CHAPTER 3: Substance Classifications, Effects, and Associated Dangers

1. CHAPTER 3: Substance Classifications, Effects, and Associated Dangers Substance Abuse and Addiction Treatment: Practical Application of Counseling Theory First Edition Todd F. Lewis Developed by Katie A. Wachtel, University of North Carolina at Greensboro

2. Introduction • It is important to have a basic understanding of the physiology and pharmacology of specific drugs and addiction. • Knowledge of drug categories, effects and withdrawal symptoms can help clinicians to be more in tune with the needs of their clients. • This chapter aims to discuss additional important terms, increase knowledge of physiological and pharmacological concepts related to addiction, and describe major drugs of abuse, their classification, effects and associated dangers.

3. Physiological and Pharmacological Aspects Related to Substance Abuse and Addiction • Drugs have a significant affect on brain functioning • Drugs impact neurotransmitters in the brain which help the brain communicate messages • The most commonly affected neurotransmitters are: • --Serotonin - regulates sleep, mood and appetite • --Aminobutyric acid (GABA)-promotes relaxation • --Catecholamines: • ---Dopamine - helps control pleasure and motivation • ---Norepinephrine - helps control the fight or flight response and sympathetic nervous activity

4. Physiological and Pharmacological Aspects Related to Substance Abuse and Addiction Cont. • Mechanisms of action on the brain • 1. Drugs increase the release of neurotransmitters • 2. Mimicry - drugs mimic the action of neurotransmitters • 3. Drugs block receptor sites - preventing neurotransmitters from making connections, resulting in more neurotransmitter in the synapse. • 4. Drugs block the reuptake process - this also results in excess neurotransmitter in the synapse • Drugs can affect the brain in hundreds of different ways and can affect different people in different ways

5. Routes of Administration • Oral • Approximately 15 minutes to take effect • Effects often last longer than other routes of administration • Intravenous injection • Rapid onset of effect (from 30-120 seconds) • Peak highs • Short overall duration

6. Routes of Administration Continued • Inhalation • Fastest onset of effect • Experience an immediate high • Short duration of effect • Insufflation • Inhaling drug powder through the nose • Slowest onset of effect • Peak effects from 15-60 minutes

7. How the Brain Becomes Addicted: A Theory • Drug use increases dopamine which creates an experience of pleasure • When the brain experiences pleasure, it wants more of it • This desire for pleasure can lead people to ignore basic needs to obtain pleasure • The brain responds to the rapid release of dopamine caused by drug use by naturally producing less dopamine • Over time, individuals are unable to naturally experience pleasure, which can lead to more drug-seeking

8. Additional Terminology • Cross-tolerance • When an individual develops a tolerance to one drug, then begins to take another drug within the same classification and does not feel much of an effect of the second drug • Potentiate • When one drug increases the activity and effect of another drug • Effective dose (ED) • The percentage of the population who would respond to a given dose of a drug

9. Additional Terminology Continued • Lethal dose (LD) • The percentage of the population that, in theory, would die from a certain dose of a chemical • Therapeutic Index (TI) • Used to determine the safety of a drug • “The ratio between the effectiveness of a chemical and its potential for harm” (Doweiko, 2009) • Drug half-life • The period of time required for the individual to get rid of 50 percent of an ingested dose of a drug (Liska, 1997)

10. Central Nervous System Depressants • Includes CNS depressants, sedatives, or sedative-hypnotics • Work on the brain and body by slowing down nervous tissue throughout the nervous system • General effects: slurred speech, disorientation, drunken behavior, relaxed inhibitions • Withdrawal symptoms: anxiety, insomnia, tremors, delirium, convulsions, or death • Common CNS depressants: alcohol, barbiturates, and benzodiazepines

11. Alcohol • Effects and dangers • Slows down general physiological functioning • Metabolized by the liver, which can be overworked • Continued use can lead to physical and medical problems: • --Liver disease • --Impairs quality of sleep and sexual functioning • --Wernicke’s syndrome and Korsakoff’s syndrome implicated with long-term alcohol use

12. Barbiturates • Powerful sedatives used to aid anxiety and sleep and to control seizures • Phenobarbital, pentobarbital, secobarbital, and amobarbital • Effects and dangers • --Have a small TI • --Excessive doses inhibit the respiratory centers in the brain • --Can slow down physiological functioning to the point of breathing cessation • --Lower inhibitions, enhance mood, increase self- esteem, vigor and confidence,

13. Benzodiazepines • Most commonly prescribed drugs for sleep problems, acute stress reactions, convulsions, and anxiety • Safer sedatives than Barbiturates due to the higher TI • Dangerous when combined with other CNS depressants • Effects and dangers • --Cross-tolerance and potentiation are common • --Can develop physiological addiction

14. Central Nervous System Stimulants • CNS stimulants, uppers • Opposite effect on the brain as CNS depressants • General effects: elevation of mood, increased feelings of well-being, and increased energy and alertness (NIDA, 2011) • Withdrawal symptoms: apathy, long periods of sleep, irritability, depression and disorientation • Common CNS stimulants: amphetamines, methamphetamines, cocaine, ecstasy, Ritalin, and Adderall

15. Amphetamines • Many come in pill form and are prescribed to treat disorders such as Attention-Deficit Hyperactivity Disorder (ADHD) • Effects and dangers • Produce feelings of euphoria • Relief from fatigue • Increase mental alertness • Enhance mood • Insomnia • Irregular heartbeat • Mild paranoia • Cardiovascular effects

16. Methamphetamines • A derivative of amphetamine and comes in clear crystals or powder that is odorless and colorless • Effects and dangers • Increasing activity and feelings of euphoria • Increased anxiety, confusion, paranoia and aggression • Psychotic behavior • Hallucinations • Respiratory problems • Cardiovascular problems • Extreme weight loss/anorexia • Meth mouth

17. Cocaine • Two common forms: powder cocaine and crack cocaine • Effects and dangers • Increased feelings of well-being, self-confidence, and power • Enhanced alertness and energy • Decreased anxiety • Heightened sex drive • Cardiovascular problems • Irritability, nervousness and agitation • Strong connection between cocaine use and depression • Increased respiratory function and blood pressure • Mimics manic symptoms

18. Opiates • Also referred to as narcotics and used to kill pain (analgesics) • Commonly experience a rush of pleasure followed by a dreamy, pleasant state • General effects: slowed breathing, flushed skin, drowsiness, reduction in pain, sense of tranquility, and pinpoint pupils • Withdrawal symptoms: dilated pupils, vasodilation, rapid heartbeat, elevated blood pressure, vomiting, diarrhea, goose bumps, tremors, chills, nausea, cramps and loss of appetite • Common opiates: opium, heroin, morphine, codeine, prescription pain killers

19. Heroin • Creates a rapid experience of a “rush” or “flash” of pleasure • Effects and danger • Initial surge of euphoria followed by a dreamlike state of drowsiness • Clouded mental functioning • Increased self-esteem and decreased concern for life stressors • HIV and hepatitis (from sharing needles) • Heart, lung, kidney, liver, or brain damage • Pulmonary complications • Strong addiction potential-small window between abuse and addiction

20. Prescription Pain Medication • Oxycodone, Oxycontin, Percocet, Percodan, and Vicodin • Effects and Dangers • Similar effects as heroin without the initial rush • Drowsiness, constipation, nausea, and depressed breathing • Euphoria, lack of motivation, pain relief • Potential for physical addiction and withdrawal symptoms

21. Hallucinogens • Produce visual and/or auditory perceptual distortions • General effects: feelings of detachment, emotional ups and downs, and altered sensations, hallucinations, pseudo-hallucinations and illusions • Psychological addiction may occur, but physical addiction does not • Common hallucinogens: lysergic acid (LSD), MDMA (ecstasy), phencyclidine (PCP)

22. PCP and LSD • Effects and dangers of PCP • Increased feelings of well-being, manic-like symptoms • belligerence, agitation • Coma, seizures, death • Body dysmorphic effects, increased blood pressure, dizziness, nausea, blurred vision, no experience of pain, hallucinations, aggression • Effects and dangers of LSD • Numbness, weakness, trembling, elevated heart rate and blood pressure, dilated pupils, nausea, dizziness • Enhanced visual effects, wavelike motions, feelings of euphoria, distorted space perceptions and slowing of time • Sleeplessness, dry mouth, tremors, flashbacks, psychopathology

23. Marijuana • Tetrahydrocannabinol (THC) is the main psychoactive ingredient • Difficult to classify, but legally considered a Schedule I narcotic • Effects and dangers • Effects mood, memory, coordination, cognitive ability and sense perception • Wide range of effects including mild euphoria, perceptual and time distortions, low motivation, hallucinations and body image distortions • Respiratory problems • Impaired reaction time • Lower intensity of dependence

24. Inhalants • A group of substances made up of assorted chemical structures that produce a state of intoxication when inhaled • Often commonly kept household items, such as glue, aerosols, gasoline, spray paint, cleaning products, etc. • Hydrocarbon is the active ingredient • Popular among youth • Effects and dangers • Altered state, delirium, restlessness, confusion, disorientation • High potential for danger when combined with other drugs • Coma or death

25. Schedule of Substances • Controlled Substances Act-categorized all drugs into five schedules based on abuse potential and medicinal value • The lowest level (Schedule I) drugs are the most dangerous, have no medicinal value and have a high abuse/addiction potential