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Some people who drink alcohol, use illegal drugs, or misuse prescription or nonprescription medicines may develop substance use disorder. This means that a person uses these substances even though it causes harm to themselves or others.
Substance use disorder can range from mild to severe. The more signs of this disorder you have, the more severe it may be. Moderate to severe substance use disorder is sometimes called addiction. People who have it may find it hard to control their use of these substances.
When a person has substance use disorder:
- They may argue with others about the amount of alcohol or drugs they're using.
- Their job may be affected because of their substance use.
- They may use alcohol or drugs when it's dangerous or illegal, such as when they drive.
- They may have a strong need, or craving, to use alcohol or drugs.
- They may feel like they must use it just to get by.
A person might not realize that their substance use is a problem. They might not use alcohol or drugs in large amounts when they use it. Or they might go for days or weeks between drinking episodes or using drugs. But even if they don't drink or use drugs very often, their substance use could still be harmful and put them at risk.
Alcohol and drug use may be an unconscious attempt at self-treatment for another problem, such as depression.
Using alcohol or drugs can put others at risk. For example, a woman who uses alcohol while pregnant puts her baby at risk for problems from fetal alcohol syndrome. Alcohol may affect the baby's growth and development, behavior, and ability to learn.
Children who are exposed to alcohol or drug use in the home may develop mental health problems, such as depression and anxiety. They may have behavioral problems and trouble with learning and do poorly in school. And they may be more likely to develop substance use disorder.
Alcohol and drugs can affect a teen's brain development. They can also affect emotional and social development. Alcohol use can cause changes in a teen's alertness, perception, movement, judgment, and attention. This can make it harder for teens to think, learn, reason, and make good choices.
People who use alcohol and drugs may be more likely to engage in risky behaviors. For example, they may not use condoms during sex. And they may have more than one sex partner. This increases a person's chance of having an unintended pregnancy and getting sexually transmitted infections (STIs), hepatitis B, and human immunodeficiency virus (HIV). They may drive when "high" or when they've had too much to drink. This may increase the risk of injury or car crashes.
Alcohol is part of many people's lives. It may have a place in cultural and family traditions. So it may be hard to know when someone is drinking too much and when it's a sign of alcohol use disorder. Someone may have alcohol use disorder if they find it hard to control their use and they keep using alcohol even though it's having harmful effects on their life.
People who drink alcohol are more likely to have poor grades or job performance. They're more likely to use tobacco products and to experiment with illegal drugs. And their drinking may increase their risk of getting hurt or being in a car crash.
Over time, drinking too much alcohol may cause health and behavior problems, like high blood pressure; liver, heart, brain, and nervous system problems; and problems with digestion. It may also cause sexual problems, osteoporosis, and cancer.
The use of alcohol with medicines or illegal drugs may increase the effects of each.
Recreational and illegal drugs
People who use marijuana or illegal drugs, such as methamphetamines, cocaine, heroin, or other "street drugs," may develop substance use disorder. They may use drugs to get a "high" or to relieve stress and emotional problems.
Drugs like ecstasy (MDMA), ketamine, GHB, Rohypnol, and LSD may be found at all-night dances, raves, trances, or clubs. These drugs are known as "club drugs." They account for increasing numbers of drug overdoses and emergency room visits. Inhalants like nitrous oxide may also be used at these clubs.
Drugs come in different forms and can be used in different ways. They can be smoked, snorted, inhaled, or taken as pills. They can be put in liquids or food. They can be put in the rectum or vagina or be injected with a needle. Teens and young adults may be at risk for becoming victims of sexual assault or violent behavior in situations where these drugs are used.
Prescription and nonprescription medicines
Some people misuse prescription medicines, like opioids (such as OxyContin and Norco), benzodiazepines (such as Valium and Xanax), and stimulants (such as Ritalin and Adderall). Misusing prescription medicines can cause serious harm and, in some cases, even death.
Some nonprescription medicines, such as cold medicines that have dextromethorphan in them, are being misused by teens and young adults as a way to get a "high."
Glue, shoe polish, cleaning fluids, and aerosols are common household products with ingredients that can also be used to get a "high."
Check Your Symptoms
The medical assessment of symptoms is based on the body parts you have.
- If you are transgender or nonbinary, choose the sex that matches the body parts (such as ovaries, testes, prostate, breasts, penis, or vagina) you now have in the area where you are having symptoms.
- If your symptoms aren’t related to those organs, you can choose the gender you identify with.
- If you have some organs of both sexes, you may need to go through this triage tool twice (once as "male" and once as "female"). This will make sure that the tool asks the right questions for you.
Many things can affect how your body responds to a symptom and what kind of care you may need. These include:
- Your age. Babies and older adults tend to get sicker quicker.
- Your overall health. If you have a condition such as diabetes, HIV, cancer, or heart disease, you may need to pay closer attention to certain symptoms and seek care sooner.
- Medicines you take. Certain medicines, herbal remedies, and supplements can cause symptoms or make them worse.
- Recent health events, such as surgery or injury. These kinds of events can cause symptoms afterwards or make them more serious.
- Your health habits and lifestyle, such as eating and exercise habits, smoking, alcohol or drug use, sexual history, and travel.
Try Home Treatment
You have answered all the questions. Based on your answers, you may be able to take care of this problem at home.
- Try home treatment to relieve the symptoms.
- Call your doctor if symptoms get worse or you have any concerns (for example, if symptoms are not getting better as you would expect). You may need care sooner.
If you are with a person who is drunk or high, it's a good idea to seek medical help right away if:
- The person may have an injury.
- The person is hard to wake up or cannot stay awake.
- The person has vomited more than once and is not acting normal.
- You're not comfortable taking care of the person, or you're not in an environment that is safe enough for you to take care of the person.
Being dependent on alcohol or drugs means that you have a physical or emotional dependence on the substance. When you are dependent on a substance:
- You are not able to stop using the substance even if you try.
- You may feel that you should cut down, but you continue to use the substance even though it causes problems in your life.
- You may have physical signs of dependence. These are different depending on the substance, but they can include problems like:
- Blackouts, which cause you to not remember what happened.
- Stomach problems.
- Repeated infections.
- Sleep problems.
- Loss of appetite.
- Less interest in sex.
Severe withdrawal symptoms may include:
- Being extremely confused, jumpy, or upset.
- Feeling things on your body that are not there.
- Seeing or hearing things that are not there.
- Severe trembling.
- Chest pain.
- Shortness of breath.
Mild withdrawal symptoms may include:
- Intense worry.
- Nausea or vomiting.
- Feeling a little tense or edgy.
The risk of a suicide attempt is highest if:
- You have the means to kill yourself, such as a weapon or medicines.
- You have set a time and place to do it.
- You think there is no other way to solve the problem or end the pain.
The use of alcohol and drugs can affect your behavior. Here are some questions to think about:
- Has your use of alcohol or drugs harmed your relationships with your family or friends?
- Do you ever drive a car or operate machinery when you are drunk, high, or hungover?
- Have you missed any days of work or school during the past year because you were drunk, high, or hungover?
- Have family members or friends tried to get you to cut down on alcohol or drugs?
- Do you sometimes go on binges with alcohol or drugs?
Seek Care Now
Based on your answers, you may need care right away. The problem is likely to get worse without medical care.
- Call your doctor now to discuss the symptoms and arrange for care.
- If you cannot reach your doctor or you don't have one, seek care in the next hour.
- You do not need to call an ambulance unless:
- You cannot travel safely either by driving yourself or by having someone else drive you.
- You are in an area where heavy traffic or other problems may slow you down.
Seek Care Today
Based on your answers, you may need care soon. The problem probably will not get better without medical care.
- Call your doctor today to discuss the symptoms and arrange for care.
- If you cannot reach your doctor or you don't have one, seek care today.
- If it is evening, watch the symptoms and seek care in the morning.
- If the symptoms get worse, seek care sooner.
Call 911 Now
Based on your answers, you need emergency care.
Call 911 or other emergency services now.
Sometimes people don't want to call 911. They may think that their symptoms aren't serious or that they can just get someone else to drive them. Or they might be concerned about the cost. But based on your answers, the safest and quickest way for you to get the care you need is to call 911 for medical transport to the hospital.
Make an Appointment
Based on your answers, the problem may not improve without medical care.
- Make an appointment to see your doctor in the next 1 to 2 weeks.
- If appropriate, try home treatment while you are waiting for the appointment.
- If symptoms get worse or you have any concerns, call your doctor. You may need care sooner.
If you are concerned about your own or another person's alcohol or drug use, learn what steps to take to help yourself or someone else.
- Never ignore the problem.
- Know the signs of substance use. These include new problems at work or school.
- Make an appointment with a doctor or another health professional, such as a counselor, to discuss it as a medical problem.
- Find out when support groups, such as Alcoholics Anonymous (AA) or Narcotics Anonymous (NA), meet. These self-help groups help members get sober and stay that way. Call them for the times of scheduled meetings.
- Ask the other person if they would accept help. Don't give up after the first "no." Keep asking. If the person agrees, act that very day to arrange for help. If you are supporting another person, attend a few meetings of Al-Anon. It's a support group for family members and friends of people who have problems with alcohol. Read some 12-step program information.
- Provide support for another person during detoxification or other treatment.
- Help set up community services in the home, if needed. Older adults may benefit from services like home care, nutritional programs, transportation programs, and other services.
- Help with decision-making. Many people who use substances can't process information or communicate their decisions well.
- Check out what services are available in your area.
- Talk to your human resources department about getting a referral to your employee assistance program, if your employer offers it.
- If you are supporting a teen, go to the website drugstrategies.org/teens/programs for information about teen drug treatment programs across the United States.
- Contact the Substance Abuse and Mental Health Services Administration (SAMHSA) online at www.samhsa.gov/find-help to learn about treatment programs in your area.
Some problems with alcohol and drug use can be prevented.
- Do not drink alcohol or use drugs if you are pregnant. Drinking or using drugs before trying to become pregnant and during pregnancy increases your baby's chances of being born with birth defects and fetal alcohol syndrome.
- Talk to your children about the effects of alcohol and drugs. Children are less likely to use alcohol or other drugs if their parents teach them early (during the elementary school years) about the effects of alcohol and drugs. Set a good example for your children by not overusing alcohol or using drugs.
- Encourage your teenager to avoid alcohol and drugs. Drinking alcohol or using drugs during the teen years can harm growth and development. It can also cause some teens to develop substance use disorder later in life. Drug use in this age group increases the chance that your teen will be involved in crime, high-risk sexual behavior, accidents, and injuries.
- Provide nonalcoholic beverages at parties and meals. Don't give your children the impression that you have to have alcohol to have a good time as an adult.
- Cut down on your drinking. Safe levels are: less than 2 drinks a day for men and 1 drink a day for women. One drink is 12 fl oz (360 mL) of beer, 5 fl oz (150 mL) of wine, or 1.5 fl oz (45 mL) of hard liquor. Do not drink every day. See the topic Drinking and Your Health.
- Look for signs of mental stress. Try to understand and resolve sources of depression, anxiety, or loneliness. Don't use alcohol or drugs to deal with these problems.
- Ask your pharmacist or doctor whether any of your current medicines can cause dependence.
- Be especially aware of pain medicines (such as opioids), tranquilizers, sedatives, and sleeping pills. Follow the instructions carefully, and do not take more than the recommended dose.
- Make sure that your doctors are aware of medicines prescribed by another doctor. Use only one pharmacy when getting your prescriptions filled.
- Do not regularly use medicines to sleep, lose weight, or relax. Seek nondrug solutions.
- Do not suddenly stop taking any medicine without your doctor's supervision.
- Do not drink alcohol when you are taking medicines. Alcohol can react with many medicines and cause serious complications.
- Do not smoke or use other tobacco products. Many people relate tobacco use to alcohol and drug use. For more information, see the topic Quitting Smoking.
Preparing For Your Appointment
You can help your doctor diagnose and treat your condition by being prepared to answer the following questions:
- How often do you drink or use drugs? What drugs do you use?
- Do you use alcohol and other drugs, both prescription and nonprescription, at the same time?
- Do you sometimes drink or use more than you mean to?
- What types of alcohol or drugs do you use? How much do you use each day?
- Do you drink or use drugs when you feel "stressed"?
- Do you drink or use drugs when you are alone?
- Have you tried to cut back on your drinking or drug use, but you were unable to?
- Is alcohol or drug use causing problems with your work, your school, or in your family?
- Have your family or friends ever told you they thought you had a problem with alcohol or drugs?
- Have you ever been treated for a similar problem in the past?
- Have you ever been hospitalized for a drug or alcohol problem? If so, be prepared to discuss the details with your doctor.
- What prescription and nonprescription medicines do you take? Bring a complete list with you to your appointment.
- Do you have any health risks?
Current as of: June 26, 2019
Author: Healthwise Staff
William H. Blahd Jr. MD, FACEP - Emergency Medicine
Adam Husney MD - Family Medicine
Kathleen Romito MD - Family Medicine
H. Michael O'Connor MD - Emergency Medicine
David Messenger MD - Emergency Medicine, Critical Care Medicine
Current as of: June 26, 2019