This population demographic is at a particularly high risk for
illicit drug abuse.
14 Twenty-five percent of the United States
population suffers from mental illness, with one out of every 10
Americans taking a prescription medication for depression.
a health-care professional sees the signs and symptoms listed in
Table 1 in a patient, chemical dependency should be suspected,
and the provider should open a dialogue with the patient using
Tolerance to, or need for, increased amounts
of the drug to get an effect.
2, 11, 1
Withdrawal symptoms that occur when decreasing or stopping use
of the drug; difficulty cutting back or quitting use of the drug.
Spending a lot of time to get, use, and recover
from the effects of using drugs.
Withdrawal from social and recreational activities.
Continued use of the drug while aware of the physical, psychological,
and family or social problems that the drug use is causing.
Continually wanting or unsuccessfully trying to cut down
or control use of drugs or alcohol.
Cravings, or strong desires, to use drugs or alcohol.
2, 11, 12
Engaging in risky behaviors such as sexual, financial,
or driving under the influence.
Table 1. Signs of Chemical Dependence
Susceptibility to chemical dependency spans across all races, professions, and economic status in America. Substance abuse has a
lifetime prevalence in the United States population of 7. 7 percent
for drug abuse and 17. 8 percent for alcohol abuse.
15 In 2014, the
Centers for Disease Control and Prevention (CDC) reported that
10. 2 percent of the United States population ages 12 and older
have used an illegal substance in the last month, and 2. 5 percent
have used a psychotherapeutic drug.
16 Drug poisoning (overdose)
is the number one cause of injury-related death in the United
States, accounting for 43,982 deaths annually.
16 The rate for deaths
involving heroin overdose has almost tripled since 2010, accounting for 2. 7 deaths per 100,000.17 There is an average of 1. 1 million
annual emergency room visits for drug poisoning with the highest
population group being people ages 20 to 34.
Table 2 provides statistics from the CDC that demonstrate
the use of selected substances in the past month among persons
ages 12 and older, comparing the years 2002 to 2014.18 With
an increase in drug abuse across all categories, these statistics
support a call to action among lawmakers and politicians for
improved public health programs.
There are programs and laws in the United States geared to-
ward reducing chemical dependency rates. The Americans with
Disabilities Act of 1990 provides employment protections for
those with past alcohol and other drug problems.
19 Schools have
adopted “zero tolerance” policies. College students with adult
drug convictions can be denied federal financial aid to attend
college for varying lengths of time.
Any illicit substance 8. 3 10. 2
Marijuana 6. 2 8. 4
Nonmedical use of
2. 7 2. 5
Alcohol 51.0 52. 7
Medical and dental state boards have adopted various chemical dependency programs for providers that assist in the recovery
process and protect the individual’s ability to maintain licensure.
In a 2015 large sample survey supported by the Mayo Clinic, it
was found that over 20 percent of American physicians met the
diagnostic criteria for alcohol abuse or dependence.
20 Abuse rates
of prescription and illicit drugs in this population were low.
These providers were shown to have an increased risk for suicide,
medical error, poor quality of life, depression, and lower career
20 Most prevalence studies do not show that medical
professionals are at a higher risk for chemical dependency than
the general public, and nurses tend to have similar rates of substance abuse as physicians.
There are numerous documented etiological theories related to
a person’s susceptibility for the disease of chemical dependency.
The five most common etiologies reported in the literature are
genetics, environmental stressors (economic, finances, stress),
societal pressures (peer, lifestyle, culture, social rewards, family), individual personality characteristics, and psychiatric disorders.
2, 11 It is documented that children of alcoholic parents are
more vulnerable to develop alcoholism themselves.
11 There are
two identified genes associated with alcoholism, GABRA2 and
CHRM2.( 11) Researchers have also found evidence of susceptible
loci for alcohol dependence on chromosomes 1, 2, and 7, and a
possible protective locus on chromosome 4.
The A2A receptor gene (ADORA2A) has been associated
with caffeine consumption.
8 Variability in the cytochrome P450
CYP1A2, as well as the aryl hydrocarbon receptor gene (AHR),
which regulates CYP1A2, has also been associated with cytochrome caffeine consumption.
8 The P450 enzyme systems in the
liver are responsible for the metabolism of many substances, and
alterations to their function can adversely affect all body systems.
Determining the etiology in an individual is an important step
in treatment. Understanding the cause of the chemical dependen-
cy problem assists both medical and mental health professionals in
developing appropriate treatment and interventions.
Diagnosis and Treatment
Diagnosis of chemical dependency is commonly made by ei-
ther a physician or mental health specialist.
2 Clinical findings
are extremely dependent on both the specific chemical and its