4.5 Substance Use and Abuse

• Some people also may experience altered states of consciousness by taking drugs and other substances.

Substance Use Disorders

• According to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, a guide for diagnosing individuals suffering from various psychological disorders, substance use disorders are listed as:

  • a person who often uses more of a substance than they originally intended to and continues the use despite experiencing significant adverse consequences.

• There is a compulsive pattern of drug use often associated with physical and psychological dependence.

  • Physical dependence involves changes in normal bodily functions.
    • Example: withdrawal from a drug upon cessation of use.
  • Psychological dependence involves an emotional need for the drug or for psychological distress relief.

• Tolerance occurs when a person needs more of the drug to achieve effects previously experienced at lower doses.

  • It can be used to increase the dose of the drug taken, even above to a dangerous level, leading to overdose, and eventually death.

• Withdrawal is a variety of symptoms experienced when drug use is discontinued.

  • Symptoms of withdrawal are usually opposite of the drug.

• Psychological dependence is a recent addition to the criteria diagnostic criteria for a substance use disorder.

  • This is because we can experience withdrawal and develop tolerance to drugs we do not abuse.

Class of Drug	Examples	Effects on the Body	Effects on Low Doses	Effects in High Doses
Stimulants	cocaine amphetamines methamphetamines, MDMA, nicotine, caffeine	Increased heart rate, blood pressure, body temperature	Increased alertness, mild euphoria, decreased appetite	agitation, paranoia. heightened sensitivity to physical stimuli.
Depressants	alcohol barbiturates benzodiazepines	Decreased heart rate, blood pressure	Increases relaxation, decreases inhibitions	Induces sleep, causes motor disturbance, memory loss, decreased respiratory function
Opiates	opium heroin fentanyl morphine oxycodone vicodin methacodone other prescription pain relievers	Decreased pain, pupil constriction, decreased gut motility, decreased respiratory function	Pain relief, euphoria, sleepiness	death due to respiratory depression
Hallucinogens	marijuana LSD Peyote dissociative anaesthetics (eg. ketamine)	Increased heart rate and blood pressure that may dissipate over time	Mild to intense perceptual changes with high variability	Mild to intense perceptual changes with high variability

Depressants

• drugs that suppress the central nervous system

• they serve as agonists of the gamma-aminobutyric acid neurotransmitter system.

• they are often prescribed to treat anxiety and insomnia due to the “quieting effect” of GABA agonists.

• Drug withdrawal for depressants can be a life-threatening process.

  • It should only be done under medical supervision.

Alcohol

• Alcohol at low doses results in a variety of changes in the consciousness.
  • At low doses, alcohol is associated with feelings of euphoria.
  • As the dose increases, feelings of sedation can be experienced.
• Alcohol generally decreases:
  • reaction time,
  • visual perception,
  • alertness,
  • behavioral control
• On excessive use, they may experience:
  • complete loss of consciousness
  • difficulty of remembering events occurred during period of intoxication.
• A pregnant person consuming alcohol may have significant effects to their infant.
  • Specifically, the infant may exhibit a range of birth defects called fetal alcohol syndrome (FAS)

Stimulants

• drugs that tend to increase overall levels of neural activity.
• they act as agonists of the dopamine neurotransmitter system.
  • dopamine is associated with reward and craving.

Cocaine

• agonizes the dopamine neurotransmitter system by blocking the reuptake of dopamine in the synapse.
• it can be taken in multiple ways:
  • some users snort cocaine in powder form,
  • some administer cocaine intravenously,
  • some use the drug through inhalation or by smoking it (freebase cocaine/crack).

Amphetamines

• blocks dopamine reuptake and stimulates dopamine release.

• often prescribed as medication for people diagnosed with attention deficit hyperactivity disorder (ADHD)

  • stimulant medications are used to treat disorders that involve hyperactivity by increasing neurotransmitter activity in areas in the brain that associated with impulse control (prefrontal cortex and the basal ganglia).

• Methamphetamine

  • a type of amphetamine made from readily available ingredients (eg. medications containing pseudoephedrine)
  • often called “crystal meth” in its smokable form.
    • can be very potent as it can quickly reach the brain and produce a intense euphoria for a very short amount of time.
    • its very short-term effects prompt users to continue taking more of the drug.
  • often consumed every few hours across days-long binges called “runs”
  • a popular choice among drug users nowadays
    • this is because it is more potent, inexpensive, more available, and has a lower risk of overdose than opiate drugs.
  • may cause long-term health issues:
    • dental problems (“meth mouth”)
    • skin abrasions from excessive scratching
    • memory loss
    • sleep problems
    • violent behavior
    • paranoia
    • hallucinations
  • addiction to methamphetamine can be difficult to treat as it can produce an intense craving to the substance.

MDMA

• chemically known as 3,4-methelynedioxy-methamphetamine
• also known as “ecstasy” or “Molly”
• a mild stimulant with perception-altering effects
• typically consumed as pills
• effects include:
  • increased energy
  • feelings of pleasure
  • emotional warmth
• repeated use may have significant adverse effects, which may include:
  • physical symptoms, such as:
    • nausea,
    • increased blood pressure,
    • increased heart rate
  • some psychological and emotional symptoms, such as:
    • feelings of anxiety,
    • hallucinations,
    • paranoia
  • it may also alter normal brain functioning
    • this is done by depletion of monoamine neurotransmitters
      *(dopamine, serotonin, norepinephrine)
    • depletion of these neurotransmitters may lead to:
      • mood dysphoria
      • cognitive problems
      • compulsion to try using other stimulants (cocaine, amphetamines)

Caffeine

• commonly used drug in the world
• much less potent compared to other drugs previously discussed
• generally used to maintain increased levels of alertness and arousal
• antagonizes adenosine activity
  • this neurotransmitter system promotes sleep
  • this means that caffeine inhibits adenosine receptors, therefore promoting wakefulness
• high levels of caffeine may cause:
  • insomnia,
  • muscle twitching,
  • agitation,
  • nausea,
  • irregular heartbeat,
  • death

Nicotine

• highly addictive substance found in tobacco products

• associated with increased risk of:

  • heart disease
  • stroke
  • various cancers

• exerts effects through interaction with acetylcholine receptors

  • acetylcholine acts as a neurotransmitter for reward and arousal mechanisms, and for motor neurons in the PNS.

• some psychotherapeutic therapies currently exist for people who want to discontinue their use of tobacco products

  • some studies have proven that it is still unclear whether they are effective in the long-term

• Vaping is a recent method of administering nicotine.

  • It uses battery-powered devices, called e-cigarettes that deliver liquid nicotine and flavorings as a vapor.
  • It is now known that vaping is known to be dangerous and that it leads to serious lung disease and death.

Opioids

• category of drugs that have analgesic (pain-reducing) properties

• they mimic the body’s endogenous opioid neurotransmitter system

  • the body produces small quantities of opioid compounds which bind to opioid receptors
  • these receptors reduce pain and produce euphoria

• Opiates

  • also called natural opioids
  • derivatives of the compound opium
    • naturally occurring compound found in the poppy plant.

• Some synthetic versions of opioid drugs have more potent painkilling effects.

  • This lead to tighter regulations and more research to their misuse and abuse.

• Some opioid-like compounds are also found in other medications such as cough suppressants, anti-diarrhea, and anti-nausea medications.

• Withdrawal from an opioid drug should resemble a severe case of the flu.

  • It can be extremely unpleasant, but not life-threatening.

Heroin

• a commonly abused opioid drug in history.

• can be snorted, smoked, or injected intravenously.

• some effects may include:

  • can produce intense feelings of euphoria and pleasure.
    • effects are amplified when injected intravenously.
  • 4-6 hour period of alternating between wakefulness and drowsiness.
  • mental and physical lethargy

• Users who use the drug intravenously often leave track marks on the spot of injection.

  • Therefore, some users inject into areas between their toes or fingers so that track marks will not be as obvious.
  • Users who also use the drug this way may have high risk for contracting tuberculosis and HIV.

Methadone

• synthetic opioid that is less euphorigenic than heroin and similar drugs.
• often given to people with opioid addiction to manage withdrawal symptoms.

Codeine

• opioid with low potency
• often prescribed for minor pain relief
• available in over-the-counter medications in some countries.
• still has the potential for abuse.

The Opioid Crisis

• began in the 1990s when pharmaceutical companies mass-marketed these pain-relieving opioid drugs as non-addictive, which were now proven to be false.

• as more people are prescribed with these drugs, the rates for misuse and the chances for addiction skyrocketed,

• these people who took opiate drugs even if they were taken as prescribed became addicted to it in less than a week.

• withdrawal from opioids includes pain, which patients interpret as the pain caused by the problem that led them to take the original prescription

• this interpretation may lead patients to continue taking more of the drug.

• as a result, the FDA recommended in 2013 to tighten regulations on opiate prescriptions.

  • this includes banning patients addicted to opioids from obtaining legitimate prescriptions for opioid drugs.

• this created a black market for the drug, where prices soared as high to $80 or more for a single pill.

  • as a result, many people turned to the much cheaper heroin.

• to keep heroin affordable, dealers began adding other synthetic, more potent opioids like fentanyl and carfentanyl.

  • these drugs can be so potent that small doses can cause overdose and death.

Hallucinogens

• class of drugs that results in alterations in sensory and perceptual experiences.
• some effects may include:
  • visual hallucinations
  • hallucinations of body sensations
  • skewed perception of the passage of time.