Drugs of Abuse
Any drug that distorts the operations of the central nervous system (CNS) is considered a psychoactive drug. Each of these drugs has the capacity to enter the bloodstream, circulate throughout the body and cross the blood brain barrier, altering the function of the CNS. Because they also alter mood and perception, psychoactive drugs can become drugs of abuse. (Read more about all drugs of abuse, click here...)

Alcohol
Alcohol is probably the oldest of the abused drugs. It is used throughout most of the world and continues to be legal in most countries. There are the well-documented diseases related to alcoholism, such as cirrhosis, pancreatitis and cardiomyopathy. (To read more about alcohol, click here...)

Marijuana
Cannabis has been in use for many centuries. The widespread use in the United States is a phenomenon of the last third of the 20th century. The negative impact of this drug has been underestimated by most users, but research and anecdotal experience are showing a dangerous underbelly to this "harmless" drug. (more about marijuana, click here...)

Stimulants
Stimulants include cocaine, amphetamines, nicotine and caffeine - all of which stimulate activity of the central nervous system. The effects - more energy, increased confidence, decreased appetite and pursuant weight loss - are sought in our society. Stimulants can make the user feel that instincts - such as the need to eat or sleep - have been satisfied. (more about stimulants, click here...)

Opiates
The narcotic analgesic drugs are our great pain relievers. Some of these drugs - opium, morphine and codeine - are derived directly from the opium poppy. Some are synthesized, such as heroin, Percodan, methadone, Dilaudid, Demerol and Darvon. Opiates are currently our most effective pain control drugs but have huge potential for addiction. (To read more about opiates, click here...)

Prescription Drugs
Prescription drugs are a great help to society. Drugs such as barbiturates, benzodiazepines, opiates, diet pills and even some antihistamines serve important medical functions, but are mood altering and carry a risk for addiction - sometimes even when used according to physicians' directions. (To read more about some of the prescription drugs of abuse, click here...)

Please also see our Links page to read extensively about specific drugs. If at any time you would like to speak with us, please contact us. We are available seven days a week, 24 hours a day.

DRUGS OF ABUSE

Any drug that distorts the operations of the central nervous system (CNS) is considered a psychoactive drug. Each of these drugs has the capacity to enter the bloodstream, circulate throughout the body and cross the blood brain barrier, altering the function of the CNS. Many psychoactive drugs become drugs of abuse.

Psychoactive drugs are not new. They have been used as a shortcut to altered consciousness for much of the history of human beings. The use of drugs such as alcohol, opiates, marijuana, psychedelic mushrooms, cocaine, tobacco and other mood altering drugs have been documented for centuries in most human societies. Why? Because they work! They seem to take care of problems and they allow us to have experiences that may not be so accessible without drugs. We realized early in our history that drugs could be used...

...as medicines. Some drugs work wonderfully well for pain control, sedation and anxiety relief. Others control diarrhea and cramps or take care of other symptoms of disease. Sometimes they even cure disease.

...as a mechanism for inducing pleasure, even euphoria.

...as an access to religious experiences - for sacred ceremonies and rituals, or to create visions There are numerous reasons for humans to seek drugs. Drugs have all kinds of effects; some desirable, some not.

Desired Effects

• Euphoria
• Self-Medication
• Pain Relief
• Anxiety control
• Confidence
• Energy
• Competitive edge
• Peer acceptance
• Social grease
• Boredom relief
• Spirituality
• To solve life problems
• Escape
• Oblivion

We usually call those effects that we do not want "side effects." One of the earmarks of addiction is to tolerate increasingly serious side effects in the search for the desired effects.

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DRUG Classification

Methods of drug classification vary, since there is overlap among drug effects and a variety of reasons for classifying them. The Federal Drug Enforcement Agency (FDEA), for instance, classifies drugs on "schedules," determined by their perceived potential for abuse and illegal activity. On FDEA schedules, marijuana and heroin are listed together as Schedule I drugs, though their actions on the body are quite dissimilar. Other classifications group drugs according to their chemical makeup and their effects on the body.

For our purposes, the categories of drugs we are concerned about are those which cause intoxication, create dependence and can be self-administered. We will borrow and summarize a particularly useful, practical classification system offered by Inaba, Cohen and Holstein in their text, Uppers, Downers, All Arounders (4th. Edition, 2004) which offers a clear overview of abused drugs and their effects.

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"Uppers" (CNS Stimulants)

Uppers include cocaine, amphetamines, nicotine and caffeine - all of which stimulate activity of the CNS. In some ways, uppers seem to be the "All-American" drugs. The effects - more energy, increased confidence, decreased appetite and pursuant weight loss - are sought in our society. We have great respect for energetic, confident, thin people. Stimulant drugs seem to help us toward this ideal. One of the effects of stimulants is that we feel an instinct has already been satisfied. Because the brain's reward and pleasure mechanisms are disrupted, we may not experience the need to eat, or perhaps to sleep on these drugs. These are the general effects of uppers:

Uppers: Effects

• Borrowed energy
• Energized muscles
• Pleasure center stimulation
• Decreased appetite
• Weight loss
• Confidence
• Decreased need for sleep
• Blood vessels constrict
• Heart rate
• Respiratory rate
• Blood pressure

Most of these effects look attractive, but naturally, there is a down side. The down side may go far down during withdrawal, when the euphoric and energizing effects of the supper drugs are replaced with lethargy and depression.

Uppers: Problems

• Overstimulations of the CNS
• Increased risk of heart attack, stroke
• Anxiety
• Paranoia
• Mental Confusion
• Exhaustion
• Depression
• The Crash
• Seizures
• Overdose
• HIV/AIDS
• Violent death

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Cocaine

Cocaine is derived from the coca plant and its use by natives of South America goes back many centuries. It was used for ritual and religious purposes as well as to promote energy and to allay hunger. South Americans chewed the leaves of the plant, which delivered a far less potent form of the drug than the methods of delivery in use today.

In this country, we have used cocaine both for medicinal and recreational purposes. An ingredient in patent medicines and tonics sold in the late 19th century and even in early CocaCola, cocaine was used for its uplifting and energizing effects. Doctors prescribed it for depression and fatigue. In all its forms, it has been a well-publicized problem in the United States. There was an epidemic of cocaine use in the 1980's. Since the development of smokable forms of cocaine, such as "freebase" and "crack," cocaine use has been increasingly associated with violent crime. Cocaine does have legitimate medical uses, including topical anesthesia, but most use of this highly addictive drug in the 20th century has been related to illegal activity. It is snorted, smoked and sometimes injected.

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Amphetamines

Amphetamines are synthetic stimulants, including prescription drugs and a variety of illegal drugs, including methamphetamine (often called "speed" or "crank.") Drugs such as Dexedrine, Dexamyl and Benzedrine were widely prescribed for weight loss in the 1950's and 60's and have been used medically to treat narcolepsy and depression. The clear dangers of addiction and the diversion of these drugs for illegal purposes were recognized in the late 60's and early 70's. Doctors curtailed much use of amphetamines. The federal government also took action against the prescription use of these drugs.

Various forms of illegal "speed," often snorted, smoked or injected, have been very popular. When asked about the difference between cocaine and amphetamine, one addict explained that, "Speed's a better buy!" (His answer referred to the comparatively lower cost and longer action for amphetamines.) The negative effects, including paranoia, tend to hang on longer than with cocaine.

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Amphetamine-like drugs

Other diet pills have been developed with the intention of creating a safer alternative, but, despite the modified effects, there continue to be problems similar to those experienced with amphetamines. One very popular combination, referred to as Fen-Phen (Fenflyueramine and phentermin lonamin, has recently been associated with heart problems and deaths, so its use has been discontinued. Ritalin (Methylphenidate) is another amphetamine-like drug, which has been used to treat attention deficit hyperactivity disorder and narcolepsy.

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Nicotine

Nicotine is the currently the deadliest drug of all. Quickly and thoroughly addicting, this legal, highly available drug is responsible for more deaths in the United States and worldwide than any other drug. The World Health Organization estimates that there are currently 3.5 million death a year from tobacco, a figure expected to rise to about 10 million by 2030 (WHO, 1999). Nicotine use is declining in this country, but there are disturbing trends worldwide. "Long, relentless public health awareness campaigns in the U.S., Britain and other western countries have finally shown some results, with the number of smokers dropping steadily at about 1% per year. To make up for this, and to pay the enormous costs of the recent settlements, tobacco companies have had to turn elsewhere for sales. They seem to be successful, sales worldwide are up 2%!" (The Web of Addictions, 1996).

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Caffeine

Caffeine, widely used as a stimulant, is a natural substance that is present in the leaves, seeds or fruits of more than 60 plant species. It is readily available in coffee, tea, soft drinks and over-the-counter pills such as No Doz and Excedrine Migraine. Americans use caffeine regularly with little consideration of the drug effect. While a mild and relatively safe stimulant, when compared to amphetamines or cocaine, there are still problems associated with excessive caffeine intake. "Excessive intake" is considered to be more than five or six cups per day. Sleep disturbances, withdrawal syndrome (headache, depression, fatigue) and panic attacks are the problems most clearly related to excessive use. While research has been done in efforts to understand the health risks of caffeine, results have not been conclusive in finding links between caffeine use and serious illness.

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"Downers" (CNS Depressants)

These are the drugs which slow the functioning of the CNS and tend to slow the body and mind. They include alcohol, opiates, barbiturates, benzodiazepines and antihistamines. The effects of downers can be very pleasurable. In fact, it has been said of heroin, "It's too good to try even once."

Downers: Effects

• CNS function
• Sedation
• Pain control
• Anxiety relief
• Muscle relaxation
• Sleepiness
• Increased pleasure
• Dulling of the senses
• Heart Rate
• Respiratory rate
• Energy
• Inhibitions

The problems associated with downer drugs are significant. The problems increase with illegal use, of course, but even medicinal downers, used on doctors' orders, have potential for creating problems.

Downers: Problems

• Depression
• Failure to respond to pain
• Respiratory depression
• Muscle wasting, coordination problems
• Constipation
• Dry, itchy skin
• Addiction and withdrawal
• Neonatal effects
• Adulteration
• Contamination of needles
• Illegal activities
• Blackouts
• Accidents
• Overdose, suicide

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Alcohol

Alcohol is probably the oldest of the abused drugs. It is used throughout most of the world and continues to be legal in most countries. While nicotine is currently the most lethal, alcohol continues to do terrible damage to individuals, families and society.

There are the well-documented diseases related to alcoholism, such as cirrhosis, pancreatitis and cardiomyopathy. However, the damage is not only related to addiction. There can be serious problems with alcohol abuse. Even low dose use during pregnancy or in the presence of disease can cause great damage. Statistics on the relationship of alcohol to accidents, suicides, homicides and domestic violence are simply astounding.

About two-thirds of men and women in this country are drinkers at some point in their lives. Today, many of them start young. Estimates are that about half of high school students and three-quarters of college students have had at least one drink in the last month. Many have drunk heavily.

Of those who use alcohol, about 10% will develop a problem of some type - either abuse or addiction. That translates into millions of alcoholics and abusers in the United State (usually estimated at between 10 and 15 million). The percentage continues to be lower for women at this time, but women's problems with alcohol are on the rise.

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Sedative-hypnotics

These are the drugs used for anxiety and sleeplessness. Sedatives and hypnotics are currently the most prescribed psychoactive drugs.

Barbiturates, developed soon after the turn of the century, were the primary antianxiety drugs before the development of benzodiazepines in the 1940's and 1950's. Barbiturates are still used as sedatives, but with caution. Many deaths, intentional and accidental, have been associated with them. The therapeutic dose for barbiturates is so close to the lethal dose, that they represent a very dangerous class of drugs, especially when used with alcohol. Overdoses from the barbiturate and alcohol combination occurred so frequently among the famous that these overdoses became known as "Hollywood Death."

Barbiturates continue to have use as medicines: Seconal and Nembutol are prescribed to induce sleep; Phenobarbital is used to control seizures in epilepsy; and sodium pentothal is used as an anesthetic.

While barbiturates are still prescribed for anxiety, they have been largely replaced by benzodiazepines. Benzodiazepines such as Valium, Librium and Xanax have shown a greater degree of safety. The overdose potential is far less. However, these drugs have, unfortunately, been associated with addiction at relatively low levels of use. Further, users who become addicted may experience relatively severe withdrawal symptoms. Finally, despite the much safer ration of therapeutic to lethal dosage, overdose is still an issue, especially in mixture with alcohol because of the potentiating effect of the drugs when used together.

Other drugs used for sedation and sleep which are neither barbiturates nor benzodiazepines, but act similarly, include Quaalude, Doriden, Miltown, Soma and the drug that has become known as the "date rape drug," Royhypnol.

Antipsychotics, often called "major tranquilizers" are different chemically from the minor tranquilizers and are not often used for recreational purposes. Patients who must take these drugs tend to dislike them. Major tranquilizers, lithium and antidepressants are rarely seen as drugs of abuse.

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Opiates and Opioids

The narcotic analgesic drugs are the great pain relievers and pleasure inducers. They are also used for cough suppression and to reduce bowel motility. Some of these drugs - opium, morphine and codeine - are derived directly from the opium poppy. Some are synthesized, partially or completely, to approximate opiate effects. These include heroin, Percodan, methadone, Dilaudid, Demerol, Darvon and many others. At this time, opiates and opioids are our best sources of pain control in medical situations, but they have attendant problems, including a great potential for addiction.

Heroin addiction continues to be a serious problem in the United States. There is a current surge of heroin use among young people and the newspapers often report the deaths of young heroin addicts. Drug dealers have found a ready market for snortable heroin in small, relatively inexpensive packages. As with crack cocaine, this new packaging makes the drug very accessible to teens and those in their early twenties. Many teens assume that snorting the drug prevents the addiction potential. They are wrong about that. Many have become addicted without ever using the needle. Many others have progressed to needle use, further endangering themselves.

While addiction to heroin and other opiates is a terrible problem, our fear of opiate addiction has led to another type of drug abuse: undermedication of patients with serious pain. Often, terminally ill patients who could obtain merciful symptom relief through use of opiate drugs, have gotten too little medication, administered too infrequently to stop the pain. The hospice movement, with its keen attention to pain relief and palliative care, has helped encourage physicians and other health care professionals not to withhold needed, humane treatment in terminal illnesses.

This is also the case with some non-malignant chronic pain. The American Academy of Pain Medicine and the American Pain Society released a joint position statement in 1994 supporting the use of opioids for non-cancer chronic pain, stating that the development of new addictions is rare. The American Society of Addiction Medicine (1998) has more recently distinguished between the physical dependence that occurs with regular, therapeutic opioid use and addiction. There are guidelines for protecting sobriety when a recovering person needs pain relief.

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"All Arounders"

This category includes a diverse group of drugs with different chemical makeup and effects, including hallucinogens, cannabis, inhalants and steroids.

Hallucinogens

Psychedelic or hallucinogenic drugs, substances that distort perception, induce delusions or hallucinations, have been used for centuries. Naturally occurring hallucinogens include peyote and psilocybin mushrooms. Both of these have been used for religious ceremonies and rituals. Psychedelics entered a new era in the 1960's, however, when use of synthesized hallucinogens, such as LSD, became widespread.

The use of hallucinogens has continued since the sixties, with variable popularity. In recent years, the "designer drugs," such as MDA and MDMA ("ecstasy") have been associated with all night dance parties called "Raves." LSD, in lower dosage than used in the past is currently used by high schoolers, who find that it is less easily detected than alcohol. Teens sometimes call LSD "fry," presumably recognizing the brain effects.

Physical effects of hallucinogens vary with the drug and are usually less pronounced than mental effects. Hallucinogenic plants may cause dizziness, nausea and sometimes, vomiting. LSD raises the blood pressure, dilates the pupils and causes sweating. Hallucinogens tend to cause overstimulation and sleeplessness, so users often take some "downer" drug to get to sleep.

Hallucinogens distort messages to and from the brain. Physical stimuli may be intensified or misinterpreted. For example, the user may experience an illusion - seeing or hearing something real, but perceiving it quite differently. For instance, having taken mescaline, the user may perceive a domesticated cat as a larger, more threatening type of cat. Sometimes under the influence of hallucinogens, people will experience hallucinations, visual or auditory. They may also experience delusions.

Clearly, hallucinogens tend to impair reasoning and judgment and leave their users confused. For this reason, one of the serious consequences of hallucinogen use may be accidents. Long-term use may result in chronic difficulty with memory, attention span and abstract thinking.

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Cannabis (Marijuana, hashish, THC)

Cannabis has been in use for many centuries. The widespread use in the population of the United States, however, is a recent phenomenon. Marijuana is the most widely used controlled substance in the United States (Indiana Prevention Resource Center, 1998). According to the National Household Survey on Drug Abuse (1996), about 68.5 million Americans (32%) have tried marijuana at least once in their lifetimes and about 18 million had used within the last year. For younger people, those in their 20's and 30's, about 70% have had some experience with this drug. While still illegal, its recreational use seems to be accepted in our society, given the current statistics.

The negative impact of this drug has been underestimated by most users, who do not usually experience ill effects early in use. Even later on, when use may be heavy and on a daily basis, the effects are more subtle - not dramatic and obvious, as they might be with cocaine or alcohol. However, research and anecdotal experience are slowly showing a dangerous underbelly to this seemingly harmless drug.

Smokers enjoy the relaxing effects of marijuana and talk about feeling "laid back." They may enjoy an altered sense of time and find some boring tasks easier to endure. They often report a sense of being in touch with their emotions and may claim an aphrodisiac effect from the drug. Marijuana does seem to increase self-preoccupation and to impair short-term memory. Some of the physical effects are increased heart rate, dry mouth, bloodshot eyes and impaired coordination and reaction time.

Research on the long-term effects has not been conclusive, but has pointed to a variety of risks that long-term users may face. These include psychological damage, changes in the reproductive system, gynecomastia (abnormal breast enlargement in men,) impairment of the immune system, and without a doubt, damage to the pulmonary system. The tendency of regular, heavy smokers to become too "laid back," leaving them with little motivation to work or accomplish, has become known as "amotivational syndrome."

The risks to children and adolescents are compounded by the fact that marijuana use interferes with their learning and ultimately, with mastery of key developmental tasks. Of course, there are legal problems attached to the use and sale of this drug.

Is marijuana really addictive? Users have claimed that there is no physical withdrawal from this drug, but that is apparently not the case. The symptoms are more subtle, in part because marijuana is fat soluble, rather than water soluble, as alcohol is. This means that the primary active ingredient, tetrahydrocannabinol (THC), is released from the body more slowly. For that reason, drug withdrawal is protracted - perhaps even months for long-term users.

Marijuana Anonymous, a 12 Step program specific to this drug, is growing in the United States and abroad. In a pamphlet on detoxification from marijuana, a number of symptoms are listed which have been reported by MA members (Marijuana Anonymous 1992). Withdrawal symptoms reported anecdotally by MA members are:

• Insomnia
• Vivid dreams or nightmares
• Restlessness
• Irritability and anger
• Loss of appetite
• Night sweats
• Tremor
• Nausea, diarrhea

More research is being conducted that should help clarify some of the important questions about whether this drug has medicinal uses superior to other available prescription drugs and whether legalization makes sense.

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Inhalants

Inhalants are gaseous substances, which are inhaled and absorbed through the lungs. Some are anesthetics, such as ether or chloroform. Many Americans regularly use nitrous oxide ("laughing gas") in dentists' offices as a mild anesthesia and relaxant. Nitrous oxide has become a drug of abuse in recent years and has been associated with a number of deaths, particularly among young people.

Amyl nitrate, an inhalant used to treat angina, also has sexual stimulant qualities and has become a drug of abuse to enhance sexual pleasure, perhaps particularly among gay men. A variety of over-the-counter nitrate inhalants have been on the market and used for that purpose.

Other inhalants include glues, gasoline, metallic paints and a variety of household sprays. There are numerous chemical substances which can be inhaled for their mind-altering effect. Adolescents are particularly vulnerable because of the combination of ready availability and their poor understanding of the potentially serious side-effects.

Physical Effects vary with the drug, but one thing is clear: the effects come quickly - within 7-10 seconds. There is usually CNS depression and may be dizziness, slurred speech, lowered blood pressure, unsteady gait and drowsiness. There can also be impulsiveness, excitement, irritability and even hallucinations or delirium, depending on the drug. The effects can be grave. Inhalants can do permanent damage to many of the body systems - lungs, liver, kidney and of course, to the brain.

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Other drugs

There are other drugs which can be abused and may be seen in clinical practice. These include antihistamines, skeletal muscle relaxants, bromides, steroids and sports drugs. Clients sometimes present with addiction to over-the-counter medications, such as Robitussin, Nyquil, or other cough preparations.

It is important to understand the specific effects of the drugs used, particularly when safe withdrawal is a concern. However, we must remember that today, polydrug abuse is highly likely. No matter what the client's drug of choice, we will often find a history of using drug combinations or several drugs used in tandem over time. Sometimes the client cannot tell us all the drugs they have used because they do not know. Anyone who buys drugs illegally may be buying drugs which are adulterated or cut with other substances.

No matter what drugs are used, there is a constellation of problems which tend to show up again and again that indicates the presence of addiction. When addiction has taken hold, it is time for a new approach to these drugs - and abstinence seems to be the only safe approach.

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