Substance abuse

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Uma Maveli[2]

Synonyms and keywords:


Historical Perspective

  • Substance abuse has been around for centuries
  • Dr. Benjamin Rush was one of the primary researchers in substance abuse
  • The technology to tackle the "intricacies to tack the cellular response to the drugs" were not present at the time.


Alcoholism may be classified according to its symptomatic expression into three distinguished types:[1]

  • episodic excessive drinking
  • habitual excessive drinking
  • dependency of alcohol.


  • The pathogenesis of substance abuse is not definitive.[1]
  • Medical practitioners, instead, use symptoms to determine what the disease is
  • This arises problems because clinicians are not able to diagnose the disorder as effectively as systematic clinical visits
  • First et al. [citation] and other analysis provides evidence that clinicians
    • "were most likely making DSM diagnoses using a method other than by evaluating each of the diagnostic criteria in sequence." [citation]


  • Substance abuse can emerge later on in life, but can still be influenced by factors from one's childhood.[2]
  • Studies have found that early life stress and a tendency to have depression/ mental illnesses has proven to lead to substance abuse disorder later in life

Differentiating Substance Abuse from other Diseases

[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].


[Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].

Epidemiology and Demographics

This table uses data from [citation]. When talking about any disease, there are many demographic characteristics that may affect the trends of the disorder.

Population Analysis of the Percentages of Unauthorized Drugs
Population Composition Percent Total of Population
Row heading 1 Cell 2 Cell 3
Row heading A Cell B Cell C

Risk Factors

  • Alcohol is one of the oldest "psychoactive substances" that humankind has known.[1]
  • Excessive drinking is a problem in the United States
  • It can lead to intoxication
  • Is the "third preventable leading cause of death in the United States."


  • It is essential that the screening process be structured an thorough, so the client is properly diagnosed
  • Substance abuse cannot be detected with a simple X-ray machine
  • The Alcohol Use Disorder Identification Test [citation] is a screening test for General Alcohol and Drug Abuse
    • It is a ten-question survey that takes about two minutes to answer
  • Substance abuse could be the result of/ can lead to mental disorders
  • According to the U.S. Preventive Services Task Force 2002 [citation], screening for psychiatric diseases need to be thorough and follow these four steps:
    • "comprehensive assessment, accurate diagnosis, effective treatment, and careful followup." [citation]

Natural History, Complications, and Prognosis

  • Cannabis use disorder is a type of substance abuse disorder that about 42.4% of the US population has developed in the past 3 years.[3]
  • Although not conventional, warning signs include:
    • Reduced frequency of use
    • Abusing the substance when using it
    • Developing other medical conditions


Diagnostic Study of Choice

  • It is common that people with substance abuse disorder also have a severe mental illness.[4]
  • Mental illness can lead to a substance abuse disorder
  • It has been recorded that about 7-10 million people in America possess at least one mental illness along with their substance abuse disorder.

History and Symptoms

  • Since substance abuse disorder is the result of abusing virtually any drug, there are an array of symptoms depending on the substance
  • This disorder can be common in people with other illnesses
  • Researchers have seen a spike in the number of substance abuse cases among schizophrenia patients
  • Many hold it to the "self-medication theory."
  • Since schizophrenia can lead to "social withdrawal, apathy, dysphoria, and sleeping problems", many patients self-medicate to get rid of the negative feelings.
    • Alcohol abuse among schizophrenic patients may lead to over-the-top hallucinations and delusions
    • Cannabis abuse can lead to outrageous psychotic symptoms
    • Cocaine abuse among schizophrenic patients, on the other hand, leads to a depressed mood.

Physical Examination

Some common symptoms that doctors look for are:

  • poor personal hygiene
  • significantly fluctuating weight
  • marks on the skin that indicate injections,
  • signs of withdrawal:
    • slurred speech
    • uneasy eyes
    • euphoria
    • sweating
    • runny nose
    • agitation
    • sedation

Laboratory Findings

  • Some lab tests that check for substance abuse include blood-alcohol content and urine Breathalyzers
    • Although they are legal and effective, they only check for current use of the substance
  • Urine tests are used across the spectrum of substance abuse, not just alcohol.


There are no ECG findings associated with substance abuse.


There are no x-ray findings associated with substance abuse.

Echocardiography or Ultrasound

There are no echocardiography/ultrasound findings associated with substance abuse.

CT scan

There are no CT scan findings associated with substance abuse.


There are no MRI findings associated with substance abuse.

Other Imaging Findings

There are no other imaging findings associated with [disease name].

Other Diagnostic Studies

There are no other diagnostic studies associated with [disease name].


Medical Therapy

  • Substance abuse affects different circuits in the brain.[5]
    • Standard medications and therapy, although helpful, cannot cure this disease
  • People with this disorder have a tendency to relapse if treated with these types of medical therapies
  • A field of medicine called neuromodulation has made advances in target and enhance treatment
    • This method has proven effective for certain movement disorders such as epilepsy and OCD
    • The data and interest in applying this to addiction is rapidly increasing


  • Surgery is not recommended to prevent substance relapse
    • this disorder can damage parts of the body that may require surgery to fix

Primary Prevention

  • The first step to preventing this disease is an intervention.[6]
  • Interventions are not easy to complete successfully
    • However, intensive family interventions and mass media campaigns are some methods that have proven to be effective.

Secondary Prevention

  • The next step after the intervention is providing intensive care:[7]
    • Therapy and another psycho/socio care
    • Although these are valid tactics in the journey of recovery from substance abuse, they are understudied and require more research before they can be named "gold standard" treatment options


  1. 1.0 1.1 1.2 Robinson, Sean; Adinoff, Bryon (2016). "The Classification of Substance Use Disorders: Historical, Contextual, and Conceptual Considerations". Behavioral Sciences. 6 (3): 18. doi:10.3390/bs6030018. ISSN 2076-328X.
  2. Scheller-Gilkey, G.; Thomas, S. M.; Woolwine, B. J.; Miller, A. H. (2002). "Increased Early Life Stress and Depressive Symptoms in Patients With Comorbid Substance Abuse and Schizophrenia". Schizophrenia Bulletin. 28 (2): 223–231. doi:10.1093/oxfordjournals.schbul.a006933. ISSN 0586-7614.
  3. Sarvet, Aaron L.; Hasin, Deborah (2016). "The natural history of substance use disorders". Current Opinion in Psychiatry. 29 (4): 250–257. doi:10.1097/YCO.0000000000000257. ISSN 0951-7367.
  4. Santucci, Karen (2012). "Psychiatric disease and drug abuse". Current Opinion in Pediatrics. 24 (2): 233–237. doi:10.1097/MOP.0b013e3283504fbf. ISSN 1040-8703.
  5. Bari, Ausaf; DiCesare, Jasmine; Babayan, Diana; Runcie, Mariama; Sparks, Hiro; Wilson, Bayard (2018). "Neuromodulation for substance addiction in human subjects: A review". Neuroscience & Biobehavioral Reviews. 95: 33–43. doi:10.1016/j.neubiorev.2018.09.013. ISSN 0149-7634.
  6. Das, Jai K.; Salam, Rehana A.; Arshad, Ahmed; Finkelstein, Yaron; Bhutta, Zulfiqar A. (2016). "Interventions for Adolescent Substance Abuse: An Overview of Systematic Reviews". Journal of Adolescent Health. 59 (4): S61–S75. doi:10.1016/j.jadohealth.2016.06.021. ISSN 1054-139X.
  7. Fischer, Benedikt; Blanken, Peter; Da Silveira, Dartiu; Gallassi, Andrea; Goldner, Elliot M.; Rehm, Jürgen; Tyndall, Mark; Wood, Evan (2015). "Effectiveness of secondary prevention and treatment interventions for crack-cocaine abuse: A comprehensive narrative overview of English-language studies". International Journal of Drug Policy. 26 (4): 352–363. doi:10.1016/j.drugpo.2015.01.002. ISSN 0955-3959.

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