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4. Medical Complications

Substance abuse causes irreparable damage to the body's organs, tissues and cells. Because it does most of the work, the organ that suffers the most is the liver. There are three major forms of liver disease associated with substance abuse. The first is acute fatty liver; the second is alcoholic hepatitis, and the third is cirrhosis.

Fatty Liver

Fatty liver occurs because alcohol replaces fat as the preferred fuel for the liver and the unburned fat builds up in the liver. This increase in fat hinders the supply of blood to the liver cells, and cellular death may occur. Laboratory reports will show a slight increase in the alkaline phosphotase and SCOT. Symptoms may be some pain in the right upper quadrant, and jaundice and tenderness at the liver site. With the cessation of alcohol and proper nutrition, this condition is reversible.

Alcoholic Hepatitis

Alcoholic hepatitis is a more serious form of liver disease. This is actually an inflammation and is very painful. The person may experience jaundice, nausea and fever. Jaundice is a yellowish cast of the skin and the white (sclera) of the eyes. The yellow color comes from the pigment found in the bile, a digestive juice made by the liver.

Alcoholic hepatitis often follows a long bout of heavy drinking. Some symptoms are loss of appetite, weakness, fatigue, loss of weight, occasional nausea, dark urine and light-colored stools. With the cessation of alcohol, this problem is reversible.

Alcoholic Cirrhosis

Alcoholic cirrhosis develops at a later stage in liver disease. The liver is so plugged up with toxic substances that blood cannot flow and backs up. The blood in turn picks up these toxins and carries them to the head where they do further damage to an already damaged brain. This process has been called "blood sludge."

Cirrhosis of the liver is a disease in which there is widespread destruction of the liver cells. These cells are replaced with non-functioning scar tissue. The word cirrhosis means scarring.

The symptoms of cirrhosis are jaundice, ascites and peripheral edema. Ascites is the accumulation of tissue fluid directly into the abdominal cavity. This fluid would normally be transported back to the heart by the hepatic veins and lymphatics, but this can't happen because of the blockage. This blockage results in great pressure put on the circulatory system causing small blood vessels in the face and head to rupture. It is also this pressure that causes the veins in the esophagus to become distended, developing esophageal varices, and causing hemorrhage.

Many liver cancers occur in cirrhotic livers, but the person often dies of the cirrhosis before the cancer manifests. Another complication that is serious is hepatic coma. This is caused by the buildup of the toxins in the bloodstream.

The main elements of treatment for cirrhosis are: abstinence from alcohol; adequate nutrition with a low-sodium diet; multivitamins; rest and visitors limitation. Discuss with the patient, when he's ready to listen, the effects of alcohol on the liver. Watch for blood in the stools or vomitus. Provide careful skin care; assess skin for bruises. Measure abdominal girth daily and record.

The liver manufactures essential blood components, and liver dysfunction can impair clotting. The person will also bruise easily because of the deficiency of vitamin K and the clotting impairment. Another result of alcoholic liver disease is the diminished ability of the liver to store glycogen (the body's form of sugar) and produce glucose from other nutrients such as protein. Insufficient amounts of blood sugar can cause coma. This is important to remember when treating an alcoholic diabetic, because insulin also lowers the blood sugar.

The history and pattern of a person's substance abuse dictates the treatment and future management of the disease.

Cardiovascular System

The same fatty process that invades the liver also occurs in the heart. Substance abuse has an irritating effect upon the myocardium and results in damage to the heart muscle. This hinders the heart's ability to pump. Symptoms of cardiac involvement include chronic shortness of breath, swelling of the hand and feet (peripheral edema), fatigue and abnormalities in heart rhythm.

There is a correlation between substance abuse and hypertension.

Carl was a 51-year-old plumber who worked successfully at his job and consumed large amounts of alcohol since his teenage years. He started to drink right after lunch and continued the rest of the day. He insisted and his wife confirmed that he never got drunk. He was laid off from work and the drinking got out of control. He developed chest pains and had a triple bypass. His surgery and recovery were very rocky due to his addiction. His surgeon told him he didn't 'want him as a patient if he continued to drink. Carl was frightened and didn't drink for three years.

But now he has started the habit of drinking wine before meals. And goodness knows where it will lead.

Gastrointestinal System

Patients are admitted to the hospital with a diagnosis of gastrointestinal bleeding, but the underlying problem may be ulcers caused by substance abuse.

The gastrointestinal system is the route by which alcohol enters the body. The alcohol stimulates the secretion of hydrochloric acid which irritates the stomach's lining. This irritation causes gastritis. Prolonged substance abuse will result in ulcers. The ulcers are painful. It is an immediate emergency when an ulcer erodes and causes a hemorrhage. The substance abuser frequently incurs cancer of the tongue, pharynx, larynx and esophagus.

George thought he had an acute attack of indigestion. He was nauseated, vomited and had extreme pain in the region of the stomach that radiated to the back. His pain was so severe that his wife insisted he go to the emergency unit of the hospital where with a diagnosis of pancreatitis was made. George received fluids intravenously until the edema of the pancreas and pancreatic duct had subsided, and the digestive juices from the pancreas could once again flow into the duodenum. Toradol was given intravenously to relieve the pain and nothing by mouth (NPO) was allowed.

George recovered in a few days from the acute stage of pancreatitis and vowed never to take alcohol again. Let's hope he keeps that vow because if he continues to drink there will be further destruction of the cells of the pancreas, and the pancreatic duct will become fibrotic. A diet low in fat and the administration of an antisposmatic drug is helpful for chronic pancreatitis.

Diabetes can be the end result of the destruction of the cells of the pancreas. The pancreas loses its capacity to release insulin as a result of chronic cell damage.

Endocrine System

The production of sex hormones is altered from chronic substance abuse. Sexual interest and pursuit may be heightened by the release of inhibitions, but many times the ability to perform sexually is impaired. The testosterone level and sperm count in the male is lowered.

Prolonged use of alcohol also affects the pituitary gland. There are increased levels of MSH (melanocyte-stimulating hormone). This produces a darkened skin color.

Substance abuse also affects the adrenal glands. There is an increase in the hormones they produce. Aldosterone, an adrenal hormone, is important in regulating the balance of salt and water levels in the body. The increase in this hormone explains why chronic abusers suffer from peripheral edema. The skin, tissue, thyroid gland and breast are all affected by the increase in hormones. The chemical balance of the body is in jeopardy and anything can happen.

Nervous System

Chronic substance abuse can also lead to varying degrees of irreversible dementia and brain disease. Drugs attack and numb the higher brain center, impairing judgment, and motor coordination, releasing inhibitions, interfering with cognitive processes and changing personalities.

Wernicke's Syndrome

Wemicke's syndrome is brain damage due to lack of nutrients and excessive alcohol ingestion. Symptoms consist of loss of short-term memory, confusion, blurred vision and ataxia (difficulty in walking). This is treated with thiamine and is reversible.

Korsakoff's Psychosis

A later irreversible stage of Wemicke's syndrome is Korsakoff's psychosis. It is characterized by disorientation, severe memory loss and confabulation. Confabulation is fluent story-telling with no regard to fact. The damage to the brain is so severe that the person cannot process and store information, and to fill the gap, he makes up stories. Both these diseases have a sudden onset, though it is the result of chronic substance abuse. Because of the damage and loss of brain cell and cerebral atrophy, there is alcoholic dementia. Treatment includes abstinence and the administration of thiamine. Recovery process is slow and patients with Korsakoff's psychosis never fully recover.

Degeneration due to brain damage leads to gait disorders, bladder dysfunction (incontinence), diminished language and motor skills.

Persons suffering from drug abuse have a chronic lower level of consciousness. Their mind seems to be "in a fog." It is difficult for them to reason or rationalize. Their bizarre behavior and sometimes hostility creates a disadvantage for them in maintaining skills and living a life of stability.

Sleep Disturbances

Sleep is necessary for the body and mind and substance abuse interferes with the neurochemicals that balance the waking system and the sleeping system. There are four stages of sleep: transition period, nondreaming sleep, delta and REM (rapid eye movement).

The transition period is different for everyone. Some go to sleep with music or the TV Others need absolute darkness and quiet. The transition period leads into the drowsy state and into the non-dreaming sleep. Three quarters of our sleeping time is spent in this state. Gradually our sleep deepens, and a few hours after we first fall asleep, we go into the deep sleep state of delta.

We again return to non-dreaming sleep and then REM begins. The body is relaxed, but the eyes are moving rapidly under closed eyelids. This is when we dream. The dream may last five minutes. Then the cycle continues throughout our sleeping period. Dreams occur about one fourth of the sleeping time. When you dream, part of the brain is awake and part is not. Some people wake up from the dreaming part because it is a light stage. In order to remember your dream, you may have to wake up from it and write it down. Dreams are good for your psychological stability.

This is the catch: Drugs depress the REM sleep and create a disturbance in the cycle of nondreaming and dreaming. The result is the person never feels refreshed and is impulsive and irritable. This explains why insomnia is always a symptom of substance abuse.

Musculoskeletal System

Chronic alcoholism can cause generalized weakness of the muscles called myopathy. Symptoms are muscle cramps, weakness and gradual loss of function.

Abuse of alcohol can also cause osteoporosis. This is a thinning of the bone from loss of calcium and may explain the many fractures that happen to substance abusers.

Fetal Alcohol Syndrome

Substance abuse during pregnancy is a horrendous risk for the infant. Research has discovered that drugs can pass through the placenta to the developing fetus and interfere with prenatal development. The baby of a substance abuser at birth is smaller in weight and length, and the head is smaller probably due to decrease in brain growth. Fetal alcohol syndrome is one of the leading causes of mental retardation and cardiac problems for the newborn.

A woman does not have to take drugs in excess to cause damage to the fetus; abstinence is the safest thing to do during pregnancy. The jittery and tremulous infant is heartbreaking to see. Pregnancy complicated with substance abuse is serious.

Addicted Newborn

Cocaine constricts the uterine blood vessels that supply oxygen and nutrients to the developing fetus. The drug can cause spontaneous abortion, premature delivery or premature separation of the placenta. It can also cause congenital abnormalities such as missing digits, valve occlusion, seizures or cerebral infarction. These babies cry a lot, and sometimes cannot tolerate regular food and may require intravenous feedings. Other symptoms are disturbed sleep, diarrhea, dehydration and agitation.

To quiet the irritable baby, hold her close to the body. Snuggle her in a closely wrapped blanket. Keep the surroundings quiet.


Depression, a feeling of overwhelming incapacity to cope with everyday situations, results when drugs are stopped. Appetite is poor, sleep is disturbed, energy is zapped and life is put on hold. In extreme cases suicide is a possibility. Depression can last for over a month after the last drug was taken and is the main reason the person reverts back to substance abuse "to feel good."

The medical complications of substance abuse are many, sometimes debilitating, frequently painful and potentially life-threatening. The taking of something to escape life's situation has a tremendous effect on the body and mind and rarely worth it.


Nutrients get to the cells by way of the circulatory system and sluggish circulation will hinder the body's supply and distribution of necessary nutrients. The substance abuser is so preoccupied with the drug that he forgets to eat. Diarrhea which afflicts some abusers drains the body of its nutrients. Adequate diet is helpful for the substance abuser, but food alone won't protect him from having a problem. I knew a man who was surprised to learn he had cirrhosis. His comment was, "But I've always eaten well."


In a study by two neurologists (David Kaku and Daniel Lowenstein) from the University of California, it was found that people who use drugs, particularly powder and crack cocaine, are six times more likely to suffer a stroke than those who don't. The study confirmed that cocaine raises the blood pressure, rupturing brain blood vessels and cutting off the flow of blood to the brain. Heroin and amphetamines are also known to pose a similar risk.

Taking two aspirins before cocktail hour can turn a mild drink into a potential catastrophe. The aspirin suppresses the stomach enzyme alcohol dehydrogenase. This enzyme helps the body break down the alcohol before it moves into the bloodstream. Two other drugs, cimetidine and ranitidine (ulcer medications) have the same effect.

Pharmaceutical manufacturers list every possible known side effect of their product in the package insert, but few read it. Most of the time there is a label on the bottle that says "no alcohol." Even medicines that have minimal psychoactive effects may produce toxic reactions when combined with alcohol. Poison or toxicity is only a matter of quantity. All essential elements and chemicals are dangerous in excessive amounts. Because some of them are capable of producing temporary enjoyment, they become the object of abuse.


There are three major forms of liver disease associated with substance abuse: fatty liver, alcoholic hepatitis, and cirrhosis.

The main treatment for cirrhosis is abstinence from alcohol. The same fatty process that invades the liver occurs in the heart.

Diabetes can be the end result of damage to the cells of the pancreas.

Testosterone level in the male is lowered from chronic substance abuse.

Drugs depress the REM sleep and create a disturbance in the sleep pattern.

Abstinence from drugs is best for the pregnant woman.

When a person takes an overdose of an amphetamine, he can experience elevated blood pressure, rapid and unclear speech and insomnia.

Valium has a half-life of 24 to 48 hours.

Anti-anxiety drugs can cause psychological dependence.