Introduction –
Substance abuse (Drug Addiction) refers to the harmful or hazardous use of Psychoactive Substances, including Alcohol, Tobacco, and illicit drugs. key impacts of the illicit drug use on Society is the Negative Health Consequences experienced by its members.
According to the World Health Organization (WHO, 2024), substance use disorders affect over 35 million people worldwide, leading to widespread Disability and reduced Life expectancy.
Definition –
WHO defines Substance Abuse as the Harmful or Hazardous use of Psychoactive Substances leading to Dependence, Health problems, or Social Consequences.
The American Psychiatric Association (DSM-5, 2013) categorizes it under Substance Use Disorders (SUDs), characterized by Impaired Control, Risky use, Tolerance, and Withdrawal symptoms.
Etiology and Risk factors –
- Biological factors : Genetic vulnerability, Neurochemical imbalances (Dopamine dysregulation), lack of Parental Supervision.
- Psychological factors: Stress, Anxiety, and Depression, Personality traits ( like impulsivity and low self-control).
- Social and Environmental factors: Peer pressure, Drug experiments, Broken family, Unemployment and Poverty.
Types of Commonly Abused Substances
- Alcohol: Most widely Abused; associated with Liver disease, and Social problems.
- Nicotine: Leading cause of Preventable Deaths due to Cancer, Cardiovascular and Respiratory diseases.
- Cannabis: leads impaired memory, concentration problems, and sometimes Psychosis.
- Opioids (Heroin, Morphine, prescription painkillers): More possibility for dependence, linked to overdose deaths.
- Cocaine and Amphetamines: Stimulants that leads Euphoria, Agitation, and Cardiovascular complications.
- Sedatives and prescription drugs: it causes tolerance, dependence, and withdrawal problems.
Clinical Features
- Physical Health Issues: Weight loss, Tremors, Lack of energy, Sleep deprivation, Organ damage.
- Psychological signs: Mood swings, Irritability, Impaired judgment, Depression.
- Behavioral signs: Neglect responsibilities, Financial issues, Risky behaviors, Social withdrawal.
Consequences of Substance Abuse
- Health consequences :
Mentalhealth issues (depression, anxiety, suicidal behaviour ), Liver cirrhosis, lung cancer, Cardiovascular diseases.
2. Social consequences:
Domestic violence, Crime, Disintegration in family and Poor Academic or Occupational Performance.
3. Economic consequences: High cost of Healthcare, Rehabilitation, and Productivity loss.
Diagnosis
- Based on DSM-5 criteria for Substance Use Disorders (at least 2 of 11 criteria in 12 months, e.g., Craving, Tolerance, Withdrawal, Neglect of activities).
- Screening tools: AUDIT (Alcohol Use Disorders Identification Test), DAST (Drug Abuse Screening Test).
Management
1. Medical Treatment
Detoxification: Safely managing withdrawal symptoms.
Medications:
-Naltrexone, Acamprosate, Disulfiram (for alcohol), Methadone, Buprenorphine (for opioids).
-Nicotine replacement therapy (for smoking cessation)
2. Psychological Interventions
-Cognitive Behavioral Therapy (CBT)
-Motivational Enhancement Therapy
-Relapse prevention training
3. Social and Community Support
Rehabilitation centers
- 12-step programs (e.g., Alcoholics Anonymous, Narcotics Anonymous)
- Family counseling and Community Awareness Campaigns.
Prevention Strategies
- Primary prevention: School based awareness, life-skills training, awareness campaigns.
- Secondary prevention: Early Identification and Intervention in at-risk individuals.
- Tertiary prevention: Rehabilitation, Relapse prevention, and Reintegration into society.
Global and Indian scenario
- Globally – WHO estimates substance abuse contributes to 11.8 million death annually (2023).
- India- As per the AIIMS – NDDTC report ( 2019), about 5.7 crore Indians are Alcohol- dependent and 77 lakh use opioids, making it a growing challenge for public health.
Conclusion
Substance Abuse is a complex Biopsychosocial disorder with devastating health, social, and economic consequences. Effective management requires a multidisciplinary approach, including medical treatment, psychological support, and strong community involvement. Preventive measures such as Education, Family support, and Stricter drug policies are essential to reduce the burden of this Global crisis.
References
- World Health Organization (2024). Substance Use and Dependence – Fact Sheet.
- American Psychiatric Association (2013). DSM-5: Diagnostic and Statistical Manual of Mental Disorders.
- Chassin L, Pitts SC, Prost J. Binge drinking trajectories from adolescence to emerging adulthood in a high-risk sample: predictors and substance abuse outcomes. J Consult Clin Psychol. 2002;70(1):67-78.
- National Drug Intelligence Center. The economic impact of illicit drug use on American society. Washington, DC: United States Department of Justice, 2011.
- Rehm J, Mathers C, Popova S, Thavorncharoensap M, Teerawattananon Y, Patra J. Global burden of disease and injury and economic cost attributable to alcohol use and alcohol-use disorders. Lancet 373(9682):2223-2233, 2009.
- Centers for Disease Control and Prevention. Best Practices for Comprehensive Tobacco Control Programs—2014. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014.
- Centers for Disease Control and Prevention. (2020, March 20). Drug and Opioid-Involved Overdose Deaths—United States, 2017–2018. Morbidity and Mortality Weekly Reports. Retrieved from
