Chronic Drug and Alcohol Abuse
It can result in a variety of debilitating health problems, including:1
- Cardiovascular problems.
- Respiratory problems.
- Disease contraction, such as hepatitis B and C.
- Several types of cancer.
The pervasive reach of substance use extends through several organ systems and their associated physiological processes. Here you’ll find an overview of the major organ systems and how they are impacted by drug use.
The types of substance-related health consequences likely to be faced by an individual will be dependent upon which drugs are being abused and with what frequency. For example, using marijuana from time to time may not impact a person’s health as negatively as chronic alcohol abuse; however, both can cause problems.
The health of the individual who is engaging in drug or alcohol abuse matters, too. Those who are immunocompromised, for example by HIV, may be more likely to suffer additional health effects.2 Drug abuse is associated with both contracting infectious diseases such as HIV and hepatitis, as well as with worsening the progression of these conditions.2,3
Our lungs and their life-sustaining functions are quite susceptible to the harms of various substances. Smoking cigarettes, crack cocaine, or marijuana may differentially contribute to the development of several respiratory issues and chronic pulmonary diseases including:4
- Chronic bronchitis.
- Lung cancer.
Several substances—including opioids as well as central nervous system depressants such as alcohol, benzodiazepines, and other sedatives—are associated with significant respiratory depression, which may be fatal in severe cases.4 Combining these drugs is a significant risk factor for life-threatening respiratory depression.5
Other respiratory complications from substance abuse include:6,7
- Injury to the upper airway (from sniffing drugs).
- Collapsed lung (from inhaling drugs).
Injecting drug users are especially at risk for:8,9
- Community-acquired pneumonia (10x higher risk than the general population).
- Fatal asthma attacks.
- Pulmonary edema.
- Pulmonary vascular disease.
- Interstitial lung disease.
- Septic embolism (an infectious embolism that travels into the lungs).
- Lung inflammation, infection, or abscess resulting from injecting foreign particulates found in many prescription and illicit drugs.
The cardiovascular system is negatively impacted by most drugs of abuse, according to the National Institute on Drug Abuse (NIDA). Drugs can affect the heart rate and rhythm and even cause heart attack.10Cocaine is one drug known to adversely affect the heart—so much so that some researchers have named it “the perfect heart attack drug.”11
Drug abuse can also alter blood pressure, causing dangerous drops or spikes. Altered heart rate, abnormal heart rhythms, and pathological changes in blood pressure may all contribute to an increased risk of cardiovascular events such as myocardial infarction and stroke.11
Cocaine and amphetamines are strongly associated with cardiovascular risks, such as cardiomyopathy, or disease of the heart muscle, and both hemorrhagic and ischemic stroke.10,12
Injection drug use, in particular, can cause cardiovascular issues such as:10,11,13
- Vascular inflammation and collapsed veins.
- Bacterial infections in the blood vessels and heart valves.
- Endocarditis (infection of the inner lining of the heart chambers and valves).
Effects of Drug Abuse on the liver
Most drugs pass through the liver, as for many drugs the liver is the primary site of metabolism. This makes the liver particularly susceptible to injury from chronic abuse of or overdose on certain substances.
Of all drugs that have the potential to harm the liver, alcohol is at the top of the list. Chronic, heavy alcohol use can result in a spectrum of alcoholic liver diseases including:14
- Alcoholic steatosis (fatty liver).
- Alcoholic hepatitis.
According to the National Institute on Alcohol Abuse and Alcoholism:15
- In 2015, nearly half (47%) of all deaths resulting from liver disease were alcohol related.
- Almost 48% of all cirrhosis deaths in 2013 were related to alcohol. The proportion of cirrhosis deaths related to drinking was highest (nearly 77%) among young adults between 25 and 34 years of age.
- In 2009, alcohol-related liver disease was the reason for nearly one-third of all liver transplants that year.
A lesser-known risk to the liver is that of acetaminophen. While safe in recommended/prescribed doses, taking a toxic amount of acetaminophen can cause:
- Fulminant hepatic necrosis or acute liver failure.
In some cases, people combine multiple drugs not realizing that more than one contains acetaminophen. Many opioid painkillers also contain acetaminophen, and taking high and/or very frequent doses of these drugs (as is common with those addicted to painkillers) can result in serious liver injury.
In a 6-year analysis of 662 people who suffered from acute liver failure, it was determined that 42% of cases were attributed to acetaminophen-related liver injury.16 Concurrent use of alcohol can further decrease the threshold for acetaminophen toxicity and hepatic injury.
Injection drug use is also a huge risk factor for contracting hepatitis B and C. Untreated viral hepatitis may lead to cirrhosis of the liver, as well as liver cancer. Almost half of all cases of liver cancer develop in association with hepatitis C infection.3
- The kidneys are also impacted by drug abuse, as every drug (and/or their metabolites) will ultimately pass through the kidneys prior to being excreted in the urine. According to the National Kidney Foundation (NKF), heavy alcohol consumption (and its subsequent impact on fluid balance and blood pressure) can result in an acute decline in renal function and contribute to the development of chronic kidney disease.17
- Illicit drugs may also harm the kidneys, either directly or indirectly from dehydration, dangerously high body temperature (common among ecstasy users),18 and muscle breakdown (rhabdomyolysis).19
- Cocaine and heroin, particularly, are associated with acute glomerulonephritis, interstitial nephritis, and nephrotic syndrome—a cluster of symptoms including fatigue, elevated urinary protein, and severe edema that indicate the kidneys are not working as they should.20
- The gastrointestinal system is not spared from the effects of drug abuse. Nausea, vomiting, diarrhea and constipation are common side effects of many substances and may also occur in association with acute withdrawal from many drugs. Opioid use is associated with severe constipation, for example, while opioid withdrawal often causes diarrhea.21,22
- NIDA lists opioid use as a cause of acid reflux and cocaine a cause of mesenteric ischemia, abdominal pain, and bowel tissue decay.21
- Chronic alcoholism can increase the risk of gastric and duodenal ulcers, esophagitis, esophageal varices (in association with alcoholic liver disease and portal hypertension), and gastrointestinal bleeding. Esophageal cancer is also a risk, especially for those who drink alcohol heavily and/or smoke.
- An estimated 2/3 of all cases of esophageal cancer are linked to tobacco smoking. The risk increases if the person drinks and smokes. Fortunately, the risk goes down if the person stops one or both.23
- Drugs impact the brain in numerous ways. Some of the effects are reversible over time, while some may not be. Drug use may also harm the developing brain. For example, persistent marijuana use among those who initiated use in adolescence is associated with neuropsychological decline that does not appear to fully reverse even after stopping use.24
- Alcohol consumption has been found to be associated with multiple indicators of abnormal brain structure, such as the impairment of white matter microstructure, and cognitive decline. Heavy drinking is linked to a higher risk of developing dementia and of suffering widespread atrophy of the brain.25
- Substance abuse also changes the way the brain responds to rewards so that over time, natural and healthy activities are no longer associated with adequately rewarding feelings. Only the drug will elicit the desired level of reinforcing pleasure, and even then the response will diminish over time and more will be needed to feel the same reward.
- The person may eventually start to feel unmotivated, depressed, and unable to find pleasure from activities they once enjoyed.26 Drug abuse can also lead to impaired impulse control and poor decision-making. As time goes on, the ability to stop using drugs becomes increasingly difficult.27
- Substance use can also sometimes bring about symptoms of mental illness, such as anxiety, paranoia, or depression, or worsen the course of an existing mental illness.28
“As time goes on, the ability to stop using drugs becomes increasingly difficult.”
How Substance Abuse Treatment Can Help
- On the spectrum of devastating health consequences, nothing is more severe and permanent than death, and yet it is all too common a substance use-related outcome. The United States is currently in the midst of an overdose epidemic, with more than 70,000 people dying from overdose in 2017 alone.29
- While drug abuse and addiction can bring serious health consequences, much of the damage can be effectively reversed with proper care and sustained abstinence.
- And while using and abusing drugs raises the likelihood of developing several medical conditions, in many cases these risks fall when drug use stops. Treatment can save your life, not just in preventing overdose, but in saving you from causing significant, long-term damage to your body and brain.
- National Institute on Drug Abuse. (2018). Addiction and Health.
- National Institute on Drug Abuse. (2019). Drug Use and Viral Infections (HIV, Hepatitis).
- National Institute on Drug Abuse. (2018). Viral Hepatitis—A Very Real Consequence of Substance Use.
- National Institute on Drug Abuse. (2017). Respiratory Effects.
- Schmitz A. (2016). Benzodiazepine use, misuse, and abuse: A review. The mental health clinician, 6(3), 120–126.
- Glassroth, J., Adams, GD, Schnoll, S. (1987). The impact of substance abuse on the respiratory system. Chest, 91, 596-602.
- Ghuran, A., & Nolan, J. (2000). The cardiac complications of recreational drug use. The Western journal of medicine, 173(6), 412–415.
- Karpel, J. (n.d.). Overview of pulmonary disease in injection drug users.
- Hendra, P. Farber, H. (n.d.). Foreign body granulomatosis.
- National Institute on Drug Abuse. (2017). Cardiovascular Effects.
- American Heart Association. (2018). Illegal Drugs and Heart Disease.
- Fonseca, AC., Ferro, JM. (2013). Drug abuse and stroke. Curr Neurol Neurosci Rep., 13(2), 325
- Moss, R., & Munt, B. (2003). Injection drug use and right sided endocarditis. Heart (British Cardiac Society), 89(5), 577–581.
- Maher, J. (1997). Exploring Alcohol’s Effects on Liver Function. Alcohol Health & Research World, 21(1), 5-12.
- National Institute on Alcohol Abuse and Alcoholism. (2018). Alcohol Facts and Statistics.
- Larson, AM, Polson, J. Fontana, RJ., et al. (2005). Acetaminophen-induced acute liver failure: results of a United States multicenter, prospective study. Hepatology, 42(6), 1364-72.
- National Kidney Foundation. (n.d.). Which Drugs are Harmful to Your Kidneys?
- Liechti M. E. (2014). Effects of MDMA on body temperature in humans. Temperature (Austin, Tex.), 1(3), 192–200.
- National Institute on Drug Abuse. (2017). Kidney Damage.
- Jaffe, J.A., A Kimmel, P.L. (2006). Chronic Nephropathies of Cocaine and Heroin Abuse: A Critical Review. J Clinical Journal of the American Society of Nephrology, 1(4), 655-667.
- National Institute on Drug Abuse. (2017). Gastrointestinal Effects.
- S. National Library of Medicine. (2018). Opiate and Opioid Withdrawal.
- Cancer Research UK. (2016). Causes and Risks.
- Meier, et al. (2012). Persistent cannabis users show neuropsychological decline from childhood to midlife. PNAS, 109 (40), E2657-E2664.
- Topiwala Anya, Allan Charlotte L, ValkanovaVyara, Zsoldos Enikő, Filippini Nicola, SextonClaireet al. Moderate alcohol consumption as risk factor for adverse brain outcomes and cognitive decline: longitudinal cohort study. BMJ 2017; 357 :j2353.
- National Institute on Drug Abuse. (2018). Drugs and the Brain.
- National Institute on Drug Abuse. (2017). Neurological Effects.
- National Alliance on Mental Illness. (2017). Dual Diagnosis.
- Centers for Disease Control and Prevention. (2018). Drug Overdose Deaths.