ALCOHOL AND OTHER DRUGS OF ABUSE
For Those Who Care
Alcohol and other drugs of abuse are best understood if discussed according to their major effects. The major categories include depressants, stimulants, marijuana, anabolic steroids, psychedelics and inhalants, beginning with depressants. Depressants are agents that cause slow and faulty thinking, slow heart rate, breathing etc. In other words depressants are drugs that reduce the activities of the body organs by their effect on the brain. They differ mostly in the degree and length of time the effect lasts.
Depressants
Alcohol is by far the most common depressant... The only alcohol that is used as a beverage is ethyl alcohol (ethanol), which is made by the yeast fermentation of grains and fruits. Some is brewed such as beer and wine and others are distilled. The latter includes whiskey, vodka, gin, brandy, rum, tequila and others. Most of these have an alcoholic content of 40%. Beer most commonly is 5% and wines average 12%. Any of these can be abused although many do not consider beer “the hard stuff” On the contrary; beer is just as likely to lead to addiction as any of the others. Alcohol is a rapid acting drug that takes only minutes to travel from the stomach and small intestine to the brain where it exerts its effects. Initially the effects include relaxation, inhibition of the centers that depend on training such as previous experience, memory, concentration and insight. Because of inhibition, 80% of violent crimes occur under the influence of alcohol. If drinking continues the person suffers sensory and motor problems, e.g., staggering and then becomes excited and overactive. It is during this stage that most crimes occur. Still later the drinker “passes our”, is anesthetized and is close to death as the breathing and heart beat become slow.
When drinking is daily or frequent, the person becomes increasingly tolerant and drinks more to get the same effect. As the alcohol in the blood increases, there is memory loss which is commonly referred to as “blackout” and the drinker cannot remember events that occurred while in blackout, even if they were very important. If drinking continues there may be substitution of drink for food resulting in nutritional deficiencies and multiple medical problems such as cirrhosis of the liver.
Over a period of years the tolerance for alcohol increases and the body becomes dependent. It often takes twenty years to develop true addiction such that the person must drink to avoid withdrawal. When drinking begins in infancy or childhood, addiction develops earlier. It is characterized by craving, needing to take a drink (or more) on awakening in order to function. Finally, lack of availability of alcohol or illness causes intake to stop and the drinker experiences withdrawal.
Because alcohol is a short acting drug, withdrawal begins about eight (8) hours after the last drink. The person feels anxious and ill. Then tremor, sweating, nausea and vomiting begin along with rising blood pressure, pulse and temperature (fever). Diarrhea and muscle aches are also the rule and dehydration always occurs... Many of those who are withdrawing also experience convulsions, also known as seizures, as well as hallucinations... Alcohol withdrawal can be fatal and requires medical treatment. It is the most dangerous withdrawal of any drug.
Whereas early withdrawal just briefly described begins in 8 to 12 hours after the last drink or reduced drinking, delirium tremens (D.Ts) begin about three to four days when the early withdrawal begins to improve. The person has no more seizures but becomes extremely agitated, hallucinates, does not eat, drink or sleep and becomes psychotic, i.e., loses all touch with reality. Attempting to treat D.Ts. without hospitalization is not advised. Fortunately, D.T.s does not occur often but once a person develops them, they are more likely to do so again unless they cease drinking.
Opiates
are derivatives of the opium poppy and have been used to relieve pain for
thousands of years. Synthetic opiates
are known as Opioids and have very similar
effects. Opioid
is becoming the preferred term. These
drugs are a medical necessity but a few patients, about 1%, treated for
prolonged pain become addicted.
Addiction most commonly occurs when they are used for reasons other than
pain, e.g., “to get high.” Throughout
history the juice of the opium poppy alone or dissolved in alcohol was
used. Then in the early 19th
century, morphine was extracted from the poppy, and in 1874 heroin was make
from morphine. The hypodermic needle was
developed at mid-century. Heroin is more
potent than morphine but is not used medically in
Heroin China White (also slang for fentanyl), snow, junk
Not legal in
Morphine M, Morpho
Oxycodone Percodan, Percocet (names of prescription drugs)
OxyContin Long acting oxycodone
Dilaudid Doctors (street name)
Methadone Dollies (street name)
Heroin is the most commonly used opioid sold on the streets. Some start with snorting and then progress to intravenous (IV) use because it is the most potent and rapid. First there is euphoria and, for some, an orgasm like experience. This is followed by a dream state, constricted pupils, slow pulse and flushed face that lasts several hours. Tolerance develops and more of the drug must be used to give the same pleasure. As dependence, i.e., addiction develops, the user must spend more and more time obtaining the drug and must resort to crime such as theft and/or prostitution to get the next “fix”, usually about three a day. Since street drugs are almost always adulterated in order to increase profitability for the dealer, the purchaser never knows what strength or what other substances may have been added. Also, when the user can no longer inject into the damaged veins-note the needle marks in the arms/legs- he/she must resort to “skin popping” into the fatty tissue or muscle. Whether injected in vein or other tissues the often contaminated drug causes many serious infections in the heart, muscle or skin. Sharing needles with other users is equally dangerous because an ill user can pass his/her infection along through a contaminated syringe or needle. When the user is no longer able to obtain a “fix” due to illness, lack of money etc., withdrawal symptoms begin, usually in six to eight hours but for some in as little as five hours.
Withdrawal from heroin or other opioids is not as dangerous as alcohol withdrawal but it is miserable, often characterized as the “super flu” with runny nose, goose bumps, tremors and sweating, muscle aches, cramps, nausea/vomiting and insomnia. Withdrawal lasts from three to ten days but the insomnia lasts longer.
Overdose can occur and may be fatal. If the user is difficult to awaken it is not wise to let them “sleep it off.” Fifty to ninety percent develop fluid in the lungs with pink frothy sputum. Respiratory failure and death may follow. This develops slowly over a period of hours so there is usually time to get the person to an emergency room.
Other opioids are similar to heroin and differ mainly in potency and time. Long acting ones such as OxyContin are usually obtained through prescription drug abuse, e.g. “doctor shopping” but may also be street drugs. The long acting ones are especially dangerous when a tablet intended to relieve pain for 12 hours is crushed and injected or bitten so that the entire contents are immediately absorbed and result in overdose. Methadone is another long acting drug with similar potential.
Benzodiazepines are much used, valuable sedative/hypnotic drugs. They come in long and short acting types and are used in many medical procedures to reduce anxiety, induce anesthesia, or to control seizures. Even in overdose, fatalities are rare—but still possible, especially when combined with alcohol. Addiction is not common but it does occur and when it does it can cause the same problems as alcohol, e.g. erratic driving, problems operating machinery, memory blackouts, etc. When addiction occurs, withdrawal at sometime is inevitable. It is not as difficult and life threatening as alcohol withdrawal but, at the worst, withdrawal is similar and the user may require medical help. Common benzodiazepines are:
Generic Name Trade Name
Alprazalam Xanax
Clonazepam Klonipin
Chlordiazepoxide Librium
Diazepam Valium
Flurazepam Dalmain
Lorazepam Ativan
Oxazepam Serax
Not used in
Barbiturates are also sedative/hypnotic drugs that have been largely, but not totally,
replaced by benzodiazepines for medical use because the latter are safer
drugs. There are some unique medical
uses that are beyond the scope of this paper. Effects are similar to alcohol
except that most are longer acting. They
can be dangerous when combined with alcohol and there is much more potential
for addiction than with benzodiazepines.
When addiction and inevitable withdrawal occur, the shorter acting
barbiturates like pentobarbital cause more intense and dangerous symptoms while
the longer acting ones such as Phenobarbital are excreted slowly and act as
their own taper. The withdrawal symptoms
are similar to alcohol withdrawal but not as dangerous unless the dosage is
high and prolonged. Some of the more
common barbiturates are:
Generic Name Trade Name
Pentobarbital Nembutal
Street name: yellow jackets
Phenobarbital Generic name only
Secobarbital Seconal
Street names: reds and red birds
All of the barbiturates at one time or another is called downers and/or sleeping pills.