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Addiction Medicine

Drugs and alcohol can have serious long-term consequences for those who consume excessively for long periods of time.

SUBSTANCE INDUCED DISORDERS

Introduction

While most information presented in this website focuses on addiction and substance abuse there is another group of disorders associated with drug and alcohol use that does not typically get as much attention.

Disorder Defined

Webster’s New Collegiate Dictionary defines a disorder as an “abnormal physical or mental condition.” For health professionals, the term “disorder” is very common. Examples include growth disorder, bipolar disorder, genetic disorder, bleeding disorder, etc.

Substance Disorders Explained

Substance disorders are those directly related to the taking of any mood-altering drug, including alcohol, over the counter and prescription medications.

Substance disorders are divided into two groups:

  • Substance Use Disorders
  • Substance Induced Disorders

Substance Use Disorders

A substance use disorder refers to an addiction to drugs or alcohol or the abuse of drugs or alcohol. Abuse and addiction are distinguished by whether an individual continues to use in spite of increasingly negative consequences (refer to the assessment section of this website for tests that help distinguish between addiction and abuse).

Substance Induced Disorders

A substance induced disorder is a change in physical or mental functioning due to the use of a mood-altering drug or alcohol. Substance induced disorders are caused by intoxication or withdrawal from substances.

There are two types of substance disorders: (1)  is a technical term for the two types of  (intoxication, withdrawal, delirium, persisting dementia, persisting amnesia, persisting psychotic disorder, mood disorder, anxiety disorder, sexual dysfunction and sleep disorder.

i. Substance Intoxication

Drug and alcohol intoxication can mimic mental disorders such as anxiety, mood disorders (depression) and psychosis. Other disorders that result from drug and alcohol intoxication include sexual dysfunction and sleep disorders. Symptoms usually disappear when the substance is no longer present in the person’s system, but the resolution of those symptoms can take weeks or months and may require treatment. Hallucinations and delusions may occur. Impairment in mood and thought processes such as reasoning, retention and recall are the most common symptoms of intoxication.  Depending on length of abuse and the substance of choice, these symptoms can become permanent.

Approximately two percent of those experiencing cocaine induced psychosis never recover fully. Anxiety disorders and depressive illness (not present before a psychotic episode) are the most common psychiatric illnesses people may suffer from following a psychotic break. Others are not so fortunate and do not recover from a psychotic state, and may require long term supported care.

Psychiatric symptoms can worsen or suddenly develop during detox and withdrawal and may not abate on physical recovery.

ii. Substance Withdrawal

Alcohol, Benzodiazepines (Valium, Ativan) and Phenobarbital (Tuinal, Seconal) can cause seizures during the detox process. Medically supervised detoxification is essential to monitor health status, and reduce health risks. Withdrawal from chronic substance abuse can be life threatening.

Each subsequent detox and withdrawal tends to be more intense, require more support and longer physical recovery time. Damage to the body is incremental with each detox and withdrawal.

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ALCOHOL-INDUCED LIVER DISEASE (ALD)

Alcohol-induced liver disease is damage to the liver caused by the excessive consumption of alcohol. The three main types of ALD are fatty liver, alcoholic hepatitis and alcoholic cirrhosis.

Fatty liver, the most common form of ALD, is the buildup of fat inside the liver cells which leads to enlargement of the liver and abdominal pain.

Alcoholic hepatitis is severe liver inflammation where liver cells are destroyed and scarring occurs. The liver enlarges and is tender to the touch. Other symptoms include fever, a high white blood cell count, jaundice and a darkening of the veins in the skin.

The most serious form of ALD is alcoholic cirrhosis where scar tissue develops, hampering the flow of blood to the liver. Studies (*) have shown that cirrhosis can occur without first passing through the less serious stage of alcoholic hepatitis.

Many people who have ALD are also infected with hepatitis C, a liver disease not related to alcohol consumption (see below). Hepatitis C can be more difficult to treat with heavy drinking.

Abstinence is recommended for all three conditions. Fatty liver is a reversible condition. Alcoholic hepatitis can be reversible but may also be fatal if not treated. Alcoholic cirrhosis is also reversible but, again, may also be fatal. When liver function is seriously impaired, a liver transplant may be required.

See Alcohol and the Liver published by the National Institute of Alcoholism and Alcohol Abuse (NIAAA) Alcohol Alert No. 19-1993 for more information.

(*) Source: Maddrey, W.C. Alcoholic hepatitis: Clinicopathologic features and therapy. Seminars in Liver Disease 8(1):91-102, 1988

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HEPATITIS C

Generally speaking, hepatitis is an inflammation of the liver. Although it is often caused by a virus, other causes may include alcohol, medications that have a harmful effect on the liver, toxins or autoimmune disorders.

Types of hepatitis

There are at least 7 known types of hepatitis strains: A, B, C, D, E, F and G. Of these viral forms, hepatitis C may be the leading cause of chronic liver disease in the western world. Hepatitis A, which is not blood borne, and hepatitis B, which is blood borne, are also very widespread. Only hepatitis A, B and C can be spread directly from one person to another. Hepatitis C is spread by contact with infected blood.

How hepatitis is transmitted

Common routes of transmission are through:

  • Transfusion
  • recreational I.V. drug use
  • needle stick injuries
  • acupuncture
  • body piercing or electrolysis

Any contact with dirty needles including tattoo needles that have not been sterilized or have been dipped into contaminated ink will increase the risk of infection.

Sharing personal care items like toothbrushes, nail clippers or files, razors, and other household items that may have blood on them will also increase risk. These items may come into contact with small amounts of blood that are not even visible.

Intranasal cocaine use through shared use of straws may lead to blood to blood contact through nasal ulcers or cuts and scrapes.

Sexual activity that results in blood to blood contact between an infected and uninfected partner is also a route of transmission for hepatitis C.   

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SEXUALLY TRANSMITTED DISEASES

Sexually transmitted diseases (STDs) and sexually transmitted infections, once called venereal diseases, are among the most common infectious diseases in North America today. These infections are usually passed through having intercourse, but are also spread through other types of sex. STDs can be caused by bacteria or by virus. Viral STDs include hepatitis B, HIV and the human papilloma virus (HPV). STDs caused by bacteria include chlamydia, gonorrhea and syphilis. The populations most likely to contract an STD include addicts and adolescents. The organisms which cause these diseases (except for crabs and scabies) usually enter the body via the mucous membranes, such as the warm moist surfaces of the genitalia and the mouth.

There are more than 20 STDs including:

  1. AIDS
  2. Chlamydia
  3. Gonorrhea
  4. Herpes
  5. Syphilis
  6. Other organisms (such as crabs and scabies) and syndromes

Every day STDs are passed from person to person mainly through sexual contact. STDs are almost impossible to detect initially. A check up is essential if:

  1. Your partner is infected
  2. You are promiscuous
  3. You have a sexual relationship with someone who is promiscuous
  4. If you share dirty needles for IV drug use

Symptoms of infection are likely to take the form of:

  • Discharge from the penis, anus or vagina
  • Itching or soreness around the genitals or anus
  • A lump or rash on the genitals, anus or mouth

Your risk for having an STD is higher with (1) the number of partners you have had, (2) the number of contacts your partner may have had and (3) having sex without a condom. Never assume that a partner is not now infectious.

Share personal information regarding your sexual history. Your partner will need to be informed. Do not feel embarrassed to be asked and guard against defensiveness if YOU are asked.

If you suspect you may have an STD you should see your doctor or clinic straight away. You will be tested as quickly as possible and if the test is positive, you will be advised to contact recent sexual partners as they too may need treatment.

When diagnosed and treated early, many STDs can be treated effectively. Some infections have become resistant to the drugs used to treat them and now require newer and stronger types of antibiotics. Experts believe that having other STDs other than the AIDS virus increases one’s risk for becoming infected with the AIDS virus.

The best way to prevent STDs is avoid sexual contact with others. Anyone who is sexually active should:

Correctly and consistently use a condom. Condoms are not foolproof but are the best choice for protection from infection during intercourse.

Have a mutually monogamous sexual relationship with an uninfected partner.

Have regular checkups for STDs even in the absence of symptoms, and especially if having sex with a new partner. These tests can be done routinely in a doctor’s office.

Be aware of the most common symptoms of STDs. Seek medical help immediately if any suspicious symptoms develop, even if they seem mild.

Any STD is a reportable, recordable disease through Public Health.

Anyone diagnosed with an STD should:

Notify all recent sex partners and urge them to get a check up with their doctor or at a STD Clinic through Public Health. Partners should be treated whenever possible, to effectively curtail spread of disease.

Avoid all sexual activity while being treated for an STD.

Follow the doctor’s orders and complete the full course of medication as prescribed. A follow-up test to ensure that the infection has been cured is an important step in the treatment.

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DRUG SMOKING AND LUNG INFECTIONS

Tobacco, marijuana, or crack cocaine increases the user’s risk of developing bacterial pneumonia and other serious infections of the lungs.

Smoking anything appears to paralyze the cilia which are hair-like projections in the lungs that sweep out microbes and other matter that may cause disease.

Some drugs seem to have specific damaging effects when smoked. For example, smoking cocaine appears to weaken the lungs’ natural resistance to infection.

Other risks from smoking drugs such as crack and cocaine include pneumothorax (collapsed lung), scattered hyaline membranes (the lining protecting the lungs), dyspnea (inability to catch one’s breath), interstitial and alveolar infections (infection between the two linings of the lungs), bronchitis, pneumonia, drug induced asthma, and barotraumas (resulting from deep inhalation, followed by a valsavalva maneuver). This typically causes the alveoli to burst causing scar tissue to form and decreasing lung capacity over time.

Free-base (powder) and crack cocaine smokers report throat and lung problems. “Crack hack” produces black or bloody phlegm. They can also inhale small bits of metal from the use of a screen or brillo pad for smoking drugs.

By the time a younger user gets to the age of thirty, drug use has caused aging of the blood vessels and lungs, making a heart attack more likely. Triple vessel disease is something that could be expected in people in their late fifties and early sixties.

Typical symptoms that cause drug smokers to attend the emergency room include blood clotting, chest pain, palpitations, breathlessness, increase in blood pressure, and heart attack.

Additional damage due to the method of use includes airways damage, crack lung and probable permanent lung damage. Thermal burns to the nasal passages and the throat may go unnoticed due to the anesthetizing effects of cocaine and crack.

Cocaine users who snort may literally burn holes through the septum and burn away the mucous membranes in the nostrils, causing scab formation which, in turn, cause painful staph infections in the nostrils. Staph infections have the nasty habit, if left untreated, of spreading to the sinuses and possibly the brain.

Both cocaine and crack users have a distinctive sickly sweet odor to their breath. This is most likely due to the smell of cocaine and crack and low grade infection in the upper respiratory tract.

All of the above-noted damage can leave the user with a chronic cough, chronic infection and microvascular damage.

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NUTRITION AND RECOVERY FROM ADDICTION

It is important to understand the impact of nutrition on recovery from addiction. Anyone who is actively using excessive quantities of drugs and/or alcohol is malnourished. Fat is the only substance that has more calories alcohol when measured by volume. Alcohol dehydrates the body at the cellular level. Cocaine and ecstasy further the dehydration. Seizures due to fluid and electrolyte imbalance are common.

Alcohol and drugs prevent the body from properly absorbing and breaking down nutrients and expelling toxins. This can lead to a number of health problems. Because diet is neglected, gastrointestinal disorders such as diarrhea and/or constipation are common. Lack of appetite, nausea and vomiting may occur. Permanent gastrointestinal conditions may result. These include acid reflux, stomach and intestinal ulceration and esophageal burns.

Food affects mood. Deficiencies in nutrients like amino acids and other B-complex vitamins have serious and negative impact. Sugar and caffeine can contribute to mood swings.

It is important to make healthy choices surrounding dietary needs in recovery.  Good nutrition, relaxation, and exercise all play an important part in good physical health.

THE IMPACT OF STEROID ABUSE ON THE BODY

Steroids cause a disruption in the body’s production of hormones. For example, men can develop breasts in a condition known as gynecomastia.

Steroid abuse can also be the sign of psychological problems such as muscle dysmorphia, a condition where a person has a distorted image of themselves when they look in the mirror. Regardless of their size, individuals with muscle dysmorphia will see themselves as weak and skinny.

More information is available in the anabolic steroids section of this website.

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FOR MORE INFORMATION

Additional information is available on the medical aspect of addiction by referring to specific drugs in our drugs of abuse section.

SEXUAL FUNCTION

Yes, it can. Alcohol has a direct and indirect damaging effect on testicular, or male sex gland, tissue. As a result of a man’s long-term alcohol abuse, the amount of male sex hormone in his body decreases so that he becomes impotent and his sex glands produce greatly reduced numbers of sperm, a condition known as relative sterility. Furthermore, with reduced circulating testosterone, long-term alcohol abuse can lead to feminizing features in men such as loss of facial and body hair, female breast configuration and reduced muscle mass. This is due to a relative increase in estrogenic (female) hormones in the liver. Even short-term heavy use of alcohol temporarily lowers male sex hormone levels, but long-term heavy drinking causes irreversible damage. In the female, heavy alcohol use during pregnancy can have a profound adverse effect on the development of the fetus. Alcohol can also interfere with ovarian function causing a disruption in the normal female cycle.

So, yes, alcohol interferes with the delicate biochemical and hormonal functioning of the sexual system and continued long-term heavy drinking can shut the system down permanently.

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ALCOHOLIC GASTRITIS

Over the past few months I have pains in my stomach after a few drinks which continue for a couple of hours. When I don’t drink alcoholic beverages, I don’t have any trouble. I have been a fairly heavy drinker for years but I don’t think of it as a problem. Now I know that if I take even two drinks I get these pains. What’s happening?

Your body may be warning you that your heavy drinking days may be nearing an end. It is possible, even probable, that each time you drink alcohol, these same distressing symptoms will occur. Your pain can come from several conditions. The most likely cause is alcoholic gastritis; an inflammation of the stomach lining caused by alcohol. The symptoms include nausea, vomiting and some bleeding. This inflammation heals over a three-month period with abstinence. Another more uncommon condition is pancreatitis, an inflammation of the gland that lies in the upper abdomen and produces vital substances for your body, such as insulin.

It seems, regardless of the cause, once these symptoms of upper abdominal pain begin to occur after drinking, they will continue each time a person drinks. Alcoholic pancreatitis can progress from repeated acute attacks following alcohol intake to a more chronically debilitating condition called chronic relapsing pancreatitis. Alcohol causes one third of all pancreatitis cases. Gallstones cause another third and other conditions, viral, drug-induced, metabolic, or traumatic, cause the remaining third. Most people in whom this condition exists should stop drinking permanently, simply because they cannot tolerate the effects of “just a few drinks.”

Call your physician now to schedule an appointment and find out what condition you are suffering from. There are other disorders not related to alcohol that can cause these symptoms as well.

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WET BRAIN SYNDROME

Good question. The term wet brain refers to a very real condition known as Wernicke-Korsakoff syndrome. This chronic brain syndrome is caused by long-term alcoholism and is accompanied by a triad of symptoms: 1) mental disturbance; 2) confusion, drowsiness and paralysis of eye movements; and 3) ataxia or a staggering gait. A primary cause for this is a thiamine (vitamin B1) deficiency due to severe malnutrition and poor intestinal absorption of food and vitamins caused by alcohol. The person with wet brain acts much like the Alzheimer’s victim with loss of recent memory, disorientation with regard to time and place, confusion and confabulation, or telling imagined and untrue experiences as truth. If wet brain is identified in its early onset, an infusion of thiamine (B1) may help. Unfortunately, there is no recovery from Wernicke-Korsakoff syndrome. Therefore, it is one of the most tragic consequences of alcoholism.

BREAST CANCER AND ALCOHOL

Is there a connection between breast cancer and alcohol?

There seems to be.  A statistical analysis of a number of studies [Alcohol Health and Research World 16 (3): 223-229, 1992] suggests that breast cancer rates tend to increase proportionately with increasing exposure to alcohol.  The average increase in risk of breast cancer associated with each drink consumed daily is about 10 percent – so if you have two drinks each day over a long period of time, your chances of getting breast cancer will increase 20 percent.  Experiments show that after three months, women who drink daily have increased levels of serum estrogen at about the time of ovulation.

Because increased levels of estrogen have been implicated as a cause of breast cancer in humans, this alcohol-hormone link fits with existing theories of the mechanism of breast cancer in humans.

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A Note on the Use of Scare Tactics in Addiction Treatment

Although we realize that this information may be new to you and that, for some, it may lead to a change in drug or alcohol use habits, we also acknowledge that this information has limited benefit when it comes to actually addressing a person’s addiction. At Sunshine Coast Health Center, we believe a focus on the causal factors of a person’s addiction and a forward-looking, positive approach to encouraging improved lifestyle and relationships is a preferred approach. For more information see the Drug Rehab Programs & Services section of this website.

Permanent Brain Damage by Alcohol includes the latest research from leading scientists on alcohol on the adolescent brain. Karen Murray, ScienCentral.

Resources

I. PRINTED RESOURCES

Alcohol and Heart Disease (1997) includes the latest research on the negative effects of drinking on cardiovascular health. Ronald Ross Watson, Adam K, Myers.

Handbook of the Medical Consequences of Alcohol and Drug Abuse (2004) examines the medical consequences of alcohol, stimulants, inhalants, marijuana, and opiates – as well as the consequences of prenatal exposure alcohol and other drugs.  John Brick, PhD, Editor.

III. ONLINE RESOURCES

Research on Medical Aspects of Addiction

Alcoholism: Science Made Easy (2004) has a section specific to physical health and alcohol. Addiction Technology Transfer Center (ATTC).

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