Chapter 12 Substance Abuse
The National Institute on Drug Abuse (NIDA) calls drug abuse and addiction “one of America’s most challenging public health problems.”1 Substance abuse places a tremendous burden on society, affects every aspect of life, and has been called “an equal opportunity destroyer.”1 It is also an expensive national problem. NIDA estimates that drug abuse and addiction costs the United States more than $500 billion annually.2 The cost of drug abuse includes the loss of earning potential of those addicted and the loss of wages of those injured by accidents caused by impaired persons. Included in the societal cost of substance abuse are law enforcement salaries, legal fees, and the cost of maintaining federal prison facilities needed for those incarcerated as a result of drug-related offenses. An estimated 31% of America’s homeless population have addiction issues.1 NIDA also notes that 50% to 80% of all child maltreatment cases involve some form of substance abuse by the child’s caregivers.1
An estimated 19.5 million Americans age 12 years and older are current users of illegal drugs. More than 51% of America’s teenagers have at least tried an illegal drug before they leave high school.1 In 2008 more than 31 million people admitted to driving while under the influence of alcohol at least once in the past year3 (see Chapter 13, Alcohol Abuse). According to the National Survey on Drug Use and Health (NSDUH), current cocaine use gradually declined between 2003 and 2009 among people age 12 years and older (from 2.3 million to 1.6 million).16
Anabolic Steroids
Recent international scandals in professional sports have highlighted the dangers of steroid use. Anabolic-androgenic steroids, sometimes called “roids” or “juice,” are synthetic substances similar to testosterone. While anabolic steroids have legitimate medical uses, they should not be used simply to build up muscle bulk. The most common names of abused anabolic steroids are Andro, oxandrolone (Oxandrin), methandrostenolone (Dianabol), stanozolol (Winstrol), nandrolone decanoate (Deca-Durabolin), and boldenone undecylenate (Equipoise).4
Signs and Symptoms
• Cardiovascular effects: Increases in serum low-density lipoprotein and decreases in high-density lipoprotein levels. Steroids increase atherosclerosis, placing the patients who have taken steroids at risk for a heart attack or stroke.
• Skeletal effects: Hypocalcemia, which can lead to osteoporosis. If taken before puberty is completed, the use of these substances can cause early skeletal maturation.
• Feminization or masculinization effects: Males may have decreasing testicular size along with reduced sperm counts. Men taking steroids may also become bald, develop breasts, and potentially develop prostate cancer. Women taking steroids can grow facial hair while becoming bald, stop menstruating, and develop a permanently deeper voice.
• Mood effects: Extreme mood swings that have led to “roid rage” or violent behavior. Users may have feelings of invincibility, jealousy, and depression that can be followed by suicide attempts.
• Cognitive effects: Memory loss and learning disabilities.
Cocaine
Cocaine is a strong central nervous system stimulant that is highly addictive. NIDA reports that, in 2008, 5.3 million Americans age 12 years and older had abused cocaine in some form.5 There are many street names for cocaine, including blow, bump, C, candy, Charlie, coke, flake, rock, snow, and toot.5
There are three common ways in which cocaine is used.
• Snorting: The powder form of the drug is inhaled through the nose to be absorbed by the nasal membranes
• Smoking: Vapors from burning cocaine are inhaled directly into the lungs for rapid absorption
• Injecting: Drug is put into a syringe and injected directly into the bloodstream
Signs and Symptoms
Cocaine affects every organ and system in the human body.
• Cardiovascular effects: Constricts blood vessels, elevates blood pressure, and increases heart rate. Acute myocardial infarctions have been reported up to 2 weeks after cocaine use in patients with and without preexisting cardiac disease, some as young as 19 years old.6
• Neurotoxicity: Cocaine is the most common stimulant that produces seizures. Other forms of cocaine-induced neurotoxicity include subarachnoid hemorrhage, cerebral infarction, vasculitis, transient ischemic attacks, and toxic delirium.7
• Psychiatric and mood disorders: Causes anxiety, irritability, and restlessness and it is not uncommon for these patients who have taken cocaine to have severe paranoia along with auditory hallucinations.
Cocaine readily crosses the placenta and is excreted in breast milk for up to 36 hours after use.
Therapeutic Interventions
Interventions are dependent on the patient’s presenting signs and symptoms. Consuming alcohol along with the cocaine causes a synergistic effect, especially on ventricular contraction.8 Benzodiazepines are the initial treatment of choice for cocaine-induced chest pain of cardiac origin.
Heroin
NIDA reported that the number of current heroin users in the United States age 12 years and older rose from 153,000 in 2007 to 213,000 in 2008.9 In the same year 114,000 first-time heroin users were reported.9 Heroin’s street names include brown sugar, dope, H, horse, junk, skag, skunk, smack, and white horse.10
Signs and Symptoms
The classic triad of heroin use is central nervous system depression, respiratory depression, and miosis.9 Assess for any signs and symptoms of chronic abuse. These include redness and swelling of the nares and multiple scars or “track marks” in numerous locations. Drug abuse paraphernalia found among the patient’s belongings (i.e., syringes, bent spoons, bottle caps, and rubber tubing) is another indicator of heroin abuse. Heroin addicts, like all drug abusers, are susceptible to multiple infectious diseases and processes, including human immunodeficiency virus (HIV), hepatitis B and C, endocarditis, and multiple skin abscesses.