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Alcohol Use Disorders
Alcohol dependence is a chronic disease that requires medical and behavioral interventions to treat. For many people, drinking alcohol is nothing more than a pleasant way to relax. People with alcohol use disorders, however, drink to excess, endangering both themselves and others. For most adults, moderate alcohol use – no more than two drinks per day for a male and one for a female and older people – is relatively harmless. Moderate use, however, lies at one end of a range that moves through alcohol abuse to alcohol dependence. Individuals with severe alcohol problems get the most public attention, but even mild to moderate problems can cause substantial damage to the individual, their families, and the community.
What is Alcohol Abuse?
Alcohol abuse is a drinking pattern that results in significant and recurrent negative consequences. For example, alcohol abusers may be unable to fulfill major school, work, or family obligations. They may have drinking-related legal problems, such as repeated arrests for driving while intoxicated, and they may have relationship problems related to their drinking.
People with alcoholism – technically known as alcohol dependence – have lost control of their alcohol use. It does not matter what kind of alcohol is being consumed, or even how much: Alcohol Dependent individuals oftentimes unable to stop drinking once they start. Alcohol dependence is characterized by tolerance and withdrawal symptoms if drinking abruptly stops. Withdrawal symptoms, depending on the severity are life-threatening. They can include nausea, sweating, restlessness, irritability, tremors, hallucinations and seizures.
The Impact of Alcohol Abuse
While some research suggests that small amounts of alcohol may have beneficial cardiovascular effects, there is widespread agreement that heavier drinking can lead to health problems. Short-term effects include memory loss, hangovers, and blackouts. Long-term problems associated with heavy drinking include stomach ailments, heart problems, cancer, brain damage, serious memory loss, and liver cirrhosis. Heavy drinkers also markedly increase their chances of dying from automobile accidents, homicide, and suicide. Although men are more likely than women to develop alcoholism, women’s health suffers more, even at lower levels of consumption. Drinking problems also have a very negative impact on mental health. Alcohol abuse and alcoholism can worsen existing conditions such as depression or induce new problems such as serious memory loss, depression or anxiety. Alcohol problems do not just hurt the drinker. Partners and children of heavy drinkers may face family violence; children may suffer physical and sexual abuse and neglect and develop psychological problems. Women who drink during pregnancy run a serious risk of damaging their fetuses. Relatives, friends, and strangers can be injured or killed in alcohol-related accidents and assaults.
When to Get Professional Help
Individuals often hide their drinking or deny they have a problem. Signs of a problem include having friends or relatives express concern, being criticized about the quantity, feeling guilty about drinking and thinking about cutting down, but being unable to do so, or needing a drink to steady nerves or relieve a hangover. Often times, individuals will initially attempt to treat themselves. In rare cases, with the support of friends and family, this is possible. However, those with alcohol dependence usually cannot stop drinking through willpower alone. Many need outside help. They may need medically supervised detoxification to avoid potentially life-threatening withdrawal symptoms, such as seizures. Once stabilized physically, many need help resolving psychological issues associated with their drinking.
There are several approaches available for treating alcohol problems. Treatment is individualized, which means that it is based on the specific needs of the individual. These approaches include cognitive-behavioral therapy, coping skills development and management, and motivational enhancement therapy*.
Additionally, individuals may benefit from using self-help programs such as Alcoholics Anonymous (AA). These therapies have been proven to be effective. They help individuals to increase their motivation to stop drinking, identify circumstances that trigger drinking, learn new methods to cope with high-risk drinking situations, and develop social support systems within their own communities.
*See the Medication Assisted Treatment MAT for an explanation of an additional tool that can be used to treat alcohol use disorders.
Opioid Use Disorder
Opioids are a class of drugs that include the illicit drug heroin as well as the licit prescription pain reliever’s oxycodone, hydrocodone, codeine, morphine, fentanyl, and others.
Opioids are chemically related and interact with opioid receptors in the brain and nervous system to produce pleasurable effects and relieve pain. If an individual uses an opioid regularly for a short period of time, they can become dependent.
Once an individual is dependent on an opioid, the absence of it causes extremely painful withdrawal symptoms. It is due to the withdrawal that the vicious cycle of this chronic disease continues as introducing an opioid back into the system causes almost immediate relief. Examples of opioid withdrawal include yawning, watery eyes, goosebumps, nausea, vomiting, diarrhea, stomach cramps, body aches, and pains and insomnia to name a few.
The Impact of Opioid Addiction
A significant factor that has contributed to the increased number of individuals using opioids, is the rate in which prescription opioids have been prescribed. In 2012, 259 million prescriptions for opioids were written, which is more than enough to provide each American with their own bottle of pills. Once an individual becomes addicted, they attempt to obtain the prescription medication from the Doctor repeatedly. Eventually, the Doctor realizes what is taking place and stops prescribing the medication. At this point, an individual may either “Doctor shop,” “Emergency Department surf,” or attempt to purchase the opioid pain medication illegally.
The street value of prescription opioids is so expensive, and the desperation to “get high” or avoid withdrawal is so great that many individuals try Heroin. Four in five new heroin users start out misusing prescription painkillers.
*See Opioid Epidemic and Prevent Opioid Overdose for more education and information
When to Get Help
Individuals that seek treatment early on in their addiction have a better chance for success in achieving sobriety. Therefore, the earlier an opioid use disorder is identified, the better. Most opioid users will require detoxification from the opioid. This is most commonly done at a detox center where medications are used to decrease the discomfort experienced during the withdrawal process. Therapy is recommended immediately.
There are several approaches available for treating opioid dependence. Treatment is individualized, which means that it is based on the specific needs of the individual. Treatment approaches include cognitive-behavioral therapy, coping skills development and management, and motivational enhancement therapy. Additionally, individuals may benefit from using self-help programs such as Narcotics Anonymous (NA). These therapies have been proven to be effective. They help individuals to increase their motivation to stop using, identify circumstances that trigger use, learn new methods to cope with high-risk situations, and develop social support systems within their own communities. Due to the chronic relapsing nature of opioid dependence, medication-assisted treatment (Buprenorphine/Naloxone, Methadone, Vivitrol) is often necessary to assist an individual in the recovery process. Medication-assisted treatment alone does not work, but when joined with counseling and psychosocial support, it is extremely effective.
*See the Medication Assisted Treatment section for an explanation of the additional tools that can be used to treat opioid use disorders.
Cocaine Related Disorders
Cocaine is a powerfully addictive stimulant drug made from the leaves of the coca plant. Individuals can snort cocaine powder through the nose, or rub it into their gums. Others dissolve the powder in water and inject it into the bloodstream. Some people inject a combination of cocaine and heroin, called a Speedball. Another popular method of use is to smoke cocaine that has been processed to make a rock crystal (also called “freebase cocaine”). The crystal is heated to produce vapors that are inhaled into the lungs. This form of cocaine is called Crack.
The Impact of Cocaine Use
The short-term health effects of cocaine include extreme happiness and energy, mental alertness, hypersensitivity to light, sound, and touch, irritability, paranoia—extreme and unreasonable distrust of others. Some people find that cocaine helps them perform simple physical and mental tasks more quickly, although others experience the opposite effect. Large amounts of cocaine can lead to bizarre, unpredictable, and violent behavior. Cocaine’s effects appear almost immediately and disappear within a few minutes to an hour. How long the effects last and how intense they depend on the method of use. Injecting or smoking cocaine produces a quicker and stronger but shorter-lasting high than snorting.
Some long-term side effects of cocaine depend on the method of use and include the following:
- Snorting: loss of sense of smell, nosebleeds, frequent runny nose, and problems with swallowing.
- Consuming by mouth: severe bowel decay from reduced blood flow.
- Needle injection: higher risk for contracting HIV, hepatitis C, and other bloodborne diseases.
An overdose occurs when the person uses too much of a drug and has a toxic reaction that results in serious, harmful symptoms or death. An overdose can be intentional or unintentional. Death from overdose can occur on the first use of cocaine or unexpectedly thereafter. Many people who use cocaine also drink alcohol at the same time, which is particularly risky and can lead to overdose. Others mix cocaine with heroin, another dangerous—and deadly—combination. Some of the most frequent and severe health consequences leading to overdose involve the heart and blood vessels, including irregular heart rhythm and heart attacks, and the nerves, including seizures and strokes.
Behavioral therapy may be used to treat cocaine addiction. Examples include cognitive-behavioral therapy, contingency management, or motivational incentives—providing rewards to patients who remain substance-free, residential treatment—drug-free residences in which people in recovery from SUD’s help each other to understand and change their behaviors, and Narcotics Anonymous (NA) or Cocaine Anonymous (CA). While no government-approved medicines are currently available to treat cocaine addiction, researchers are testing some treatments.