(^72) CHAPTER 4 Substance Abuse
Tolerance also has a metabolic effect commonly referred to as pharmacologic
tolerance. Prolonged exposure to a drug increases the excretion of the drug from
the body. This means there is a lower concentration of the drug in plasma that is
distributed throughout the body.
Pathophysiologic Changes Occurring
in Substance Abuse
Drug abusers frequently exhibit pathophysiologic changes that require treatment
along with the patient’s drug addition. These debilitating changes are malnutri-
tion, dehydration, and hypovitaminosis.
In addition, these patients can experience respiratory diseases such as pneu-
monia, blood clots (pulmonary emboli), and abscesses.
In addition, drug abusers rarely use aseptic techniques for administering drugs
intravenously which can lead to localized and systemic infections such as endo-
carditis (infection of the lining of the heart), HIV, and sepsis (infection of the entire
circulatory system). Drug abusers also incur cellulitis (infection in the tissues),
sclerosis (scaring of the veins), phlebitis (irritation of veins), and skin abscesses.
Drug abusers are always at risk of overdosing because the active ingredient in
illegal drugs are frequently adulterated with dangerous substances such as amphet-
amines, benzodiazepines, hallucinogens, and alcohol. This makes the potency of
the drug unreliable and the risk of death from an accidental overdose is high.
Cultural Aspects of Substance Abuse
The views of drug use differ among cultures around the world. Some drugs con-
sidered illegal in one culture are accepted in another culture. Alcohol, caffeine,
and nicotine are addictive drugs that are widely accepted in the United States and
elsewhere throughout the world.
Cannabis, on the other hand, is illegal in the Untied States and in many other
countries. Hallucinogens that affect the auditory and visual senses such as
peyote are used by Native Americans as part of religious rituals. Coca leaves that