Cocaine is a stimulant and a frequently abused street drug. It comes in various forms that are smoked, inhaled, and injected. Cocaine powder can be snorted or mixed with water and injected. When mixed with water and baking soda, it becomes a solid “rock” that is smoked as “crack.” The high is brief, lasting minutes to hours. A variety of amphetamines (including methamphetamine) are also widely available. Amphetamines are usually taken orally or intravenously but can also be snorted or smoked. The amphetamine high lasts 12-24 hours, and takes 1-4 days to exit the system. Nevertheless, they are fat soluble leading to “flashback” episodes

Other stimulants include prescribed and over-the-counter medications such as Adderall, methylphenidate, a medication for attention deficit disorder; dexadrine, used for weight loss; and ephedrine or pseudoephedrine, a decongestant. When these medications are used in higher amounts than recommended, they can have effects similar to cocaine and amphetamines. Additionally, use of ADD medications by people without ADD does not help them focus, it just keeps them awake.

intoxication and short-term effects on mental illness

In small doses, stimulants increase alertness, enhance energy, suppress appetite, and induce a feeling of well-being or euphoria. Think about the last time you drank a few cups of strong coffee. The high wears off rapidly, however, and often leads to a cycle of depression and repeated use that goes on for many hours or days.

At higher doses, symptoms of intoxication occur, including euphoria, hypervigilance, paranoia, agitation, sleeplessness, racing thoughts and pressured speech. Anxiety, irritability, and psychosis can also occur. With very high doses, confusion and disorientation can occur, as well as seizures, strokes, and heart attacks.

Even brief or occasional use of stimulants for a person with severe mental illness can induce or worsen psychiatric symptoms or precipitate major relapses. Episodes of mania or psychosis often are initiated by stimulant use, and depression is exacerbated by the cycle of stimulant use. When the person uses, the “feel good chemicals” are used up extra fast. When the drug wears off, there are not enough “feel good” chemicals left and depression sets in.

stimulant tolerance and withdrawal

The quick “high” followed quickly by the “crash” make stimulants highly addictive. Individuals often use the drug repeatedly to sustain the highs and avoid the lows. Repeated use produces tolerance, or diminished effects of the drug, and is followed by the use of larger amounts. This pattern can lead rapidly to addiction. While alcohol use typically transitions into addiction over years, people typically become addicted to cocaine and amphetamines within weeks or months (sometimes days).

 When an individual stops heavy use of stimulants, withdrawal occurs. Withdrawal from stimulants occurs in three phases: The first phase is a “crash” with feelings of depression, agitation and intense craving. Within days, the individual experiences fatigue, low energy and decreased interest in just about everything. Weeks to months later, in the third phase, the individual may experience episodic intense craving. This is called protracted withdrawal and is a significant risk factor in relapse.
 

long-term effects

Addiction, by definition, involves increasing preoccupation with getting, using and recovering from a substance or behavior. Long term addiction often leads to criminal behavior. The euphoria of stimulants also results in risk-taking behaviors, and increases mental health symptoms such as anxiety, depression and hallucinations.

Over the long term, repeated use and the development of tolerance lead the user to more potent routes of administration, such as intravenous use (IV or injection), which dramatically increase the risk of blood-borne infections such as hepatitis and HIV. The viruses that cause hepatitis and AIDS are spread through contact with infected blood and sex fluids, which can occur when sharing a straw through which drugs are snorted, by sharing injection equipment, and by having unprotected sex.

The counselors at Doctor-Is-In can provide support, mental health counseling, substance abuse and addictions counseling and education on topics such as anger, anxiety, addictions, behavior modification, bulimia, binge eating, depression, grief, parenting, relationships, self-esteem, time management.

Alcohol

Many people who drink alcohol also have issues with other types of substance abuse, anger, anxiety, behavioral addictions, eating disorders, bulimia, binge eating, depression, grief, parenting, relationships, self-esteem, time management. Counseling, education and support groups are often helpful. Alcohol is a drug that produces a dual effect on the body: a depressant or relaxing effect that lasts a relatively short time, and a weaker exciting or stimulating effect that persists about six times as long as the depressant effect. In a quiet, nonsocial environment people often easily feel the sedation and drowsiness produced by alcohol. In a social or exciting environment or situation the depressant effect often helps people “relax” and lose their inhibitions and stimulant influence often leads to impulsive and sometimes aggressive behavior. The drinker may be excited, talkative, vivacious, self-confident, and general loss of self restraint. As the person drinks more, and during chronic intoxication, the alcohol produces more of the same effects. There may be slurred speech, staggering, loss of emotional control, stupor from which arousal is difficult, severe respiratory depression, coma, and death.

Since the stimulant effects last longer than the depressant effects, the alcohol is also responsible for causing the jittery, anxious feeling most people get (That they usually tame with another drink). People prone to panic attacks of high anxiety often have “episodes” after heavy drinking. Alcohol affects the serotonin (happy chemicals) in your brain as well. A very simple explanation is that when you drink, your body uses more happy chemicals than usual, causing you to feel good in the moment. Unfortunately, when the alcohol wears off, you have used up too much of those chemicals and feel depressed. It takes your body a couple of days to replenish the supply from even one night of heavy drinking.

¼ oz. of alcohol is metabolized every hour. The legal limit is .08, but impairment is seen at .02 in nonalcoholics As it is broken down by the body, alcohol and its by-products are toxic or irritating to cells and tissues and disrupts body chemistry putting people at greater risk for diseases.

Things that affect alcohol’s effects:

How much you drink
How much you weigh
Body composition
Gender
Dehydration
What is in your stomach
Other drugs/medications you are on
Type of mixer used
Type of alcohol drank
Temperature of the drink
Personal expectations
Tolerance

Withdrawal symptoms include restlessness, shakiness, confusion, increased blood pressure, hyperventilation, hallucination, and convulsions. Symptoms of alcohol withdrawal are usually far more dangerous than those of other drugs. Severity of the symptoms depends on the length of alcohol abuse and the degree of intoxication. Typically, symptoms begin within the first 24 hours after the last drink, reach their peak intensity within two or three days, and disappear within one or two weeks. During the first day of withdrawal, there may be headaches, anxiety, involuntary twitching of muscles, tremor of hands, weakness, insomnia, and nausea.
Alcohol detoxification can be life threatening. There may be a fall in blood pressure; fever; delirium characterized by disorientation, delusions, and visual hallucinations; and convulsions. The fever, delirium, and convulsions are the most serious symptoms and have proved fatal in a number of instances. Early alcoholic drinking may produce the following specific medical conditions:

Loss of control of eye muscles
Hypoglycemia
Gastritis
Increased susceptibility to infections
Cardiac arrhythmia
Anemia
Constant flushing of facial edema
Peripheral
Neuritis
Pancreatitis
Increase in blood alcohol level
Withdrawal signs
Fatty liver
Increase in blood pressure

 
Chronic alcohol drinking produces even more severe conditions, some of which may be irreversible, such as:

Liver damage
Korsokoff Syndrome (vitamin B deficiency)
Brain damage
Cardiomyopathy
Cancer of the tongue, mouth, or pharynx, hypopharynx, esophagus, and liver

In fact, the brains of some alcoholics after death are so soft, pulpy, and deteriorated that they are not suitable for dissection by medical students who need to study brain structure.

Treatment
Depending upon the severity of the symptoms, complications due to use, co-occurring mental health problems such as depression, anxiety and schizophrenia, the level of motivation for change and the health/supportiveness of the recovery environment/support system, treatment may be able to be accomplished with a combination of self-help groups and outpatient therapy (online or face-to-face) or may require more intensive treatment up to and including long-term residential.

Helpful Links

http://ncadi.samhsa.gov/ Clearinghouse for Alcohol and Addictions Treatment Information. Contains excellent free videos/webcasts for classroom use as well.

http://www.drugabuse.gov/drugpages.htmlInformation on all types of drugs

http://teens.drugabuse.gov/parents/index.asp  Site designed for Teens

Elementary School

• Brain Power! The NIDA Junior Scientist Program (For grades K-1)
  
• Brain Power! The NIDA Junior Scientist Program (For grades 2-3)
  
• Brain Power! The NIDA Junior Scientist Program (For grades 4-5)
   

Middle & High School

• NIDA for Teens Web Site
  The Science Behind Drug Abuse (For grades 5-9)
• Mind Over Matter
  The Effects of Drug Abuse on Your Body & Brain (For grades 5-9)
• Teacher’s Guide for the Mind Over Matter Series
  (For grades 5-9)
• HEADS UP: Real News About Drugs and Your Body
  A Scholastic and NIDA cooperative education project (For grades 6-10)
• Trends in Drug Use, High School and Youth
  (NIDA Infofacts)
• Slide Teaching Packets
  The Neurobiology of Ecstasy, Understanding Drug Abuse and Addiction, more…
• The Brain: Understanding Neurobiology Through the Study of Addiction
  NIH Curriculum Supplement Series (For grades 9-12)
• NIDA Goes Back to School
  Free science-based educational materials developed by NIDA, online ordering available.
• NIH Science Education Homepage
  Curricula developed by NIH for elementary, middle, and high school classes

Read each statement carefully. If it is true for you, place a checkmark beside it.

• I experiment with alcohol or drugs
• I drink or use drugs occasionally in social settings
• I function well at work and home
• I use alcohol or drugs for pleasure
• I use drugs or drink regularly at social or sporting events
• Using makes me feel like one of the group
• My rebellion is normal midlife or college behavior
• My functioning at work remains stable
• I feel like I need to drink or use drugs
• When you use you feel in control
• I use drugs or drink on a daily basis
• Relationships with my family are becoming strained
• I hide my drinking or drug use from my family
• Most of my friends do drugs or drink
• I devote less time and attention to school work
• I need to drink or use drugs to feel better
• I have lost control over alcohol and drug use
• I need to drink or use drugs to feel normal
• I have not been taking care of your appearance, health
• My tolerance to alcohol or specific drugs has increased
• I use drugs or drink several times a day
• I do not believe I have a problem
• I have stopped functioning completely at work may even quit
  or get fired
• I have become very depressed and even contemplated suicide
• I have withdrawal symptoms if I stop use of alcohol or drugs
• I blame others for my problems

Are there any behaviors you see as warning signs? If so, which ones and why?

Is there anything about your use of alcohol or drugs that you want to change? If so, what is it and how can you go about making the changes?