This section, “Substance Abuse,” presents an
overview discussion of the health implications of
substance abuse and alcoholism and entries about
substances of abuse, health risks related to sub-
stance abuse, and treatment for substance abuse.
From Tonic to Toxin: Opium’s Odyssey
Many substances currently restricted because of
their high potential for abuse were once in com-
mon use. For centuries cultures around the world
used opium, the dried sap from the poppy plant,
Papaver somniferum,to relieve PAIN, induce sleep,
and provide INTOXICATION. In 1805 a young phar-
macist’s assistant, Freidrich Wilhelm Adam Ser-
turner (1783–1841), isolated morphine, opium’s
most potent ingredient, from opium; 90 years
later chemists at the Bayer Company created
HEROINfrom morphine. For the next decade the
most common use of heroin was to treat mor-
phine addiction—clearly a circumstance, in retro-
spect, of leaping from the frying pan into the fire.
By 1913 the Bayer Company stopped produc-
ing heroin, and in the 1920s opium and heroin
became illegal in the United States. Federal law
regulated the manufacture, sale, and possession of
morphine and other medicinal OPIATES. Nonethe-
less heroin continued to make its way into the
United States, and in 1970 its abuse peaked with
more than 750,000 Americans addicted. Perhaps
not so coincidentally the US Congress passed the
Controlled Substances Act, the first comprehen-
sive classification and enforcement legislation for
drugs, in the same year. Through concerted legal,
social, and medical efforts heroin abuse declined
significantly over the following 30 years, and in
2004 the US Substance Abuse and Mental Health
Administration (SAMHA) estimated 166,000 peo-
ple actively using heroin.
Opiates, and in particular morphine and its
direct derivatives, remain the mainstay of analge-
sia (pain relief) in medical treatment though
under tight regulatory control. Tens of millions of
Americans use opiates for effective pain manage-
ment. However, PRESCRIPTION DRUG ABUSEof opiate
NARCOTICSsuch as hydromorphone, hydrocodone,
oxycodone, and codeine becomes problematic for
about four million of them.Health Implications of Substance Abuse
Addiction is a condition that develops over time,
regardless of the substance or behavior that is the
source of the addiction. Social factors compound
the health issues of addiction; many people are
afraid or reluctant to acknowledge a possible addic-
tion for fear of repercussions in all areas of their
lives. Despite advances in understanding addiction
in recent years, the perception remains that addic-
tion is a matter of insufficient willpower. However,
addiction arising from substance abuse (whether
alcohol, NICOTINE, illicit drugs, or prescription
drugs) represents a complex entanglement of phys-
iologic, psychologic, and social factors. Many peo-
ple abuse multiple substances though have a
primary substance of abuse.SUBSTANCE ABUSE
Substance abuse is the use of any DRUG, including ALCOHOL, or other psychoactive substances in ways that are harmful
to a person or others whom the person’s actions may affect. Health-care practitioners who provide care for people who
have substance abuse problems, alcohol or drug DEPENDENCE, and ADDICTIONmay be physicians (MDs or DOs), psychi-
atrists (physicians who specialize in psychiatric disorders), psychologists (PhDs), social workers (LSWs), and clinical
registered nurse practitioners (CRNPs). Practitioners may be certified substance abuse professionals (SAPs), designat-
ing that they have additional education and experience in treating substance abuse (including ALCOHOLISM).
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