The misuse of substances is a major public health challenge. The most recent available data show that 107,941 Americans died from presumed overdose in 2022. Many more lives and families are being compromised by substance misuse. To effectively address this problem, it is important for everyone to understand the basic facts behind this high-risk behavior. This guide aims to provide a common vocabulary to encourage meaningful discussions about this issue.
Key clinical terms in substance use
Dependence: Occurs when the body relies on a drug for normal functioning, leading to withdrawal symptoms when the substance is not used. For example, individuals dependent on alcohol might experience shaking or anxiety when they stop drinking.
Tolerance: The need to use increasing amounts of a substance to achieve the same effect. Someone who has developed tolerance to prescription painkillers might need to take more pills to get the same pain relief.
Addiction: A condition where an individual cannot control his or her use of a substance, even when it causes significant harm. Addiction implies compulsive use, craving and impaired control in addition to physical dependence.
Substance use disorder: The medical term for addiction, describing a set of symptoms related to continued substance use despite major negative consequences.
Common substances and their effects
Opioids are designed to relieve pain.
— Euphoria and other mood changes often accompany pain relief.
— At higher doses, respiratory depression is common and can be fatal.
— Morphine and heroin historically were the most misused opioids.
— Newer drugs (e.g., oxycodone and especially fentanyl) are now widely available on the street and have become even more dangerous.
— Naloxone (Narcan) is an opioid antagonist which can reverse opioid overdoses in emergencies.
Alcohol is a very commonly used and often misused substance in our society.
— Light, intermittent, social use may promote relaxation, but regular and heavy use can lead to dependance, with liver and cardiac damage.
— It impairs judgment and coordination
Stimulants at low to moderate doses heighten wakefulness, improve alertness, diminish fatigue and provoke feelings of energy and well-being.
— At higher doses, they produce agitation, hallucinations and paranoia.
— Nicotine, methamphetamine and cocaine are commonly abused stimulants.
Cannabis compounds promote relaxation and alter sensory perceptions.
— They are now widely available in many states for medicinal and recreational use despite their being illegal under federal law.
— Because of federal prohibition of relevant research, little is known about long-term consequences of regular and significant use.
Psychedelics have significant effects on psychological processes, such as thinking, auditory and visual perception, and emotion.
— Psychoactive drugs are often taken to produce an altered state of consciousness.
— They are sometimes seen as “countercultural” and include mescaline (peyote cactus), psilocybin (“magic mushrooms”) and LSD.
— Because most psychedelics are illegal, there is limited data on long term use. However, there is interest in evaluating their use as treatment options for mental illnesses especially post-traumatic stress disorder (PTDS).
Benzodiazepines depress central nervous system activity, produce sedation and relax skeletal muscles.
— Librium and Valium are among the most common.
How substances enter the body
Dependent users find many creative ways to get substances into the brain.
— Oral ingestion (swallowing pills or liquids)
— Inhalation, smoking or vaping
— Injection (subcutaneous, intravenous or intramuscular)
— Snorting (through the nose)
— Rectal and vaginal suppositories
— Absorption through skin
Understanding routes of administration can help communities recognize potential signs of substance use. Finding syringes or small plastic bags in parks or vacant areas might indicate injection drug use.
Legal and societal responses
Prohibition: The Controlled Substances Act of 1970 classified drugs based on their potential for medical use and abuse potential. However, over time, that classification has become somewhat outdated and controversial. For example, cannabis (marijuana) is classified as a very high-risk drug, but that designation is being widely questioned (a revision of that previous classification is currently being considered).
Harm Reduction: Approaches that aim to minimize the negative impacts of substance use, such as needle exchange programs or supervised injection sites.
Medications For Opioid Use Disorder: This was previously known as MAT (Medication Assisted Treatment or MAT). It combines relatively safe prescribed opioid medications (buprenorphine, methadone) with counseling to help people recover from addiction. A local clinic might offer buprenorphine treatment for opioid addiction, helping individuals maintain employment and family responsibilities while in recovery.
Community-based approaches
— Education: Implementing substance use prevention programs in schools and community centers. This could involve bringing in recovered individuals to share their experiences with high school students.
— Support groups: Establishing local support networks for individuals and families affected by substance use. A church or community center might host weekly meetings.
— Training: Providing first responders and community members with training on recognizing overdoses and administering naloxone. Local pharmacies could offer free naloxone training sessions.
Getting help:
— Individuals who are possibly showing signs of substance misuse should be encouraged to speak with a healthcare provider (The Marblehead Counseling Center is an important resource for individuals and families in town.)
— In emergent situations, local substance abuse helplines should be contacted. (Call 911 immediately if there is any question of a substance overdose.)
— Friends and families reaching out to users can be important, even lifesaving, but should be approached with sensitivity and compassion.
Recognizing signs of substance
— Changes in behavior, mood or appearance
— Neglecting responsibilities at work, school or home
— Financial problems or unexplained spending
— Secretive behavior or lying
Conclusion
Substance use disorder is a complex issue that requires compassion, understanding and community-wide efforts to address effectively. Whether supporting a friend in recovery, advocating for better treatment options or simply being more aware of the signs of substance misuse, everyone can play a role in addressing this challenge.
Dr. Thomas A Massaro, MD and Ph.D, is a member of the Board of Health. The views expressed are his own and not of the board. Massaro also sits on the Mental Health Task Force.
