drug abuse

薬物濫用

WordNet

1. use wrongly or improperly or excessively; "Her husband often abuses alcohol"; "while she was pregnant, she abused drugs"
2. use foul or abusive language towards; "The actress abused the policeman who gave her a parking ticket"; "The angry mother shouted at the teacher" (同)clapperclaw, blackguard, shout
3. a rude expression intended to offend or hurt; "when a student made a stupid mistake he spared them no abuse"; "they yelled insults at the visiting team" (同)insult, revilement, contumely, vilification
4. use recreational drugs (同)do drugs
5. administer a drug to; "They drugged the kidnapped tourist" (同)dose
6. a substance that is used as a medicine or narcotic
7. used improperly or excessively especially drugs; "an abused substance"
8. subjected to cruel treatment; "an abused wife" (同)ill-treated, maltreated, mistreated

PrepTutorEJDIC

1. 〈U〉〈C〉(自分の,あるいは人の権利などの)『乱用』,悪用《+『of』+『名』》 / 〈C〉《しばしば複数形で》悪習,悪弊 / 〈U〉『悪口』,悪態,ののしり / 〈地位・権力など〉'を'『乱用する』,悪用する / …'を'『虐待する』(maltreat),酷使する / …'を'『ののしる』,‘の'悪口をいう
2. 『薬』,薬品,薬剤 / 『麻薬』,麻酔剤 / 〈人〉‘に'薬(特に麻酔剤)を与える / 〈飲食物〉‘に'(麻酔薬・毒薬などの)薬を混ぜる

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2017/03/17 23:13:34」(JST)

wiki en

[Wiki en表示]

See also: Substance use disorder

This article is about Drug abuse. For the Dice album, see Drug Abuse (album).

Substance abuse
Comparison of the perceived societal and personal harm for various psychoactive drugs from a poll among medical psychiatrists specialized in addiction treatment.
Classification and external resources
Specialty	Psychiatry
ICD-10	F10.1-F19.1
ICD-9-CM	305
DiseasesDB	3961
MedlinePlus	001945
MeSH	D019966

Substance abuse, also known as drug abuse, is a patterned use of a drug in which the user consumes the substance in amounts or with methods which are harmful to themselves or others, and is a form of substance-related disorder. Widely differing definitions of drug abuse are used in public health, medical and criminal justice contexts. In some cases criminal or anti-social behavior occurs when the person is under the influence of a drug, and long term personality changes in individuals may occur as well. In addition to possible physical, social, and psychological harm, use of some drugs may also lead to criminal penalties, although these vary widely depending on the local jurisdiction.

Drugs most often associated with this term include: alcohol, barbiturates, benzodiazepines, cannabis, cocaine, methaqualone, opioids and substituted amphetamines. The exact cause of substance abuse is not clear, with theories including one of two: either a genetic disposition which is learned from others, or a habit which if addiction develops, it manifests itself as a chronic debilitating disease.

In 2010 about 5% of people (230 million) used an illicit substance. Of these 27 million have high-risk drug use otherwise known as recurrent drug use causing harm to their health, psychological problems, or social problems or puts them at risk of those dangers. In 2013 drug use disorders resulted in 127,000 deaths up from 53,000 in 1990. The highest number of deaths are from opioid use disorders at 51,000. Cocaine use disorder resulted in 4,300 deaths and amphetamine use disorder resulted in 3,800 deaths. Alcohol use disorders resulted in an additional 139,000 deaths.

Classification

Public health definitions

Public health practitioners have attempted to look at substance use from a broader perspective than the individual, emphasizing the role of society, culture, and availability. Some health professionals choose to avoid the terms alcohol or drug "abuse" in favor of language they consider more objective, such as "substance and alcohol type problems" or "harmful/problematic use" of drugs.

The Health Officers Council of British Columbia — in their 2005 policy discussion paper, A Public Health Approach to Drug Control in Canada — has adopted a public health model of psychoactive substance use that challenges the simplistic black-and-white construction of the binary (or complementary) antonyms "use" vs. "abuse". This model explicitly recognizes a spectrum of use, ranging from beneficial use to chronic dependence

Medical definitions

'Drug abuse' is no longer a current medical diagnosis in either of the most used diagnostic tools in the world, the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM), and the World Health Organization's International Statistical Classification of Diseases and ICRIS Medical organization Related Health Problems (ICD)

Substance abuse has been adopted by the DSM as a blanket term to include 10 separate classes of drugs, including alcohol; caffeine; cannabis; hallucinogens; inhalants; opioids; sedatives, hypnotics, and anxiolytics; stimulants; tobacco; and other substances. The ICD uses the term Harmful use to cover physical or psychological harm to the user from use.

Physical dependence, abuse of, and withdrawal from drugs and other miscellaneous substances is outlined in the DSM a:

When an individual persists in use of alcohol or other drugs despite problems related to use of the substance, substance dependence may be diagnosed. Compulsive and repetitive use may result in tolerance to the effect of the drug and withdrawal symptoms when use is reduced or stopped.

However, other definitions differ; they may entail psychological or physical dependence, and may focus on treatment and prevention in terms of the social consequences of substance uses.

Drug misuse

Legal drugs are not necessarily safer. A 2010 study asked drug-harm experts to rank various illegal and legal drugs. Alcohol was found to be the overall most dangerous drug.

Drug misuse is a term used commonly when prescription medication with sedative, anxiolytic, analgesic, or stimulant properties are used for mood alteration or intoxication ignoring the fact that overdose of such medicines have serious adverse effects. It often involves drug diversion from the individual for whom it was prescribed. Prescription misuse has been defined differently and rather inconsistently based on status of drug prescription, the uses without a prescription, intentional use to achieve intoxicating effects, route of administration, co-ingestion with alcohol, and the presence or absence of dependence symptoms. Chronic use leads to a change in the central nervous system which means the patient has developed tolerance to the medicine that more of the substance is needed in order to produce desired effects.When this happens, any effort to stop or reduce the use of this substance would cause withdrawal symptoms to occur.

The rate of prescription drug abuse is fast overtaking illegal drug abuse in the United States. According to the National Institute of Drug Abuse, 7 million people were taking prescription drugs for nonmedical use in 2010. Among 12th graders, prescription drug misuse is now second only to cannabis. "Nearly 1 in 12 high school seniors reported nonmedical use of Vicodin; 1 in 20 reported abuse of OxyContin." Both of these drugs contain opioids.

Avenues of obtaining prescription drugs for misuse are varied: sharing between family and friends, illegally buying medications at school or work, and often "doctor shopping" to find multiple physicians to prescribe the same medication, without knowledge of other prescribers.

Increasingly, law enforcement is holding physicians responsible for prescribing controlled substances without fully establishing patient controls, such as a patient "drug contract." Concerned physicians are educating themselves on how to identify medication-seeking behavior in their patients, and are becoming familiar with "red flags" that would alert them to potential prescription drug abuse.

As a value judgment

Correlations between drugs usage. Correlations between usage of 18 legal and illegal drugs: alcohol, amphetamines, amyl nitrite, benzodiazepine, cannabis, chocolate, cocaine, caffeine, crack, ecstasy, heroin, ketamine, legal highs, LSD, methadone, magic mushrooms (MMushrooms), nicotine and volatile substance abuse (VSA). Links indicate correlations with absolute values of Pearson correlation coefficient r above 0.4. Medium, strong, and very strong correlations are indicated by the colour of link.

Philip Jenkins claims that there are two issues with the term "drug abuse". First, what constitutes a "drug" is debatable. For instance, GHB, a naturally occurring substance in the central nervous system is considered a drug, and is illegal in many countries, while nicotine is not officially considered a drug in most countries. Second, the word "abuse" implies a recognized standard of use for any substance. Drinking an occasional glass of wine is considered acceptable in most Western countries, while drinking several bottles is seen as an abuse. Strict temperance advocates, who may or may not be religiously motivated, would see drinking even one glass as an abuse. Some groups even condemn caffeine use in any quantity. Similarly, adopting the view that any (recreational) use of cannabis or substituted amphetamines constitutes drug abuse implies a decision made that the substance is harmful, even in minute quantities. In the U.S., drugs have been legally classified into five categories, schedule I, II, III, IV, or V in the Controlled Substances Act. The drugs are classified on their deemed potential for abuse. Usage of some drugs is strongly correlated. For example, the consumption of seven illicit drugs (amphetamines, cannabis, cocaine, ecstasy, legal highs, LSD, and magic mushrooms) is correlated and the Pearson correlation coefficient r>0.4 in every pair of them; consumption of cannabis is strongly correlated (r>0.5) with usage of nicotine (tobacco), heroin is correlated with cocaine (r>0.4), methadone (r>0.45), and strongly correlated with crack (r>0.5)

Signs and symptoms

Depending on the actual compound, drug abuse including alcohol may lead to health problems, social problems, morbidity, injuries, unprotected sex, violence, deaths, motor vehicle accidents, homicides, suicides, physical dependence or psychological addiction.

There is a high rate of suicide in alcoholics and other drug abusers. The reasons believed to cause the increased risk of suicide include the long-term abuse of alcohol and other drugs causing physiological distortion of brain chemistry as well as the social isolation. Another factor is the acute intoxicating effects of the drugs may make suicide more likely to occur. Suicide is also very common in adolescent alcohol abusers, with 1 in 4 suicides in adolescents being related to alcohol abuse. In the USA approximately 30% of suicides are related to alcohol abuse. Alcohol abuse is also associated with increased risks of committing criminal offences including child abuse, domestic violence, rapes, burglaries and assaults.

Drug abuse, including alcohol and prescription drugs, can induce symptomatology which resembles mental illness. This can occur both in the intoxicated state and also during the withdrawal state. In some cases these substance induced psychiatric disorders can persist long after detoxification, such as prolonged psychosis or depression after amphetamine or cocaine abuse. A protracted withdrawal syndrome can also occur with symptoms persisting for months after cessation of use. Benzodiazepines are the most notable drug for inducing prolonged withdrawal effects with symptoms sometimes persisting for years after cessation of use. Abuse of hallucinogens can trigger delusional and other psychotic phenomena long after cessation of use.

Cannabis may trigger panic attacks during intoxication and with continued use, it may cause a state similar to dysthymia. Researchers have found that daily cannabis use and the use of high-potency cannabis are independently associated with a higher chance of developing schizophrenia and other psychotic disorders. Severe anxiety and depression are commonly induced by sustained alcohol abuse, which in most cases abates with prolonged abstinence. Even sustained moderate alcohol use may increase anxiety and depression levels in some individuals. In most cases these drug induced psychiatric disorders fade away with prolonged abstinence.

Drug abuse makes central nervous system (CNS) effects, which produce changes in mood, levels of awareness or perceptions and sensations. Most of these drugs also alter systems other than the CNS. Some of these are often thought of as being abused. Some drugs appear to be more likely to lead to uncontrolled use than others.

Impulsivity

Impulsivity is characterized by actions based on sudden desires, whims, or inclinations rather than careful thought. Individuals with substance abuse have higher levels of impulsivity, and individuals who use multiple drugs tend to be more impulsive. A number of studies using the Iowa gambling task as a measure for impulsive behavior found that drug using populations made more risky choices compared to healthy controls. There is a hypothesis that the loss of impulse control may be due to impaired inhibitory control resulting from drug induced changes that take place in the frontal cortex. The neurodevelopmental and hormonal changes that happen during adolescence may modulate impulse control that could possibly lead to the experimentation with drugs and may lead to the road of addiction. Impulsivity is thought to be a facet trait in the neuroticism personality domain (overindulgence/negative urgency) which is prospectively associated with the development of substance abuse.

Screening and assessment

There are several different screening tools that have been validated for use with adolescents such as the CRAFFT Screening Test and in adults the CAGE questionnaire.

Treatment

Psychological

From the applied behavior analysis literature, behavioral psychology, and from randomized clinical trials, several evidenced based interventions have emerged: behavioral marital therapy, motivational Interviewing, community reinforcement approach, exposure therapy, contingency management

They help suppress cravings and mental anxiety, improve focus on treatment and new learning behavioral skills, ease withdrawal symptoms and reduce the chances of relapse.

In children and adolescents, cognitive behavioral therapy (CBT) and family therapy currently has the most research evidence for the treatment of substance abuse problems. Well-established studies also include ecological family-based treatment and group CBT. These treatments can be administered in a variety of different formats, each of which has varying levels of research support Research has shown that what makes group CBT most effective is that it promotes the development of social skills, developmentally appropriate emotional regulatory skills and other interpersonal skills. A few integrated treatment models, which combines parts from various types of treatment, have also been seen as both well-established or probably effective. A study on maternal alcohol and drug use has shown that integrated treatment programs have produced significant results, resulting in higher negative results on toxicology screens. Additionally, brief school-based interventions have been found to be effective in reducing adolescent alcohol and cannabis use and abuse. Motivational interviewing can also be effective in treating substance use disorder in adolescents.

Alcoholics Anonymous and Narcotics Anonymous are one of the most widely known self-help organizations in which members support each other not to use alcohol.

Social skills are significantly impaired in people suffering from alcoholism due to the neurotoxic effects of alcohol on the brain, especially the prefrontal cortex area of the brain. It has been suggested that social skills training adjunctive to inpatient treatment of alcohol dependence is probably efficacious, including managing the social environment.

Medication

Pharmacological therapy – A number of medications have been approved for the treatment of substance abuse. These include replacement therapies such as buprenorphine and methadone as well as antagonist medications like disulfiram and naltrexone in either short acting, or the newer long acting form. Several other medications, often ones originally used in other contexts, have also been shown to be effective including bupropion and modafinil.

Methadone and buprenorphine are sometimes used to treat opiate addiction. These drugs are used as substitutes for other opioids and still cause withdrawal symptoms.

Antipsychotic medications have not been found to be useful.

Acamprostate is a glutamatergic NMDA antagonist, which helps with alcohol withdrawal symptoms because alcohol withdrawal is associated with a hyperglutamatergic system.

Dual diagnosis

Main article: Dual diagnosis

It is common for individuals with drugs use disorder to have other psychological problems. The terms “dual diagnosis” or “co-occurring disorders,” refer to having a mental health and substance use disorder at the same time. According to the British Association for Psychopharmacology (BAP), “symptoms of psychiatric disorders such as depression, anxiety and psychosis are the rule rather than the exception in patients misusing drugs and/or alcohol.”

Individuals who have a comorbid psychological disorder often have a poor prognosis if either disorder is untreated. Historically most individuals with dual diagnosis either received treatment only for one of their disorders or they didn’t receive any treatment all. However, since the 1980s, there has been a push towards integrating mental health and addiction treatment. In this method, neither condition is considered primary and both are treated simultaneously by the same provider.

Epidemiology

Disability-adjusted life year for drug use disorders per 100,000 inhabitants in 2004.

  no data

  <40

  40–80

  80–120

  120–160

  160–200

  200–240

  240–280

  280–320

  320–360

  360–400

  400–440

  >440

Total recorded alcohol per capita consumption (15+), in litres of pure alcohol

The initiation of drug and alcohol use is most likely to occur during adolescence, and some experimentation with substances by older adolescents is common. For example, results from 2010 Monitoring the Future survey, a nationwide study on rates of substance use in the United States, show that 48.2% of 12th graders report having used an illicit drug at some point in their lives. In the 30 days prior to the survey, 41.2% of 12th graders had consumed alcohol and 19.2% of 12th graders had smoked tobacco cigarettes. In 2009 in the United States about 21% of high school students have taken prescription drugs without a prescription. And earlier in 2002, the World Health Organization estimated that around 140 million people were alcohol dependent and another 400 million with alcohol-related problems.

Studies have shown that the large majority of adolescents will phase out of drug use before it becomes problematic. Thus, although rates of overall use are high, the percentage of adolescents who meet criteria for substance abuse is significantly lower (close to 5%). According to BBC, "Worldwide, the UN estimates there are more than 50 million regular users of morphine diacetate (heroin), cocaine and synthetic drugs."

History

APA, AMA, and NCDA

In 1932, the American Psychiatric Association created a definition that used legality, social acceptability, and cultural familiarity as qualifying factors:

…as a general rule, we reserve the term drug abuse to apply to the illegal, nonmedical use of a limited number of substances, most of them drugs, which have properties of altering the mental state in ways that are considered by social norms and defined by statute to be inappropriate, undesirable, harmful, threatening, or, at minimum, culture-alien."

In 1966, the American Medical Association's Committee on Alcoholism and Addiction defined abuse of stimulants (amphetamines, primarily) in terms of 'medical supervision':

…'use' refers to the proper place of stimulants in medical practice; 'misuse' applies to the physician's role in initiating a potentially dangerous course of therapy; and 'abuse' refers to self-administration of these drugs without medical supervision and particularly in large doses that may lead to psychological dependency, tolerance and abnormal behavior.

In 1973, the National Commission on Marijuana and Drug Abuse stated:

...drug abuse may refer to any type of drug or chemical without regard to its pharmacologic actions. It is an eclectic concept having only one uniform connotation: societal disapproval. ... The Commission believes that the term drug abuse must be deleted from official pronouncements and public policy dialogue. The term has no functional utility and has become no more than an arbitrary codeword for that drug use which is presently considered wrong.

DSM

The first edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (published in 1952) grouped alcohol and drug abuse under Sociopathic Personality Disturbances, which were thought to be symptoms of deeper psychological disorders or moral weakness.

The third edition, published in 1980, was the first to recognize substance abuse (including drug abuse) and substance dependence as conditions separate from substance abuse alone, bringing in social and cultural factors. The definition of dependence emphasised tolerance to drugs, and withdrawal from them as key components to diagnosis, whereas abuse was defined as "problematic use with social or occupational impairment" but without withdrawal or tolerance.

In 1987, the DSM-IIIR category "psychoactive substance abuse," which includes former concepts of drug abuse is defined as "a maladaptive pattern of use indicated by...continued use despite knowledge of having a persistent or recurrent social, occupational, psychological or physical problem that is caused or exacerbated by the use (or by) recurrent use in situations in which it is physically hazardous." It is a residual category, with dependence taking precedence when applicable. It was the first definition to give equal weight to behavioural and physiological factors in diagnosis.

By 1988, the DSM-IV defines substance dependence as "a syndrome involving compulsive use, with or without tolerance and withdrawal"; whereas substance abuse is "problematic use without compulsive use, significant tolerance, or withdrawal." Substance abuse can be harmful to your health and may even be deadly in certain scenarios

By 1994, The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) issued by the American Psychiatric Association, the DSM-IV-TR, defines substance dependence as "when an individual persists in use of alcohol or other drugs despite problems related to use of the substance, substance dependence may be diagnosed." followed by criteria for the diagnose

DSM-IV-TR defines substance abuse as:

• A. A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by one (or more) of the following, occurring within a 12-month period:

1. Recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home (e.g., repeated absences or poor work performance related to substance use; substance-related absences, suspensions or expulsions from school; neglect of children or household)
2. Recurrent substance use in situations in which it is physically hazardous (e.g., driving an automobile or operating a machine when impaired by substance use)
3. Recurrent substance-related legal problems (e.g., arrests for substance-related disorderly conduct)
4. Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (e.g., arguments with spouse about consequences of intoxication, physical fights)

• B. The symptoms have never met the criteria for Substance Dependence for this class of substance.

The fifth edition of the DSM (DSM-5), planned for release in 2013, is likely to have this terminology revisited yet again. Under consideration is a transition from the abuse/dependence terminology. At the moment, abuse is seen as an early form or less hazardous form of the disease characterized with the dependence criteria. However, the APA's 'dependence' term, as noted above, does not mean that physiologic dependence is present but rather means that a disease state is present, one that most would likely refer to as an addicted state. Many involved recognize that the terminology has often led to confusion, both within the medical community and with the general public. The American Psychiatric Association requests input as to how the terminology of this illness should be altered as it moves forward with DSM-5 discussion.

Society and culture

Legal approaches

Related articles: Drug control law, Prohibition (drugs), Arguments for and against drug prohibition, Harm reduction

Most governments have designed legislation to criminalize certain types of drug use. These drugs are often called "illegal drugs" but generally what is illegal is their unlicensed production, distribution, and possession. These drugs are also called "controlled substances". Even for simple possession, legal punishment can be quite severe (including the death penalty in some countries). Laws vary across countries, and even within them, and have fluctuated widely throughout history.

Attempts by government-sponsored drug control policy to interdict drug supply and eliminate drug abuse have been largely unsuccessful. In spite of the huge efforts by the U.S., drug supply and purity has reached an all-time high, with the vast majority of resources spent on interdiction and law enforcement instead of public health. In the United States, the number of nonviolent drug offenders in prison exceeds by 100,000 the total incarcerated population in the EU, despite the fact that the EU has 100 million more citizens.

Despite drug legislation (or perhaps because of it), large, organized criminal drug cartels operate worldwide. Advocates of decriminalization argue that drug prohibition makes drug dealing a lucrative business, leading to much of the associated criminal activity.

Cost

Policymakers try to understand the relative costs of drug-related interventions. An appropriate drug policy relies on the assessment of drug-related public expenditure based on a classification system where costs are properly identified.

Labelled drug-related expenditures are defined as the direct planned spending that reflects the voluntary engagement of the state in the field of illicit drugs. Direct public expenditures explicitly labeled as drug-related can be easily traced back by exhaustively reviewing official accountancy documents such as national budgets and year-end reports. Unlabelled expenditure refers to unplanned spending and is estimated through modeling techniques, based on a top-down budgetary procedure. Starting from overall aggregated expenditures, this procedure estimates the proportion causally attributable to substance abuse (Unlabelled Drug-related Expenditure = Overall Expenditure × Attributable Proportion). For example, to estimate the prison drug-related expenditures in a given country, two elements would be necessary: the overall prison expenditures in the country for a given period, and the attributable proportion of inmates due to drug-related issues. The product of the two will give a rough estimate that can be compared across different countries.

Europe

As part of the reporting exercise corresponding to 2005, the European Monitoring Centre for Drugs and Drug Addiction's network of national focal points set up in the 27 European Union (EU) Member States, Norway, and the candidates countries to the EU, were requested to identify labeled drug-related public expenditure, at the country level.

This was reported by 10 countries categorized according to the functions of government, amounting to a total of EUR 2.17 billion. Overall, the highest proportion of this total came within the government functions of Health (66%) (e.g. medical services), and Public Order and Safety (POS) (20%) (e.g. police services, law courts, prisons). By country, the average share of GDP was 0.023% for Health, and 0.013% for POS. However, these shares varied considerably across countries, ranging from 0.00033% in Slovakia, up to 0.053% of GDP in Ireland in the case of Health, and from 0.003% in Portugal, to 0.02% in the UK, in the case of POS; almost a 161-fold difference between the highest and the lowest countries for Health, and a 6-fold difference for POS. Why do Ireland and the UK spend so much in Health and POS, or Slovakia and Portugal so little, in GDP terms?

To respond to this question and to make a comprehensive assessment of drug-related public expenditure across countries, this study compared Health and POS spending and GDP in the 10 reporting countries. Results found suggest GDP to be a major determinant of the Health and POS drug-related public expenditures of a country. Labelled drug-related public expenditure showed a positive association with the GDP across the countries considered: r = 0.81 in the case of Health, and r = 0.91 for POS. The percentage change in Health and POS expenditures due to a one percent increase in GDP (the income elasticity of demand) was estimated to be 1.78% and 1.23% respectively.

Being highly income elastic, Health and POS expenditures can be considered luxury goods; as a nation becomes wealthier it openly spends proportionately more on drug-related health and public order and safety interventions.

UK

The UK Home Office estimated that the social and economic cost of drug abuse to the UK economy in terms of crime, absenteeism and sickness is in excess of £20 billion a year. However, the UK Home Office does not estimate what portion of those crimes are unintended consequences of drug prohibition (crimes to sustain expensive drug consumption, risky production and dangerous distribution), nor what is the cost of enforcement. Those aspects are necessary for a full analysis of the economics of prohibition.

United States

Year	Cost (billions of dollars)
1992	107
1993	111
1994	117
1995	125
1996	130
1997	134
1998	140
1999	151
2000	161
2001	170
2002	181

These figures represent overall economic costs, which can be divided in three major components: health costs, productivity losses and non-health direct expenditures.

• Health-related costs were projected to total $16 billion in 2002.
• Productivity losses were estimated at $128.6 billion. In contrast to the other costs of drug abuse (which involve direct expenditures for goods and services), this value reflects a loss of potential resources: work in the labor market and in household production that was never performed, but could reasonably be expected to have been performed absent the impact of drug abuse.

Included are estimated productivity losses due to premature death ($24.6 billion), drug abuse-related illness ($33.4 billion), incarceration ($39.0 billion), crime careers ($27.6 billion) and productivity losses of victims of crime ($1.8 billion).

• The non-health direct expenditures primarily concern costs associated with the criminal justice system and crime victim costs, but also include a modest level of expenses for administration of the social welfare system. The total for 2002 was estimated at $36.4 billion. The largest detailed component of these costs is for state and federal corrections at $14.2 billion, which is primarily for the operation of prisons. Another $9.8 billion was spent on state and local police protection, followed by $6.2 billion for federal supply reduction initiatives.

According to a report from the Agency for Healthcare Research and Quality (AHRQ), Medicaid was billed for a significantly higher number of hospitals stays for Opioid drug overuse than Medicare or private insurance in 1993. By 2012, the differences were diminished. Over the same time, Medicare had the most rapid growth in number of hospital stays.

Special populations

Immigrants and refugees

Immigrant and refugees have often been under great stress, physical trauma and depression and anxiety due to separation from loved ones often characterize the pre-migration and transit phases, followed by "cultural dissonance," language barriers, racism, discrimination, economic adversity, overcrowding, social isolation, and loss of status and difficulty obtaining work and fears of deportation are common. Refugees frequently experience concerns about the health and safety of loved ones left behind and uncertainty regarding the possibility of returning to their country of origin. For some, substance abuse functions as a coping mechanism to attempt to deal with these stressors.

Immigrants and refugees may bring the substance use and abuse patterns and behaviors of their country of origin, or adopt the attitudes, behaviors, and norms regarding substance use and abuse that exist within the dominant culture into which they are entering.

Street children

Street children in many developing countries are a high risk group for substance misuse, in particular solvent abuse. Drawing on research in Kenya, Cottrell-Boyce argues that "drug use amongst street children is primarily functional – dulling the senses against the hardships of life on the street – but can also provide a link to the support structure of the ‘street family’ peer group as a potent symbol of shared experience."

Musicians

In order to maintain high-quality performance, some musicians take chemical substances. As a group they have a higher rate of substance abuse. The most common chemical substance which is abused by pop musicians is cocaine, because of its neurological effects. Stimulants like cocaine increase alertness and cause feelings of euphoria, and can therefore make the performer feel as though they in some ways ‘own the stage’.

Another way in which substance abuse is harmful for a performer (musicians especially) is if the substance being abused is aspirated. The lungs are an important organ used by singers, and addiction to cigarettes may seriously harm the quality of their performance. Smoking causes harm to alveoli, which are responsible for absorbing oxygen.

Veterans

Substance abuse can be another contributing factor that affects physical and mental health of veterans. Substance abuse may also damage personal relationships families and lead to financial difficulty. There is evidence to suggest that substance abuse disproportionately affects the homeless veteran population. A 2015 Florida study compared causes of homelessness between veterans and non veteran populations in a self reporting questionnaire. The results from the study found that 17.8% of the homeless veteran participants attributed their homelessness to alcohol and drug related problems compared to just 3.7% of the non-veteran homeless group.

A 2003 study found that homelessness was associated with access to support from family/friends and services. However, this relationship was not true when comparing homeless participants who had a current substance-use disorders. The U.S. Department of Veterans Affairs provide a summary of treatment options for veterans with substance use disorder. For treatments that do not involve medication, they offer a therapeutic options that focused on finding outside support groups and “looking at how substance use problems may relate to other problems such as PTSD and depression”.

See also

• ΔFosB
• Addictive personality
• Combined drug intoxication
• Controlled Substances Act
• Drug addiction
• Drug overdose
• List of controlled drugs in the United Kingdom
• List of drug-related deaths
• Harm reduction
• Low-threshold treatment programs
• Needle-exchange programme
• Poly drug use
• Polysubstance abuse
• Risk factors in pregnancy
• Self-medication
• Substance use disorder
• American Indian Committee on Alcohol and Substance Abuse

References

Further reading

• Lowinson, Joyce H; Ruiz, Pedro; Millman, Robert B; Langrod, John G (eds) (2005). Substance Abuse: A Comprehensive Textbook (4th ed.). Philadelphia: Lippincott Williams & Wilkins. ISBN 0-7817-3474-6. Retrieved 2 December 2010 
• Walker, Evelyn, and Perry Deane Young (1986). A Killing Cure. New York: H. Holt and Co. xiv, 338 p. N.B.: Explanatory subtitle on book's dust cover: One Woman's True Account of Sexual and Drug Abuse and Near Death at the Hands of Her Psychiatrist. Without ISBN
• Alexander, G. Caleb; Kruszewski, Stefan P.; Webster, Daniel W. (2012). "Rethinking Opioid Prescribing to Protect Patient Safety and Public Health". Jama. pp. 1865–1866. doi:10.1001/jama.2012.14282. 

External links

• Substance abuse at DMOZ
• Adverse Childhood Experiences: Risk Factors for Substance Misuse and Mental Health Dr. Robert Anda of the U.S. Centers for Disease Control describes the relation between childhood adversity and later ill-health, including substance abuse (video)
• The National Institute on Drug Abuse

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

• 1. 物質使用障害（SUD）：一般診療における認識と評価の原則 substance use disorder principles for recognition and assessment in general medical care
• 2. 物質使用障害に対する緊急的マネージメント：理論的基礎、原則、評価、および要素 contingency management for substance use disorders theoretical foundation principles assessment and components
• 3. プライマリケアにおけるアルコールおよびその他の薬物の有害な使用のスクリーニング screening for unhealthy use of alcohol and other drugs in primary care
• 4. Contingency management for substance use disorders: Efficacy, implementation, and training
• 5. 物質使用障害および不安関連障害を併発した成人の治療 treatment of co occurring substance use disorder and anxiety related disorders in adults

English Journal

• Crack abuse during pregnancy: maternal, fetal and neonatal complication.

• Aghamohammadi A1, Zafari M1.
• The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians.J Matern Fetal Neonatal Med.2016 Mar;29(5):795-7. doi: 10.3109/14767058.2015.1018821. Epub 2015 Mar 9.
• OBJECTIVE: The aim of this study was to assess the effects of crack on pregnancy outcomes.METHODS: We studied 88 crack user pregnant women in this study. These women were matched to a drug-free group (n = 90) chosen from the population of the same hospital. Maternal outcomes including preeclamps
• PMID 25747949

• Critical needs in drug discovery for cessation of alcohol and nicotine polysubstance abuse.

• Van Skike CE1, Maggio SE2, Reynolds AR2, Casey EM1, Bardo MT3, Dwoskin LP4, Prendergast MA5, Nixon K6.
• Progress in neuro-psychopharmacology & biological psychiatry.Prog Neuropsychopharmacol Biol Psychiatry.2016 Feb 4;65:269-87. doi: 10.1016/j.pnpbp.2015.11.004. Epub 2015 Nov 12.
• Polysubstance abuse of alcohol and nicotine has been overlooked in our understanding of the neurobiology of addiction and especially in the development of novel therapeutics for its treatment. Estimates show that as many as 92% of people with alcohol use disorders also smoke tobacco. The health risk
• PMID 26582145

• Psychometric modeling of abuse and dependence symptoms across six illicit substances indicates novel dimensions of misuse.

• Clark SL1, Gillespie NA2, Adkins DE3, Kendler KS4, Neale MC4.
• Addictive behaviors.Addict Behav.2016 Feb;53:132-40. doi: 10.1016/j.addbeh.2015.10.015. Epub 2015 Oct 17.
• AIMS: This study explored the factor structure of DSM III-R/IV symptoms for substance abuse and dependence across six illicit substance categories in a population-based sample of males.METHOD: DSM III-R/IV drug abuse and dependence symptoms for cannabis, sedatives, stimulants, cocaine, opioids and h
• PMID 26517709

Japanese Journal

• 薬物乱用・依存 (特集 精神科救急の最新知識) -- (症候・精神疾患に対する対応)

• 成瀬 暢也
• 臨床精神医学 43(5), 729-735, 2014-05
• NAID 40020083762

• 保護観察における専門的処遇プログラムの効果測定のあり方

• 羽間 京子,ハザマ キョウコ,Hazama Kyoko,勝田 聡,カツタ サトシ,Katsuta Satoshi
• 千葉大学教育学部研究紀要 62, 17-22, 2014-03-01
• … More than five years have passed since specialised treatment programs based on cognitive behaviour therapyfor adult sexual offenders, drug offenders, and violent offenders on probation or parole were first implemented inJapan. …
• NAID 120005438720

• カリフォルニア州における薬物乱用防止教育の制度的事例研究 : オルタナティブ学校とCommunity based Organizationとの連携

• 宮古 紀宏
• 日本特別活動学会紀要 = Journal of JASEA (22), 47-54, 2014-03
• NAID 40020122852

Related Links

• National Institute on Drug Abuse (NIDA)

This infographic of the NIH’s 2016 Monitoring the Future survey highlights drug use trends among the Nation’s youth for marijuana, alcohol, cigarettes, e-cigarettes, and prescription opioids.

• Drugs of Abuse | National Institute on Drug Abuse (NIDA)

Includes an overview on the drug, its effects on the brain and body, statistics and trends, and publications and articles written by NIDA. ... Learn the facts about the most commonly abused drugs. Each drug page includes a brief ...

Related Pictures

---

★リンクテーブル★

リンク元	「薬物濫用」「drug usage」「drug habituation」
拡張検索	「intravenous drug abuse」
関連記事	「abuse」「drug」

「薬物濫用」

　　[★]

英

drug abuse, substance abuse

同

薬物乱用

関

薬物依存、薬物嗜癖、物質乱用、物質依存症、薬物使用、接着剤吸引

薬物使用が身体に及ぼす効果

• 濫用 substance abuse：a pattern of abnormal substance use that leads to impairment of occupational, physical, or social functioning(BBS.73)
• 依存 substance dependence：ub stance abuse puls withdrawal symptoms, tolerance, or a pattern of repetitive use(BBS.73)
• 離脱 withdrawal：the development of physical or pschological symptoms after the reduction or cessation of intake of a substance(BBS.73)
• 耐性 tolerance：the need for increased amounts of the substance to achieve the same positive psychological effect(BBS.73)
• 交差耐性 cross-tolerance：the development of tolerance to one substance as the result of using another substance(BBS.73)

薬物

• 1. 中枢神経興奮薬(覚醒剤を含む) stimulants　　身体依存はないとされている

• カフェイン caffeine
• ニコチン nicotine
• amphetamines　精神依存有り。身体依存無し

• アンフェタミン amphetamine　精神依存有り。身体依存無し。耐性は連用で出現
• デキストロアンフェタミン dextroamphetamine Dexedrine
• メタンフェタミン methamphetamine Desoxyn speed ice ヒロポン　精神依存有り。身体依存無し。耐性は連用で出現　　←　以前、日本で多く使われた
• メチルフェニデート methylphenidate Ritalin
• methylene dioxymethamphetamine MDMA ecstasy

• コカイン cocaine crack freebase　精神依存有り。身体依存無し　精神依存生じやすい。耐性発現殆ど無し　コカ

• 2. sedatives

• alcohol　　精神依存有り。身体依存有り。
• barbiturates
• benzodiazepines

• ⇔flumazenil Mazicon Romazicon

• 3. opioids

• morphine　精神依存・身体依存有り　けし
• heroin　精神依存・身体依存が強い。耐性発現早い。離脱症状激しい
• codeine
• pethidine
• fentanyl
• methadone
• l-alpha-acetylmethadol acetate LAMM
• buprenorphine Temgesic

• 4. hallucinogens and related agents

• cannabis(marijuana(tetrahydrocannabinol THC,hashish)　精神依存有り。身体依存無し　精神依存軽度。耐性は長期使用で軽度出現　大麻草
• lysergic acid diethylamide LSD
• phencyclidine PCP angel dust
• psilocybin
• mescaline

精神依存、身体依存

	精神依存	身体依存
コカイン、アンフェタミン類(アンフェタミン、メチルフェタミン)、大麻	○
麻薬(モルヒネ、ヘロイン、コデイン)、バルビツール酸系(フェノバルビタール、チオペンタール)、アルコール	○	○

「drug usage」

　　[★]

• 薬物使用

関

drug abuse、drug addiction、drug dependence、drug habituation、drug use disorder、glue sniffing、substance abuse、substance dependence、substance use disorder、substance-related disorder

「drug habituation」

　　[★]

• 薬物嗜癖

関

drug abuse、drug addiction、drug dependence、drug usage、drug use disorder、glue sniffing、substance abuse、substance dependence、substance use disorder、substance-related disorder

「intravenous drug abuse」

　　[★]

静脈内薬物乱用

関

intravenous substance abuse

「abuse」

　　[★]

• vt.

• (才能、地位、人の好意などを)濫用する、悪用する、誤用する。(薬物などを)濫用する
• 虐待する、酷使する。口汚く罵る、罵倒する

• n.

• 濫用、悪用、誤用。(薬物、酒などの)不正使用、過剰摂取、濫用。悪弊、悪習
• 虐待、酷使

• ex.

• child abuse 児童虐待、sexual abuse 性的虐待

同

substance abuse

関

dependence

　 　 　 　

「drug」

　　[★]

同

drugs