substance abuse substance abuse 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 substance-related disorder. 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 also occur. in addition to possible physical, social, and psychological harm, the use of some drugs may also lead to criminal penalties, although these vary widely depending on the local jurisdiction. substance abuseother namesdrug abuse, substance use disorder, substance misuse disordera tin containing drugs and drug paraphernaliaspecialtypsychiatrycomplicationsdrug overdosefrequency27 milliondeaths307,400 (2015) a person using an inhalant drugs most often associated with this term include: alcohol, amphetamines, barbiturates, benzodiazepines, cannabis, cocaine, hallucinogens (although there is no known psychedelic, one of the three categories of hallucinogens, that has been found to have any addictive potential), methaqualone, and opioids. the exact cause of substance abuse is not clear, but there are two predominant theories: either a genetic predisposition or a habit learned from others, which, if addiction develops, 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, causing psychological problems, and or causing social problems that put them at risk of those dangers. in 2015, substance use disorders resulted in 307,400 deaths, up from 165,000 deaths in 1990. of these, the highest numbers are from alcohol use disorders at 137,500, opioid use disorders at 122,100 deaths, amphetamine use disorders at 12,200 deaths, and cocaine use disorders at 11,100. classification public health definitions a drug user receiving an injection of the opiate heroin 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 considered 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 a 2010 study ranking various illegal and legal drugs based on statements by drug-harm experts. alcohol was found to be the overall most dangerous drug. '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 this diagram depicts the correlations among the usage of 18 legal and illegal drugs: alcohol, amphetamines, amyl nitrite, benzodiazepines, cannabis, chocolate, cocaine, caffeine, crack, ecstasy, heroin, ketamine, legal highs, lsd, methadone, magic mushrooms (mmushrooms), nicotine and volatile substance abuse (vsa). usage is defined as having used the drug at least once during years 2005–2015. the colored links between drugs indicate the correlations with |r|>0.4, where |r| is the absolute value of the pearson correlation coefficient. 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 western countries, while drinking several bottles is seen as abuse. strict temperance advocates, who may or may not be religiously motivated, would see drinking even one glass as abuse. some groups (mormons, as prescribed in “the word of wisdom”) 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. the 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 the usage of nicotine (tobacco), heroin is correlated with cocaine (r>0.4) and methadone (r>0.45), and is strongly correlated with crack (r>0.5) drug misuse drug misuse is a term used commonly when prescription medication with sedative, anxiolytic, analgesic, or stimulant properties is used for mood alteration or intoxication ignoring the fact that overdose of such medicines can sometimes have serious adverse effects. it sometimes involves drug diversion from the individual for whom it was prescribed. 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. 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, 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 cannabis. in 2011, "nearly 1 in 12 high school seniors reported nonmedical use of vicodin; 1 in 20 reported such use of oxycontin." both of these drugs contain opioids. fentanyl is an opioid that is 100 times more potent than morphine, and 50 times more potent than heroin. a 2017 survey of 12th graders in the united states, found misuse of oxycontin of 2.7 percent, compared to 5.5 percent at its peak in 2005. misuse of the combination hydrocodone/paracetamol was at its lowest since a peak of 10.5 percent in 2003. this decrease may be related to public health initiatives and decreased availability. 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. signs and symptoms rational scale to assess the harm of recreational drug use drug drug class physicalharm dependenceliability socialharm avg.harm methamphetaminecns stimulant3.002.802.722.92 heroinopioid2.783.002.542.77 cocainecns stimulant2.332.392.172.30 barbituratescns depressant2.232.012.002.08 methadoneopioid1.862.081.871.94 alcoholcns depressant1.401.932.211.85 ketaminedissociative anesthetic2.001.541.691.74 benzodiazepinesbenzodiazepine1.631.831.651.70 amphetaminecns stimulant1.811.671.501.66 tobaccotobacco1.242.211.421.62 buprenorphineopioid1.601.641.491.58 cannabiscannabinoid0.991.511.501.33 solvent drugsinhalant1.281.011.521.27 4-mtadesigner ssra1.441.301.061.27 lsdpsychedelic1.131.231.321.23 methylphenidatecns stimulant1.321.250.971.18 anabolic steroidsanabolic steroid1.450.881.131.15 ghbneurotransmitter0.861.191.301.12 ecstasyempathogenic stimulant1.051.131.091.09 alkyl nitritesinhalant0.930.870.970.92 khatcns stimulant0.501.040.850.80 notes about the harm ratings the physical harm, dependence liability, and social harm scores were each computed from the average of three distinct ratings. the highest possible harm rating for each rating scale is 3.0.physical harm is the average rating of the scores for acute binge use, chronic use, and intravenous use.dependence liability is the average rating of the scores for intensity of pleasure, psychological dependence, and physical dependence.social harm is the average rating of the scores for drug intoxication, health-care costs, and other social harms.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, 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 us, 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 withdrawal. in some cases, 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. both alcohol, barbiturate as well as benzodiazepine withdrawal can potentially be fatal. abuse of hallucinogens, although extremely unlikely, may in some individuals trigger delusional and other psychotic phenomena long after cessation of use. this is mainly a risk with deliriants, and most unlikely with psychedelics and dissociatives. 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. 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. 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. 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 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 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. assessments are used to clarify the nature of the substance use behavior to help determine appropriate treatment. 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 magnetic resonance imaging could help diagnose addiction in the future. targeted assessments 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. some