Morbidity: Short- and Long-Term Health Outcomes of Addiction

Few people consider the short-term physical, mental, emotional, and financial consequences of possibly developing an addiction when they first experiment with a substance, change a dose of a prescription drug without first consulting their primary care provider, or use a drug or behavior as a means of coping. Even fewer can or will allow themselves to anticipate how substance abuse will damage their bodies in the long-term.  This article provides a general overview of the many possible health complications that can result from both substance and behavioral addictions.

Alcohol
As reported by the National Institute on Alcohol Abuse and Alcoholism, alcoholics commonly develop a thiamine deficiency related to poor nutrition, which can lead to Wernike-Korsakoff syndrome and other serious brain disorders.  Chronic alcohol use puts a person at greater risk for blackouts and other memory problems.  A well-known effect of alcoholism is liver damage and cirrhosis; but a lesser known effect is hepatic encephalopathy, which results from an extensive period of liver dysfunction. Among the symptoms of hepatic encephalopathy are asterixis (shaking or flapping hands), decreased attention span, depression, anxiety, sleep disturbance, personality alterations and, in extreme cases, coma.  Excessive alcohol consumption can also disrupt the growth of new brain cells for adults and can also cause pancreatitis.

Barbiturates
Barbiturate abuse has been linked to such negative long-term outcomes as sexual dysfunction, chronic fatigue, slowed response time, breathing disorders, poor coordination, and menstrual abnormalities.  As with most other drugs, injection of barbiturates is associated with a high rate of death and co-occurring conditions from un-sterile practices (e.g., not cleaning the injection site or sharing needles with other, potentially infected addicts): hepatitis, endocarditis, septicemia, necrotic ulceration, gangrene, and thrombophlebitis.  Barbiturates (often in combination with other substances) are also one of the most commonly implicated drugs in unintentional overdoses as well as suicide attempts.

Behavioral Addictions
Aside from eating disorders (see more detailed description below), there has not been much research done on the long-term physical effects of behavioral addictions like sex, gambling, and screen addictions.  Sex addicts are likely to be exposed to a number of sexually transmitted diseases if engaging in risky types of sexual behavior as a result of the addiction. If the sex addiction includes compulsive viewing of online pornography, the sex addict may experience similar consequences as those of internet and other screen addicts. For example, screen addicts may have vision problems from spending long periods in front of a screen and maybe develop joint issues and/or arthritis from using keyboards, controllers, or other devices.  Moreover, screen addicts commonly spend many hours in a seated position.  This sedentary lifestyle can lead to obesity (and numerous related comorbidities) and poor hygiene.  There has been at least one death of presumed heart failure reported in South Korea from a 50-hour gaming session during which the 28 year old player neither slept nor ate and drank appropriately, likely causing exhaustion and possibly dehydration. The financial consequences of gambling addiction will likely affect a gambling addict’s access to food and health care, which, in turn, could lead to malnutrition or poor health. One study found that the suicide rate in three cities with legalized gambling—Reno, Las Vegas, and Atlantic City—was as much as four times higher than in other, similar-sized metropolitan areas that did not allow gambling.  As with many substance abuse disorders, people with behavioral addictions often develop depression, anxiety, and feelings of shame and guilt that would benefit from treatment.

Cocaine and Crack
People who are addicted to cocaine damage the dopaminergic reward system in the brain.  Depending on the route of administration, users may experience nose bleeds, difficulty swallowing, bowel gangrene, decreased sense of smell, track marks, allergic reactions, hoarseness, abscesses, and damaged veins. Prolonged cocaine use can cause or exacerbate existing movement disorders.  Furthermore, cocaine addicts cause damage to their hearts and may suffer from cocaine-induced psychosis.

Eating Disorders
The exact consequences of untreated eating disorders vary by type.  People who have anorexia commonly develop malnutrition, osteopenia, osteoporosis, irregular heart rhythms and chest pains that can signal impending heart failure, esophageal cancer (from reflux), kidney failure, dental problems, depression, gastrointestinal problems, infertility, liver failure, malnutrition, and changes in muscle, skin, nails, and hair. They often suffer from a number of cognitive deficits including poor attention and concentration, difficulty with problem solving, and impaired insight. Anorexia in particular is associated with a high mortality rate from starvation and/or suicide; some research suggests that patients who have anorexia may have an increased chance of abusing alcohol. Bulimia can cause dental, throat and esophageal problems (from purging; eye problems from the pressure on the eyes associated with self-induced vomiting; swollen salivary glands; calloused hands and knuckles from contact with teeth when purging; chronic constipation and potentially a need for a colostomy bag related to laxative abuse; infertility, miscarriage, low-birth weight, premature birth, and other reproductive problems; and kidney and pancreas problems including dehydration and electrolyte imbalances from diuretic abuse.  Binge eating disorder can lead to weight gain, obesity, and related complications such as gallbladder disease, hypertension, high cholesterol, type 2 diabetes, certain cancers and heart disease. Other potential effects include digestive issues, joint pain, suicidal thoughts, headaches, difficulty sleeping, and menstrual problems.

Hallucinogens
Addiction to hallucinogens has a range of possible long-term consequences depending on the substance that is being abused.  LSD, for example, can cause a user to have flashbacks even more than a year after the most recent administration of the drug.  In some people, this can result in a condition known as HPPD or hallucinogen-induced persisting perceptual disorder, which can make it difficult for the person to function in social or work environments.  PCP abuse produces memory loss, depression, weight loss, and problems with thought and speech. Psilocybin use can lead to changes in behavior, motor reflexes, perception, and autonomic function; users may experience panic, hallucinations, psychosis, flashbacks, impaired memory, and unusual perceptions of the passage of time.  However, a recent study conducted by researchers at Johns Hopkins suggested that psilocybin can improve “openness,” which, as one researcher argued, can change a person’s attitude for the better about life situations like quitting smoking or learning of a cancer diagnosis. Still, additional research is needed to verify these results.

Heroin (and Opiates)
Heroin users frequently inject the drug, putting themselves at risk for endocarditis, an infection of the heart valves as a result of unsterile intravenous injection practices. Injection may also collapse a user’s veins and produce abscesses. Pneumonia is a frequent complication as well, in part from heroin’s effect of depressing respiratory function and an addict’s general neglect of his or her health.  Many people who have been addicted to heroin or prescription opiates like Vicodin, Morphine, or Oxycontin for a long period of time suffer from severe constipation and, in some cases, bowel obstruction.  Withdrawal from heroin (and other opiates) is also extremely uncomfortable and yet likely to be experienced often by an addict when financing the habit becomes difficult.

Inhalants
Abuse of inhalants can have a number of adverse consequences over the long term. These may include muscle weakness, poor coordination, weight loss, decreased attention, depression, disorientation, and general irritability.  Heavy use of these substances can leave a user lethargic for hours with a persistent headache.  Among the organs that can be damaged by extensive abuse are the kidneys, brain, liver, and heart.  The central nervous system and brain in particular may experience permanent damage.  Other possible physical consequences resulting from inhalant addiction or abuse are aplastic anemia and polyneuropathy.

Marijuana
There is some research that suggests a connection between prolonged marijuana use and such outcomes as schizophrenia and testicular cancer. In the case of the former, it is not completely clear whether marijuana addiction is the cause of some users' development of schizophrenia or if those who have a genetic or environmental risk of developing this mental health condition are more likely to begin using it, perhaps as a form of self treatment. Depression and anxiety are also common outcomes associated with marijuana use. According to the National Institute on Drug Abuse, chronic marijuana use produces similar results to those experienced by habitual tobacco smokers, especially increased respiratory infections. Short-term use has been correlated with elevated heart attack risk, especially among older adults, because of marijuana's propensity to cause arrhythmias and increase heart rate.

Methamphetamine
According to Dr. Rawson at UCLA, meth users experience a release of dopamine on the order of 1,200 units (comparatively, sex produces a release of about 200 units). This certainly explains the allure of crystal meth for new users. But the long-term damage to the brain and body, much (but not all) of which cannot be reversed, is far from attractive. First, meth addicts develop "meth mouth," which describes stained, rotting, broken teeth. Some researchers believe it is caused by the harsh chemical components used to produce meth; others think that it is related to direct effects of the drug. Specifically, blood vessels shrink when meth is in a person's system, leading to decreased blood flow to the mouth and possibly killing the small blood vessels, which severely restricts the oxygen necessary to maintain a healthy mouth. Second, meth is responsible for much irreversible brain damage, some of which can be caused by extreme increases in body temperature (hyperthermia) that users experience. Although studies suggest that the damage to dopamine receptors can be fixed (allowing abstinent addicts to again feel pleasure albeit commonly after many years away from the drug), these brain imaging studies have found areas of permanent damage in motor coordination, judgment, and memory, symptoms akin to those associated with Parkinson. Third, because many methamphetamine addicts prefer IV injection sometimes sharing needles and/or are compelled to participate in sexual risk-taking, numerous addicts suffer from indirect consequences related to Hepatitis, AIDS, and other contagious diseases. Other potential long-term effects of crystal meth use include impotence, stroke, seizures, decreased immune response to infection, malnutrition, skin damage, psychosis, aggressive behavior, and liver damage.

Tobacco
Among the most widely known effects of smoking are lung cancer and emphysema. Other possible health complications include coronary artery disease, stroke, and cancers of the mouth, esophagus, cervix, and pancreas.  Smoking cigars or cigarettes in the home for years or decades puts other young family members at risk for respiratory-tract infections.  An estimated 3,000 individuals who do not smoke die annually from lung cancer as a result of inhaling smoke regularly in their environments.  People who chew tobacco often suffer from bad breath, tooth decay, gum erosion, and oral and stomach cancers.