Substance Use And Abuse

Front 1

Marijuana

Back 1

is a hemp plant whose biological name is
cannabis sativa. It consists of green, brown, or a grey
mixture of dried, shredded leaves, stems, seeds, and flowers.

Front 2

THC

Back 2

delta-9-tetrahydrocannabinol) is the primary mind-altering ingredient in marijuana

Front 3

Brief History and Trends

Back 3

Marijuana has historically been a valued crop. The woody fibers of the stem yield a fiber that can be made into cloth and rope.

Early records of marijuana use:
China 2737 BC and India (religious ceremonies)
Assyrians, dating back to 650 BC used it for making rope, cloth, and consumed it to experience euphoria
Ancient Greeks also knew about marijuana
In North America, in Jamestown (1611), marijuana was used to make rope and clothing
Currently, marijuana grows wild in many U.S. states

Front 4

Today marijuana is how many times more potent than the marijuana on the street in the 1960s and 1970s?

Back 4

Approximately 20 times more potent as result of more efficient agriculture largely due to new methods of harvesting, new varieties, and special processing marijuana of plants

Front 5

How many Americans are current marijuana users?

Back 5

Aged 12 or older in 2008: Out of 20.1 million illicit drug users, approximately 57.3% reported current use of only marijuana and another 18.4% used marijuana with another illicit drug. (This means that a staggering 75.7% [57.3% + 17.3%] either used marijuana alone or used marijuana with another drug.) The remaining 26% of drug users used an illicit drug but not marijuana.

Front 6

Major Factors Affecting Marijuana Use: Structural factors

Back 6

Age, gender, family background, lack of any religious beliefs

Front 7

Major Factors Affecting Marijuana Use: Social and interactional factors

Back 7

Type of interpersonal relationships, friendship cliques, drug use within the peer group setting

Front 8

Major Factors Affecting Marijuana Use: Setting:

Back 8

Type of community and neighborhood (physical location of drug use

Front 9

Major Factors Affecting Marijuana Use: Attitudinal factors:

Back 9

Personal attitudes toward the use of drugs, self esteem, maturation level

Front 10

Hashish:

Back 10

Average concentration of THC is 12.4% for domestic, 7.03% for non-domestic, and 20.76 for samples seized by law enforcement officials

Front 11

Ganja:

Back 11

Consists of the dried tops of female plants. The term is also used as a slang term for marijuana (pot, weed, reefer)

Front 12

Sinsemilla

Back 12

(without seeds), “hydro” (grown in water), kind bud, dro, 30s, AK-47, and blueberry (more recent names of popular types of marijuana). The average concentration of THC is 7.5% and higher

Front 13

Bhang:

Back 13

Average concentration of
THC is 1% to 2%

Front 14

Behavioral Effects of marijuana

Back 14

Low to moderate doses produce euphoria and a pleasant state of relaxation.

Common effects: dry mouth, elevated heartbeat, some loss of coordination and balance, slower reaction times, reddening of the eyes, elevated blood pressure, some mental confusion (short-term memory loss).

A typical high lasts from 2 to 3 hours (length of effect depends on amount of THC), and the user experiences altered perception of space and time as well as impaired memory.

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Subjective euphoric effect

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The ongoing social and psychological experiences incurred while intoxicated with marijuana. These include both the user’s altered state of consciousness and his/her perceptions while intoxicated.

Front 16

Differential association

Back 16

Behavioral satisfaction derived from friends who use marijuana (“fun-times when high with friends”).

Front 17

Critical Thinking Skills

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Marijuana has been found to have a negative impact on critical thinking skills.
Specifically, heavy marijuana use impairs attention, memory and learning.
Marijuana alters brain activity because residues of this drug persist in the brain.

Front 18

Amotivational syndrome

Back 18

refers to a belief that heavy use of marijuana causes a lack of motivation or impaired desire and reduced productivity.

Front 19

Medical marijuana use:

Back 19

Involves using the THC derived from smoking marijuana or using Marinol as a drug to calm or relieve symptoms of an illness. (Marinol is an FDA-approved THC in capsule form.)

Some research shows that THC can be used for treating:
Glaucoma: potentially blinding eye disease causing continual and increasing intraocular pressure

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Appetite stimulant:

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Patients experiencing anorexia, AIDS, chemotherapy and radiation therapy

Front 21

Antiseizure

Back 21

Aids in the prevention of seizures (epilepsy)

Front 22

Antiasthmatic effect

Back 22

Short-term smoking of marijuana improves breathing for asthma patients

Front 23

Antidepressant effect:

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Used in Great Britain as a euphoriant for treating depression

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Muscle relaxation

Back 24

Aids in muscle spasms

Front 25

Analgesic effect:

Back 25

In patients experiencing frequent migraines and chronic headaches or inflammation

Front 26

Arguments Against Marijuana Use

Back 26

It contains 421 chemicals.

It is stronger than it was 20 years ago.

Smoking this drug is worse for the lungs than tobacco.

Impairs short-term memory and causes the “amotivational syndrome.”

U.S. federal law continues to legally prohibit the possession, the sale, and use of marijuana. (The federal government believes marijuana has no medically proven use.)

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Physiological Effects

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Central nervous system: Alters mood, coordination, memory, and self-perception

Respiratory system: Damages the lungs

Cardiovascular system: Marijuana products limit the amount of oxygen that can be carried to the heart

Sexual performance and reproduction: Affects the sympathetic nervous system, increasing vasodilation in the genital and delaying ejaculation; high doses can decrease sexual desire

Front 28

Effects of Marijuana on the Central Nervous System

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Altered perceptions
Changes in the interpretation of stimuli resulting from marijuana use

“Munchies”
Hunger experienced while under the effects of marijuana

Anandamide
Possible neurotransmitter acting at the marijuana (cannabinoid) receptor site

Front 29

Effects on Other Systems

Back 29

Alveolar Macrophages (respiratory system)
Special white blood cells that play a role in cleaning lung tissue are less able to remove debris when exposed to smoke

Vasodilation (cardiovascular system)
Enlarged blood vessels

Aphrodisiac (sexual performance and reproduction)
Refers to a compound (in marijuana, THC is believed to cause sexual arousal)

Front 30

Tobacco Use: Scope of the Problem

Back 30

Tobacco use is the leading preventable cause of disease and premature death in the United States.
443,000 deaths annually in United States
Tobacco is the single largest cause of preventable death and a risk factor for 6/8 of the leading causes of death.

Front 31

Current Tobacco Use in the U.S.

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In 2009, 69.7 million Americans, or 27.7% of the population age 12 or older, reported current use of a tobacco product.

Approximately 33.5 percent of males and 22.2% of females age 12 or older were current users of any tobacco product.

Front 32

Cigarette Smoking:A Costly Addiction

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Cigarette smoking is the leading preventable cause of death in the United States.

More deaths are caused each year by tobacco use than by HIV, illegal drug use, murders, alcohol use, suicides, and motor vehicle injuries combined.

Front 33

History of Tobacco Use

Back 33

Mayans: tobacco smoke as “divine incense”
Turkey: poets vs. priests
France: Louis XIII vs. Louis XIV
Nicholas Monardes: infallible cure
Pope Urban VII: excommunication for tobacco users

Front 34

History of Tobacco Usein America

Back 34

Cigars became popular in the United States in the early 1800s.

The introduction of the cigarette-rolling machine spurred cigarette consumption because cigarettes became cheaper than cigars.

Front 35

Tobacco Production

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Nicotiana tabacum is the primary species of tobacco.
Flue-cured tobacco is cured with heat transmitted through a flue without exposure to smoke or fumes.

Front 36

Government Regulation

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1964: The Advisory Committee to the U.S. Surgeon General reported that cigarette smoking is related to lung cancer.
1970: Warnings on cigarette labels.

Front 37

Master Settlement Agreement

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Limitations on advertising
Ban on cartoon characters in advertising
Ban on “branded” merchandise
Limitations on sponsoring of sporting events
Disbanding of tobacco trade organizations
Funds designated to support anti-smoking measures and research to reduce youth smoking

Front 38

Family Smoking Prevention and Control Act1

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The FSPTCA gave the FDA the ability to:
Establish good manufacturing practices

Set and enforce standards for tobacco product ingredients and design

Institute product labeling and health warnings

Regulate the marketing and promotion of tobacco products

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Family Smoking Prevention and Control Act2

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As a consequence of its charge to regulate, the FDA has:
Established the Center for Tobacco Products

Convened a Tobacco Products Scientific Advisory Committee that began to study the impact of the use of menthol in cigarettes on the public health

Begun to enforce the prohibition described in the Act on manufacturing, distributing or selling certain flavored cigarettes, such as spice-, fruit-, and candy-flavored cigarettes

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Family Smoking Prevention and Control Act 3

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. Implemented new statutory authorities, under which tobacco product manufactures have registered their establishments and listed their products with the FDA, provided detailed information about product ingredients and their own research into the health effects of their products

5. Established the tobacco user fee program, which provides funding for FDA tobacco regulation support activities

Front 41

Pharmacology of Nicotine

Back 41

It is a colorless, highly volatile liquid alkaloid.

When smoked, nicotine enters the lungs and is then absorbed into the bloodstream.

When chewed or dipped, nicotine is absorbed through the mucous lining of the mouth.Amount of tobacco absorbed depends on
Exact composition of tobacco
How densely the tobacco is packed in the cigarette
Whether a filter is used and characteristics of filter
The volume of smoke inhaled
The number of cigarettes smoked

Front 42

Physiological Effects

Back 42

Stimulates central dopamine release

Stimulates cardiovascular system

Front 43

Cigarette Smoking

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Cigarette smokers not only tend to die at an earlier age than nonsmokers, but also have a higher probability of developing certain diseases, including cardiovascular disease, cancer, bronchopulmonary disease, and other illnesses

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Cardiovascular Disease

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Smoking causes coronary heart disease, the leading cause of death in the United States.
Compared with non-smokers, smoking increases the risk of coronary heart disease two to four times.
Smoking puts smokers at greater risk for developing peripheral artery disease.
Women who smoke have twice the risk of developing coronary artery disease

Front 45

Cancer

Back 45

Cigarette smoking is a major cause of cancers of the lung, bladder, pancreas, cervix, esophagus, stomach, oral cavity and kidney.
The risk of cancer increases according to the number of cigarettes smoked each day, the number of years a person has smoked, and the age at which smoking began.
The risk of lung cancer in men who smoke two or more packs per day is 23 times greater than the risk for nonsmokers, while the risk for women is approximately 13 times greater.

Front 46

Bronchopulmonary Disease

Back 46

Cigarette damages the airways and alveoli, and causes emphysema, chronic airway obstruction and emphysema

Front 47

Light Cigarettes

Back 47

There is no conclusive evidence of reduced health risks associated with low-tar cigarettes.

Filtered cigarettes reduce levels of tar, nicotine, and carbon monoxide at the mouth end of the filter and should be of some limited benefit.

Many smokers lose this benefit because they often smoke more cigarettes per day, increase puff number and volume, or block the filter holes with their fingers or lips.

Front 48

Electronic Cigarettes

Back 48

Electronic cigarettes (e-cigarettes) are devices designed to deliver nicotine or other substances to a user as a vapor.

The FDA has not evaluated e-cigarettes for effectiveness or safety.

Front 49

Tobacco Use Without Smoking

Back 49

Chewing tobacco and snuff.

Use can lead to nicotine addiction and dependence.

Adolescents who use smokeless tobacco are more likely to become cigarette smokers.

Contains 28 cancer-causing agents.

Smokeless tobacco is strongly associated with leukoplakia.

Smokeless tobacco increases the risk of developing cancer of the oral cavity and pancreas.

Front 50

Secondhand Smoke

Back 50

Secondhand smoke includes a mixture of smoke that comes directly from the lighted tip of a cigarette, cigar, or pipe tip.

Passive smoking refers to nonsmokers’ inhalation of tobacco smoke.
Secondhand smoke exposure causes an estimated 46,000 heart disease deaths annually in the United States

Front 51

Benefits of Cessation

Back 51

A return to normalcy of heart rate and blood pressure (which are abnormally high while smoking).

A decline of carbon monoxide in the blood within hours.

Improved circulation, production of less phlegm, and decreased rate of coughing and sneezing within weeks.

Substantial improvements in lung function within several months.

Decreased risk for lung and other types of cancer.

6. Decreased risk for coronary heart disease, stroke, and peripheral vascular disease.

7. Decreased respiratory symptoms such as coughing, wheezing, and shortness of breath.

Decreased risk of developing chronic obstructive pulmonary disease.

9. Decreased risk for infertility in women.

10. Decreased risk of having a low birth weight baby.

Front 52

Methods for Quitting

Back 52

Nicotine gum
Nicotine patches
Nicotine spray
Nicotine lozenges
Bupropion
Varenicline

Front 53

What Are Narcotics?

Back 53

The term narcotic currently refers to naturally occurring substances derived from the opium poppy and their synthetic substitutes.
These drugs are referred to as the opioid (or opiate) narcotics because of their association with opium.

Front 54

The History of Narcotics

Back 54

A 6000-year-old Sumerian tablet
The Egyptians
The Greeks
Arab traders
China and opium trade
The Opium War of 1839
American opium use
Abuse problems often associated with war

Front 55

Pharmacological Effects of narcotics

Back 55

The most common clinical use of the opioid narcotics is as analgesics to relieve pain.
The opioid narcotics relieve pain by activating the same group of receptors that are controlled by the endogenous substances called endorphins.
Activation of opioid receptors blocks the transmission of pain through the spinal cord or brain stem but can also reduce the effects of stress.

Front 56

Pharmacological Effects of narcotics (continued)

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Morphine is a particularly potent pain reliever and often is used as the analgesic standard by which other narcotics are compared.
With continual use, tolerance develops to the analgesic effects of morphine and other narcotics.
Physicians frequently underprescribe narcotics, for fear of causing narcotic addiction.

Front 57

Pharmacological Effects of narcotics (continued

Back 57

The principle side effects of the opioid narcotics, besides their abuse potential, include:
Drowsiness, mental clouding
Respiratory depression
Nausea, vomiting, and constipation
Inability to urinate
Drop in blood pressure

Front 58

Abuse, Tolerance, Dependence, and Withdrawal

Back 58

All the opioid narcotic agents that activate opioid receptors have abuse potential and are classified as scheduled drugs.
Tolerance begins with the first dose of a narcotic, but does not become clinically evident until after 2 to 3 weeks of frequent use.

Front 59

Abuse of Opioid Narcotics

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Tolerance occurs most rapidly with high doses given in short intervals.
Doses can be increased as
much as 35 times in order to regain the narcotic effect.
Physical dependence invariably accompanies severe tolerance and typically expresses when these drugs are used for more than 2–4 weeks.
Psychological dependence can also develop with continual narcotic use.

Front 60

Guidelines to Avoid Prescribed Opiate Abuse

Back 60

Only use opioid analgesics when pain severity warrants
Doses and duration of use should be as conservative as possible
Patients should store these medications securely to prevent their theft and misuse
Do not share with anyone else

Front 61

Guidelines to Avoid Prescribed Opiate Abuse (continued)

Back 61

Patients should be educated about potential abuse problems prior to being prescribed opioid drugs
If significant abuse is suspected, the clinician should discuss concerns with patient to find appropriate steps to stop the abuse

Front 62

Opioid Side Effects

Back 62

Drowsiness
Respiratory depression
Nausea/vomiting
Inability to urinate
Constricted pupils
Constipation
Physical dependence and withdrawal

Front 63

Heroin Abuse

Back 63

Heroin is classified as a Schedule I drug.
One of the most widely abused illegal drugs in the world; accounts for >$120 billion sales/year
Illicitly used more than any other drug of abuse in the United States (except for marijuana) until 20 years ago, when it was replaced by cocaine
Some of the recent increases in heroin use likely due to increased abuse of prescription opioid painkillers

Front 64

Heroin Combinations

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Pure heroin is a white powder.
More than 90% of world’s heroin is from Afghanistan.
Heroin is usually “cut” (diluted) with lactose.
When heroin first enters the United States, it may be 95% pure; by the time it is sold, it may be 3% to 70% pure.
If users are unaware of the variance in purity and do not adjust doses accordingly, results can be fatal

Front 65

Heroin Combinations (continued)

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Heroin has a bitter taste and is often cut with quinine, which can be a deadly adulterant.
Heroin plus the artificial narcotic fentanyl can be dangerous due to its unexpected potency.
Heroin is most frequently used with alcohol.
Heroin combined with cocaine is called “speedballing.”

Front 66

Facts About Heroin Abuse

Back 66

What is the estimated number of heroin addicts in the United States?
600,000
What are “shooting galleries”?
Locations that serve as gathering places for addicts

Front 67

Heroin and Crime

Back 67

Factors related to crime:
Pharmacological effects encourage antisocial behavior that is crime-related
Heroin diminishes inhibition
Addicts are often self-centered, impulsive, and governed by need
Cost of addiction

Front 68

Patterns of Heroin Abuse

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Heroin has become purer (60% to 70% purity) and cheaper (~$10/bag).
Greater purity leads users to administer heroin in less efficient ways.
Many youth believe that heroin can be used safely if not injected

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Patterns of Heroin Abuse (continued)

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Because of its association with popular fashions and entertainment, heroin has been viewed as glamorous and chic, especially by many young people, although lately this attitude has been changing.
Emergency room visits due to narcotic overdoses were over 190,000 in 2009.

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Stages of Dependence

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Initially, the effects of heroin are often unpleasant.
Euphoria gradually overcomes the aversive effects.
The positive feelings increase with narcotic use, leading to psychological dependence.
In addition to psychological dependence, physical dependence occurs with daily use over a 2-week period.
If the user abruptly stops taking the drug after physical dependence has developed, severe withdrawal symptoms result.

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Methods of Administration heroine

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Sniffing the powder
Injecting it into a muscle (intramuscular)
Smoking
Mainlining (intravenous injection)

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Heroin Addicts and AIDS

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More than 250,000 patients in United States contracted AIDS by drug injection, of which most were heroin users.
Fear of contracting HIV from IV heroin use has contributed to the increase in smoking or snorting heroin.
Many who start by smoking or snorting progress to IV administration due to its more intense effects.

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Heroin and Pregnancy

Back 73

Heroin use by a pregnant woman leads to:
Physical dependence on heroin in the newborn
Withdrawal symptoms after birth in the newborn (Note: similar withdrawal occurs in newborns of any woman who uses significant amounts of opiate drugs during pregnancy, including prescribed opiate painkillers)

Front 74

Withdrawal Symptoms of heroine

Back 74

After the effects of the heroin wear off, the addicts have only a few hours in which to find the next dose before severe withdrawal symptoms begin.
A single “shot” of heroin lasts 4 to 6 hours.
Withdrawal symptoms: runny nose, tears, minor stomach cramps, loss of appetite, vomiting, diarrhea, abdominal cramps, chills, fever, aching bones, and muscle spasms.

Front 75

Treatment for heroine addiction

Back 75

Methadone or buprenorphine are frequently used to help narcotic addicts.
These drugs block withdrawal symptoms.
Treatment should also include regular counseling and other supplemental services such as job training.

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Other Narcotics

Back 76

Morphine
Methadone
Fentanyl
Hydromorphone
Oxycodone (OxyContin)
Meperidine

Buprenorphine
MPTP
Codeine
Pentazocine
Tramadol

Front 77

Narcotic-Related Drugs

Back 77

Dextromethorphan: OTC antitussive
Clonidine: Relieves some of the opioid withdrawal symptoms
Naloxone/Naltrexone: Narcotic antagonist; used for narcotic overdoses

Front 78

Major Stimulants

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All major stimulants increase alertness, excitation, and euphoria; thus, these drugs are referred to as “uppers.”

Schedule I (“designer” amphetamines)
Schedule II (amphetamine, cocaine, methylphenicate-Ritalin)

Front 79

Amphetamines

Back 79

Cause dependence due to their euphoric properties and ability to mask fatigue.

Can be legally prescribed by physicians.

Abuse occurs in people who acquire their drugs by both legitimate and illicit ways.

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History of Amphetamines

Back 80

First synthesized in 1887 by L. Edeleano.

In 1927, Gordon Alles gave a firsthand account of its effects.
Reduced fatigue
Increased alertness
Caused a sense of confident euphoria

In 1932, Benzedrine inhalers became available as a nonprescription medication.

Front 81

History of Amphetamines (continued)

Back 81

The Benzedrine inhalers became widely abused for their stimulant action.
1971, all potent amphetamine-like compounds in nasal inhalers were withdrawn from the market.

Widely used in World War II to counteract fatigue.

Other users: Korean War soldiers, truck drivers, homemakers, high achievers under pressure (as performance-enhancers).

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How Amphetamines Work

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Synthetic chemical similar to the natural neurotransmitters such as norepinephrine, dopamine, and epinephrine

Increase the release and block the metabolism of these catecholamine substances, as well as serotonin, in the brain and peripheral nerves associated with the sympathetic nervous system

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How Amphetamines Work

Back 83

Amphetamines can cause
“Fight-or-flight” effect, a response to crisis
Alertness
Anxiety, severe apprehension, or panic
Potent effects on dopamine in the reward center of the brain
Behavioral stereotypy: Meaningless repetition of a single activity

Front 84

Approved Uses of Amphetamines

Back 84

Narcolepsy

Attention Deficit Hyperactivity Disorder (ADHD)

Weight reduction

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Side Effects of Therapeutic Doses

Back 85

Abuse and addiction

Cardiovascular toxicities
Increased heart rate
Elevated blood pressure
Damage to blood vessels

Front 86

Current misuse of amphetamines

Back 86

Decline in abuse in the late 1880s and early 1990s.

In 1993 the declines were replaced by an increase.

Currently, 3–6% annual use of methamphetamine by adolescents in the United States.

Due to the ease of production, methamphetamine can be made in makeshift labs using cookbook-style recipes.

Toxic chemicals in such labs pose a threat to residents, neighbors, law enforcement officials, and the environment.

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Patterns of High-Dose Use

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Amphetamines can be taken:
Orally
Intravenously (speed freak)
Smoked (ice)

Front 88

Summary of the Effects of Amphetamines Body

Back 88

Body
increased heartbeat, increased blood pressure, decreased appetite, increased breathing rate, inability to sleep, sweating, dry mouth, muscle twitching, convulsions, fever, chest pain, irregular heartbeat, death due to overdose

Front 89

Summary of the Effects of Amphetamines mind

Back 89

decreased fatigue,
increased confidence,
increased feeling of alertness,
restlessness, talkativeness,
increased irritability,
fearfulness, apprehension,
distrust of people,
behavioral stereotypy,
hallucination,
psychosis

Front 90

Amphetamines

Back 90

Amphetamine combinations
Speedballs

Designer drugs
Methylenedioxymethamphetamine (MDMA, Ecstasy; most popular of the designer amphetamines)
Methylenedioxyamphetamine (MDA)

A special amphetamine
Methylphenidate (Ritalin)

Front 91

Treatment of Amphetamine Abuse

Back 91

Methamphetamine addiction is the principal problem with these drugs.

Addiction causes long-term brain damage and is difficult, but not impossible, to treat.

Requires long-term treatment to deal with compromised decision-making, memory deficits, increased impulsivity and lack of emotion control.

No FDA-approved medications/treatment is principally behavioral management.

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MDMA (Ecstasy)

Back 92

A designer amphetamine that continues to be popular with young people.

It enhances sensory input and is referred to as an entactogen (a combination of psychedelic and stimulant effects) and it releases both serotonin and dopamine.

While dependence can occur, it tends to be unusual.

Withdrawal includes depression and sleep disruption that can last for days.

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Performance Enhancers

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These are stimulants used to embellish physical/mental endurance and enhance performance.

Often used by college, and even high school, students to help academically.

The drugs used can be illegal amphetamines or related prescription stimulants that are used to treat ADHD, like Ritalin.

As with other potent stimulants, use of these drugs can be very dangerous and cause dependence.

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Cocaine

Back 94

Cocaine abuse continues to be a major drug concern in the United States.

From 1978 to 1987, the United States experienced the largest cocaine epidemic in history.

As recently as the early 1980s cocaine was not believed to cause dependency.

Cocaine is known to be highly addictive.
In 2010, approximately 2.9% of high school seniors used cocaine.

Front 95

History of Cocaine

Back 95

The first cocaine era (2500 BC)
South American Indians
Erythroxylon coca shrub

The second cocaine era (began 19th century)
Vin Mariani
Coca-Cola
Sigmund Freud

The third cocaine era (began 1980s)
Celebrities
Decreased in price to $10 a “fix”

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Cocaine Administration

Back 96

Form of administration important in determining intensity of cocaine’s effects, its abuse liability, and likelihood of toxicity.

Orally: Chewing of the coca leaf

Inhaled: Into the nasal passages (“snorting”)

Injected: Intravenously

Smoked: Freebasing, crack; crack babies

Front 97

Pharmacological Effects of Cocaine

Back 97

Enhanced activity of the catecholamine and serotonin transmitters

Blocks the reuptake of these substances following their release from neurons

The summation of cocaine’s effects on dopamine, noradrenaline, adrenaline, and serotonin is to cause CNS stimulation
Cardiovascular system
Local anesthetic effect

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Main Stages of Cocaine Withdrawal

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Crash: Initial abstinence phase consisting of depression, agitation, suicidal thoughts, and fatigue

Withdrawal: Including mood swings, craving, anhedonia, and obsession with drug seeking

Extinction: Normal pleasure returns, mood swings, cues trigger craving

Front 99

Treatment of Cocaine Dependence

Back 99

Is highly individualistic and has variable success. Most cocaine users use other drugs as well, such as alcohol.

Principal treatment strategies include inpatient and outpatient programs.

Drug therapy is often used to relieve cocaine craving and mood problems.

Psychological counseling, support, and a highly motivated patient are essential.

Front 100

Cocaine and Pregnancy

Back 100

Cocaine babies; not clear the effect of cocaine on the fetus. Some possibilities are:
Microencephaly
Reduced birth weight
Increased irritability
Subtle learning and cognitive defects

Front 101

Minor Stimulants

Back 101

Caffeine is the most frequently consumed stimulant in the world.
It is classified as a xanthine (methylxanthine)
It is found in a number of beverages
Also found in some OTC medicines and chocolate


In the U.S., the average daily intake of caffeine is equivalent to __ cups of coffee a day.
(Answer: 2–3)

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Physiological Effects of Xanthines

Back 102

CNS effects
Enhances alertness, causes arousal, diminishes fatigue

Adverse CNS effects
Insomnia, increase in tension, anxiety, and initiation of muscle twitches
Over 500 milligrams: panic sensations, chills, nausea, clumsiness
Extremely high doses (5 to 10 grams): seizures, respiratory failure, and death

Front 103

History of Hallucinogens

Back 103

The Native American Church:
The American Indian Religious Freedom Act of 1978

Timothy Leary and the League of Spiritual Discovery:
The Psychedelic Experience
Some mental health providers claim these drugs can assist with psychotherapy.

Front 104

The Nature of Hallucinogens

Back 104

Many drugs can exert hallucinogenic effects:
Traditional hallucinogens (LSD-types)
Phenylethylamines (Ecstasy, amphetamines)
Anticholinergic agents (Jimsonweed and other natural products)
Cocaine
Steroids

Front 105

Nature of Hallucinogens

Back 105

Psychedelic

Psychotogenic

Psychotomimetic

Front 106

Sensory and Psychological Effects of Hallucinogens

Back 106

Altered senses
Synesthesia

Loss of control
Flashbacks

Self-reflection
“Make conscious the unconscious”

Loss of identity and cosmic merging
“Mystical-spiritual aspect of the drug experience

Front 107

Traditional Hallucinogens: LSD Types of Agents

Back 107

LSD (lysergic acid diethylamide), mescaline, psilocybin, dimethyltryptamine (DMT), and myristicin

These drugs cause predominantly psychedelic effects

Of high school seniors sampled:
1996: 8.8% had used LSD
2010: 2.6% had used LSD

Front 108

Traditional Hallucinogens: LSD Types of Agents (continued

Back 108

Physical properties of LSD
In pure form: colorless, odorless, tasteless
Street names: acid, blotter acid, microdot, window panes

Front 109

LSD Types of Agents

Back 109

Physiological effects:
Massive increase in neural activity in some brain regions (“electrical storm”).
Activates sympathetic nervous system (rise in body temperature, heart rate, and blood pressure).
Parasympathetic nervous system (increase in salivation and nausea).
Individuals do not become physically dependent, but psychological dependency can occur.

Front 110

LSD Types of Agents (continued)

Back 110

Effects of this hallucinogen begin 30–90 minutes after ingestion and can last up to 12 hours.

Tolerance to the effects of LSD develops very quickly.

Behavioral effects:
Creativity and insight
Adverse psychedelic effects
Perceptual effects

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Mescaline (Peyote)

Back 111

Mescaline is the most active drug in peyote; it induces intensified perception of colors and euphoria.
Effects include dilation of the pupils, increase in body temperature, anxiety, visual hallucinations, alteration of body image, vomiting, muscular relaxation.
Street samples are rarely authentic

Front 112

Psilocybin

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Principle source is the Psilocybe mexicana mushroom.
It is not very common on the street.
Hallucinogenic effects similar to LSD.
Cross-tolerance among psilocybin, LSD, and mescaline.
Stimulates autonomic nervous system, dilates the pupils, increases body temperature.

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Dimethyltryptamine (DMT)

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A short-acting hallucinogen.
Trace amounts are found in the body.
Found in seeds of certain leguminous trees and prepared synthetically.
It is inhaled and is similar in action to psilocybin

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Foxy

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Relatively new hallucinogen (not scheduled by DEA).
Lower doses: euphoria.
Higher doses: similar to LSD.

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Nutmeg

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Myristica oil responsible for physical effects.
High doses can be quite intoxicating.
Often causes unpleasant trips.

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Phenylethylamine Hallucinogens

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The phenylethylamine drugs are chemically related to amphetamines.

They have varying degrees of hallucinogenic and CNS stimulant effects.
LSD-like: predominantly release serotonin; dominated by their hallucinogenic action.
Cocaine-like: predominantly release dopamine; dominated by their stimulant effects.

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Dimthoxymethylamphetamine (DOM or STP)

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Designer” amphetamines
3,4-Methylenedioxyamphetamine (MDA)
Methylenedioxymethamphetamine
(MDMA, Ecstasy); referred to as an entactogen (in 2010 used by 4.5% of high school seniors)

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Anticholinergic Hallucinogens

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The anticholinergic hallucinogens include naturally occurring alkaloid substances that are present in plants and herbs.

The potato family of plants contains most of these mind-altering drugs.

Three potent anticholingergic compounds in these plants:
Scopolamine
Hyoscyamine
Atropine

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Naturally Occurring Anticholinergic Hallucinogens

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Atropa Belladonna: The Deadly Nightshade
Mandragora Officinarum: The Mandrake
Hyoscyamus Niger: Henbane
Datura Stramonium: Jimsonweed

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Phencyclidine (PCP)

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Considered by many experts as the most dangerous of the hallucinogens although it has a host of other effects as well.
It was developed as an intravenous anesthetic but was found to have serious adverse side effects.

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Phencyclidine (PCP) physiological effects

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Hallucinogenic effects, stimulation, depression, anesthesia, analgesia
Large doses can cause coma, convulsions, and death

PCP psychological effects
Feelings of strength, power, invulnerability, perceptual distortions, paranoia, violence, and psychoses and users appear like schizophrenics

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Other Hallucinogens

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Ketamine (general anesthetic; PCP-like)

Dextromethorphan (cough suppressant)
High doses cause PCP-like effects
Commonly abuse by adolescents (6.6% high school seniors used in 2010)

Marijuana

Salvia divinorum
“Legal” hallucinogenic herb, used by 5.5% of high school seniors in 2010
Can cause intense hallucinations and short-term memory loss