Chapter 3 – Understanding Drug Addiction
The Definition of Drug Addiction
The definition of drug addiction comes from the same defining principles as alcoholism, also known as alcoholic addiction. Drug addiction can be defined as both a chronic and progressive disorder that is characterized by compulsive drug seeking and using, despite the adverse consequences that can result.
Chronic use and abuse of drugs, whether illicit in nature or prescribed, can cause long-term damage to both the user’s body and brain. Each class of substance comes with unique risks, and abuse can often be recognized by specific warning signs. Yet, it’s important to know there are specific characteristics a person exhibits when he or she is abusing substances or addicted.
The American Society of Medicine describes drug addiction using what is called the ABCDE Model:
- A—Inability to consistently abstain from using drugs, characterized by the persistent recurrence of relapse after periods of abstinence. There are also problems with both compulsivity and judgment.
- B—Impaired behavioral control, which is characterized by a frequent and excessive engagement in addictive behaviors and a focus narrowed on the obtaining and using of drugs. There are adverse impacts on work, school and relationships, yet, even if these adverse impacts are realized by the addict, they will do little or nothing to change behaviors.
- C—Craving, or an increased hunger for drugs and the rewarding experience that drug use brings to the brain and body.
- D—Diminished recognition of significant problems with behaviors and interpersonal relationships. Evaluations of one’s drug use is distorted, often rationalized as being productive and normal, and any problems related to addiction are attributed to other sources.
- E—Dysfunctional emotional response, which is marked by increased anxiety, emotional pain, and sensitivity to external triggers. Impairments are seen not only in the ability to identify one’s own emotions, but also in the dynamics of relationships with others.
Commonly Abused Drugs
There are many classes of drugs that are being used and abused by Americans and these drugs can be either illicit or prescribed by health professionals. Rather than list every drug in the myriad of categories they occupy, here is a breakdown of the commonly abused drugs that are being used in the United States.
Marijuana belongs to a family of substances called cannabinoids that are related to delta-9-tetrahydrocannabinol (THC), which is the main psychoactive ingredient. Marijuana refers to the dried leaves, flowers, stems and seeds from the Cannabis sativa plant which contains THC. Also part of the cannabinoid family is hashish, which is produced by collecting and compressing the most potent parts of the female cannabis plant.
Marijuana is usually smoked, either in hand-rolled cigarettes, pipes, or water pipes—also known as bongs. Another method that is used to smoke marijuana is through the use of blunts. Blunts are cigars that have been emptied of the tobacco and refilled with a mixture of marijuana and tobacco. Marijuana can also be used in food recipes and brewed as a tea.
When marijuana is smoked, THC is rapidly processed from the lungs and into the bloodstream, which transports the chemical to the brain. Whether marijuana is smoked, prepared in food, or brewed as a tea, THC specifically acts upon certain molecular targets on brain cells called cannabinoid receptors. Such receptors normally activate in the presence of chemicals that naturally occur in the body and are similar in makeup to THC, such as anandamide—a neurotransmitter known as “the bliss molecule” because of its positive effects on mood. These receptors are part of a neural communication network called the endocannabinoid system, which plays an important role in both brain development and functioning.
Cannabinoid receptors are concentrated in the parts of the brain which influence pleasure and memory, as well as sensory perception, coordinated movement, thinking, and concentration. Marijuana overstimulates the endocannabinoid system, causing altered perceptions and changes in mood, as well as impaired coordination, thinking, and decision making. Marijuana can also affect brain development, especially in young people who use the drug. The use of marijuana can also impact cardiopulmonary health, because marijuana smoke is an irritant to the lungs. Users may experience the same respiratory issues that are experienced by tobacco smokers, including chronic cough, increased risks of lung infections, and a greater frequency of chest illnesses.
Marijuana use can also affect mental health. For people with existing mental health issues such as anxiety, depression, or schizophrenia, marijuana use can worsen the symptoms associated with these disorders. While not all people who smoke marijuana will develop schizophrenia, people who are already at risk for developing this illness—including individuals with family relatives that have severe mental illness—will be more likely to experience psychosis if they are using marijuana.
In this population of individuals, people who regularly smoke marijuana are diagnosed with schizophrenia at a younger age, hospitalized more frequently for their illness, and are less likely to experience complete recovery even with high quality treatment. This is particularly concerning, as approximately one-third of people in America with schizophrenia regularly abuse marijuana.
The Effects of Marijuana Use on the Body and Brain
The effects of marijuana use can be seen physically, as well as physiologically and psychologically. As previously stated, the physical effects of marijuana use can include impairments in coordination and motor movements. Among the brain structures that marijuana effects are the cerebellum and basal ganglia. Marijuana’s effects on these regions can cause disturbances in walking, talking, and performing tasks like driving a vehicle.
The physiological effects of marijuana use can range from:
- rapid heart rate
- increased blood pressure
- elevated breathing rate
- red eyes
- dry mouth
- increased appetite
- slower reaction times
While the effects of the drug are reduced three to four hours after using, THC stays in the system for a much longer period—sometimes as long as a month. Lingering effects of marijuana use can still manifest for weeks after use.
Additionally, there are the psychological effects in connection with marijuana use. Along with increasing manifestations of both anxiety and depression, a user can experience paranoia. There are also impairments in short-term memory, and some users will engage in magical thinking, in which a person may believe her or she can bring about events by merely wishing for them to occur. Long-term marijuana users trying to quit report withdrawal symptoms including irritability, sleeplessness, decreased appetite, anxiety, and drug craving, all of which can make it difficult to abstain.
Cocaine belongs to the stimulant family of drugs and is derived from the leaves of the coca plant, which is native to South America. Cocaine is either inhaled through the nose, mixed with water and injected intravenously, or smoked when it is in crack cocaine form. Crack cocaine is a processed form of cocaine powder which transforms to a crystalline rock form. The crystal is heated to produce vapors that are absorbed into the bloodstream via the lungs.
The intensity and duration of the pleasurable effects of the drug depend on the route of administration. If cocaine is injected or smoked it produces a quicker and stronger high, but will be shorter lasting in comparison to snorting cocaine. The high from snorting cocaine may last between 15 to 30 minutes, while smoking or injecting the drug may last 5 to 10 minutes. Because there is such a short period between the time that the drug is taken and the time that its effects start to subside, cocaine users often take the drug repeatedly and frequently (known as binging) in an attempt to maintain the pleasurable effects of the high.
The Effects of Cocaine Use on the Body and Brain
Cocaine is a powerful stimulant that acts upon the central nervous system. When cocaine enters the bloodstream, the levels of the neurotransmitter dopamine spike in the brain circuits that regulate pleasure and movement—most notably the nucleus accumbens. The nucleus accumbens is the brain structure located in the limbic system, and it regulates both reward and pleasure sensations. In general, dopamine is released by neurons in brain circuits and structures like the nucleus accumbens in response to potential rewards, and then it is recycled back into the cells that released it.
With regular cocaine use, there is no recycling of dopamine and excessive amounts start to build up in the synapses. Therefore, the dopamine signal is magnified and there are disruptions in normal brain functioning. Additionally, repeated use can change the brain’s reward system, as well as other brain systems, and lead to more addictive behaviors.
In regards to other effects that cocaine has on the body, some of the effects seen include the following:
- Blood vessels constriction
- Dilated pupils
- Increase in body temperature
- Increase in blood pressure
- Gastrointestinal complications
- Decrease in appetite
In the most serious cases, those who use cocaine have a greater risk for suffering heart attacks or strokes. If cocaine is injected intravenously, there is a risk of contracting HIV, hepatitis, and other diseases from dirty needles. If cocaine is snorted frequently, it can lead to a loss in the sense of smell, nosebleeds, and difficulties in swallowing. If cocaine is ingested, it can lead to severe bowel gangrene, bring about severe allergic reactions, as well as bring on an increased risk of contracting hepatitis C, HIV, and other blood borne diseases.
Cocaine abuse also comes with a host of psychological effects, starting with general suspicion and paranoia. These symptoms are early indicators of psychosis developing, which can produce hallucinations and delusions. These effects are especially pronounced if a user is experiencing cocaine withdrawals. It also has been hypothesized that these psychological symptoms may produce violent behaviors. The neurotransmitter norepinephrine, released by cocaine, is also involved in “fight-or-flight” behavior. Individuals who use cocaine are often considered “hyper alert” and “armed to the outside world.” Any rapid or unexpected movement by those around them “may be interpreted as hostile.”
Cocaine abusers may also have problems thinking logically. The most frequently reported cognitive difficulties involve impaired executive functioning—decision making, judgment, attention, planning, and mental flexibility. Research has shown that this relates primarily to the functionality of the brain’s prefrontal lobe, which also regulates impulse control. The impulsivity experienced in the face of severe cocaine craving can lead to poor judgment and decisions.
Other Stimulant Drugs
In addition to cocaine, there are several other substances in the stimulant family of drugs, all of which are amphetamine-based: amphetamines, methamphetamine, and MDMA (also known as Ecstasy or Molly). Both amphetamines and methamphetamine can be administered orally, snorted, or injected intravenously. In the case of methamphetamine, it can also be smoked. Ecstasy (MDMA) is almost always taken in pill form. It can also be crushed into a powder and snorted, or ingested in liquid form.
Each of these drugs has specific properties, but stimulants generally have some characteristic effects:
- surges of energy
- feelings of euphoria
- extreme talkativeness
- feelings of restlessness
- elevated heart rate
- increased blood pressure
- enlarged pupils
Taken in larger doses, as well as over extended periods of time, people can become hostile, violent, and paranoid. A user may also experience fevers, sweating, headaches, blurred vision, dizziness, chest pain, nausea, vomiting, and diarrhea. Duration of these effects vary depending on the route of administration. For example, the effects of both methamphetamine and amphetamine can last 6 to 8 hours if injected or taken by mouth, and 10 to 12 hours if smoked.
Amphetamines were developed in the late nineteenth century, but were not used until the 1920s when medical professionals discovered their beneficial uses. Researchers at the time learned that the drug widened airways, and therefore could treat asthma, allergies, and colds. It was also discovered that amphetamines helped people stay awake and alert, and was even given to some soldiers during wars.
The drug eventually became available legally, purchased by housewives and other people who sought the increased energy and suppressed appetite that amphetamine produces. By the 1970s, restrictions on the drug were enforced and it is now only allowed in certain medicines. Today, a prescription containing amphetamines (such as Ritalin and Adderall) may be given to people with narcolepsy and ADHD.
Amphetamines are extremely addictive drugs and the body quickly builds up a tolerance to them. Withdrawal symptoms can also occur in regular users who suddenly stop taking the drug. Symptoms such as extreme fatigue, hunger, irritability, and depression can occur. Long-term use can lead to serious physical and mental health problems. One of the more common consequences of using amphetamines on a regular basis is called amphetamine psychosis, which consists of hallucinations, paranoia, and bizarre or violent behavior.
Methamphetamine was first developed in Japan in the late 1800s and was derived from an amphetamine called ephedrine. Methamphetamine was not widely used until World War II, when American, German and Japanese governments gave the drug to their military personnel to enhance performance. In addition to its usage on the war-front, it was also used by Japanese factory workers to work longer hours.
In comparison to other amphetamines, methamphetamine has longer lasting and more toxic effects. This is largely because of a group of compounds called the N-methyl group that differentiates methamphetamine from amphetamine. Methamphetamine is methylated and more water soluble, so it’s absorbed into the bloodstream quicker and it crosses the blood/brain barrier much easier.
Unique physical and psychological characteristics develop with chronic use of methamphetamine. Blood vessels begin to constrict, and, with increasing constriction, blood flow is gradually cut off throughout the body. Heavy usage can weaken and destroy these vessels, causing tissues to become prone to damage and inhibiting the body’s ability to repair itself.
This damage eventually becomes visible physically, manifesting in severe acne, the appearance of sores which take longer to heal, and the loss of skin’s elasticity. Some chronic users are covered in small sores and scabs, caused by obsessive skin-picking brought on by the hallucination of having bugs crawling beneath the skin—a disorder known as formication.
Constant tooth grinding and poor hygiene is also common among meth abusers, and can cause their teeth to rot. A condition known as “meth mouth” is a tell-tale characteristic, marked by the appearance of discolored, broken, and rotted teeth. This occurs because the chronic use of methamphetamine dries up the salivary glands, causing the mouth’s acids to build up and rot the teeth away.
MDMA, also known as Ecstasy or Molly, is a synthetic chemical made in labs. The compound is similar in structure to methamphetamine, as well as mescaline, which is a hallucinogen. Because of this, it acts as both a stimulant and a psychedelic, producing a surge in energy, distortions in time and perception, and enhanced enjoyment of tactile experiences. Users who take MDMA say they are “rolling.” Ecstasy is typically sold in the form of colorful tablets that can look like candy, but MDMA can also be found in powder and crystal form.
Ecstasy is often called a “party” or “club drug” because of its popularity at night clubs, music festivals, and concerts. It’s euphoric and surge of energy are known to lower users’ inhibitions, inspire them to dance, and heighten sexuality. Users report a general feeling of closeness, warmth, and empathy, earning the drug its reputation as a “love drug.” MDMA is often combined with a hallucinogen like LSD so a user can “candy flip.” This drug has even become more popular among working adults because of its reputation as a “love drug,” producing warm and empathic feelings.
Despite many of the positive feelings associated with MDMA, a user takes serious risks. MDMA severely dehydrates a user and elevates body temperature. Combined with a culture of clubbing, the drug can cause hyperthermia and lead to the damage of internal organs. The biggest risk is the lack of certainty concerning the potency and dosage of most Ecstasy tablets. Such tablets are often produced in underground black market laboratories, and the MDMA is almost always mixed with other, harmful drugs (i.e. meth, ketamine, cocaine, flakka). Some tablets and powders don’t even contain any MDMA.
With Ecstasy use, the brain releases a dramatic surge of serotonin and a slight surge of dopamine. Serotonin is a neurotransmitter which plays a crucial role in the regulation of sleep, mood, pain, and appetite. It has been suggested that damage to the serotonin receptors can result in long-lasting confusion, chronic depression, as well as deficits in learning and attention. For women who are pregnant—especially young women—MDMA use can cause damage to the fetus, especially in the brain areas that regulate learning and memory.
Ecstasy also has addiction potential, though not as high as other stimulants. The withdrawal symptoms are similar to cocaine and amphetamine use—confusion, anxiety, depression, strong cravings, sleep problems, and paranoia.
Heroin belongs to a family of drugs called narcotics. Narcotics are analgesics, also known as pain relievers, that work by binding to receptors in the brain and blocking sensations of pain. Heroin comes in the form of a white or brown powder, or a black, sticky goo called tar heroin. Heroin is derived from morphine, a natural substance which is found in the seedpod of the Asian poppy plant. Heroin can be mixed with water and injected with a needle, as well as smoked or snorted. Regardless of the means of administration, heroin is highly addictive.
Heroin was developed initially in an effort to replace the extremely addictive drug morphine, which was used widely in the 1800’s as a pain reliever. By the mid-19th century, morphine was commonly prescribed by doctors and touted as a “wonder drug”. However, the addictive side of the drug become more prevalent, and, during that time period, addiction to morphine could rival alcohol abuse. In 1874, German scientists developed heroin and it was imported to the United States shortly after its invention. At the time, heroin was marketed as a safe alternative to morphine.
The Effects of Heroin Use on the Body and Brain
The initial effects of heroin include a surge of intense sensation, which is often described as a rush, usually accompanied by a warm feeling on the skin and a dry mouth. Sometimes, a user’s initial reaction after the administration of heroin can include vomiting or severe itching. After these initial effects fade, the user becomes drowsy for several hours. The basic body functions, such as breathing and heartbeat, slow down. A user can also experience clouded mental functioning or hypothermia—a potentially dangerous drop in body temperature. If there is an overdose, a user may go into a coma or die. Especially with heroin, the danger of overdose is extremely real. Considering how common intravenous injection is among users, along with the fact that heroin is not regulated and can often be laced with other drugs, heroin overdose has become a serious national problem.
The intense high a user seeks lasts only a few minutes. Within hours after the drug’s effects have decreased, the addict’s body begins to crave more. With continued and chronic use, the heroin user needs increasing amounts of the heroin just to feel normal. If the user does not get another fix, they will begin to experience withdrawal symptoms. Withdrawal symptoms can include restlessness, aches and pains in the bones, diarrhea, vomiting and severe discomfort. In many users, especially with high frequency and dosage, medical detoxification is necessary to ensure the person’s safety.
For a long-term heroin user, frequent injections of the drug can cause their veins to collapse and, resulting in infections of the blood vessels and heart valves for some. Diseases such as tuberculosis, hepatitis C, and AIDS are seen in greater frequency with heroin addicts, typically from sharing needles. It is estimated that 35,000 new cases of hepatitis C2 infections are reported in the U.S. each year. Hepatitis C2 is responsible for the formation and progression of liver disease. Other long-term effects of heroin use include:
- Bad teeth
- Inflammation of the gums
- Cold sweats
- Weakening of the immune system
- Muscular weakness
- Possibility of partial paralysis
- Reduced sexual capacity and long-term impotence in men
- Menstrual disturbance in women
- Inability to achieve orgasm (both women and men)
- Loss of appetite
Prescription Narcotic Drugs
There are two distinct classes within the narcotic drug family: opiates and opioids. These terms are often seen as interchangeable but, while the effects of these drugs have a great amount of similarities, there are notable differences that need to be understood.
Opiates originate from naturally occurring alkaloids found in the immature seedpods of the opium poppy plant. The pain-killing properties of opiates are derived from these plant alkaloids. Heroin falls within the opiate class of narcotics, along with morphine, codeine and opium.
Another difference between opiates and opioids is in how the drugs interact with the body. Natural opiates, such as heroin and opium, activate opioid receptor sites and stimulate endorphin secretions. Opiates also have the highest potential for addiction. Some opioid drugs—such as oxycodone and hydrocodone—are called agonists because they activate cell receptors. Opioid drugs that block cell receptor sites are called antagonists, such as naloxone and naltrexone. Antagonists do not have any potential for abuse, because they are used to block the high of opioid agonists or reverse the effects of an opioid overdose.
Effects of Opiate and Opioid Use on the Brain and Body
Opiates are designed to resemble the naturally occurring chemicals in the brain, like endorphins, that have binding sites called opioid receptors. When the opioid receptors are activated, our body experiences a surge of pain relief and euphoria. There are three major areas that are affected by opiates:
- The brainstem, which controls functions like breathing and heartbeat:
- Opiates can affect the brainstem by slowing breathing or reducing coughing.
- The limbic system, which controls emotions:
- Opiates may act upon the limbic system to create feelings of pleasure or relaxation.
- The spinal cord, which sends messages from the brain to the rest of the body, and vice versa:
- In this part of the body, opiates work to reduce pain.
When opiates and opioids are taken for a considerable length of time, the body becomes desensitized to the drugs’ effects. With increased tolerance, the body needs more and more of the drug to achieve the same effect. With chronic use, anyone can become physically dependent upon an opiate or opioid and experience withdrawal if they abruptly stop taking the drug. However, physical dependence is different than addiction, which is the compulsive seeking and using of a drug despite the consequences. This physical dependence can still be very dangerous though, and increases the risk of accidental overdose.
Prolonged use of these drugs changes the way nerve receptors work in the brain, and these receptors become dependent upon the substance to function. Withdrawal symptoms are the body’s physical response to the absence of the drug. Withdrawal symptoms for opiates and opioids are similar to those of heroin withdrawal, both of which are safer through a medical detoxification process.
Central nervous system (CNS) depressants—also referred to as sedatives and tranquilizers—are used to treat anxiety and sleep disorders. These drugs slow down brain activity, which makes them useful for people with anxiety or insomnia. Most CNS depressants are prescribed medications that serve a specific purpose, but these drugs are also commonly abused.
There are three classes of CNS depressants: benzodiazepines, non-benzodiazepine sleep medications, and barbiturates.
- Often referred to as “benzos“
- Not prescribed for long-term use because of the risk for developing tolerance, dependence, or addiction
- Used in the treatment of anxiety, acute stress reactions, and panic attacks
- Valium (diazepam)
- Xanax (alprazolam)
- Prescribed for the short-term treatment of sleep disorders
- Halcion (triazolam)
- ProSom (estazolam)
Non-Benzodiazepine Sleep Medications
- Different chemical structure than benzodiazepines, but act upon the same brain receptors
- Thought to have fewer side effects and less risk of dependence than benzos
- Prescribed to people with insomnia and other sleep disorders
- Ambein (zolpidem)
- Lunesta (eszopiclone)
- Sonata (zalepon)
- Used less frequently to help with anxiety or sleep problems because of their higher risk of overdose
- Still used in surgical procedures, and in the treatment of seizure disorders
- Mebaral (mephobarbital)
Luminal Sodium (phenobarbital)
- Nembutal (pentobarbital sodium)
Effects of CNS Depressant Use on the Brain and Body
Each of the three types works in a unique way but, in general, CNS depressants affect the GABA neurotransmitter in the brain. These drugs have the ability to increase GABA levels, which inhibits brain activity and produces a drowsy, calming effect. When used as prescribed for people with anxiety or sleep disorders, the function of these drugs is extremely beneficial.
Despite their medical utility, CNS depressants have a high potential for abuse. Initially, when a person first takes a CNS depressant, there are a few days of drowsiness and lack of coordination while the body adjusts. As the body becomes accustomed to the drug’s effects and develops a tolerance, such side effects stop occurring. In a long-term user, much like with narcotics, larger doses are needed to achieve the drug’s therapeutic effects.
Physical dependence develops with continued use of CNS depressants, and a user will experience withdrawal if they abruptly stop taking the drug. Since CNS depressants are intended to slow down the brain’s activity, a chronic user’s brain is at risk for seizures or other harmful consequences if they stop taking the drug. Benzodiazepine withdrawal can be uncomfortable and problematic for a person’s health, but it is rarely life-threatening. Withdrawal from chronic use of barbiturates, on the other hand, can produce life-threatening complications. Anyone taking a CNS depressant, whether abusing it or taking it as prescribed, should consult with a doctor before they stop using it.
Because many people are poly-drug abusers, those who incorporate CNS depressants can face serious dangers if they use them with other drugs. Mixing CNS depressants with opiates, opioids, or alcohol is especially risky, because all of these substances depress the central nervous system and slow down the brain. In combination, these substances can affect a user’s heart rhythm, slow down breathing, and even lead to death.
Club drugs are often abused at bars, nightclubs, and parties by teenagers and young adults. There are many different club drugs, like MDMA, methamphetamine, and ketamine. But, two of the most popular—and most dangerous—club drugs fall within the CNS depressant class: GHB and Rohypnol.
Both GHB and Rohypnol are abused for their intoxicating effects, similar to other CNS depressants, but they each have unique effects. GHB acts on the GABA-B receptor and, if it is taken in high doses, the intense sedative effects may result in sleep, coma, or death. Rohypnol, on the other hand, acts on the GABA-A receptor and, if taken in high doses, can cause anterograde amnesia—loss of memory after an incident.
Because GHB and Rohypnol are both available in odorless, colorless, and tasteless forms, they are frequently combined with alcohol and other beverages. Both of these drugs have become well-known for their frequent use in sexual assaults (also known as “date rape,” “drug rape,” “acquaintance rape,” or “drug-assisted” assault). Because these CNS depressants can sedate and incapacitate unsuspecting victims, it preventing them from resisting sexual assault.
GHB (Gamma-Hydroxybutyric acid)
Also known as Xyrem, GHB was approved by the FDA in the early 2000s for the treatments of narcolepsy. However, its approval came with severe restrictions: it can only be used for the treatment of narcolepsy, and users are required to enter into a patient registry that is regularly monitored by the FDA.
GHB is usually sold as a liquid, or as a white powder that is dissolved in a liquid like water alcohol and packaged in small vials or bottles. It is clear and colorless with a slightly salty taste. In addition to its effects as a CNS depressant, it can also produce visual hallucinations and violent behavior. The drug also has anabolic effects (it stimulates protein synthesis), and has been used by bodybuilders to aid in fat reduction and muscle building.
High doses of GHB can cause unconsciousness, seizures, slowed heart rate and breathing, lower body temperature, nausea, vomiting, coma, and death. Chronic GHB use leads to withdrawal effects that include insomnia, anxiety, tremors, sweating and, in some cases, psychotic thoughts. If GHB is used in conjunction with other drugs, withdrawal reactions can be more severe. In general, when medical detoxification is utilized to wean someone off of GHB, it will take between 10 to 14 days to stabilize the individual.
Also known as Flunitrazapem, Rohypnol is a benzodiazepine with a similar chemical structure to Valium and Xanax. It is a powerful sedative that currently is not approved for any medical use in the United States. It is also considered a hypnotic and a muscle relaxant. Rohypnol is typically taken orally in pill form, which can be swallowed, crushed and snorted, or dissolved in liquid.
Formerly, Rohypnol was colorless, tasteless, and odorless when mixed into a drink. Because of concerns about the drug’s role in sexual assaults, Rohypnol is now manufactured as an oblong olive green tablet will dye light-colored drinks blue when dissolved. However, generic versions of thedrug may not contain the blue dye.
Since it is part of the benzodiazepine family of drugs, Rohypnol produces tolerance and physical dependence issues. This means a chronic user can also experience withdrawal from Rohypnol. Because the drug has no medical use, it’s mostly used for recreational purposes and often mixed with other drugs. Combined with other depressants like alcohol or heroin, Rohypnol can cause severe sedation, unconsciousness, slow heart rate, and suppression of respiration that may result in death.
Hallucinogens are a class of drugs that cause profound distortions in a person’s perception of reality. These drugs can be found in certain plants and mushrooms, or they can be man-made. Hallucinogens can fall into two broad categories: hallucinogens and dissociative drugs. Those who are under the influence experience rapid and intense emotional swings and report audio, visual or tactile hallucinations and other sensations that are perceived as real but are not.
The exact mechanisms by which these drugs work aren’t exactly known, but research has suggested that hallucinogens and dissociative drugs work by disrupting the communication between the neurotransmitter systems throughout the brain and spinal cord. These disruptions in communication impact mood, sensory perception, sleep, hunger and muscle control among other functions.
Examples of drugs in the classic hallucinogen family include the following:
- LSD is a clear or white, odorless, and water-soluble material synthesized from lysergic acid. It is produced initially in a crystalline form, which can then be used to produce tablets, thin squares of gelatin, or liquid. It is most often dosed onto sheets of blotter paper when sold for recreational use.
- Psilocybin, also known as magic mushrooms, is extracted from certain types of mushrooms that are found in tropical and subtropical regions of South America, Mexico, and the United States. Psilocybin comes in either dried or fresh forms, and it can eaten raw, mixed in with food, or brewed into tea.
- Mescaline, also known as peyote, is an intoxicating liquid extracted from a small, spineless cactus. It is known for its use in some religious ceremonies among native cultures in northern Mexico and the southwestern United States. Disc-shaped buttons are cut out from top of the peyote cactus, then chewed or soaked in water to produce liquid mescaline. Because the extract is so bitter, some users boil peyote cactus into tea instead.
- DMT (Dimethyltryptamine) is a powerful hallucinogen that occurs naturally in some Amazonian plant species, which are used to make a hallucinogenic brew called ayahuasca tea. Synthetic DMT is synthesized in a lab, usually in the form of a white, crystalline powder that users vaporize or smoke in a pipe. It’s gained popularity as “the spirit molecule,” because of a theory proposed in the 1990s that DMT is found in the human brain and is released in large quantities just moments before we die.
Examples of dissociative drugs include the following:
- PCP-PCP, or phencyclidine, was originally developed in the 1950’s as a general anesthetic and can be found in a variety of forms including tablets, capsules, powder or liquid. PCP can be smoked, snorted, injected, or swallowed, and it can also be mixed with marijuana or tobacco.
- Ketamine, or Special K, is currently used an as anesthetic on both humans and animals. It is manufactured as a liquid that is injectable, but it is also evaporated to a powder form that is either snorted or compressed into pill form. Most of the ketamine that is available for sale on the street has been taken from veterinary offices. Ketamine is odorless, tasteless, and has amnesia-inducing properties. It can create pronounced distortions in perception of sight and sound.
- DXM-DXM, or dextromethorphan, is a cough suppressant found in some over-the-counter cough medicines. The most- abused are typically extra-strength cough syrups, pills, or gel capsules with around 15 milligrams of DXM per dose.
- Salvia is a plant with psychoactive properties that is found most commonly is southern areas of Mexico, as well as South America. Salvia is most commonly consumed by chewing fresh leaves or drinking the juices that are extracted from the plant. The dried leaves can also be smoked, as well as vaporized and inhaled.
How Hallucinogens and Dissociative Drugs Affect the Body and Brain
As stated earlier, the precise mechanisms of how these drugs work is not fully understood. However, research has shown that classic hallucinogens act on the neural pathways of the brain that use serotonin. The most prominent effects are seen in the prefrontal cortex area which is the area involved in mood, cognition, and perception. These areas of the brain are also important in the regulation of arousal, as well as the physiological responses to both stress and panic.
- Hallucinations (audio, visual, tactile)
- Greater intensity in emotions and sensory experiences
- Mixing of the senses
- Altered perception of the senses and time
- Increased heart rate
The following symptoms are common after long-term use:
There is also a disorder called hallucinogen persisting perception disorder (HPPD) that can occur with prolonged use of hallucinogens. The common traits of this disorder are:
- Other visual disturbances, such as seeing spots, halos, or trails
- Symptoms that can be mistaken for other neurological disorders, such as stroke or brain tumor
Research suggests that dissociative drugs disrupt the actions of glutamate at certain types of receptors in the brain, known as the NMDA (N-methyl-D-aspartate) receptors. Glutamate plays an essential role in learning, memory, emotion, and the perception of pain. Salvia, on the other hand, acts upon a certain type of opioid receptor in the brain called the kappa opioid receptor, but it’s still considered a dissociative drug.
The short-term effects of dissociative drugs depend largely on the dosage taken. In the case of those who take dissociative drugs in low to moderate doses, the following effects are common:
- Loss of coordination
- Dizziness, nausea, and vomiting
- Feelings of detachment from both self and their environment
- Increases in blood pressure, heart rate, and body temperature
In higher doses, the following effects may be experienced:
- Memory loss
- Physical distress
- severe changes in blood pressure, respiration and body temperature
- Psychological distress
- panic, fear, anxiety, aggression, exaggerated strength
The longer an individual stays “high” on dissociative drugs, the greater the risk of brain damage. This is especially true with excessive use of ketamine, PCP, or DXM.
In particular, ketamine has caused long-term cognitive impairments, psychosis, and paranoia in chronic users. Users often experience cognitive and psychological symptoms similar to stimulant withdrawal, which makes ceasing use more difficult. If a person’s ketamine abuse resulted from a mental health issue, mood disorder, or behavioral problem, the co-occurring disorder may also prevent stopping without professional intervention.
Among dissociative drug abusers in general, there is an increased risk of experiencing seizures in the brain. These phenomena are especially pronounced if a user has a history of epilepsy, but can also be seen in people with normal brain functioning. Individuals who abuse dissociative drugs are also at a greater risk of developing psychosis and schizophrenia.
Synthetic drugs, also referred to as “designer drugs,” are chemically created in a lab to mimic the effects of another drug. However, synthetic drugs have a different effect on the brain and body than the drugs they seek to mimic. Many are created in illegal labs, making their ingredients and strength nearly impossible to know. Abuse of these new, unregulated drugs has often resulted in violent and unpredictable behavior. Like any psychoactive substance, synthetic drugs have the potential for abuse and addiction.
Synthetic marijuana is usually called Spice or K2, all of which are known as synthetic cannabinoids. These drugs are meant to mimic the effects of THC, the active compound in marijuana, and are often sold as “herbal incense” or “potpurri.” Spice or K2 can usually be bought at small convenience stores, gas stations, head shops, and even online.
Synthetic marijuana is essentially a chemical compound that comes in powder form. Before it’s packaged, the powder is dissolved in a solvent (like acetone) before it’s applied to the dry plant matter that is sold as “herbal incense.” Most users then smoke the plant material in many of the same ways as actual marijuana. There are also liquid cannabinoids now, which are typically vaporized in electronic cigarettes.
These substances have a host of adverse effects on a user:
- elevated heart rate and blood pressure
- numbness and tingling
Some users have even died of a heart attack. These substances are particularly dangerous because of the ease with which large-scale laboratories can develop new compounds and manufacture them. Though the DEA has worked to control many synthetic cannabinoids, there are so many more that have yet to be controlled by legislation and more are being created all of the time. Abuse of synthetic marijuana comes with countless additional risks because these new compounds have not been regulated and their effects are not well understood, especially in chronic users.
The name “bath salts” refers to synthetic cathinones—CNS stimulants that are designed to mimic the effects of stimulants like cocaine, methamphetamine, and MDMA. These substances are often marketed as “research chemicals” labeled “not for human consumption” in order to evade the law and disguise the true reason for the product’s existence. They are commonly sold on the Internet, as well as head shops, convenience stores, gas stations, and sex shops.
Many synthetic cathinones come in crystalline or powder form, while some are compressed into gelatin capsules. Users typically sniff or snort bath salts, but some also swallow, smoke, or inject them. They are sought out and abused because of the euphoria and alertness that they produce. Yet, this euphoria also comes with a host of undesired side-effects:
- rapid heartbeat
- hyperthermia (over-heating)
- breakdown of muscle fibers
- teeth grinding
- paranoia, hallucinations, and delusions
- acute psychosis
- agitation, aggression, and violence
- self-destructive behavior
One synthetic cathinone that is extremely popular in Florida and has caused significant concern is flakka. It was first developed in the 1960s using a chemical found in the khat plant, native to Ethiopia. With the chemical name alpha-PVP, flakka takes the form of a white or pink crystal with a foul smell. It can be eaten, snorted, injected, or vaporized in an e-cigarette. Vaporizing has proven to be particularly dangerous, sending the drug quickly into the blood stream and often causing overdose.
It is popular among users for the same reasons people have feared it’s spread across the country: flakka produces a state of “excited delirium,” which involves hyperstimulation, paranoia, and hallucinations that can lead to violent aggression and self-injury. In the thick of this delirium, some users have jumped from extremely high places, jumped through glass windows, and even scratched of large portions of their skin.
The drug has also been linked to deaths, either by suicide or heart attack. It can also dangerously raise body temperature and lead to kidney damage or kidney failure. In 2013, CBS News reported 126 flakka-related deaths in Florida. Authorities have tried to crack down on the sale and distribution of flakka, due to national concern that the deadly and toxic drug will spread throughout the rest of the country.
The DEA is constantly discovering new synthetic drugs and actively works to bring each new compound under the jurisdiction of the law. Considering the similarity of their effects with those of non-synthetic stimulants, these drugs have a high potential for abuse. Like synthetic marijuana, using these substances comes with some of the highest risks because their effects are hardly understood at all, especially in the brand new compounds that appear on the market all of the time.
Anabolic steroids are a synthetically-produced variant of a naturally-occurring male hormone, testosterone. These drugs also have a high potential for abuse, although not because of their psychoactive effects. Anabolic steroids are abused in an attempt to promote muscle growth, enhance athletic performance, and alter physical appearance. They are commonly referred to as “Juice,” “Roids,” and “Pumpers.”
While anabolic steroids do serve various therapeutic and medical purposes, they are only prescribed in rare and extreme cases. Steroid abusers are often competitive athletes and bodybuilders, but some people abuse them solely to modify their physical appearance. Many users purchase steroids on the Internet, or through local connections like gyms, bodybuilding competitions, and even school athletic trainers or coaches.
Some of the most frequently abused steroids are:
These steroids come in a variety of forms, which can be ingested orally, injected intramuscularly, or applied to the skin. The doses people abuse are often 10 to 100 times higher than any approved therapeutic and medical treatment dosages. Abusing high doses of anabolic steroids can cause serious mood and behavioral problems. Some people experience dramatic mood swings, impaired judgment, as well as increased hostility and aggression—often referred to as “roid rage.” Anabolic steroid abuse causes psychological dependence and addiction, like other synthetic drugs. When steroid use stops, users often experience depression that can become suicidal.
Most alarming are the physical consequences of steroid abuse. In young people, anabolic steroid use can stunt growth. In young boys, it can cause early sexual development and acne. Young girls and women can experience a deepening of the voice, increased facial and body hair, menstrual irregularities, and baldness. Men who abuse steroids deal with testicles shrinking, enlargement of breast tissue, and sterility. In general, steroid abuse can cause high cholesterol as well as an increased risk of stroke and heart attack. Those who inject steroids face the same dangers of contracting serious infections from contaminated needles.
The term inhalants refer to the vapors that come from toxic substances which are inhaled to reach a quick high. There are more than 1,000 household and other common products that could be abused as inhalants. The most often used are:
- shoe polish
- toluene (a colorless liquid that is used is fuel and solvents)
- nitrous oxide
- spray paint
- amyl nitrite
- lacquer thinner or other paint solvent
Most of these produce effects similar to anesthetics, which slow down the body’s functions. After an initial high and loss of inhibition comes drowsiness, light-headedness, and agitation. The chemicals are rapidly absorbed through the lungs into the bloodstream and quickly reach the brain and other organs. Sometimes this rapid absorption causes irreversible physical and mental damage.
Users inhale the chemical vapors directly from open containers (“sniffing”) or breathe in fumes from rags that are soaked in chemicals (“huffing”). Some spray the substance directly into the nose or mouth, while others pour it onto their collar, sleeves, or cuffs and sniff them periodically. “Bagging” is when the user inhales the fumes of a substance that is inside a paper or plastic bag. Bagging in a closed area greatly increases the chances of suffocation.
Effects of Inhalants on the Body and Brain
There are numerous effects on both the body and brain of a person who abuses inhalants. Firstly, inhalants starve the body of oxygen and force the heart to beat more rapidly and irregularly. Inhalants can also cause significant damage to the following organs:
- Lungs: repeated use of spray solvents as an inhalant can cause severe lung damage.
- Heart: inhalant abuse can cause the heart’s rhythm to be disturbed, which can result in what is called sudden sniffing death syndrome.
- Liver: some of the chemicals used in solvents can permanently damage the liver.
- Kidney: inhalants which contain toluene can impair the kidney’s ability to regulate the amount of acids in the blood, and long-term abuse can lead to kidney stones.
The following complications can occur in an inhalant user’s brain:
- Senses and psychology: the chemicals abused by inhalant users affect different parts of the brain, producing a variety of sensory and psychological disorders.
- Cells: Many inhalants are thought to dissolve the protective myelin sheath that surrounds neurons (brain cells) resulting in cell death.
- Cerebral Cortex: if there is cellular death at the cerebral cortex, permanent personality changes, memory impairments, hallucinations, and learning disabilities occur.
- Cerebellum: inhalants cause a loss of coordination and slurred speech, as well as tremors and shaking over a period of abuse.
- Ophthalmic Nerve: using inhalants—especially toluene—can cause sight disorders.
Short and Long-Term Effects of Inhalants
In addition to the complications and symptoms listed above, the short term effects of inhalants may include:
- Severe headaches
Long-term effects can progress into:
- Muscle weakness and deterioration
- Hearing loss
- Bone damage
- Death from heart failure or asphyxiation
More than 22 million Americans age 12 and older have used inhalants, and every year more than 750,000 use inhalants for the first time. Despite the substantial prevalence and serious toxicities that are seen with inhalant use, it has been termed “the forgotten epidemic.” Inhalant abuse remains the least-studied form of substance abuse, although research on its abuse has increased over the past few years.
Natural sedatives, or herbal sedatives, are plants and other naturally-occurring substances that produce stress-relieving, soothing, and tranquilizing effects. Many cultures embrace different plants that function as sleep-aids, aphrodisiacs, and psychoactive relaxants. Because these substances occur in nature, there is an assumption that they are all safe.
Yet, besides synthetic drugs, all of the substances that have been discussed thus far are produced from plants and the psychoactive chemicals that occur naturally within them. While some natural sedatives have only mild effects, there are other natural sedatives powerful enough to cause full sedation. Especially in high doses, these natural sedatives have a potential for abuse:
Kratom (Mitragyna speciosa)
Kratom is a tropical tree that is native to Southeast Asia, and its leaves contain a psychoactive substance called mitragynine. The leaves are classified as an herb that is part of the coffee family. These leaves are crushed and then smoked, brewed into a tea, or put into gel capsules. Consuming these leaves can produce stimulant effects in low doses, but produces intense, sedative effects in high doses.
In alternative medicine and drug communities, kratom is seen as a way to combat fatigue, ease pain, and even treat heroin addiction. Some researchers consider kratom an opiate alternative, with the potential to help opiate addicts kick their habit without a painful withdrawal. Yet, in many countries and states, kratom is illegal or consumption of it is banned.
The danger in kratom is that the herb’s psychoactive ingredient activates opioid receptors, similarly to morphine. This part of the brain regulates pain, along with rewards and addictive behaviors. Though it’s not classified as an opiate, kratom affects the body and brain much like an opiate would—creating cravings and physical dependence with chronic use.
Most people who abuse kratom ingest it in pill form. Some chronic users of kratom have exhibited psychotic symptoms, such as confusion, hallucinations, and delusions. Because of its strong sedation effects, it’s also dangerous to mix with other CNS depressants, like alcohol. In combination, there is an increased risk of sedating the cardiovascular system until the heart stops beating.
Kava (Piper methysticum)
The kava plant is a member of the pepper family and is native to the islands of the South Pacific. It has been used as a ceremonial drink in that region for hundreds of years. The main active ingredient in kava is called kavalactones, which is found in the root of the plant. In some parts of the world, whole kava roots are chewed for their medicinal value and pain-relieving properties, which may explain why it creates a temporary numbness and tingling sensation on the tongue. Kava is also available in liquid form, as a standardized extract, and can be powdered into capsules or tablets.
Kava is known best for its relaxing qualities. Some people report its effects are similar to alcohol, and that it can elevate mood and well-being. Several studies have found that kava may be useful in the treatment of anxiety, insomnia, menopausal symptoms, and related nervous disorders. Yet, some countries have taken kava off the market due to serious concerns that kava may cause liver damage.
It remains available in the United States, but the Food and Drug Administration (FDA) issued a consumer advisory in March 2002 about the “rare” but potential risk of liver failure in people who consume kava-containing products. Despite this warning, kava bars have become popular places of recreation, much like hookah bars, where bar-goers can purchase “relaxation drinks” that contain kava. Some online vendors also sell kava, promoting it as a “legal alternative” to other, illegal sedatives.
Many researchers claim that kava does not have addictive properties, and there are lots of people who consider kava an effective treatment for their anxiety. Yet, especially for an addict or substance abuser, kava can be psychologically addictive. The sedative effects it produces can leave a user wanting to come back for more, and can even produce the same kind of compulsive substance-use as other drugs. For people in recovery, kava can produce effects that mimic other CNS depressants or opiates, potentially sparking a craving that could lead them back to these more powerful substances.