Dealing with Substance Abuse

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Dr. Doriane C. Miller
Dr. Doriane C. Miller

When we talk about drug and alcohol abuse, African-American families can sometimes dismiss it as something to laugh at, shake your head at or ignore altogether. We dont always approach it as a serious problem with serious consequences. Sometimes well even watch the addicted person act out, get hurt or hurt someone else. But still we dont step in to help.

Then, as years pass, organs start to fail. Normal functioningboth mentally and physicallybegins to fade. Its not until the worst happens that the addicted person gets help usually while lying in a hospital bed. This happens to about 4.6 million people in the United States, who visit the emergency department each year because of drug or alcohol use, according to the National Institute on Drug Abuse. More than one in five of those visits involve illicit drugs like cocaine, heroin, marijuana or methamphetamine, also known as speed. Alcohol played a role in about 32 percent of these visits. And even though African-Americans are less likely to abuse drugs than whites or Hispanics, we still need to understand the importance of recognizing dangerous drug and alcohol use before its too late.

Causes and Red Flags

Among my patients, the most common reason behind addictions is untreated depression. An emotional pain is too much to bear, so they self-medicate. Years of addiction are often coupled with denial about having a problem, which is why help often comes too late. Family denial is an important part too. That denial could simply be a lack of awareness. Most people who are social drinkers often dont know that consuming five or more drinks for men and four or more drinks for women in two hours is considered a binge. Most people Ive encountered who smoke marijuana do not think getting high every day, feeling an urge for something stronger or struggling with depleted energy and ambition are red flags.

The problem is even more disguised by the notion of functional alcoholics or functional drug users, meaning the person is clearly dependent, but can hold down a job. But heres something to think about: How functional is that person in day-to-day relationships? How well do they resolve conflicts are the calm or out of control? If these people are so-called functional, then why does substance abuse have such a strong connection to domestic violence for both the victim and the abuser. Studies from the U.S. Department of Justice have found that 36 percent of people in domestic violence programs also had substance abuse problems, while 61 percent of domestic violence offenders do so as well. And even if a drug or alcohol abuser can hold down a job, are they performing at their best or just getting by? Drug and alcohol addictions limit the ability to engage in work and life.

Consequences to Your Health

Then, there are the major consequences. A recent patient swore to me that she never injected heroin; she only snorted it. She was adamant, rolling up her sleeves to show me her arm veins. But as I asked more questions, she revealed that shed had a sexual relationship with someone who did inject. Test results showed that person infected her with Hepatitis C. This silent virus attacks the liver and leads to inflammation and sometimes leading to liver cancer or liver failure, requiring a transplant. People with the virus usually dont know they have it until the liver starts breaking down. Needle sharing and sexual intercourse are also responsible for the HIV epidemic among drug use, but Hepatitis C is much more common. Nearly three million people are living with the disease.

Alcohol can have the same devastating impact. Aside from problems with personal relationships, work and finances, alcohol abuse can also lead to cirrhosis or scarring of the liver and increase the risk of heart failure or stroke. It also increases the risk of cancer in the mouth, throat, liver and breast. Excessive marijuana use has been linked with mental conditions like psychosis, impaired memory and hallucinations. Also, a persons risk of heart attack increases four-fold during the first hour after smoking marijuana. Long-term health defects are very similar to those who smoke cigarettes: lung infections, bronchitis and possibly a higher risk of lung cancer, according to the National Institute on Drug Abuse.

How Your Physician Can Help

When most people start to seek help for an addiction, its usually after a rock-bottom type of event: a near-death experience, a court order or a humiliating confrontation from a loved one. Assessments like the CAGE Questionnaire can help establish the extent of the problem, particularly for alcohol users. This four-question test is effective for diagnosing alcoholism by asking questions about whether or not the person has considered Cutting down on drinking. Is the person Annoyed by criticism about their drinking? Do the feel Guilty about alcohol use? Do they need alcohol to get up in the morning (Eye-Opener)?

Physicians can connect drug and alcohol abusers with treatment centers. As the person receives treatment for the actual addiction, physicians can perform tests to evaluate whether persons body has been damaged by drug or alcohol use.

The first step to preventing or addressing a substance abuse problem is to be honest with your family, with your physician and, most importantly, with yourself.

By Doriane C. Miller, MDDr. Doriane C. Miller is the Director of the Center for Community Health and Vitality, the Urban Health Initiative of the University of Chicago Medicine. For information on The Urban Health Initiative visit uhi.uchospitals.edu

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