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Addiction and Medical Conditions

Addiction often co-occurs with medical conditionsAddiction and physical health conditions often co-occur together. In fact, approximately 1/3 of people in recovery from drug and alcohol addiction also suffer from a chronic health condition, such as liver disease, HIV/AIDS, or hepatitis C.1

For some people, drug and alcohol abuse can lead to physical health problems that may continue to persist even they stop using.1 For example, chronic alcohol abuse can cause pancreatitis, liver disease, and heart problems.2 Physical health conditions such as these can lead to poor quality of life and reduced life expectancy.1

Drug and alcohol addiction may also develop following a diagnosis of a medical disorder. For example, people who experience chronic pain may become addicted to opioid medications and may eventually become addicted to illicit opioids such as heroin.3

People who suffer from co-occurring disorders are best served by integrative healthcare services that address addiction, medical, and mental health disorders simultaneously. 3

Addiction Ups the Risk of Medical Conditions

Addiction can directly and indirectly lead to physical health problems. Certain drugs and alcohol are linked to a higher risk of developing specific medical conditions. 

Alcoholism

Alcohol abuse is associated with certain cancers and can lead to cardiovascular, gastrointestinal, and pancreatic problems: 2,3,4,5,6

  • People who abuse alcohol are at higher risk for developing head and neck cancers, particularly of the larynx, pharynx, esophagus, mouth, liver, colon, rectum, and breast.
  • Excessive alcohol use can lead to heart-related issues like cardiomyopathy, irregular heartbeat, stroke, and hypertension.
  • Alcohol abuse can cause gastrointestinal problems, including gastritis and reflux esophagitis. Alcohol can impact the functioning of the esophagus, which can cause gastric contents to enter into the lower esophagus and cause heartburn and indigestion. Drinking alcohol can also increase secretion of stomach acids and lead to gastritis, which causes symptoms like stomach pain, nausea, and vomiting.

Alcohol and the Liver

Alcohol use can cause serious liver problems such as:2,6

  • Fatty liver.
  • Cirrhosis.
  • Alcoholic hepatitis.
  • Fibrosis.

Symptoms of liver disease may range based on the severity of its progression but can include tenderness around the liver, abdominal swelling, nausea and vomiting, and fever. Liver disease may progress to liver failure.6                         

Alcohol abuse can lead to a buildup of toxins in the liver, which can cause both acute and chronic pancreatitis, a very painful and dangerous condition involving inflammation of the blood vessels in the pancreas. Alcohol abuse is the second most common cause of acute pancreatitis and the single most common cause of chronic pancreatitis.7,8 Symptoms of acute pancreatitis may include: 2,6

  • Increased heart rate.
  • Fever.
  • Nausea.
  • Vomiting.
  • Severe abdominal pain.

Those who have suffered an attack of alcohol-related acute pancreatitis and continue to drink heavily (4 or more drinks a day) are at a high risk of permanent damage to the pancreas leading to chronic pain, maldigestion and diabetes.6,9

Stages of liver disease

Opioid Addiction

Addiction to opioids like heroin and prescription painkillers is associated with issues like infectious disease transmission and overdose.3,4,5

  • Heroin and other opioid users who inject drugs are at risk of developing infectious diseases like HIV and hepatitis C. These diseases can be transmitted through shared needles.5
  • Opioid addiction puts people at higher risk for overdose.4 Opioid overdose results in significant respiratory depression, which can lead to oxygen deprivation in the brain. If a person survives the overdose, they may be left with a serious brain injury.10

Marijuana Addiction

Smoking marijuana is associated with respiratory and cardiovascular problems. 3,4,11

Marijuana smoke is similar to tobacco in that it contains toxins and tar that are irritating to the throat and lungs.11 Smoking marijuana leads to symptoms such as phlegm production, wheeze and acute bronchitis.12 The concurrent use of tobacco among marijuana smokers in much of the scientific research makes it difficult to untangle the individual effects of marijuana smoking—but the research is clear that concurrent tobacco and marijuana smoking increases many of the risks associated with tobacco use alone, including cancer.13,14 Because marijuana is typically inhaled more deeply and held for longer than tobacco, marijuana smokers who also smoke cigarettes may absorb significantly more tar in the lungs as users of tobacco alone.11

Smoking marijuana over time can cause respiratory problems like:11

  • Persistent cough.
  • Chronic bronchitis.

Marijuana smoke contains carcinogens and although studies don’t point to an increased risk for the development of lung or upper airway cancer from light to moderate use, there’s evidence that suggests an increased risk of cancer with chronic long-term use.11 Studies are mixed, but marijuana smoke may increase the risk for head and neck squamous cell carcinoma, lung cancer, prostate cancer, and cervical cancer.15

Smoking marijuana has an immediate effect on the cardiovascular system by increasing heart rate and blood pressure. Some evidence suggests that a person’s risk for heart attack is approximately 5x higher in the hour after smoking marijuana.11

Regular marijuana consumption (at least weekly) has also been linked to cannabinoid hyperemesis syndrome (CHS), which is marked by cyclical bouts of uncontrollable vomiting and nausea that are alleviated by hot showers or baths.16 The combination of hot showers and vomiting may put those suffering from CHS at greater risk of fluid imbalance and acute kidney failure.17

Cocaine Addiction

Cocaine addiction can cause gastrointestinal, cardiovascular, neurological, and movement problems:3,4,6,18,19

  • Cocaine use can decrease blood flow to the digestive tract, which can cause tears and ulcerations to this area.
  • Cocaine use can cause cardiovascular issues, including inflammation of the heart muscle and increased risk of stroke and aortic ruptures. Using the drug also increases the risk for heart attack.
  • Neurological problems like brain bleeding and seizures can arise from cocaine use.
  • Chronic cocaine use can also increase the risk of developing Parkinson’s disease, a movement disorder that involves tremors, difficulty with movement, and cognitive problems.
  • While cocaine is frequently snorted by users, some people may inject the drug. Injecting cocaine can significantly increase the risk of developing intravenous diseases like HIV and hepatitis C.

Medical Conditions May Increase Addiction Risk

Woman taking pills for pain

Medical issues are common among people with substance use disorders and those in recovery from addiction.1,3 People with substance use disorders (SUDs) are more likely than non-users to suffer from certain medical conditions, such as cancer, cardiovascular problems, and chronic pain. 3, 5 Around 1/3 of people in recovery from an SUD also have a co-occurring medical condition.1

Perhaps the most talked-about scenario in which medical conditions increase addiction risk is the link between pain management and opioid addiction. Approximately 10% of people with chronic pain abuse opioids. Persistent pain and the distress it causes can create issues with the brain’s stress and rewards circuits, making a person more susceptible to developing an opioid use disorder. 5

Substance abuse is also associated with attempts to self-medicate symptoms of medical conditions.20 Self-medication involves taking medicine to treat a symptom without the guidance of a medical professional.20 Approximately 25% of people suffering from tooth pain, facial pain, and arthritis use alcohol as a form of pain relief.21

Substance use disorders also have a high rate of co-morbidity with mental health conditions like anxiety, depression, bipolar disorder, and attention-deficit hyperactivity disorder. People with mental health disorders may also turn to drugs and alcohol to self-medicate.5

Self-medication is a dangerous practice because it can lead to taking the wrong medication, incorrect dosing, and dangerous side effects. Self-medicating can also mask the symptoms of a severe illness, which may prevent a person from getting the proper treatment.20

Another danger of self-medication is the risk of developing dependence or addiction.20 Using a substance to manage symptoms without the guidance of a medical professional can lead to difficulty controlling use, cravings, tolerance, and withdrawal. Once these problems begin, it may be difficult to stop using the substance even when it becomes apparent that doing so worsens the condition.22

The Importance of Integrated Care

Traditionally, treatment for substance use disorders, medical conditions, and mental illness has been delivered separately from one another. For many years, addiction was viewed as a distinctly moral or social issue to be treated in isolation. However, the lack of consideration to the impact that substance abuse could have on other conditions and vice versa can lead to inadequate treatment.3

Integrating addiction and healthcare services is important because people with substance use disorders are almost twice as likely to have a chronic medical condition.3 Integrating services can help reduce barriers to getting proper treatment. Integration of treatment can also:3

  • Make healthcare more affordable.
  • Allow healthcare providers to better coordinate with one another, which can improve health outcomes for patients.

Healthcare integration is especially important for people with medical disorders who are undergoing detoxification from drugs or alcohol. When a person stops using drugs or alcohol, withdrawal symptoms may arise that can range from uncomfortable to dangerous. This is especially true for people with co-occurring medical conditions, who may be at higher risk for more dangerous and complicated withdrawal.6

People with medical conditions who are undergoing withdrawal are best served in a detoxification program that is equipped to identify and treat medical issues during withdrawal management.6 During detox, healthcare providers assess, monitor, and treat withdrawal symptoms to promote a safer and more comfortable withdrawal process.6 Laguna Treatment Hospital is Orange County’s first chemical dependency recovery hospital and offers hospital-based medical detox in a comfortable environment with 24/7 nursing. 

Finding Help Now

Medical conditions and addictions frequently co-occur with one another.1 In some cases addictions may arise from medical disorders, which is sometimes the case with chronic pain patients who begin using opioids to self-medicate.5,20 In other cases, medical disorders may be the result of substance use.2,3 Other times, medical disorders and substance use may exist independently from one another.

Regardless of the causal relationship between addiction and medical disorders, integrative healthcare care is the key to properly treating these conditions, improving access to treatment, and providing quality care.3 Laguna Treatment Hospital provides integrated treatment for certain co-occurring disorders. To discuss whether our program is right for you or a loved one, reach out to us at any time.

References:

  1. Massachusetts General Hospital. “Many recovering from addiction have chronic health problems, diminished quality of life: More than a third of those in recovery have health problems related to previous substance use.”
  2. National Institute on Alcohol Abuse and Alcoholism. (n.d.). Alcohol’s effects on the body.
  3. Substance Abuse and Mental Health Services Administration & Office of the Surgeon General. (2016). Health care systems and substance use disorders. In Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health (Internet). US Department of Health and Human Services.
  4. National Institute on Drug Abuse. (2017). Substance use disorders are associated with major medical illnesses and mortality risk in a large integrated health care system.
  5. National Institute on Drug Abuse. (2018). Common comorbidities with substance use disorders.
  6. Substance Abuse and Mental Health Services Administration. (2015). Detoxification and substance abuse treatment.
  7. Yadav D and Lowenfels AB. Trends in the epidemiology of the first attack of acute pancreatitis: a systematic review. Pancreas 33(4): 323-330, 2006. PMID: 17079934.
  8. Cote GA, Yadav D, Slivka A, Hawes RH, Anderson MA, Burton FR, et al. Alcohol and smoking as risk factors in an epidemiology study of patients with chronic pancreatitis. Clin Gastroenterol Hepatol 9(3): 266-273; quiz e227, 2011. PMID: 21029787.
  9. Irving HM, Samokhvalov AV and Rehm J. Alcohol as a risk factor for pancreatitis. A systematic review and meta-analysis. JOP 10(4): 387-392, 2009. PMID: 19581740.
  10. Brain Injury Association of America. (n.d.). Non-lethal Opioid Overdose and Acquired Brain Injury.
  11. National Institute on Drug Abuse. (2019). Marijuana.
  12. American Lung Association. (2019). Marijuana and Lung Health.
  13. LuisRibeiro, Philip W. (2018). Marijuana and the lung: hysteria or cause for concern? Breathe Sep, 14 (3) 196-205.
  14. Ware, Mark A. (2013). Cannabis and the Lung: No More Smoking Gun? Annals of the American Thoracic Society, 10(3).
  15. Owen KP, Sutter ME, Albertson TE. (2014). Marijuana: respiratory tract effects. Clin Rev Allergy Immunol, 46(1), 65-81.
  16. ChocronYaniv, Zuber Jean-Philippe, Vaucher Julien. Cannabinoid hyperemesis syndrome BMJ 2019; 366 :l4336
  17. ASAM Principles page 1186.
  18. National Institute on Drug Abuse. (2016). Research report series: Cocaine.
  19. Tripathi, K., & Tripathi, R. (2017). Parkinson’s disease and drug abuse. EC Neurology, 7, 117-127.
  20. Ruiz, M. E. (2010). Risks of self-medication practices. Current Drug Safety, 5(4), 315-323.
  21. Kelly, J. (2009). Up to one quarter of pain patients self-medicate with alcohol. Medscape.
  22. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.

 

 

 

 

 

About The Contributor
Ryan Kelley, NREMT
Medical Editor, American Addiction Centers
Ryan Kelley is a nationally registered Emergency Medical Technician and the former managing editor of the Journal of Emergency Medical Services (JEMS). During his time at JEMS, Ryan developed Mobile Integrated Healthcare in... Read More