Alcohol and Drug Problems
The overuse or misuse of alcohol (alcoholism) or other drugs is called a substance use problem. It can cause or worsen many medical problems and can destroy families and lives.
If you think you may have a problem with drugs or alcohol, take a short quiz to evaluate your symptoms:
Alcohol misuse causes over 100,000 deaths in the United States and Canada each year. It is the drug most commonly used by children ages 12 to 17. Alcohol-related car crashes are the leading cause of death in teenagers. People who drink alcohol are more likely to engage in high-risk sexual behavior, have poor grades or job performance, use tobacco products, and experiment with illegal drugs. Alcohol and drug use may be an unconscious attempt at self-treatment for another problem, such as depression.
You have an alcohol problem if your use of alcohol interferes with your health or daily living. You develop alcoholism if you physically or emotionally depend on alcohol to get you through your day.
Long-term heavy drinking damages the liver, nervous system, heart, and brain. It can lead to high blood pressure, stomach problems, medicine interactions, sexual problems, osteoporosis, and cancer. Alcohol misuse can also lead to violence, accidents, social isolation, jail or prison time, and problems at work and home.
Symptoms of an alcohol problem include personality changes, blackouts, drinking more and more for the same "high," and denial of the problem. A person with an alcohol problem may gulp or sneak drinks, drink alone or early in the morning, and suffer from the shakes. He or she may also have family, school, or work problems or get in trouble with the law because of drinking.
The use of alcohol with medicines or illegal drugs may increase the effects of each.
Alcohol misuse patterns vary. Some people drink and may be intoxicated (drunk) every day. Other people drink large amounts of alcohol at specific times, such as on the weekend. It is common for someone with an alcohol or drug problem to call in sick for work on Monday or Friday. He or she may complain of having a virus or the flu. Others may be sober for long periods and then go on a drinking binge that lasts for weeks or months.
Someone with alcohol dependence may suffer serious withdrawal symptoms, such as trembling, delusions, hallucinations, and sweating, if he or she stops drinking suddenly ("cold turkey"). After alcohol dependence develops, it becomes very hard to stop drinking without outside help. Medical detoxification may be needed.
Drug misuse includes the use of illegal drugs—such as marijuana, methamphetamines, cocaine, heroin, or other "street drugs"—and the misuse of legal prescription and nonprescription drugs. Some people use drugs to get a "high" or to relieve stress and emotional problems.
Drugs like ecstasy (MDMA), ketamine, GHB, Rohypnol, and LSD, which are known as "club drugs," may be found at all-night dances, raves, trances, or clubs. The use of club drugs accounts 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, taken as pills, put in liquids or food, put in the rectum or the vagina, or 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 medicines that may be misused include opioids (morphine and codeine), diazepam (Valium), hydrocodone and acetaminophen (Norco), methylphenidate (Ritalin), and oxycodone (OxyContin).
Some nonprescription medicines, such as cold medicines that have dextromethorphan as an ingredient, 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."
In the United States and Canada, approximately 40% of adults will use an illegal drug at some time during their lives. This does not include the use of alcohol or prescription medicines. Many people use more than one illegal substance at a time.
Drug dependence or addiction occurs when you develop a physical or emotional "need" for a drug. You are unable to control your use of a drug despite the negative impact it has on your life. You may not be aware that you have become dependent on a drug until you try to stop taking it. Drug withdrawal can cause uncomfortable and sometimes dangerous symptoms. The usual treatment is to gradually reduce the dose of the drug until you can completely stop using it.
Some groups of people are more likely than others to have problems related to alcohol or drug use. These groups include:
- Teenagers and young adults. Approximately one-half of all high school seniors in the U.S. admit to having used alcohol or an illegal drug. Substance use in this age group increases the risk of involvement in crime, high-risk sexual behavior, accidents, and injuries. Teens that use alcohol and drugs are more likely to have poor school performance and have higher dropout rates. For more information, see the topic Teen Alcohol and Drug Use.
- Although women are less likely than men to misuse alcohol, they are more likely to have alcohol-related health problems, such as liver disease.
- Women are more likely to have problems with prescription medicines. More than two-thirds of all tranquilizers are prescribed for women. Tranquilizers, sedatives, pain medicines, and amphetamines are misused most often by women.
- Alcohol and drug misuse in women increases the risk of developing other health problems, such as osteoporosis or depression.
- Women who misuse alcohol and drugs attempt suicide four times more frequently than those who do not.
- Adults older than age 65. Drug misuse in this age group is a problem because of the high number of prescription medicines and the lack of coordination between doctors. Signs of alcohol or drug misuse may be mistaken for other disease problems or simply overlooked as a symptom of "aging." Many older adults "self-medicate" with alcohol to help relieve sleep problems, depression, and other problems. Alcohol misuse is more common than drug misuse in older adults. Alcohol contributes to car crashes and other types of severe injury in this group of people. For more information, see the topic Substance Use Problems in Older Adults.
- Low-income populations. Drug and alcohol use is a problem for many minorities, including disabled adults, the homeless, and minority populations.
- Babies. Drug and alcohol use during pregnancy can cause birth defects and increase the risk of infant death. Babies are more likely to have learning disabilities and social and behavioral problems when their mothers use alcohol or drugs during pregnancy. Babies with mothers who use alcohol are at risk for problems from fetal alcohol syndrome.
- Children. Studies show that children who are exposed to drug misuse in the home, especially methamphetamine, have higher rates of depression, anxiety, post-traumatic stress, anger, and alcohol and drug misuse. They also are more likely to have learning problems and do poorly in school.
Recognizing a problem
Alcohol is part of many people's lives and may have a place in cultural and family traditions. It can sometimes be hard to know when you begin to drink too much.
There is a strong connection between the use of drugs and alcohol and high-risk sexual behaviors. This increases a person's chance of getting sexually transmitted infections (STIs), hepatitis B, and human immunodeficiency virus (HIV).
Check your symptoms to decide if and when you should see a doctor.
Health Tools help you make wise health decisions or take action to improve your health.
Check Your Symptoms
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.
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.
- Make an appointment with a doctor 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 Alcoholics Anonymous or Narcotics Anonymous for the times of scheduled meetings.
- Ask another person if he or she would accept help. Don't give up after the first "no"—keep asking. If he or she agrees, act that very day to arrange for help. If you are supporting another person, attend a few meetings of Al-Anon, a support group for family members and friends of alcoholics. 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 such community services as home care, nutritional programs, transportation programs, and other services.
- Help with decision-making. Many people with substance use problems are unable to process information or effectively communicate their decisions.
- Check out what services are available in your area.
- Discuss the need for a referral to your employee assistance program with your human resources department, if you have the service available.
- If you are supporting a teen, go to the website http://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/about/csat.aspx for information about treatment programs in your area.
Symptoms to watch for during home treatment
Call your doctor to evaluate your symptoms if your alcohol or drug problem becomes more frequent or severe.
Some alcohol and drug use problems 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 misusing 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 problems 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?
Other Works Consulted
- Ewing JA (1984). Detecting alcoholism: The CAGE questionnaire. JAMA, 252: 1905-1907.
Current as ofSeptember 23, 2018
Author: Healthwise Staff
Medical Review: William H. Blahd, Jr., MD, FACEP - Emergency Medicine
Adam Husney, MD - Family Medicine
Kathleen Romito, MD - Family Medicine
H. Michael O'Connor, MD, MMEd, FRCPC - Emergency Medicine