Final Ch 10-16

What is Salvinorum A? What are it's effects and mechanism of action?

*A chemical found in a plant in the sage family* (Salvia divinorum) and often referred to as diviner's sage or just *salvia.* Salvia is not currently a federal controlled substance, although some states have banned it. *Appears to act differently on the brain from any of the previously known hallucinogens* by affecting specialized opiate receptors known as *kappa receptors*, and thus we classify it as a kappa hallucinogen

What are the dissociative anesthetic hallucinogens? How are they similar to and different from the other hallucinogens?

*A class of drugs including PCP and ketamine.* They have the *ability to produce surgical anesthesia while an individual remains at least semiconscious.* Dissociative anesthetics are thought to act through a receptor that influences activity of the excitatory amino acid neurotransmitter, glutamate

What are the anticholinergic hallucinogens? What are some examples of them?

*A class of drugs including atropine and scopolamine.* Less familiar to most people and includes drugs such as atropine and scopolamine found in plants such as mandrake, henbane, belladonna, and jimsonweed. *These drugs produce a dreamlike trance in users from which they awaken with little or no memory of the experience.*

What is ibogaine? How is it being used?

*A shrub native to West Africa.* Several tribal groups in the region made up of Cameroon, Congo, and Gabon have used this plant for many centuries for its hallucinogenic properties. This plant *produces divine visions* and permits them to *commune with their ancestors.* *In recent years, ibogaine may be of value in the treatment of addiction. * Anecdotes from ex-addicts who believe that ibogaine visions *helped in their recovery from dependency on alcohol, cocaine, and heroin* have circulated since the 1960s.

How does LSD differ from other serotonergic hallucinogens?

*LSD is the most potent of the class*, with oral doses as small as 25 micrograms producing effects. Prepared by placing *a small amount of LSD solution in a gel, tablet, or, most commonly, on paper* LSD is rapidly absorbed, and subjective *effects are usually noted within 20 to 60 minutes* after consumption.

What about LSD and chromosome damage? Flashbacks? Bad trips? Long-term psychiatric disorder?

*LSD was claimed to cause chromosome damage*; users were said to be likely to have mutant children. However, after considerable research into this question, there is *no convincing evidence that LSD (or any other serotonergic hallucinogen) increases birth defects* in offspring when taken in normal doses. *As with most drugs, however, there is risk of fetal damage if taken by pregnant women.* *Bad Trips:* If the visions are terrifying, the subject may behave in a psychotic manner. Bad trips can *leave individuals in an acute psychotic state during which they may harm themselves or others.* *Flashbacks: Re-experience of some aspect of a hallucinogenic trip that may have occurred months or even years before.* The nature of the experience usually *involves visual disturbances* such as flashes of color, trails in the visual field, or fleeting percep- tions in the peripheral field of view. *Flashbacks are often brought on by stress, fatigue, entering a dark environment, or marijuana use* *Long-term Psychiatric Disorder:* LSD might cause long term psychiatric disorders. Example would be Charles Manson and subsequent mass murders. *Difficult to determine whether LSD causes psychosis or the person was psychotic to begin with and LSD made the symptoms more apparent.*

What is the relation between opium, morphine, heroin and codeine?

*Morphine* is the major active chemical in opium (codeine is another opiate drug found in opium) and is about 10 times more potent than crude opium. In 1874, British chemist C. R. Alder Wright published reports of experiments that produced a new chemical compound based on an alteration of morphine: diacetylmorphine, because this compound was so powerful, it was viewed as a new treatment with "heroic" possibilities and was christened *heroin*.

Distinguish between primary and secondary prevention.

*Primary prevention:* which pertains to the avoidance of substance abuse before it has a chance to occur. The goal is to preclude the initial use of a substance. *Never starting to use a drug, it is argued, means that you will not have any problems with it* *Secondary prevention:* Refers to interventions applied *when substance use problems already have begun to appear.* This type of prevention is analogous to early treatment in that *interventions* are used when problems are first surfacing. For example, people arrested for driving under the influence of alcohol often are referred to alcohol education courses designed to decrease the likelihood of the people drinking and driving again.

What are the long-term effects?

*Respiratory:* Lung functioning appears to be altered as a consequence of smoking cannabis, such as airway obstruction. Cannabis tar contains greater amounts of cancerous agents than does tobacco tar. *Cardiovascular*: No evidence shows that smoking marijuana produces deleterious cardiovascular effects among healthy individuals. The acute effects produced (for example, increased heart rate) are, however, potentially *dangerous among people who have existing cardiovascular problems*, such as abnormal heart functioning or atherosclerosis. *Immune System:* Cannabis poses no significant long-term threat to the immune system. However, cannabis can act as an immunosuppressant and decrease resistance to some viruses and bacteria. *Reproductive System:* Cannabis does disrupt the reproductive system in both males and females. *Chronic marijuana use has been associated with decreases in the number of sperm* and sperm motility among men. Frequent use of cannabis by women may *produce nonovulatory menstrual cycles*, in which menstruation is not preceded by the release of an ovum. When a fetus is exposed to an array of cannabinoids, it does not appear that *major birth malformations result : premature birth, shorter body length, and lower infant birth weight* *Children exposed to marijuana prenatally were found to show deficits on a sustained attention tasks*, to be more impulsive, hyperactive, and to have cognitive deficits, poorer school performance, and increased risk for tobacco and/or marijuana use later in life Overall, it appears the *majority of effects associated with marijuana use are more acute than chronic* and that longer-term effects tend to be reversible with the termination of drug use.

What about the tolerance and cross-tolerance to LSD?

*There is cross-tolerance between LSD, mescaline, and other drugs of this class* This suggests a common mechanism of action.

What are the 5 models that have been proposed to account for substance abuse problems? Compare and contrast their respective approaches to causes and treatments.

1. *Moral Model*: in which individuals are seen as personally responsible for problems they may incur from their use of drugs and alcohol. *Their addiction is product of a series of personal decisions* or choices to use those substances in a way that is harmful. 2. *American Disease model*: is especially important because of its widespread prevalence and prominence in the United States. Foundation of AA. In this model, *dependence on alcohol and drugs is viewed as the product of a progressive, irreversible disease.* 3. *Biological Model:* In this model, dependence on alcohol or other drugs is viewed as the result of genetic or physiological processes. The goal is to counsel those who are at risk to avoid alcohol and other drugs altogether. 4. *Social learning model*: Is the position that alcohol and drug disorders are the *result of complex learning from an interaction of individuals within their environments.* The treatment for this is that the person's environment is adjusted so that abuse is punished, and non-abuse is rewarded. 5. *Socioculture Model:* States that subcultures and societies shape alcohol and drug use patterns and consequences. *Examples are norms and rules that a subculture has for alcohol use.* The treatment that follows from this perspective involves interventions that affect large groups of people or society in general.

What are some of the factors that determine the absorption of THC?

1. The mode of consumption. The most rapid and efficient absorption of marijuana is through smoking. Inhalation results in absorption directly through the lungs, and THC action begins within minutes. Lasting several. hours. 2. The potency of cannabis being smoked. Higher THC potency is generally found in "homegrown" cannabis—that is, marijuana grown in large-scale domestic indoor environments. 3. Time the inhaled smoke is held in the lungs; the longer the smoke is held, the more time for absorption of the THC. 4. Number of people who share the cigarette because more smokers may decrease the amount of marijuana available to any one user. 5. Oral ingestion of marijuana is much slower and relatively inefficient. However, the onset of action is longer than when smoked. The marijuana is absorbed primarily through the gastrointestinal tract. The dose needed to create a comparable high when orally ingested is estimated as three times greater than that needed when smoking

What are the serotonergic hallucinogens?

A class of drugs that includes LSD, mescaline, and psilocybin and drugs with similar effects and mechanisms of actions. All *produce vivid visual hallucinations and a variety of other effects on consciousness.* Binds to the 5-HT2A receptor.

What about marijuana and violence?

A long-standing claim regarding cannabis use, dating in this country to 1920s, is that marijuana causes users to be aggressive and violent. The overwhelming conclusion drawn from data, including surveys, laboratory investigations, and field studies, however, is *that cannabis use is not causally related to increased aggression* A more a function of the beliefs and characteristics of the individual drug users. In fact, *levels of aggression actually decrease following cannabis use*.

What are the basic principles of the alcoholics anonymous (AA) program?

A peer self-help movement organized for helping individuals identified as alcoholics. *The core of AA is the model of recovery outlined in Twelve Steps.* The beginning of recovery occurs when those with alco- holism *admit to themselves as being powerless over alcohol,* that without alcohol a return to health is possible, and that with it, the downward spiral to self-destruction continues. A final point is that the Twelve Steps recovery program is oriented toward action, both in self-examination and change and in behavior toward others.

What is naloxone (Narcane)?

A short-acting opiate antagonist. When naloxone is given to a patient who is suffering from an over- dose of heroin or morphine, it completely reverses the effects of those drugs.

Amotivational syndrome

A term used in the late 1960s. Defined as the loss of effectiveness and reduced capacity to accomplish conventional goals as a result of chronic marijuana use. The list of behaviors proposed as part of the syndrome includes *apathy, decreased effectiveness, lost ambition, decreased sense of goals, and difficulty in attending and concentrating.* *Amotivational syndrome has been seen in youths who do not use marijuana and is often not seen in other daily users of marijuana* . Thus, both *preexisting personality characteristics and some drug effects together probably account for the clustering labeled the amotivational syndrome.*

Psychological effects of opiate drugs.

Addiction, memory problems, hallucinations, delusions, paranoia, worsening of mental health, decrease in emotional well-being, increase in symptoms of mental illness

What is the relationship between IV drug use and AIDS?

Addicts are at great risk for disease and death from AIDS, hepatitis, and other diseases spread by sharing contaminated needles. The virus does spread among both heterosexuals and homosexuals, and the babies born of HIV-positive mothers will usually develop AIDS as well. Using a needle contaminated with the blood of someone who has HIV leads to direct blood- to-blood transmission, which involves a very high risk of infection.

Be able to review the early history of marijuana.

Although cannabis was used for its mind-altering properties for several cen- turies in other parts of the world, its psychoactive properties were not recognized in the United States until the first third of the 20th century. The earliest known evidence of the use of cannabis occurred more than 10,000 years ago during the Stone Age. It has been speculated that cannabis was used in this period in China for sedating, treating pain and illness, countering the influences of evil spirits, and gaining its general psychoactive effects Cannabis use gradually spread from China to sur- rounding Asian countries. Of particular note was its adoption in India, where cannabis served a religious function. Not until much later did cannabis use spread to the Middle East and then on to North Africa. The (medical) use of cannabis was in- troduced to Great Britain primarily by William O'Shaughnessy, an Irish physician. However, In fact, using cannabis for its psychoactive properties did not become widespread in Europe until the 1960s, when it was reintroduced by, among others, tourists from the United States

What is psilocybin? Where did this hallucinogen come from? Consider their early history.

An LSD-like hallucinogen found in mushrooms.

What is Mescaline? Where did this hallucinogen come from? Consider their early history.

An LSD-like hallucinogen found in the peyote cactus. *Mescaline's chemical structure is far more similar to amphetamine than to LSD.* However, it does *produces vivid visual hallucinations virtually identical in form to those of LSD.* *Tolerance to all the effects of Mescaline develops fairly rapidly.* In addition, *there is cross-tolerance between LSD, mescaline,* and other drugs of this class.

Correlated Vulnerabilities Theory

An alternative theory to the gate-way theory. It suggests that the so-called "stepping-stone" pattern of substance abuse is explained by the common characteristics of those who use cannabis and other drugs, not the drug itself.

What is synesthesia?

An effect sometimes produced by hallucinogens that is characterized by the perception of a stimulus in a modality other than the one in which it was presented (for example, a subject may report "seeing" music).

Cannabis Buyers Club

An offshoot of medical efforts has been the establishment of "cannabis clubs" in several major U.S. cities. *These organizations purchase marijuana in bulk and provide it (free or at cost) to patients with AIDS, cancer, and other disease*

How are anticholinergic hallucinogens similar to and different from the serotonergic hallucinogens?

Anticholinergic hallucinogens are antagonists of a subtype of acetylcholine receptors called muscarinic receptors.

How long to metabolites of THC remain detectible?

Approximately half of the THC is excreted over several days and the remainder by the end of about a week. However, some metabolites of the THC, a number of which may still be active in the system, can be detected in the body *at least 30 days* following ingestion of a single dose and in the urine for several weeks following chronic use

In what states is recreational use of marijuana now legal?

California became the first state, via Proposition 15, to legalize *medical marijuana*. At present, medical marijuana use is legal in 18 states, although the number fluctuates as a function of ballot initiatives and changes in state laws. The 2012 approval of two state referendums, in *Colorado and Washington*, regulated, taxed, and controlled marijuana. A majority of Americans (52%) support the legalization of marijuana.

What were the conclusions of the LaGuardia commission on marijuana?

Data was gathered on marijuana use and effects in tea-pads as well as in laboratory settings. The general finding of the study was that marijuana use was not particularly harmful to users or to society at large. The report failed to find evidence for the claim that aggression, violence, and belligerence were common consequences of marijuana smoking. This was not intended to suggest, how- ever, that marijuana did not induce psychoactive effects.

What types of drugs are used to treat alcohol problems, and how do they work?

Doctors will use *monoamine oxidase (MAO)* inhibitors to treat depressions that inhibit the activity of the enzyme monoamine oxidase, which degrades the neurotrans-mitters of norepinephrine and serotonin.

What is dual diagnosis?

Dual-diagnosis patients *have major psychiatric problems to go along with their substance use problems. * They typically have more complex and extensive treatment needs than do patients without major psychiatric problems, and dual-diagnosis patients tend to do more poorly in and following treatment.

What is the significance of the heroin addiction epidemic that failed to occur in the 1970's?

During the early 1970s, as the Vietnam War was drawing to a close, heroin ad- diction rates were high among returning American soldiers, with some estimates reaching 21%. These soldiers were required to go through a detoxification before their return to the United States, but given a 90% relapse rate, one would have expected most would return to heroin use at home.

What are the major psychological effects of LSD? Consider the form constants and synesthesia.

Experiences with hallucinogens are *tremendously variable* among individuals and may vary from one experience to the next for a single individual. Common to all the serotonergic hallucinogens are *profound changes in visual perception, and there is some consistency in the types of visual changes that occur.* *Researchers have noted the spiral explosions and vortex patterns* Additionally, *the lattice pattern: a checkerboard pattern that appears in an otherwise plain surface.* Also *Synesthesia* Flashing lights, increased brightness and saturation of colors, trails or plumes around objects, and the sense of movement in stable objects

What is anandamide?

From the Sanskrit word for "bliss", it is a chemical that binds to the same receptors on brain cells as do cannabinoids. Researchers are now using the compound anandamide to study how the cannabinoid receptors affect functions such as memory, movement, hunger, and pain, which are affected by marijuana use.

What is the Marijuana Tax Act?

Harry J. Anslinger, the director of the Federal Bureau of Narcotics in 1932, was convinced that marijuana represented a major threat to the safety and well-being of the country. So he pushed to pass a law to ban it. Eventually, the 1937 law passage *Marijuana Tax Act* was passed. The act did *not* officially ban marijuana; rather, it acknowledged the medicinal uses of marijuana and permitted the prescription of marijuana following payment of a license fee of $1 per year. Any other possession or sale of marijuana was strictly outlawed. Punishments for violation were a $2,000 fine, five years of imprisonment, or both. Throughout the 1960s, judges often had the option of sentencing users or sellers of marijuana to life imprisonment. A second offense of selling marijuana to a minor in Georgia could be punished by death.

How was LSD popularized by Leary and Kesey, etc.?

Harvard psychologist Leary toke LSD and other hallucinogens and become convinced of their psychological and spiritual value. At some point, *Leary had stepped out of his role as a scientist and had become the leader of a social and religious movement. Calling him- self "High Priest," Leary claimed LSD was a ticket for a trip to spiritual enlightenment* On the West Coast, LSD was popularized by Ken Kesey, celebrated author, and his "merry pranksters." *Kesey's "acid tests" were large parties where hundreds of people were "turned on to LSD" in a single night. LSD began to make an impact on the emerging hippie subculture, particularly through the music of groups whose music became known as "acid rock."*

How was it introduced in the Americas?

In the North American colonies, the Jamestown settlers in Virginia raised the cannabis plant for fiber in 1611. Cannabis was harvested in New England starting in 1629; it remained a core U.S. crop until after the Civil War. The center of hemp production was Kentucky, where it was a major crop product for decades. American physicians used cannabis in the 1800s, as a general, all-purpose medication. Cannabis was consumed for recreational purposes only to a limited extent during this period, and de- scriptions of its psychoactive effects were not com- mon. The 1920s brought a wider use of cannabis, this is said to have happened because of the alcohol prohibition.

William O'Shaughnessy

Irish Physician who introduced Cannabis to Great Britain. In India, he observed the medical applications of cannabis and described them in his writings.

What is DMT (Ayahuasca)? Where did this hallucinogen come from? Consider their early history.

Is found in many plants in South America such as Brazil, Colombia, Peru, Ecuador, and Bolivia. *Comes from the Virola tree, Virola calophylla, and other species* DMT is normally not effective when taken orally because it is broken down by enzymes. *Ayahuasca produces a brief (1- to 2-hour) experience characterized by intense visual hallucinations and is traditionally used in healing ceremonies, initiation rites, and other rituals.*

How is the LSD experience similar to schizophrenia? In what ways is it different?

It is true that hallucinations, unusual affective reactions, and loss of reality contact are characteristics of both schizophrenia and hallucinogenic experiences, but there also are important differences. *Hallucinations experienced under the influence of LSD are primarily visual, whereas those of schizophrenics are usually auditory*

How do LSD and similar hallucinogens act on the brain?

LSD was claimed to cause chromosome damage; users were said to be likely to have mutant children. *It was said to cause insanity, suicide, acts of violence, and homicidal behavior* However,* hallucinogens, including LSD, became associated with the "club" scene in recent years,* and the protracted parties or concerts that are sometimes referred to as "raves" are often occasions for hallucinogen drug use. LSD produces such dramatic effects of visual hallucinations and alterations of consciousness. They *act by mimicking serotonin and thus activate serotonin receptors in the brain.* Serotonin is distributed widely in the brain. *Serotonin is thought to play an important role in mood, which is consistent with the powerful emotional effects of these drugs.* *LSD is rapidly absorbed, and subjective effects are usually noted within 20 to 60 minutes* after consumption.

What is LAAM?

Levo-alpha- acetylmethadol or LAAM is a drug used in *treating heroin addiction* that is similar in action to methadone but has longer-lasting effects. The advan- tage of a longer-lasting methadone substitute is that *patients are more likely to comply with the regimen for taking the drug.*

What are the main symptoms of the opiate abstinence syndrome?

Low energy, Irritability, Anxiety, Agitation, Insomnia., runny nose, teary eyes, hot and cold sweats, goose bumps, yawning, muscle aches and pains, abdominal cramping, nausea, vomiting, diarrhea

What are some possible adverse effects associated with ecstasy? Be able to discuss the controversy regarding residual effects of ecstasy.

MDMA is considered a rave or "club" drug. There are many adverse effects of MDMA (ecstasy), including claims that it *may produce brain damage and death.* The effects of MDA and MDMA seem to be primarily a *mild euphoria* accompanied by openness, *sweating, rise in body temp,* high blood pressure, feelings of warmth and empathy, and lack of defensiveness. Some scientists classify MDMA with the hallucinogens, others with the amphetamines. MDMA also *blocks the reuptake of serotonin* and, to a lesser extent, dopamine.

What are the major risks associated with heroin addiction?

Many heroin addicts become involved in criminal activity to support their habit. Many users find that they take the drug more and more frequently, and because tolerance develops rapidly to heroin and other opiates, higher doses are soon required to produce the desired effect. Consider the findings of a study that followed 581 heroin addicts over a period of 33 years. Half of these individuals died during the study period, 50 to 100 times the death rate in the general population of the same age. Of the surviving addicts at the end of the period, 20% were still using heroin (and another 10% refused to be tested) and 14% were in prison. Addicts are at great risk for disease and death from AIDS, hepatitis, and other diseases spread by sharing contaminated needles (

What about LSD and psychotherapy?

One notion was that LSD produced a model psychosis and that psychotherapists would benefit from having experiences similar to those of their patients. The general idea was that therapists would be able to learn important information when their patients were using LSD and that *the patients would be better able to gain insight into their condition because LSD could break down ego defenses.*

What are the methylated amphetamines? How are they similar to and different from the serotonergic hallucinogens? Consider recent trends in MDMA use.

Methylated amphetamines are a class of drugs including MDA and MDMA (Ecstasy). *These drugs are structurally related to amphetamine.* MDA and MDMA *produce alterations in mood and consciousness* with little or no sensory change. Like amphetamine and cocaine, *these drugs act on dopamine, norepinephrine, and serotonin synapses.* Their effects are most potent on the serotonergic system, *they do not bind selectively to the 5-HT2A receptor, and this is thought to be the basis of their difference from the LSD-like hallucinogens*

Where is opium grown today?

Mexico has become an important opium producer as well, and most of the heroin entering the United States today comes from poppies grown in Latin America, primarily Mexico and Colombia

What was soldier's disease?

Morphine dependence was so common among soldiers on both sides during the Civil War in America that it was often called "soldier's disease

What trends may be observed in surveys of marijuana use?

Most commonly, Marijuana does not cause violence, aggression, or anything else harmful. However, most studies shoes that it has psychoactive effects. A number of individual changes were noted, including in more extreme form "mental confusion and excite- ment of a delirious nature with periods of laughter and of anxiety" The latter report concluded that there was scientific foundation for studying marijuana as a treatment vehicle in such areas as pain relief, control of nausea and vomiting, and appetite stimulation.

What is designer heroin?

Most designer heroin compounds are derivatives of the powerful opioid, fentanyl. One problem with these fentanyl derivatives (often sold on the street as "China white") is that they may be 10 to 1,000 times more potent than heroin. Thus, the risk of overdose death is greater.

What are the acute physiological effects of marijuana?

Most of these actions are different for different users, not only in strength or intensity of the effect but also in duration. In general, the acute physiological effects of marijuana in a healthy individual are not dramatic. The most commonly experienced effects are usually physical, or cardiovascular. Predominant among these is *bloodshot eyes, an increase in heart rate and pulse rate, generalized decrease in motor activity, talkative behavior, some users report drowsiness, dry mouth, thirst, fluctuations in respiration and body temperature, hunger or "the munchies" or dizziness.*

What is the significance of motivation to change?

Motivation to change is considered essential if individuals have any hope that treatment of a behavioral or psychological problem will be effective. Researchers look at "readiness" (or commitment) to change instead of grappling with the abstract idea of motivation. *The model has five stages: precontemplation, contemplation, preparation, action, and maintenance.*

How are anti-drug drugs used in treatment? Consider naltrexone.

Naltrexone works as an opiate antagonist. The FDA approved the use of naltrexone (in 1994) for the treat- ment of alcohol use disorders.

How did opiate drug use change from the 19th to the 20th century?

Opium dependence was a serious problem in China by the beginning of the 19th century, but it was not yet seen as such in Europe or the United States. Opium preparations were readily available and com- pletely legal in 19th-century Europe and the United States. In the 20th century, the growing awareness of the danger and pervasiveness of opiate dependence led to a number of legal changes. 1914 Harrison Act came into play. The Harrison Act placed the control of opiate drugs in the hands of physicians; determination of whether an addict had a valid medical need for opiates was exclusively the physician's decision.

Is marijuana a "gateway" drug? Consider the complexities of this issue.

Opponents of legalization argue that marijuana use is the first step on a path that leads to the use of—and potentially addiction to—drugs such as heroin and cocaine. As it turns out, research has shown that the vast majority of marijuana users do not go on to become heroin addicts. Nevertheless, substance use does appear to follow a uniform sequence of drugs. High school students of all races and genders tend to use drugs in the same sequence: alcohol, marijuana, and then the so-called hard drugs (such as cocaine, crack, hallucinogens, and heroin). In a later study, researchers found that crack users almost always had used marijuana. First, and perhaps most important, not everyone who uses alcohol will subsequently use marijuana, and not everyone who uses marijuana will subsequently use other illicit drugs. (Indeed, in both cases, most will not.) Finally, consider that an alternative to the gateway theory has been proposed. Called the "correlated vulnerabilities" theory, it suggests that the so-called "stepping-stone" pattern of substance use is explained by the common characteristics of those who use cannabis and other drugs.

What is analgesia?

Pain relief produced without a loss of consciousness. Opium causes this to happen.

Describe the role of self-help groups (12-step and others) in substance abuse treatment and recovery.

Peer self-help groups are a major part of the treatment of substance use disorders. Members of peer self-help groups *perform therapeutic functions without professional credentials.* The ultimate goal in 12 step programs and abuse treatment recoveries, is oriented toward action, both in self-examination and change and in behavior toward others. One purpose of group meetings is to *aid recovery through peer identification* and learning from the experience of others. Building social relationships that do not re- volve around alcohol represents an entirely new social life.

What adverse effects are especially likely to occur with PCP and ketamine?

Phencyclidine (PCP) and ketamine are classified as dissociative anesthetic hallucinogens. *They produce a potent intoxication at moderate doses and complete surgical anesthesia at higher doses.*

What is AMP?

Popular in the 1980s and *now also called "dank."* AMP/dank is *marijuana soaked in embalming fluid or formaldehyde (the fluid's main ingredient) and dried before being smoked.* Users showed some profound psychiatric effects and impairments. Several of them reported they "immediately felt as if a transparent field has been placed between them and their surroundings." Among the symptoms associated with AMP intoxication are a *slowed sense of time, memory impairment, disorientation, paranoid thoughts, anxiety, confusion, disordered thought and difficulties in reality testing, and tremor.* Physiological symptoms were *elevated blood pressure, hypersalivation, tachycardia, and psychomotor excitement*

What is spontaneous remission?

Resolution of a problem without the help of formal treatment. In Chapter 7, you saw that many ex-smokers stopped without help. The same applies to people with alcohol or other drug problems, though as with smoking, it may take a few tries to do so.

What are endorphins? Consider their normal role in the brain.

Several morphine-like substances are found in the brain naturally. These complex peptide molecules are referred to collectively as endorphins. Endorphins share many properties with opiate drugs, such as pain relief and production of pleasure. One idea is that en- dorphins are part of a natural pain-relief system.

What are the active ingredients in marijuana?

Studies have shown cannabis to be a complex plant. More than *400* individual chemical compounds have been identified in the plant. Over 60 of these chemicals, collectively called cannabinoids, are unique to the cannabis plant. Despite years of study, the principal psychoactive agent in cannabis was not isolated until 1964. This substance has been labeled *delta-9-tetrahydrocannabinol* but is more commonly known as D-9-THC, or simply *THC*. Although THC is the prime psychoactive agent in cannabis, other cannabinoids, such as cannabidiol and cannabinol, can be biologically active and can modify THC effects.

What are the possible medical uses for marijuana? Note the political developments involving medical marijuana.

The earliest physical evidence of marijuana used as a medicine was uncovered recently by Israeli scientists who found residue of marijuana buried with the body of a young woman who apparently died in childbirth 1,600 years ago. They suggested that the marijuana was used to *speed the birth process and to ease the associated pain*. *The use of cannabis can treat problems as rheumatism, pain, rabies, convulsions, hysteria, mental depression, insanity, restlessness, coughs, painkiller for sufferers of multiple sclerosis, improving memory loss in Alzheimer's disease, Increased use of marijuana by AIDS patients who claim that marijuana reduces the nausea and vomiting caused by the disease, stimulates appetite, thus helping them to regain weight lost during their illness.* In the U.S, it was recognized as a therapeutic drug well into the 1900s.

What about tolerance and dependence to THC?

The evidence for tolerance to cannabis in humans is very unclear. Tolerance is more likely to occur with higher doses used over longer periods of time. There is an ongoing debate as to whether physical dependence can occur in the context of marijuana use. Some have argued that there is no significant withdrawal syndrome identifiable and certainly no clustering of withdrawal symptoms as identified for other substances such as alcohol or heroin. On the other hand, researchers have described several aspects of dependence associated with sustained heavy use of marijuana. These aspects entailed sleep distur- bance, nausea, irritability, and restlessness following the cessation of marijuana use.

What opiate drugs are used medically, and for what are they employed?

The major medical use of opiate drugs is for their analgesic or pain-relieving effects. After receiving moderate doses of opiates, patients remain conscious and are able to report painful sensations but do not suffer from the pain. The other major drugs that possess such analgesic properties are the over-the-counter painkillers: aspirin, acetaminophen, and ibuprofen, but none of these are as effective at relieving pain as the opiate. Morphine is the prototype opiate analgesic and is the standard by which others are measured. It is used primarily for severe pain. (Post surgeries, etc)

What are the behavioral and cognitive effects of marijuana? Again, consider acute and long-term effects.

The most common behavioral effect is a *generalized decrease in psychomotor activity* and decrements in some domains of psychomotor performance, with *feelings of relaxation and tranquility.* Additionally, *rapid or slurred speech*, circumstantial talk, and loquaciousness. Finally, other research has shown a *decreased sensitivity to pain* during marijuana intoxication. Dysfunctions in motor coordination such as signal detection and the *ability to monitor a moving object* Some report that *sexual pleasures are more intense and enjoyable when using marijuana, whereas others de- scribe a disinterest in sex.* It has been associated with *temporary impotence among men* and *temporary decreases in sex drive among women.*

How does the motivation to use opiates change with chronic use?

The withdrawal symptoms associated with opiate dependence may appear after only one to two weeks of chronic use of heroin, morphine, or a synthetic opiate drug.

What properties do the various hallucinogens have in common?

These drugs *mimic the symptoms of functional psychoses such as schizophrenia*. They are considered "mind-expanding or mind-revealing". Hallucinogens alter nearly all aspects of psychological functioning, and the phrase *"altered state of consciousness" describes these drugs better than any we have considered.* Despite differing chemical structures, these drugs also have in common *the action of influencing serotonergic transmission in the brain.* They all seem to bind to a particular subtype of serotonin receptor referred as the *5-HT2A receptor*

What are the physiological effects of serotonergic hallucinogens?

They are *generally similar to those of amphetamine and cocaine*; that is, they are sympathomimetic. Thus, the effects include *pupil dilation, increased heart rate, blood pressure, body temperature, and sweating*

What are synthetic phenethylamines and what issues are associated with them?

They are a third group of new synthetic compounds includes a host of hallucinogens with MDMA or LSD-like effects. *They are often sold over the Internet* A serious issue with these drugs is that *very little is known about their effects including the range of safe doses.* A group of teenagers in the Minneapolis area attended a rave and took a drug purchased over the Internet called 2C-E, or Europa, *resulting in a mass overdose.* Phenethylamine compounds were explicitly banned by the 2012 Synthetic Drug Abuse Prevention Act.

What is the harm reduction approach?

They are policies that focus on decreasing the negative consequences of drug use for individuals and the community, even if they endorse continued but safer drug use in the interim. The policy of harm reduction has not been fully embraced in the United States.

What is Spice? K2? What effects do they produce?

They are synthetic forms of marijuana. Synthetic designer cannabinoids are sprayed onto herbal or plant material and advertised for sale as an herbal preparation. The first synthetic cannabis products (sold as Spice) appeared in Europe in 2004. Smoking these plant materials is very likely to mimic a powerful marijuana-like "high" Acute effects reported by users presented to emergency rooms include elevated heart rate and blood pressure, drowsiness, agitation, vomiting, paranoia, and loss of physical control. In several cases, its use has resulted in various stages of kidney failure.

Consider the issues of abstinence vs. moderation as treatment goals for people with drinking problems.

Traditionally, and still predominantly in the United States and Canada, the assumption is that *the goal of treatment for alcohol problems is abstinence from alcohol.* However, a number of people have stated that individuals identified as alcohol abusers or alcohol dependent can modify their alcohol use to a stable, moderate level. Overall, it seems that less severe alcohol dependence, an individual's belief that moderate drinking is possible, younger age, employment, and psychological and social stability provide the "backdrop" for the feasibility of a moderate drinking outcome.

How are opiate drugs administered?

Uncut heroin can be quite pure and appears as a white odorless powder that can be injected, smoked, or taken intranasally (snorted). On the other hand, crude heroin that is like black tar, produced in Mexico, is generally too impure to be smoked or even to dissolve in water and has to be melted to be injected.

What is the Stepped Care Approach to drug and alcohol treatment?

When individuals seek professional treatment, one model to follow in finding the services needed is called the "stepped care approach,". In this approach, the selection of any treatment is guided by three principles: *(1) Treatment should be individualized with regard to the client's needs and problems;* (2) the treatment selected should be consistent with the current knowledge about effectiveness; and (3) the treatment that is chosen should be the least restrictive

What is Polysubstance abuse?

When people use and abuse more than one drug.

How were the hallucinogenic properties of LSD discovered?

When the Spanish conquistadores began to explore and colonize Mexico and other parts of Central and South America, they encountered civilizations with new customs and religious practices. *Among these practices was the use of hallucinogenic plants in religious ceremonies.* *The royal physician of the king of Spain, Fernando Hernandez studied the plants the Aztecs used* and noted the use of peyote cactus (referred to as peyotl), psilocybe mushrooms (called teonanacatl), and morning glory seeds (called ololiuqui). *Hallucinogenic mushrooms were viewed as sacred* Mushroom icons found in Mayan ruins dating back to before 1000 b.c. Despite the long history of hallucinogenic drug use, these drugs had virtually no impact on main- stream European or American culture until the 1960s, when hallucinogen use exploded.

Where does opium come from?

comes from Papaver somniferum, one of the many species of the poppy plant. The opium poppy is native to the Middle East, in the areas that border the Mediter- ranean Sea, but it is now cultivated extensively throughout Asia and the Middle East. The petals fall after the poppy blooms, leaving a round seedpod the size of an egg. If the seedpod is scored lightly with a knife, it secretes a milky white sap. After drying, this sap forms a thick, gummy, brown sub- stance that is called opium.

What is Cannabis sativa?

more commonly known as marijuana, is a hemp plant that grows freely throughout the world. The cannabis plant is known most commonly today as a potent psychoactive substance, but for many years, it was harvested primarily for its fiber.

Physical effects of opiate drugs

pain relief, respiratory depression, sedation, muscle spasms, vomiting, insomnia, constipation, iItching, nausea, vomiting, sweating, seizures, coma, death

What is opium?

the dried sap produced by the poppy plant