At the conclusion of this course, the dental health professional
will be able to:
1. Define chemical dependency.
2. Recognize the signs and symptoms of chemical dependency.
3. Be familiar with the etiology of chemical dependency.
4. Understand the diagnosis and treatment modalities for
patients with chemical dependency.
5. Safely render dental treatment to patients with chemical
Chemical dependency is a worldwide problem and a major
public health concern in the United States. To adjust for the
magnitude of this crisis, The Diagnostic and Statistical Manual
(DSM)-V has expanded the definition of chemical dependency.
Chemical dependency causes a multitude of physiological and
neurological effects in a patient, which has the potential to
alter a dental professional’s treatment plan. With high relapse
rates in this population, dental providers will likely encounter
those in active and long-term treatment and management. This
course will explore chemical dependency in the United States
and focus on its etiology, diagnosis, treatment, and dental
Chemical dependency is a major public health concern in
the United States and causes adverse effects to individuals
abusing substances, their families, and the economy. The
economic burden of chemical dependency in America is vast,
affecting individual health, public safety, crime, productivity,
1 Health-care costs are related to mortality,
morbidity, hospitalizations, and prevention.
1 Research has
shown that investment in treatment is more cost effective for a
society compared with the cost of untreated abuse.
1 For every
dollar the U.S. invests in chemical dependency treatment, a
four to twelve dollar return is seen through reduced crime and
Globally, drug abuse ranks nineteenth in causes of mortality,
with alcohol third, and tobacco second.
1 Drugs of abuse also
have an impact on safe driving. According to the International
Narcotics Control Board, “Cannabis is the most prevalent drug
detected in drivers and causes a 9.5-fold greater risk of driving
accidents. Cocaine increases the risk 2-10 times, amphetamines
increase the risk 5-30 times, and alcohol in combination with
drugs increases the risk of being seriously injured or killed while
driving by a factor of 20-200.”
In 2011, lost productivity related to chemical dependency
cost the United States 120 billion dollars or 0.9 percent of the
gross domestic product.
1 Therefore, it is imperative that health-care professionals work with government officials to attend to
this societal public health menace, improve the quality of life,
and provide economic relief.
Chemical Dependency Defined
Chemical dependency and substance abuse are medical terms
used to describe an abuse or addiction to a substance that causes
significant problems or alterations to one’s life.
2 According to
Johns Hopkins Medicine, substance dependence “is the medical
term used to describe abuse of drugs or alcohol that continues
even when significant problems related to their use have developed,” such as strained relationships, work complications,
unemployment, or criminal activity.
2 Chemical dependency is
a chronic relapsing disorder for which relapse prevention is a
primary focus of treatment.
Substance abuse encompasses the abuse of illegal substances
such as heroin, cocaine, methamphetamine, and hallucinogens,
or the abuse of legal substances such as alcohol, nicotine, anabolic steroids, caffeine, or prescription medications.
2, 4 Prescription
medications most commonly abused are opioids and anxiolytics.
5, 6 Marijuana is a Schedule I drug and federally illegal; however, as of this time, eight states and the District of Columbia
have legalized its recreational use.
Caffeine dependence is a recognized condition and is entitled
Caffeine Use Disorder in the DSM-V.
8 Caffeine is the most widely
abused drug in the world, with more than 90 percent of American
adults dependent on its effects.
8 Sodas contain approximately 35
mg of caffeine per 12-oz can.
4 One cup of coffee contains 95-200
mg of caffeine.
9 Energy drinks contain many ingredients including
artificial sweeteners, “energy blends” (taurine, ginseng, guarana),
sugar (54-110 g), and caffeine (70-320 mg).
4 According to the
Mayo Clinic, adults should consider cutting back their daily caffeine intake if they drink more than 500 mg/day.
Lawmakers are concerned about the youthful marketing of
energy drinks in America and the adverse effects of energy drink
consumption in adolescents.
4 In 2012, adolescents saw 165 ads for
energy drinks, with 30 million ads on Facebook and six million ads
on You Tube.
4 This is double the exposure as compared to 2008.4
Various public health surveys report 18 to 35 percent of American middle and high school students consume energy drinks.
The American Academy of Pediatrics does not recommend that
children or adolescents consume energy drinks, and the American
Medical Association has adopted a policy to support banning the
marketing of energy drinks to anyone under the age of 18.
Signs and Symptoms
Chemical dependency can cause long-lasting neurological effects. It can increase a person’s risk for seizures, strokes, cardiac
arrest, and intracerebral hemorrhage.
11 Persons with substance
abuse problems are also at higher risk for infections such as HIV,
endocarditis, tuberculosis, hepatitis, herpes, sexually transmitted diseases, and skin infections such as cellulitis, impetigo, or
abscesses at injection sites.
11 Common signs of chemical dependency are presented in Table 1.
The inability to control impulses is common in persons
with chemical dependency. Comorbidities such as addictions
to sex, gambling, eating, and internet gaming are common.