Substance abuse

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Synonyms and keywords:

Historical Perspective

Substance abuse has been around for centuries. Dr. Benjamin Rush was one of the primary researcher in substance abuse. The technology to tackle the "intricacies to tack the cellular response to the drugs" [citation] were not present at the time.

Classification

Alcoholism may be classified according to its symptomatic expression into three distinguished types: episodic excessive drinking, habitual excessive drinking, and dependency of alcohol.

Pathophysiology

The pathogenesis of substance abuse is not definitive. Medical practitioners, instead, use symptoms to determine what the disease is. This arises problems because clinicians are not able diagnose the disorder as effectively as systematic clinical visits. First et al. [citation] and other analysis provides evidence that clinicians "were most likely making DSM diagnoses using a method other than by evaluating each of the diagnostic criteria in sequence." [citation]

Causes

Substance abuse can emerge later on in life, but can still be influenced by factors from ones childhood. Studies have found that early life stress and a tendency to have depression/ mental illnesses has proven to lead to substance abuse disorder later in life.

Differentiating Substance Abuse from other Diseases

[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].

OR

[Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].

Epidemiology and Demographics

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Risk Factors

Alcohol is one of the oldest "psychoactive substances" [citation] that humankind has known. Excessive drinking is a problem in the United States, and it can lead to intoxication and is the "third preventable leading cause of death in the United States." [citation]

Screening

It is essential that the screening process be structured an thorough, so the client is properly diagnosed. Substance abuse cannot be detected with a simple X-ray machine. The Alcohol Use Disorder Identification Test [citation] is a screening test for General Alcohol and Drug Abuse. It is a ten-question survey that takes about two minutes to answer. Substance abuse could be the result of/ can lead to mental disorders. According to the U.S. Preventive Services Task Force 2002 [citation] , screening for psychiatric diseases need to be thorough and follow these four steps: "comprehensive assessment, accurate diagnosis, effective treatment, and careful followup." [citation]

Natural History, Complications, and Prognosis

Cannabis use disorder is a type of substance abuse disorder that about 42.4% of the US population has developed in the past 3 years. Although not conventional, warning signs include a reduced frequency of use, abusing the substance when using it, and developing other medical conditions.

Diagnosis

Diagnostic Study of Choice

It is common that people with substance abuse disorder also have a severe mental illness. Mental illness can lead to substance abuse disorder, and it has been recorded that about 7-10 million people in America possess at least one mental illness along with their substance abuse disorder.

History and Symptoms

The majority of patients with [disease name] are asymptomatic.

OR

The hallmark of [disease name] is [finding]. A positive history of [finding 1] and [finding 2] is suggestive of [disease name]. The most common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3]. Common symptoms of [disease] include [symptom 1], [symptom 2], and [symptom 3]. Less common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].

Physical Examination

Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].

OR

Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

The presence of [finding(s)] on physical examination is diagnostic of [disease name].

OR

The presence of [finding(s)] on physical examination is highly suggestive of [disease name].

Laboratory Findings

An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of [disease name].

OR

Laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].

OR

[Test] is usually normal among patients with [disease name].

OR

Some patients with [disease name] may have elevated/reduced concentration of [test], which is usually suggestive of [progression/complication].

OR

There are no diagnostic laboratory findings associated with [disease name].

Electrocardiogram

There are no ECG findings associated with [disease name].

OR

An ECG may be helpful in the diagnosis of [disease name]. Findings on an ECG suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

X-ray

There are no x-ray findings associated with [disease name].

OR

An x-ray may be helpful in the diagnosis of [disease name]. Findings on an x-ray suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no x-ray findings associated with [disease name]. However, an x-ray may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

Echocardiography or Ultrasound

There are no echocardiography/ultrasound findings associated with [disease name].

OR

Echocardiography/ultrasound may be helpful in the diagnosis of [disease name]. Findings on an echocardiography/ultrasound suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no echocardiography/ultrasound findings associated with [disease name]. However, an echocardiography/ultrasound may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

CT scan

There are no CT scan findings associated with [disease name].

OR

[Location] CT scan may be helpful in the diagnosis of [disease name]. Findings on CT scan suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no CT scan findings associated with [disease name]. However, a CT scan may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

MRI

There are no MRI findings associated with [disease name].

OR

[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no MRI findings associated with [disease name]. However, a MRI may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

Other Imaging Findings

There are no other imaging findings associated with [disease name].

OR

[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

Other Diagnostic Studies

There are no other diagnostic studies associated with [disease name].

OR

[Diagnostic study] may be helpful in the diagnosis of [disease name]. Findings suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

Other diagnostic studies for [disease name] include [diagnostic study 1], which demonstrates [finding 1], [finding 2], and [finding 3], and [diagnostic study 2], which demonstrates [finding 1], [finding 2], and [finding 3].

Treatment

Medical Therapy

Substance abuse affects different circuits in the brain, and because of that standard medications and therapy, although helpful, cannot cure this disease. People with this disorder have a tendency to relapse if treated with these types of medical therapies. A field of medicine called neuromodulation has made advances in target and enhance treatment. This method has proven effective for certain movement disorders such as epilepsy and OCD. The data and interest in applying this to addiction is rapidly increasing.

Surgery

Although surgery is not recommended to prevent substance relapse, this disorder can damage parts of the body that may require surgery to fix.

Primary Prevention

The first step to preventing this disease is intervention. Interventions are not easy to complete successfully, but intensive family interventions and mass media campaigns are some methods that have proven to be effective.

Secondary Prevention

The next step after intervention is providing intensive care: therapy and other psycho/socio care. Although these are valid tactics in the journey of recovery from substance abuse, they are understudied and require more research before they can be named "gold standard" treatment options.

References

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