Editing Substance abuse (section)

==Signs and symptoms==
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{| class="wikitable sortable" style="text-align:center; float:right; margin-left:8px; width:610px;"
|+ style="background:Khaki; border:1px solid black" | Rational scale to assess the harm of recreational drug use<ref name="Nutt">{{Cite journal | journal = The Lancet | first4 = C. | last4 = Blakemore | author-link4 = Colin Blakemore| author-link1 = David Nutt| volume = 369 | issue = 9566| pmid=17382831 | pages = 1047–1053 | first3 = W. | last3 = Saulsbury | year = 2007 | title = Development of a rational scale to assess the harm of drugs of potential misuse | last1 = Nutt | first1 = D. | first2 = L. A. | last2 = King | doi = 10.1016/S0140-6736(07)60464-4| s2cid = 5903121 }}</ref>
! scope="col" | Drug
! scope="col" | [[Drug class]]
! scope="col" | Physical<br />harm
! scope="col" | Dependence<br />liability
! scope="col" | Social<br />harm
! scope="col" | Avg.<br />harm
<!-- Background colors used for levels of harm:
    All colors are relatively pale to ensure high contrast with foreground black text, though are progressively slightly darker for each higher harm level as a possible aid to those with reduced color vision.
    0.00-0.99: Yellow (#FFFFC0)
    1.00-1.49: Orange (#FFE0C0)
    1.50-1.99: Red (#FFC0C0)
    2.00-3.00: Magenta (#FF90FF)
-->
|-
| style="text-align:left" | [[Methamphetamine]] || style="text-align:left" | [[Central nervous system|CNS]] [[stimulant]] || style="background: #FF90FF;" | 3.00 || style="background: #FF90FF;" | 2.80 || style="background: #FF90FF;" | 2.72 || style="background: #FF90FF;" | '''2.92'''
|-
| style="text-align:left" | [[Heroin]] || style="text-align:left" | [[Opioid]] || style="background: #FF90FF;" | 2.78 || style="background: #FF90FF;" | 3.00 || style="background: #FF90FF;" | 2.54 || style="background: #FF90FF;" | '''2.77'''
|-
| style="text-align:left" | [[Cocaine]] || style="text-align:left" | [[Central nervous system|CNS]] [[stimulant]] || style="background: #FF90FF;" | 2.33 || style="background: #FF90FF;" | 2.39 || style="background: #FF90FF;" | 2.17 || style="background: #FF90FF;" | '''2.30'''
|-
| style="text-align:left" | [[Barbiturate]]s || style="text-align:left" | [[Central nervous system|CNS]] [[depressant]] || style="background: #FF90FF;" | 2.23 || style="background: #FF90FF;" | 2.01 || style="background: #FF90FF;" | 2.00 || style="background: #FF90FF;" | '''2.08'''
|-
| style="text-align:left" | [[Methadone]] || style="text-align:left" | [[Opioid]] || style="background: #FFC0C0;" | 1.86 || style="background: #FF90FF;" | 2.08 || style="background: #FFC0C0;" | 1.87 || style="background: #FFC0C0;" | '''1.94'''
|-
| style="text-align:left" | [[Alcohol (drug)|Alcohol]] || style="text-align:left" | [[Central nervous system|CNS]] [[depressant]] || style="background: #FFE0C0;" | 1.40 || style="background: #FFC0C0;" | 1.93 || style="background: #FF90FF;" | 2.21 || style="background: #FFC0C0;" | '''1.85'''
|-
| style="text-align:left" | [[Ketamine]] || style="text-align:left" | [[Dissociative anesthetic]] || style="background: #FF90FF;" | 2.00 || style="background: #FFC0C0;" | 1.54 || style="background: #FFC0C0;" | 1.69 || style="background: #FFC0C0;" | '''1.74'''
|-
| style="text-align:left" | [[Benzodiazepine]]s || style="text-align:left" | Benzodiazepine || style="background: #FFC0C0;" | 1.63 || style="background: #FFC0C0;" | 1.83 || style="background: #FFC0C0;" | 1.65 || style="background: #FFC0C0;" | '''1.70'''
|-
| style="text-align:left" | [[Amphetamine]] || style="text-align:left" | [[Central nervous system|CNS]] [[stimulant]] || style="background: #FFC0C0;" | 1.81 || style="background: #FFC0C0;" | 1.67 || style="background: #FFC0C0;" | 1.50 || style="background: #FFC0C0;" | '''1.66'''
|-
| style="text-align:left" | [[Tobacco]] || style="text-align:left" | Tobacco ||style="background: #FFE0C0;" |  1.24 || style="background: #FF90FF;" | 2.21 || style="background: #FFE0C0;" | 1.42 || style="background: #FFC0C0;" | '''1.62'''
|-
| style="text-align:left" | [[Buprenorphine]] || style="text-align:left" | [[Opioid]] || style="background: #FFC0C0;" | 1.60 || style="background: #FFC0C0;" | 1.64 || style="background: #FFE0C0;" | 1.49 || style="background: #FFC0C0;" | '''1.58'''
|-
| style="text-align:left" | [[Cannabis]] || style="text-align:left" | [[Cannabinoid]] || style="background: #FFFFC0;" | 0.99 || style="background: #FFC0C0;" | 1.51 || style="background: #FFC0C0;" | 1.50 || style="background: #FFE0C0;" | '''1.33'''
|-
| style="text-align:left" | [[Inhalant#Solvents|Solvent drugs]] || style="text-align:left" | [[Inhalant]] || style="background: #FFE0C0;" | 1.28 || style="background: #FFE0C0;" | 1.01 || style="background: #FFC0C0;" | 1.52 || style="background: #FFE0C0;" | '''1.27'''
|-
| style="text-align:left" | [[4-Methylthioamphetamine|4-MTA]] || style="text-align:left" | [[Designer drug|Designer]] [[selective serotonin releasing agent|SSRA]] || style="background: #FFE0C0;" | 1.44 || style="background: #FFE0C0;" | 1.30 || style="background: #FFE0C0;" | 1.06 || style="background: #FFE0C0;" | '''1.27'''
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| style="text-align:left" | [[LSD]] || style="text-align:left" | [[Psychedelic drug|Psychedelic]] || style="background: #FFE0C0;" | 1.13 || style="background: #FFE0C0;" | 1.23 || style="background: #FFE0C0;" | 1.32 || style="background: #FFE0C0;" | '''1.23'''
|-
| style="text-align:left" | [[Methylphenidate]] || style="text-align:left" | [[Central nervous system|CNS]] [[stimulant]] || style="background: #FFE0C0;" | 1.32 || style="background: #FFE0C0;" | 1.25 || style="background: #FFFFC0;" | 0.97 || style="background: #FFE0C0;" | '''1.18'''
|-
| style="text-align:left" | [[Anabolic steroid]]s || style="text-align:left" | Anabolic steroid || style="background: #FFE0C0;" | 1.45 || style="background: #FFFFC0;" | 0.88 || style="background: #FFE0C0;" | 1.13 || style="background: #FFE0C0;" | '''1.15'''
|-
| style="text-align:left" | [[Gamma-Hydroxybutyric acid|GHB]] || style="text-align:left" | [[Neurotransmitter]] || style="background: #FFFFC0;" | 0.86 || style="background: #FFE0C0;" | 1.19 || style="background: #FFE0C0;" | 1.30 || style="background: #FFE0C0;" | '''1.12'''
|-
| style="text-align:left" | [[MDMA|Ecstasy]] || style="text-align:left" | [[Empathogen–entactogen|Empathogenic]] [[stimulant]] || style="background: #FFE0C0;" | 1.05 || style="background: #FFE0C0;" | 1.13 || style="background: #FFE0C0;" | 1.09 || style="background: #FFE0C0;" | '''1.09'''
|-
| style="text-align:left" | [[Alkyl nitrite]]s || style="text-align:left" | [[Inhalant]] || style="background: #FFFFC0;" | 0.93 || style="background: #FFFFC0;" | 0.87 || style="background: #FFFFC0;" | 0.97 || style="background: #FFFFC0;" | '''0.92'''
|-
| style="text-align:left" | [[Khat]] || style="text-align:left" | [[Central nervous system|CNS]] [[stimulant]] || style="background: #FFFFC0;" | 0.50 || style="background: #FFE0C0;" | 1.04 || style="background: #FFFFC0;" | 0.85 || style="background: #FFFFC0;" | '''0.80'''
|-
! scope="col" colspan="6" | {{Hidden
| headerstyle = background:PapayaWhip; font-size: 110%; border:1px solid black
| header = Notes about the harm ratings
| contentstyle = text-align:left;
| content = {{nobold|<small>The ''Physical harm'', ''Dependence liability'', and ''Social harm'' scores were each computed from the average of three distinct ratings.<ref name="Nutt" /> The highest possible harm rating for each rating scale is 3.0.<ref name="Nutt" /><br />''Physical harm'' is the average rating of the scores for acute binge use, chronic use, and intravenous use.<ref name="Nutt" /><br />''Dependence liability'' is the average rating of the scores for intensity of pleasure, [[psychological dependence]], and [[physical dependence]].<ref name="Nutt" /><br />''Social harm'' is the average rating of the scores for [[drug intoxication]], health-care costs, and other social harms.<ref name="Nutt" /><br />''Average harm'' was computed as the average of the ''Physical harm'', ''Dependence liability'', and ''Social harm'' scores.</small>}}
}}
|}
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Depending on the actual compound, drug abuse including alcohol may lead to health problems, [[social problems]], [[morbidity]], [[injuries]], [[unprotected sex]], [[violence]], [[deaths]], [[motor vehicle accidents]], [[homicides]], [[suicides]], [[physical dependence]] or [[Addiction|psychological addiction]].<ref>{{Cite journal|vauthors=Burke PJ, O'Sullivan J, Vaughan BL |title=Adolescent substance use: brief interventions by emergency care providers |journal=Pediatr Emerg Care |volume=21 |issue=11 |pages=770–6 |date=November 2005 |pmid=16280955 |doi= 10.1097/01.pec.0000186435.66838.b3|s2cid=36410538 }}</ref>

There is a high rate of suicide in [[alcoholics]] and other drug abusers. The reasons believed to cause the increased risk of suicide include the [[Health effects of alcohol|long-term abuse of alcohol]] and other drugs causing physiological distortion of brain chemistry as well as the social isolation.<ref>{{cite journal | vauthors = Serafini G, Innamorati M, Dominici G, Ferracuti S, Kotzalidis GD, Serra G | title = Suicidal Behavior and Alcohol Abuse | journal = International Journal of Environmental Research and Public Health | publisher = International Journal Environmental Research and Public Health | date=April 2010 | volume = 7 | issue = 4 | pages = 1392–1431 | doi = 10.3390/ijerph7041392 | pmid = 20617037| pmc = 2872355 | doi-access = free }}</ref> Another factor is the acute intoxicating effects of the drugs may make suicide more likely to occur. Suicide is also very common in [[adolescent]] alcohol abusers, with 1 in 4 suicides in adolescents being related to alcohol abuse.<ref name="understanding_suicidal_behaviour_a02">{{Cite book| last1 = O'Connor | first1 = Rory | last2 = Sheehy | first2 = Noel | title = Understanding suicidal behaviour | url = https://books.google.com/books?id=79hEYGdDA3oC | date = 29 January 2000 | publisher = BPS Books | location = Leicester | isbn = 978-1-85433-290-5 | pages = 33–36 }}</ref> In the US, approximately 30% of suicides are related to alcohol abuse. Alcohol abuse is also associated with increased risks of committing criminal offences including [[child abuse]], [[domestic violence]], [[rapes]], [[burglaries]] and [[assaults]].<ref name="drug_use_a_reference_handbook">{{Cite book| last1 = Isralowitz | first1 = Richard | title = Drug use: a reference handbook | url = https://books.google.com/books?id=X0mxxfbIbp4C | year = 2004 | publisher = ABC-CLIO | location = Santa Barbara, Calif. | isbn = 978-1-57607-708-5 | pages = 122–123}}</ref>

Drug abuse, including alcohol and prescription drugs, can induce symptomatology which resembles mental illness. This can occur both in the intoxicated state and also during [[Drug withdrawal|withdrawal]]. In some cases, [[Substance-induced psychosis|substance-induced psychiatric disorders]] can persist long after detoxification, such as prolonged psychosis or [[major depression|depression]] after amphetamine or cocaine abuse. A [[protracted withdrawal syndrome]] can also occur with symptoms persisting for months after cessation of use. [[Benzodiazepines]] are the most notable drug for inducing prolonged withdrawal effects with symptoms sometimes persisting for years after cessation of use. Both alcohol, barbiturate as well as benzodiazepine withdrawal can potentially be fatal. Abuse of [[hallucinogens]], although extremely unlikely, may in some individuals trigger delusional and other psychotic phenomena long after cessation of use. This is mainly a risk with [[deliriant]]s, and most unlikely with [[Psychedelic drug|psychedelics]] and [[dissociative]]s.

[[cannabis (drug)|Cannabis]] may trigger [[panic attack]]s during intoxication and with continued use, it may cause a state similar to [[dysthymia]].<ref>{{Cite web |title=SUBSTANCE ABUSE & HEALTH RISKS |url=http://www.miami.edu/ref/index.php/umpd/CampusSafety_faqs/substance_abuse_/ |url-status=dead |archive-url=https://web.archive.org/web/20130104095306/http://www.miami.edu/ref/index.php/umpd/CampusSafety_faqs/substance_abuse_/  |archive-date=4 January 2013 |website=[[University of Miami]]}}</ref> Researchers have found that daily cannabis use and the use of [[Cannabis strain#Skunk|or low-potency indoor grown cannabis]] are independently associated with a higher chance of developing schizophrenia and other [[psychotic disorder]]s.<ref>{{cite web |title=High-strength skunk 'now dominates' UK cannabis market |url=https://www.nhs.uk/news/mental-health/high-strength-skunk-now-dominates-uk-cannabis-market/ |website=nhs.uk |language=en |date=28 February 2018 |access-date=18 January 2021 |archive-date=11 November 2020 |archive-url=https://web.archive.org/web/20201111163235/https://www.nhs.uk/news/mental-health/high-strength-skunk-now-dominates-uk-cannabis-market/ |url-status=dead }}</ref><ref name="Cannabis systematic review">{{cite journal | vauthors = Di Forti M, Marconi A, Carra E, Fraietta S, Trotta A, Bonomo M, Bianconi F, Gardner-Sood P, O'Connor J, Russo M, Stilo SA, Marques TR, Mondelli V, Dazzan P, Pariante C, David AS, Gaughran F, Atakan Z, Iyegbe C, Powell J, Morgan C, Lynskey M, Murray RM | title = Proportion of patients in south London with first-episode psychosis attributable to use of high potency cannabis: a case-control study | journal = Lancet Psychiatry | volume = 2 | issue = 3 | pages = 233–8 | year = 2015 | pmid = 26359901 | doi = 10.1016/S2215-0366(14)00117-5 | url = http://www.thelancet.com/pb/assets/raw/Lancet/pdfs/14TLP0454_Di%20Forti.pdf| doi-access = free }}</ref><ref>{{cite journal|url= |title=Daily Use, Especially of High-Potency Cannabis, Drives the Earlier Onset of Psychosis in Cannabis Users|journal=Schizophrenia Bulletin|date=17 December 2013|author=Marta Di Forti|doi=10.1093/schbul/sbt181|pmid=24345517|pmc=4193693|volume=40|issue=6|pages=1509–1517}}</ref>

Severe anxiety and depression are often induced by sustained alcohol abuse. Even sustained moderate alcohol use may increase anxiety and depression levels in some individuals. In most cases, these drug-induced psychiatric disorders fade away with prolonged abstinence.<ref>{{Cite book|last1=Evans |first1=Katie |last2=Sullivan |first2=Michael J. |title=Dual Diagnosis: Counseling the Mentally Ill Substance Abuser |url=https://books.google.com/books?id=lvUzR0obihEC |edition=2nd |date=1 March 2001 |publisher=Guilford Press |isbn=978-1-57230-446-8 |pages=75–76 }}</ref> Similarly, although substance abuse induces many changes to the brain, there is evidence that many of these alterations are reversed following periods of prolonged abstinence.<ref name=Hamp2019>{{cite journal | vauthors = Hampton WH, Hanik I, Olson IR | title = [Substance Abuse and White Matter: Findings, Limitations, and Future of Diffusion Tensor Imaging Research] | language = en | journal = Drug and Alcohol Dependence | volume = 197 | issue = 4 | pages = 288–298 | year = 2019 | pmid = 30875650 | pmc = 6440853 | doi = 10.1016/j.drugalcdep.2019.02.005 | quote = Given that our the central nervous system is an intricately balanced, complex network of billions of neurons and supporting cells, some might imagine that extrinsic substances could cause irreversible brain damage. Our review paints a less gloomy picture of the substances reviewed, however. Following prolonged abstinence, abusers of alcohol (Pfefferbaum et al., 2014) or opiates (Wang et al., 2011) have white matter microstructure that is not significantly different from non-users. There was also no evidence that the white matter microstructural changes observed in longitudinal studies of cannabis, nicotine, or cocaine were completely irreparable. It is therefore possible that, at least to some degree, abstinence can reverse effects of substance abuse on white matter. The ability of white matter to "bounce back" very likely depends on the level and duration of abuse, as well as the substance being abused.}}</ref>

===Impulsivity===
[[Impulsivity]] is characterized by actions based on sudden desires, whims, or inclinations rather than careful thought.<ref>{{cite book |last=VandenBos |first=G. R. |year=2007 |pages=470 |title=APA Dictionary of Psychology |url=https://archive.org/details/apadictionaryofp00vand |url-access=registration |location=Washington, DC |publisher=[[American Psychiatric Association]] |isbn=9781591473800 }}</ref> Individuals with substance abuse have higher levels of impulsivity,<ref name="Moeller">{{Cite journal |last1=Moeller |first1=F. Gerard |last2=Barratt |first2=Ernest S. |last3=Dougherty |first3=Donald M. |last4=Schmitz |first4=Joy M. |last5=Swann |first5=Alan C. |date=November 2001 |title=Psychiatric Aspects of Impulsivity |url=http://psychiatryonline.org/doi/abs/10.1176/appi.ajp.158.11.1783 |url-status=dead |journal=[[The American Journal of Psychiatry]] |language=en |volume=158 |issue=11 |pages=1783–1793 |doi=10.1176/appi.ajp.158.11.1783 |issn=0002-953X |pmid=11691682 |archive-url=https://archive.today/20130415163112/http://journals.psychiatryonline.org/article.aspx?articleid=175139%23R15811CCHGHBGG |archive-date=April 15, 2013}}</ref> and individuals who use multiple drugs tend to be more impulsive.<ref name = Moeller/> A number of studies using the [[Iowa gambling task]] as a measure for impulsive behavior found that drug using populations made more risky choices compared to healthy controls.<ref>{{cite journal | pmc = 3152830 | pmid=21836771 | doi=10.1002/bdm.641 | volume=22 | issue=4 | title=Similar Processes Despite Divergent Behavior in Two Commonly Used Measures of Risky Decision Making | year=2009 | journal=J Behav Decis Mak | pages=435–454 |vauthors=Bishara AJ, Pleskac TJ, Fridberg DJ, Yechiam E, Lucas J, Busemeyer JR, Finn PR, Stout JC }}</ref> There is a hypothesis that the loss of impulse control may be due to impaired [[inhibitory control]] resulting from drug induced changes that take place in the frontal cortex.<ref>{{cite journal |last1=Kreek |first1=Mary Jeanne |last2=Nielsen |first2=David A |last3=Butelman |first3=Eduardo R |last4=LaForge |first4=K Steven |title=Genetic influences on impulsivity, risk taking, stress responsivity and vulnerability to drug abuse and addiction |journal=Nature Neuroscience |date=26 October 2005 |volume=8 |issue=11 |pages=1450–1457 |doi=10.1038/nn1583|pmid=16251987 |s2cid=12589277 }}</ref> The [[neurodevelopmental]] and hormonal changes that happen during [[adolescence]] may modulate impulse control that could possibly lead to the experimentation with drugs and may lead to addiction.<ref>{{cite journal | pmc = 2919168 | pmid=12777258 | doi=10.1176/appi.ajp.160.6.1041 | volume=160 | issue=6 | title=Developmental neurocircuitry of motivation in adolescence: a critical period of addiction vulnerability | year=2003 | journal=Am J Psychiatry | pages=1041–52 |vauthors=Chambers RA, Taylor JR, Potenza MN }}</ref> Impulsivity is thought to be a facet trait in the neuroticism personality domain (overindulgence/negative urgency) which is prospectively associated with the development of substance abuse.<ref name="NeuroticismMA">{{cite journal |author1=Jeronimus B.F.|author2=Kotov, R.|author3=Riese, H.|author4=Ormel, J.| year = 2016 | title = Neuroticism's prospective association with mental disorders halves after adjustment for baseline symptoms and psychiatric history, but the adjusted association hardly decays with time: a meta-analysis on 59 longitudinal/prospective studies with 443 313 participants | journal = Psychological Medicine | doi=10.1017/S0033291716001653 | pmid=27523506 | volume=46 |issue=14| pages=2883–2906|s2cid=23548727|url=https://zenodo.org/record/895885}}</ref>
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