Each year in the United States, approximately 400,000 deaths result from cigarette smoking, 100,000 from misuse of alcohol, and 20,000 from use of illicit drugs. Many of the adverse health effects associated with the use of tobacco, alcohol, and illicit drugs result from long-term use caused by substance dependence (i. e. , addiction)—a cluster of cognitive, behavioral, and physiological symptoms indicating sustained psychoactive substance use despite ubstance-related problems.
In addition, substance dependence is characterized by repeated self-administration that usually results in tolerance, withdrawal, and compulsive drug-taking behavior. Nicotine is the psychoactive substance in cigarettes and other forms of tobacco that accounts for the addictive properties of tobacco. In addition to tobacco, other potentially addictive substances include alcohol, marijuana, and cocaine.
To assess the prevalence of selected indicators of substance dependence among the U. S. population, CDC and the National Institute on Drug Abuse analyzed data from the National Household Survey on Drug Abuse (NHSDA) for 1991–1992. The findings in this report suggest that a symptom of substance dependence is more likely to be reported by persons who smoke cigarettes and persons who use cocaine than by persons who use alcohol or marijuana.
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In order for a chemical to be considered a drug it must have the capacity to affect how the body works–to be biologically active. No substance that has the power to do this is completely safe, and drugs are approved only after they demonstrate that they are relatively safe when used as directed, and when the benefits outweigh their risks. Thus, some very dangerous drugs are approved because they are necessary to treat serious illness.
Digitalis, which causes the heart muscle to contract, is a dangerous drug, but doctors are permitted to use it because it is vital for treating patients whose heart muscle is weak. A drug as potent as digitalis would not be approved to treat such minor ailments as temporary fatigue because the risks outweigh the benefits. Many persons suffer ill effects from drugs even though they take the drug exactly as directed by the doctor or the label. The human population, unlike a colony of ants or bees, contains a great variety of genetic variation.
Drugs are tested on at most a few thousand people. When that same drug is taken by millions, some people may not respond in a predictable way to the drug. A person who has a so-called idiosyncratic response to a particular sedative, for example, ay become excited rather than relaxed. Others may be hypersensitive, or extremely sensitive, to certain drugs, suffering reactions that resemble allergies. A patient may also acquire a tolerance for a certain drug.
This means that ever-larger doses are necessary to produce the desired therapeutic effect. Tolerance may lead to habituation, in which the person becomes so dependent upon the drug that he or she becomes addicted to it. Addiction causes severe psychological and physical disturbances when the drug is taken away. Morphine, cocaine, and Benzedrine are common habit-forming drugs. Finally, drugs often ave unwanted side effects. These usually cause only minor discomfort such as a skin rash, headache, or drowsiness.
Certain drugs, however, can produce serious, even life-threatening adverse reactions. For example, the drug Thalidomide was once called one of the safest sedatives ever developed, but thousands of women in the United Kingdom who took it during pregnancy gave birth to seriously deformed babies. Other adverse reactions stem from mixing drugs. Thus, taking aspirin, which has blood-thinning qualities, for a headache can be very harmful if one is also taking other blood-thinning drugs such as heparin or dicumarol.
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