chapter 12

Dependence of marijuana

Although marijuana is less addictive than heroin or tobacco, it can cause dependence. One in six of those who start smoking pot at younger ages may become addicted. Young users also show significant impairment in brain development and functioning. Marijuana also increases the risk of respiratory problems, stroke, and cancer in users of all ages.

Among young people (ages 16 to 25), the following behaviors indicate increased risk of problem gambling:

Being male. Gambling at an early age (as young as age 8). Having a big win early in one's gambling career. Consistently chasing losses (betting more to recover money already lost). Gambling alone. Feeling depressed before gambling. Feeling excited and aroused during gambling. Behaving irrationally during gambling. Having poor grades at school. Engaging in other addictive behaviors (smoking, drinking alcohol, and using illegal drugs). Lower socioeconomic class. Parent with a gambling or other addiction problem. A history of delinquency or stealing money to fund gambling. Skipping class to go gambling.

Researchers have identified key indicators associated with "pathological" gambling:

Gambling more than once a month. Gambling more than 2 hours at a time. Wagering more than 10 percent of monthly income. A combination of parental gambling problems, gambling frequency, and psychological distress.

Risks and Potential Health Consequences Pregnancy

Lower birth weight. More health problems after birth. Impaired motor development in nursing infants whose mothers smoke pot.

Cancer and marijuana

Marijuana smoke contains known cancer-causing chemicals. Some studies have suggested a link with cancers of the head and neck, lungs, and testicles, but most of the subjects also smoked tobacco, so the findings are inconclusive.

Causes of Substance Use Disorders

No one fully understands why some people develop drug dependence or substance use disorders, whereas others, who may experiment briefly with drugs, do not. Inherited body chemistry, genetic factors, and sensitivity to drugs may make some individuals more susceptible than others. These disorders may stem from many complex causes.

The dangers of nonadherence (not properly taking prescription drugs) include:

Recurrent infections. Serious medical complications. Emergency hospital treatment.

Doctors recommend that all adults limit their caffeine intake to 500 milligrams a day, with lesser amounts for those who have heart problems, high blood pressure, or trouble sleeping or who are taking medications. The recommended maximum for adolescents is 100 milligrams of caffeine a day. Ingesting more than 250 milligrams of caffeine may produce caffeine intoxication, which is diagnosed on the basis of five or more of the following signs and symptoms:

Restlessness. Nervousness. Excitement. Insomnia. Flushed face. Increased urination. Digestive disturbances. Muscle twitching. Rambling thoughts or speech. Rapid or irregular heart rate. Periods of inexhaustibility. Agitation.

Environmental health.

The use of some substances, such as tobacco, directly harms the environment. Abusers of alcohol and drugs also pose indirect threats to others because their behavior can lead to injury and damage.

During its early stages, the opioid epidemic took its highest toll in rural areas and small towns. Over time, larger cities also have been affected, with a sharp increase in opioid-related emergency department visits, hospitalizations, and overdose deaths. Demographic characteristics of heroin users have also changed, from younger nonwhite individuals in more urban areas to older white men and women in nonurban areas, many of whom first used prescription opioids prior to using heroin.

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Various factors influence which students use drugs, including the following:

Genetics and family history. Some college students inherit a genetic or biological predisposition to substance abuse. Researchers have identified specific genes tied to all types of addictions. Some genes associated with alcohol dependence are closely linked with addictions to marijuana, nicotine, cocaine, heroin, and other substances. Also, the risk for problem drinking and alcohol abuse is higher among children of substance abusers. Parental attitudes and behavior. Parents' concerns or expectations influence whether and how much most students drink, smoke, or use drugs. Those who perceive that their parents approve of their drinking, for instance, are more likely to report a drinking-related problem, such as memory loss or missing class. Check-in How would you describe your parents' attitudes toward alcohol and drugs? Substance use in high school. Many students start abusing drugs or alcohol well before getting to college. Misusing alcohol or drugs before age 15 increases by four times the risk of a substance abuse disorder later in life. Social norms. College students tend to overestimate drug use on campus. In the ACHA survey, students reported believing that 10.4 percent of undergraduates had never used marijuana. In fact, 66.5 percent never had. Positive expectations. Many students expect a drug to make them feel less stressed or anxious, more relaxed or confident, less shy or inhibited. Among students who use illicit drugs, many say that they do so to relieve stress. Self-medication. Some students take drugs to relieve depression or anxiety. Some abuse prescription medications, such as Adderall and Ritalin, because they mistakenly think these drugs will energize them to study longer or perform better. Risk perception. Individuals who view marijuana as not harmful, for instance, are more than nine times as likely to report having used the drug in the past. Mental health problems. Students with feelings of hopelessness, sadness, depression, and anxiety as well as those with clinical mental disorders have higher rates of prescription drug abuse and illegal drug use. Students diagnosed with depression in the past school year have higher rates of marijuana, cocaine, alcohol, and tobacco use. Those with a history of ADHD (discussed in Chapter 2) are more likely to report having used marijuana and other illicit drugs, to begin use at a younger age, and to suffer higher levels of impairment. Social influences. More than 9 in 10 students who use illegal drugs were introduced to the habit through friends; most use drugs with friends. Sorority and fraternity members, who tend to socialize more often than their peers, are more likely to abuse prescription stimulants, but students who live off campus have higher rates of marijuana and cocaine use. Alcohol use. Often individuals engage in more than one risky behavior. Researchers have found that students who report binge drinking are much more likely than other students to report current or past use of marijuana, cocaine, or other illegal drugs. Race/ethnicity. In general, white students have higher levels of alcohol and drug use than do African American students. African American students at historically black colleges tend to have lower rates of alcohol and drug use than did either white or African American students at predominantly white schools. The reason may be that these colleges provide a greater sense of self-esteem, which helps prevent alcohol and drug use. Sexual identity. Gay, lesbian, and bisexual teens may rely on alcohol and marijuana to lessen social anxiety and boost self-confidence when they first come out. However, once they become more involved in the gay community, many are less likely to do so. Nonetheless, lesbians are significantly more likely than heterosexual women to use marijuana, Ecstasy, and other drugs. Gay and bisexual men are significantly less likely than heterosexual men to drink heavily but more likely to use drugs. Media influences. In a recent survey, watching reality television and identifying with drug-using characters were associated with greater illegal drug use by college students.

Inhalants

Inhalants or deliriants (called Poppers, Snappers, or Whippets) are chemicals that produce vapors with psychoactive effects. The most commonly abused inhalants are solvents, aerosols, model-airplane glue, fabric protectors, cleaning fluids, and petroleum products such as kerosene and butane. Some anesthetics and nitrous oxide (laughing gas) are also abused. Only alcohol is a more widely used intoxicant among preteens and teens. Young people who have been treated for mental health problems, have a history of foster care, or already abuse other drugs have an increased risk of abusing or becoming dependent on inhalants. In addition, adolescents who first begin using inhalants at an early age are more likely to become dependent on them. Approximately 11 percent of adolescents nationwide report having used inhalants in their lifetime. Many report coexisting multiple drug abuse and dependence, mental health treatment, and delinquent behaviors. Inhalants very rapidly reach the lungs, bloodstream, and other parts of the body. At low doses, users may feel slightly stimulated; at higher doses, they may feel less inhibited. Intoxication often occurs within 5 minutes and can last more than an hour. Inhalant users do not report the intense rush associated with other drugs, nor do they experience the perceptual changes associated with LSD. However, inhalants interfere with thinking and impulse control, so users may act in dangerous or destructive ways. Often there are visible external signs of use, such as: Rash around the nose and mouth. Breath odor. Residue on the face, hands, and clothing. Redness, swelling, and tearing of the eyes, and Irritation of the throat, lungs, and nose that leads to coughing and gagging. Nausea and headache. Regular use of inhalants leads to tolerance, so the sniffer needs more and more to attain the desired effects. Younger children who use inhalants several times a week may develop dependence. Older users who become dependent may use the drugs many times a day. Although some young people believe inhalants are safe, this is far from true. Inhalation of butane from cigarette lighters displaces oxygen in the lungs, causing suffocation. Users can also suffocate while covering their heads with a plastic bag to inhale a substance or from inhaling vomit into their lungs while high. The effects of inhalants are unpredictable, and even a single episode can trigger asphyxiation or cardiac arrhythmia, leading to disability or death. Other adverse effects include: Difficulties with memory and abstract reasoning. Lack of coordination. Uncontrollable movements of the extremities. Confusion. Hallucinations. Convulsions or seizures. Liver and kidney damage. Damage to bone marrow. Sudden "sniffing" deaths due to heart failure, asphyxiation, suffocation, and choking.

Polyabuse

Most users prefer a certain type of drug but also use several others; this behavior is called polyabuse. The average user who enters treatment is on five different drugs. The more drugs anyone uses, the greater the chance of side effects, complications, and possibly life-threatening interactions.

Prescription Drug Abuse

Nonmedical use of any prescription medication is highest among young adults between the ages of 18 and 25, compared with other age groups.

Legalized Marijuana

Residents of more than 33 states and the District of Columbia are considering or have voted to remove criminal and civil penalties for the adult possession of up to 1 ounce of cannabis. However, the possession and sale of marijuana remain illegal under federal law. Medical scientists and policy experts are monitoring the effects of marijuana decriminalization on health, safety, crime, and other dimensions of daily life, but the impact is not yet clear. Some see legalized marijuana as no more (or less) perilous than alcohol; others fear that legalization will increase use by young people under age 21, marijuana-related accidents, and serious health consequences. Colorado, for instance, has reported a steep increase in pot-related emergencies.

Intellectual health.

The brain is one of the targets of alcohol and drugs. Under their influence, logic and reasoning break down. Impulses become more difficult to control. Judgment falters. Certain substances, such as Ecstasy, can lead to permanent changes in brain chemistry.

Like OTC drugs, many prescribed medications aren't taken the way they should be; millions simply aren't taken at all. As many as 70 percent of adults have trouble understanding dosage information, and 30 percent can't read standard labels, according to the FDA, which has called for larger, clearer drug labeling.

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Risks and Potential Health Consequences Brain and Central Nervous System

Causes brain abnormalities. Dulls sensory and cognitive skills. Impairs short-term memory. Alters motor coordination. Causes changes in brain chemistry. Leads to difficulty in concentration, attention to detail, and learning new complex information. Increases risk of stroke. Increases risk of psychotic symptoms. Causes disturbed sleep.

Risks and Potential Health Consequences Respiratory System

Damages the lungs (50 percent more tar than tobacco). May cause lung cancer. May damage throat from inhalation.

Risks and Potential Health Consequences Lungs

Effects similar to those of smoking tobacco, although long-term effects on pulmonary function may vary. Frequent respiratory infections. Chronic bronchitis. Emphysema.

Amphetamine intoxication can lead to:

Feelings of grandiosity, anxiety, tension, hypervigilance, anger, social hypersensitivity, fighting, jitteriness or agitation, paranoia, and impaired judgment in social or occupational functioning. Increased heart rate, dilated pupils, elevated blood pressure, perspiration or chills, and nausea or vomiting. Less frequent effects, such as speeding up or slowing down of physical movement; muscular weakness; impaired breathing, chest pain, heart arrhythmia; confusion, seizures, impaired movements or muscle tone; or even coma. In high doses, a rapid or irregular heartbeat, tremors, loss of coordination, and collapse.

The characteristics of a substance use disorder include:

Taking a substance in larger amounts or over a longer period than was originally intended. A persistent desire to cut down or stop substance use. Unsuccessful efforts to decrease or discontinue use. A great deal of time given to obtaining the substance, using the substance, or recovering from its effects. Cravings, which may be so strong that a user cannot think of anything else. Failure to fulfill major obligations at work, school, or home because of substance use. Recurrent substance use in physically hazardous situations.

Risks and Potential Health Consequences Marijuana produces a range of effects in different organs (see Figure 12.4):

brain, heart, lungs, Brain and Central Nervous System, Cardiovascular System, Respiratory System, reproductive system, Pregnancy,

Herbal Drugs

Salvia, khat

Generic Drugs

The generic name is the chemical name for a drug. A specific drug may appear on the pharmacist's shelf under a variety of brand names, which tend to cost far more than the generic equivalent. About 75 percent of all prescriptions specify a brand name, but pharmacists may—and in some states must—switch to a generic drug unless the doctor specifically tells them not to. Prescriptions filled with generic drugs cost 20 to 85 percent less than their brand-name counterparts. Generic drugs have the same active ingredients as brand-name prescriptions, but their fillers and binders, which can affect the absorption of a drug, may be different. For some serious illnesses, the generics may not be as effective; some experts recommend sticking with brand names for heart medications, psychiatric drugs, and anticonvulsant drugs (for epilepsy and other seizure disorders).

Intoxication and Withdrawal

Intoxication refers to maladaptive behavioral, psychological, and physiologic changes that occur as a result of substance use. Withdrawal is the development of symptoms that cause significant psychological and physical distress when an individual reduces or stops drug use.

In low to moderate doses, marijuana typically creates:

A mild sense of euphoria. Slowed thinking and reaction time. A dreamy sort of self-absorption. Confusion. Some impairment in thinking and communicating. Heightened sensations of color, sound, and other stimuli. Impaired balance and coordination. Increased pulse rate, bloodshot eyes, and dry mouth and throat. Slowed reaction times. Impaired motor skills. Increased appetite. Diminished short-term memory and problems learning.

Health policy analysts blame the spread of the opioid epidemic on a combination of factors, including:

A successful marketing campaign to promote the use of prescription opioids for pain. Misleading messages that opioids carry a low risk of addiction and overdose. Exaggerated claims of efficacy. Weak regulation in some states to control nonmedical use of opioids. Social and political factors, including rising unemployment, declining local economies, and poor access to behavioral health treatment.

Club Drugs

A variety of drugs—MDMA, GHB, GBL, ketamine, fentanyl, Rohypnol, and nitrites—called club drugs—first became popular among teens and young adults at nightclubs, bars, and raves (i.e., night-long dances often held in warehouses or other unusual settings). Their use by teenagers has been dropping in recent years.

Drugs and Alcohol

About 4 in 10 current drinkers in the United States take prescription drugs that interact with alcohol. Depending on the medication, the combination could cause side effects that range from drowsiness to depressed breathing and lower heart rate. Alcohol can change the rate of metabolism and the effects of many different drugs. Because it dilates the blood vessels, alcohol can add to the dizziness sometimes caused by drugs for high blood pressure, angina, or depression. Also, its irritating effects on the stomach can worsen stomach upset from aspirin, ibuprofen, and other anti-inflammatory drugs.

Stimulants

Central nervous system stimulants are drugs that increase activity in some portion of the brain or spinal cord. Some stimulants increase motor activity and enhance mental alertness, and some combat mental fatigue. Amphetamine, methamphetamine, caffeine, cocaine, and khat are stimulants. As discussed on page 400, some college students use stimulant medications prescribed for others to boost their concentration and alertness.

Depressants

Depressants depress the central nervous system, reduce activity, and induce relaxation, drowsiness, or sleep. They include the benzodiazepines and barbiturates, the opioids, and alcohol.

Amphetamines pt 1

Drugs that trigger the release of epinephrine (adrenaline) and therefore stimulate the central nervous system include amphetamines such as benzedrine, dextroamphetamin, methamphetamine, Desoxyn, and related uppers such as the prescription drugs methylphenidate (Ritalin), pemoline (Cylert), and phenmetrazine (Preludin). They were once widely prescribed for weight control because they suppress appetite, but they have emerged as a global danger. Street Names: Bennies, Copilots, Crank, Dex, Meth, and Speed. How Administered: Taken orally or injected. How Users Feel: Agitated and restless. Talkative, moody, and irritable. Confused and anxious. Confident in one's ability to perform exceptionally well—although amphetamines do not boost performance or thinking. Violent.

Methamphetamine pt 2

How Users Feel: Smoking or injection causes an intense pleasurable sensation, called a rush or flash, that lasts only a few minutes. Oral or intranasal use produces a high but not a rush. Increased wakefulness and physical activity. Decreased appetite. Increased breathing, heart rate, blood pressure, and temperature. Irregular heartbeat. Risks and Possible Health Consequences: Users may become addicted quickly, using more methamphetamine more and more frequently. Despair and suicidal thinking can develop when the stimulant effect wears off. Even small amounts of methamphetamine can increase wakefulness and physical activity, depress appetite, and raise body temperature. Other effects on the central nervous system include: Irritability. Insomnia. Confusion. Aggressive behavior. Tremors. Convulsions. Anxiety. Paranoia. Intellectual impairment. Intense itching leading to skin sores from scratching. Depression. Increased heart rate and blood pressure. Irreversible damage to blood vessels in the brain, producing strokes. Damage to the frontal cortex of developing teen brains. Respiratory problems. Irregular heartbeat. Extreme loss of appetite and weight. Elevated body (and probably brain) temperature, sometimes resulting in convulsions and high fevers that can be fatal. Inability to cope with everyday problems. High risk of psychotic symptoms, such as hallucinations and delusions that may persist for months or years after use stops. "Meth mouth," with teeth turning a grayish-brown, twisting, falling out, and taking on a peculiar texture; about 40 percent of meth users have serious dental problems. Risky sex; meth has been linked to an increase in unsafe practices, including needle-sharing with partners, which has led to a spike in HIV and hepatitis C infections in gay communities. Abnormalities in brain regions associated with selective attention and in those associated with memory; the brain may recover somewhat after months of abstinence, but problems often remain. With long-term use, changes in brain chemistry that may lead to compulsive drug-seeking and that make addiction especially hard to overcome. Significantly increased risk of Parkinson's disease. Even after stopping use, chronic apathy and anhedonia (inability to experience pleasure).

Cocaine pt 4

Treatment: Overcoming an addiction to cocaine or another stimulant drug can be challenging. The FDA has not approved any medications for addictions to cocaine and other stimulants, but several drugs have shown promise. These include Antabuse, widely used for alcohol dependence; the muscle relaxant baclofen (Lioresal); the anticonvulsant topiramate (Topamax); and the stimulant modafinil (Provigil), used to treat narcolepsy. Among the behavioral approaches that have shown the greatest success are contingency management, which uses tangible rewards, such as vouchers for movies, to encourage abstinence, and the Matrix Model, which combines a 12-Step program, behavioral therapy, family education, and individual counseling. Exercise may help reduce craving and impulsivity.

Synthetic Designer Drugs

Unregulated psychoactive substances, often referred to as designer drugs, include marijuana-like smoking blends frequently branded as "K2" or "Spice," designer stimulant preparations of powders generally termed "bath salts," and various tablets or capsules frequently described as "party pills" or "research chemicals." Their use on college campuses has fallen in recent years. These compounds, many available legally via the Internet, may be sold as bath salts, plant food, insecticides, chicken feed, and research chemicals, often labeled "not for human consumption." Some are highly toxic industrial chemicals with potentially life-threatening adverse effects. Specific agents include methoxetamine, sold on the Internet as "legal ketamine"; piperazine derivatives, amphetamine-like compounds known as BZP, TMFPP, or "legal Ecstasy"; and Kratom, a legal plant product derived from a Southeast Asian tree with opium-like effects, as well as the drugs described in the following sections.

Motor Vehicle Accidents AND MARIJUANA

Fatal crashes have increased among drivers who tested positive for marijuana after the drug was legalized in their states.

Salvia pt 1

An herb, salvia (Salvia divinorum) is grown in southern Mexico and Central and South America. Its main active ingredient, salvinorin A, activates kappa opioid receptors that differ from those activated by the more commonly known opioids, such as heroin and morphine. Street Names: Diviner's Sage, Magic Mint, Maria Pastora, Sally-D, and Shepherdess's Herb. How Administered: Although it is traditionally ingested by chewing fresh leaves or drinking their extracted juices, S. divinorum can also be dried and smoked as a joint or in a water pipe or vaporized and inhaled.

Benzodiazepines and Barbiturates pt 2

Benzodiazepine sleeping pills have largely replaced the barbiturates, which were used medically in the past for inducing relaxation and sleep, relieving tension, and treating epileptic seizures. These drugs are usually taken by mouth in tablet, capsule, or liquid form. When used as a general anesthetic, benzodiazepines are administered intravenously. They differ widely in their mechanism of action, absorption rate, and metabolism, but all produce similar intoxication and withdrawal symptoms. Rohypnol, a trade name for flunitrazepam (called Circles, Forget-Me Pill, Lunch Money, Mexican Valium, Mind Eraser, Pings, R2, Reynolds, Rib, Roach, Rocha, Roofies, Rope, Rophie, Ruffles, Trip-And-Fall, and Wolfs) is one of the benzodiazepines that has been of particular concern for the past few years because of its abuse in date rape. When mixed with alcohol, Rohypnol, which is flavorless and odorless, can incapacitate victims and prevent them from resisting sexual assault. It produces "anterograde amnesia," which means individuals may not remember events they experienced while under the effects of the drug.

Dissociative Drugs

Drugs such as PCP (phencyclidine) and ketamine, initially developed as general anesthetics for surgery, distort perceptions of sight and sound and produce feelings of dissociation or detachment from the environment and self. They alter distribution of the neurotransmitter glutamate—which is involved in perception of pain, responses to the environment, and memory—in the brain. Because these mind-altering effects are not hallucinations, scientists refer to PCP and ketamine as "dissociative anesthetics." High doses of dextromethorphan, a widely available cough suppressant, and the herb salvia can produce effects similar to those of PCP and ketamine.

Khat pt 1

For centuries people in East Africa and the Arabian Peninsula consumed the fresh young leaves of the Catha edulis shrub in ways similar to our drinking coffee. Its active ingredients are two controlled substances, cathinone and cathine. Street Names: Abyssinian Tea, Catha, Chat, and Kat. How Administered: Chewed. How Users Feel: Less fatigue. More energy. Reduced appetite.

Herbal Ecstasy

Herbal Ecstasy, also known as Cloud Nine, Herbal Bliss, and Herbal X, is a mixture of stimulants such as ephedrine, pseudoephedrine, and caffeine. Sold in tablet or capsule form as a "natural" and safe alternative to Ecstasy, its ingredients vary greatly. Herbal Ecstasy can have dangerous and unpleasant side effects, including stroke, heart irregularities, and a disfiguring skin condition.

Amphetamines pt 2

If taken intravenously, a rush of elation and confidence as well as adverse effects, occur, including: Tremors. Rambling or incoherent speech. Headache. Palpitations. Paranoia. Excessive sweating. Unusual perceptions, such as ringing in the ears, a sensation of insects crawling on the skin, or hearing one's name called. High blood pressure. Convulsions. Cardiac arrest. Risks and Possible Health Consequences: Dependence with episodic or daily use. Bingeing—taking high doses over a period of several days—can lead to an extremely intense and unpleasant crash, characterized by a craving for the drug, shakiness, irritability, anxiety, and depression.

Risks and Potential Health Consequences of Herbal drugs:

Increased risk of death and stroke in those with heart disease. With compulsive use, manic behavior, grandiose illusions, paranoia, and hallucinations.

Ecstasy poses risks similar to those of cocaine and amphetamines, including:

Long-lasting confusion. Depression. Problems with attention, memory, and sleep. Drug craving. Severe anxiety. Paranoia. Muscle tension. Involuntary teeth clenching. Nausea and vomiting. Dizziness. Blurred vision. Rapid eye movement. Faintness. Chills. Sweating. Less interest in sex. Increases in heart rate and blood pressure, which pose a special risk for people with circulatory or heart disease. When combined with extended physical exertion, like dancing, hyperthermia (severe overheating), severe dehydration, serious increases in blood pressure, stroke, and heart attack. Without sufficient water, dehydration and heat stroke, which can be fatal; individuals with high blood pressure, heart trouble, or liver or kidney disease are in the greatest danger. Fatal damage and death when users drink large amounts of water to counteract drug-induced hyperthermia. Acute hepatitis, which can lead to liver failure; even after liver transplantation, the mortality rate for individuals with this condition is 50 percent. If combined with the antidepressants known as SSRIs (see Chapter 2), which modulate the mood-altering brain chemical serotonin, jaw-clenching, nausea, tremors, and, in extreme cases, potentially fatal elevations in body temperature. Although not a sexual stimulant (if anything, MDMA has the opposite effect), strong feelings of intimacy that may lead to risky sexual behavior. Risks to a developing fetus, including a greater likelihood of heart and skeletal abnormalities and long-term learning and memory impairments in children born to women who used MDMA during pregnancy.

The long-term effects of amphetamine abuse include:

Malnutrition. Skin disorders. Ulcers. Insomnia. Depression. Vitamin deficiencies. Brain damage that results in speech and thought disturbances. Sexual dysfunction. Withdrawal, characterized by fatigue, disturbing dreams, much more or less sleep than usual, increased appetite, and speeding up or slowing down of physical movements; depression and irritability may persist for months. Significantly increased risk of suicide.

Methamphetamine pt 1

Methamphetamine, an addictive stimulant that is less expensive and possibly more addictive than cocaine or heroin, has become America's leading problem drug. More than 12 million Americans have tried methamphetamine, and 1.5 million are regular users, according to federal estimates. The estimated annual economic cost of methamphetamine is $23.4 billion. In addition to causing respiratory problems, brain damage, and mental impairment, methamphetamine damages teeth. Made in illegal laboratories, methamphetamine is chemically related to amphetamine, but its effects on the central nervous system are greater. The release of large amounts of dopamine creates a sensation of euphoria, increased self-esteem, and alertness. Users also report a marked increase in sexual appetite, which often leads to risky sexual behaviors while under the drug's influence. Street Names: Chalk, Crank, Crystal, Fire, Meth, and Speed; methamphetamine hydrochloride, clear chunky crystals resembling ice that can be inhaled by smoking, is called Crystal, Glass, Ice, and Tina. How Administered: Snorted, smoked, injected, or ingested orally.

Ecstasy pt 1

Methylenedioxymethamphetamine (MDMA) is more commonly called Ecstacy on the streets. It is a synthetic compound with both stimulant and mildly hallucinogenic properties that belongs to a family of drugs called enactogens, which literally means "touching within." MDMA increases the activity of three brain chemicals: dopamine, norepinephrine, and serotonin. Medical emergencies related to the drug have increased 75 percent in recent years. Most Ecstasy users requiring emergency care were between ages 18 and 29. Street Names: Adam, Clarity, E, Lover's Speed, Peace, Uppers, X, and XTC. How Administered: Although it can be smoked, inhaled (snorted), or injected, Ecstasy is almost always taken as a pill or tablet. Its effects begin in 45 minutes and last for 3 to 6 hours. Ecstasy pills often contain a variety of other chemicals that increase the danger to users.

Treatment of Substance Dependence and Misuse

Most Americans with a substance use disorder never get professional help. The first step for a drug user is to admit that he or she is in fact an addict. If drug users are not forced to deal with their problem through some unexpected trauma, such as being fired or going bankrupt, those who care—family, friends, coworkers, and doctors—may have to confront them and insist that they do something about their addiction. Often such an intervention can be the turning point for an addict and his or her family. Treatment has proved equally successful for young people and for older adults. It also yields economic benefits. According to the Surgeon General, every dollar invested in treatment saves $4 in health-care costs and $7 in criminal justice system costs. Undergraduates who enter substance abuse treatment programs are more likely to complete them successfully than nonstudents, often in a shorter period. The reason may be that academics provides a source of external goals and optimism that improves motivation to change and enhances a sense of urgency to complete treatment. Treatment may take place in an outpatient setting, a residential facility, or a hospital. Increasingly, treatment thereafter is tailored to address coexisting or dual diagnoses. A personal treatment plan may consist of individual psychotherapy, marital and family therapy, medication, and behavior therapy. Once an individual has made the decision to seek help for substance abuse, the first step is usually detoxification, which involves clearing the drug from the body. The aim of chemical dependence treatment is to help individuals establish and maintain their recovery from alcohol and drugs of abuse. Recovery is a dynamic process of personal growth and healing in which the drug user makes the transition from a lifestyle of active substance use to a drug-free lifestyle. Anti-addiction medications that target neurotransmitters in the brain are becoming safer and more effective. With treatment, substance abusers are less prone to relapse. If they do return to drug use, their relapses tend to be shorter and less frequent.

The physical effects of cocaine use include:

Narrowed blood vessels. Dilated pupils. Elevated or lowered blood pressure. Perspiration or chills. Increased body temperature. Nausea and vomiting. Speeding up or slowing down of physical activity. Muscular weakness. Impaired breathing. Chest pain. Impaired movements or muscle tone. With prolonged snorting, ulceration of the mucous membrane of the nose and damage to the nasal septum (the membrane between the nostrils) severe enough to cause it to collapse. Sexual side effects. At low doses, delayed orgasm and heightened sensory awareness. With regular use, problems maintaining erections and ejaculating, low sperm counts, less active sperm, more abnormal sperm than in nonusers. Both male and female chronic cocaine users tend to lose interest in sex and have difficulty reaching orgasm. Increased risk of stroke, bleeding in the brain, coma, and potentially fatal brain seizures. Psychiatric or neurological complications with repeated or high doses, including impaired judgment, hyperactivity, panic attacks, nonstop babbling, feelings of suspicion and paranoia, and violent behavior (see Figure 12.5). The brain never learns to tolerate cocaine's negative effects; users may become incoherent and paranoid and may experience unusual sensations. Damage to the liver and lungs in freebasers. Smoking crack causes bronchitis and may promote the transmission of HIV through burned and bleeding lips. Some smokers have died of respiratory complications, such as pulmonary edema (buildup of fluid in the lungs). Rapid rise in heart rate and blood pressure, which can trigger the symptoms of a heart attack in young people Other cardiac complications, including arrhythmia (disruption of heart rhythm), angina (chest pain), and acute myocardial infarction (heart attack). Dangers to pregnant women and their babies, including miscarriages, developmental disorders, and life-threatening complications during birth; reduced fetal oxygen supply may interfere with the development of the fetal nervous system. Greatly increased risk of suicide.

Nitrites

Nitrites (amyl, butyl, and isobutyl nitrite) are clear, amber liquids that have had a history of abuse for more than three decades, especially in gay and bisexual men. Popular in dance clubs, they are used recreationally for a high feeling, a slowed sense of time, a carefree sense of well-being, and intensified sexual experiences. Sold in small glass ampoules containing individual doses, nitrites are usually inhaled and rapidly absorbed into the bloodstream. Users feel their physiological and psychological impact in seconds. Acute adverse effects include headache, dizziness, a drop in blood pressure, changes in heart rate, increased pressure within the eye, and skin flushing. Some individuals develop respiratory irritation and cough, sneezing, or difficulty breathing. Chronic use can lead to crusty skin lesions and chemical burns around the nose, mouth, and lips.

GHB and GBL

Once sold in health-food stores for its muscle-building and alleged fat-burning properties, gamma hydroxybutyrate (GHB)—also known as G, Georgia Home Boy, Grievous Bodily Harm, Liquid Ecstasy, Liquid X, Soap, and Scoop—was banned because of its effects on the brain and nervous system. The main ingredient is gamma butyrolactone (GBL), an industrial solvent often used to strip floors, which converts into GHB once ingested. GHB acts as a sedative while producing feelings of euphoria and heightened sexuality as well as confusion and impaired memory. Because of its amnesic properties, GHB has been used as a "date-rape" drug, similar to Rohypnol. Alcohol intensifies its effects, which typically last up to 4 hours. Large doses can cause someone to pass out in 15 minutes and fall into a coma within half an hour. Death can occur. Other side effects include aggressive behavior, nausea, amnesia, hallucinations, decreased heart rate, convulsions, and sometimes blackouts. Long-term use at high doses can lead to a withdrawal reaction: rapid heartbeat, tremor, insomnia, anxiety, and psychotic thoughts and hallucinations that last a few days to a week. GHB is addictive. Users who attempt to quit may experience significant withdrawal symptoms, including anxiety, tremors, and insomnia. Most symptoms decrease within 1 to 2 weeks of cessation, but severe psychological effects can last for weeks to months.

Young people may take club drugs to relax, energize, and enhance their social interactions, but a large number also experience negative consequences. As many as three in four report side effects such as:

Profuse sweating. Hot and cold flashes. Tingling or numbness. Blurred vision. Trouble sleeping. Hallucinations. Depression. Confusion. Anxiety. Irritability. Paranoia. Loss of libido (sex drive). Difficulty with their usual daily activities. Financial and work troubles.

Benzodiazepines and Barbiturates pt 4

Sedative-hypnotic drugs and alcohol together have a synergistic effect that can be dangerous or even lethal. For example, an individual's driving ability, already impaired by alcohol, will be made even worse, increasing the risk of an accident. Alcohol in combination with sedative-hypnotics leads to respiratory depression and may result in respiratory arrest and death. Withdrawal: Regular users of any of these drugs who become physically dependent should not try to cut down or quit on their own. If they try to quit suddenly, they run the risk of seizures, coma, and death. Withdrawal from sedative-hypnotic drugs may range from relatively mild discomfort to a severe syndrome with grand mal seizures, depending on the degree of dependence. Symptoms include: Malaise or weakness. Sweating. Rapid pulse. Coarse tremors (of the hands, tongue, or eyelids). Insomnia. Nausea or vomiting. Temporary hallucinations or illusions. Physical restlessness. Anxiety or irritability. Grand mal seizures. Withdrawal may begin within 2 to 3 days after stopping drug use, and symptoms may persist for many weeks.

12-Step Programs

Since its founding in 1935, Alcoholics Anonymous (AA)—the oldest, largest, and most successful self-help program in the world—has spawned a worldwide movement. Participation in 12-Step programs for drug abusers, such as Substance Anonymous, Narcotics Anonymous, and Cocaine Anonymous, is of fundamental importance in promoting and maintaining long-term abstinence. Based on the Alcoholics Anonymous model, "12 Step" programs have helped many people overcome addiction. The one requirement for membership is a desire to end a pattern of addictive behavior. The basic precept of 12-Step programs is that members have been powerless when it comes to controlling their addictive behavior on their own. Meetings are held daily in almost every city in the country. Some chapters, whose members often include disabled individuals or those in remote areas, meet via Internet chat rooms or electronic bulletin boards. There are no dues or fees for membership. Many individuals belong to several programs because they have several problems, such as alcoholism, substance abuse, and pathological gambling. All these programs have only one requirement for membership: a desire to stop an addictive behavior.

The drugs most likely to be taken incorrectly are those that treat problems with no obvious symptoms (such as high blood pressure), require complex dosage schedules, treat psychiatric disorders, or have unpleasant side effects. The most common reason that college students fail to take medicines as directed is forgetting. Others are concerned about cost, or they stop when they feel better.

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The more that students use mind-altering substances, the less they engage in drug-free activities. This may be because substance abuse diminishes the brain's chemical response to other forms of pleasure. As a result, the deliciousness of chocolate or the excitement of bungee-jumping fails to trigger the normal surge in dopamine, the brain's "feel-good" chemical. Instead, chronic substance abusers develop anhedonia, an inability to experience pleasure. t/f

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Without treatment, addiction becomes progressively more severe and can lead to disability, illness, or premature death. Like other chronic diseases, addiction often involves cycles of relapse frequently triggered by environmental cues and emotional stressors. These triggers also heighten activity and, as a recent landmark report from the Office of the Surgeon General documented, can and should be treated with evidence-based, compassionate care. t.\f

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The term problem gambling refers to all gambling-related problems, including mild or occasional ones. Here are some relevant key points:

Problem gambling has become more common than alcohol dependence among American adults. Two factors associated with higher risk are male gender and lack of family engagement. Levels of gambling, frequent gambling, and problem gambling increase during the teen years (even though underage gambling is illegal in most states), then peak in the 20s and 30s, and decline after age 70. Men are more than twice as likely as women to be frequent gamblers and reach their highest gambling rates in their late teens. Whites are much more likely to report gambling in the past year than blacks or Asians, but both African Americans and Native Americans report higher levels of frequent gambling.

As documented in numerous studies, caffeine can:

Relieve drowsiness. Boost performance at repetitive tasks. Improve memory for up to 14 hours after consumption. Improve performance and endurance during prolonged, exhaustive exercise. Enhance, to a lesser degree, short-term, high-intensity athletic performance. Sharpen concentration. Reduce fatigue. Increase alertness. Lower the risk of type 2 diabetes and cardiovascular disease. Possibly protect against Parkinson's disease, colon cancer, liver cirrhosis, gallstones, and stroke. Possibly relieve migraines, boost mood, and prevent cavities. Protect against depression. Possibly reduce the risk of endometrial cancer in women who drink four or more cups a day. Possibly lower the likelihood of multiple sclerosis in people drinking about six cups a day. Possibly delay or protect against late-life cognitive impairment or decline, especially in women, although researchers describe the evidence to date as "inconclusive."

Commonly Abused Drugs

The common drugs of abuse fall within these categories: cannabinoids, herbal drugs, club drugs, stimulants, dissociative drugs, hallucinogens, opioids, and other compounds.

Gamblers typically progress through various stages:

Winning. In the winning phase, they feel empowered by their winnings and success. Losing. Next comes the losing phase, during which gamblers try to win back their losses. Desperation. During the desperation phase, a gambler may resort to illegal activity, including stealing, to continue gambling. Giving up. In the giving-up phase, gamblers may desperately try to stay afloat in a game even though they realize they can't win.

Medical Marijuana

A growing number of states have passed voter referenda or legislative actions making marijuana available for a variety of medical conditions upon a doctor's recommendation. There is limited scientific evidence supporting the use of cannabis or cannabinoid drugs as a medical therapy. A recent comprehensive meta-analysis of clinical trials of medical marijuana found some benefits for relieving nausea and vomiting related to chemotherapy, specific pain syndromes, and spasticity from multiple sclerosis. Research has shown little or weak evidence for the use of marijuana in treating conditions such as hepatitis C, Crohn's disease, Parkinson's disease, and Tourette's syndrome. Common adverse effects among patients treated with marijuana included dizziness, dry mouth, nausea, fatigue, sleepiness, euphoria, vomiting, disorientation, drowsiness, confusion, loss of balance, and hallucinations. There is also a risk of dependence.

Fentanyl

A synthetic narcotic, fentanyl (the generic name for Sublimaze) was developed as an anesthetic. It may be 50 to 100 times more potent than morphine. Injected when used in surgery, fentanyl (called Apache, Cash, China Girl, China White, Dance Fever, Friend, Goodfella, Jackpot, Murder 8, Tango, and TNT) is usually snorted or smoked by abusers. It depresses the respiratory system, decreases blood pressure and heart rate, and slows the digestive tract, causing constipation. Side effects include nausea, dizziness, delirium, decreased blood pressure, vomiting, blurred vision, and respiratory and cardiac arrest, which can be fatal. Fentanyl is often combined with other drugs, especially heroin, which increases the potential for adverse reactions. The potential for addiction is extremely high.

Cocaine pt 1

A white crystalline powder, cocaine is extracted from the leaves of the South American coca plant. Street Names: Blow, Bump, C, Coke, Crack, Flake, Lady, Rock, Snow, and Toot. How Administered: Usually mixed with various sugars and local anesthetics like lidocaine and procaine, cocaine powder is generally inhaled. When sniffed or snorted, cocaine anesthetizes the nerve endings in the nose and relaxes the lung's bronchial muscles. Cocaine can be dissolved in water and injected intravenously. The drug is rapidly metabolized by the liver, so the high is relatively brief, typically lasting only about 20 minutes. This means that users commonly inject the drug repeatedly, increasing the risk of infection and damage to their veins. Cocaine alkaloid, or freebase, is obtained by removing the hydrochloride salt from cocaine powder. Freebasing is smoking the fumes of the alkaloid form of cocaine. Crack, pharmacologically identical to freebase, is a cheap, easy-to-use, widely available, smokable, and potent form of cocaine named for the popping sound it makes when burned. Because it is absorbed rapidly into the bloodstream and large doses reach the brain very quickly, it is particularly dangerous. However, its low price and easy availability have made it a common drug of abuse in poor urban areas.

Synthetic Cathinone pt 1

"Bath salts" are a new family of drugs that contain one or more synthetic chemicals related to cathinone, an amphetamine-like stimulant found naturally in the khat plant. They should not be confused with products like Epsom salts, which have no druglike properties. The majority of users are young men, most often between ages 20 and 29. Bath salts are usually a white or brown crystalline powder in small plastic or foil packages labeled "not for human consumption," may be labeled as "plant food"—or, more recently, as "jewelry cleaner" or "phone screen cleaner"—and sold online and in drug product stores under a variety of brand names. Street and Brand Names: Bath salts, Bloom, Cloud Nine, Cosmic Blast, Flakka, Ivory Wave, Lunar Wave, Scarface, Vanilla Sky, and White Lightning. How Administered: Typically swallowed, inhaled, or injected; the worst dangers are associated with snorting and needle injection. Bath salts contain various amphetamine-like chemicals, such as methylenedioxypyrovalerone (MDPV), mephedrone, and pyrovalerone. "Bath salts" are synthetic stimulants, often sold legally, that can cause dangerous physical and psychological effects.

Students who misuse stimulants typically perceive them as relatively safe, but they produce a range of effects.

*Short-Term Effects* Increased alertness, attention, and energy. Increased blood pressure and heart rate. Narrowed blood vessels. Increased blood sugar. With high doses: dangerously high body temperature and irregular heartbeat, heart failure, and seizures. *Long-Term Effects* Heart problems. Psychosis. Anger. Paranoia. Use of alcohol and other drugs. Risky behaviors, including unsafe sex and reckless driving.

CBD MORE INFO

*Street Names* Marijuana: Blunt, Bud, Dope, Ganja, Grass, Green, Herb, Joint, Mary Jane, Pot, Reefer, Trees, Smoke, Sinsemilla, Skunk, and Weed; Hashish: Boom, Gangster, Hash, and Hemp. *How Administered* Swallowed or smoked in a joint (hand-rolled cigarette) or pipe. It may also be drunk in tea or eaten as an ingredient in other foods (as when baked in brownies), though with a less predictable effect. *How Users Feel* The circumstances in which marijuana is smoked, the communal aspects of its use, and the user's experience, all can affect the way a marijuana-induced high feels.

Spiritual health.

Addictive behavior blocks the pursuit of meaning and inner fulfillment. As they rely more on a chemical or behavioral escape, individuals lose their sense of self and of connection with other people and with a spiritual higher power.

Prescription Drugs on Campus

About 12 percent of college students report using drugs that were not prescribed for them, including stimulants, painkillers, sedatives, and antidepressants. Among painkillers, oxycodone—the active ingredient in OxyContin— and hydrocodone are the most widely used. College women use more antidepressants; college men, more painkillers and stimulants.

Physical health.

Abuse of alcohol, tobacco, and drugs takes a toll on every organ system in the body, increasing the likelihood of disease, disability, and premature death. People who start using hard drugs, such as cocaine and amphetamines, as young adults and continue to use them in middle age have a fivefold increased risk of early death.

Principles of Drug Addiction Treatment Decades of scientific research have shown that treatment can help drug-addicted individuals stop drug use, avoid relapse, and successfully recover their lives. Based on this research, the National Institute on Drug Abuse (NIDA) has developed fundamental principles that characterize effective drug abuse treatment. They include the following:

Addiction is a complex but treatable disease that affects brain function and behavior. No single treatment is appropriate for everyone. Treatment needs to be readily available. Effective treatment attends to multiple needs of an individual, not just his or her drug abuse. Remaining in treatment for an adequate period of time is critical. Counseling—individual and/or group—and other behavioral therapies are the most commonly used forms of drug abuse treatment. Medications are an important element of treatment for many patients, especially when combined with counseling and other behavioral therapies. Many drug-addicted individuals also have other mental disorders. Medically assisted detoxification is only the first stage of addiction treatment and by itself does little to change long-term drug abuse. Treatment does not need to be voluntary to be effective. Drug use during treatment must be monitored continuously, as lapses during treatment do occur.

Social health

Addictive behavior strains and, in time, severs ties to family, friends, colleagues, and classmates. The primary relationship in the life of alcoholics or addicts is with a behavior or a drug. As addicts withdraw from others, they become increasingly isolated.

As discussed later in this chapter, abuse of these medications can cause serious, potentially fatal side effects, including:

Drowsiness. Increased sensitivity to pain. Constipation. Nausea, vomiting, and dry mouth. Sleepiness and dizziness. Confusion. Depression. Confusion. Slowed breathing. Death.

The Psychology of Vulnerability

Although scientists do not believe there is an addictive personality, certain individuals are at increased risk of drug dependence because of psychological factors, including: Difficulty controlling impulses. A lack of values that might constrain drug use (whether based in religion, family, or society). Low self-esteem. Feelings of powerlessness. Depression. The one psychological trait most often linked with drug use is denial. Young people in particular are absolutely convinced that they will never lose control or suffer in any way as a result of drug use. People with mental illness such as depression, anxiety, schizophrenia, or bipolar disorder have an increased risk for substance use. Individuals may self-administer drugs to treat psychiatric symptoms; for example, they may take sedating drugs to suppress a panic attack. An estimated 8.4 million adults in the United States have both a mental and substance use disorder. Users of illicit drugs are much more likely than the general population to think about suicide, according to the U.S. Substance Abuse and Mental Health Services Administration's (SAMHSA's) most recent National Survey on Drug Use and Health.

A drug can interact with other drugs in four different ways:

An additive interaction is one in which the resulting effect is equal to the sum of the effects of the different drugs used. A synergistic interaction is one in which the total effect of the two drugs taken together is greater than the sum of the effects the two drugs would have had if taken by themselves on separate occasions. Mixing barbiturates and alcohol, for example, has up to four times the depressant effect that either drug has alone. A drug can be potentiating—that is, one drug can increase the effect of another. Alcohol, for instance, can increase the drowsiness caused by antihistamines (antiallergy medications). Drugs can interact in an antagonistic fashion—that is, one drug can neutralize or block another drug with opposite effects. Tranquilizers, for example, may counter some of the nervousness and anxiety produced by cocaine.

Substance Use Disorders

An estimated 20.8 million Americans have a substance use disorder, defined by the American Psychiatric Association as "a cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues using the substance despite significant substance-related problems" (see Health Now!). Only 1 in 10 receives treatment. A key characteristic is an underlying change in brain circuits that may persist beyond detoxification, particularly in individuals with severe disorders. These brain changes may result in repeated relapses and intense craving for the drug.

Drugs can enter the body in a number of ways:

By swallowing: The most common way of taking a drug is by swallowing a tablet, capsule, or liquid. However, drugs taken orally don't reach the bloodstream as quickly as drugs introduced into the body by other means and may not have any effect for 30 minutes or more. By inhaling: Drugs can enter the body through the lungs either by inhaling smoke (e.g., from marijuana) or by inhaling gases, aerosol sprays, or fumes from solvents or other compounds that evaporate quickly. Young users of such inhalants, discussed later in this chapter, often soak a rag with fluid and press it over their nose. Or they may place inhalants in a plastic bag, put the bag over their nose and mouth, and take deep breaths—a practice called huffing that can produce serious, even fatal, consequences. By injecting: Drugs can be injected with a syringe subcutaneously (beneath the skin), intramuscularly (into muscle tissue, which is richly supplied with blood vessels), or intravenously (directly into a vein). Intravenous (IV) injection gets the drug into the bloodstream immediately (within seconds, in most cases); intramuscular injection involves moderately fast results (within a few minutes); and subcutaneous injection, more slowly (within 10 minutes).

CBD

Cannabidiol, or CBD, the second most-abundant cannabinoid in cannabis, comes in various strains, including some that are not psychoactive and do not produce the euphoric highs associated with THC. Although research is limited, CBD is being widely marketed as a treatment for pain, inflammation, anxiety, and other chronic conditions. CBD can be consumed like other cannabinoids—by smoking or vaporizing a CBD-rich flower, eating a CBD-infused edible, swallowing a CBD oil capsule, applying a CBD lotion, or using a CBD tincture under the tongue. The strongest scientific evidence has been in treating a rare form of childhood epilepsy.

Caffeine-containing energy drinks (CCEDs, in the medical literature) have become extremely popular, especially in Western and Asian countries. These fortified beverages differ from soft drinks or sports drinks in that they contain higher levels of caffeine—typically 500 milligrams or more—as well as sugars and dietary supplements. As consumption has increased, especially among adolescents and young adults, medical professionals have raised concerns about health impacts, including the following:

Disrupted sleep. Increased heart rate and blood pressure. Overweight and obesity. Heightened anxiety and tension. Hallucinations (with the equivalent of seven or more cups of coffee a day). Dehydration. Dental erosion. Possible contribution to seizures or stroke.

Psychological Side Effects

Dozens of drugs—both OTC and prescription—can cause changes in the way people think, feel, and behave. Unfortunately, neither patients nor their physicians usually connect such symptoms with medications. Doctors may not even mention potential mental and emotional problems because they don't want to scare patients away from what otherwise may be a very effective treatment. What you don't know about a drug's effects on your mind can hurt you. Among the medications most likely to cause psychiatric side effects are drugs for high blood pressure, heart disease, asthma, epilepsy, arthritis, Parkinson's disease, anxiety, insomnia, and depression. Some drugs—such as the powerful hormones called corticosteroids, used for asthma, autoimmune diseases, and cancer—can cause different psychiatric symptoms, depending on dosage and other factors. The older you are, the sicker you are, and the more medications you're taking, the greater your risk of developing some psychiatric side effects.

No drug is completely safe; all drugs have multiple effects that vary greatly in different people at different times. Knowing how drugs affect the brain, body, and behavior is crucial to understanding their impact and making responsible decisions about their use:

Drug abuse is a pattern of substance use resulting in negative consequences or impairment. Drug dependence is a pattern of continuing substance use despite cognitive, behavioral, and physical symptoms. Drug misuse is the taking of a drug for a purpose other than that for which it was intended or by a person other than for whom it was intended or not taking the recommended doses. Drug diversion is the transfer of a medication from the individual to whom it was prescribed to another person.

The Neurobiology of Dependence

Drug dependence is a brain disease triggered by frequent use of drugs that change the biochemistry and anatomy of neurons and alter the way they work. A major breakthrough in understanding dependence has been the discovery that certain mood-altering substances and experiences—a puff of marijuana, a slug of whiskey, a snort of cocaine, a big win at blackjack—trigger a rise in a brain chemical called dopamine, which is associated with feelings of satisfaction and euphoria. This brain chemical or neurotransmitter is one of the crucial messengers that link nerve cells in the brain, and its level rises during any pleasurable experience, whether it be a loving hug or a taste of chocolate. The mechanism governing the rise in dopamine levels is not the same for all drugs. Figure 12.2 shows the one for cocaine. Normally, after dopamine is released from the axon terminal of a neuron and activates dopamine receptors on the adjacent neuron, the dopamine is then transported back to its original neuron by "uptake pumps." Cocaine binds to the uptake pumps and prevents them from transporting dopamine back into the neuron terminal. So more dopamine builds up in the synapse and is free to activate more dopamine receptors.

Recovery

Health professionals describe opioid addiction as "a chronic relapsing brain disease." Because of the high rate of relapse, maintenance therapy is usually needed to prevent consumption of illegal opioids, such as heroin, and potentially fatal overdoses. The most effective maintenance therapies include methadone, buprenorphine, and extended-release naltrexone, combined with psychosocial therapy. Researchers are continuing to develop new approaches, including cannabinoids, to aid in recovery.

Risks and Potential Health Consequences HEART

Heart attacks and sudden death, even in healthy persons, shortly after smoking marijuana. Risk of elevated blood pressure and decreased oxygen supply to the heart muscle. If combined with cocaine, potentially deadly increases in heart rate and blood pressure.

Synthetic Marijuana pt 2

How Users Feel: Elevated mood. Relaxation. Altered perception. Effects similar to those of marijuana but in some cases much more intense. Risks and Potential Health Consequences: Confusion. Anxiety and paranoia. Hallucinations. Agitation. Extreme nervousness. Nausea and vomiting. Fast heartbeat. Elevated blood pressure. Tremors. Seizures. Heart attack. Acute, potentially fatal kidney failure. Users of synthetic marijuana have required emergency treatment for reactions such as paranoia, anxiety, agitation, high blood pressure, profuse sweating, palpitations, elevated heart rate, dizziness, slowed speech, confusion, muscle rigidity, and catatonia (an inability to respond to verbal or physical stimulation).

Salvia pt 2

How Users Feel: Hallucinations or "psychotomimetic" episodes (a transient experience that mimics a psychosis) that occur in less than a minute and last less than 30 minutes. Emotional swings. Laughter and euphoria. Feelings of detachment. Risks and Potential Health Consequences: Psychedelic-like changes in visual perception. Mood changes. Dizziness. Slurred speech, emotional swings, and a greatly altered perception of external reality and the self.

In 2017, the Department of Health and Human Services declared the opioid epidemic "a public health emergency" and outlined the five following strategies to address it:

Improve access to prevention, treatment, and recovery support services. Target the availability and distribution of overdose-reversing drugs. Strengthen public health data reporting and collection. Support cutting-edge research on addiction and pain. Advance the practice of pain management.

Synthetic Cathinone pt 2

How Users Feel: Intense stimulation. Alertness. Euphoria. Increased sociability. Heightened sex drive. Risks and Possible Health Consequences: The most common synthetic cathinone found in the blood and urine of patients admitted to emergency departments after taking bath salts raises brain dopamine in the same way as cocaine but is at least 10 times stronger. Its effects include. Paranoia. Agitation. Hallucinations. Depression. Panic attacks. Cloudy thinking. Break with reality. Reduced motor control. Increased heart rate and blood pressure. Nausea and vomiting. Nosebleeds. Sweating. Insomnia. Irritability. Dizziness. Suicidal thoughts. Violent behavior. Heart problems (such as racing heart, high blood pressure, and chest pains). Kidney failure. "Excited delirium," characterized by dehydration, breakdown of skeletal muscle tissue, and kidney failure. Suicide; those who survive suicide attempts may suffer long-term psychiatric symptoms.

Benzodiazepines and Barbiturates pt 3

How Users Feel: Reduced or relieved tension with low doses. Loosening of sexual or aggressive inhibitions with increasing doses. Rapid mood changes. Impaired judgment. Impaired social or occupational functioning. Risks and Potential Health Consequences: All sedative-hypnotic drugs can produce physical and psychological dependence within 2 to 4 weeks. A complication specific to sedatives is cross-tolerance (cross-addiction), which occurs when users develop tolerance for one sedative or become dependent on it and develop tolerance for other sedatives as well. Adverse effects include: Decreased blood pressure. Drowsiness and sedation. Visual disturbances. Headache. Slowed breathing and heart rate. Dizziness. Blacking out. Confusion. Urinary retention. Digestive problems. Changes in mood or behavior, such as inappropriate sexual or aggressive acts. Mood swings. Impaired judgment. Slurred speech. Poor coordination. Unsteady gait. Involuntary eye movements. Impaired attention or memory. Stupor or coma.

Ecstasy pt 2

How Users Feel: Relaxation and euphoria. Lower inhibitions. Sense of connectedness with others; in some settings, they reveal intimate details of their lives (which they may later regret), and in other settings, they join in collective rejoicing. Enhanced sensory experience. In rare cases, visual distortions, sudden mood changes, or psychotic reactions. In regular users, depression and anxiety the week after taking MDMA. The psychological effects of Ecstasy become less intriguing with repeated use, and the physical side effects become more uncomfortable. Risks and Potential Health Consequences: Ecstasy is more likely than other stimulants, such as methamphetamine, to kill young, healthy people between the ages of 16 and 24 who are not known to be regular drug users. Researchers theorize that young people's brains, which are still developing in late adolescence and early adulthood, may be more vulnerable to the effects of the drug.

Cocaine pt 2

How Users Feel: A powerful stimulant to the central nervous system, cocaine targets several chemical sites in the brain, producing: Feelings of soaring well-being. Boundless energy. Restlessness and anxiety, although users feel that they have enormous physical and mental ability. After a brief period of euphoria, users slump into a depression. They often go on cocaine binges, lasting from a few hours to several days, and consume large quantities of cocaine. Crack cocaine is produced by mixing cocaine with baking soda and water and then heated to produce small chunks or rocks, which can be smoked. It was dubbed "crack" because smoking rocks produces a crackling sound. Crack cocaine can be injected as well as smoked. Dependence develops quickly. As soon as crack users come down from one high, they want more crack. Whereas heroin addicts may shoot up several times a day, crack addicts need another hit within minutes. Thus, a crack habit can quickly become more expensive than heroin addiction. Risks and Potential Health Consequences: Cocaine dependence is an easy habit to acquire. With repeated use, the brain becomes tolerant of the drug's stimulant effects, and users must take more of it to get high. Those who smoke or inject cocaine can develop dependence within weeks. Those who sniff cocaine may not become dependent on the drug for months or years. It is thought that 5 to 20 percent of all coke users—a group as large as the estimated total number of heroin addicts—are dependent on the drug.

Opioids pt 3

How Users Feel: All opioids relax the user. When injected, they can produce an immediate rush (high) that lasts 10 to 30 minutes. For 2 to 6 hours thereafter, users may feel indifferent, lethargic, and drowsy; they may slur their words and have problems paying attention, remembering, and going about their normal routine. The primary attractions of heroin are the euphoria and pain relief it produces. However, some people experience very unpleasant feelings, such as anxiety and fear. Other effects include: Sensation of warmth or heaviness. Clouded thinking. Itching. Alternate wakeful and drowsy states. Dry mouth. Facial flushing. Nausea and vomiting (particularly in first-time users). Risks and Potential Health Consequences: Addiction is common. Almost all regular users of opioids rapidly develop drug dependence, which can lead to lethargy, weight loss, loss of sex drive, and the continual effort to avoid withdrawal symptoms through repeated drug administration. Users continue taking opioids as much to avoid the discomfort of withdrawal, a classic sign of opioid addiction, as to experience pleasure. In addition, they may experience adverse effects, including: Anxiety. Insomnia. Restlessness. Craving for the drug. Constricted pupils (although pupils may dilate from a severe overdose). Drowsiness. Slurred speech. Impaired attention or memory. Collapsed veins. Infection of the lining and valves in the heart. Pneumonia. Liver or kidney disease. In pregnant women, increased risk of miscarriage, stillbirth, or low birth weight; babies born to addicted mothers experience withdrawal symptoms after birth.

The American Academy of Pediatrics has officially opposed legalizing marijuana because greater access may lead to greater use by teens and increased risks, including:

Impaired memory and concentration. Interference with learning. Lower odds of completing high school or obtaining a college degree. Impaired motor control, coordination, and judgment, which may contribute to unintentional deaths and injuries. Psychological problems, poorer lung health, and a higher likelihood of drug dependence in adulthood.

Risks and Potential Health Consequences Reproductive System

In women, may impair ovulation and cause fetal abnormalities if used during pregnancy. In men, may suppress sexual functioning and may reduce the number, quality, and motility of sperm, possibly affecting fertility.

Once people thought of addiction—a compulsive need for and reliance on a habit-forming substance or behavior—as a moral issue. We now understand that addiction is a chronic illness that affects brain, body, and spirit. According to the American Society of Addiction Medicine, its characteristics are:

Inability to abstain from use of a substance. Craving or "hunger" for a substance or rewarding experience. Diminished recognition of significant problems with one's behavior and interpersonal relationships. Dysfunctional or unhealthy emotional response.

Risks and Potential Health Consequences Cardiovascular System

Increases heart rate. Increases blood pressure. Decreases blood flow to the limbs.

Ketamine

Ketamine—called K, Special-K, and Vitamin K—is an anesthetic used by veterinarians. When cooked, dried, and ground into powder for snorting, ketamine blocks chemical messengers in the brain that carry sensory input. As a result, the brain fills the void with hallucinations. Users may report an "out-of-body" experience, with distorted perceptions of time and space. The effects typically begin within 30 minutes and last for approximately 2 hours. Ketamine has become common in clubs and has been used as a date-rape drug. Low doses can cause: Impaired attention and memory. Anxiety. Agitation. Paranoia. Vomiting. Higher doses can cause: Delirium. Amnesia. Impaired motor function. High blood pressure. Depression. Potentially deadly breathing problems. Repeated ketamine use can be addictive, and even a single use can occasionally produce audiovisual "flashbacks," similar to those described by PCP users, and long-term memory loss.

The majority of undergraduates do not use illegal drugs or abuse prescription drugs. In general, students are more influenced by fear of negative consequences than by barriers such as not having money for drugs. Here are other factors that keep them drug-free:

Lack of interest. At one liberal arts college in the Northeast, 8 in 10 of the undergraduates who reported never taking prescription drugs for nonmedical reasons said they simply had no interest in doing so. Timing of enrollment. Students who delay enrollment or enter college at an older age are less likely to use drugs than those who enroll in college directly from high school. Spirituality and religion. The greater a student's religiousness or religiosity—terms that encompass prayer, attendance at religious services, and reading spiritual materials—the less likely the student is to use alcohol, illegal drugs, or tobacco. Academic engagement. Illicit drug use is much less common among students who actively participate in classes and feel connected with the subject matter. Socioeconomic status. Students from lower socioeconomic status are less likely to use illicit drugs or misuse prescription drugs than those from more affluent families. Athletics. Although male and female college athletes drink at higher rates than nonathletes, they are less likely to use illegal drugs. One exception is the use of anabolic steroids, which college athletes use more than other students.

Cannabinoids

Marijuana (pot) is derived from several species of the cannabis plant. Hashish is more potent than cannabis sativa, the most widespread cannabis plant. The major psychoactive ingredient in the cannabinoids is THC (delta-9-tetrahydrocannabinol). More than 100 million Americans have tried marijuana, the third most popular recreational drug in the United States (after alcohol and tobacco). According to government surveys, some 12 million Americans use cannabis; more than 1 million cannot control this use. An estimated 12.5 percent of adults report using marijuana in the previous year. On college campuses, marijuana remains the most widely used illicit drug. (See Student Snapshot in this chapter.) Because of careful cultivation, the strength of today's marijuana is much greater than that used in the 1960s and 1970s. Today, a marijuana joint contains 150 milligrams of THC, compared to 10 milligrams in the 1960s.

withdrawal of marijuana

Marijuana users can develop a compulsive, often uncontrollable craving for the drug. Stopping after long-term marijuana use can produce marijuana withdrawal syndrome, which is characterized by insomnia, restlessness, loss of appetite, and irritability. People who smoke marijuana daily for many years may become aggressive after they stop using it and may relapse to prevent aggression and other symptoms.

Beginning at a very early age, males and females show different patterns in drug use:

Men generally encounter more opportunities to use drugs than women do and are more likely to use drugs to fit into a group. Women abusing certain drugs tend to "escalate" or increase use more rapidly than men and to suffer more negative effects. Women often encounter more barriers to treatment for substance use disorders, but both men and women have similar outcomes after treatment. Given an opportunity to use drugs for the first time, both sexes are equally likely to do so and to progress from initial use to dependence. Men and women are equally likely to become addicted to or dependent on cocaine, heroin, hallucinogens, tobacco, and inhalants. Women are more likely than men to become addicted to or dependent on sedatives and drugs designed to treat anxiety or sleeplessness. Men are more likely than women to abuse alcohol and marijuana. Male and female long-term cocaine users showed similar impairment in tests of concentration, memory, and academic achievement. Female cocaine users are more vulnerable to poor nutrition and below-average weight, depression, physical abuse, and, if pregnant, preterm labor or early delivery. Smoking marijuana, taking prescription painkillers, or using illegal drugs during pregnancy is associated with double or even triple the risk of stillbirth.

Coexisting Conditions

Mental disorders and substance use disorders have a great deal of overlap. Many individuals with substance use disorders also have another psychiatric disorder, such as depression. Individuals with such dual diagnoses require careful evaluation and appropriate treatment for the complete range of complex and chronic difficulties they face.

Buying Drugs Online

Millions of people in the United States purchase prescription medications online. Although some websites fill only faxed prescriptions from medical doctors, others ignore or sidestep traditional regulations and safeguards. Cyberspace distributors often ship pills across state lines without requiring a physical examination by a medical doctor. Instead, a "cyberdoc," who may or may not be qualified or up to date in a given specialty, reviews information submitted by a "patient." International pharmacies sometimes sell drugs that are not available or approved in the United States. And patients themselves use bulletin boards and other online resources to sell unused or unwanted medications to each other. Many individuals turn to the Internet for "lifestyle" drugs such as pills for erectile dysfunction, weight control, and smoking cessation. Customers like the convenience and anonymity of buying drugs online. Although many people assume that drugs cost less on the Internet, shipping costs tend to drive prices up to the same amount as or more than the price at a pharmacy. Consumers have to be wary. Ordering a drug like Accutane, an acne treatment, online may seem harmless. However, without close monitoring by a physician, you could develop complications, such as a bad reaction that aggravates hepatitis or inflames the pancreas. Quality control is another concern. Counterfeit drugs, increasingly sold online, may do little, if any, good and could be harmful. Cyberspace pharmacies provide no information on how the drug was stored or whether its expiration date has passed. In addition, since importing medications without a prescription is against the law, you could find yourself in legal trouble.

Here are more statistics on campus drug use from the Monitoring the Future study:

More than a third of college students— 38 percent—report marijuana use in the previous year. Fifty-five percent of students report use of an illicit drug during their lifetimes. Far fewer—26 percent—report use of drugs other than marijuana. Nonmedical use of prescription opioid, or narcotic, drugs, such as Oxycontin, Vicodin, Percocet, and fentanyl, in the previous year has fallen from nearly 9 percent a decade ago to around 3 percent. Use of heroin, another opioid, is low—about 1 percent. Thirteen percent of college students report that they have used amphetamines, 7 percent hallucinogens, 6.5 percent cocaine, and 5 percent LSD or Ecstasy. Use of synthetic marijuana products, such as salvia, "K-2," and "Spice," has fallen significantly. There has been little change in nonprescribed use of tranquilizers and sedatives in recent years.

Opioids pt 4

Morphine affects blood pressure, heart rate, and blood circulation in the brain. Both morphine and heroin slow the respiratory system; overdoses can cause fatal respiratory arrest. Over time, users who inject opioids may develop infections of the heart lining and valves, skin abscesses, and lung congestion. Infections from unsterile solutions, syringes, and shared needles can lead to hepatitis, tetanus, liver disease, and HIV. Depression is common and may be both an antecedent and a risk factor for needle sharing. Heroin overdose deaths have skyrocketed in recent years, quadrupling since 2000. More than 70,200 Americans died from drug overdoses in 2017, a twofold increase in a single decade. Withdrawal: If a regular user stops taking an opioid, withdrawal begins within 6 to 12 hours. The intensity of the symptoms depends on the degree of the addiction; they may grow stronger for 24 to 72 hours and gradually subside over a period of 7 to 14 days, though some symptoms, such as insomnia, may persist for several months. Individuals may develop craving for an opioid, irritability, nausea or vomiting, muscle aches, runny nose or eyes, dilated pupils, sweating, diarrhea, yawning, fever, and insomnia. Opioid withdrawal is usually not life threatening.

Physical Side Effects

Most medications, taken correctly, cause only minor complications. No drug is entirely without side effects for all individuals taking it. Serious complications that may occur include heart failure, heart attack, seizures, kidney and liver failure, severe blood disorders, birth defects, blindness, memory problems, and allergic reactions. Overdoses of opioid painkillers now cause more deaths than heroin and cocaine combined—one fatality every 19 minutes, according to the Centers for Disease Control and Prevention (CDC). Allergic reactions to drugs are common. The drugs that most often provoke allergic responses are penicillin and other antibiotics (drugs used to treat infection). Aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), sulfa drugs, barbiturates, anticonvulsants, insulin, and local anesthetics can also provoke allergic responses.

The United States is experiencing a deadly epidemic caused by addiction to opioids. These drugs, also discussed on page 397, are chemically similar to the neurotransmitters and other brain chemicals naturally produced by our bodies. They reduce the intensity of pain perception by interacting with opioid receptors in the spinal cord and brain. Opioids are classified into categories according to how they are manufactured:

Natural opiates, made from the opium poppy, such as morphine and codeine. Semisynthetic opioids, such as hydrocodone from codeine. Fully synthetic opioids, such as fentanyl and methadone. [The most prescribed opioids in the United States are hydrocodone and extended- and immediate-release oxycodone. According to federal estimates, 4.7 million individuals use prescription opioids nonmedically every month. Another 1.9 million are addicted to prescription opioids.]

The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), classifies persistent and recurrent problematic gambling that leads to significant impairment or distress as a gambling disorder, similar to other addictive disorders in its effects on brain and behavior. A diagnosis is made if individuals exhibit four or more of the following symptoms in a 12-month period:

Need to gamble with increasing amounts of money to achieve excitement. Becoming restless or irritable if they cut down or stop gambling. Repeated unsuccessful attempts to control, reduce, or stop gambling. Preoccupation with gambling. Gambling when feeling guilty, anxious, or distressed. After losing money, trying to recoup by "chasing" losses. Lying to conceal the extent of gambling. Putting a significant relationship, job, or opportunity in jeopardy because of gambling. Reliance on others for money to relieve desperate financial situations caused by gambling.

Drug Interactions

OTC and prescription drugs can interact in a variety of ways. For example, mixing some cold medications with tranquilizers can cause drowsiness and coordination problems, thus making driving dangerous. Moreover, what you eat or drink can impair or completely wipe out the effectiveness of drugs or lead to unexpected effects on the body. For instance, aspirin takes 5 to 10 times as long to be absorbed when taken with food or shortly after a meal than when taken on an empty stomach. If tetracyclines encounter calcium in the stomach, they bind together and cancel each other out. To avoid potentially dangerous interactions, do the following: Check the label(s) for any instructions on how or when to take a medication, such as "with a meal." If the directions say that you should take a drug on an empty stomach, take it at least 1 hour before eating or 2 to 3 hours after eating. Don't drink a hot beverage with a medication; the temperature may interfere with the effectiveness of the drug.

The following statistics summarize the toll of the epidemic in the United States:

On average, 130 Americans die every day from an opioid overdose. The rate of overdose deaths involving opioids has risen by 200 percent over the last 10 years. In the past decade, more than 700,000 people have died from a drug overdose. More than two-thirds of fatal drug overdoses involve an opioid. The number of overdose deaths involving opioids (including prescription opioids and illegal opioids like heroin and illicitly manufactured fentanyl) is six times higher than it was in 1999. Non-Hispanic whites, American Indians/Alaskan Natives, and people from lower socioeconomic backgrounds have experienced a higher prevalence of opioid misuse, addiction, and overdoses (see Figure 12.3).

Abuse of prescription medications on college campuses has increased in the last 15 years. Here is what we know about it:

Only marijuana use is more widespread on campus than prescription drug abuse. College men have higher rates of prescription drug abuse than women. White and Hispanic undergraduates are significantly more likely to abuse medications than are African American and Asian students. Undergraduates who misuse or abuse prescription medications are much more likely to report heavy binge drinking and use of illicit drugs. College women who abuse prescription drugs are at increased risk for sexual victimization and assault.

As many as half of all patients take the wrong medications, in the wrong doses, at the wrong times, or in the wrong ways. Every year these inadvertent errors lead to an estimated 125,000 deaths and more than $8.5 billion in hospital costs. Mistakes occur among people of all ages, both sexes, and every race, occupation, level of education, and personality type. Their number-one cause: not understanding directions. Doctors occasionally make errors when it comes to prescription drugs. The most frequent are

Over dosing or underdosing. Omitting information from prescriptions. Ordering the wrong dosage form (a pill instead of a liquid, for example). Not recognizing a patient's allergy to a drug.

More than half a million health products—remedies for everything from bad breath to bunions—are readily available without a doctor's prescription. This doesn't mean that they're necessarily safe or effective. Like other drugs, over- the-counter (OTC) medications can be used improperly, often simply because of a lack of education about proper use. Among those most often misused are the following:

Painkillers. Federal regulators have issued warnings for many popular painkillers, including OTC pills such as Advil (ibuprofen) and Aleve (naproxen). Their labels cite risks to the heart, stomach, and skin. Tylenol (acetaminophen) and aspirin are generally considered safe for people with temporary pain such as headaches and muscle aches. However, aspirin can cause stomach irritation and bleeding, and Tylenol, which is found in more than 600 OTC and prescription medications, poses multiple dangers (see Table 12.2). Nasal sprays. Nasal sprays relieve congestion by shrinking blood vessels in the nose. If they are used too often or for too many days in a row, the blood vessels widen instead of contract, and the surrounding tissues become swollen, causing more congestion. To make the vessels shrink again, many people use more spray more often. The result can be permanent damage to nasal membranes, bleeding, infection, and partial or complete loss of smell. Laxatives. Believing that they must have one bowel movement a day (a common misconception), many people rely on laxatives. Brands that contain phenolphthalein irritate the lining of the intestines and cause muscles to contract or tighten, often making constipation worse rather than better. Bulk laxatives are less dangerous, but regular use is not advised. A high-fiber diet and more exercise are safer and more effective remedies for constipation. Eye drops. Eye drops make the blood vessels of the eye contract. However, as in the case of nasal sprays, with overuse (several times a day for several weeks), the blood vessels expand, making the eye look redder than before. Sleep aids. Although OTC sleeping pills are widely used, there has been little research on their use and possible risks. A national consensus panel on insomnia concluded that they are not effective and cause side effects such as morning-after grogginess. Medications such as Tylenol PM and Excedrin PM combine a pain reliever with a sleep-inducing antihistamine, the same ingredient that people take for hay fever or cold symptoms. Although they make people drowsy, they can leave a groggy feeling the next day, and they dry out the nose and mouth. Cough syrup. Many of the "active" ingredients in OTC cough preparations may be ineffective. Young people may chug cough syrup (called roboing, after the OTC medication Robitussin) because they think of dextromethorphan (DXM), a common ingredient in cough medicine, as a "poor man's version" of the popular drug Ecstasy.

Risks and Potential Health Consequences BRAIN

Problems with memory and learning. Distorted perceptions. Difficulty thinking and solving problems. Loss of coordination. Increased anxiety. Panic attacks. Impaired verbal fluency, memory, and coordination. Disrupted sleep. Impaired brain development and possible lower IQ in adolescents and young adults. Psychotic symptoms (particularly in young users) and worsening of symptoms in those diagnosed with psychosis. Five times greater risk of alcohol abuse and addiction. Double the risk of stroke in young adults, even in those with no other risk factors. Significant brain abnormalities, including shrinkage of key structures involved in memory, learning, and emotion, that can lead to memory loss, difficulty learning new information, and psychotic symptoms. Younger users seem most susceptible. Cognitive impairment. Marijuana lowers performance in tests measuring memory, attention, reaction time, tracking, and motor function. The effects depend on the dose and are highest in the first hour after smoking marijuana or within 1 to 2 hours after oral intake. Frequent or heavy users show greater impairment than those who smoked marijuana an average of once a month. Psychological symptoms. Some users experience feelings of anxiety and/or paranoia, with hallucinations and other psychotic symptoms that may last for minutes, hours, or, in some cases, days. Studies have also linked marijuana use with an earlier age of onset and increased incidence of schizophrenia and other psychiatric disorders (discussed in Chapter 2).

MISUSE

Some drug users do not develop the symptoms of tolerance and withdrawal that characterize dependence, yet they use drugs in ways that clearly have a harmful effect on them. These individuals are diagnosed as having a psychoactive substance abuse disorder. They continue to use drugs despite their awareness of persistent or repeated social, occupational, psychological, or physical problems related to drug use, or they use drugs in dangerous ways or situations (before driving, for instance).

Psychological health

Sometimes people begin abusing substances or engaging in addictive behavior as a way of "self-medicating" symptoms of anxiety or depression. However, alcohol and drugs provide only temporary relief. As abuse continues, shame and guilt increase, and coping with daily stressors becomes more difficult. Depression and anxiety are as likely to be consequences as causes of substance abuse.

Prescription Stimulants

Stimulants are among the most widely abused prescription drugs on campus, with about 6 percent of students reporting their misuse. The most widespread are Adrenal, Benzedrine, Concerta, and Ritalin. Their street names include Bennies, Black Beauties, Crosses, Hearts, Users, Truck Drivers, Skippy, and Vitamin R (for Ritalin). Misuse of the prescription drug Adderall, which increases brain chemicals linked with better cognitive functioning and has a false reputation for making people smarter, has surged among young adults ages 18 to 25. (See page 407 for more on stimulants.) Users generally obtain these drugs from peers with prescriptions for the treatment of attention-deficit/hyperactivity disorder (ADHD), which affects an estimated 2 to 8 percent of undergraduates. They are more likely than other students to be Caucasian, male upperclassmen rather than freshmen or sophomores, from higher-income families, and members of fraternities and sororities. Students generally take stimulants to focus better while studying, stay awake to study longer, and improve their grades. However, a meta-analysis of existing research found no scientific basis for these alleged benefits. The lower a student's GPA, the greater the odds of stimulant misuse, which is also associated with skipping class and studying less. Other reasons for stimulant misuse include wanting to get high, to prolong the effects of alcohol and other drugs, and to lose weight.

Opioids pt 2

Street Names: Brown Sugar, China White, Dope, H, Horse, Junk, Skag, Smack, and White Horse. How Administered: Heroin users typically inject the drug into their veins. However, individuals who experiment with recreational drugs often prefer skin-popping (subcutaneous injection) rather than mainlining (intravenous injection); they also may snort heroin as a powder or dissolve it and inhale the vapors. To try to avoid addiction, some users begin by chipping, taking small or intermittent doses. Regardless of the method of administration, tolerance can develop rapidly. Morphine, used as a painkiller and anesthetic, acts primarily on the central nervous system, eyes, and digestive tract. By producing mental clouding, drowsiness, and euphoria, it does not decrease the physical sensation of pain as much as it alters a person's awareness of the pain; in effect, the morphine user no longer cares about the pain.

Synthetic Marijuana pt 1

Synthetic versions of the active ingredient in marijuana, developed for medical use, act on the brain like the THC in smoked marijuana but eliminate the need to inhale harmful chemicals. Various herbal mixtures, marketed as safe and legal alternatives to pot yet labeled "not for human consumption," contain dried, shredded plant material and chemical additives. The majority of users are young men in their teens. U.S. poison control centers have experienced an exponential increase in emergency calls regarding synthetic marijuana. Street Names: Fake Weed, K2, Moon Rocks, Skunk, Spice, and Yucatan Fire. How Administered: Some products are sold as incense, but they are mainly smoked or drunk in an herbal infusion.

Methamphetamine pt 3

The Toll on Society: Law enforcement officials consider methamphetamine their biggest drug problem. Meth addicts are pouring into prisons and recovery centers at an ever-increasing rate. "Meth babies" are crowding the foster-care system. Meth-making operations, which have been uncovered in all 50 states, involve the release of poisonous gases and toxic waste that is often dumped down household drains, in backyards, or by the side of the road. The cost of cleaning up the environmental impacts of meth is a growing problem for many communities. OTC cold medicines (ephedrine and pseudoephedrine) are commonly used in meth production, which is one reason for federal and state restrictions on their sale. Withdrawal: Methamphetamine addiction is difficult to treat. As with cocaine, coming off methamphetamine causes intense distress, so users often seek out the drug to relieve their pain. Treatment usually requires the intervention of the patient's family as well as a substance abuse specialist team experienced in treating individuals with methamphetamine addiction. Standard substance abuse treatment methods such as education, behavior therapy, individual and family counseling, and support groups may be effective for some. Methamphetamine abusers often use other illicit drugs as well, a problem that can be addressed as part of a comprehensive program.

Cocaine pt 3

The combination of alcohol and cocaine is particularly lethal. The liver combines the two agents and manufactures cocaethylene, which intensifies cocaine's euphoric effects, while possibly increasing the risk of sudden death. Cocaine users who inject the drug and share needles put themselves at risk for another potentially lethal problem: HIV infection. Withdrawal: When addicted individuals stop using cocaine, they often become depressed. This may lead to further cocaine use to alleviate depression. Other symptoms of cocaine withdrawal include: Fatigue. Vivid and disturbing dreams. Excessive or inadequate sleep. Irritability. Increased appetite. Physical slowing down or speeding up. The initial crash may last 1 to 3 days after cutting down or stopping heavy use of cocaine. Some individuals become violent, paranoid, and suicidal. Withdrawal symptoms usually reach a peak 2 to 4 days after cutting down or stopping heavy use of cocaine, although depression, anxiety, irritability, lack of pleasure in usual activities, and low-level cravings may continue for weeks. As memories of the crash fade, the desire for cocaine intensifies. For many weeks after stopping, individuals may feel an intense craving for the drug.

Hallucinogens

The drugs known as hallucinogens produce vivid and unusual changes in thought, feeling, and perception. Hallucinogens do not produce dependence in the same way as cocaine or heroin. Individuals who have an unpleasant experience after trying a hallucinogen may stop using the drug completely without suffering withdrawal symptoms. Others continue regular or occasional use because they enjoy the effects. LSD (lysergic acid diethylamide), commonly known as acid, was initially developed as a tool to explore mental illness. It became popular in the 1960s and resurfaced among teenagers in the 1990s. Its street names include Acid, Blotter, Blue Heaven, Cubes, Microdot, and Yellow Sunshine. LSD is taken orally, usually blotted onto pieces of paper that are held in the mouth or chewed along with another substance, such as a sugar cube. Peyote (whose active ingredient is mescaline) is another hallucinogen, but it is much less commonly used in this country. Its health effects include: Rapid mood swings. Distorted perceptions. Impaired rational thinking and ability to communicate. Dry mouth. Sweating. Numbness, weakness, tremors, and enlarged pupils. Frightening flashbacks. Ongoing visual disturbances. Paranoia.

PCP

The illicit drug phencyclidine (PCP) has a brand name Sernyl; and street names Angel Dust, Hog, Love Boat, and Peace Pill. It is manufactured as a tablet, capsule, liquid, flake, spray, or crystal-like white powder that can be swallowed, smoked, sniffed, or injected. Sometimes it is sprinkled on crack, marijuana, tobacco, or parsley and smoked. A fine-powdered form of PCP can be snorted or injected. PCP use peaked in the 1970s, but it remains a popular drug of abuse in both inner-city ghettos and suburban high schools. Users often think that the PCP they take together with another illegal psychoactive substance, such as amphetamines, cocaine, or hallucinogens, is responsible for the highs they feel, so they seek it out specifically. The effects of PCP are utterly unpredictable. It may trigger violent behavior or irreversible psychosis the first time it is used, or the 20th time, or never. In low doses, PCP produces changes similar to those produced by other psychoactive drugs, including: Hallucinations. Delusions. Feelings of emptiness or numbness. Impaired thinking. Anxiety. Increased breathing rate, blood pressure, and heart rate. Shallow breathing. Facial redness. Sweating. Numbness in hands and feet. Problems with coordination and movement. Higher doses may produce: A stupor that lasts several days. Lower heart rate and blood pressure. Paranoia. Dizziness. Nausea and vomiting. Blurred vision. Eye flickering. Drooling. Loss of balance. Violence. Self-injury. Suicidal thoughts. Seizures, coma. Death. Some people experience repetitive motor movements (such as facial grimacing), hallucinations, and paranoia. Suicide is a definite risk. Intoxication typically lasts 4 to 6 hours, but some effects can linger for several days. Delirium may occur within 24 hours of taking PCP or after recovery from an overdose and can last as long as a week.

Relapse Prevention

The most common clinical course for substance abuse disorders involves a pattern of relapses over the course of a lifespan. It is important for individuals with these problems and their families to recognize this fact. When relapses occur, they should be viewed as neither a mark of defeat nor evidence of moral weakness. While painful, relapses do not erase the progress that has been achieved and ultimately may strengthen self-understanding. They can serve as reminders of potential pitfalls to avoid in the future. One key to preventing relapse is learning to avoid obvious cues and associations that can set off intense cravings. This means staying away from the people and places linked with past drug use. As therapists emphasize, every lapse does not have to lead to a full-blown relapse. Users can turn to the skills acquired in treatment—calling people for support and going to meetings—to avoid a major relapse. Ultimately, users must learn much more than how to avoid temptation; they must examine their entire view of the world and learn new ways to live in it without turning to drugs. This is the underlying goal of the recovery process.

Opioids pt 1

The opioids include opium and its derivatives (morphine, codeine, and heroin) and synthetic drugs that have similar sleep-inducing and pain-relieving properties. The opioids come from a resin taken from the seedpod of the Asian poppy. Synthetic opioids, such as meperidine (Demerol), methadone, and propoxyphene (Darvon), are synthesized in a chemical laboratory. Whether natural or synthetic, these drugs are powerful narcotics, or painkillers. Opioid drugs, made from the Asian poppy, come in both legal and illegal forms. All are highly addictive. Heroin use has soared in the last decade, with an estimated 914,000 reported users in the United States and a spike in overdose deaths. Male addicts outnumber female addicts by three to one. Among people ages 18 to 25, the percentage of heroin users who inject the drug has doubled in the past decade. Nearly 80 percent of people who recently started using heroin had previously used prescription pain relievers illegally. Among the risk factors for transitioning to heroine are starting pill use at an early age, using pills to get high rather than to treat a health problem, and injecting or snorting a prescription opiate.

Benzodiazepines and Barbiturates pt 1

These depressants are the sedative-hypnotics, also known as anxiolytic or antianxiety drugs. They include chlordiazepoxide (Librium), diazepam (Valium), oxazepam (Serax), lorazepam (Ativan), flurazepam (Dalmane), and alprazolam (Xanax). Benzodiazepines and barbiturates are most often prescribed for tension, muscular strain, sleep problems, anxiety, panic attacks, and anesthesia. They are also used to treat alcohol withdrawal. As prescriptions for these agents have increased, so have deaths from overdoses of Xanax, Valium, Ativan, and other sedatives, which can slow breathing, particularly if taken with alcohol or narcotics such as Oxycontin. Because Rohypnol is colorless, tasteless, and odorless, it can be added to beverages without your knowledge.

Young adults have the highest rates of illicit drug use. Many do not realize that substance abuse and other self-destructive behaviors, such as gambling or compulsive eating, can affect every dimension of health. Some of the harmful effects are as follows:

psychical health, psychological health, intellectual health, social health, and environmental health.

A drug can act locally, as novocaine does to deaden pain in a tooth; generally, throughout a body system, as barbiturates do on the central nervous system; or selectively, as a drug does when it has a greater effect on one specific organ or system than on others, such as a spinal anesthetic. A drug that accumulates in the body because it's taken in faster than it can be metabolized and excreted is called cumulative; alcohol is such a drug. t./f

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A gambling disorder can begin during adolescence or young adulthood but generally develops over the course of years. Many college students "grow out" of the disorder over time, although it remains a lifelong problem for some. Gambling disorders are more common among young men than among young women. Younger individuals prefer forms of gambling such as sports betting and Internet poker, whereas older adults are more likely to play slot machines or games of chance like bingo. Psychological interventions can improve outcomes and reduce symptom severity for individuals with a gambling disorder. These include behavioral and cognitive treatment with a professional therapist as well as self-directed workbooks and computer-facilitated programs. No specific approach has consistently proven more effective than other alternatives, but cognitive-behavioral therapy has the most empirical support for the treatment of gambling disorder. t/f

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Addictions are not limited to brain-altering substances. Researchers have described a similar process of dependence, tolerance, and withdrawal with a variety of behaviors, including video gaming, indoor tanning, night eating, texting and smartphone use, and Internet addiction. Gambling disorder is the only "behavioral" addiction officially recognized as a psychiatric diagnosis. However, Internet use, video game playing, shopping, eating, and other behaviors also bear a resemblance to alcohol and drug dependence. Researchers are investigating their causes, characteristics, and impact on psychological and physical well-being. t/f

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Although prescription drug abuse remains widespread on campuses, the drug scene across the United States may be changing. The use of many illicit drugs—including MDMA (Ecstasy), inhalants, synthetic marijuana, the hallucinogen salvia, and the amphetamine-like stimulants known as bath salts—has declined among adolescents and young adults. This is also true for college students—except for marijuana use, which has risen. Nonetheless, according to the American College Health Association (ACHA) National College Health Assessment, 6 in 10 undergraduates have never tried marijuana t/f

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An estimated 2 million Americans abuse or are dependent on prescription painkillers. Each day an estimated 1,000 people are treated for misusing prescription opioids in emergency departments across the United States. The most commonly abused prescription painkillers are codeine (sold under various brand names), Vicodin, Dilaudid, Demerol, OxyContin, Percodan, and Percocet. About 5 percent of undergraduates report use of Vicodin or OxyContin. Students who are members of fraternities and sororities, who are enrolled at more competitive schools, who earn lower grade-point averages, and who engage in substance use and other risky behaviors are more likely to abuse these drugs. Like other addictions, a prescription painkiller "habit" is a treatable brain disease but not an easy habit to break. Recovery usually requires carefully supervised detoxification, appropriate medications (similar to those used for opioid dependence), behavioral therapy, and ongoing support.

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An estimated 35.5 percent of Americans suffer from chronic pain of some kind; 11 percent, with severe chronic pain. They are most likely to take prescription opioids. An estimated one in four patients receiving long-term opioid therapy struggles with opioid addiction. Anyone who takes prescription opioids, including those using them for nonmedical reasons, can become addicted to them. Once addicted, it can be hard to stop. As tolerance develops, users may take more medication for the same pain relief and may suffer withdrawal symptoms if they cut back or stop. Taking too many prescription opioids can stop a person's breathing and cause death.

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Simply having access to casino machines, ongoing card games, or Internet gambling sites increases the likelihood that students will gamble. Researchers view problem or pathological gambling as an addiction that runs in families. Individuals predisposed to gambling because of their family history are more likely to develop a problem if they are regularly exposed to gambling. Alcoholism and drug abuse often occur along with gambling, leading to chaotic lives and greater health risks. t/f

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As a stimulant, caffeine relieves drowsiness, helps in the performance of repetitive tasks, and improves the capacity for work. Caffeine improves performance and endurance during prolonged, exhaustive exercise and, to a lesser degree, enhances short-term, high-intensity athletic performance. Additional benefits include improved concentration, reduced fatigue, and sharpened alertness. You'll stay more alert, particularly if you are fighting sleep deprivation, if you spread your coffee consumption over the course of the day. For instance, rather than drinking two 8-ounce cups in the morning, try consuming smaller servings of an ounce or two during the course of the day. In recent decades, some 19,000 studies have examined caffeine's impact on the body and the brain. Their conclusion: For most people, caffeine poses few serious health risks. Drinking up to six cups a day of caffeinated or decaffeinated coffee won't shorten your lifespan and may convey some health benefits. Researchers have found no significant relationship between coffee and tea consumption and the risk of breast cancer or of miscarriage. Contrary to common belief, regular caffeine consumption also does not cause dangerous racing of the heart. Despite these positive findings, doctors advise pregnant women, heart patients, and those at risk for osteoporosis to limit or avoid coffee. Too much caffeine, particularly in high-powered energy drinks, can be dangerous for everyone and particularly harmful for children. A single dose of 5 grams can be fatal. t/f

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Caffeine, which has been drunk, chewed, and swallowed since the Stone Age, is the most widely used psychoactive (mind-affecting) drug in the world. Genetics may determine how much caffeine one craves. Scientists have identified the genes that drive people to consume more—or less—of this stimulant. More than 85 percent of Americans consume caffeine. Coffee is our principal caffeine source, with Americans drinking an average of 3.5 cups a day. Coffee contains 100 to 150 milligrams of caffeine per cup; tea, 40 to 100 milligrams; cola, about 45 milligrams. Most medications that contain caffeine are one-third to one-half the strength of a cup of coffee. However, some, such as Excedrin, are very high in caffeine. (See Table 12.1 for caffeine counts of various products.) t/f

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College students tend to be aware of the potential side effects of too much caffeine, but they generally continue to drink coffee and other caffeinated beverages. Higher doses may also produce ringing in the ears or flashes of light. Among the potentially life-threatening conditions that can result from caffeine intoxication are acute kidney injury, hepatitis, seizures, strokes, coronary artery spasms, and heart attack. Caffeine withdrawal for those dependent on this substance can cause headaches and other neurological symptoms. Those who must cut back should taper off gradually. One approach is to mix regular and decaffeinated coffee, gradually decreasing the quantity of the former. t/f

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Gambling has become a more serious and widespread problem on college campuses. About half of students who gamble at least once a month experience significant problems related to their gambling, including poor academic performance, heavy alcohol consumption, illicit drug use, unprotected sex, and other risky behaviors. An estimated 3 to 6 percent of college students engage in "pathological gambling," which is characterized by "persistent and recurrent maladaptive gambling behavior." t/f

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Many of these drinks contain herbs that enhance the effects of caffeine and can interact with medication, causing harmful effects. Emergency department visits related to energy drinks have more than doubled in recent years. Alcohol mixed with energy drinks (AmED, in the medical literature) presents even greater dangers. About a third of college students report having consumed AmED in the past year. Students mixing alcohol and caffeine engage in more high-risk drinking behaviors and are twice as likely to report being hurt or injured as those who don't. t/f

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Marijuana remains the most widely used illicit drug on campuses, but the nonmedical use of prescription drugs now outranks other forms of substance abuse. About 11 percent of college students report that they misused prescription drugs in the last year. Substance abuse remains a serious health risk for the minority of undergraduates who do use drugs. Drugs can threaten students' physical and psychological health as well as their academic futures. Pot smoking in particular is strongly linked with "discontinuous enrollment"—in lay terms, dropping out of school. t/f

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Medications derived from the opium poppy have been used for centuries to treat pain, cough, and diarrhea. Before the 1990s, doctors often prescribed opioids to treat cancer and postsurgery pain. In 1996, Purdue Pharma began promoting Oxycontin (extended-release oxycodone) to relieve chronic noncancer pain, despite a lack of quality studies demonstrating the drug's safety and efficacy. Initially, Oxycontin—whose active ingredient is twice as potent as morphine—was marketed as a safe drug that would not lead to addiction "if taken as prescribed." Health-care providers without adequate training in pain management became the largest prescribers of Oxycontin, and manufacturers sold billions of dollars of this and similar medications every year.

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Most college students do not engage in addictive behaviors. One fundamental reason is that they have better things to do. "Substance-free reinforcement"—in simpler terms, a positive addiction to anything from rock-climbing to snowboarding to Zumba—can produce very real "highs," often for very little money. Without passions to pursue, young adults are more likely to use and abuse multiple substances, including marijuana, alcohol, and emerging tobacco products (discussed in Chapter 13). Such "polysubstance abuse" greatly increases their risk of physical, social, legal, and academic problems and pushes them deeper into drug involvement. t/f

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Other health effects include miscarriage, low birth weight, risk of drug interactions, and spreading of HIV, hepatitis, and other infectious diseases from shared needles. To prevent misuse, the CDC has issued recommendations for clinicians prescribing opioids. They include starting treatment with nondrug or nonopioid options, using opioids only in the lowest effective doses, and limiting opioid use to three days or fewer.

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Overdoses can cause delirium, confusion, aggressiveness, hallucinations, and psychotic symptoms. Combining stimulants with alcohol increases the likelihood of blackouts, accidents, and unprotected or unplanned sex. In individuals with certain cardiac conditions, stimulant medications can cause serious, even fatal, complications. Some universities are setting strict regulations for ADHD medications, including confirmation of the diagnosis through a medical evaluation and a formal written promise to submit to drug testing and not to share the pills.

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Some users—particularly those smoking marijuana for the first time or taking a high dose in an unpleasant or unfamiliar setting—experience acute anxiety, which may be accompanied by a panicky fear of losing control. They may believe that their companions are ridiculing or threatening them and experience a panic attack, a state of intense terror. All the reactions experienced with low doses are intensified with higher doses, leading to sensory distortion and, in the case of hashish, vivid hallucinations and LSD-like, psychedelic reactions. The sense of being stoned peaks within half an hour and usually lasts about 3 hours. Even when alterations in perception seem slight, it is not safe to drive a car for as long as 4 to 6 hours after smoking a single joint. The drug remains in the body's fat cells 50 hours or more after use, so people may experience psychoactive effects for several days afterward. Drug tests may produce positive results for days or weeks after last use.

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Specific symptoms of dependence vary with particular drugs. Some drugs, such as marijuana, hallucinogens, and phencyclidine, do not cause withdrawal symptoms. The degree of dependence also varies. In mild cases, a person may function normally most of the time. In severe cases, the person's entire life may revolve around obtaining, using, and recuperating from the effects of a drug. Individuals with drug dependence become intoxicated or high on a regular basis—whether every day, every weekend, or several binges a year. They may try repeatedly to stop using a drug and yet fail, even though they realize that their drug use is interfering with their health, family life, relationships, and work.

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Substance users may develop psychological dependence and feel a strong craving for a drug because it produces pleasurable feelings or relieves stress and anxiety. Physical dependence occurs when a person develops tolerance to the effects of a drug and needs larger and larger doses to achieve intoxication or another desired effect. Individuals who are physically dependent and have a high tolerance to a drug may take amounts many times those that would produce intoxication or an overdose in someone who was not a regular user. Men and women with a substance dependence disorder may use a drug to avoid or relieve withdrawal symptoms, or they may consume larger amounts of a drug or use it over a longer period than they'd originally intended

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The dosage level at which a drug becomes poisonous to the body, causing either temporary or permanent damage, is called its toxicity. In most cases, drugs are eventually broken down in the liver by special body chemicals called detoxification enzymes. t/f

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The impact of the opioid epidemic extends beyond addiction and fatal overdoses. Sharing drug-injection equipment has tripled the prevalence of hepatitis C infections. Babies of pregnant women addicted to opioids are born with opioid withdrawal syndrome, which makes them more likely to suffer low birth weight and respiratory and central nervous system complications. The total economic burden of the opioid epidemic is estimated to be around $78.5 billion, comprised of increased health care and substance abuse treatment, crime-related costs, and lost productivity.

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