Substance abuse
Substance abuse | |
---|---|
Other names | Drug abuse, substance use disorder, substance misuse disorder |
A tin containing drugs and drug paraphernalia | |
Specialty | Psychiatry |
Complications | Drug overdose |
Frequency | 27 million[1][2] |
Deaths | 1,106,000 US residents (1968–2020)[3] |
Substance abuse, also known as drug abuse, is the use of a drug in amounts or by methods that are harmful to the individual or others. It is a form of
Drugs most often associated with this term include
In 2010, about 5% of people (230 million) used an illicit substance.
Classification
Public health definitions
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 Classification of Diseases (ICD).
Value judgment
Philip Jenkins suggests 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
Drug misuse
Drug misuse is a term used commonly when
Prescription misuse has been defined differently and rather inconsistently based on the 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.[14][15] Chronic use of certain substances leads to a change in the central nervous system known as a "tolerance" to the medicine such that more of the substance is needed in order to produce desired effects. With some substances, stopping or reducing use can cause withdrawal symptoms to occur,[16] but this is highly dependent on the specific substance in question.
The rate of prescription drug use is fast overtaking illegal drug use 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, nonmedical prescription drug use is now second only to
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 the 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.[21]
Signs and symptoms
Drug | Drug class | Physical harm |
Dependence liability |
Social harm |
Avg. harm |
---|---|---|---|---|---|
Methamphetamine | CNS stimulant | 3.00 | 2.80 | 2.72 | 2.92 |
Heroin | Opioid | 2.78 | 3.00 | 2.54 | 2.77 |
Cocaine | CNS stimulant | 2.33 | 2.39 | 2.17 | 2.30 |
Barbiturates | CNS depressant | 2.23 | 2.01 | 2.00 | 2.08 |
Methadone | Opioid | 1.86 | 2.08 | 1.87 | 1.94 |
Alcohol | CNS depressant | 1.40 | 1.93 | 2.21 | 1.85 |
Ketamine | Dissociative anesthetic |
2.00 | 1.54 | 1.69 | 1.74 |
Benzodiazepines | Benzodiazepine | 1.63 | 1.83 | 1.65 | 1.70 |
Amphetamine | CNS stimulant | 1.81 | 1.67 | 1.50 | 1.66 |
Tobacco | Tobacco | 1.24 | 2.21 | 1.42 | 1.62 |
Buprenorphine | Opioid | 1.60 | 1.64 | 1.49 | 1.58 |
Cannabis | Cannabinoid | 0.99 | 1.51 | 1.50 | 1.33 |
Solvent drugs | Inhalant | 1.28 | 1.01 | 1.52 | 1.27 |
4-MTA | SSRA |
1.44 | 1.30 | 1.06 | 1.27 |
LSD | Psychedelic | 1.13 | 1.23 | 1.32 | 1.23 |
Methylphenidate | CNS stimulant | 1.32 | 1.25 | 0.97 | 1.18 |
Anabolic steroids | Anabolic steroid | 1.45 | 0.88 | 1.13 | 1.15 |
GHB | Neurotransmitter | 0.86 | 1.19 | 1.30 | 1.12 |
Ecstasy | Empathogenic stimulant | 1.05 | 1.13 | 1.09 | 1.09 |
Alkyl nitrites | Inhalant | 0.93 | 0.87 | 0.97 | 0.92 |
Khat | CNS stimulant | 0.50 | 1.04 | 0.85 | 0.80 |
Notes about the harm ratings
The Physical harm, Dependence liability, and Social harm scores were each computed from the average of three distinct ratings. drug intoxication, health-care costs, and other social harms.[22] Average harm was computed as the average of the Physical harm, Dependence liability, and Social harm scores. |
Depending on the actual compound, drug abuse including alcohol may lead to health problems,
There is a high rate of suicide in
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
Severe anxiety and depression are commonly induced by sustained alcohol abuse. 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.[31] Similarly, although substance abuse induces many changes to the brain, there is evidence that many of these alterations are reversed following periods of prolonged abstinence.[32]
Impulsivity
Screening and assessment
The screening and assessment process of substance use behavior is important for the diagnosis and treatment of substance use disorders. Screeners is the process of identifying individuals who have or may be at risk for a substance use disorder and are usually brief to administer.[39] Assessments are used to clarify the nature of the substance use behavior to help determine appropriate treatment.[39] Assessments usually require specialized skills, and are longer to administer than screeners.
Given that addiction manifests in structural changes to the brain, it is possible that non-invasive
Targeted assessments
There are several different screening tools that have been validated for use with adolescents such as the CRAFFT Screening Test[40] and in adults the CAGE questionnaire.[41] Some recommendations for screening tools for substance misuse in pregnancy include that they take less than 10 minutes, should be used routinely, include an educational component. Tools suitable for pregnant women include i.a. 4Ps, T-ACE, TWEAK, TQDH (Ten-Question Drinking History), and AUDIT.[42]
Treatment
Psychological
From the
In children and adolescents, cognitive behavioral therapy (CBT)[46] and family therapy[47] 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.[48] These treatments can be administered in a variety of different formats, each of which has varying levels of research support[49] 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.[50] A few integrated[51] treatment models, which combines parts from various types of treatment, have also been seen as both well-established or probably effective.[48] A study on maternal alcohol and other drug use has shown that integrated treatment programs have produced significant results, resulting in higher negative results on toxicology screens.[51] Additionally, brief school-based interventions have been found to be effective in reducing adolescent alcohol and cannabis use and abuse.[52] Motivational interviewing can also be effective in treating substance use disorder in adolescents.[53][54]
Medication
A number of medications have been approved for the treatment of substance abuse.[58] 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.[59] These drugs are used as substitutes for other opioids and still cause withdrawal symptoms but they facilitate the tapering off process in a controlled fashion. When a person goes from using fentanyl every day, to not using it at all, they will experience a point where they need to get used to not using the substance. This is called withdrawal.[citation needed]
Antipsychotic medications have not been found to be useful.[60] Acamprostate[61] is a glutamatergic NMDA antagonist, which helps with alcohol withdrawal symptoms because alcohol withdrawal is associated with a hyperglutamatergic system.
Heroin-assisted treatment
Three countries in Europe have active HAT programs, namely England, the Netherlands and Switzerland. Despite critical voices by conservative think-tanks with regard to these harm-reduction strategies, significant progress in the reduction of drug-related deaths has been achieved in those countries. For example, the US, devoid of such measures, has seen large increases in drug-related deaths since 2000 (mostly related to heroin use), while Switzerland has seen large decreases. In 2018, approximately 60,000 people have died of drug overdoses in America, while in the same time period, Switzerland's drug deaths were at 260. Relative to the population of these countries, the US has 10 times more drug-related deaths compared to the Swiss Confederation, which in effect illustrates the efficacy of HAT to reduce fatal outcomes in opiate/opioid addiction.[62][63]
Dual diagnosis
It is common for individuals with drugs use disorder to have other psychological problems.[64] 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."[65]
Individuals who have a comorbid psychological disorder often have a poor prognosis if either disorder is untreated.[64] Historically most individuals with dual diagnosis either received treatment only for one of their disorders or they did not 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.[65]
Epidemiology
The initiation of drug use including alcohol is most likely to occur during adolescence, and some experimentation with substances by older adolescents is common. For example, results from 2010
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%).[69] According UN estimates, there are "more than 50 million regular users of morphine diacetate (heroin), cocaine and synthetic drugs."[70]
More than 70,200 Americans died from drug overdoses in 2017.[63] Among these, the sharpest increase occurred among deaths related to fentanyl and synthetic opioids (28,466 deaths).[63] See charts below.
-
Drug use is higher in countries with high economic inequality.
-
Total recorded alcohol per capita consumption (15+), in litres of pure alcohol[71]
-
Total yearly U.S. drug deaths[72]
-
US yearly overdose deaths, and the drugs involved[63]
History
APA, AMA, and NCDA
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 1972, 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.[73]
In 1973, the
...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.[74]
DSM
The first edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (published in 1952) grouped alcohol and other drug abuse under "sociopathic personality disturbances", which were thought to be symptoms of deeper psychological disorders or moral weakness.[75] 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
The DSM-IV-TR defines substance abuse as:[77]
- 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:
- 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)
- 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)
- Recurrent substance-related legal problems (e.g., arrests for substance-related disorderly conduct)
- 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)
- the symptoms have never met the criteria for substance dependence for this class of substance
The fifth edition of the DSM (
Society and culture
Legal approaches
- Related articles: Prohibition (drugs), Arguments for and against drug prohibition, Harm reduction
Most governments have designed
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.[80][81] 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.[82]
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.
Some states in the U.S., as of late, have focused on facilitating safe use as opposed to eradicating it. For example, as of 2022, New Jersey has made the effort to expand needle exchange programs throughout the state, passing a bill through legislature that gives control over decisions regarding these types of programs to the state's department of health.[83] This state level bill is not only significant for New Jersey, as it could be used as a model for other states to possibly follow as well. This bill is partly a reaction to the issues occurring at local level city governments within the state of New Jersey as of late. One example of this is in the Atlantic City Government which came under lawsuit after they halted the enactment of said programs within their city.[84] This suit came a year before the passing of this bill, stemming from a local level decision to shut down related operations in Atlantic City made in July that same year. This lawsuit highlights the feelings of New Jersey residents, who had a great influence on this bill passing the legislature.[85] These feelings were demonstrated in front of Atlantic City City hall, where residents exclaimed their desire for these programs. All in all, the aforementioned bill was signed effectively into law just days after it passed legislature, by New Jersey Governor Phil Murphy.[86]
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.[87]
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) the member states, Norway, and the candidates' countries to the EU, were requested to identify labeled drug-related public expenditure, at the national level.[87]
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 six-fold difference for POS.
To respond to these findings 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 suggest GDP to be a major determinant of the health and POS drug-related public expenditures of a country. Labeled 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.[87]
United Kingdom
The UK Home Office estimated that the social and economic cost of drug abuse[88] to the UK economy in terms of crime, absenteeism and sickness is in excess of £20 billion a year.[89] 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.[90]
United States
Year | Cost (billions of dollars)[91] |
---|---|
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.[92]
Canada
Substance abuse takes a financial toll on Canada's hospitals and the country as a whole. In the year 2011, around $267 million of hospital services were attributed to dealing with substance abuse problems.[93] The majority of these hospital costs in 2011 were related to issues with alcohol. Additionally, in 2014, Canada also allocated almost $45 million towards battling prescription drug abuse, extending into the year 2019.[94] Most of the financial decisions made on substance abuse in Canada can be attributed to the research conducted by the Canadian Centre on Substance Abuse (CCSA) which conduct both extensive and specific reports. In fact, the CCSA is heavily responsible for identifying Canada's heavy issues with substance abuse. Some examples of reports by the CCSA include a 2013 report on drug use during pregnancy[95] and a 2015 report on adolescents' use of cannabis.[96]
Special populations
Immigrants and refugees
Immigrant and refugees have often been under great stress,[97] 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.[98][99] For some, substance abuse functions as a coping mechanism to attempt to deal with these stressors.[99]
Immigrants and refugees may bring the substance use and abuse patterns and behaviors of their country of origin,[99] or adopt the attitudes, behaviors, and norms regarding substance use and abuse that exist within the dominant culture into which they are entering.[99][100]
Street children
Musicians
In order to maintain high-quality performance, some musicians take chemical substances.[103] Some musicians take drugs such as alcohol to deal with the stress of performing. As a group they have a higher rate of substance abuse.[103] The most common chemical substance which is abused by pop musicians is cocaine,[103] 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'. One 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.[103] Smoking harms the alveoli, which are responsible for absorbing oxygen.
Veterans
Substance abuse can be a factor that affects the physical and mental health of veterans. Substance abuse may also harm personal and familial relationships, leading to financial difficulty. There is evidence to suggest that substance abuse disproportionately affects the homeless veteran population. A 2015 Florida study, which compared causes of homelessness between veterans and non-veteran populations in a self-reporting questionnaire, found that 17.8% of the homeless veteran participants attributed their homelessness to alcohol and other drug-related problems compared to just 3.7% of the non-veteran homeless group.[104]
A 2003 study found that homelessness was correlated with access to support from family/friends and services. However, this correlation was not true when comparing homeless participants who had a current substance-use disorders.[105] The U.S. Department of Veterans Affairs provides a summary of treatment options for veterans with substance-use disorder. For treatments that do not involve medication, they offer therapeutic options that focus on finding outside support groups and "looking at how substance use problems may relate to other problems such as PTSD and depression".[106]
Sex and gender
Part of a series on |
Sex differences in humans |
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Biology |
Medicine and health |
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Neuroscience and psychology |
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Sociology |
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There are many sex differences in substance abuse.[107][108][109] Men and women express differences in the short- and long-term effects of substance abuse. These differences can be credited to sexual dimorphisms in the brain, endocrine and metabolic systems. Social and environmental factors that tend to disproportionately affect women, such as child and elder care and the risk of exposure to violence, are also factors in the gender differences in substance abuse.[107] Women report having greater impairment in areas such as employment, family and social functioning when abusing substances but have a similar response to treatment. Co-occurring psychiatric disorders are more common among women than men who abuse substances; women more frequently use substances to reduce the negative effects of these co-occurring disorders. Substance abuse puts both men and women at higher risk for perpetration and victimization of sexual violence.[107] Men tend to take drugs for the first time to be part of a group and fit in more so than women. At first interaction, women may experience more pleasure from drugs than men do. Women tend to progress more rapidly from first experience to addiction than men.[108] Physicians, psychiatrists and social workers have believed for decades that women escalate alcohol use more rapidly once they start. Once the addictive behavior is established for women they stabilize at higher doses of drugs than males do. When withdrawing from smoking women experience greater stress response. Males experience greater symptoms when withdrawing from alcohol.[108] There are gender differences when it comes to rehabilitation and relapse rates. For alcohol, relapse rates were very similar for men and women. For women, marriage and marital stress were risk factors for alcohol relapse. For men, being married lowered the risk of relapse.[109] This difference may be a result of gendered differences in excessive drinking. Alcoholic women are much more likely to be married to partners that drink excessively than are alcoholic men. As a result of this, men may be protected from relapse by marriage while women are at higher risk when married. However, women are less likely than men to experience relapse to substance use. When men experience a relapse to substance use, they more than likely had a positive experience prior to the relapse. On the other hand, when women relapse to substance use, they were more than likely affected by negative circumstances or interpersonal problems.[109]
See also
- ΔFosB
- Combined drug intoxication
- Drug addiction
- Handbook on Drug and Alcohol Abuse
- Harm reduction
- Hedonism
- International Day Against Drug Abuse and Illicit Trafficking
- List of controlled drugs in the United Kingdom
- United States drug overdose death rates and totals over time
- List of deaths from drug overdose and intoxication
- Low-threshold treatment programs
- Needle-exchange programme
- Nihilism
- Poly drug use
- Polysubstance abuse
- Responsible drug use
- Supervised injection site
- Wellness check
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External links
- Substance abuse at Curlie
- "The Science of Drug Use: A Resource for the Justice Sector". North Bethesda, Maryland: National Institute on Drug Abuse. 26 May 2020. Archived from the original on 1 September 2022. Retrieved 23 December 2021.
- School-Based Drug Abuse Prevention: Promising and Successful Programs (PDF). ISBN 978-1-100-12181-9. Archived(PDF) from the original on 19 May 2021. Retrieved 23 December 2021.
- Adverse Childhood Experiences: Risk Factors for Substance Misuse and Mental Health. 6 March 2013. Archived from the original on 29 June 2019 – via YouTube. 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)