Substance abuse and dependence

• Substance abuse - Substance abuse is used to describe a pattern of substance (drug) use leading to significant problems or distress such as failure to attend school, substance use in dangerous situations (driving a car), substance-related legal problems, or continued substance use that interferes with friendships and or family relationships. Substance abuse, as a disorder, refers to the abuse of illegal substances or the abusive use of legal substances. Alcohol is the most common legal drug of abuse. 
• Substance dependence - Substance dependence is used to describe continued use of drugs or alcohol, even when significant problems related to their use have developed. Signs include an increased tolerance or need for increased amounts of substance to attain the desired effect, withdrawal symptoms with decreased use, unsuccessful efforts to decrease use, increased time spent in activities to obtain substances, withdrawal from social and recreational activities, and continued use of substance even with awareness of physical or psychological problems encountered by extent of substance use. 
• Chemical dependence - Chemical dependence is also used to describe the compulsive use of chemicals (drugs or alcohol) and the inability to stop using them despite all the problems caused by their use.

• Alcohol. 
• Marijuana. 
• Hallucinogens. 
• Cocaine. 
• Amphetamines. 
• Opiates. 
• Anabolic steroids.

What causes substance abuse/chemical dependence?
Cultural and societal norms influence acceptable standards of substance use. Public laws determine the legal use of substances. The question of whether there is a normative pattern of substance use in adolescence remains controversial. Substance-related disorders in adolescence are caused by multiple factors including genetic vulnerability, environmental stressors, social pressures, individual personality characteristics, and psychiatric problems. However, determining which of these factors are primary and which are secondary in adolescent populations has not been determined. Most of the knowledge available regarding substance use and abuse comes from studying adult populations. A lack of research studying youthful substance use and abuse leaves questions concerning how it differs from substance abuse in other age groups unanswered.

Who is affected by substance abuse/chemical dependence?
Parental and peer substance use are considered two of the more common factors contributing to youthful decisions regarding substance use. Alcohol use among adolescents has increased during the last 10 years.

Some adolescents are more at risk of developing substance-related disorders, including adolescents with one or more of the following conditions present:

• Children of substance abusers. 
• Adolescents who are victims of physical, sexual, or psychological abuse. 
• Adolescents with mental health problems, especially depressed and suicidal teens. 
• Physically disabled adolescents.

What are the symptoms of substance abuse/chemical dependence?
The following are the most common behaviors that indicate an adolescent is having a problem with substance abuse. However, each adolescent may experience symptoms differently. Symptoms may include:

• Getting high on drugs or getting intoxicated (drunk) on a regular basis. 
• Lying, especially about how much they are using or drinking. 
• Avoiding friends and family members. 
• Giving up activities they used to enjoy such as sports or spending time with non-using friends. 
• Talking a lot about using drugs or alcohol. 
• Believing they need to use or drink in order to have fun. 
• Pressuring others to use or drink. 
• Getting in trouble with the law. 
• Taking risks, such as sexual risks or driving under the influence of a substance. 
• Suspension from school for a substance-related incident. 
• Missing school due to substance use. 
• Depressed, hopeless, or suicidal feelings.

The symptoms of substance abuse may resemble other medical problems or psychiatric conditions. Always consult your adolescent's physician for a diagnosis.

How is substance abuse/chemical dependence diagnosed?
A pediatrician, psychiatrist, or qualified mental health professional usually diagnoses substance abuse in adolescents. However, adolescent substance abuse is believed by some to be the most commonly missed pediatric diagnosis. Adolescents who use drugs are most likely to visit a physician's office with no obvious physical findings. Substance abuse problems are more likely to be discovered by physicians when adolescents are injured in accidents occurring while under the influence, or when they are brought for medical services because of intentional efforts to hurt themselves. Clinical findings often depend on the substance abused, the frequency of use, and the length of time since last used, and may include the following:

• Weight loss. 
• Constant fatigue. 
• Red eyes. 
• Little concern for hygiene.

• Your adolescent's age, overall health, and medical history. 
• Extent of your adolescent's symptoms. 
• Extent of your adolescent's dependence. 
• The substance abused. 
• Your adolescent's tolerance for specific medications or therapies. 
• Expectations for the course of the condition. 
• Your opinion or preference.

A variety of treatment programs for substance abuse are available on an inpatient or outpatient basis. Programs considered are usually based on the type of substance abused. Detoxification (if needed, based on the substance abused) and long-term follow-up management are important features of successful treatment. Long-term follow-up management usually includes formalized group meetings and developmentally age-appropriate psychosocial support systems, as well as continued medical supervision. Individual and family psychotherapy are often recommended to address the developmental, psychosocial, and family issues that may have contributed to and resulted from the development of a substance abuse disorder.

Prevention of substance abuse/chemical dependence:
There are three major approaches frequently used to prevent adolescent substance use and abuse, including the following:

• School-based prevention programs - School-based prevention programs usually provide drug and alcohol education and interpersonal and behavior skills training. 
• Community-based prevention programs - Community-based prevention programs usually involve the media and are aimed for parents and community groups. Programs such as Mothers Against Drunk Driving (MADD) and Students Against Drunk Driving (SADD) are the most well known community-based programs. 
• Family-focused prevention programs - Family-focused prevention programs involve parent training, family skills training, adolescent's social skills training, and family self-help groups. Research literature available suggests that components of family-focused prevention programs have decreased the use of alcohol and drugs in adolescents and improved effectiveness of parenting skills that favorably affected their adolescent's risk factors.