Drug abuse and addiction is a common problem in the world and is everywhere you look. With this disorder so common, the truth is shed on the misconceptions that people have about drug abuse and addiction. This paper provides a brief overview of drug abuse and addiction, while also looking at the aspects of epidemiology, pathophysiology, social problems, and ethical problems that might present with emergency medical responders.
Addiction and abuse; what does it mean; who does it affect? Addiction and abuse are often confused with each other. Abuse occurs whenever a substance is used – usually alcohol or illicit drugs – while on the other hand addiction can occur in a wide variety activities and substances. Addiction is defined as “compulsive need for and use of a habit-forming substance (as heroin, nicotine, or alcohol) characterized by tolerance and by well-defined physiological symptoms upon withdrawal; broadly: persistent use compulsive of a substance known by the user to be harmful”. (http://www.merriam-webster.com/dictionary/addiction) Addiction is not always a habit-forming substances, it can also include such things as sex, gambling, video games, or even the internet. Even so, the main focus of society is still on drugs, alcohol and tobacco. Some characteristics of the epidemiology and pathophysiology will be discussed along with the social impacts that addiction may cause and any ethical issues that might be found with addiction and emergency medical service providers.
The study of addictive behavior is relatively young. According to Dr. Volkhow (2010) science only began to study addictive behavior in the 1930s. Before this, scientists that were studying drug abuse were plagued with shadows of misconceptions and myths of the nature of addiction. But with the discoveries today and with the information of how chemicals work in the brain and the ways it alters it there is a better understanding of drug and alcohol addiction. According to Dr. Dryden-Edwards (n.d.) “Drug addiction, also called substance dependence or chemical dependency, is a disease that is characterized by a destructive pattern of drug abuse that leads to significant problems involving tolerance to or withdrawal from the substance, as well as other problems that use of the substance can cause for the sufferer, either socially or in terms of their work or school performance. More than 2.6% of people suffer from drug addiction at some time in their life.” (http://www.medicinenet.com/drug_abuse/article.htm) Common substances that are abused and that become addicting are alcohol, amphetamines, anabolic steroids, caffeine, cannabis, cocaine, ecstasy, hallucinogens, inhalants, nicotine, opiates, phencyclidine, as well as sedative, hypnotic, or anti-anxiety drugs. Though drug and alcohol addiction is considered a mental- health problem, there is no single cause that can be determined. Though some people believe that abuse and addiction is a genetic disease, this is false. There is a predisposition to develop the drug dependency due to one’s environment.
The social risk factors for drug abuse and addiction include the male gender, being between that age eighteen and forty four, persons of Native-American heritage, lower socioeconomic status, and unmarried marital status. According to state statistics residents of the western United States are more susceptible to substance abuse and dependency. While men are more prone to developing alcoholism, women seem to be much more vulnerable to alcoholism at much lower amount of alcohol consumption, due to lower average body mass that males. (Dryden-Edwards, n.d.) The combined medical, economic, criminal, and social impact costs Americans upwards of half a trillion dollars a year. Every year abuse of drugs and alcohol contributes to the deaths of 100,000 Americans, with tobacco contributing to an estimated 440,000 deaths per year. People of all ages suffer the harmful consequences of drug and alcohol abuse and addiction. Babies can be affected while still in the mother’s womb if she is to use drugs or alcohol, which will cause birth defects and slow the intellectual development in their later life. Adolescents often act out, perform poorly in school and often drop out if they are abusing drugs. They are more at risk or unplanned pregnancies, infectious diseases, and violence. Adults and parents are also affected, often clouding their cognitive abilities. With all of the exposure, the stage is set for the next generation to step right in to the addictive lifestyle.
Addiction mainly affects the brain, but affects cascade throughout a person’s organ systems. Drugs and mind altering substances that can be abused target the body’s natural reward system either purposefully or unintentionally causing over all euphoric effects for the user. These effects come from the dopamine, which is a neurotransmitter that regulates movement, cognition, emotion, feelings of pleasure, and motivation. Dopamine is released naturally to reward the body for natural behaviors and initiates a cycle to repeat the behavior. The dopamine neurotransmitter floods the reward system that is usually secreted in limited amounts from routine actions such as eating or even sex. The brain views this as a life-sustaining activity due to the reward system being activated. When the chemical substance is introduced into a person’s system and the euphoric effects are achieved, the individual’s brain makes a note that some important event is happening and it teaches itself to do this action again and again as a force of habit. (Volkhow 2010) The taking of an illicit drug can cause a person to act on impulse when the reasons system of the brain would delay or prevent an action. This system is bypassed, leading to an undesired activity that can potentially have a negative consequence on the user’s life. Though some of the effects of drugs and chemical substances are euphoric at times, other times the substance can cause paranoia, depression, and suicidal thoughts. (Dryden-Edwards n.d.) If use of the drug continues, the brain becomes acclimated to the influx of dopamine in the reward system. This leads to the reduction of release of dopamine and the number of dopamine receptors in the system itself. This in turn affects the user’s ability to achieve the desired effects of the used drug. This response by the individual’s brain causes them to try to reactivate the receptors by increasing the amount or dosage of the drug to achieve the same dopamine high. This effect is known as a tolerance. With long-term abuse of a drug, changes occur to other systems in the brain. The neurotransmitter glutamate – which also is part of the reward systems – can be altered which causes an inability to learn. When the optimal level of glutamate is off balance the brain attempts to compensate, which in turn affects the user’s cognitive function. (NIDA 2011) When the brain has become accustomed to the effect of the drug, dependence is formed and cessation of the drug abuse will cause an event referred to as withdrawal. While most symptoms of withdrawal are at most uncomfortable for an addict, there are also some serious symptoms that can include tonic-clonic seizures, myocardial infarction, stroke, hallucinations, and delirium tremens. (Melemis 2011)
Social, Ethical Issues and The Impact on EMS:
The consequences of addiction and abuse are evident in a person’s social life. The destructive behavior of addiction affects everything from work to their personal life, even from the beginning of the abuse. The signs of addiction from the physical stand point include a changing of sleeping habits and changes in eating habits, which contribute to both weight loss and weight gain. Recurrent drug abuse leads to the lack of meeting important obligations at home, school, or work. (Dryden-Edwards) Other affects of addiction can include family disintegration, domestic violence, child abuse, failure in school, and loss of employment. Subjects with addictions tend to be risk takers and thrill seekers. With the changes in the reward system of the brain, the subject expects a positive reaction before they take a substance which satisfies their need for risk or thrills. Impulse control is hard when their drug of choice is around people with addiction. This feeds the addiction even more. (Nash & Johnson, 2007)
The impact on the emergency medical services is immeasurable. The calls caused by addiction can vary from trauma to a medical overdose. The role of the emergency medical provider in calls for an overdose patient requires the paramedic to find out what and how much the patient took, and what the proper medication is to reverse the condition that the patient is currently experiencing. Along with the calls comes the danger. With possible violent outbreaks by addicts, the paramedic has to be aware of his or her surroundings while trying to calm the patient. Patients experiencing withdrawals can hallucinate an entire event and incorporate the paramedic in it, causing the patient to become violent towards their care provider. Addiction is a very dangerous condition and can be considered a psychiatric problem, which needs to be treated with a certain diligence and suspicion.
In the realm of EMS the occurrence of calls for addiction are rare since it is not really an emergency situation. The occasion does arise if a patient is experiencing violent symptoms of withdrawal or has overdosed on a substance. The patient could appear to be in an agitated state or even be unconscious. There is no predetermined way to handle a patient experiencing addiction related problems. They main key is to treat the patient’s symptoms. All patients need to be put on supplemental oxygen via nonrebreather if it can be tolerated. Intravenous access should be obtained with an infusion of normal saline to help flush out the patient’s system. If the patient is in an agitated state or seizing, a sedative should be administered, such as valium or versed. Beware, with the administration of benzodiazepines the risk of respiratory depression or failure is present. If the patient is experiencing an overdose of an opiate and their breathing is shallow or nonexistent the administration of Narcan 0.4 to 2 milligrams, but beware to administer this drug slowly and titrate it to where the patient can breathe just enough to sustain life. If airway and breathing problems persist then intubation should be considered to secure the patient’s airway. Rapid transport with due regard is suggested so that the patient can be evaluated and the hospital staff can begin their detoxification.
The world of addiction is harsh and unforgiving if one is not willing to leave it behind. Some people say that addiction is all in the head, and my research verifies this. The affects on the brain from forming a learned habit is rewarded in much the same way such as eating or drinking. The reward system practically gets destroyed by the drugs or substances being used by the influx of neurotransmitters released. With the receptors becoming desensitized, the subject will need to increase the intake of the substance to achieve their high. The repercussions of the abuse and addiction become apparent after time when the violence and compulsiveness takes over. The physical tolls, including depression and illness can be debilitating at times. The only way to decrease drug abuse and addiction is to educate the public. The best prevention is avoidance.