17 SUBSTANCEABUSE 409
Substance use/abuse and related disorders are a
nationalhealth problem. Findings from surveys con-
ducted by the National Institute for Mental Health
show that in the United States, about 14% of adults
meet the criteria for an alcohol-related disorder and
6.2% of adults meet the criteria for a substance-
related disorder other than alcohol or tobacco (Jaffe,
2000 c). These figures do not include adolescents,
whose increasing use of alcohol and other drugs is a
national concern. Findings from a survey of 12- to
17-year-olds by the Substance Abuse and Mental
Health Services Administration indicated that 9%
had used an illicit substance and 18.8% had con-
sumed alcohol in the month before the survey (1997).
The actual prevalence of substance abuse is difficult
to determine precisely because many people meeting
the criteria for diagnosis do not seek treatment and
surveys conducted to estimate prevalence are based
on self-reported data that may be inaccurate.
Drug and alcohol abuse costs business and indus-
try an estimated $100 billion annually. Alcoholism
alone accounts for 500 million lost days of work. Up to
40% of industrial fatalities and 47% of workplace in-
juries are linked to alcoholism and alcohol consump-
tion. Estimates of motor vehicle fatalities related to
alcohol are 50% (Substance Abuse and Mental Health
Services Administration, 2002).
The number of babies suffering the physiologic
and emotional consequences of prenatal exposure to
alcohol or drugs (e.g., fetal alcohol syndrome, “crack
babies”) is increasing at alarming rates. Chemical
abuse also results in increased violence including do-
mestic abuse, homicide, and child abuse and neglect.
These rising statistics regarding substance abuse do
not bode well for future generations.
Studies have shown that 50% of all people seek-
ing treatment for alcohol-related disorders have at
least one parent who is or was an alcoholic (Brown
University Digest, 2002). Many people in treatment
programs as adults report having had their first
drink of alcohol as a young child, before 10 years of
age. This first drink was often a taste of the drink of
a parent or family member. With the increasing rates
of use being reported among young people today, this
problem seems to be spiraling out of control unless
great strides can be made through programs for pre-
vention, early detection, and effective treatment.
TYPES OF SUBSTANCE ABUSE
Many substances can be used and abused; some can
be obtained legally while others are illegal. This dis-
cussion includes alcohol and prescription medica-
tions as substances that can be abused. Abuse of
more than one substance is termed polysubstance
abuse.The DSM-IV-TRlists 11 diagnostic classes of
substance abuse:- Alcohol
- Amphetamines or similarly acting sympath-
omimetics - Caffeine
- Cannabis
- Cocaine
- Hallucinogens
- Inhalants
- Nicotine
- Opioids
- Phencyclidine (PCP) or similarly acting drugs
- Sedatives, hypnotics, or anxiolytics
It also categorizes substance-related disorders into
two groups: those that include disorders of abuse and
dependence, and substance-induced disorders such
as intoxication, withdrawal, delirium, dementia, psy-
chosis, mood disorder, anxiety, sexual dysfunction,
and sleep disorder.
This chapter describes the specific symptoms of
intoxication, overdose, withdrawal, and detoxifica-
tion for each substance with the exception of caffeine
and nicotine. Although caffeine and nicotine abuse
can cause significant physiologic health problems
and result in substance-induced disorders such as
sleep disorders, anxiety, and withdrawal, treatment
of these two substances usually is not viewed as
falling into the mental health arena.
Intoxicationis use of a substance that results
in maladaptive behavior. Withdrawal syndrome
refers to the negative psychological and physical re-
actions that occur when use of a substance ceases or
dramatically decreases. Detoxificationis the process
of safely withdrawing from a substance. The treat-
ment of other substance-induced disorders such as
psychosis and mood disorders is discussed in depth
in separate chapters.
Substance abusecan be defined as using a drug
in a way that is inconsistent with medical or social
norms and despite negative consequences. The DSM-
IV-TRdistinguishes substance abuse from depen-
dence for purposes of medical diagnosis. Substance
abuse denotes problems in social, vocational, or legal
areas of the person’s life, whereas substance depen-
dencealso includes problems associated with addic-
tion such as tolerance, withdrawal, and unsuccessful
attempts to stop using the substance. This distinction
between abuse and dependence frequently is viewed
as unclear and unnecessary (Jaffe, 2000c), because the
distinction does not affect clinical decisions once with-
drawal or detoxification has been completed. Hence
the terms substance abuse and substance dependence
or chemical dependence can be used interchangeably.
In this chapter, the term substance use is used to in-
clude both abuse and dependence; it is not meant to
refer to the occasional or one-time user.