Alcohol

Alcohol is a part of our culture and social environment. It is also the third leading cause of preventable death in the US: about 88,000 deaths per year result from alcohol-related causes. Nearly half of these deaths are from liver disease. Chronic alcohol use also increases the risk of cancers of the mouth, esophagus, larynx, liver, and breast.

New Mexico has ranked highest in alcohol-related deaths for more than thirty years. One in six deaths of people between 20 and 64 are due to alcohol. Excessive alcohol consumption also increases domestic violence, crime, poverty, unemployment, car accidents, and mental illness.

Alcohol Use Disorder (AUD) is a chronic relapsing brain disease characterized by an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences. AUD can range from mild to severe. Regardless of severity, recovery is possible.

American Psychiatric Association (2013) Desk Reference To The Diagnostic Criteria from DSM-5. Pp 227-283

https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/alcohol-use-disorders

https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption

https://ibis.health.state.nm.us/indicator/complete_profile/AlcoholRelatedDth.html

Heroin, Opioids and Opiates (other)

Every brain has receptors to chemicals that control pain, feelings of pleasure, and addictive behaviors. These opioid receptors respond to a variety of chemicals. Opiates (including heroin, morphine, and codeine) are naturally derived; opioids (like Vicodin, oxycodone, fentanyl and methadone) are synthetic drugs. All of them bind to the same receptors.

Heroin enters the brain quickly, and binds to opioid receptors throughout the body. This creates a rush of euphoria, coupled with slowed heart rate, heaviness in the limbs, and sleep – or something like it. Because of this rush and a sharp “letdown,” heroin is highly addictive. Users quickly develop tolerance, requiring larger and more frequent doses.

Prescription opioids have similar effects. In fact, most people using heroin started with prescription painkillers. Prescription opioid use for pain is widespread, but tolerance grows quickly and causes increased sensitivity to pain. A person needs more to get the same relief. Most heroin users start out overusing prescription pain meds.

Withdrawal can include restlessness and irritability, severe muscle and bone pain, insomnia, diarrhea, vomiting, cold flashes, and uncontrollable leg movements, as well as overpowering cravings. It can be very painful, physically and emotionally.

Long term effects include physical, emotional and cognitive damage. Those who inject risk collapsed veins, abcesses, infections, and are at high risk for contracting HIV or hepatitis. Snorting or smoking drugs can lead to damaged sinuses and lung disease. All opioid users may experience chronic insomnia; constipation; liver and kidney disease; depression; sexual dysfunction and irregular menstrual cycles. Long term use damages the brain, affecting decision making and impulse control.

Overdoses are very common. As the heart rate slows down, breathing slows and sometimes stops. If a person survives an overdose, they may sustain brain damage or coma from oxygen deprivation.

Naloxone is a fast-acting opioid blocker that can reverse overdose. It is increasingly available and can be injected by a paramedic or given as a nasal spray (Narcan) by almost anyone. More than one dose may be needed, and its effects are short-lived. Overdose can recur if it wears off before additional emergency treatment.

There are many approaches to treating opioid addiction. Best practices include some combination of medication and behavioral therapy. Methadone and suboxone are opioids themselves, but they take up the receptors and allow someone to begin to build some stability without constant craving. Vivitrol is administered after a person detoxes from all opioids, including suboxone, and reduces cravings in early recovery. Individual and group therapy helps people learn to live drug-free, and community support seems to be essential as well.
Individual treatment plans allow professionals to tailor approaches to clients’ unique needs and offer the greatest success.

(1) (https://www.centeronaddiction.org/the-buzz-blog/we-asked-you-answered-there-difference-between-opioid-and-opiate. 11.21.18)

(2) (https://www.drugabuse.gov/publications/drugfacts/heroin)

(3) https://www.drugabuse.gov/related-topics/opioid-overdose-reversal-naloxone-narcan-evzio

(4) https://www.drugabuse.gov/publications/research-reports/relationship-between-prescription-drug-abuse-heroin-use/introduction

Methamphetamine

Amphetamines are pharmaceutical stimulants that may be used to treat conditions including narcolepsy or ADHD. Methamphetamine is similar, but is manufactured illegally and is highly addictive. It may resemble a powder, small glass shards, or shiny gravel. It may contain contaminants or byproducts, and its potency may vary widely.

Meth can be smoked, snorted, swallowed, or injected. Meth releases dopamine into the body, creating a sense of euphoria, increased wakefulness and activity, increased heart rate and decreased appetite. It can cause a person to be paranoid, anxious and shaky. It may also cause perspiration, chills, nausea or vomiting, agitation, muscular weakness, chest pains, heart problems, confusion, twitching and spasms, seizures, and coma. is very fast-acting and wears off just as quickly, reinforcing the desire to use again. People often binge on the drug for days at a time.

Withdrawal can be physically and emotionally painful, and may include fatigue, vivid and unpleasant dreams, insomnia, increased appetite, psychosis, agitation, depression, and strong cravings.

Methamphetamine users risk disease including HIV and hepatitis. Meth can cause weight loss, dental and bone loss, skin irritation and sores, anxiety, violence, paranoia and hallucinations. Cognitive abilities, rational decision making, and mood are affected. Meth will eventually reduce coordination and impair verbal learning. Long term use increases risk of developing Parkinson’s disease, a nerve disorder affecting movement.

Overdose of methamphetamine can result in stroke, heart attack, or organ failure. All of these can lead to death.

There is no prescription medication that can treat methamphetamine addiction. It takes time for the brain to heal. Individual and group therapy, community support, and a whole life, whole-body approach seems to be most effective.

https://www.drugabuse.gov/drugs-abuse/methamphetamine American Psychiatric Association (2013) Desk Reference To The Diagnostic Criteria from DSM-5. Pp 227-283

Cocaine and Crack

Cocaine is a highly addictive stimulant derived from the coca plant. It is a powder which may be snorted, used topically, or dissolved and injected. Cocaine is often processed with amphetamines or synthetic opioids. This is especially dangerous, resulting in increasing overdose and toxicity.

“Crack” is cocaine that can be smoked. This allows the drug to reach the brain faster. Crack cocaine creates a very intense, immediate, very brief high.

Cocaine affects movement and reward centers of the brain. It will immediately stimulate cravings. Stronger and more frequent doses are needed to obtain the same effect and relieve withdrawal.

Initially, cocaine causes euphoria, mental alertness, and increased energy. It can also cause paranoia, irritability, and hypersensitivity to sight, sound, and touch. Cocaine constricts blood vessels, dilates the pupils, increases body temperature and heart rate, and can cause nausea, restlessness, and tremors or twitching.

Long-term effects may include loss of smell, nosebleeds, and holes in the nasal cavity; respiratory distress and infections; severe bowel decay; risk of contracting HIV and hepatitis, skin or soft tissue infections, and collapsed veins.

Chronic use can cause severe depression, irritability, aggression and paranoia, delirium or psychosis. Users risk heart attack and heart disease, stroke, respiratory failure, seizures, sexual dysfunction and infertility in both men and women, and movement disorders such as Parkinson’s disease.

Withdrawal symptoms include depression, irritability, extreme fatigue, anxiety, intense craving, and sometimes psychosis. A person will often continue using the drug to avoid the discomfort of withdrawal.

Cocaine addiction is not currently treated with medication. Residential treatment, cognitive-behavioral therapy, and community-based recovery groups are effective.

https://www.drugabuse.gov/drugs-abuse/cocaine

http://www.cesar.umd.edu/cesar/drugs/crack.asp

American Psychiatric Association (2013) Desk Reference To The Diagnostic Criteria from DSM-5. Pp 227-283

Sleeping Pills (Ambien, Sonata & others)

Ambien (Zolpidem, Z) is prescribed for severe insomnia. It was claimed to be less addictive than other sleeping pills, but over the years this has proven false. The company that manufactures Ambien has been involved in class-action lawsuits, in part because they marketed the drug as safe and non-habit forming. It is easy to develop a tolerance for Ambien, requiring higher doses over time. Abuse and dependency are widespread.

Other drugs that work like Ambien seem to have similar risks. Lunesta (eszopiclone), and Sonata (zaleplon) are also “sedative hypnotics,” and while each new drug claims to have less potential for abuse, dependency is always a problem. Taking these drugs for more than two weeks often creates “rebound insomnia:” people cannot sleep if they took it the night before.

Ambien is particularly addictive and dangerous. It can have euphoric and hallucinatory effects. Ambien is also known to cause people to act in strange ways, or to do things while sleepwalking and have no memory of it later. Side effects include slurred speech, confusion, light-headedness, problems with movement and memory, dizziness, dry mouth, headache, lowered blood pressure and slowed breathing. Blackouts are common, and combination with alcohol increases risks dramatically. Overdose can slow or stop breathing altogether, which can lead to brain damage, coma, or death.

Long term use can result in withdrawal symptoms, including seizures if a person stops taking the drug without controlled tapering. Other withdrawal symptoms may include shakiness, anxiety, agitation, insomnia, and sweating; increased heart rate, blood pressure, and temperature; hallucinations, chronic fatigue, nausea and vomiting; and severe cravings. People who develop addiction to sedative-hypnotics should be treated in a supervised medical detox, followed by treatment including whole-life changes that naturally promote normal sleep.

https://www.drugabuse.gov/publications/drugfacts/prescription-cns-depressants

Prescription Stimulants – Amphetamine

Stimulants like Adderal, Ritalin, Dexedrine, Concerta and Strattera may be prescribed to treat attention deficit disorders and narcolepsy. They increase alertness, attention, and energy levels.

These drugs may also create a euphoric “rush” feeling, and increase heart rate. They can be rapidly and severely habit forming, and tolerance may grow quickly with overuse. At high doses they can cause dangerously high body temperatures, irregular heart beat, heart attack and seizures. Repeated misuse can cause psychosis, volatile behaviors, and paranoia. Eventually, overuse of stimulants can lead to heart, stomach, and nerve damage.

Stimulant overdose results in tremors, rapid and uncontrolled breathing, confusion, aggression, increased fever and muscle pain, nausea, vomiting, diarrhea and abdominal cramps. Overdose can result in seizures and convulsions, coma, and death.

Withdrawal symptoms can include fatigue, depression, and long term sleep disorders.

Detoxification and behavioral therapy with a focus on managing triggers, stress, and behaviors; whole life/whole body solutions; and community support are all parts of effective treatment. Tailoring treatment to the individual increases success.

American Psychiatric Association (2013) Desk Reference To The Diagnostic Criteria from DSM-5. Pp 227-283

https://www.drugabuse.gov/publications/drugfacts/prescription-stimulants

Marijuana

Marijuana is widely used and not always viewed as dangerous. It is legal in some states, but use or possession is still a felony in others. Medical and legal approaches to marijuana are as uneven as opinions about it.

Marijuana is often smoked, which can lead to respiratory problems. It may also be eaten, and the slower onset of the drug can make dosage and duration hard to gauge. THC, the psychoactive component, causes altered sensations (eg., brighter colors), altered sense of time, slowed reaction times, impaired memory, cognition, and decision-making. Hallucinations, delusions, and psychosis can occur with large doses. Marijuana also increases symptoms of schizophrenia.

Marijuana affects brain development, especially in young people. It has been shown to decrease IQ. Marijuana use can affect memory, learning and thinking abilities, and motivation.

Use in pregnancy can lead to decreased birth weight, and behavioral and cognitive problems in babies.

Some people cannot stop using marijuana even if it is causing physical, emotional, or mental problems. Withdrawal from chronic marijuana use can include increased irritability, restlessness, difficulty sleeping, and cravings. Treatment for marijuana overuse includes behavioral therapy and addressing underlying emotional distress.

American Psychiatric Association (2013) Desk Reference To The Diagnostic Criteria from DSM-5. Pp 227-283

https://www.drugabuse.gov/publications/drugfacts/marijuana

MDMA (ecstasy/Molly)

MDMA, 3,4-methylenedioxy-methamphetamine, is a synthetic drug with similarities to both stimulants and hallucinogens. MDMA increases energy levels, alters mood and perceptions, heightens feelings of pleasure, and distorts perceptions of time and sensation.

MDMA primarily comes in pill or tablet form. MDMA increases the activity of dopamine, norepinephrine, and serotonin, affecting the brain’s reward center, increasing energy, increasing heart rate and blood pressure, and increasing feelings of pleasure and sexual arousal. Side effects may include nausea, muscle cramps, involuntary teeth clenching, blurred vision, chills and sweating.

Prolonged use can increase irritability, depression, impulsiveness, and sleep, memory and attention problems. It can decrease interest or pleasure from sex. Repeated use can affect the body’s ability to regulate temperatures leading to liver, kidney, and heart failure – and possibly death.

MDMA may be mixed with other drugs including cocaine, ketamine, methamphetamine, over-the-counter cough medicine, or synthetic cathinones (“bath salts”). Tampered MDMA can increase danger.

MDMA can be addictive. Withdrawal symptoms include fatigue, depression, decreased appetite, difficulty concentrating, and decreased sensations of pleasure.

American Psychiatric Association (2013) Desk Reference To The Diagnostic Criteria from DSM-5. Pp 227-283

https://www.drugabuse.gov/drugs-abuse/mdma-ecstasymolly

Hallucinogens

Hallucinogens is a broad term for a range of naturally occurring and synthetic drugs that cause vivid auditory and visual hallucinations, distorted time and sensory perceptions, and marked increase in energy. Examples of hallucinogens include LSD, DMT, ayahuasca, peyote, and psilocybin mushrooms. Other hallucinogens are DMX, ketamine, PCP, and salvia.

Hallucinogens can be swallowed as a pill or tablet, taken in liquid form or brewed into a tea, snorted, injected, inhaled, smoked, injected, or eaten raw as with mushrooms. Hallucinogens interfere with communication in brain chemical systems, interfering with serotonin which regulates mood, sensory perception, body temperature and muscle control; and/or interferes with glutamate which regulates pain perception, responses to the environment, emotion, learning and memory.

Physical effects include increased heart rate, blood pressure, breathing, and body temperature; nausea; uncoordinated movements; feeling of disassociation; loss of appetite; sleep problems; excessive sweating; and in extreme cases psychosis.

There has not been much research on the long-term effects of chronic or repeated hallucinogen use, but speech and memory problems, depression, and anxiety have been noted, and long-time ketamine users can develop ulcers and kidney problems. High doses of PCP can result in seizure, coma, or death. While rare, long term use of hallucinogens can cause persistent psychosis, including visual disturbances, distorted thinking, paranoia, and mood changes, and flashbacks. People who ingest psilocybin are at risk for poisoning.

Research varies on the addictive qualities of hallucinogens. LSD is not considered an addictive drug, but a person may develop a tolerance for it, requiring more of the drug to get the desired effects. This is particularly dangerous if the purity of the drug is unknown. PCP on the other hand is an addictive drug and can cause cravings as well as withdrawal symptoms if stopped suddenly.

American Psychiatric Association (2013) Desk Reference To The Diagnostic Criteria from DSM-5. Pp 227-283

https://www.drugabuse.gov/publications/drugfacts/hallucinogens

Benzodiazepines (Xanax, Valium & others)

Benzodiazepines are Central Nervous System (CNS) depressants which slow brain activity and cause drowsiness. They are used in treating anxiety, panic, and acute stress reactions. These drugs can calm or sedate a person by raising the level of the inhibitory neurotransmitter GABA in the brain. Common benzodiazepines include Valium (diazepam), Xanax (alprazolam), and Klonopin (clonazepam).

As with any drug, long term use can lead to dependence and tolerance, requiring higher doses to achieve the desired effect. Long term use can also result in withdrawal symptoms when use is suddenly reduced or stopped, and a person may experience seizures if they stop taking the drug immediately without controlled tapering. Other withdrawal symptoms may include shakiness, anxiety, agitation, insomnia, overactive reflexes, increased heart rate, blood pressure, and temperature, sweating and hallucinations, and severe cravings.

Overdose is possible when a person takes more than prescribed as high doses of sedatives can slow or stop breathing altogether which can lead to brain damage, coma, or death. According to the National Institute on Drug Abuse, more than 30% of opioid overdoses also involve a benzodiazepine. People prescribed opioid pain relievers are often also prescribed benzodiazepines, a dangerous combination as both are CNS depressants and can inhibit breathing. Studies have shown that overdose death rates are ten times higher in people taking both drugs than in people taking just opioids.

In 2015, of the total 30,000+ opioid overdose deaths, nearly a third of those deaths included benzodiazepines in the person’s system. Because of this, the Centers for Disease Control and Prevention (CDC) issued new guidelines for prescribing of opioids, recommending that clinicians avoid prescribing benzodiazepines concurrently with opioids whenever possible. Both prescription opioids and benzodiazepines now carry FDA “black box” warnings on the label highlighting the dangers of using these drugs together. Using these prescriptions with alcohol also greatly increases the chance of overdose and death.

People who develop an addiction to benzodiazepines should be treated in a supervised medical detox where the dosage is gradually tapered. Cognitive Behavioral Therapy (CBT) can be especially helpful when treating this type of Substance Use Disorder once detox is completed.

https://www.drugabuse.gov/publications/drugfacts/prescription-cns-depressants

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Kratom

Kratom is derived from the leaves of a tropical tree. It is not currently illegal and can be bought as a powder, extract, capsule, gum, tea or cigarette. It is also known as Biak, Ketum, Kakuam, Ithang, and Thom.

Because Kratom is unregulated by the FDA, it may be mixed or contaminated with impurities that have been dangerous or deadly. Deaths from Kratom have been reported, mostly in conjunction with other drugs. Deaths from Kratom alone usually resulted from an adulterated product.

Kratom claims to be “all things to all people.” It is marketed as a sedative or stimulant, to decrease pain, or lose weight. Kratom is also pitched as an herbal alternative to managing cravings for other drugs or to treat addiction, but there is currently no scientific evidence to support this.

Kratom can cause uncomfortable, sometimes dangerous side effects, including nausea, itching, sweating, dry mouth, constipation, seizures, and hallucinations. Symptoms of psychosis have been reported.

Kratom is still relatively unusual and has not been extensively studied. But there are reports of dependence with prolonged use and withdrawal symptoms, including muscle aches, jerky movements, insomnia, irritability, hostility, aggression and mood swings.

https://www.drugabuse.gov/publications/drugfacts/kratom