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Patient Story

A young mother and her four children are being seen in a free clinic within a homeless shelter for various health reasons (Figure 229-1). The woman is currently clean and sober, but has a long history of cocaine use and addiction (Figure 229-2). Her children span the ages of 3 months to 5 years. She was recently living with her mother after the birth of her youngest child, but was kicked out of her mother’s home when she began to use cocaine once again. The patient gave written consent to the photograph and when she was shown the image on the digital camera she noted how depressed she looked. She asked for us to tell the viewers of this photograph that these can be the consequences of drug abuse—being depressed, homeless, and a single mom. Only time will reveal the effect of this situation on her four children. They are at risk for so many problems including neglect, abuse, behavioral issues and being placed in foster care. They are also at higher risk of developing substance abuse disorder. Being the health care provider for these children requires understanding the disease of addiction and the consequences of this on the family.

FIGURE 229-1

A cocaine-addicted mother with her children in a homeless shelter. Her drug addiction resulted in their homelessness. (Used with permission from Richard P. Usatine, MD.)

FIGURE 229-2

Purified cocaine. (Used with permission from DEA.)


Addiction occurs when substance use has altered brain function to an extent that an individual loses a degree of control over his or her behaviors. Addiction is an epigenetic phenomenon. Many genes influence the brain functions that affect behavior and genetic variants. These genes differ in their susceptibility to environmental conditions, which trigger the changes in brain circuitry, and contribute to the development of addiction. Addiction must be recognized and treated as a chronic illness with an interprofessional team and social support.


  • An estimated 69.6 million Americans age 12 years or older were current users of a tobacco product in 2010. This represents 27.4 percent of the population in that age range. In addition, 58.3 million persons (23% of the population) were current cigarette smokers, 13.2 million (5.2%) smoked cigars, 8.9 million (3.5%) used smokeless tobacco, and 2.2 million (0.8%) smoked tobacco in pipes.1

  • An estimated 22.6 million Americans age 12 years or older were current illicit drug users in 2010. This represents 8.9 percent of the population in that age range.1

  • Marijuana was the most commonly used illicit drug (17.4 million users; Figures 229-3 and 229-4). It was used by 76.8 percent of current illicit drug users. Among ...

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