Drug

The term ‘drug’ has become something of a misnomer. Strictly, a drug is a chemical substance
used to treat disease in animals, including man. Today, a drug is a pure chemical substance
whose structure is known and is formulated, by mixing it with other materials, into a
preparation suitable for administration. This results in the familiar tablets, pills, injections,
liquid mixtures, emulsions, and syrups; ointments, creams, and salves; infusions and
tinctures; drops for eyes, ears, and noses; sprays for inhalation, gases delivered by machine,
supositories, and the like. In earlier times drugs were not always pure, single substances, but
mixtures of substances together with many unknown constituents, and were derived from
medicinal plants. Here the dried leaves, roots, stems, bark, or rhizomes of plants were ground
into powders or used to prepare infusions, tinctures, syrups etc. For example, malaria was
treated with infusions made from cinchona bark, and constipation by extracts of casacara
sagrada bark. Today, the same diseases might be treated with tablets containing quinine or
emodins, respectively.

A. Absorption

Alcohol is primarily absorbed through the stomach and the small intestines. It is considered a
food because it has calories, but does not need to be digested and proceeds directly into the
body through the digestive system. After ingestion it is carried through the blood stream and
crosses the blood–brain barrier, at which time impairment begins. A greater amount of ingestion
causes greater impairment to the brain, which, in turn, causes a person to have a greater degree
of difficulty in functioning

B. Metabolism/Elimination.

The majority of alcohol in the body is eliminated by the liver. Ninety percent is eliminated through
the body, while ten percent is eliminated (unchanged) through sweat and urine. Before the liver
can process alcohol, a threshold amount is needed and can occur at the rate of one 12 oz. can of
beer, one 5 oz. glass of wine, or 1 1/2 oz. shot of whiskey per hour.

C. Brief Overview

1. Alcohol is a central nervous system depressant.

2. Alcohol is among the most abused drugs in our society.
3. Alcohol can be as potent as many other illegal drugs.
4. Alcohol can cause severe damage to a developing fetus.

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 5. People often do not realize that they are becoming dependent on alcohol.

D. Short-term Effects

1. Reduces sensitivity to pain.

2. Affects vision in the following ways: narrows the visual field, reduces resistance to glare,
interferes with the ability to differentiate intensities of light, and lessens sensitivity to
colors.

E. Long-term Effects

1. Damage to vital organs; including liver, heart and pancreas.

2. Linked to several medical conditions; including gastro intestinal problems, malnutrition,

high blood pressure, and lower resistance to disease. Also linked to several types of
cancer; including esophagus, stomach, liver, pancreas and colon.

F. Special Hazards Involving the Driving Task

Specific elements to the hazards of alcohol use and driving are listed in a separate section of the
curriculum. However, alcohol impairs one's ability to drive or operate machinery safely

G. Effects with Other Drugs

Alcohol produces a synergistic effect when taken with other central nervous system
depressants. These include: sedative hypnotics, barbiturates, minor tranquilizers,
narcotics, codeine, methadone, and some analgesics.

Alcohol can be additive in nature when taken with antipsychotic medications, antihistamines,
solvents or motion sickness preparations. When used on a daily basis, in conjunction with aspirin,
it may cause gastro intestinal bleeding. Also, when used with acetaminophen, an increase in liver
damage could occur.

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II. BLOOD ALCOHOL CONCENTRATIONS

Alcohol begins to affect individuals prior to reaching the legally intoxicated Blood Alcohol
Concentration level of .08%. If a 150 lb. person consumes one drink equal to twelve ounces
of beer (5 percent alcohol), five ounces of wine (12 percent alcohol) or one-and-a-half
ounces of hard liquor (40 percent alcohol), all would contain about the same amount of
alcohol and would raise the person's Blood Alcohol Concentration about .02%. It takes the
liver approximately one hour to oxidize or metabolize one drink.

A. Factors Influencing Blood Alcohol Concentrations

1. Weight
2. Gender
3. Food in Stomach
4. Duration of Administration
5. Dosage

B. Tests for Intoxication

1. Blood Analysis
The methodology of blood analysis measures the amount or percentage of alcohol
per 1,000 drops of blood.
2. Breath Analysis
Measures the blood alcohol content of air in the lungs.

3. Urinalysis
Detects marijuana, cocaine, PCP, and heroin; and gives the presence of the drug.
It does not provide the level of impairment, since legal levels of impairment have
not been established.

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I. DRUG ABSORPTION/METABOLISM/ELIMINATION

A. Method of Administration
Drugs are administered to or enter the human body in a number of ways, including
injection, inhalation, and ingestion. The method of administration impacts on how the
drug affects the person. For example: injection takes the drug directly into the blood
stream, providing more immediate effects; while ingestion requires the drug to pass
through the digestive system, delaying the effects.

B. Factors Affecting Absorption/Metabolism

Factors that affect absorption/metabolism include physical, emotional and drug-

related factors.

1. Physical Factors
Physical factors that affect the absorption or metabolism of a drug include:

a. Person's weight and age – The amount of physical mass a drug must travel
through will have an outcome on the drug's total effect on the body. Also, the
aging process affects the manner in which the drug exerts its effects on the
body.

b. Individual biomedical/chemical make-up – Each individual tolerates

substances differently. For example: a person's physical condition as well as
hypersensitivity (allergies) or hyposensitivity (need for larger doses to gain the
desired effect) will influence the total effect of the drug on the individual.

c. Rate of metabolism – Each drug metabolizes or processes within the body at

a different rate. The drug remains active in the body until metabolism occurs.
For example: certain medications require dosages to be taken every four, twelve
or twenty-four hours, depending on the duration and rate at which the drug is
metabolized.

d. Food – Food in the body slows absorption of the drug into the body by not

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 allowing it to pass directly through the digestive process without first being
processed by the digestive system. A slower process occurs, since the body is
digesting food in addition to the substance or drug utilized by the person.

2. Emotional Factors
The emotional factors that may influence drug absorption and metabolism within
the body are:

a. Emotional state – A person's specific emotional state or degree of

psychological comfort or discomfort will influence how a drug may affect the
individual. For example: if a person began using alcohol and was extremely
angry or upset, the alcohol could intensify this anger or psychological
discomfort. On the other hand, if alcohol was being used as part of a
celebration, the psychological state of pleasure could be enhanced by the use of
the drug.

b. Anticipation/Expectancy – The degree to which a person believes that a given

drug will affect them, may have an effect on their emotional state. If a person
truly believes that by using a substance, they will experience a given effect, then
their expectations may cause a psychological change in the manner in which the
drug affects them.

3. Drug-Related Factors
The drug-related factors that influence the way drugs are absorbed and
metabolized within the body are:

a. Tolerance – Tolerance refers to the amount of a given substance necessary

to receive its desired effect.

b. Presence or use of other drugs – The presence or use of other drugs such as
prescription, over-the-counter, nicotine, and caffeine also influence the rate of
absorption and metabolism of drugs in the body.

c. Method of administration – A drug injected directly into the blood stream will
affect an individual at a greater rate, since it will be directly absorbed through
the blood stream and presented to various organs. If a drug is snorted or
inhaled, the effects may be enhanced, due to the fact that the sinus cavity is

5
 located in close proximity to the brain. On the other hand, if a drug is ingested,
the effects may be slower due to the fact that they must pass through the
digestive system.

d. Physical dependence (addiction) – If a person is physically addicted to a drug,

then more of a given substance may be necessary and the effects on the body
will differ from those seen in a non-dependent individual.

C. Elimination

Drugs are eliminated from the body primarily through the liver. The liver and kidneys act
as a body's filter to filter out and excrete drugs from the body. The liver metabolizes
ninety percent of alcohol in the body, while ten percent is excreted through the lungs
and sweat. Also, the liver metabolizes drugs in a fairly consistent manner. For example:
alcohol is removed at the rate of one 12 oz. can of beer, one 5 oz. glass of wine, or 1
1/2 oz. shot of whiskey per hour.

II. SPECIFIC EFFECTS ON THE CENTRAL NERVOUS SYSTEM

Drugs affect the various areas of the brain and change normal brain activity. It is
important to know what specific functions are located in each of the major brain areas,
to better understand the effects of drugs and alcohol on behavior and functioning.

A. Hypothalamus
The hypothalamus regulates homeostasis, the body's system for keeping itself
balanced. This includes: sleep and wake cycles, hunger, thirst, sexual behavior,
blood pressure, and temperature. Also, the hypothalamus determines what parts of
the body are affected by analgesics and regulates hormonal impulses and emotions.

B. Medulla

The medulla is responsible for head balance, movement, and assisting the
hypothalamus in regulating automatic body functions.

C. Cerebral Cortex

The cerebral cortex contains half of the nervous system's cells, which regulates the
speed and vomiting reflexes. It is also responsible for language, abstract thinking,
personality, and interpretation of emotion and sensory information, including
judgment.

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 D. Cerebellum

The cerebellum is responsible for coordination of muscles, maintenance of balance,

and specific memory and learning system functions that are not to one part of the
brain.

III. DRUG CATEGORIES

A. Marijuana

1. Absorption
Marijuana may be inhaled or ingested.

2. Metabolism/Elimination
THC (Delta-9-tetrahydrocannabinol) is highly fat-soluble and may take up to three
months to be fully eliminated from the body by the liver and kidneys. One joint
affects the body for a period of two to four hours.

3. Brief Overview
Marijuana is the most frequently used illicit drug in America and has been linked to
harming a developing fetus. It has the same or similar effects as depressants,
stimulants, and hallucinogens. Marijuana cigarettes yield almost four times as
much tar as tobacco, creating a higher risk of lung damage.

4. Short-term Effects
a. Increases in heart rate, body temperature, and appetite.
b. Drowsiness.
c. Dryness of the mouth and throat.
d. Reddening of the eyes and reduction in ocular pressure.

5. Long-term Effects
a. Can cause the following medical conditions: respiratory problems, lung damage,
and cancer.
b. Memory and concentration impairments.
c. Possible motivational syndrome.

6. Special Hazards Involving the Driving Task

Marijuana has been linked to the impairment of the ability to drive a vehicle.
Concentration is affected and there is difficulty in perceiving time and distance,

7
 which can lead to the following: bad judgment, impaired reaction time, poor speed
control, an inability to accurately read signs, drowsiness, and distraction.

7. Effects with Other Drugs

When marijuana is combined with alcohol it creates greater impairment in areas
such as reaction time and coordination. When combined with sedatives and
opiates, it can cause an increase in anxiety and even hallucinations, along with an
increase in heart rate and blood pressure when used with amphetamines. On the
other hand, effects are somewhat unpredictable when marijuana is combined with
stimulants, such as nicotine, caffeine, amphetamines, and cocaine.

B. Cocaine

1. Absorption
Cocaine enters the body in one of three ways: injection, smoking, or snorting.

2. Metabolism/Elimination
Cocaine is a strong stimulant to the central nervous system. Its effects can last
anywhere from 20 minutes to several hours, depending on the content, purity,
administration, and dosage of the drug.

3. Brief Overview
a. Cocaine users become dependent on the drug.
b. Crack is a form of the drug that is highly addictive.
c. Exposure to the drug can harm a developing fetus.
d. It produces short-lived senses of euphoria, the length depends on how the drug
was administered.

4. Short-term Effects
a. May cause extreme anxiety and restlessness.
b. May experience the following medical conditions: twitches, tremors, spasms,
coordination problems, chest pain, nausea, seizures, respiratory arrest, and
cardiac arrest.

5. Long-term Effects
a. May cause extreme alertness, watchfulness, impaired judgment, impulsiveness,
and compulsively repeated acts.
b. May cause stuffiness, runny nose, tissue deterioration inside the nose, and
perforation of the nasal septum.

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 6. Special Hazards Involving the Driving Task
a. Cocaine may successfully mask fatigue, however, high dosages impair judgment
and interfere with the ability of the driver to concentrate.
b. Coordination and vision are impaired.
c. There is an increase in impulsive behaviors with tendencies to take more risks
and create confusion within the user.

7. Effects with Other Drugs

a. Additive effects are noted when cocaine is combined with over-the-counter
products, such as diet pills or antihistamines.
b. Cocaine taken with psychotropic drugs, especially antidepressants, can be
extremely detrimental.
c. A person who has extremely high blood pressure and uses cocaine may suffer
from a stroke or heart attack.
d. Some users combine cocaine with alcohol and sedatives to cushion the "crash"
or feeling of depression and agitation that sometimes occurs as the effects of
cocaine wear off.
e. A person using cocaine maintains the illusion of being alert and stimulated,
although physical reactions are impaired.
f. Further research indicates that additive and antagonistic effects can be produced
when cocaine is mixed with alcohol.
g. If cocaine is used in high doses, as in the case of overdose, alcohol will probably
have an additive effect on the symptoms that eventually contribute to death.
h. When cocaine is injected in combination with heroin, sometimes called
"speedballing," there is an increased risk of toxicity, overdose, and death.

C. Sedative Hypnotics (Barbiturates, Benzodiazepines)

1. Absorption
Sedative Hypnotics are absorbed through ingestion.

2. Metabolism/Elimination
Sedative Hypnotics are eliminated by the liver and excreted in urine. Their effect
can last anywhere from two to ten hours.

3. Brief Overview
a. Antianxiety tranquilizers are among the most commonly prescribed drugs in the
world.
b. Driving under the influence of tranquilizers is dangerous.

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 c. A person can become dependent on tranquilizers and depressant drugs, which
make them feel calmer, more relaxed, and drowsy.

4. Short-term Effects
a. Short-term effects can occur with low to moderate use.
b. May experience moderate relief of anxiety and a sense of well-being.
c. There may be temporary memory impairment, confusion, and impaired thinking.
d. A person could be in a stupor, and have altered perception and slurred speech.

5. Long-term Effects
a. May include over-sedation, decreased motivation, apathy, and lack of interest in
surroundings.
b. A person may experience headaches, dizziness, sleep disorders, anxiety,
depression, and tremors.
c. There may be an increase in appetite and impairment of thinking, memory, and
judgment.

6. Special Hazards Involving the Driving Task

a. The use of tranquilizers produces drowsiness, incoordination, altered
perceptions, memory impairment, poor control of speech, and slower reaction time.
b. Effects on driving include: poor tracking, difficulty in maintaining lane position,
and neglecting roadside instructions.
c. When combined with alcohol, the effects may be more hazardous.

7. Effects with Other Drugs

a. Some people in methadone treatment programs use benzodiazepines to
enhance the effects of methadone.
b. When tranquilizers are combined with alcohol or other central nervous system
depressants, synergistic effects may be produced, which may be fatal.
c. Alcohol increases the absorption of benzodiazepines, slows their break down in
the liver and can cause cardio vascular and respiratory depression.
d. People who take stimulants sometimes take tranquilizers to off set agitation and
sleepiness.

D. Opiates (Morphine, Heroin, Codeine, Opium)

1. Absorption
Opiates are normally absorbed though injection.

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2. Metabolism/Elimination

Opiates are metabolized by the liver and may have a lengthy metabolism due to
excessive half-lives of the drugs.

3. Brief Overview
a. Opiates can cause sedation and euphoria.
b. They are often used to relieve pain, suppress coughs, and control physical
conditions such as diarrhea.
c. Respiratory depression and death can occur from overdoses of opiates.
d. Opiates may impair a person's ability to drive.
e. A person can become physically and psychologically addicted to opiates.

4. Short-term Effects
a. Include drowsiness, dizziness, mental confusion, constriction of pupils, and
euphoria.
b. Some opiate drugs, such as Codeine, Demerol, and Darvon, also have
stimulating effects.
c. Stimulating effects include: central nervous system excitation, increased blood,
elevated blood pressure, increased heart rate, tremors, and seizures.

5. Long-term Effects
a. May include impaired vision, pulmonary complications, and menstrual
irregularity.
b. A person may experience nightmares, hallucinations, and mood swings.

6. Special Hazards Involving the Driving Task

a. Opiates can cause drowsiness, mental confusion, and visual impairment even at
lower, moderate doses.
b. A driver may have difficulty keeping the vehicle in the correct lane and may
make errors in judgment.

7. Effects with Other Drugs

a. Alcohol greatly increases the present effects of opiates and can lead to
respiratory arrest.
b. A person injecting heroin mixed with cocaine or methamphetamines, known as
"speedballing," produces a stimulant effect.
c. The listed drug combinations increase the risk of toxicity, overdose, and death.

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E. Amphetamines

1. Absorption
Amphetamines are absorbed by the body in one of three ways: snorting,
swallowing, or injection.

2. Metabolism/Elimination
Amphetamines are eliminated through the liver.

3. Brief Overview
a. Amphetamines have a strong central nervous system stimulant which can
increase alertness and induce a sense of well-being.
b. If used while driving, amphetamines are dangerous.
c. The use of amphetamines reduces a person's resistance to disease.

4. Short-term Effects
a. A person may experience a loss of appetite, increased alertness, and a feeling
of well-being.
b. A person's physical condition may be altered by an increase in breathing and
heart rate, elevation in blood pressure, and dilation of pupils.

5. Long-term Effects
a. Anxiety and agitation.
b. Sleeplessness.
c. Higher blood pressure and irregular heart beat.
d. Increased susceptibility to disease.

6. Special Hazards Involving the Driving Task

The use of amphetamines can interfere with concentration, impair vision, and
increase the driver's tendencies to take risks.

7. Effects with Other Drugs

a. Amphetamines should never be taken with a class of antidepressants known as
MAO inhibitors, because of potential hypertensive crisis.
b. Amphetamine users sometimes use marijuana and depressant drugs in order to
avoid the adverse side effects of the "crash," therefore creating multiple drug
dependencies.

F. Poly-drug Use

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(Poly-drug use is where the use of more than one substance normally causes one of
three reactions: additive, synergistic, or antagonistic.

1. Additive Effects
Additive effects occur when drug combinations produce an effect that is like simple
addition, such as the equation: 1 + 1 = 2.

2. Synergistic Effects
Synergistic effects occur when drug combinations produce an effect that is greater
than the sum of the effects of the two drugs, such as the equation: 1 + 1 = 3.

3. Antagonistic Effects
Antagonistic effects occur when a drug combination produces an effect that is less
than the sum of the effects of the drugs acting alone, such as the equation: 1 + 1 =
1 or 1 + 1 = 0.

I. IMPACT OF DRUG USE ON DRIVING

A. Necessary Driving Skills

1. Several skills necessary for driving include: vision, reaction time, judgment,
hearing, and simultaneous task processing/accomplishment.

2. Driving skills can be divided into cognitive skills, such as information processing,
and psycho motor skills.

B. Drug Impact on Driving Skills

1. Impairment is related to alcohol, in terms of its concentration in the blood

stream.

2. The brain's control of eye movements is highly vulnerable to alcohol. It only

takes low to moderate blood alcohol concentrations (.03 to .05%) to interfere
with voluntary eye movements and impair the eyes' ability to rapidly track a
moving target.

13
 3. Steering an automobile is adversely affected by alcohol, as alcohol affects eye-
to-hand reaction times, which are superimposed upon the visual effects.
Significant impairment and deterioration of steering ability begin at
approximately .03 to .04% Blood Alcohol Concentrations and continue to
deteriorate as Blood Alcohol Concentration rises.

4. Almost every aspect of the brain's information-processing ability is impaired by

alcohol. Alcohol-impaired drivers require more time to read street signs or
respond to traffic signals than unimpaired drivers. Research on the effects of
alcohol on the performance of automobile and aircraft operators shows a
narrowing of the attention field beginning at .04% blood alcohol concentration.

C. Dividing Attention Among Component Skills

1. Most sensitive aspect of the driving performance.

2. Component skills involve maintaining the vehicle in the proper lane and
direction (tracking task), while monitoring the environment for vital safety
information, i.e. other vehicles, traffic signs, and pedestrians.

3. Alcohol-impaired drivers who are required to divide their attention between two
tasks tend to favor just one task. Often times the favored task is concentrating
on steering while becoming less vigilant with respect to other safety information.

4. Numerous studies indicate that divided attention deficits occur as low as .02%
Blood Alcohol Concentration.

5. Four conclusions can be drawn from results of epidemiologic and experimental

studies.
a. The degree of impairment depends on the complexity of the task involved as
well as the Blood Alcohol Concentration.
b. The magnitude of alcohol-induced impairment rises as the Blood Alcohol
level increases and dissipates as the alcohol is eliminated from the body.
c. At a given time and Blood Alcohol Concentration, some skills are more
impaired than others.
d. There is no evidence of an absolute BAC threshold below which there is no
impairment of any kind. Therefore, certain skills important to the driving task are
impaired at .01 to .02% blood alcohol level the lowest levels that can be reliably
measured by the commonly used devices.

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II. THE DUI ARREST AS A WARNING SIGN

A. The Court Reporting Network (CRN)

1. CRN is the Pennsylvania Alcohol Highway Safety Program's Court Reporting

Network.
2. Helps provide a coordinated and integrated systems approach to the alcohol
highway safety problem and resultant driving under the influence counter-
measures in the Commonwealth of Pennsylvania.
3. Purpose of CRN is to provide a computer-assisted information system that links
the county DUI programs into a comprehensive statewide network and assists
local coordinators in planning, implementing, and monitoring their programs.

(See CRN Flow Chart)

B. Three Problem Levels of Alcohol Users - CRN divides alcohol users into one of
three problem levels.

1. Level I - Non-problem, Social Drinker

a. Client has not been identified as having a problem with alcohol, based on all
available criteria.
b. Individual will receive a recommendation for Alcohol Highway Safety School.

2. Level II - Presumptive Problem Drinker

a. Client appears to be experiencing some degree of life problems due to
alcohol.
b. Individual will often receive a recommendation for Alcohol Highway Safety
School and outpatient counseling.

3. Level III - Highly Presumptive Problem Drinker

a. Client has been identified as experiencing serious life problems due to their
abuse of alcohol, based on available criteria.
b. Individual will often receive a recommendation for Alcohol Highway Safety
School and outpatient treatment.

4. CRN data indicates that 80% of all arrests for driving under the influence of
alcohol place the individual in either Level II or Level III; hence, the DUI arrest
may be part of a more total inclusive alcohol problem.

15
 5. The DUI Educational Program should serve as a mechanism by which the
person can evaluate his or her problem and hope to identify the need for further
counseling.

III. THEORIES ABOUT ADDICTION/DEPENDENCE

A. Definition of Addiction
Physiological and/or psychological dependence on a drug. The overpowering
physical or emotional urge to repeatedly do something that is uncontrollable by the
individual and is accompanied by a tolerance for the drug, with withdrawal symptoms
if the drug is stopped.

B. Causes of Addiction - There are many different approaches to looking at addiction.

1. Disease concept refers to alcohol and chemical dependency as a disease.

2. Genetics have been shown to play a predisposition factor. Essentially, in

families where chemical dependency appears to be prevalent and multi-
generational, some members may be more susceptible to becoming chemically
dependent.

3. Environmental factors and what people are exposed to within their environment
play a critical role in addiction.

4. Cultural influences and the belief systems which evolve around the use and
abuse of drugs are factors which contribute to addiction.

C. Stages Of Addiction - Addiction develops in a predictable series of stages.

1. Early Stage Addiction

a. Characterized by an increase in tolerance and dependence.
b. People who are becoming addicted can use larger and larger quantities
without becoming intoxicated or suffering harmful consequences.
c. As the body cells change to tolerate larger quantities of the chemical, even
larger quantities are needed to achieve the same effect.
d. Difficult to distinguish addictive use from heavy non-addictive use because
there are few outward symptoms.
e. Alcohol or drugs are used so frequently that the person comes to depend on
them.

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 f. Use begins to seem normal; life without use begins to seem abnormal.

2. Middle Stage Addiction

a. Marked by a progressive loss of control.
b. It takes more alcohol or drugs to get high.
c. Increased quantities damage the liver, alter brain chemistry, and eventually,
tolerance begins to decrease.
d. The drug is used to relieve the pain created by not using.
e. Physical, psychological, and social problems develop.

3. Chronic Stage Addiction

a. Marked by physical, psychological, behavioral, social, and spiritual
deterioration.
b. All systems of the body can be affected.
c. Mood swings are common as the person uses the drug to feel better, but
cannot maintain the good feelings.
d. There is less and less control over behavior.
e. Relationships are damaged.
f. The person loses touch with a higher power and with a sense of purpose and
meaning in life.
g. Life is consumed with the need to use.

D. Addiction Terminology

1. Tolerance - Physical tolerance is the body's ability to adapt to the usual effects
of a drug so that an increased dosage is needed to achieve the same effect as
before. Tolerance begins to occur in the early stage of addiction.

2. Cross-Tolerance - Among certain related drugs (narcotics), tolerance built up to

the effects of one drug will carry over to another drug.

3. Enabling Behavior - In the area of chemical abuse, behaviors of one person

which encourage another's chemical abuse are known as enabling behaviors.
These behaviors may be conscious or unconscious, intentional or unintentional.
An example would be someone who downplays or denies the problems a friend
is having with drugs.

4. Withdrawal - This is the result of discontinuing the intake of a drug after

17
 developing physical dependence. With alcohol this may cause such reactions
as mild disorientation, hallucinations, shaking, and convulsions.

IV. PATTERNS OF ALCOHOL USE

A. Alcohol Abuse

1. Refers to patterns of problem drinking that have resulted in detrimental effects

on both social and health problems.

2. Alcohol can have negative effects on the social well-being and physical health
of the problem drinker.

B. Alcohol Dependence

1. Often referred to as Alcoholism.

2. Refers to a disease characterized by compulsive alcohol-seeking behavior that

leads to the inability to control drinking.

C. Differences between Abuse and Dependence

1. Alcohol dependency and alcohol abusers experience many of the same harmful
effects of drinking.

2. Critical difference is the physical dependence displayed by alcoholics and their

lack of ability to regulate their consumption of alcohol.

3. Alcoholics will continue to drink in spite of severe negative consequences of

their drinking.

D. Warning Signs of Problem Drinking

1. Frequently drinking to state of intoxication.

2. Using alcohol to seek relief from problems and cope with stress.
3. Engaging in antisocial behavior during and after drinking.
4. Going to work intoxicated or decline in job performance.
5. Experiencing family or economic problems.

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 6. Driving a car under the influence of alcohol.
7. Sustaining injuries as a result of intoxication.

8. Seeking out places where alcohol is available and avoiding places where it is
not.

V. ALCOHOLISM

A. Definition of Alcoholism
The National Council on Alcoholism and Drug Dependence (1990) defines
alcoholism as:

ALCOHOLISM is a primary, chronic disease with genetic, psychosocial, and

environmental factors influencing its development and manifestations. The disease is
often progressive and fatal. It is characterized by continuous or periodic impaired
control over drinking, preoccupation with the drug alcohol, use of alcohol despite
adverse consequences, and distortions in thinking–most notably denial.
1) Terms in the Definition of Alcohol Dependency

a. Primary
i. Refers to the nature of alcoholism as a disease entity in addition to and
separate from other pathophysiologic states which may be associated with it.
ii. Suggests that alcoholism, as an addiction, is not a symptom of an
underlying disease state.

b. Disease
i. Means an involuntary disability.
ii. Represents the sum of the abnormal phenomena displayed by a group of
individuals.
iii. These phenomena are associated with a specified common set of
characteristics by which these individuals differ from the norm, and which
places them at a disadvantage.

c. Often Progressive and Fatal

i. Means the disease persists over time and that physical, emotional and
social changes are often cumulative and may progress as drinking continues.
ii. Causes premature death through overdose, organic complications involving
the brain, liver, heart, and many other organs.
iii. Contributing to suicide, homicide, motor vehicle crashes, and other
traumatic events.

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d. Impaired Control
Means the inability to limit alcohol use or to consistently limit on any drinking
occasion the duration of the episode, the quantity consumed, and/or the
behavioral consequences of drinking.

e. Preoccupation
i. Refers to excessive focused attention given to the drug alcohol, its effects,
and/or its use.
ii. The relative value thus assigned to alcohol by an individual often leads to a
diversion of energies away from important life concerns.

f. Adverse Consequences
i. Refers to alcohol-related problems or impairments.
ii. Physical health problems, i.e. alcohol withdrawal
syndromes, liver disease, gastritis, anemia,
neurological disorders.
iii. Psychological functioning problems, i.e.
impairments in cognition, changes in mood and
behavior.
iv. Interpersonal functioning problems, i.e. marital
problems, child abuse and impaired social
relationships.
v. Occupational functioning problems, i.e. scholastic or
job problems.
vi. Legal, financial, or spiritual problems.

g. Denial
Refers to a defense mechanism reducing the significance of events, but more
broadly includes a range of psychological maneuvers designed to reduce
awareness of the fact that alcohol use is the cause of an individual's problems
rather than a solution. It becomes an integral part of the disease and a major
obstacle to recovery. Examples of denial:

i. "I only drink on weekends." (minimizing)

ii. "You'd drink too if you had my job." (blaming)
iii. "Everyone drinks and drives." (generalizing)

h. Progression of the Disease

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 An addiction develops and can be classified into the following three distinct
stages:

i. Early Stage - Early problems are not observed or clearly linked to addiction.
ii. Middle Stage - problems are identified or observed but not yet associated
with the use of alcohol.
iii. Late or Chronic Stage - the disease makes it difficult, if not impossible,to
think or observe in a rational manner.

B. Symptoms Of Addiction

The behavioral symptoms of alcoholism, discussed previously, which manifest

themselves within the three (3) stages of addiction will not be present for every
individual at the same time period. The following is an overview of the symptoms
within each major stage of addiction.

1. The Disease Concept Chart (See Addiction & Recovery Chart on the following page)

The disease concept chart, on the following page, indicates the progressive nature of
the chemical dependency through the early, middle, and late/chronic stages of
addiction.

2. Recovery
a. Refers to a continuous lifelong process.
b. Critical to know where to find resources to help in the identification and treatment of
abusive use of alcohol and/or other drugs.

3. Symptoms of Alcohol Dependency

The following symptoms mark the three stages of alcoholism, but not all are seen in
every individual. These stages are intended only as guidelines, since every individual
may experience some or all of these symptoms at different times in their alcoholism.

a. Early Stage
i. Sneaking drinks.
ii. Gulping drinks.
iii. Preoccupation with drinking.
iv. Personality changes when drinking.
v. Drinking to the point of drunkenness.
vi. Guilt feelings about drinking.

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 vii. Missing responsibilities of work and school due to hangovers.
viii. Seeking companions who are heavy drinkers.
ix. Blackouts.
x. Increased tolerance to alcohol.
xi. Changing forms of alcohol (i.e. vodka to beer).
xii. Spouse complaining of drinking.
xiii. Losing interest in activities not directly associated with drinking.

b. Middle Stage

i. Drinking more than intended (loss of control).

ii. Protecting the supply of alcohol.
iii. Drinking to relieve anger, tension, insomnia, fatigue depression, social
discomfort.
iv. Increased incidence of infections and colds.
v. Benders.
vi. Morning drinking.
vii. Drinking despite strong social reasons not to, such as marital and family
disruptions, arrests for drunk driving, etc.
viii. Repeated attempts at abstinence.
ix. Paranoid attitude.
x. Projection, resentments, and denial become more severe.

c. Late Stage

i. Alcoholic hepatitis.
ii. Cirrhosis (enlargement of the liver).
iii. Lowering of personal standards.
iv. Tremors when sober.
v. Lowering of tolerance to alcohol.
vi. Blatant and indiscriminate use of alcohol.
vii. Choice of work situations which facilitate drinking.
viii. Brain damage.
ix. Alcoholic seizures.
x. Delirium tremens.
xi. Alcoholic hallucinations.
xii. Fears of "going crazy".
xiii. Depression, isolation, and suicidal preoccupation.

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Top 10 Drugs and their Effects

Share This- Published September 27, 2007 - 443 Comments

Drug abuse is a very common problem in most countries so it seemed like a good
topic for a list. This is a list of ten of the most abused drugs and the effects they
have on people.

1. Heroin

Heroin is an opiate processed directly from the extracts of the opium poppy. It was
originally created to help cure people of addiction to morphine. Upon crossing the
blood-brain barrier, which occurs soon after introduction of the drug into the
bloodstream, heroin is converted into morphine, which mimics the action of
endorphins, creating a sense of well-being; the characteristic euphoria has been
described as an “orgasm” centered in the gut. One of the most common methods of
heroin use is via intravenous injection.

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.. Fear.

2. Cocaine

Cocaine is a crystalline tropane

alkaloid that is obtained from the
leaves of the coca plant. It is both
a stimulant of the central nervous
system and an appetite
suppressant, giving rise to what
has been described as a euphoric
sense of happiness and increased energy. It is most often used recreationally for this
effect. Cocaine is a potent central nervous system stimulant. Its effects can last from
20 minutes to several hours, depending upon the dosage of cocaine taken, purity,
and method of administration. The initial signs of stimulation are hyperactivity,
restlessness, increased blood pressure, increased heart rate and euphoria. The
euphoria is sometimes followed by feelings of discomfort and depression and a
craving to experience the drug again. Sexual interest and pleasure can be amplified.
Side effects can include twitching, paranoia, and impotence, which usually increases
with frequent usage.
effects of cocaine came directly from knowing that I had reached a plateau and I was
going to be fine. I felt invigorated, yet also very comfortable.

One of the best treatment for drug addiction is to consult with cocaine rehab centers
for recovery.

3. Methamphetamine

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Methamphetamime, popularly shortened to meth or ice, is a psychostimulant and
sympathomimetic drug. Methamphetamine enters the brain and triggers a cascading
release of norepinephrine, dopamine and serotonin. Since it stimulates the
mesolimbic reward pathway, causing euphoria and excitement, it is prone to abuse
and addiction. Users may become obsessed or perform repetitive tasks such as
cleaning, hand-washing, or assembling and disassembling objects. Withdrawal is
characterized by excessive sleeping, eating and depression-like symptoms, often
accompanied by anxiety and drug-craving.

and it burned our skin too. My husband and I haven’t done any drugs at all for four
weeks, and things are slowly going back to normal. But I still want it. I can’t sleep
tonight because I want it. I wrote this in all honesty mostly to help myself, to remind
myself why I don’t want it. And still I want it.

4. Crack Cocaine

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Crack cocaine, often nicknamed “crack”, is believed to have been created and made
popular during the early 1980s . Because of the dangers for manufacturers of using
ether to produce pure freebase cocaine, producers began to omit the step of
removing the freebase precipitate from the ammonia mixture. Typically, filtration
processes are also omitted. Baking soda is now most often used as a base rather
than ammonia for reasons of lowered odor and toxicity; however, any weak base can
be used to make crack cocaine. When commonly “cooked” the ratio is 1:1 to 2:3
parts cocaine/bicarbonate.
As I held the smoke in for a ten count and exhaled, I thought I felt nothing except a
little excitement that was neither bad nor pleasurable. The complete rush some
writers have called a ‘whole-body orgasm’ hit me shortly after and I distinctly
remember demanding ‘more’ as soon as the realization of heaven-on-earth came.
Some people say that the effects of smoking crack lasts 10-15 minutes. For me, it
was just a shortest instant of gratification. Everything afterwards was just a great
increase in energy and confidence geared towards obtaining more of the drug.

5. LSD

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Lysergic acid diethylamide, LSD, LSD-25, or acid, is a semisynthetic psychedelic drug
of the tryptamine family. Arguably the most regarded of all psychedelics, it is
considered mainly as a recreational drug, an entheogen, and a tool in use to
supplement various types of exercises for transcendence including in meditation,
psychonautics, and illegal psychedelic psychotherapy whether self administered or
not. LSD’s psychological effects (colloquially called a “trip”) vary greatly from person
to person, depending on factors such as previous experiences, state of mind and
environment, as well as dose strength. They also vary from one trip to another, and
even as time passes during a single trip. An LSD trip can have long term
psychoemotional effects; some users cite the LSD experience as causing significant
changes in their personality and life perspective. Widely different effects emerge
based on what Leary called set and setting; the “set” being the general mindset of
the user, and the “setting” being the physical and social environment in which the
drug’s effects are experienced.

6. Ecstasy

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Ecstasy (MDMA) is a semisynthetic psychedelic entactogen of the phenethylamine
family that is much less visual with more stimulant like effects than most all other
common “trip” producing psychedelics. It is considered mainly a recreational drug
that’s often used with sex and associated with club drugs, as an entheogen, and a
tool in use to supplement various types of practices for transcendence including in
meditation, psychonautics, and illicit psychedelic psychotherapy whether self
administered or not. The primary effects of MDMA include an increased awareness of
the senses, feelings of openness, euphoria, empathy, love,happiness, heightened
self-awareness, feeling of mental clarity and an increased appreciation of music and
movement. Tactile sensations are enhanced for some users, making physical contact
with others more pleasurable. Other side effects, such as jaw clenching and elevated
pulse, are common.

7. Opium

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Opium is a resinous narcotic formed from the latex released by lacerating (or
“scoring”) the immature seed pods of opium poppies (Papaver somniferum). It
contains up to 16% morphine, an opiate alkaloid, which is most frequently processed
chemically to produce heroin for the illegal drug trade. Opium has gradually been
superseded by a variety of purified, semi-synthetic, and synthetic opioids with
progressively stronger effect, and by other general anesthesia. This process began in
1817, when Friedrich Wilhelm Adam Sertürner reported the isolation of pure
morphine from opium after at least thirteen years of research and a nearly
disastrous trial on himself and three boys.

8. Marijuana

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Cannabis, known as marijuana in its herbal form, is a psychoactive product of the
plant Cannabis sativa. Humans have been consuming cannabis since prehistory,
although in the 20th century there was a rise in its use for recreational, religious
or spiritual, and medicinal purposes. It is estimated that about four percent of the
world’s adult population use cannabis annually. It has psychoactive and physiological
effects when consumed, usually by smoking or ingestion. The minimum amount of
THC required to have a perceptible psychoactive effect is about 10 micrograms per
kilogram of body weight. The state of intoxication due to cannabis consumption is
colloquially known as a “high”; it is the state where mental and physical facilities are
noticeably altered due to the consumption of cannabis. Each user experiences a
different high, and the nature of it may vary upon factors such as potency, dose,
chemical composition, method of consumption and set and setting.
became amazingly irritable and wanted them to leave me alone or not talk in my
presence. They did not understand or appreciate my fear, and they began to get loud
again. I ran upstairs to my parents bed and laid down with some wistful hope that I
could wait out this storm.

9. Psilocybin Mushrooms

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Psilocybin mushrooms (also called psilocybian mushrooms) are fungi that contain the
psychedelic substances psilocybin and psilocin, and occasionally other psychoactive
tryptamines. There are multiple colloquial terms for psilocybin mushrooms, the most
common being magic mushrooms or ‘shrooms. When psilocybin is ingested, it is
broken down to produce psilocin, which is responsible for the hallucinogenic effects.
The intoxicating effects of psilocybin-containing mushrooms typically last anywhere
from 3 to 7 hours depending on dosage, preparation method and personal
metabolism. The experience is typically inwardly oriented, with strong visual and
auditory components. Visions and revelations may be experienced, and the effect
can range from exhilarating to distressing. There can be also a total absence of
effects, even with large doses.

becoming totally bewitched by her charm, her wit, her intelligence, her knowledge,
her unconditional affection for me and her seemingly infinite perspective. I have
come to think of her as my other-worldly girlfriend.

10. PCP

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PCP (Phencyclidine) is a dissociative drug formerly used as an anesthetic agent,
exhibiting hallucinogenic and neurotoxic effects. It is commonly known as Angel
Dust, but is also known as Wet, Sherm, Sherman Hemsley, Rocket Fuel, Ashy Larry,
Shermans Tank, Wack, Halk Hogan, Ozone, HannaH, Hog, Manitoba Shlimbo, and
Embalming Fluid, among other names. Although the primary psychoactive effects of
the drug only last hours, total elimination from the body is prolonged, typically
extending over weeks. PCP is consumed in a recreational manner by drug users,
mainly in the United States, where the demand is met by illegal production. It comes
in both powder and liquid forms (PCP base dissolved most often in ether), but
typically it is sprayed onto leafy material such as marijuana, mint, oregano, parsley
or Ginger Leaves, and smoked. PCP has potent effects on the nervous system
altering perceptual functions (hallucinations, delusional ideas, delirium or confused
thinking), motor functions (unsteady gait, loss of coordination, and disrupted eye
movement or nystagmus), and autonomic nervous system regulation (rapid heart
rate, altered temperature regulation). The drug has been known to alter mood states
in an unpredictable fashion causing some individuals to become detached and others
to become animated.

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Drug Addiction
Many people think about drug addiction as either something that is confined to certain socioeconomic
groups or that always involves the use of illegal substances. Neither of those assumptions are true,
unfortunately. Drug use and addiction is a problem affecting people from all backgrounds, and no one can
assume that they are immune from the possibility of it happening to themselves or someone they care
about.

Alcohol Addiction
Alcohol is a substance that is perfectly legal for adults to buy and consume, and has the potential to become
addictive. We tend to use euphemisms like "drinking problem" or say that someone likes to "bend the elbow"
when talking about an addiction to alcohol. It's a polite way of talking about an addiction that can have
serious health consequences, including cirrhosis of the liver and brain damage. It is no coincidence that
thousands ofalcohol treatment centers exist across the world. Learn more...

Nicotine Addiction
If you have ever wondered why giving up smoking is so difficult, blame the fact that nicotine is one of the
most addictive substances on the planet. Every time a smoker lights up, they are getting a "hit" of nicotine
that works on the pleasure center in their brain. Cravings are just the body's way of looking for more of the
same. Unfortunately, smoking has been linked to several types of cancer, heart disease, and stroke. Learn
more...

Cocaine Addiction
Cocaine is a highly-addictive stimulant that is made from the leaves of the coca plant. Whether you call it
"coke," "blow," or "nose candy," it gives the user a relatively brief, but very intense, high. See cocaine
pictures here. This drug also causes the user's heart rate and blood pressure to increase rapidly, sometimes
with tragic results in the form of a heart attack or a stroke. Learn more...

Opiate Addiction
Codeine, morphine, and heroin are all powerful painkilling drugs derived from the opium poppy. Not only can
they alleviate pain, but they also produce a feeling of euphoria, which opens up the door to addiction.
Someone who is in the throes of an addiction to these kinds of drugs may lose the ability to make good
decisions for themselves. They also run the risk of contracting HIV/AIDS if they are using needles to inject
themselves. Often, a visit to a drug detox center is necessary even before entering a treatment facility for
opiate addiction treatment.Learn more...

Heroin Addiction
Heroin is known by several names, including "smack," "horse," and "brown sugar" due to its varying forms
and colors, seen in these heroin pictures. It produces a feeling of euphoria for the more than half a million
people in the United States who use it. Heroin can cause physical dependency in users within days of being
used regularly, which means that trying to give it up can be very difficult. Learn more...

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Meth Addiction
Some people turn to meth, a type of amphetamine, as their drug of choice because it is an appetite
suppressant. It also produces an intense "high" when injected, smoked, snorted, or swallowed. Addiction
can happen very quickly, and it's possible to become addicted after using meth only once. Learn more...

Methadone Addiction
In a twist of irony, methadone, which is used to treat people who are addicted to heroin, is itself a highly-
addictive drug. Like heroin, methadone is an opiate, and it is used to relieve the cravings that a recovering
heroin addict may experience. Many wonder whether trading one addiction for another is such a good
idea.Learn more...

Marijuana Addiction
More than three million people in the United States use marijuana on either a daily or an almost-daily basis,
making it the most popular illegal drug in the country. There are more than 200 different names used to
describe the leaves, stems, and flowers of the hemp plant, which are dried and rolled prior to being smoked.
The question of whether marijuana is addictive remains a popular debate with opposing viewpoints. Learn
more...

Caffeine Addiction
Do you enjoy your morning Java? Many people do, but there are some for whom caffeine isn't just
something that helps them feel alert through the day. They develop a full-blown addiction, including
withdrawal symptoms when they try to switch to decaf or cut back on caffeine-laden soft drinks and
chocolate. Learn more...

Steroid Addiction
Athletes and body builders who want to increase muscle mass may be tempted to use steroids to get bigger,
faster. They may not realize that the sense of well-being they experience when using them is from the 'roids
themselves. An addiction to steroids may be more difficult to recognize than someone using a substance to
achieve a "high" though there are typically signs that can be detected. Learn more...

Vicodin Addiction
Vicodin is usually prescribed for moderate pain. This opiate not only relieves pain, but also produces a
feeling of euphoria. Approximately one person in five in the United States has taken a prescription
medication for a purpose other than the one for which it was prescribed, and vicodin is the drug most often
used in this way.Learn more...

Prescription Drug Addiction

Using prescription drugs for a long time or taking more than the recommended dose may lead to an
addiction. This is the reason doctors limit the amount of medication they prescribe. Any prescription drug
taken to relieve pain has the potential to create a physical dependency.Learn more...

Behavioral Addiction
Behavioral addiction is different from drug addiction in the sense that no mind-altering substance is being
ingested. Still, it displays the same symptoms as drug or alcohol abuse. A behavioral addict, by definition, is

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someone who couldn't control or stop an activity despite experiencing adverse consequences of the activity.
Learn more about the different types of behavioral addictions.

• Gambling Addiction Most people gamble for fun. When gambling stops being a recreational
activity and becomes a way to seek thrills or as a means of escape on a regular basis, then it
becomes an addiction. Learn more about gambling addiction.
• Food Addiction We all eat to live. Some people, however, live to eat, as they compulsively and
obsessively crave for and eat food even when they're not hungry or when they're depressed. Learn
more about food addiction symptoms.
• Sex Addiction Few people would admit they're addicted to sex. Little do they know that when the
compulsive use of pornography and masturbation to repeated sexual affairs, regular use of
prostitutes, voyeurism or just obsessively thinking about sex becomes the norm, they are
already sex addicts.
• Love Addiction Love addiction is not really about love. Truth be told, love addiction is closer to
codependency, an unhealthy one at that, than love. Learn more about the symptoms of relationship
and love compulsions.
• Porn Addiction Porn addiction is characterized by compulsive reading of pornography, obsessive
viewing or thinking about pornography and any other sexual themes. If
you'http://www.thegooddrugsguide.com/addiction-types/behavioral-addiction/relationship-and-
obsessive-love-signs-and-treatment.htmve got boxes upon boxes of porn videos at home, or when
you actually think that the Internet is for porn, chances are, you're a porn addict.
• Work Addiction otherwise known as "workaholism" in the U.S., is the most respectable,
encouraged and praised of all addictions. It's also pretty deadly, claiming hundreds of lives a year
mainly through stress related heart attack and stroke. Find out if you or someone you know could
be a workaholic.
• Exercise Addiction Exercising is healthy. Exercising to the point of dependency and compulsion is
not. Learn more about exercise addiction effects.
• Video Game Addiction This is one addiction parents should really worry about. After all, children
and teenagers make up the bulk of video game addicts. Find out if you or a loved one have
become addicted to video games.

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