Definition:
An illness marked by consumption of alcoholic beverages at a level that interferes with physical or mental health, and social, family, or occupational responsibilities. People with alcohol dependence, the most severe alcohol disorder, usually experience tolerance (a need for markedly increased amounts of alcohol to achieve intoxication or the desired effect), and withdrawal symptoms when alcohol is discontinued or intake is decreased. They also spend a great deal of time drinking alcohol, and obtaining it. Alcohol abusers are "problem drinkers", that is, they may have legal problems, such as drinking and driving, or binge drinking (drinking six or more drinks on one occasion). People who are dependent on or abuse alcohol return to its use despite evidence of physical or psychological problems, though those with dependence have more severe problems and a greater compulsion to drink.

Alternative Names: Alcohol dependence; Alcohol abuse

Causes, incidence, and risk factors:
Alcoholism is a type of drug addiction. There is both physical and psychological dependence with this addiction. Physical dependence reveals itself by withdrawal symptoms when alcohol intake is interrupted, tolerance to the effects of alcohol, and evidence of alcohol-associated illnesses.

Alcohol affects the central nervous system as a depressant, resulting in a decrease of activity, anxiety, tension, and inhibitions. Even a few drinks can result in behavioral changes, a slowing in motor performance, and a decrease in the ability to think clearly. Concentration and judgment become impaired. In excessive amounts, intoxication may result.
Alcohol also affects other body systems. Irritation of the gastrointestinal tract can occur with erosion of the lining of the esophagus and stomach causing nausea and vomiting, and possibly even bleeding. Vitamins are not absorbed properly, which can lead to nutritional deficiencies with the long-term use of alcohol. Liver disease, called alcoholic hepatitis, may also develop and can progress to cirrhosis. The heart may be affected by cardiomyopathy. Sexual dysfunction can also occur, causing erectile dysfunction in men and cessation of menstruation in women. Alcohol affects the nervous system and can result in neuropathy and dementia. Chronic alcohol use also increases the risk of cancer of the larynx, esophagus, liver, and colon.

Alcohol consumption during pregnancy can cause severe birth defects. The most serious is fetal alcohol syndrome, which may result in mental retardation and behavior problems; a milder form of the condition which can still cause lifelong impairment is called fetal alcohol affects.
The social consequences of problem drinking and alcohol dependence can be as serious as the medical problems. People who abuse or are dependent on alcohol have a higher incidence of unemployment, domestic violence, and problems with the law. About half of all traffic fatalities are related to alcohol use.

The development of dependence on alcohol may occur over a period of years, following a relatively consistent pattern of progression. At first, a tolerance of alcohol develops. This results in a person being able to consume a greater quantity of alcohol before its adverse effects are noticed. Memory lapses ("black outs")relating to drinking episodes may follow tolerance. Then, people may lose control over drinking and find it difficult or impossible to stop if they try. The most severe drinking behavior includes prolonged binges of drinking with associated mental or physical complications. Some people are able to gain control over their dependence in earlier phases before a total lack of control occurs-- the problem is, no one knows which heavy drinkers will be able to regain control and which will not.

Withdrawal develops because the brain has physically adapted to the presence of alcohol and cannot function adequately in the absence of the drug. Symptoms of withdrawal may include elevated temperature, increased blood pressure, rapid heart rate, restlessness, anxiety, psychosis, seizures, and rarely even death.

There is no known common cause of alcoholism; however, several factors may play a role in its development. A person who has an alcoholic parent is more likely to become an alcoholic than a person without alcoholism in the immediate family. Research suggests that certain genes may increase the risk of alcoholism but which genes or how they exert their influence is controversial. Psychological factors may include a need for relief of anxiety, ongoing depression, unresolved conflict within relationships, or low self-esteem. Social factors include availability of alcohol, social acceptance of the use of alcohol, peer pressure, and stressful lifestyles.

The incidence of alcohol intake and related problems is increasing. Data from many sources indicate that about 15% of the population in the United States are "problem drinkers", and approximately 5% to 10% of male drinkers and 3% to 5% of female drinkers could be diagnosed as alcohol dependent (12.5million people).

Facts About Drug Abuse and Dependence

Definition:
Drug dependence (addiction) is compulsive use of a substance despite negative consequences which can be severe; drug abuse is simply excessive use of a drug or use of a drug for purposes for which it was not medically intended.

Physical dependence on a substance (needing a drug to function) is not necessary or sufficient to define addiction. There are some substances that don't cause addiction but do cause physical dependence (for example, some blood pressure medications) and substances that cause addiction but not classic physical dependence (cocaine withdrawal, for example, doesn't have symptoms like vomiting and chills; it is mainly characterized by depression).
See also drug abuse and drug abuse first aid.

Alternative Names: Drug addiction; Addiction - drug

Causes, incidence, and risk factors:
Drug abuse can lead to drug dependence or addiction. Drug dependence may also follow the use of drugs for physical pain relief, though this is rare in people without a previous history of addiction.

The exact cause of drug abuse and dependence is not known. However, the genetic make-up of the individual, the pharmacology of the particular drug, peer pressure, emotional distress, anxiety, depression, and environmental stress are all factors, which seem to be involved.
Risk factors that predispose people to drug dependence are different from those that predispose to use or abuse. Peer pressure may lead to use or abuse, but at least half of those who go on to addiction have depression, attention-deficit disorder, post-traumatic stress disorder or another psychological problem.

Children who grow up in an environment of illicit drug use may first see their parents using drugs. This may put them at a higher risk for developing an addiction later in life for both environmental and genetic reasons.

Signs of drug use in children include but are not limited to:
· A change in the child's friends, a new group
· Reclusive behavior
· Long unexplained periods away from home
· Lying
· Stealing
· Involvement with the law
· Deteriorating family relations
· Obvious intoxication (e.g., drunk), delirious, incoherent, or unconscious
· Distinct changes in behavior and normal attitude
· Decreased school performance

Commonly abused substances include:
· Opiates and narcotics are powerful painkillers with sedative and euphoric qualities. These include heroin, opium, codeine, meperidine (Demerol), hydromorphone (Dilaudid), Oxycontin and others.
· Central nervous system stimulants include amphetamines, cocaine, dextroamphetamine, methamphetamine, and methylphenidate (Ritalin). The most commonly used stimulants are caffeine and nicotine. These drugs have a stimulating effect and can produce tolerance.
· Central nervous system depressants include barbiturates (amobarbital, pentobarbital, secobarbital), benzodiazepine (Valium, Ativan, Xanax), chloral hydrate, and paraldehyde. The most commonly used, by far, is alcohol. These substances produce a soothing sedative and anxiety-reducing effect and can lead to dependence.
· Hallucinogens include LSD, mescaline, psilocybin ("mushrooms"), and phencyclidine (PCP or "Angel Dust"). They have hallucinogenic properties and can produce psychological dependence.
· Tetrahydrocannabinol (THC) is the active ingredient found in cannabis, marijuana, and hashish. Although used for their relaxing properties, THC-derived drugs can also lead to paranoia and anxiety.

Drug intoxication and drug overdose may be accidental or intentional. Drug withdrawal symptoms can occur when use of a substance is stopped or reduced. Withdrawal symptoms vary, depending on the abused substance. The onset of withdrawal symptoms depends on the length of time the drug normally stays within the body. Drug intoxication, overdose, and withdrawal can be life threatening in some situations.

Drug abuse first aid

Definition:
Drug abuse is the misuse or overuse of any medication or drug, including alcohol.

Alternative Names: Overdose from drugs

Considerations:
Many street drugs have no therapeutic benefits. Any use of these drugs is a form of drug abuse.
Legitimate medications can be abused by people who take more than the recommended dose or who intentionally take them with alcohol or other drugs.

Drug interactions also produce adverse effects. Therefore, it is important to let your physician know about all the drugs you are taking.

Many drugs are addictive. Sometimes the addiction is gradual, while with others (such as cocaine), an addiction can happen after only a few doses.
Someone who has become addicted to a drug will likely experience withdrawal symptoms if they suddenly stop taking it. Withdrawal is greatly assisted by professional help.

A drug dose that is large enough to be toxic is called an overdose. Prompt medical attention may save the life of someone who accidentally or deliberately takes an overdose.

Drug emergencies are not always easy to identify. If you suspect someone has overdosed, or if you suspect someone is experiencing withdrawal, give first aid and seek medical assistance.

Causes:
· An overdose of narcotics can cause sleepiness and even unconsciousness.
· Uppers (stimulants) produce excitement, increased rate of heartbeat, and rapid breathing. Downers (depressants) do just the opposite.
· Mind-altering drugs (hallucinogens), including LSD and other street drugs, may produce paranoia, hallucinations, aggressive behavior, or extreme social withdrawal.
· Cannabis-containing drugs, such as marijuana may produce euphoria, relaxation, impaired motor skills, and increased appetite.

Legal prescription drugs are sometimes taken in overdose to achieve effects other than the therapeutic effects for which they were intended. This may lead to exaggeration of their effect (as can happen with uppers and downers), or serious side effects.