Alcoholism and Substance Abuse

The costs to society are enormous; the National Institute on Alcohol Abuse and Alcoholism estimates that alcohol and drug abuse are associated with 100,000 deaths per year and cost society $100 billion per year. The distinction between addiction and problem use is particularly important. The problem drinker or drug user may have undiagnosed medical or social problems but not yet have experienced a major loss of control. In full-blown addiction, patients continue using alcohol or drugs despite negative consequences, have a compulsion to continue using alcohol or drugs, and are in denial about the effects on themselves and others. Patients who abuse alcohol and drugs are much more likely to develop medical problems than the general population.

Drug and alcohol use during adolescence differs from use in adults. The typical acting out of adolescents can be confused with the effects of alcohol and drug use. Adolescents' mistrust of adult authority frequently complicates the detection of substance abuse. A family physician that has interacted with an adolescent over time probably is trusted more than other adult authority figures. The physician should be suspicious of substance abuse in patients with mental disorders. A detailed outline of the treatment of substance abuse is beyond the scope of this article these patients have experienced some negative consequences but have not yet experienced a major loss of control. The patient who has been diagnosed with substance abuse should be referred to an addiction-medicine specialist or an inpatient or outpatient treatment centre. These steps give the patient a solid start on the recovery process.