Alcohol is probably the oldest of the abused drugs. It is used throughout most of the world and continues to be legal in most countries. While nicotine is currently the most lethal, alcohol continues to do terrible damage to individuals, families and society. There are the well-documented diseases related to alcoholism, such as cirrhosis, pancreatitis and cardiomyopathy.

There are the well-documented diseases related to alcoholism, such as cirrhosis, pancreatitis and cardiomyopathy. However, the damage is not only related to addiction. There can be serious problems with alcohol abuse. Even low dose use during pregnancy or in the presence of disease can cause great damage. Statistics on the relationship of alcohol to accidents, suicides, homicides and domestic violence are simply astounding.

About two-thirds of men and women in this country are drinkers at some point in their lives. Today, many of them start young. Estimates are that about half of high school students and three-quarters of college students have had at least one drink in the last month. Many have drunk heavily.

Of those who use alcohol, about 10% will develop a problem of some type – either abuse or addiction. That translates into millions of alcoholics and abusers in the United State (usually estimated at between 10 and 15 million). The percentage continues to be lower for women at this time, but women’s problems with alcohol are on the rise.

These are the drugs used for anxiety and sleeplessness. Sedatives and hypnotics are currently the most prescribed psychoactive drugs.

Barbiturates, developed soon after the turn of the century, were the primary anti-anxiety drugs before the development of benzodiazepines in the 1940’s and 1950’s. Barbiturates are still used as sedatives, but with caution. Many deaths, intentional and accidental, have been associated with them. The therapeutic dose for barbiturates is so close to the lethal dose, that they represent a very dangerous class of drugs, especially when used with alcohol. Overdoses from the barbiturate and alcohol combination occurred so frequently among the famous that these overdoses became known as “Hollywood Death.”

Barbiturates continue to have use as medicines: Seconal and Nembutol are prescribed to induce sleep; Phenobarbital is used to control seizures in epilepsy; and sodium pentothal is used as an anesthetic.

While barbiturates are still prescribed for anxiety, they have been largely replaced by benzodiazepines. Benzodiazepines such as Valium, Librium and Xanax have shown a greater degree of safety. The overdose potential is far less. However, these drugs have, unfortunately, been associated with addiction at relatively low levels of use. Further, users who become addicted may experience relatively severe withdrawal symptoms. Finally, despite the much safer ration of therapeutic to lethal dosage, overdose is still an issue, especially in mixture with alcohol because of the potentiating effect of the drugs when used together.

Other drugs used for sedation and sleep which are neither barbiturates nor benzodiazepines, but act similarly, include Quaalude, Doriden, Miltown, Soma and the drug that has become known as the “date rape drug,” Royhypnol.

Antipsychotics, often called “major tranquilizers” are different chemically from the minor tranquilizers and are not often used for recreational purposes. Patients who must take these drugs tend to dislike them. Major tranquilizers, lithium and antidepressants are rarely seen as drugs of abuse.

The narcotic analgesic drugs are great pain relievers and pleasure inducers. They are also used for cough suppression and to reduce bowel motility. Some of these drugs – opium, morphine and codeine – are derived directly from the opium poppy. Some are synthesized, partially or completely, to approximate opiate effects. These include heroin, methadone, Percodan, Dilaudid, Demerol, Darvon and many others. At this time, opiates and opioids are our best sources of pain control in medical situations, but they have attendant problems, including a great potential for addiction.

Heroin addiction continues to be a serious problem in the United States. There is a current surge of heroin use among young people and the newspapers often report the deaths of young heroin addicts. Drug dealers have found a ready market for snortable heroin in small, relatively inexpensive packages. As with crack cocaine, this new packaging makes the drug very accessible to teens and those in their early twenties. Many teens assume that snorting the drug prevents the addiction potential. They are wrong about that. Many have become addicted without ever using the needle. Many others have progressed to needle use, further endangering themselves.

While addiction to heroin and other opiates is a terrible problem, our fear of opiate addiction has led to another type of drug abuse: under-medication of patients with serious pain. Often, terminally ill patients who could obtain merciful symptom relief through use of opiate drugs have gotten too little medication, administered too infrequently to stop the pain. The hospice movement, with its keen attention to pain relief and palliative care, has helped encourage physicians and other health care professionals not to withhold needed, humane treatment in terminal illnesses.

This is also the case with some non-malignant chronic pain. The American Academy of Pain Medicine and the American Pain Society released a joint position statement in 1994 supporting the use of opioids for non-cancer chronic pain, stating that the development of new addictions is rare. The American Society of Addiction Medicine (1998) has more recently distinguished between the physical dependence that occurs with regular, therapeutic opioid use and addiction. There are guidelines for protecting sobriety when a recovering person needs pain relief.