen cooking dinner and that happened seventeen steps up and I had no idea. No idea that when she left this house that was gonna happen. And I spend my Sundays looking at a gray headstone in a patch of grass. I will be spending my Christmases there, her birthdays there, all my holidays because she took that wrong turn.

...She got out ...came home on February 12 ...[and] died February 18. ...It’s that powerful that you could spend seven months clean, clean and being educated on nothing but how to beat it, how bad it is for you, you know, all this, and you last six days.

...Cierra did not take life for granted until she started using. It is much stronger than you. And it will win. It will win, because this doesn’t just affect you. It affects everybody in your family for the rest of their lives. Don’t think you can do it alone ‘cause you can’t. ..[And] we’re the ones stuck here missing you.” - Patricia Vallejo (Trish), the mother of Cierra whose history of drug addiction - among many others - is featured in the “Chasing the Dragon” documentary.

The “Chasing the Dragon: The Life of an Opiate Addict” documentary was produced and directed by James Barrett and Thomas Benca. The documentary - available for viewing or downloading - as well as additional resources and guidance can be found on the FBI website.

Related pagesEdit


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