1.2 Substances: Use, Intoxication, and Overdose
Open Resources for Nursing (Open RN)
A substance is defined as a psychoactive compound with the potential to cause health and social problems, including substance use disorder. Substances can be divided into four major categories: alcohol, illicit drugs (including nonmedical use of prescription drugs), over-the-counter drugs, and other substances. See examples of substances known to have a significant public health impact in Table 14.2a. Substance use refers to the use of any of the psychoactive substances listed in Table 14.2a.
Table 14.2a Categories and Examples of Substances[1]
| Substance Category | Examples |
|---|---|
| Alcohol | Beer, malt liquor, wine, and distilled spirits |
| Illicit drugs (including prescription drugs used nonmedically) |
|
| Over-the-counter drugs (used nonmedically) | Dextromethorphan, pseudoephedrine, and other cold medications |
| Other substances | Inhalants such as spray paint, gasoline, and cleaning solvents; Delta-8 THC |
Millions of Americans misuse substances. See Figure 14.1[2]regarding the number of people aged 12 and older who reported using various substances in a one-month period of time.
Controlled Substances
The Controlled Substances Act is a federal law that places all controlled substances (i.e., substances regulated by the U.S. Drug Enforcement Agency) into one of five categories called schedules. This placement is based on the substance’s medical use, its potential for abuse or dependency, and related safety issues. For example, Schedule I drugs have a high potential for abuse and potentially cause severe psychological and/or physical dependence, whereas Schedule V drugs represent the least potential for abuse.[3] Dependence means that when a person suddenly stops using a drug, their body goes through withdrawal, a group of physical and mental symptoms that can range from mild to life-threatening. See examples of controlled substances categorized by schedule in Table 14.2b.
Table 14.2b Examples of Substances by Schedule[4]
Schedule |
Definition |
Examples |
|---|---|---|
| Schedule I | No currently accepted medical use and a high potential for abuse. | Heroin, LSD, MDMA (Ecstasy), and cannabis (marijuana) |
| Schedule II | High potential for abuse, with use potentially leading to severe psychological or physical dependence. These drugs are also considered dangerous. | Hydrocodone, cocaine, methamphetamine, methadone, hydromorphone, meperidine, oxycodone, fentanyl, amphetamine/dextroamphetamine salts (Adderall), methylphenidate (Ritalin), and phencyclidine (PCP) |
| Schedule III | Moderate to low potential for physical and psychological dependence. Abuse potential is less than Schedule I and Schedule II drugs but more than Schedule IV. | Acetaminophen with codeine, ketamine, anabolic steroids, and testosterone |
| Schedule IV | Low potential for abuse and low risk of dependence. | Alprazolam (Xanax), diazepam (Valium), lorazepam (Ativan), zolpidem (Amb