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Drugs are an integral part of everyday life for many people, and drug use among adolescents remains high (see Problems in Adolescents: Drug and Substance Use and Abuse). The legality and social acceptance of a particular drug often depend on what it is used for, what its effects are, and who is using it. For example, use of marijuana for pleasure is illegal and considered socially unacceptable by many people, but use of marijuana to relieve nausea in a person with advanced cancer has been legalized by some governments and is viewed as acceptable by some people. The legality and social acceptance of a drug often vary among different societies or countries. Legality and acceptance may also change within a society or country over time, as has happened with alcohol in the United States.

Many drugs, some legal and some not, alter the mind. Some mind-altering drugs affect brain function each time they are used, regardless of how much is used. Other mind-altering drugs affect brain function only if a large amount is used or if it is used continually. Some drugs affect the brain in such a way that a person wants or feels a need to use the drug again and again (craving).

Doctors may suspect problems created by the use of mind-altering drugs when they notice changes in mood or behavior. Specific questions may then be asked about potential consequences of prolonged use of specific drugs. Blood and urine tests are sometimes used to confirm suspicions that a person has been taking certain mind-altering drugs.

The problems created by use of mind-altering drugs are given many different terms, for example, drug abuse, drug dependence, and drug addiction. Doctors and other experts, in treating these problems, often disagree about the exact meaning of these terms.

Drug Abuse: Drug abuse is the use of a mind-altering drug without medical need, in an amount large enough or over a period long enough to threaten the quality of life or health and safety of the user or others. Many people use drugs without medical need but keep that use under control so that it does not threaten their health or adversely affect their functioning.

Taking a drug that does not usually alter the mind is still considered abusive if the drug is taken without medical need and if the drug endangers the quality of life or health and safety of the user or others. Drug abuse occurs in all socioeconomic groups and involves highly educated and professional people as well as those who are uneducated and unemployed.

Overdose of a drug may occur as part of abuse. With some drugs, an overdose may be profoundly frightening or even fatal.

Other Drugs of Abuse Although mind-altering drugs typically are those that have potential for abuse, several other drugs that do not alter the mind (or do so only occasionally) are often taken without medical need, even when doing so endangers the quality of life or health and safety of the user. Using a drug this way is considered drug abuse. People who stop abusing any of these drugs do not experience withdrawal symptoms, but they may experience medical problems when the drug is discontinued abruptly (problems that are usually preventable if discontinuation is supervised by a doctor). Anabolic Steroids Anabolic steroids are very similar to the hormone testosteroneSome Trade Names DELATESTRYL DEPOTESTOSTERONE . Anabolic steroids have many physical effects on the body, including muscle growth and increased strength as well as increased energy level. Thus, anabolic steroids are often abused to gain a competitive edge in sports. Users are often athletes, typically football players, wrestlers, or weight lifters, and almost all users are male. Many side effects are associated with the abuse of anabolic steroids. Very high doses of anabolic steroids may cause erratic mood swings, irrational behavior, and increased aggressiveness (often called steroid rage). Anabolic steroids can damage the liver and cause jaundice. Regular use of any amount also tends to increase body hair. Acne commonly gets worse with anabolic steroid use and is one of the few side effects for which an adolescent may visit a doctor. Laboratory tests can measure anabolic steroid breakdown products in the urine. Growth Hormone Growth hormone is produced by the brain to help the body control how protein, carbohydrates, and fats are used to stimulate growth. Growth hormone is also manufactured as a drug and is sometimes given to children of small stature because their body is unable to make enough growth hormone. Some athletes abuse growth hormone because they believe it will increase their muscle growth and strength while decreasing their body fat. Use of growth hormone without medical need over a long period can cause an increase in fat levels in the blood, diabetes, and an increase in heart size that may result in heart failure. Laboratory tests to measure growth hormone not made by a person's body are not routinely available. Erythropoietin and Darbepoietin ErythropoietinSome Trade Names EPOGEN PROCRIT is a hormone produced by the kidney that stimulates the bone marrow to produce red blood cells. ErythropoietinSome Trade Names EPOGEN PROCRIT is also manufactured as a drug and is routinely given to many people with anemia resulting from kidney failure as well as to people with certain other types of anemia. Darbepoietin is a drug similar to erythropoietinSome Trade Names EPOGEN PROCRIT that is also used for people with certain kinds of anemia. Some athletes abuse these drugs because they believe that with more red blood cells more oxygen will get to their muscles, enabling them to perform better. ErythropoietinSome Trade Names EPOGEN PROCRIT or darbepoietin use without medical need may change the body's regulation of red blood cell production, so that the number of red blood cells suddenly decreases when erythropoietinSome Trade Names EPOGEN PROCRIT or darbepoietin use is discontinued. Laboratory tests to measure erythropoietinSome Trade Names EPOGEN PROCRIT not made by a person's body are not routinely available. Diuretics Diuretics are drugs that speed elimination of salt and water by the kidneys. Diuretics are used to treat a variety of diseases, including heart failure and high blood pressure. However, some people, including athletes and people with eating disorders such as anorexia nervosa, abuse diuretics to help them lose weight quickly. Inappropriate use of diuretics may cause dehydration and severe deficiencies of electrolytes such as potassium. Ipecac Syrup Ipecac syrup is a drug that triggers vomiting. It is used to treat children who have swallowed chemicals or poisons. However, people with eating disorders such as anorexia nervosa often abuse ipecac syrup to help them lose weight. Inappropriate use of ipecac may cause diarrhea, severe deficiencies of electrolytes, weakness, irregular heart rhythms, and heart failure. Laxatives Laxatives are drugs that promote bowel movements and are used to treat constipation. However, people who falsely believe they must have frequent bowel movements as part of being healthy often abuse laxatives. In addition, people with eating disorders such as anorexia nervosa sometimes abuse laxatives because they believe doing so will help them lose weight. Laxatives used often and without medical need may cause dehydration and severe deficiencies of electrolytes. Regular use of laxatives can also interfere with absorption of other drugs, causing them to stop working. Inappropriate use of laxatives over a long period can damage the muscle layers of the large intestine, which can lead to severe constipation.

Drug Dependence: Drug dependence is a compelling need to continue taking a mind-altering drug to induce pleasure or to relieve anxiety and tension and avoid discomfort. Drug dependence is caused by a combination of biologic and psychologic factors. Drugs that cause dependence may produce euphoria, feelings of increased mental and physical ability, and altered sense perceptions.

Dependence can be very powerful and difficult to overcome. The body adapts to the continuous use of a drug that produces dependence, leading to tolerance and to withdrawal symptoms when use stops. Tolerance is the need to use progressively larger amounts of a drug to reproduce the effects originally achieved with the starting amount.

Withdrawal symptoms occur when drug use is stopped or when the drug's effects are blocked by another drug. A person undergoing withdrawal feels sick and may develop headaches, diarrhea, or shaking (tremors). Withdrawal can evoke a serious and even life-threatening illness.

Drug Addiction: Drug addiction is the disruptive behavior or activity associated with obtaining and using a drug that a person is dependent on. Addiction generally interferes with the ability to work, study, or interact normally with family and friends. A person can become dependent on illegal drugs or legal ones and can become dependent when a drug is used for a medical need or for less acceptable reasons. However, the behavior or activity associated with obtaining and using a drug is likely to vary tremendously based on the legality and acceptance of that drug. Obtaining a legal drug to meet a medical need is often as unremarkable as going to the doctor, getting a prescription, and then going to the pharmacy. However, for an illegal drug or a legal drug used without medical need and for unacceptable reasons, the behavior or activity may include lying and stealing.

When a person with advanced cancer becomes dependent on an opioid drug such as morphineSome Trade Names
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, his behavior is not usually considered an addiction. However, when a person dependent on, for example, heroin steals to have money to buy heroin and lies to family and friends about his whereabouts or what he is doing, his behavior is considered an addiction.

At times, family members or friends may behave in ways that allow an addict to continue to use drugs or alcohol; these people are called enablers (also referred to as codependents when their own needs are intertwined with perpetuating the addict's use of his addictive substance). Enablers may call in sick for an addict or make excuses for the addict's behavior. The enabler may plead with the addict to stop using drugs or alcohol but rarely does anything else to help the addict change his behavior.

A pregnant addict exposes her fetus to the drugs she is using. Often, a pregnant addict does not admit to her doctor that she is using drugs or alcohol. The fetus may become dependent and may develop serious defects as a result of the mother's drug use (see Birth Defects: Exposure to Harmful Substances (Teratogens)). Soon after delivery, the newborn can experience severe or even fatal withdrawal, particularly when the doctor has not been informed of the mother's addiction.

Last full review/revision February 2003