The Impact of Codependence Recovery Paper
Write a 1400- 1750 word page integrative paper that explores how the process of recovery for an addict is changed when the co-addict in their life focuses on a codependent recovery. Be sure to include the following:
- How substance abuse affects the addict’s physical, emotional, and psychological wellbeing?
- What recovery behaviors might the addict exhibit which aligns with the 5 dysfunctional patterns of codependency?
- How are the addict’s family relationships affected by codependency?
- How is the process of recovery different when the co-addict takes a codependency approach to recovery?
- Include at least two peer-reviewed research articles.
- How is the process of recovery different when the co-addict takes a codependency approach to recovery?
Format your paper consistent with APA guidelines.
hapter 2
Classification of Drugs
MyCounselingLab™
Visit the site (www.MyCounselingLab.com) for Substance Abuse: Information for School Counselors, Social Workers, Therapists, and Counselors, Fifth Edition, to enhance your understanding of chapter concepts. You’ll have the opportunity to practice your skills through video- and case-based Assignments and Activities as well as Building Counseling Skills units and to prepare for your certification exam with Practice for Certification quizzes.
Case Examples
| Casey is a 48-year-old male who visits his primary care physician. He complains of insomnia, anxiety, frequent acid indigestion, and fatigue. On his blood panel, he shows some impairment in his liver functioning. He is borderline diabetic and has hypertension. | |
| Matilda is a 33-year-old female who comes in to an emergency room complaining of severe lower back pain. An x-ray is negative. She is restless and agitated, has a runny nose, and complains of an upset stomach. Her vital signs are normal. | |
| Chris and his wife are seeing you for marriage and family therapy. Chris works in the financial industry in a high-paced, stressful environment. His wife says Chris hardly sleeps and does not eat regularly. His moods are erratic. The couple has some financial problems, which Chris attributes to bad investments. The couple was court-ordered to counseling following a domestic violence incident. |
As we noted in Chapter 1, this textbook is designed for the mental health professional (e.g., school counselor, mental health counselor, rehabilitation counselor, social worker, marriage and family therapist) who will encounter AOD problems with clientele but who, generally, will not provide treatment for these problems. Therefore, the goal of this chapter is to provide an overview of the drugs (including alcohol and tobacco) that are most often abused and drugs that are used in the treatment of some mental disorders. However, a thorough understanding of the pharmacology of drugs and related issues (e.g., medical management of overdose, use of psychotropic medications in the treatment of mental disorders) would require far more attention than one chapter can offer. Also, information in this area changes rapidly as a result of research. For example, there is no medication that has been found to be effective in significantly reducing cocaine craving. However, there is considerable research in this area. By the time you read this book, there may be pharmacological management of cocaine withdrawal that does not currently exist. We are including an additional reading list at the end of this chapter if you want to acquire more comprehensive information on the topics discussed. In addition, we encourage you to develop contacts with AOD treatment providers who are likely to remain current with regard to research in this area. This will reduce the probability that you will pass along misinformation or outdated information to your clients.
Different methods exist that are used to classify drugs. We will use the method that classifies drugs by their pharmacological similarity. Drugs exist that do not fit nicely into one classification, and these will be noted. For each drug classification, we will mention the common drugs contained in the classification and some common street names, the routes of administration, major acute and chronic effects, signs of intoxication, signs of overdose, tolerance, and withdrawal. First however, we will present information on the federal schedule of drugs, a discussion of the concept of “dangerousness,” some simple definitions of terms that will be helpful in understanding the rest of the chapter, and a brief overview of the neurobiology of drugs.
Comprehensive Drug Abuse Prevention and Control Act
In 1970, the Comprehensive Drug Abuse Prevention and Control Act (often referred to as the Controlled Substances Act) was passed by the U.S. Congress. As part of this law, drugs are placed in one of five “schedules,” with regulatory requirements associated with each schedule. Schedule I drugs have a high potential for abuse, no currently accepted medical use in treatment in the United States, and a lack of a safe level of use under medical supervision. Drugs on Schedule I include heroin, methaqualone (Quaalude), LSD, and marijuana. Schedule II drugs also have a high abuse potential and can lead to psychological or physical dependence. However, these drugs have an accepted medical use in treatment. These drugs include morphine, PCP, cocaine, and methamphetamine. As you can probably surmise, the criteria for the other schedules involve less abuse potential, increased medical uses, and less likelihood of psychological and physical dependence.
As you will see from our discussion of the classification of drugs, the way some drugs are classified is clearly illogical. For example, benzodiazepines such as Valium and Xanax are Schedule IV drugs, with part of the criteria for inclusion being that the drugs have a lower abuse potential than drugs on Schedules I, II, and III. In reality, these drugs have at least the same if not greater abuse potential than marijuana, a Schedule I drug. However, the inclusion of a drug on a certain schedule is related to public policy, which will be discussed in Chapter 15. For example, the reclassification downward of a drug such as marijuana would be politically unpopular, and the reclassification of benzodiazepines upward would be resisted by the manufacturers of these drugs.
Related to the preceding discussion of schedules of drugs is the concept of the inherent dangers of certain drugs. Tobacco, alcohol, and other drugs are not safe to use. There are acute and chronic dangers, and these dangers vary by drug. For example, there is little acute danger from the ingestion of a glass of wine by an adult. The acute danger of shooting cocaine is far greater. Chronic use of any drug (including alcohol) has an increased risk, but the danger of smoking one pack of cigarettes a day for 40 years is greater than the dangers from drinking one beer a day for 40 years. Danger is also related to the method used to administer a drug. Smoking a drug or injecting it produces the most rapid and intense reaction, while ingesting a drug generally produces effects with longer duration, although less intensity. Snorting drugs is in between but has more similarities to smoking and injecting than ingesting. Although any method of administration may be dangerous both acutely and chronically, smoking or injecting drugs tends to result in the most acute problems since these routes of administration rapidly introduce the drug to the bloodstream and, subsequently, to the brain. Also, smoking drugs causes damage to the respiratory system, and the intravenous use of drugs may cause serious problems including abscesses, blood clots, allergic reactions to the substances used to “cut” the drug, and communicable diseases such as hepatitis and HIV.
It is certainly important that you understand the acute and chronic effects of different drugs and the addictive potential of tobacco, alcohol, and other drugs. However, it is essential that you understand that any of the psychoactive drugs we discuss in this chapter can be used in an addictive manner. You will learn that hallucinogens are not physically addicting in the sense that body tissues require these drugs for normal functioning. However, this does not imply that people are immune from serious problems resulting from the use of hallucinogens. Alcohol is clearly an extremely dangerous drug in spite of the fact that many people use the drug without problems. Marijuana is not as acutely or chronically dangerous as cocaine, but that does not mean it can be used safely. We have worked with clients who have serious life problems from marijuana use. This is not a sermon to “Just Say No.” It is a caution to avoid concluding that you can direct clients away from some drugs to other drugs, and a caution to avoid using your own experience with AOD as a basis for determining which drugs are safe and which are dangerous.
Terminology in the AOD field can be confusing. One author may have a very specific meaning for a particular term while another may use the same term in a more general sense. An analogy might be the use of the term neurotic in the mental health field. While one professional may use this term when referring to some very specific disorders, another may use it to describe a wide variety of mental health problems. However, there is no universal agreement about how some of these terms should be used. Therefore, the following definitions should assist you in understanding this chapter and the rest of the book, but you may find differences in definitions as you read professional and popular literature in the AOD field.
Addiction: Compulsion to use alcohol or other drugs regardless of negative or adverse consequences. Addiction is characterized by psychological dependence (see below) and, often (depending on the drug or drugs) physical dependence (see below). As we will discuss in Chapter 14, the term addiction is sometimes applied to behaviors other than AOD (e.g., eating, gambling).
Alcoholism: Addiction to a specific drug: alcohol.
Chemical dependency: A term used to describe addiction to alcohol and/or other drugs and to differentiate this type of addiction from nonchemical addictions (e.g., gambling).
Dependence: A recurrent or ongoing need to use alcohol or other drugs. Psychological dependence is the need to use alcohol or other drugs to think, feel, or function normally. Physical dependence exists when tissues of the body require the presence of alcohol or other drugs to function normally. All psychoactive drugs can produce psychological dependence and many can produce physical dependence. Dependence will also be defined in Chapter 6, based on the criteria in theDiagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) (American Psychiatric Association, 2000), to diagnose AOD dependency disorders.
Intoxication: State of being under the influence of alcohol or other drugs so that thinking, feeling, and/or behavior are affected.
Psychoactive drugs: Natural or synthetic chemicals that affect thinking, feeling, and behavior.
Psychotropic drugs: Chemicals used to treat mental disorders.
Substance abuse: The continued use of alcohol and/or other drugs in spite of adverse consequences in one or more areas of an individual’s life (e.g., family, job, legal, financial). Abuse will also be defined in Chapter 6 according to the criteria in the DSM-IV-TR.
Tolerance: Requirement for increasing doses or quantities of alcohol or other drugs in order to create the same effect as was obtained from the original dose. Tolerance results from the physical or psychological adaptations of the individual.
Cross-tolerance: Refers to accompanying tolerance to other drugs from the same pharmacological group. For example, tolerance to alcohol results in tolerance to minor tranquilizers such as Xanax, even when the individual has never used Xanax.
Reverse tolerance: Refers to a condition in which smaller quantities of a drug produce the same effects as did previous larger doses.
Withdrawal: Physical and psychological effects that occur when a drug-dependent individual discontinues alcohol or other drug use.
1This information comes from the National Institute on Drug Abuse (NIDA) Drugs, Brains, and Behavior—The Science of Addiction (2010). Available athttp://www.nida.nih.gov/scienceofaddiction/index.html. All material, including illustrations, is in the public sector.
Drugs affect the brain by impacting the way nerve cells send, receive, and process information. Drugs such as heroin and marijuana activate neurons by mimicking natural neurotransmitters. Other drugs like methamphetamine and cocaine cause nerve cells to release extremely large amounts of neurotransmitters or prevent the normal reuptake of neurotransmitters into the nerve cells (see Figure 2.1).
Figure 2.1 Effect of drugs on neurotransmitters.
Most drugs of abuse directly or indirectly target the brain’s reward system by releasing or blocking the re-uptake of the neurotransmitter dopamine. Dopamine is present in regions of the brain that regulate movement, emotion, cognition, motivation, and feelings of pleasure. When dopamine floods the neuron system in the brain’s reward center, euphoria results. Natural human behaviors (e.g., eating, sex) also release dopamine and the person experiences pleasure. Since our brains are designed for the survival of the species, we want to repeat these natural, pleasurable activities. However, when drugs stimulate the brain’s reward center, our brain is in effect “fooled” into believing that drug taking is also a survival behavior that should be repeated.
Many naturally pleasurable activities are not habitually repeated like drug taking can be. The neurobiological explanation is that 2 to 10 times more dopamine is released by drugs than by natural activities. Furthermore, depending on the method that drugs are administered, this dopamine release is almost immediate and is very intense. Therefore, the euphoric properties of drug taking can be very powerful and highly reinforcing.
Unfortunately, the brain adjusts to high levels of dopamine by producing less or reducing the number of dopamine receptors. When this occurs, the drug user has more difficulty experiencing pleasure and must increase the amount of drugs consumed to feel normal. This is referred to as “tolerance.” In Figure 2.2, the gray areas in the white ovals areas are dopamine transporters from PET scans of a normal brain and the brain of a methamphetamine abuser. You can clearly see the reduction of these gray areas in the methamphetamine abuser. When a drug abuser abstains from drugs for a period of time, the brain usually returns to normal. However, the length of time it takes depends on the type of drugs abused and the number of years that drugs were abused.
Figure 2.2 Effect of methamphetamine on the brain.
Source: Am J Psychiatry 158:377–382, 2001.
The neurobiology of addiction is a very complex subject and this brief section is intended to give you only a conceptualized understanding of the topic. (See Table 2.1 for an overview of drug classifications.) There are additional readings at the end of the chapter for those who want to pursue this area in more detail.
Table 2.1 Summary Table of Drug Classifications
| Common Drugs | Main Routes of Administration | Major Acute Effects | Major Chronic Effects | Overdose | Tolerance | Withdrawal | |
| CNS Depressants | Alcohol, barbiturates, benzodiazepines, sleep aids | Drinking, ingesting pills | Relaxation, disinhibition, reduction of anxiety, impaired motor coordination | Alcohol: Damage to every organ system | Common with alcohol, can be dangerous, synergistic effect | Develops rapidly, cross-tolerance occurs | Can be medically dangerous |
| CNS Stimulants | Cocaine, methamphetamine, caffeine, nicotine | Snorting, smoking, injecting, drinking | Alertness, mood elevation, increased heart rate and blood pressure | Health damage from tobacco products, addiction, depression, suicidal ideation | Tremors, sweating, tachycardia, anxiety, insomnia | Rapid tolerance to pleasurable and stimulating effects | Unpleasant and long-lasting but not medically dangerous |
| Opioids | Heroin, morphine, methadone, pain pills | Injecting, snorting, swallowing pills | Sedation, pain relief | Addiction, complications from lifestyle and method of administration | Depressed central nervous system functioning, death can occur | Rapid tolerance to pleasurable effects with repeated administration | Very unpleasant but not usually medically dangerous |
| Hallucinogens | LSD, magic mushrooms, PCP | Ingesting or smoking | Alters perception of sensory stimuli, panic attacks in some users | Flashbacks | Except for PCP, overdose does not occur with PCP, agitation, confusion, aggression | Tolerance to hallucinogenic properties does occur | No physical dependence |
| Cannabinols | Marijuana | Smoking or ingestion | Enhanced taste, touch, and smell; relaxation; increased appetite; impaired immediate recall | Adverse effect on lung function, decrease in testosterone, suppression of immune system; impact is controversial | Overdose does not occur; adverse reactions are panic attacks | Tolerance to normal effects occurs but it is probably not physiological | Irritability, insomnia, restlessness |
| Inhalants and Volatile Hydrocarbons | Solvents, aerosol sprays, amyl nitrate, isobutyl, nitrous oxide | Inhaling (huffing) | Reduced inhibition, dizziness, slurred speech, impaired motor coordination; unconsciousness and death can occur. | Damage to liver, kidneys, brain, and lungs | Hallucinations, muscle spasms, coma | Tolerance to nitrous oxide | No known withdrawal syndrome |
| Anabolic Steroids | Depo-Testosterone, Danocrine, Halotestin | Igested or njected | Increased muscle strength, body mass, and aggressiveness | Jaundice, liver tumors, mood swings | Increased doses result in chronic problems | No tolerance | Depression, fatigue, restlessness, Insomnia |
Central Nervous System Depressants
Central nervous system (CNS) depressants (also referred to as sedative-hypnotics) depress the overall functioning of the central nervous system to induce sedation, drowsiness, and coma. The drugs in this classification include the most commonly used and abused psychoactive drug, alcohol; prescription drugs used for anxiety, sleep disturbance, and seizure control; and over-the-counter medications for sleep disturbance, colds and allergies, and coughs. In general, CNS depressants are extremely dangerous. There are approximately 79,000 deaths annually caused by excessive alcohol use in the United States, the third leading lifestyle cause of death (Centers for Disease Control and Prevention, 2010a). Alcohol alone or in combination with other drugs accounted for nearly 36% of drug abuse-related emergency room episodes in 2007 (Substance Abuse and Mental Health Services Administration, 2010).
Alcohol is the most well-known CNS depressant because of its widespread use and legality. The alcohol content of common beverages is beer, 3% to 6%; wine, 11% to 20%; liqueurs, 25% to 35%; and liquor (whiskey, gin, vodka, etc.), 40% to 50%. The “proof” on alcohol beverages is computed by doubling the alcohol content. Therefore, a bourbon that is described as “90 proof” is 45% alcohol. It is important to remember that the amount of alcohol in one 12-ounce beer is the same as the amount of alcohol in 6 ounces of wine or in 1.5 ounces of liquor (all standard drinks). The alcohol in beer is simply contained in a larger amount of liquid.
Barbiturates are prescription drugs used to aid sleep for insomniacs and for the control of seizures. These drugs include Seconal (reds, red devils), Nembutal (yellows, yellow jackets), Tuinal (rainbows), Amytal (blues, blue heaven), and Phenobarbital. There are also nonbarbitu-rate sedative-hypnotics with similar effects but with different pharmacological properties. These include Doriden (goofballs), Quaalude (ludes), Miltown, and Equinil. Being a Schedule I drug, Quaalude cannot be legally prescribed in the United States.
The development of benzodiazepines or minor tranquilizers reduced the number of prescriptions for barbiturates written by physicians. These drugs were initially seen as safe and having little abuse potential. Although the minor tranquilizers cannot be easily used in suicide as can barbiturates, the potential for abuse is significant. The benzodiazepines are among the most widely prescribed drugs and include Valium, Librium, Dalmane, Halcion, Xanax, and Ativan. In addition, non-benzodiazepine hypnotics are being heavily marketed as sleep aids. These include Ambien, Lunesta, and Sonata. These drugs can be abused and do have addictive potential. Rozerem, another widely marketed sleep aid, is not pharmacologically similar to the other non-benzodiazepine hypnotics and is not addictive. It is like the herbal remedy melatonin.
Finally, certain over-the-counter medications contain depressant drugs. Sleep aids such as Nytol and Sominex, cold and allergy products, and cough medicines may contain scopolamine, antihistamines, or alcohol to produce the desired effects.
Obviously, alcohol is administered by drinking. Some over-the-counter medications are also in liquid form. The barbiturates, nonbarbiturate sedative-hypnotics, minor tranquilizers, and non-benzodiazepine hypnotics come in pill form. As with many psychoactive drugs, liquid forms of the drugs are produced and administered by injection.
Major Acute and Chronic Effects
The effects of CNS depressants are related to the dose, method of administration, and tolerance of the individual, factors that should be kept in mind as the effects are discussed. At low doses, these drugs produce a feeling of relaxation and calmness. They induce muscle relaxation, disinhibition, and a reduction in anxiety. Judgment and motor coordination are impaired, and there is a decrease in reflexes, pulse rate, and blood pressure. At high doses, the person demonstrates slurred speech, staggering, and, eventually, sleep. Phenobarbital and Valium have anticonvulsant properties and are used to control seizures. The benzodiazepines are also used to clinically control the effects from alcohol withdrawal.
In terms of damage to the human body and to society, alcohol is the most dangerous psychoactive drug (tobacco causes far more health damage). Alcohol has a damaging effect on every organ system. Chronic effects include permanent loss of memory, gastritis, esophagitis, ulcers, pancreatitis, cirrhosis of the liver, high blood pressure, weakened heart muscles, and damage to a fetus including fetal alcohol syndrome and fetal alcohol effect (see Chapter 12). Other chronic effects include family, social, occupational, and financial problems. Acutely, alcohol is the cause of many traffic and other accidents and is involved in many acts of violence and crime. Certainly, the other CNS depressants can cause the same acute problems that are the result of injury and accident and chronic effects on the individual and family due to addiction.
Alcohol overdose is common. We refer to this syndrome as being “drunk.” The symptoms include staggering, slurred speech, extreme disinhibition, and blackouts (an inability to recall events that occurred when the individual was intoxicated). Generally, the stomach goes into spasm and the person will vomit, helping to eliminate alcohol from the body. However, the rapid ingestion of alcohol, particularly in a nontolerant individual, may result in coma and death. This happens most frequently with young people who participate in drinking contests.
As these drugs depress the central nervous system, overdose is extremely dangerous and can be fatal. Since the fatal dosage is only 10 to 15 times the therapeutic dosage, barbiturates are often used in suicides, which is one reason they are not frequently prescribed. It is far more difficult to overdose on the minor tranquilizers. However, CNS depressants have a synergistic or potentiation effect, meaning that the effect of a drug is enhanced as a result of the presence of another drug. For example, if a person has been drinking and then takes a minor tranquilizer such as Xanax, the effect of the Xanax may be dramatically enhanced. This combination has been the cause of many accidental deaths and emergency room visits.
There is a rapid development of tolerance to all CNS depressant drugs. Cross-tolerance also develops. This is one reason why overdose is such a problem. For example, Bob, a very heavy drinker, is quite anxious and is having difficulty sleeping. He goes to his physician with these symptoms. The physician does not ask about his alcohol use and gives him a prescription of Xanax. Bob follows the directions and takes one pill. However, because he is tolerant to alcohol, he is also cross-tolerant to Xanax and the pill has no effect. He can’t sleep so he takes three more pills and has a glass of brandy. The synergistic effect of these drugs results in a coma.
The tolerance that develops to the CNS depressants is also one reason that the use of the minor tranquilizers has become problematic. People are given prescriptions to alleviate symptoms such as anxiety and sleep disturbance that are the result of other problems such as marital discord. The minor tranquilizers temporarily relieve the symptoms but the real problem is never addressed. The person continues to use the drug to alleviate the symptoms, but tolerance develops and increasing dosages must be used to achieve the desired effect. This is a classic paradigm for the development of addiction and/or overdose.
The withdrawal syndrome from CNS depressants can be medically dangerous. These symptoms may include anxiety, irritability, loss of appetite, tremors, insomnia, and seizures. In the severe form of alcohol withdrawal called delirium tremens (DTs), additional symptoms are fever, rapid heartbeat, and hallucinations. People can and do die from the withdrawal from these drugs. Therefore, the detoxification process for CNS depressants should include close supervision and the availability of medical personnel. Chronic, high-dosage users of these drugs should be discouraged from detoxifying without support and supervision. For detoxification in a medical setting, minor tranquilizers can be used, in decreasing dosages, to reduce the severity of the withdrawal symptoms.
The dangerousness of withdrawal from CNS depressants is one reason why supervised detoxification is needed. In addition, supervision and support are usually required because the withdrawal symptoms are unpleasant and rapidly alleviated by using CNS depressants. For example, a 47-year-old man decides that he has been drinking too much and wants to quit. He doesn’t tell anyone and is going to “tough it out.” Although he doesn’t have any medically dangerous symptoms, he is anxious, irritable, and has trouble sleeping. His family, friends, and coworkers remark about how unpleasant he is, and he is quite uncomfortable. He has a few drinks and finds that the symptoms are gone. Very rapidly, he is drinking heavily again.
Central Nervous System Stimulants
CNS stimulants affect the body in the opposite manner as do the CNS depressants. These drugs increase respiration, heart rate, motor activity, and alertness. This classification includes highly dangerous, illegal substances such as crack cocaine, medically useful stimulants such as Ritalin, drugs with relatively minor psychoactive effects such as caffeine, and the most deadly drug used, nicotine. The drugs in this classification were mentioned in 34% of the drug abuse-related emergency room episodes in 2007 (Substance Abuse and Mental Health Services Administration, 2010).
Cocaine (coke, blow, toot, snow) and the freebase or smokeable forms of cocaine (crack, rock, base) are the most infamous of the CNS stimulants. Cocaine is found in the leaves of the coca shrub that grows in South America. The leaves are processed and produce coca paste. The paste is, in turn, processed to form the white hydrochloride salt powder most of you know as cocaine. Of course, before it is sold on the street, it is adulterated or “cut” with substances such as powdered sugar, talc, arsenic, lidocaine, strychnine, or methamphetamine. Crack is produced by mixing the cocaine powder with baking soda and water and heating the solution. The paste that forms is hardened and cut into hard pieces, or rocks. The mixing and heating process removes most of the impurities from the cocaine. The vaporization point is lowered so the cocaine can be smoked, reaching the brain in one heartbeat less than if it is injected. Therefore, crack is a more pure form of cocaine than is cocaine hydrochloride salt powder.
Amphetamines are also CNS stimulants, and one form in particular, methamphetamine, is a major drug of addiction. The amphetamines include Benzedrine (crosstops, black beauties), Methedrine or methamphetamine (crank, meth, crystal), and Dexedrine (dexies). There are also nonamphetamine stimulants with similar properties such as Ritalin and Cylert (used in the treatment of attention deficit-hyperactivity disorder) and Preludin (used in the treatment of obesity). These drugs are synthetics (not naturally occurring), and the amphetamines were widely prescribed in the 1950s and 1960s for weight control.
Some forms of CNS stimulants are available without a prescription and are contained in many substances we use on a regular basis. Caffeine is found in coffee, teas, colas, and chocolate as well as in some over-the-counter products designed to help people stay awake (e.g., No Doz, Alert, Vivarin). Phenylpropanolamine is a stimulant found in diet-control products sold over-the-counter (e.g., Dexatrim). These products are abused by individuals who chronically diet (e.g., anorexics). Pseudoephedrine is a substance in many nasal decongestants. Since it is used in the manufacture of methamphetamine, federal and state laws have been passed to restrict the quantities of these over-the-counter medications that can be purchased.
Although it has mild euphoric properties, nicotine is the highly addictive stimulant drug found in tobacco products. According to the Centers for Disease Control and Prevention (2010b), an estimated 440,000 Americans die each year from smoking-related illnesses. This is more than five times as many deaths as result from alcohol. By a wide margin, nicotine is the most deadly drug we will discuss. Ironically, it is not only legal, it is marketed. We will mention this contradiction in public policy in Chapter 15.
With CNS stimulants, every method of administration is possible and utilized. Caffeine is consumed in beverage form, but it is also eaten (e.g., chocolate) or taken in pill form (e.g., No Doz). Nicotine is obviously smoked but can be chewed (chewing tobacco, nicotine gum) or administered through a skin patch. Cocaine and amphetamines can be snorted, smoked, injected, and ingested.
Major Acute and Chronic Effects
As with most of the psychoactive drugs, some of the CNS stimulants (cocaine and methamphetamine) have a recreational use. The purpose is to “get high,” or to experience a sense of euphoria. Methamphetamine and cocaine users report a feeling of self-confidence and self-assurance. There is a “rush” that is experienced, particularly when cocaine is smoked and when cocaine and methamphetamine are injected. The high from methamphetamine is generally less intense but longer acting than cocaine.
CNS stimulants result in psychomotor stimulation, alertness, and elevation of mood. There is an increase in heart rate and blood pressure. Performance may be enhanced with increased activity level, one reason why athletes use CNS stimulants. These drugs also suppress appetite and combat fatigue. That’s why people who want to lose weight and people who want to stay awake for long periods of time (e.g., truck drivers) will use amphetamines.
The acute effects of CNS stimulants can be dramatic and fatal. These include heart attacks, strokes, seizures, and respiratory depression. However, the results of chronic use cause the most problems. The addictive properties of these drugs are extremely high. Individuals with addictions to cocaine and methamphetamine spend a tremendous amount of money to obtain drugs, and they encounter serious life problems related to their addiction. Also, there is an increased risk of strokes and cardiovascular problems, depression, and suicide in chronic users. Symptoms of paranoid schizophrenia can occur. If cocaine or methamphetamine is snorted, perforation of the nasal septum can occur. Injection of CNS stimulants has the same risks as injecting other drugs (e.g., hepatitis, HIV). Since these drugs suppress appetite, chronic users are frequently malnourished.
If you are smugly saying to yourself that the only CNS stimulant you use is caffeine, see the caffeine-induced disorders that are described in the DSM-IV-TR (see Chapter 6). Also, caffeine may precipitate panic attacks in individuals predisposed to panic disorders, and the drug may be detrimental to some heart patients. A woman who is considering having a baby should reduce caffeine intake, and pregnant and breastfeeding women are advised to abstain.
Clearly, the chronic effects of nicotine addiction are damaging to health. The number of health-related problems, deaths, and days of work missed due to the chronic use of tobacco products is astounding.
CNS stimulants stimulate the reward center of the brain. The most powerful of these drugs result in the body’s not experiencing hunger, thirst, or fatigue. There is no built-in satiation point, so humans can continue using cocaine and methamphetamine until there is no more or they die. Therefore, the compulsion to use, the desire to maintain the high, and the unpleasantness of withdrawal make overdose fairly common. There may be tremors, sweating and flushing, rapid heartbeat (tachycardia), anxiety, insomnia, paranoia, convulsions, heart attack, or stroke. Death from overdose has been widely publicized because it has occurred with some famous movie stars and athletes. However, far more people experience chronic problems from CNS stimulant addictions than from overdose reactions.
There is a rapid tolerance to the pleasurable effects of cocaine and methamphetamine and the stimulating effects of tobacco and caffeine. If you drink five or six cups a day of combinations of coffee, tea, and colas, you probably know this with regard to caffeine. You will find that if you stop using caffeine for a couple of weeks and then start again, the initial doses of caffeine produce a minor “buzz,” alertness, and/or restlessness.
The rapid tolerance to the euphoric effects of cocaine and methamphetamine leads to major problems with these drugs. The pleasurable effects are so rewarding, particularly when the drugs are smoked or injected, that the user is prone to compulsively use in an effort to recapture the euphoric effects. When injected or smoked, the effects are enhanced but of relatively short duration. Continual use to achieve the high leads to rapid tolerance. The user is then unable to feel the pleasure but must continue to use the drug to reduce the pain of withdrawal.
A sensitization or reverse tolerance can occur, particularly with cocaine. In this instance, a chronic user with a high tolerance has an adverse reaction (i.e., seizure) to a low dose.
Unlike the withdrawal from CNS depressants, the withdrawal from these drugs is not medically dangerous. However, it is extremely unpleasant. If you have an addiction to caffeine and want to get a small taste of the withdrawal from CNS stimulants, discontinue your use of caffeine. The symptoms you can expect include a chronic headache, irritability, restlessness, and anxiety. You may have trouble sleeping and concentrating.
The withdrawal from cocaine and methamphetamine is called “crashing.” The severe symptoms usually last two to three days and include intense drug craving, irritability, depression, anxiety, and lethargy. However, the depression, drug craving, and an inability to experience pleasure may last for several months as the body chemistry returns to normal. Suicidal ideation and attempts are frequent during this time, as are relapses. Recovering cocaine and methamphetamine addicts can become very discouraged with the slow rate of the lifting of depression, and, therefore, support is very important during this time.
If you have been or are addicted to nicotine, you probably have experienced the unpleasant withdrawal symptoms during attempts to quit (we are assuming that nearly everyone addicted to nicotine has tried to quit or has succeeded). Enhance the severity of your experience dramatically, and you may be able to achieve an empathic understanding of the withdrawal syndrome for cocaine and methamphetamine addicts.
The opioids2 are naturally occurring (opium poppy extracts) and synthetic drugs that are commonly used for their analgesic (pain relief) and cough-suppressing properties. Opium was used by early Egyptian, Greek, and Arabic cultures for the treatment of diarrhea since there is a constipating effect to this drug. Greek and Roman writers such as Homer and Virgil wrote of the sleep-inducing properties of opium, and recreational use of the drug in these cultures did occur. Morphine was isolated from opium in the early 1800s and was widely available without prescription until the early 1900s when the nonmedical use of opioids was banned. Heroin accounted for 10% of drug abuse–related emergency room episodes for illicit drugs in 2007 while other opioids were involved in nearly half of emergency room visits for nonmedical pharmaceuticals (Substance Abuse and Mental Health Services Administration, 2010). The large number of emergency room visits resulting from nonmedical pharmaceuticals reflects the increasing abuse of prescription pain medications such as oxycodone (i.e., OxyContin) and hydrocodone (i.e., Loratab, Vicodin).
2We will use the term opioid to refer to any natural or synthetic drug that has an analgesic (pain relieving) effect similar to that of morphine. The termsopiate, narcotic, and analgesic are also used to describe this classification of drugs.
The opioids include opium, codeine, morphine, heroin (smack, horse), and buprenorphine, as well as familiar brand names such as Dilaudid (hydromorphone), OxyContin and Percocet (oxyco-done), Loratab and Vicodin (hydrocodone), Darvocet (propoxyphene), Dolophine (methadone) and Demerol (meperidine). Propoxyphene will no longer be available due to adverse side effects.
We are familiar with many of these drugs in the pill or liquid form when used for pain relief or cough suppression. When used illicitly, the opioids are often used intravenously, but this is also a route of administration when these drugs are used medically for pain relief. Heroin, which is used only illicitly in the United States, can be snorted or smoked in addition to the common intravenous method. As the danger of disease from dirty needles has been widely publicized, alternative routes of administration for heroin have become more popular. Opium has been smoked for centuries.
Major Acute and Chronic Effects
Opioids have medically useful effects including pain and cough suppression and constipation. Obviously, there is also a euphoric effect that accounts for the recreational use of these drugs. They can produce nausea and vomiting and itching. A sedating effect occurs, and the pupils of the eyes become constricted.
Methadone or Dolophine is a synthetic opioid that does not have the dramatic euphoric effects of heroin, has a longer duration of action (12 to 24 hours compared with 3 to 6 hours for heroin), and blocks the symptoms of withdrawal when heroin is discontinued. This is the reason for the use of methadone in the treatment of opioid addiction. In the last few years, methadone in pill form is being frequently prescribed for pain relief. Buprenorphine (usually sold under the brand name Suboxone) is now being prescribed in an office setting to treat opioid dependence.
There is an acute danger of death from overdose from injecting opioids, particularly heroin. Also, the euphoric effects of opioids rapidly decrease as tolerance increases, and, as this tolerance occurs, the opioid use is primarily to ward off the withdrawal symptoms.
Compared with the chronic use of CNS depressants, chronic use of the drugs themselves is less dangerous to the body. However, the route of administration and the lifestyle associated with chronic opioid use clearly has serious consequences. Obviously, there is the risk of communicable disease from the intravenous use of opioids and sharing needles. The lifestyle of heroin addicts often includes criminal activity to secure enough money to purchase heroin. Women may participate in prostitution, which adds the associated risks of diseases and violence. Nutrition is frequently neglected. However, those individuals who have been involved in methadone maintenance programs for long periods of time do not experience negative health consequences from the use of methadone (which is taken orally).
Death from overdose of injectable opioids (usually heroin) can occur from the direct action of the drug on the brain, resulting in respiratory depression. Death can also occur from an allergic reaction to the drug or to substances used to cut it, possibly resulting in cardiac arrest.
Overdose of other drugs in this classification may include symptoms such as slow breathing rate, decreased blood pressure, pulse rate, temperature, and reflexes. The person may become extremely drowsy and lose consciousness. There may be flushing and itching skin, abdominal pain, and nausea and vomiting.
As abuse of prescription pain medications has skyrocketed, so have overdoses from these drugs. Oxycodone is sold in time-release form, which is crushed and snorted to get a more intense effect. This has resulted in unintentional overdose. In addition, methadone in pill form has been increasingly prescribed for pain relief. However, methadone dissipates from the body very slowly. Therefore, an individual may increase the dosage beyond the recommended level or time between doses and overdose because of the residual methadone in the body from prior doses.
Frequency of administration and dosage of opioids is related to the development of tolerance. Tolerance develops rapidly when the drugs are repeatedly administered but does not develop when there are prolonged periods of abstinence. The tolerance that does develop is to the euphoric, sedative, analgesic, and respiratory effects of the drugs. This tolerance results in the individual’s using doses that would kill a nontolerant person. The tolerant individual becomes accustomed to using high doses, which accounts for death due to overdose in long-time opioid users who have been detoxified and then go back to using.
Cross-tolerance to natural and synthetic opioids does occur. However, there is no cross-tolerance to CNS depressants. This fact is important, because the combination of moderate to high doses of opioids and alcohol or other CNS depressants can (and often does) result in respiratory depression and death.
When these drugs are used on a continuous basis, there is a rapid development of physical dependence. Withdrawal symptoms are unpleasant and uncomfortable but are rarely dangerous. The symptoms are analogous to a severe case of the flu, with running eyes and nose, restlessness, goose bumps, sweating, muscle cramps or aching, nausea, vomiting, and diarrhea. There is significant drug craving. These symptoms rapidly dissipate when opioids are taken, which accounts for relapse when a person abruptly quits on his or her own (“cold turkey”). When the drugs are not available to the dependent individual, the unpleasant withdrawal symptoms also result in participation in criminal activities in order to purchase the drugs.
Many of the hallucinogens are naturally occurring and have been used for thousands of years. Some have been (and are currently) used as sacraments in religious rites and have been ascribed with mystical and magical properties. Today, many types of hallucinogens are synthetically produced in laboratories. Some of the hallucinogens became very popular in the 1960s and 1970s, with a drop in use in the 1980s. While there was a resurgence of use from 1992 to 2001 among youth, recent surveys have shown relatively low and stable levels of use (Johnston, O’Malley, Bachman, & Schulenberg, 2010).
This classification comprises a group of heterogeneous compounds. Although there may be some commonality in terms of effect, the chemical structures are quite different. The hallucinogens we will discuss include LSD (acid, fry), psilocybin (magic mushrooms, shrooms), morning glory seeds (heavenly blue), mescaline (mesc, big chief, peyote), STP (serenity, tranquility, peace), and PCP (angel dust, hog). PCP is used as a veterinary anesthetic, primarily for primates.
Hallucinogens are usually swallowed. For example, LSD may be put on a sticker, stamp, or sugar cube. Psilocybin is eaten. However, hallucinogens can also be snorted, smoked, or injected. PCP is often sprinkled on a marijuana joint and smoked.
Major Acute and Chronic Effects
These drugs produce an altered state of consciousness, including altered perceptions of visual, auditory, olfactory, and/or tactile senses and an increased awareness of inner thoughts and impulses. Sensory experiences may cross into one another (e.g., “hearing color”). Common sights and sounds may be perceived as exceptionally intricate and astounding. In the case of PCP, there may be increased suggestibility, delusions, and depersonalization and dissociation. Physiologically, hallucinogens produce a rise in pulse and blood pressure.
A fairly common and well-publicized adverse effect of hallucinogens is the experience of flashbacks. Flashbacks are the recurrence of the effects of hallucinogens long after the drug has been taken. Reports of flashbacks more than five years after taking a hallucinogen have been reported although abatement after several months is more common.
With regard to LSD, there are acute physical effects including a rise in heart rate and blood pressure, higher body temperature, dizziness, and dilated pupils. Mental effects include sensory distortions, dreaminess, depersonalization, altered mood, and impaired concentration. “Bad trips” involve acute anxiety, paranoia, fear of loss of control, and delusions. Individuals with preexisting mental disorders may experience more severe symptoms. With regard to chronic effects, we have already mentioned the rare but frightening experience of flashbacks.
On the other hand, PCP does result in significant adverse effects. Chronic use may result in psychiatric problems including depression, anxiety, and paranoid psychosis. Accidents, injuries, and violence occur frequently.
With the exception of PCP, the concept of “overdose” is not applicable to the hallucinogens. “Bad trips” or panic reactions do occur and may include paranoid ideation, depression, undesirable hallucinations, and/or confusion. These are usually managed by providing a calm and supportive environment. An overdose of PCP may result in acute intoxication, acute psychosis, or coma. In the acute intoxication or psychosis, the person may be agitated, confused, and excited, and may exhibit a blank stare and violent behavior. Analgesia (insensibility to pain) occurs that may result in self-inflicted injuries and injuries to others when attempts are made to restrain the individual.
Tolerance to the hallucinogenic properties of these drugs occurs, as well as cross-tolerance between LSD and other hallucinogens. No cross-tolerance to cannabis has been demonstrated. Tolerance to PCP has not been demonstrated in humans (American Psychiatric Association, 2000).
There is no physical dependence that occurs from the use of hallucinogens, although psychological dependence, including drug craving, does occur.
Marijuana is the most widely used illegal drug. Over 18% of adults in the 18- to 25-year range reported using marijuana in the previous month (Office of Applied Studies, 2010). The earliest references to the drug date back to 2700 B.C. In the 1700s, the hemp plant (Cannabis sativa) was grown in the colonies for its fiber, which was used in rope. Beginning in 1926, states began to outlaw the use of marijuana since it was claimed to cause criminal behavior and violence. Marijuana use became popular with mainstream young people in the 1960s. Some states have basically decriminalized possession of small amounts of marijuana although, according to the federal government, it remains a Schedule I drug. Emergency room episodes in which marijuana was mentioned comprised 16% of the total drug abuse-related emergency room visits in 2007 (Substance Abuse and Mental Health Services Administration, 2010).
The various cannabinols include marijuana (grass, pot, weed, joint, reefer, dube), hashish, charas, bhang, ganja, and sinsemilla. The active ingredient is delta-9-tetrahydrocannabinol (THC). Hashish and charas have a THC content of 7% to 14%; ganja and sinsemilla, 4% to 7%; and bhang and marijuana, 2% to 5%. For simplicity, we will refer to the various forms of cannabinols as “marijuana.”
Marijuana is usually smoked in cigarette form or pipes. It can also be ingested, normally by baking it in brownies or cookies.
Major Acute and Chronic Effects
Marijuana users experience euphoria; enhancement of taste, touch, and smell; relaxation; increased appetite; altered time sense; and impaired immediate recall. An enhanced perception of the humor of situations or events may occur. The physiological effects of marijuana include increase in pulse rate and blood pressure, dilation of blood vessels in the cornea (which produces bloodshot eyes), and dry mouth. Motor skills and reaction time are slowed.
As you are all aware, marijuana has been and continues to be controversial. Ballot measures in several states have involved marijuana laws. This controversy is related to the facts and myths regarding marijuana’s acute and chronic effects. However, the professional community has as many views of the “facts” regarding marijuana as does the general public. While our interpretation of the research may be different than others, we are confident in saying that this issue is not “black and white.” Marijuana should clearly not be a Schedule I drug. However, no psycho-active drug is safe. Marijuana can and does result in significant life problems for many people.
Marijuana is certainly not acutely or chronically dangerous when death is the measure of dangerousness. However, the effect on motor skills and reaction time certainly impairs the user’s ability to drive a car, boat, plane, or other vehicle.
Chronic use of marijuana does seem to have an adverse effect on lung function, although there is no direct evidence that it causes lung cancer. Although an increase in heart rate occurs, there does not seem to be an adverse effect on the heart. As is the case with CNS depressants, marijuana suppresses the immune system. Chronic marijuana use decreases the male hormone testosterone (as does alcohol) and adversely affects sperm formation. However, no effect on male fertility or sexual potency has been noted. Female hormones are also reduced, and impairment in ovulation has been reported.
Marijuana may be medically useful in reducing nausea and vomiting from chemotherapy, stimulating appetite in AIDS and other wasting-syndrome patients, treating spasticity and nocturnal spasms complicating multiple sclerosis and spinal cord injury, controlling seizures, and managing neuropathic pain. However, further clinical studies are necessary to reach conclusions on the value of marijuana in medical treatment.
For an objective review of the literature on all aspects of marijuana, we recommend Cannabis Use and Dependence: Public Health and Public Policy by Hall and Pacula (2003).
Overdose is unusual because the normal effects of marijuana are not enhanced by large doses. Intensification of emotional responses and mild hallucinations can occur, and the user may feel “out of control.” As with hallucinogens, many reports of overdose are panic reactions to the normal effects of the drug. In individuals with preexisting mental disorders (e.g., schizophrenia), high doses of marijuana may exacerbate symptoms such as delusions, hallucinations, disorientation, and depersonalization.
Tolerance is a controversial area with regard to marijuana. Tolerance does rapidly occur in animals but only with frequent use of high doses in humans (Hanson, Venturelli, & Fleckenstein, 2006). At the least, chronic users probably become accustomed to the effects of the drug and are experienced in administering the proper dosage to produce the desired effects.
A withdrawal syndrome can be observed in chronic, high-dosage users who abruptly discontinue their use. The symptoms include irritability, restlessness, decreased appetite, insomnia, tremor, chills, and increased body temperature. The symptoms usually last three to five days.
Inhalants and Volatile Hydrocarbons
Inhalants and volatile hydrocarbons consist largely of chemicals that can be legally purchased and that are normally used for non-recreational purposes. In addition, this classification includes some drugs that are used legally for medical purposes. As psychoactive drugs, most of these substances are used mainly by young people, particularly in low socioeconomic areas. Since most of these chemicals are accessible in homes and are readily available for purchase, they are easily used as psychoactive drugs by young people who are beginning drug experimentation and by individuals who are unable to purchase other mind-altering substances due to finances or availability.
The industrial solvents and aerosol sprays that are used for psychoactive purposes include gasoline, kerosene, chloroform, airplane glue, lacquer thinner, acetone, nail polish remover, model cement, lighter fluid, carbon tetrachloride, fluoride-based sprays, and metallic paints. Volatile nitrites are amyl nitrite (poppers), butyl and isobutyl (locker room, rush, bolt, quick silver, zoom). Amyl nitrite has typically been used in the gay community. In addition, nitrous oxide (laughing gas), a substance used by dentists, is also included in this classification.
As the name of this classification implies, these drugs are inhaled, a method of administration referred to as “huffing” or sniffing. The industrial solvents and aerosol sprays are often poured or sprayed on a rag and put in a plastic bag. The individual then places his or her head in the plastic bag and inhales rapidly and deeply.
Major Acute and Chronic Effects
The solvents and sprays reduce inhibition and produce euphoria, dizziness, slurred speech, an unsteady gait, and drowsiness. Nystagmus (constant involuntary movements of the eyes) may be noted. The nitrites alter consciousness and enhance sexual pleasure. The user may experience giddiness, headaches, and dizziness. Nitrous oxide produces giddiness, a buzzing or ringing in the ears, and a sense that the user is about to pass out.
The most critical acute effect of inhalants is a result of the method of administration, which can result in loss of consciousness, coma, or death from lack of oxygen. Respiratory arrest, cardiac arrhythmia, or asphyxiation may occur. Many of these substances are highly toxic, and chronic use may cause damage to the liver, kidneys, brain, and lungs.
Overdose of these substances may produce hallucinations, muscle spasms, headaches, dizziness, loss of balance, irregular heartbeat, and coma from lack of oxygen.
Tolerance does develop to nitrous oxide but does not seem to develop to the other inhalants.
There does not appear to be a withdrawal syndrome associated with these substances.
Anabolic steroids are synthetic drugs that are illicitly used to improve athletic performance and increase muscle mass. These drugs resemble the male sex hormone, testosterone. Although some anabolic steroids are approved for use in the United States for medical purposes, the abuse of these drugs led Congress to pass the Anabolic Steroids Act of 1990. This law regulated the distribution and sale of anabolic steroids and added these drugs to Schedule III of the Controlled Substances Act. In 2010, 1.5% of high school seniors reported steroid use in the previous year (Johnston et al., 2010).
Anabolic steroids approved in the United States include Depo-Testosterone, Durabolin, Danocrine, and Halotestin. Some veterinary anabolic steroids are illicitly sold for human use and include Finiject 30, Equipoise, and Winstrol. Delatestryl, Testex, and Maxibolan are sold legally only outside of the United States.
Anabolic steroids are taken orally or injected. “Stacking” refers to combining oral and injectable steroids.
Major Acute and Chronic Effects
Anabolic steroids are used medically for testosterone replacement and treatment of muscle loss, blood anemia, and endometriosis. However, the abuse of these drugs by athletes and by those who wish to improve their physical appearance is prompted by the effects of anabolic steroids on muscle strength, body mass, and personality. These drugs increase muscle strength, reduce body mass, and increase aggressiveness, competitiveness, and combativeness.
For males, atrophy of testicles, impaired production of sperm, infertility, early baldness, acne, and enlargement of the breasts occurs. In females, there are masculinizing effects including increased facial and body hair, lowered voice, and irregularity or cessation of menses. There is an increased risk of coronary artery disease due to reduced “good” cholesterol (HDL) and increased “bad” cholesterol (LDL). An association has also been established between oral anabolic steroids and jaundice and liver tumors. Mood swings, with periods of unreasonable and uncontrolled anger and violence, have been noted.
When used illicitly to improve athletic performance or physical appearance, the dosage is well beyond the therapeutic dose. Although there is no immediate danger of death or serious medical problems from high dosage levels of anabolic steroids, there are serious complications from long-term use (see Major Acute and Chronic Effects).
No evidence of tolerance to anabolic steroids exists.
Physical and psychological dependence on anabolic steroids does occur, and there is a withdrawal syndrome. The symptoms of withdrawal include depression, fatigue, restlessness, insomnia, loss of appetite, and decreased interest in sex.
Rather than sharing pharmacological similarities, the drugs that will be discussed in this section are grouped together because of the environment in which they are commonly used. The use of these drugs is primarily by youth and young adults associated with dance clubs, bars, and all-night dance parties (“raves”).
It would not make sense to discuss the common characteristics of overdose, tolerance, withdrawal, and acute and chronic effects since the drugs are not related pharmacologically. However, we felt that it was important to reference these drugs as a separate class because of the wide media coverage of club drugs. We will refer to the most appropriate pharmacological classification for each drug, and you can refer to the characteristics in the designated section.
Rohypnol (roofies) is a benzodiazepine (CNS depressant) that is illegal in the United States, but widely prescribed in Europe as a sleeping pill. When used in combination with alcohol, Rohypnol produces disinhibition and amnesia. Rohypnol has become known as the “date rape” drug because of reported instances in which women have been unknowingly given the drug while drinking. When women are sexually assaulted, they cannot easily remember the events surrounding the incident.
MDMA (ecstasy) has the properties of the CNS stimulants and hallucinogens. It is taken in tablet form primarily, but can also be found in powder and liquid forms. It is relatively inexpensive ($10 to $20 per pill) and long lasting. Ecstasy is primarily used by youth and college-age adults. The euphoric effects include rushes of exhilaration and the sensation of understanding and accepting others. Some people experience nausea, and depression may be experienced following use. Deaths have been reported from ecstasy use primarily as a result of severe dehydration from dancing for long periods of time without drinking water. Ecstasy can be used compulsively and become psychologically addictive.
Ketamine (K or special K) is generally considered to be a hallucinogen. It is used as a veterinary anesthetic and is usually cooked into a white powder from its liquid form and snorted. The euphoric effect of ketamine involves dissociative anesthetics or separating perception from sensation. Users report feeling “floaty” or outside their body. Higher doses expand this experience. They may have some numbness in extremities. Ketamine is very dangerous in combination with depressants, since higher doses depress respiration and breathing. Frequent use may lead to mental disorders due to the hallucinogenic properties of the drug. Psychological dependence also occurs in frequent users.
GHB (gamma hydroxybutyrate) is actually a synthetic steroid originally sold over the counter in health food stores as a body-building aid. GHB is usually sold as an odorless liquid that has a slight salty taste. The effects are similar to CNS depressants, with low doses resulting in euphoria, relaxation, and happiness. However, higher doses can cause dizziness, drowsiness, vomiting, muscle spasms, and loss of consciousness. Overdoses can result in coma or death, as can mixing GHB with other CNS depressants such as alcohol. Physical dependence can occur.
Other drugs, such as LSD, PCP, mescaline, and marijuana are sometimes classified as club drugs. However, since these drugs have a wider use, we have discussed them in other drug classifications.
Drugs Used in the Treatment of Mental Disorders
Mental health professionals will work with clients who are taking a variety of legally prescribed drugs to treat many mental disorders. These drugs generally have little or no euphoric effects and, therefore, are not used for recreational purposes. However, it is certainly important for helping professionals to have some familiarity with the uses and effects of these drugs.
Drugs Used in the Treatment of Psychotic Disorders
Antipsychotic or neuroleptic drugs are used in the treatment of schizophrenia and other psychotic disorders. These major tranquilizers produce psychomotor slowing, emotional quieting, and an indifference to external stimuli. Although these drugs are called “tranquilizers,” the effects are not euphoric or pleasant. Therefore, they are not drugs of abuse. The phenothiazines (Thorazine, Stelazine, Prolixin, Mellaril) and nonphenothiazines (Navane, Haldol) control agitation and hallucinations. Disturbed thinking and behavior is reduced. These effects have allowed many schizophrenic individuals to live in noninstitutional settings and to function more effectively. However, if the drugs are discontinued, the psychotic symptoms reappear. The drugs do not produce tolerance or physical or psychological dependence. Acute side effects include a dry mouth and Parkinson-like symptoms such as disordered motor movements, slow motor movements, and underactivity. Chronic effects include repetitive, involuntary movements of the mouth and tongue, trunk, and extremities. Massive overdoses are usually not lethal.
A new generation of antipsychotics is now on the market. These drugs include Risperdal, Zyprexa, Clozaril, Seroquel, and Zeldox. They have fewer side effects than the earlier drugs.
Drugs Used in the Treatment of Affective Disorders
Antidepressant drugs elevate mood, increase physical activity, improve appetite, reduce insomnia, and reduce suicidal ideation in most depressed clients. They are used for the treatment of acute and chronic depression. There are three types of antidepressant drugs. The MAO (monoamine oxidase) inhibitors (Nardil, Parnate) are used infrequently today because these drugs can raise blood pressure if foods with tyramine (cheeses, herring, Chianti wine) are consumed. The tricyclics (Tofranil, Elavil, Sinequan) were widely used as antidepressants until the development of the “second generation” antidepressants (Prozac, Luvox, Paxil, Zoloft). These drugs, although no more effective than the tricyclics, have a more rapid onset of effect and fewer adverse side effects. The tricyclics may take two to three weeks to produce the desired effects, while the newer drugs take about one week. This time difference can be critical with depressed clients. The tricyclics can produce cardiac problems and potentiate the effects of alcohol. Lethal overdoses are also possible. The media has widely publicized claims that Prozac has caused homicidal or suicidal behavior, but no cause-and-effect relationship has been scientifically established. However, these drugs have warnings for adolescents as there has been an established relationship between the use of antidepressants and the risk of suicidality in youth (Hammad, Laughren, & Racoosin, 2006). Second-generation antidepressants have also been used in the treatment of obsessive-compulsive disorder and panic disorders.
Lithium is used in the treatment of bipolar disorder. It is an antimanic, rather than an anti-depressant, drug. Clients who take lithium must be closely monitored, since high concentrations can cause muscle rigidity, coma, and death.
The treatment of panic attacks has included antianxiety agents (benzodiazepines) that were discussed in the Central Nervous System Depressants section of this chapter (Librium, Valium, Xanax, Ativan). However, these drugs are dependence producing and are abused. Nonbenzodiazepines that are used to treat panic disorders but are noneuphoric include Atarax, Buspar, and many antidepressants.
Drugs Used in the Treatment of Attention Deficit Disorder
There has been a great deal of attention directed toward children and adults who have attention deficit disorder. This condition may exist with or without hyperactivity and is characterized by distractibility, inability to concentrate, short attention span, and impulsivity. It has been found that Ritalin, Cylert, and amphetamines (e.g., Adderall) reduce many of these symptoms. Ritalin and amphetamines have a rapid onset of effect and a short duration, although these drugs now can be purchased in time-release form so they can be taken once a day. Cylert is longer acting but also takes longer to work. These drugs are CNS stimulants and can be abused. The use of stimulants to control the symptoms of attention deficit disorder has always seemed paradoxical. However, it may be that this disorder is due to unfocused electrical activity in the brain, and the stimulant drugs may improve the ability of the individual to concentrate and focus. Rather than calming the person down, the affected client is simply better able to focus his or her energy, concentrate, and reduce attention to extraneous stimuli. This may also reduce the anxiety that often accompanies attention deficit disorder.
Since these drugs are CNS stimulants, there are the associated side effects of appetite suppression, sleep disruption, and growth disturbance when these drugs are continuously used by preadoles-cents. A small number of individuals experience lethargy and emotional blunting. If these symptoms occur, the physician should immediately be contacted to adjust the dose or to prescribe a different drug.
A newer drug to treat attention deficit disorder is atomoxetine, marketed as Strattera. This is a nonstimulant drug that does not seem to have abuse potential. This makes the drug desirable for adolescents who may abuse drugs like Ritalin, Cylert, or Adderall. Strattera takes longer to work than drugs such as Ritalin, where the effect is very rapid.
It should also be mentioned that these drugs should not be prescribed to control unruly behavior in children. Attention deficit disorder should be diagnosed only after a careful multidisciplinary assessment. The best protocol to evaluate the efficacy of medication is a double-blind procedure in which neither the school nor parent is aware when a placebo or active drug has been taken. Behavior should be observed at school and at home, and the case manager can then determine whether medication will be helpful.
There has been speculation that children with attention deficit-hyperactivity disorder (ADHD) who are treated with stimulant drugs would be more likely to develop problems with alcohol or other drugs later in life. However, in a meta-analysis of studies, Wilens, Faraone, Biederman, and Gunawardene (2003) found that ADHD children treated with stimulant drugs are less likely to develop substance abuse problems later in life than ADHD children who do not take medication.
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· Find learning outcomes for The Major Substances of Abuse and the Body along with the national standards that connect to these outcomes.
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· Connect to videos through the Video and Resource Library.
· The federal Controlled Substances Act classifies drugs into five schedules based on the addictive potential and medical uses of the drug.
· Psychoactive drugs mimic natural, pleasurable behaviors by stimulating neurotransmitters in the reward center of the brain.
· The classifications of drugs include central nervous system depressants (alcohol, minor tranquilizers), central nervous system stimulants (cocaine, methamphetamine), opi-oids (heroin, pain pills), hallucinogens (LSD, magic mushrooms), cannabinols (marijuana), inhalants and volatile hydrocarbons, anabolic steroids, and club drugs (ecstasy).
· Drugs are used to treat various mental disorders such as psychotic disorders, affective disorders (depression, anxiety), and attention deficit-hyperactivity disorder.
· Abadinsky, H. (2008). Drug abuse: An introduction (7th ed.). Chicago: Nelson-Hall.
· Hanson, G., Venturelli, P. J., & Fleckenstein, A. E. (2008). Drugs and society (10th ed.). Boston: Jones and Bartlett.
· Inaba, D. S., & Cohen, W. E. (2007). Uppers, downers, all arounders: Physical and mental effects of psycho-active drugs (6th ed.). Ashland, OR: Cinemed.
· Inciardi, J. A., & McElrath, K. (eds.) (2007). The American drug scene: An anthology (5th ed.). Los Angeles: Roxbury.
· Julien, R. M., Advokat, C. D., & Comaty, J. E. (2011). A primer of drug action: A comprehensive guide to the actions, uses, and side effects of psychoactive drugs (11th ed.). New York: Worth.
· Maisto, S. A., Galizio, M., & Connors, G. J. (2008). Drug use and abuse (6th ed.). Belmont, CA: Wadsworth.
Comprehensive Drug Abuse Prevention and Control Act
Facts about specific drugs
Science of addiction
drugabuse.gov/scienceofaddiction/
National Household Survey on Drug Use and Health
Monitoring the Future
monitoringthefuture.org/index.html
1. Review the three case examples at the beginning of the chapter. From the information provided, what drugs or drug classifications do you think each person is struggling with?
2. Do you agree with the classification of marijuana as a Schedule I drug? Why or why not?
3. Compare the monthly rate of use of alcohol for minors to the monthly rate of use of illicit drugs for 8th, 10th, and 12th graders (from the Monitoring the Future website). What conclusions do you reach and what are the implications?
4. Which classification of drugs is the most dangerous in your opinion? What are the public policy implications of your view?
Substance Abuse. Information for School Counselors, Social Workers, Therapists, and Counselors, Fifth Edition
Chapter 2: Classification of Drugs
ISBN: 9780132613248 Authors: Gary L. Fisher, Thomas C. Harrison
Copyright © Pearson Education (2013)