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he brain changes when a person abuses il- (doh-puh-meen), which is responsible for feelings licit (illegal) and prescription drugs or , of reward and pleasure. With long-term exposure, Toften causing and making it harder a person can become addicted to and for the person to practice self-control. The addicted may continue to use products despite person may want to quit using the substance or negative health consequences. may experience negative health and social conse- • Club drugs, which include ecstasy and the “date quences as a result of using the substance, yet still rape” drug known as “roofies,” can cause re- may be unable or unwilling to quit. duced inhibitions, poor judgment, memory loss, Not everyone who abuses a substance will be- and loss of consciousness. At high doses, these come addicted. However, substance abuse can drugs can cause seizures, coma, and death. often lead to family disintegration, loss of employ- • , including LSD, cause a person to ment, failure in school, domestic violence, and child experience hallucinations (images, sounds, and abuse. Military personnel returning from combat sensations that seem real but are not) and rapid, are also at an increased risk for abuse of alcohol, intense emotional swings. Rapid heart rate, high tobacco, and prescription drugs. blood pressure, tremors, and panic are among the many varying symptoms of hallucinogens. What are the symptoms? • Marijuana is legal in 2 states for recreational use Symptoms of substance abuse and addiction vary and legal in many more states for medical use based on the substance. In general, if a person with a prescription. Despite its growth in popular- turns to the substance to cope, craves the sub- ity, it remains illegal at the federal level and is now

TEAR OFF HERE stance, or feels ill without it (withdrawal) despite not the most commonly abused illicit substance in wanting to use it, he or she is likely experiencing a the U.S. The chemical found in marijuana, known disorder or addiction. as THC, is absorbed into the bloodstream by in- • Alcohol, specifically ethanol, is found in , haling or eating the marijuana. Abuse overacti- , and liquor. Abuse of alcohol is termed alco- vates receptors in the brain, leading to a “high” holism and can be recognized by behaviors such feeling, altered perceptions of mood, decreased as an inability to limit the amount of alcohol being coordination and memory, and difficulty thinking, consumed, experiencing nausea/sweating/shaking problem solving, and learning. when not drinking, or hiding it from others. • Narcotic painkillers, such as , may • Anabolic steroids can be prescribed by a doc- be prescribed by a doctor or obtained illegally (eg, tor to treat conditions such as delayed puberty ). Symptoms of dependence include a re- or but can also be abused to build mus- duced sense of pain, sedation, depression, con- cle and enhance physical performance. Abuse of stipation, and slowed breathing. anabolic steroids may lead to aggression, mood • , including (meth- swings, paranoid jealousy, extreme irritability, de- am-fet-uh-meen) and , are highly addic- lusions, and impaired judgment. tive and cause both short- and long-term health • Cigarettes and other tobacco products, in- consequences. Weight loss, insomnia, restless- cluding , , and chewing tobacco, ness, rapid speech, paranoia, and irritability are contain the addictive drug nicotine (nick-uh- all symptoms of an addiction to stimulants. When teen). Whether chewed, inhaled, or smoked, the drug wears off, depression may set in, caus- nicotine affects the brain chemical dopamine ing the addicted person to seek another dose.

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APRIL 2014 • FEDERAL PRACTITIONER • 45 i PATIENTInformation

How do I know if I am at risk? struggling to breathe, experiencing a seizure, feels There are many ways to determine if someone is at pressure or pain in the chest, or has any other trou- risk for developing a substance use disorder. These blesome physical or mental reaction after taking a include: substance. • Family history of substance abuse • Being male How is substance abuse treated? • Personal history of a psychological disorder Research shows that combining addiction treat- • Exposure to peer pressure ment medications with behavioral therapy is the • Lack of close family or friends best way to ensure success for most patients. • Anxiety, depression, and loneliness • Medication. Without medical intervention, it can often be too difficult for a person to quit abusing Are there complications? a substance due to the withdrawal effects of ad- Substance abuse can cause serious, long-term ef- diction. Withdrawal medications can suppress fects, including problems with physical and men- these effects and serve as a first step toward de- tal health, relationships, employment, and the law. toxification (dee-tok-suh-fih-kay-shun). Treatment Mental illness can occur as a direct result of sub- medications can be used to reestablish normal stance abuse because of the close link addictive brain functioning and prevent relapse by lessen- substances have with the brain. Suicide, overdose, ing cravings. and accidental death are also serious complica- • Behavioral treatment. Treatment for substance tions of a substance use disorder. abuse and addiction can help the patient engage Other complications may include driving acci- in the treatment process, modify attitudes and dents while under the influence, financial problems, behaviors toward the substance abuse, and in- and getting an infectious disease, such as HIV crease healthy life skills. Behavioral treatment can (human immunodeficiency virus). be done on an outpatient basis, meaning the pa- tient undergoing treatment regularly visits a clinic. Can substance abuse be prevented? Most of these programs involve individual, group, The best way to prevent substance abuse is to and family talk therapy. Treatment can also be never use the substance. However, abuse can hap- done in a residential setting where the focus is pen with legal, “socially acceptable” substances on helping the patient develop a substance-free, (eg, tobacco, alcohol) or drugs prescribed by a doc- crime-free lifestyle. tor. Early intervention is key to preventing substance abuse, and recognizing the symptoms associated With treatment and support, the addicted person with substance abuse can help. can return to a substance abuse-free life. For infor- mation on seeking treatment, visit http://findtreat When do I need medical attention? ment.samhsa.gov or call (800) 662-HELP (4357). If you feel you cannot go without the substance, that using the substance is negatively impacting your life in any way, or use of the substance has led to unsafe behavior, such as using needles or having unprotected sex, make an appointment with your primary care doctor or a mental health professional. Seek emergency help by calling 911 if you or some- one you know has overdosed, lost consciousness, is

46 • FEDERAL PRACTITIONER • APRIL 2014