Description

A substance use disorder manifests as any pattern of substance use causing significant physical, mental, or social dysfunction:

• Substances of abuse include:
  • Alcohol
  • Tobacco
  • Cannabinoids (marijuana)
  • Prescription medications:
    • CNS depressants (barbiturates, benzodiazepines, hypnotics)
    • Opioids and morphine derivatives (codeine, fentanyl, hydrocodone, hydromorphone, meperidine, methadone, morphine, oxycodone)
    • Stimulants (amphetamines, methylphenidate)
    • Dextromethorphan
  • Stimulants (cocaine, amphetamines, methamphetamines)
  • Club drugs (MDMA, flunitrazepam, γ-hydroxybutyrate or GHB)
  • Emerging drugs (K2/Spice, Salvia, bath salts)
  • Opioids (heroin, opium)
  • Dissociative drugs (ketamine, phencyclidine)
  • Hallucinogens (lysergic acid diethylamide)
  • Inhalants (glue, paint thinners, nitrous oxide)
  • Anabolic steroids
• For street names see http://www.drugabuse.gov
• System(s) affected: Cardiovascular; Endocrine/Metabolic; CNS
• Synonym(s): Drug abuse; Drug dependence; Substance abuse

• Alcohol is the most commonly abused substance, and abuse often goes unrecognized.
• Higher potential for drug interactions

Pregnancy Considerations
Substance abuse may cause fetal abnormalities, morbidity, and fetal or maternal death.

Epidemiology

• Predominant age: 16–25 years
• Predominant sex: Male > Female

• 22.6 million (8.9%) Americans reported use of illicit substance in past month in 2010.
• 10.1% for age 12–17 years; 21.5% for age 18–25
• 1:6 males aged 18–25 years use marijuana.

Risk Factors

• Male gender, young adult
• Depression, anxiety
• Other substance use disorders
• Family history
• Peer or family use or approval
• Low socioeconomic status
• Unemployment
• Accessibility of substances of abuse
• Family dysfunction or trauma
• Antisocial personality disorder
• Academic problems, school dropout
• Criminal involvement

Genetics
Substances of abuse affect dopamine, acetylcholine, γ-aminobutyric acid, norepinephrine, opioid, and serotonin receptors. Variant alleles may account for susceptibility to disorders.

General Prevention

Early identification and aggressive early intervention improve outcomes.

Etiology

Multifactorial, including genetic, environmental

Commonly Associated Conditions

• Depression
• Personality disorders
• Bipolar affective disorder

ALERT
Prescription narcotic overdose is the leading cause of accidental death between the ages of 15 and 45 in the US; this correlates with increased prescribing of long-acting oxycodone http://www.cdc.gov/Injury/wisqars/pdf/10LCD-Age-Grp-US-2009-a.pdf).