Substance Use and Abuse

10.4 Substance Use and Abuse

Learning Objectives

Define the terms “substance,” “abuse,” and “addictive.”
Describe physical and mental effects associated with smoking and frequent or heavy drinking.
List the risks of using drugs.
Know how to get help if you have a substance use habit to break.

SubstanceA drug or other chemical typically used in an overindulgent manner for its effects on the body or mind. is the word health professionals use for most things you might take into your body besides food. When people talk about substances, they often mean drugsA substance used for treating, curing, or preventing disease (prescription and over-the-counter drugs) or used without medical reason to alter the body or mind (illegal drugs or prescription drugs used without prescription).—but alcohol and nicotine are also drugs and are considered substances.

Substances—any kind of drug—have effects on the body and mind. People use these substances for their effects. But many substances have negative effects, including being physically or psychologically addictiveHaving the characteristic of becoming physically or psychologically habit forming, causing cravings; the person becomes dependent on the substance and suffers adverse effects on withdrawal.. What is important with any substance is to be aware of its effects on your health and on your life as a student, and to make smart choices. Use of any substance to the extent that it has negative effects is generally considered abuseThe use of illegal drugs or the use of prescription or over-the-counter drugs or alcohol for other than their intended purposes or in excessive amounts..

First, consider your own habits and attitudes with the Substance Use Self-Assessment.

Substance Use Self-Assessment

Check the appropriate boxes.

	Daily	Sometimes	Never
1. I smoke cigarettes or use smokeless tobacco.
2. I drink beer or other alcohol.
3. I have missed a class because I was hung over from drinking the night before.
4. I have taken a medication that was not prescribed for me.
5. I have used an illegal drug.

Write your answers.

If you smoke cigarettes, how many a day do you usually smoke?

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If you drink alcohol (including beer), on how many days in a typical week do you have at least one drink?

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If you drink at parties or when out with friends, how many drinks (or beers) do you typically have at one time?

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If you use a pharmaceutical or illegal drug, how often do you take it?

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Are your habits of smoking, drinking, or using other drugs affecting your studies or grades?

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Smoking and Tobacco: Why Start, and Why Is It So Hard to Stop?

Everyone knows smoking is harmful to one’s health. Smoking causes cancer and lung and heart disease. Most adult smokers continue smoking not because they really think it won’t harm them but because it’s very difficult to stop.

If you have never smoked or used smokeless tobacco, feel good about your choices. But read this section anyway because you may have friends now or in the future who smoke, and it’s important to understand this behavior. If you do smoke, even only rarely as a “social smoker,” be honest with yourself—wouldn’t you like to stop if you thought you could without suffering? Simply by being in college now, you’ve shown that you care about your future and your life. You likely care about your health, too.

Many young smokers think there is plenty of time to quit later. Social smokers, who may have a cigarette only occasionally with a friend, usually think they won’t develop a habit. But smokers are fooling themselves. NicotineA habit-forming stimulant found in tobacco, which raises blood pressure, increases heart rate, and has toxic effects throughout the body. is one of the most addictive drugs in our society today. Admitting this to yourself is the first step toward becoming smoke free.

First, the good news. Stopping smoking brings immediate health benefits, and the benefits get better over time. Just twenty minutes after quitting, your heart rate drops. After two weeks to three months, your heart attack risk begins to drop and your lung function begins to improve. After one year, your added risk of coronary heart diseaseA heart disease caused by damage to the arteries that supply blood and oxygen to the heart. is half that of a smoker’s. And every year your health continues to improve.

Tips for Stopping Smoking

Stopping isn’t easy. Many ex-smokers say it was the hardest thing they ever did. Still, over 45 million adults in the United States once smoked and then successfully stopped.

You know it’s worth the effort. And it’s easier if you think it through and make a good plan. There’s lots of help available. Before you quit, the National Cancer Institute suggests you START with these five important steps:

S = Set a quit date.
T = Tell family, friends, and coworkers that you plan to quit.
A = Anticipate and plan for the challenges you’ll face while quitting.
R = Remove cigarettes and other tobacco products from your home, car, and work.
T = Talk to your doctor about getting help to quit.

To get ready, download the booklet “Clearing the Air: Quit Smoking Today” at http://www.smokefree.gov. The table of contents of that booklet (Figure 10.3) outlines the basic steps that will help you be successful.

Figure 10.3

“Clearing the Air,” a downloadable booklet available at http://www.smokefree.gov, presents a plan for stopping smoking that works for many smokers.

When You Really Crave a Cigarette

Remember that the urge to smoke will come and go. Try to wait it out. Use these tips:

Keep other things around instead of cigarettes. Try carrots, pickles, sunflower seeds, apples, celery, raisins, or sugar-free gum.
Wash your hands or the dishes when you want a cigarette very badly. Or take a shower.
Learn to relax quickly by taking deep breaths.
- Take ten slow, deep breaths and hold the last one.
- Then breathe out slowly.
- Relax all of your muscles.
- Picture a soothing, pleasant scene.
- Just get away from it all for a moment.
- Think only about that peaceful image and nothing else.
Light incense or a candle instead of a cigarette.
Where you are and what is going on can make you crave a cigarette. A change of scene can really help. Go outside or go to a different room. You can also try changing what you are doing.
No matter what, don’t think, “Just one won’t hurt.” It will hurt. It will undo your work so far.
Remember that trying something to beat the urge is always better than trying nothing.Smokefree.gov, “Quit Guide: Quitting,” http://www.smokefree.gov (accessed July 13, 2010).

Get Help to Stop Smoking

A lot of people are not able to stop smoking by themselves, so don’t feel bad if you aren’t successful the first try. Ask your doctor about other ways to stop. Maybe nicotine-replacement therapyThe use of a nicotine product (in gum, patches, etc.) intended to replace nicotine obtained from smoking, thereby making it easier for the person to stop smoking. is what you need. Maybe you need prescription medication. Stop by your college’s student health center and learn about smoking cessationThe general term for any of many different programs developed to help people stop smoking, including use of medications, counseling, group therapy and support, hypnosis, and other programs. programs. Your doctor and other health professionals at your school have a lot of experience helping people—they can help you find what works for you.

What’s the Big Deal about Alcohol?

Of all the issues that can affect a student’s health and success in college, drinking causes more problems than anything else. Everyone knows what happens when you drink too much. Your judgment is impaired and you may behave in risky ways. Your health may be affected. Your studies likely are affected.

Most college students report drinking at least some alcohol at some time—and even those who do not drink are often affected by others who do. Here are a few facts about alcohol use among college students from the National Institute on Alcohol Abuse and Alcoholism:

Death. Each year, 1,700 college students between the ages of 18 and 24 die from alcohol-related unintentional injuries, and 599,000 students are injured.
Assault. More than 696,000 students between the ages of 18 and 24 are assaulted by another student who has been drinking.
Sexual abuse. More than 97,000 students between the ages of 18 and 24 are victims of alcohol-related sexual assault or date rape.
Academic problems. About 25 percent of college students report academic consequences of their drinking, including missing class, falling behind, doing poorly on exams or papers, and receiving lower grades overall.
Health problems. More than 150,000 students develop an alcohol-related health problem.
Alcohol abuse and dependence. In the past twelve months, 31 percent of college students met criteria for a diagnosis of alcohol abuse and 6 percent for a diagnosis of alcohol dependenceBeing abnormally tolerant to and dependent on something that is psychologically or physically habit forming (especially alcohol or narcotic drugs); addiction..National Institute on Alcohol Abuse and Alcoholism, “A Snapshot of Annual High-Risk College Drinking Consequences,” College Drinking—Changing the Culture, http://www.collegedrinkingprevention.gov/StatsSummaries/snapshot.aspx (accessed July 13, 2010).

So why is drinking so popular if it causes so many problems? You probably already know the answer to that: most college students say they have more fun when drinking. They’re not going to stop drinking just because someone lectures them about it.

Like everything else that affects your health and happiness—eating, exercise, use of other substances—drinking is a matter of personal choice. Like most decisions we all face, there are trade-offs. The most that anyone can reasonably ask of you is to be smart in your decisions. That means understanding the effects of alcohol and deciding to take control.

Myths about Alcohol

Myth: I can drink and still be in control.

Fact: Drinking impairs your judgment, which increases the likelihood that you will do something you’ll later regret such as having unprotected sex, being involved in date rape, damaging property, or being victimized by others.

Myth: Drinking isn’t all that dangerous.

Fact: One in three 18- to 24-year-olds admitted to emergency rooms for serious injuries is intoxicated. And alcohol is also associated with homicides, suicides, and drownings.

Myth: I can sober up quickly if I have to.

Fact: It takes about three hours to eliminate the alcohol content of two drinks, depending on your weight. Nothing can speed up this process—not even coffee or cold showers.

Myth: I can manage to drive well enough after a few drinks.

Fact: About one-half of all fatal traffic crashes among 18- to 24-year-olds involve alcohol. If you are under 21, driving after drinking is illegal and you could lose your license.

Myth: Beer doesn’t have as much alcohol as hard liquor.

Fact: A 12-ounce bottle of beer has the same amount of alcohol as a standard shot of 80-proof liquor (either straight or in a mixed drink) or 5 ounces of wine.National Institute on Alcohol Abuse and Alcoholism, “Alcohol Myths,” College Drinking—Changing the Culture, http://www.collegedrinkingprevention.gov/CollegeStudents/alcoholMyths.aspx (accessed July 13, 2010).

College Alcohol Awareness Programs

Colleges have recognized the problems resulting from underage and excessive alcohol use, and in recent years they have designed programs to help students become more aware of the problems. If you are a new student, you may be in such a program now. Two popular online programs, AlcoholEdu and My Student Body, are used at many schools.

Figure 10.4 The AlcoholEdu Online Alcohol Awareness Program from Outside the Classroom

The goal of these courses is not to preach against drinking. You’ll learn more about the effects of alcohol on the body and mind. You’ll learn about responsible drinking versus high-risk drinking. You’ll think about your own attitudes and learn coping strategies to help prevent or manage a problem. These courses are designed for you—to help you succeed in college and life. They’re worth taking seriously.

How Much Alcohol Is Too Much?

There’s no magic number for how many drinks a person can have and how often. If you’re of legal drinking age, you may not experience any problems if you have one or two drinks from time to time. “Moderate drinking” is not more than two drinks per day for men or one per day for women. More than that is heavy drinking.

As with most things that can affect your health and your well-being as a student, what’s important is being honest with yourself. You’re likely drinking too much or too often if

you have missed classes or work because you were hung over or overslept after drinking;
your friends or family members have hinted that you drink too much, or you’ve hidden your drinking from others;
your drinking is causing trouble in a relationship;
you can’t remember what you did or said while drinking;
you need to drink to have a good time at a party or with friends;
you’ve driven a car when you know you shouldn’t have after drinking;
you binge drink (consume five or more drinks at a time).

Did you know that one night of heavy drinking can affect how well you think for two or three weeks afterward? This can really affect how well you perform as a student.

Pressures to Party

Most of us can remember times when we were influenced by our friends and others around us to behave in some way we might not have otherwise. Say, for example, I have a big test tomorrow, and I’ve been studying for hours, and just when I knock off to relax for a while, a friend stops by with a six-pack of beer. I’d planned to get to bed early, but my friend pops open a beer and sticks it in my hand, saying it will help me relax. So I tell myself just one, or maybe two—after all, that’s not really drinking. And let’s say I stop after two (or three) and get to bed. Maybe I don’t sleep quite as well, but I still pass the test in the morning. So—was that peer pressure or my decision?

There are no easy answers! What matters is that you think about your own habits and choices and how to take control of your own life.

Read this case study about a student who joins a college fraternity and feels pressured to drink. You may be very different from him—maybe you’re older and work full time and are taking night courses—but you still should be able to relate to his issues. As you answer the questions about his situation, think about how the same questions might also apply to someone in your own situation.

Case Study

Pressured to Drink

When John decided to pledge a fraternity in college, he knew there would likely be drinking in the house. He had had a few beers at parties through high school but had never binged and felt there was nothing wrong with that as long as he kept it under control. But he was surprised how much alcohol flowed through the fraternity house, and not just at parties—and the house advisor just seemed to look the other way. He wanted to fit in, so he usually had a few whenever his roommate or others called him away from studying. One night he definitely drank too much. He slept late, missed his first two classes, and felt rotten most of the day. He told himself he’d drink only on weekends and only in moderation. Being underage didn’t bother him, but his grades hadn’t been all that great in high school, and he didn’t want to screw up his first year in college. But it was only one day before some of the older fraternity brothers interrupted his studying again and stuck a beer in his hand. He didn’t know what to do.

Is John at risk for developing any problems if he tries to fit in with the drinkers while promising himself he would drink only moderately? Why or why not?

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If John decides to hold firm and drink only on weekends when he didn’t have to study, is he still at any risk for developing a problem? Why or why not, depending on what circumstances?

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If John decides to tell his fraternity brothers he does not want to drink, what should he say or do if they continue to pressure him?

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What to Do

If you think you may be drinking too much, then you probably are. Can you stop—or drink moderately if you are of age—and still have fun with your friends? Of course. Here are some tips for enjoying yourself in social situations when others are drinking:

Drink only moderately (if above legal age) and slowly. Your body processes alcohol at a rate of about one drink an hour—drinking faster than that leads to problems. Sip slowly. Set yourself a limit and stick to it.
Drink a mixer without the alcohol. It tastes just as good or better. Alternate alcoholic drinks with nonalcoholic ones to slow down the pace.
Rather than just standing around with others who are drinking, stay active: move about and mingle with different people, dance, and so on.
If someone tries to make you uncomfortable for not drinking, go talk to someone else.

Because drinking is a serious issue in many places, it’s a good idea to know what to do if you find yourself with a friend who has had too much to drink:

Stay with the person if there is any risk of him hurting himself (driving, biking) or passing out. Take away his keys if necessary.
If he passes out after drinking a great deal of alcohol fast and cannot be awakened, get medical help.
An intoxicated person who falls asleep or passes out on his back is at risk of choking on vomit—roll him on his side or face down.
Do not try to give him food or other substances in an effort to sober him up.
Don’t put him in a cold shower, which could cause unconsciousness.

If You Feel You Need Help

Visit the student health center or talk with your college counselor. They understand how you feel and have a lot of experience with students feeling the same way. They can help.

Prescription and Illegal Drugs

People use drugs for the same reasons people use alcohol. They say they enjoy getting high. They may say a drug helps them relax or unwind, have fun, enjoy the company of others, or escape the pressures of being a student. While alcohol is a legal drug for those above the drinking age, most other drugs—including the use of many prescription drugsA drug prescribed to a specific person for a specific medical condition by a health-care provider; many prescription drugs are illegal when used by someone other than the person for whom it was prescribed. not prescribed for the person taking them—are illegal. They usually involve more serious legal consequences if the user is caught. Some people may feel there’s safety in numbers: if a lot of people are using a drug, or drinking, then how can it be too bad? But other drugs carry the same risks as alcohol for health problems, a risk of death or injury, and a serious impact on your ability to do well as a student.

As with alcohol, the choice is yours. What’s important is to understand what you’re doing and make smart choices. What’s the gain, and what are the risks and costs?

While society may seem to condone drinking, and the laws regarding underage drinking or being drunk in public may not seem too harsh, the legal reality of being caught with an illegal drug can impact the rest of your life. Arrest and conviction may result in being expelled from college—even with a first offense. A conviction is a permanent legal record that can keep you from getting the job you may be going to college for.

Although the effects of different drugs vary widely, a single use of a drug can have serious effects and consequences. Even if you’re told that a pill is a prescription medication whose effects are mild or safe, can you really be sure of the exact ingredients and strength of that pill? Do you fully understand how it can affect you with repeated use? Can it be addictive? Could it show up on an unexpected random drug test at work?

Table 10.1 "Common Prescription and Illegal Drugs on Campuses" lists some of the possible effects of drugs used by college students. Good decisions also involve being honest with oneself. Why do I use (or am thinking about using) this drug? Am I trying to escape some aspect of my life (stress, a bad job, a boring class)? Could the effects of using this drug be worse than what I’m trying to escape?

Table 10.1 Common Prescription and Illegal Drugs on Campuses

Drug and Common Names	Intended Effects	Adverse Effects	Common Overdose Effects
Anabolic Steroids	Muscle development	Liver cancer, sterility, masculine traits in women and feminine traits in men, aggression, depression, mood swings	—
Barbiturates	Reduced anxiety, feelings of well-being, lowered inhibitions	Addiction; slowed pulse and breathing; lowered blood pressure; poor concentration; fatigue; confusion; impaired coordination, memory, and judgment	Coma, respiratory arrest, death
Prescription Opioids: OxyContin, Vicodin, Demerol	Pain relief, euphoria	Addiction, nausea, constipation, confusion, sedation, respiratory depression	Respiratory arrest, unconsciousness, coma, death
Heroin	Pain relief, anxiety reduction	Addiction, slurred speech, impaired vision, respiratory depression	Respiratory failure, coma, death
Morphine	Pain relief, euphoria	Addiction, drowsiness, nausea, constipation, confusion, sedation, respiratory depression	Respiratory arrest, unconsciousness, coma, death
Ritalin	Stimulant: mood elevation, increased feelings of energy	Fever, severe headaches, paranoia, excessive repetition of movements and meaningless tasks, tremors, muscle twitching	Confusion, seizures, aggressiveness, hallucinations
Amphetamines: Dexedrine, Benzedrine, methamphetamine	Stimulant: mood elevation, increased feelings of energy	Addiction, irritability, anxiety, increased blood pressure, paranoia, psychosis, depression, aggression, convulsions, dizziness, sleeplessness	Convulsions, death
Cocaine, Crack	Stimulant: mood elevation, increased feelings of energy	Addiction, paranoia, hallucinations, aggression, insomnia, and depression, elevated blood pressure and heart rate, increased respiratory rate, insomnia, anxiety, restlessness, irritability	Seizures, heart attack, death
Ecstasy	Stimulant: mood elevation	Panic, anxiety, depression, paranoia, nausea, blurred vision, increased heart rate, hallucinations, fainting, chills, sleep problems	Seizures, vomiting, heart attack, death
Marijuana, Hash	Euphoria	Impaired or reduced comprehension, altered sense of time; reduced ability to perform tasks requiring concentration and coordination; paranoia; intense anxiety attacks; impairments in learning, memory, perception, and judgment; difficulty speaking, listening effectively, thinking, retaining knowledge, problem solving	—
LSD	Hallucinogen: altered states of perception and feeling	Elevated blood pressure, sleeplessness, tremors, chronic recurring hallucinations (flashbacks)	—

Resources for Help

If you have questions or concerns related to drug use, your doctor or student health center can help. Check these Web sites for additional information:

Drug Information Online: http://www.drugs.com/drug_information.html
National Clearinghouse for Alcohol and Drug Information: http://ncadi.samhsa.gov
Drug and Alcohol Treatment Hotline: 1-800-662-HELP

Key Takeaways

Excessive drinking or substance abuse is a common—but unhealthy—response to the stresses of college life. While the decisions are yours, it’s important to understand the effects of tobacco, alcohol, and drugs and how they impact your life.
Quitting smoking is hard, but it’s clearly worth it—and lots of help is available. If you’re a smoker, make this the year you become proud of yourself for quitting.
If you like to drink, be honest with yourself. How much does drinking enrich your life, and how much do the effects of drinking interfere with your life? Make smart decisions so that you live your life to its fullest without regrets about losing control.
Avoiding drugs can be a complicated issue, certainly not as simple as simply deciding to say no. But you’ve already made the decision to attend college, and that’s a smart decision. Make smart choices in other areas of your life as well.

Checkpoint Exercises

“Social smoking”—having a cigarette just every now and then with a friend—may not have significant health effects, but why is this still a problem?

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For each of the following statements about drinking, circle T for true or F for false:

T	F	After a few drinks, you can sober up more quickly by eating or drinking coffee.
T	F	A fourth of college students experience academic consequences from their drinking.
T	F	A 12-ounce beer has about half the alcohol of a standard shot of 80-proof liquor.
T	F	Moderate drinking is defined as no more than four drinks a day for men or two drinks a day for women.
T	F	A night of heavy drinking affects your thinking ability for up to two weeks afterward.

If smoking marijuana relaxes you, can it minimize the stress you may feel over time in your life? Why or why not?

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