These days kids are experimenting with a wide variety of drugs. While most people don't associate cigarettes with drugs, surveys as well as our own residents in Teen Challenge report that nearly all people who have used drugs started smoking cigarettes as youngsters before they first experimented with drugs.
"No step on this path is inevitable, but this 'gateway' principle makes clear that the best way to end new addictions among the young is by drawing a line on the abstinence side of marijuana use, underage smoking and drinking," the report said.
This is not to say that everyone who smokes cigarettes today uses drugs or used to use drugs. But when children begin to smoke, this is an early sign of rebellious behavior -- especially if your family does not smoke cigarettes.
If you discover that your child is smoking cigarettes, you have to ask yourself -- why? If your child is smoking, his friends probably do also. The most common reason a child smokes is to feel "cool" or to be accepted by his friends. According to those who began using drugs as teenagers, the groups of kids at schools who smoked were also the ones most likely to use drugs and alcohol. We can try to deny it and say, "but Johnny's not a bad kid." But the reality of the situation is that those kids that smoke cigarettes are more likely to get into other kinds of trouble as opposed to those groups of kids that have other kinds of activities that are wholesome and that do not include smoking cigarettes.
Children will usually begin experimenting with drugs that don't seem dangerous to them, such as alcohol and marijuana. But once the thrill of these drugs wears off, they will often graduate to drugs like speed, LSD, and PCP. Later on, as experimentation turns into addiction, kids may turn to cocaine and heroin.
Always be on the lookout for obvious signs that your child is using drugs. When being smoked, marijuana has a very distinct odor and kids will often burn lots of incense to cover up the smell. Often after smoking marijuana kids will go on an eating binge.
Drugs such as speed will cause your child to appear very hyperactive and to stop eating and sleeping for long periods of time. If your child seems to be losing a lot of weight and is looking skinny or emaciated, there is a strong possibility that he or she might be using speed or cocaine.
When confronted about drugs many kids will say, "I'm just smoking a little pot (marijuana)." But if you see drastic physical changes such as: extreme weight loss or extreme changes in sleep patterns (too much or too little sleep), these are signs that your son or daughter is using much stronger drugs than marijuana. Marijuana will cause some tiredness but not to extremes as the harder drugs will.
acid / lsd
LSD (lysergic acid diethylamide) is one of the major drugs making up the hallucinogen class of drugs. Hallucinogens cause hallucinations—profound distortions in a person’s perception of reality. Hallucinogens cause their effects by disrupting the interaction of nerve cells and the neurotransmitter serotonin. Distributed throughout the brain and spinal cord, the serotonin system is involved in the control of behavioral, perceptual, and regulatory systems, including mood, hunger, body temperature, sexual behavior, muscle control, and sensory perception.
users often see images, hear sounds and feel sensations that do not exist
Under the influence of hallucinogens, people see images, hear sounds, and feel sensations that seem real but do not exist. Some hallucinogens also produce rapid, intense emotional swings. One of the most potent mood-changing chemicals, LSD, was discovered in 1938 and is manufactured from lysergic acid, which is found in ergot, a fungus that grows on rye and other grains.
The effects of LSD are unpredictable. They depend on the amount taken; the user's personality, mood, and expectations; and the surroundings in which the drug is used. Usually, the user feels the first effects of the drug 30 to 90 minutes after taking it. The physical effects include dilated pupils, higher body temperature, increased heart rate and blood pressure, sweating, loss of appetite, sleeplessness, dry mouth, and tremors.
users may feel several emotions at once, lose sense of time, and have sensations of "seeing" sounds and "hearing" colors
Sensations and feelings change much more dramatically than the physical signs. The user may feel several different emotions at once or swing rapidly from one emotion to another. If taken in a large enough dose, the drug produces delusions and visual hallucinations. The user’s sense of time and self changes. Sensations may seem to "cross over," giving the user the feeling of hearing colors and seeing sounds. These changes can be frightening and can cause panic.
Users refer to their experience with LSD as a "trip" and to acute adverse reactions as a "bad trip." These experiences are long; typically they begin to clear after about 12 hours.
Some LSD users experience severe, terrifying thoughts and feelings, fear of losing control, fear of insanity and death, and despair while using LSD. Some fatal accidents have occurred during states of LSD intoxication.
lsd users may suddenly re-experience aspects of their high without having retaken the drug - even a year later
Many LSD users experience flashbacks, recurrence of certain aspects of a person's experience, without the user having taken the drug again. A flashback occurs suddenly, often without warning, and may occur within a few days or more than a year after LSD use. Flashbacks usually occur in people who use hallucinogens chronically or have an underlying personality problem; however, otherwise healthy people who use LSD occasionally may also have flashbacks. Bad trips and flashbacks are only part of the risks of LSD use. LSD users may manifest relatively long-lasting psychoses, such as schizophrenia or severe depression. It is difficult to determine the extent and mechanism of the LSD involvement in these illnesses.
Most users of LSD voluntarily decrease or stop its use over time. LSD is not considered an addictive drug since it does not produce compulsive drug-seeking behavior, as do cocaine, amphetamine, heroin, alcohol, and nicotine. However, like many of the addictive drugs, LSD produces tolerance, so some users who take the drug repeatedly must take progressively higher doses to achieve the state of intoxication that they had previously achieved. This is an extremely dangerous practice, given the unpredictability of the drug.
lsd is not considered an addictive drug
Extent of Use
Monitoring the Future (MTF) Survey *
Lifetime** use dropped significantly among 12th-graders from 2004 to 2005, while annual and 30-day use remained stable. (Also see the InfoFacts on High School and Youth Trends.) Perceived availability of the drug fell among 12th-graders for this same period.
LSD Use by Students, 2005:
Monitoring the Future Survey
8th-Graders 10th-Graders 12th-Graders
Lifetime 1.9% 2.5% 3.5%
Annual 1.2 1.5 1.8
30-Day 0.5 0.6 0.7
National Survey on Drug Use and Health (NSDUH) ***
NSDUH data show decreases in annual use of LSD from 2002 to 2004. In 2004, 9.7 percent of Americans aged 12 and older reported using LSD at least once in their lifetimes, 0.2 percent had used it in the past year, and 0.1 percent used in the past month. Lifetime use declined significantly from 2003 to 2004 among persons aged 12 to 17 and 18 to 25.
MDMA (ecstasy), Rohypnol, GHB, and ketamine are among the drugs used by teens and young adults who are part of a nightclub, bar, rave, or trance scene. Raves and trance events are generally night-long dances, often held in warehouses. Many who attend raves and trances do not use club drugs, but those who do may be attracted to their generally low cost, and to the intoxicating highs that are said to deepen the rave or trance experience.
also known as, "date rape" drugs
For the third and fourth quarters of 2003, hospital emergency department mentions were estimated at 2,221 for MDMA use, 990 for GHB, and 73 for ketamine.*
GHB, Ketamine, and Rohypnol
GHB and Rohypnol are predominantly central nervous system depressants. Because they are often colorless, tasteless, and odorless, they can be added to beverages and ingested unknowingly.
These drugs emerged several years ago as "date rape" drugs.***** Because of concern about their abuse, Congress passed the "Drug-Induced Rape Prevention and Punishment Act of 1996" in October 1996. This legislation increased Federal penalties for use of any controlled substance to aid in sexual assault.
also known as, liquid ecstasy, easy lay, and Georgia home boy
Since about 1990, GHB (gamma hydroxybutyrate) has been used in the U.S. for its euphoric, sedative, and anabolic (body building) effects. It is a central nervous system depressant that was widely available over-the-counter in health food stores during the 1980s and until 1992. It was purchased largely by body builders to aid in fat reduction and muscle building. Street names include "liquid ecstasy," "soap," "easy lay," "vita-G," and "Georgia home boy."
Coma and seizures can occur following use of GHB. Combining use with other drugs such as alcohol can result in nausea and breathing difficulties. GHB may also produce withdrawal effects, including insomnia, anxiety, tremors, and sweating. GHB and two of its precursors, gamma butyrolactone (GBL) and 1,4 butanediol (BD), have been involved in poisonings, overdoses, date rapes, and deaths.
Ketamine is an anesthetic that has been approved for both human and animal use in medical settings since 1970; about 90 percent of the ketamine legally sold is intended for veterinary use. It can be injected or snorted. Ketamine is also known as "special K" or "vitamin K."
Certain doses of ketamine can cause dream-like states and hallucinations. In high doses, ketamine can cause delirium, amnesia, impaired motor function, high blood pressure, depression, and potentially fatal respiratory problems.
Rohypnol, a trade name for flunitrazepam, belongs to a class of drugs known as benzodiazepines. When mixed with alcohol, Rohypnol can incapacitate victims and prevent them from resisting sexual assault. It can produce "anterograde amnesia," which means individuals may not remember events they experienced while under the effects of the drug. Also, Rohypnol may be lethal when mixed with alcohol and/or other depressants.
Rohypnol is not approved for use in the United States, and its importation is banned. Illicit use of Rohypnol started appearing in the United States in the early 1990s, where it became known as "rophies," "roofies," "roach," and "rope."
Abuse of two other similar drugs appears to have replaced Rohypnol abuse in some regions of the country. These are clonazepam, marketed in the U.S. as Klonopin and in Mexico as Rivotril, and alprazolam, marketed as Xanax.
For more science-based information on MDMA and other club drugs, visit www.ClubDrugs.gov, www.Teens.drugabuse.gov, and www.BacktoSchool.drugabuse.gov; or call the National Clearinghouse for Alcohol and Drug Information at 1-800-729-6686.
crack / cocaine
Cocaine is a powerfully addictive stimulant drug. The powdered, hydrochloride salt form of cocaine can be snorted or dissolved in water and injected. Crack is cocaine that has not been neutralized by an acid to make the hydrochloride salt. This form of cocaine comes in a rock crystal that can be heated and its vapors smoked. The term "crack" refers to the crackling sound heard when it is heated.*
users may experience a sudden heart attack or stroke, possibly resulting in immediate death
Regardless of how cocaine is used or how frequently, a user can experience acute cardiovascular or cerebrovascular emergencies, such as a heart attack or stroke, which could result in sudden death. Cocaine-related deaths are often a result of cardiac arrest or seizure followed by respiratory arrest.
Cocaine is a strong central nervous system stimulant that interferes with the reabsorption process of dopamine, a chemical messenger associated with pleasure and movement. The buildup of dopamine causes continuous stimulation of receiving neurons, which is associated with the euphoria commonly reported by cocaine abusers.
Physical effects of cocaine use include constricted blood vessels, dilated pupils, and increased temperature, heart rate, and blood pressure. The duration of cocaine's immediate euphoric effects, which include hyperstimulation, reduced fatigue, and mental alertness, depends on the route of administration. The faster the absorption, the more intense the high. On the other hand, the faster the absorption, the shorter the duration of action. The high from snorting may last 15 to 30 minutes, while that from smoking may last 5 to 10 minutes. Increased use can reduce the period of time a user feels high and increases the risk of addiction.
Some users of cocaine report feelings of restlessness, irritability, and anxiety. A tolerance to the "high" may develop—many addicts report that they seek but fail to achieve as much pleasure as they did from their first exposure. Some users will increase their doses to intensify and prolong the euphoric effects. While tolerance to the high can occur, users can also become more sensitive to cocaine's anesthetic and convulsant effects without increasing the dose taken. This increased sensitivity may explain some deaths occurring after apparently low doses of cocaine.
Use of cocaine in a binge, during which the drug is taken repeatedly and at increasingly high doses, may lead to a state of increasing irritability, restlessness, and paranoia. This can result in a period of full-blown paranoid psychosis, in which the user loses touch with reality and experiences auditory hallucinations.
Other complications associated with cocaine use include disturbances in heart rhythm and heart attacks, chest pain and respiratory failure, strokes, seizures and headaches, and gastrointestinal complications such as abdominal pain and nausea. Because cocaine has a tendency to decrease appetite, many chronic users can become malnourished.
Different means of taking cocaine can produce different adverse effects. Regularly snorting cocaine, for example, can lead to loss of the sense of smell, nosebleeds, problems with swallowing, hoarseness, and a chronically runny nose. Ingesting cocaine can cause severe bowel gangrene due to reduced blood flow. People who inject cocaine can experience severe allergic reactions and, as with all injecting drug users, are at increased risk for contracting HIV and other blood-borne diseases.
Added Danger: Cocaethylene
When people mix cocaine and alcohol consumption, they are compounding the danger each drug poses and unknowingly forming a complex chemical experiment within their bodies. NIDA-funded researchers have found that the human liver combines cocaine and alcohol and manufactures a third substance, cocaethylene, that intensifies cocaine's euphoric effects, while potentially increasing the risk of sudden death.
The widespread abuse of cocaine has stimulated extensive efforts to develop treatment programs for this type of drug abuse.
One of NIDA's top research priorities is to find a medication to block or greatly reduce the effects of cocaine, to be used as one part of a comprehensive treatment program. NIDA-funded researchers are also looking at medications that help alleviate the severe craving that people in treatment for cocaine addiction often experience. Several medications are currently being investigated for their safety and efficacy in treating cocaine addiction.
In addition to treatment medications, behavioral interventions—particularly cognitive behavioral therapy—can be effective in decreasing drug use by patients in treatment for cocaine abuse. Providing the optimal combination of treatment and services for each individual is critical to successful outcomes.
Extent of Use
Monitoring the Future (MTF) Survey **
Lifetime,*** annual, and 30-day cocaine use remained stable among all three grades in 2005. Perceived harmfulness of occasional use also remained stable in 2005, measuring at 65.3 percent among 8th-graders, 72.4 percent among 10th-graders, and 60.8 percent among 12th-graders.
Use of Cocaine in Any Form by Students, 2005:
Monitoring the Future Survey
8th-Graders 10th-Graders 12th-Graders
Lifetime 3.7% 5.2% 8.0%
Annual 2.2 3.5 5.1
30-Day 1.0 1.5 2.3
Crack Cocaine Use by Students, 2005:
Monitoring the Future Survey
8th-Graders 10th-Graders 12th-Graders
Lifetime 2.4% 2.5% 3.5%
Annual 1.4 1.7 1.9
30-Day 0.6 0.7 1.0
Community Epidemiology Work Group (CEWG)****
Cocaine-related death mentions in 2003 were particularly high in New York City/Newark, Detroit, Boston, and Baltimore, as measured by one Federal data source. Reports from local medical examiner data named Texas and Philadelphia as sites with the highest rates of cocaine-related deaths from 2003 through 2004.
Primary cocaine treatment admissions in 2004 accounted for 52.5 percent of treatment admissions, excluding alcohol, in Atlanta, 38.9 percent in New Orleans, and approximately 36 percent in Texas and Detroit.
National Survey on Drug Use and Health (NSDUH)*****
In 2004, 34.2 million Americans aged 12 and over reported lifetime use of cocaine, and 7.8 million reported using crack. About 5.6 million reported annual use of cocaine, and 1.3 million reported using crack. An estimated 2 million Americans reported current use of cocaine, 467,000 of whom reported using crack. There were an estimated 1 million new users of cocaine in 2004 (approximately 2,700 per day), and most were aged 18 or older although the average age of first use was 20.0 years.
The percentage of youth ages 12 to 17 reporting lifetime use of cocaine was 2.4 percent in 2004. Among young adults aged 18 to 25, the rate was 15.2 percent, showing no significant difference from the previous year. However, there was a statistically significant decrease in perceived risk of using cocaine once a month among Americans in the 12 to 17 age bracket in 2004.
Past month crack use was down for 16- or 17-year-olds but up for 21- to 25-year-olds; 21-year-olds also showed increases in past year use of both crack and cocaine.
Past month use of cocaine was down among females aged 12–17 and Asians 12 or older, but up among Blacks aged 18 to 25. There was a decrease in past year cocaine use measured among Asians aged 18 to 25.
Following a decline between 2002 and 2003, NSDUH data show an increase in the number of people receiving treatment for a cocaine use problem during their most recent treatment at a specialty facility, from 276,000 in 2003 to 466,000 in 2004.
ecstasy / mdma
MDMA (3,4 methylenedioxymethamphetamine) is a synthetic, psychoactive drug chemically similar to the stimulant methamphetamine and the hallucinogen mescaline. Street names for MDMA include Ecstasy, Adam, XTC, hug, beans, and love drug. MDMA is an illegal drug that acts as both a stimulant and psychedelic, producing an energizing effect, as well as distortions in time and perception and enhanced enjoyment from tactile experiences.
MDMA exerts its primary effects in the brain on neurons that use the chemical serotonin to communicate with other neurons. The serotonin system plays an important role in regulating mood, aggression, sexual activity, sleep, and sensitivity to pain.
Research in animals indicates that MDMA is neurotoxic; whether or not this is also true in humans is currently an area of intense investigation. MDMA can also be dangerous to health and, on rare occasions, lethal.
For some people, MDMA can be addictive. A survey of young adult and adolescent MDMA users found that 43 percent of those who reported ecstasy use met the accepted diagnostic criteria for dependence, as evidenced by continued use despite knowledge of physical or psychological harm, withdrawal effects, and tolerance (or diminished response), and 34 percent met the criteria for drug abuse. Almost 60 percent of people who use MDMA report withdrawal symptoms, including fatigue, loss of appetite, depressed feelings, and trouble concentrating.
Chronic users of MDMA perform more poorly than nonusers on certain types of cognitive or memory tasks. Some of these effects may be due to the use of other drugs in combination with MDMA, among other factors.
In high doses, MDMA can interfere with the body’s ability to regulate temperature. On rare but unpredictable occasions, this can lead to a sharp increase in body temperature (hyperthermia), resulting in liver, kidney, and cardiovascular system failure, and death.
ecstasy users face many of the same risks as users of cocaine
Because MDMA can interfere with its own metabolism (breakdown within the body), potentially harmful levels can be reached by repeated drug use within short intervals.
Users of MDMA face many of the same risks as users of other stimulants such as cocaine and amphetamines. These include increases in heart rate and blood pressure, a special risk for people with circulatory problems or heart disease, and other symptoms such as muscle tension, involuntary teeth clenching, nausea, blurred vision, faintness, and chills or sweating.
These can include confusion, depression, sleep problems, drug craving, and severe anxiety. These problems can occur during and sometimes days or weeks after taking MDMA.
Research in animals links MDMA exposure to long-term damage to neurons that are involved in mood, thinking, and judgment. A study in nonhuman primates showed that exposure to MDMA for only 4 days caused damage to serotonin nerve terminals that was evident 6 to 7 years later. While similar neurotoxicity has not been definitively shown in humans, the wealth of animal research indicating MDMA's damaging properties suggests that MDMA is not a safe drug for human consumption.
Hidden Risk: Drug Purity
Other drugs chemically similar to MDMA, such as MDA (methylenedioxyamphetamine, the parent drug of MDMA) and PMA (paramethoxyamphetamine, associated with fatalities in the U.S. and Australia) are sometimes sold as ecstasy. These drugs can be neurotoxic or create additional health risks to the user. Also, ecstasy tablets may contain other substances in addition to MDMA, such as ephedrine (a stimulant); dextromethorphan (DXM, a cough suppressant that has PCP-like effects at high doses); ketamine (an anesthetic used mostly by veterinarians that also has PCP-like effects); caffeine; cocaine; and methamphetamine. While the combination of MDMA with one or more of these drugs may be inherently dangerous, users might also combine them with substances such as marijuana and alcohol, putting themselves at further physical risk.
Extent of Use
National Survey on Drug Use and Health (NSDUH)
In 2004, an estimated 450,000 people in the U.S. age 12 and older used MDMA in the past 30 days. Ecstasy use dropped significantly among persons 18 to 25—from 14.8 percent in 2003 to 13.8 percent in 2004 for lifetime use, and from 3.7 percent to 3.1 percent for past year use. Other 2004 NSDUH results show significant reductions in lifetime and past year use among 18- to 20-year-olds, reductions in past month use for 14- or 15-year-olds, and past year and past month reductions in use among females.
Community Epidemiology Work Group (CEWG)**
In many of the areas monitored by CEWG members, MDMA, once used primarily at dance clubs, raves, and college scenes, is being used in a number of other social settings. In addition, some members reported increased use of MDMA among African-American and Hispanic populations.
Monitoring the Future (MTF) Survey***
Lifetime**** use dropped significantly among 12th-graders in 2005, from 7.5 percent in 2004 to 5.4 percent. The perceived risk in occasional MDMA use declined significantly among 8th-graders in 2005, and perceived availability decreased among 12th-graders.
Heroin is an addictive drug, and its use is a serious problem in America.
also known as, smack, H, skag, and junk
Heroin is processed from morphine, a naturally occurring substance extracted from the seedpod of the Asian poppy plant. Heroin usually appears as a white or brown powder. Street names for heroin include "smack," "H," "skag," and "junk." Other names may refer to types of heroin produced in a specific geographical area, such as "Mexican black tar."
Heroin abuse is associated with serious health conditions, including fatal overdose, spontaneous abortion, collapsed veins, and, particularly in users who inject the drug, infectious diseases, including HIV/AIDS and hepatitis.
The short-term effects of heroin abuse appear soon after a single dose and disappear in a few hours. After an injection of heroin, the user reports feeling a surge of euphoria ("rush") accompanied by a warm flushing of the skin, a dry mouth, and heavy extremities. Following this initial euphoria, the user goes "on the nod," an alternately wakeful and drowsy state. Mental functioning becomes clouded due to the depression of the central nervous system. Long-term effects of heroin appear after repeated use for some period of time. Chronic users may develop collapsed veins, infection of the heart lining and valves, abscesses, cellulitis, and liver disease. Pulmonary complications, including various types of pneumonia, may result from the poor health condition of the abuser, as well as from heroin’s depressing effects on respiration.
Heroin abuse during pregnancy and its many associated environmental factors (e.g., lack of prenatal care) have been associated with adverse consequences including low birth weight, an important risk factor for later developmental delay.
In addition to the effects of the drug itself, street heroin may have additives that do not readily dissolve and result in clogging the blood vessels that lead to the lungs, liver, kidneys, or brain. This can cause infection or even death of small patches of cells in vital organs.
The Drug Abuse Warning Network* reports that eight percent of drug-related emergency department (ED) visits in the third and fourth quarters of 2003 involved heroin abuse. Unspecified opiates—which could include heroin—were involved in an additional 4 percent of drug-related visits.
Tolerance, Addiction, and Withdrawal
With regular heroin use, tolerance develops. This means the abuser must use more heroin to achieve the same intensity of effect. As higher doses are used over time, physical dependence and addiction develop. With physical dependence, the body has adapted to the presence of the drug and withdrawal symptoms may occur if use is reduced or stopped.
Withdrawal, which in regular abusers may occur as early as a few hours after the last administration, produces drug craving, restlessness, muscle and bone pain, insomnia, diarrhea and vomiting, cold flashes with goose bumps ("cold turkey"), kicking movements ("kicking the habit"), and other symptoms. Major withdrawal symptoms peak between 48 and 72 hours after the last dose and subside after about a week. Sudden withdrawal by heavily dependent users who are in poor health is occasionally fatal, although heroin withdrawal is considered less dangerous than alcohol or barbiturate withdrawal.
There is a broad range of treatment options for heroin addiction, including medications as well as behavioral therapies. Science has taught us that when medication treatment is integrated with other supportive services, patients are often able to stop heroin (or other opiate) use and return to more stable and productive lives.
In November 1997, the National Institutes of Health (NIH) convened a Consensus Panel on Effective Medical Treatment of Heroin Addiction. The panel of national experts concluded that opiate drug addictions are diseases of the brain and medical disorders that indeed can be treated effectively. The panel strongly recommended (1) broader access to methadone maintenance treatment programs for people who are addicted to heroin or other opiate drugs; and (2) the Federal and State regulations and other barriers impeding this access be eliminated. This panel also stressed the importance of providing substance abuse counseling, psychosocial therapies, and other supportive services to enhance retention and successful outcomes in methadone maintenance treatment programs. The panel’s full consensus statement is available by visiting the NIH Consensus Development Program Web site at consensus.nih.gov.
Methadone, a synthetic opiate medication that blocks the effects of heroin for about 24 hours, has a proven record of success when prescribed at a high enough dosage level for people addicted to heroin. Other approved medications are naloxone, which is used to treat cases of overdose, and naltrexone, both of which block the effects of morphine, heroin, and other opiates.
Buprenorphine is the most recent addition to the array of medications available for treating addiction to heroin and other opiates. This medication is different from methadone in that it offers less risk of addiction and can be dispensed in the privacy of a doctor's office. Several other medications for use in heroin treatment programs are also under study.
For the pregnant heroin abuser, methadone maintenance combined with prenatal care and a comprehensive drug treatment program can improve many of the detrimental maternal and neonatal outcomes associated with untreated heroin abuse. There is preliminary evidence that buprenorphine also is safe and effective in treating heroin dependence during pregnancy, although infants exposed to methadone or buprenorphine during pregnancy typically require treatment for withdrawal symptoms. For women who do not want or are not able to receive pharmacotherapy for their heroin addiction, detoxification from opiates during pregnancy can be accomplished with relative safety, although the likelihood of relapse to heroin use should be considered.
There are many effective behavioral treatments available for heroin addiction. These can include residential and outpatient approaches. Several new behavioral therapies are showing particular promise for heroin addiction. Contingency management therapy uses a voucher-based system, where patients earn "points" based on negative drug tests, which they can exchange for items that encourage healthful living. Cognitive-behavioral interventions are designed to help modify the patient’s thinking, expectancies, and behaviors and to increase skills in coping with various life stressors.
Extent of Use
Monitoring the Future (MTF) Survey **
According to the 2005 MTF, rates of heroin use were stable among all three grades measured.
Heroin Use by Students, 2005:
Monitoring the Future Survey
8th-Graders 10th-Graders 12th-Graders
Lifetime 1.5% 1.5% 1.5%
Annual 0.8 0.9 0.8
30-Day 0.5 0.5 0.5
Community Epidemiology Work Group (CEWG)****
Heroin indicators, as measured by the Community Epidemiology Work Group (CEWG), remained high in Baltimore, Newark, Boston, Chicago, New York City, Philadelphia, San Francisco, Seattle, and Washington, DC. Baltimore and Newark ranked highest of all CEWG areas in the percentage of heroin items analyzed by forensic labs in 2004; heroin was identified in 34 percent of items analyzed in Newark, and in 26 percent of items analyzed in Baltimore. Eighty-two percent of drug treatment admissions (excluding alcohol) in 2004 were attributable to primary heroin abuse in Newark, followed by 74 percent in the Boston area, and 60 percent in Baltimore.
National Survey on Drug Use and Health (NSDUH)*****
The 2004 NSDUH reports a significant decrease in lifetime heroin use among Americans age 12 or older, most notable in those 26 or older. An increase in past-month use of heroin was reported, however, among persons age 21 to 25.
Inhalants are breathable chemical vapors that produce psychoactive (mind-altering) effects. A variety of products common in the home and in the workplace contain substances that can be inhaled. Many people do not think of these products, such as spray paints, glues, and cleaning fluids, as drugs because they were never meant to be used to achieve an intoxicating effect. Yet, young children and adolescents can easily obtain them and are among those most likely to abuse these extremely toxic substances.
Inhalants fall into the following categories:
Industrial or household solvents or solvent-containing products, including paint thinners or removers, degreasers, dry-cleaning fluids, gasoline, and glue
Art or office supply solvents, including correction fluids, felt-tip-marker fluid, and electronic contact cleaners
Household aerosol propellants and associated solvents in items such as spray paints, hair or deodorant sprays, fabric protector sprays, aerosol computer cleaning products, and vegetable oil sprays
Gases used in household or commercial products, including butane lighters and propane tanks, whipping cream aerosols or dispensers (whippets), and refrigerant gases
Medical anesthetic gases, such as ether, chloroform, halothane, and nitrous oxide ("laughing gas")
Organic nitrites are volatiles that include cyclohexyl, butyl, and amyl nitrites, commonly known as "poppers." Amyl nitrite is still used in certain diagnostic medical procedures. Volatile nitrites are often sold in small brown bottles labeled as "video head cleaner," "room odorizer," "leather cleaner," or "liquid aroma."
Although they differ in makeup, nearly all abused inhalants produce short-term effects similar to anesthetics, which act to slow down the bodyï¿½s functions. When inhaled in sufficient concentrations, inhalants can cause intoxication, usually lasting only a few minutes.
However, sometimes users extend this effect for several hours by breathing in inhalants repeatedly. Initially, users may feel slightly stimulated. Repeated inhalations make them feel less inhibited and less in control. If use continues, users can lose consciousness.
Sniffing highly concentrated amounts of the chemicals in solvents or aerosol sprays can directly induce heart failure and death within minutes of a session of repeated inhalations. This syndrome, known as "sudden sniffing death," can result from a single session of inhalant use by an otherwise healthy young person. Sudden sniffing death is particularly associated with the abuse of butane, propane, and chemicals in aerosols.
High concentrations of inhalants also can cause death from suffocation by displacing oxygen in the lungs and then in the central nervous system so that breathing ceases. Deliberately inhaling from a paper or plastic bag or in a closed area greatly increases the chances of suffocation. Even when using aerosols or volatile products for their legitimate purposes (i.e., painting, cleaning), it is wise to do so in a well-ventilated room or outdoors.
Chronic abuse of solvents can cause severe, long-term damage to the brain, the liver, and the kidneys.
Harmful irreversible effects that may be caused by abuse of specific solvents include:
Hearing lossï¿½toluene (spray paints, glues, dewaxers) and trichloroethylene (dry-cleaning chemicals, correction fluids)
Peripheral neuropathies, or limb spasmsï¿½hexane (glues, gasoline) and nitrous oxide (whipped cream dispensers, gas cylinders)
Central nervous system or brain damageï¿½toluene (spray paints, glues, dewaxers)
Bone marrow damageï¿½benzene (gasoline)
Serious but potentially reversible effects include:
Liver and kidney damageï¿½toluene-containing substances and chlorinated hydrocarbons (correction fluids, dry-cleaning fluids)
Blood oxygen depletionï¿½aliphatic nitrites (known on the street as poppers, bold, and rush) and methylene chloride (varnish removers, paint thinners)
Extent of Use
Initial use of inhalants often starts early. Some young people may use inhalants as an easily accessible substitute for alcohol. Research suggests that chronic or long-term inhalant abusers are among the most difficult drug abuse patients to treat. Many suffer from cognitive impairment and other neurological dysfunction and may experience multiple psychological and social problems.
Monitoring the Future (MTF) Survey*
According to the 2005 Monitoring the Future survey, lifetime use of inhalants measured 17.1 percent among 8th-graders, 13.1 percent among 10th grade students, and 11.4 percent among 12th-graders in 2005.
Drug Abuse Warning Network (DAWN)**
The 2003 Drug Abuse Warning Network Interim Report estimates 627,923 drug-related emergency department visits for the 3rd and 4th quarters of 2003. Inhalants were attributed to 1,681 of these reported visits.
2004 National Survey on Drug Use and Health (NSDUH)***
Among youths age 12 to 17, 10.6 percent were current illicit drug users in 2004, and 1.2 percent of those reported current inhalant use. Among 12- or 13-year-olds, 1.2 percent reported current inhalant use; 1.6 percent of 14- or 15-year-olds reported current use.
Lifetime use of inhalants was down in 2004 among Americans in the 18ï¿½20 age group. While declines were reported also for lifetime use among Asians age 18ï¿½25, their past-month use of inhalants rose significantly. Past-year use rose significantly among 21 year-olds in 2004.
In 2004, the number of new inhalant users was about 857,000.
Marijuana is the most commonly abused illicit drug in the United States. A dry, shredded green/brown mix of flowers, stems, seeds, and leaves of the hemp plant Cannabis sativa, it usually is smoked as a cigarette (joint, nail), or in a pipe (bong). It also is smoked in blunts, which are cigars that have been emptied of tobacco and refilled with marijuana, often in combination with another drug. It might also be mixed in food or brewed as a tea. As a more concentrated, resinous form it is called hashish and, as a sticky black liquid, hash oil. Marijuana smoke has a pungent and distinctive, usually sweet-and-sour odor. There are countless street terms for marijuana including pot, herb, weed, grass, widow, ganja, and hash, as well as terms derived from trademarked varieties of cannabis, such as Bubble Gum, Northern Lights, Fruity Juice, Afghani #1, and a number of Skunk varieties.
most abused illicit drug in the US
The main active chemical in marijuana is THC (delta-9-tetrahydrocannabinol). The membranes of certain nerve cells in the brain contain protein receptors that bind to THC. Once securely in place, THC kicks off a series of cellular reactions that ultimately lead to the high that users experience when they smoke marijuana.
Extent of Use
In 2004, 14.6 million Americans age 12 and older used marijuana at least once in the month prior to being surveyed. About 6,000 people a day in 2004 used marijuana for the first time—2.1 million Americans. Of these, 63.8 percent were under age 181. In the last half of 2003, marijuana was the third most commonly abused drug mentioned in drug-related hospital emergency department (ED) visits in the continental United States, at 12.6 percent, following cocaine (20 percent) and alcohol (48.7 percent)2.
6,000 people every day used marijuana for the first time in 2004
Prevalence of lifetime,* annual, and use within the last 30 days for marijuana remained stable among 10th- and 12th-graders surveyed between 2003 and 2004. However, 8th-graders reported a significant decline in 30-day use and a significant increase in perceived harmfulness of smoking marijuana once or twice and regularly3. Trends in disapproval of using marijuana once or twice and occasionally rose among 8th-graders as well, and 10th-graders reported an increase in disapproval of occasional and regular use for the same period3.
Percentage of 8th-Graders Who Have Used Marijuana:
Monitoring the Future Study, 2005
1994 1995 1996 1997 1998 1999
Lifetime 16.7% 19.9% 23.1% 22.6% 22.2% 22.0%
Annual 13.0 15.8 18.3 17.7 16.9 16.5
30-Day 7.8 9.1 11.3 10.2 9.7 9.7
Daily 0.7 0.8 1.5 1.1 1.1 1.4
2000 2001 2002 2003 2004 2005
Lifetime 20.3% 20.4% 19.2% 17.5% 16.3% 16.5%
Annual 15.6 15.4 14.6 12.8 11.8 12.2
30-Day 9.1 9.2 8.3 7.5 6.4 6.6
Daily 1.3 1.3 1.2 1.0 0.8 1.0
Percentage of 10th-Graders Who Have Used Marijuana:
Monitoring the Future Study, 2005
1994 1995 1996 1997 1998 1999
Lifetime 30.4% 34.1% 39.8% 42.3% 39.6% 40.9%
Annual 25.2 28.7 33.6 34.8 31.1 32.1
30-day 15.8 17.2 20.4 20.5 18.7 19.4
Daily 2.2 2.8 3.5 3.7 3.6 3.8
2000 2001 2002 2003 2004 2005
Lifetime 40.3% 40.1% 38.7% 36.4% 35.1% 34.1%
Annual 32.2 32.7 30.3 28.2 27.5 26.6
30-day 19.7 19.8 17.8 17.0 15.9 15.2
Daily 3.8 4.5 3.9 3.6 3.2 3.1
Percentage of 12th-Graders Who Have Used Marijuana
Monitoring the Future Study, 2005
1994 1995 1996 1997 1998 1999
Lifetime 38.2% 41.7% 44.9% 49.6% 49.1% 49.7%
Annual 30.7 34.7 35.8 38.5 37.5 37.8
30-day 19.0 21.2 21.9 23.7 22.8 23.1
Daily 3.6 4.6 4.9 5.8 5.6 6.0
2000 2001 2002 2003 2004 2005
Lifetime 48.8% 49.0% 47.8% 46.1% 45.7% 44.8%
Annual 36.5 37.0 36.2 34.9 34.3 33.6
30-day 21.6 22.4 21.5 21.2 19.9 19.8
Daily 6.0 5.8 6.0 6.0 5.6 5.0
* "Lifetime" refers to use at least once during a respondent’s lifetime. "Annual" refers to use at least once during the year preceding an individual's response to the survey. "30-day" refers to use at least once during the 30 days preceding an individual’s response to the survey.
Effects on the Brain
Scientists have learned a great deal about how THC acts in the brain to produce its many effects. When someone smokes marijuana, THC rapidly passes from the lungs into the bloodstream, which carries the chemical to organs throughout the body, including the brain.
In the brain, THC connects to specific sites called cannabinoid receptors on nerve cells and influences the activity of those cells. Some brain areas have many cannabinoid receptors; others have few or none. Many cannabinoid receptors are found in the parts of the brain that influence pleasure, memory, thought, concentration, sensory and time perception, and coordinated movement4.
The short-term effects of marijuana can include problems with memory and learning; distorted perception; difficulty in thinking and problem solving; loss of coordination; and increased heart rate. Research findings for long-term marijuana abuse indicate some changes in the brain similar to those seen after long-term abuse of other major drugs. For example, cannabinoid (THC or synthetic forms of THC) withdrawal in chronically exposed animals leads to an increase in the activation of the stress-response system5 and changes in the activity of nerve cells containing dopamine6. Dopamine neurons are involved in the regulation of motivation and reward, and are directly or indirectly affected by all drugs of abuse.
Effects on the Heart
One study has indicated that an abuser's risk of heart attack more than quadruples in the first hour after smoking marijuana7. The researchers suggest that such an effect might occur from marijuana's effects on blood pressure and heart rate and reduced oxygen-carrying capacity of blood.
Effects on the Lungs
A study of 450 individuals found that people who smoke marijuana frequently but do not smoke tobacco have more health problems and miss more days of work than nonsmokers8. Many of the extra sick days among the marijuana smokers in the study were for respiratory illnesses.
risk of heart attack more than quadruples; potential to promote lung cancer
Even infrequent abuse can cause burning and stinging of the mouth and throat, often accompanied by a heavy cough. Someone who smokes marijuana regularly may have many of the same respiratory problems that tobacco smokers do, such as daily cough and phlegm production, more frequent acute chest illness, a heightened risk of lung infections, and a greater tendency to obstructed airways9. Smoking marijuana possibly increases the likelihood of developing cancer of the head or neck. A study comparing 173 cancer patients and 176 healthy individuals produced evidence that marijuana smoking doubled or tripled the risk of these cancers10.
Marijuana abuse also has the potential to promote cancer of the lungs and other parts of the respiratory tract because it contains irritants and carcinogens9,11. In fact, marijuana smoke contains 50 to 70 percent more carcinogenic hydrocarbons than does tobacco smoke12. It also induces high levels of an enzyme that converts certain hydrocarbons into their carcinogenic form—levels that may accelerate the changes that ultimately produce malignant cells13. Marijuana users usually inhale more deeply and hold their breath longer than tobacco smokers do, which increases the lungs' exposure to carcinogenic smoke. These facts suggest that, puff for puff, smoking marijuana may be more harmful to the lungs than smoking tobacco.
Other Health Effects
Some of marijuana's adverse health effects may occur because THC impairs the immune system's ability to fight disease. In laboratory experiments that exposed animal and human cells to THC or other marijuana ingredients, the normal disease-preventing reactions of many of the key types of immune cells were inhibited14. In other studies, mice exposed to THC or related substances were more likely than unexposed mice to develop bacterial infections and tumors15,16.
Effects of Use on Learning and Social Behavior
Research clearly demonstrates that marijuana has the potential to cause problems in daily life or make a person's existing problems worse. Depression17, anxiety17, and personality disturbances18 have been associated with chronic marijuana use. Because marijuana compromises the ability to learn and remember information, the more a person uses marijuana the more he or she is likely to fall behind in accumulating intellectual, job, or social skills. Moreover, research has shown that marijuana’s adverse impact on memory and learning can last for days or weeks after the acute effects of the drug wear off19,20,25.
some cognitive abilities may be restored in individuals who quit smoking marijuana, even after long-term heavy use
Students who smoke marijuana get lower grades and are less likely to graduate from high school, compared with their nonsmoking peers21,22,23,24. A study of 129 college students found that, among those who smoked the drug at least 27 of the 30 days prior to being surveyed, critical skills related to attention, memory, and learning were significantly impaired, even after the students had not taken the drug for at least 24 hours20. These "heavy" marijuana abusers had more trouble sustaining and shifting their attention and in registering, organizing, and using information than did the study participants who had abused marijuana no more than 3 of the previous 30 days. As a result, someone who smokes marijuana every day may be functioning at a reduced intellectual level all of the time.
More recently, the same researchers showed that the ability of a group of long-term heavy marijuana abusers to recall words from a list remained impaired for a week after quitting, but returned to normal within 4 weeks25. Thus, some cognitive abilities may be restored in individuals who quit smoking marijuana, even after long-term heavy use.
Workers who smoke marijuana are more likely than their coworkers to have problems on the job. Several studies associate workers' marijuana smoking with increased absences, tardiness, accidents, workers' compensation claims, and job turnover. A study among postal workers found that employees who tested positive for marijuana on a pre-employment urine drug test had 55 percent more industrial accidents, 85 percent more injuries, and a 75-percent increase in absenteeism compared with those who tested negative for marijuana use26. In another study, heavy marijuana abusers reported that the drug impaired several important measures of life achievement including cognitive abilities, career status, social life, and physical and mental health27.
Effects of Exposure During Pregnancy
Research has shown that some babies born to women who abused marijuana during their pregnancies display altered responses to visual stimuli28, increased tremulousness, and a high-pitched cry, which may indicate neurological problems in development29. During the preschool years, marijuana-exposed children have been observed to perform tasks involving sustained attention and memory more poorly than nonexposed children do30,31. In the school years, these children are more likely to exhibit deficits in problem-solving skills, memory, and the ability to remain attentive30.
Long-term marijuana abuse can lead to addiction for some people; that is, they abuse the drug compulsively even though it interferes with family, school, work, and recreational activities. Drug craving and withdrawal symptoms can make it hard for long-term marijuana smokers to stop abusing the drug. People trying to quit report irritability, sleeplessness, and anxiety32. They also display increased aggression on psychological tests, peaking approximately one week after the last use of the drug33.
Scientists have found that whether an individual has positive or negative sensations after smoking marijuana can be influenced by heredity. A 1997 study demonstrated that identical male twins were more likely than nonidentical male twins to report similar responses to marijuana abuse, indicating a genetic basis for their response to the drug34. (Identical twins share all of their genes.)
It also was discovered that the twins' shared or family environment before age 18 had no detectable influence on their response to marijuana. Certain environmental factors, however, such as the availability of marijuana, expectations about how the drug would affect them, the influence of friends and social contacts, and other factors that differentiate experiences of identical twins were found to have an important effect.34
Treating Marijuana Problems
The latest treatment data indicate that, in 2002, marijuana was the primary drug of abuse in about 15 percent (289,532) of all admissions to treatment facilities in the United States. Marijuana admissions were primarily male (75 percent), White (55 percent), and young (40 percent were in the 15-–19 age range). Those in treatment for primary marijuana abuse had begun use at an early age; 56 percent had abused it by age 14 and 92 percent had abused it by 1835.
92 percent of those treated had abused marijuana by age 18
One study of adult marijuana abusers found comparable benefits from a 14-session cognitive-behavioral group treatment and a 2-session individual treatment that included motivational interviewing and advice on ways to reduce marijuana use. Participants were mostly men in their early thirties who had smoked marijuana daily for more than 10 years. By increasing patients' awareness of what triggers their marijuana abuse, both treatments sought to help patients devise avoidance strategies. Abuse, dependence symptoms, and psychosocial problems decreased for at least 1 year following both treatments; about 30 percent of the patients were abstinent during the last 3-month followup period36.
Another study suggests that giving patients vouchers that they can redeem for goods—such as movie passes, sporting equipment, or vocational training—may further improve outcomes37.
Although no medications are currently available for treating marijuana abuse, recent discoveries about the workings of the THC receptors have raised the possibility of eventually developing a medication that will block the intoxicating effects of THC. Such a medication might be used to prevent relapse to marijuana abuse by lessening or eliminating its appeal.
Methamphetamine is a very addictive stimulant drug that activates certain systems in the brain. It is chemically related to amphetamine but, at comparable doses, the effects of methamphetamine are much more potent, longer lasting, and more harmful to the central nervous system (CNS).
also known as, speed, meth, chalk, ice, crystal, glass, tina
Methamphetamine is a Schedule II stimulant, which means it has a high potential for abuse and is available only through a prescription that cannot be refilled. It can be made in small, illegal laboratories, where its production endangers the people in the labs, neighbors, and the environment. Street methamphetamine is referred to by many names, such as "speed," "meth," and "chalk." Methamphetamine hydrochloride, clear chunky crystals resembling ice, which can be inhaled by smoking, is referred to as "ice," "crystal," "glass," and "tina."
Methamphetamine is taken orally, intranasally (snorting the powder), by needle injection, or by smoking. Abusers may become addicted quickly, needing higher doses and more often. At this time, the most effective treatments for methamphetamine addiction are behavioral therapies such as cognitive behavioral and contingency management interventions.
Methamphetamine increases the release of very high levels of the neurotransmitter dopamine, which stimulates brain cells, enhancing mood and body movement. Chronic methamphetamine abuse significantly changes how the brain functions. Animal research going back more than 30 years shows that high doses of methamphetamine damage neuron cell endings. Dopamine- and serotonin-containing neurons do not die after methamphetamine use, but their nerve endings ("terminals") are cut back, and regrowth appears to be limited. Noninvasive human brain imaging studies have shown alterations in the activity of the dopamine system. These alterations are associated with reduced motor speed and impaired verbal learning. Recent studies in chronic methamphetamine abusers have also revealed severe structural and functional changes in areas of the brain associated with emotion and memory, which may account for many of the emotional and cognitive problems observed in chronic methamphetamine abusers.
side-effects may include convulsions, cardiovascular collapse, even death
Taking even small amounts of methamphetamine can result in increased wakefulness, increased physical activity, decreased appetite, increased respiration, rapid heart rate, irregular heartbeat, increased blood pressure, and hyperthermia. Other effects of methamphetamine abuse may include irritability, anxiety, insomnia, confusion, tremors, convulsions, and cardiovascular collapse and death. Long-term effects may include paranoia, aggressiveness, extreme anorexia, memory loss, visual and auditory hallucinations, delusions, and severe dental problems.
Also, transmission of HIV and hepatitis B and C can be a consequence of methamphetamine abuse. Among abusers who inject the drug, infection with HIV and other infectious diseases is spread mainly through the re-use of contaminated syringes, needles, and other injection equipment by more than one person. The intoxicating effects of methamphetamine, however, whether it is injected or taken other ways, can alter judgment and inhibition and lead people to engage in unsafe behaviors. Methamphetamine abuse actually may worsen the progression of HIV and its consequences; studies with methamphetamine abusers who have HIV indicate that the HIV causes greater neuronal injury and cognitive impairment compared with HIV-positive people who do not use drugs.
Extent of Use
Monitoring the Future Study (MTF)
These data are from the 2005 MTF, funded by the National Institute on Drug Abuse, National Institutes of Health, DHHS, and conducted by the University of Michigan's Institute for Social Research. The study has tracked 12th-graders' illicit drug abuse and related attitudes since 1975; in 1991, 8th- and 10th-graders were added to the study.
Data from the 2005 MTF study indicate that, compared to the 2004 data:
there were no statistically significant increases in methamphetamine abuse among 8th-, 10th, and 12th-graders in 2005;
methamphetamine abuse among 8th-graders remained stable and was lower than for 10th- and 12th-graders;
10th- and 12th-graders reported significant decreases in lifetime methamphetamine abuse; and
12th-graders reported significant declines in annual and 30-day abuse;
Methamphetamine Prevalence of Abuse among 12th-Graders
Monitoring the Future Survey, 2003-2005
2003 2004 2005
Lifetime 6.2% 6.2% 4.5%
Annual 3.2 3.4 2.5
30-Day 1.7 1.4 0.9
Community Epidemiology Work Group (CEWG)
CEWG is a NIDA-sponsored network of researchers from 21 major U.S. metropolitan areas and selected foreign countries who meet semiannually to discuss the latest epidemiology of drug abuse. CEWG's most recent reports are available at http://www.drugabuse.gov/about/organization/cewg/pubs.html.
From 2004 to 2005, methamphetamine abuse did not decrease in any of the 21 CEWG areas; increased in nine CEWG areas (eight of which had high levels of methamphetamine abuse – Atlanta, Denver, Honolulu, Los Angeles, Phoenix, San Diego, Seattle, and Texas); and was reported as a growing problem in St. Louis, where a 15-percent increase occurred in methamphetamine admissions from 2004 to 2005.
Also, it was reported that methamphetamine has been replacing crack as a drug of choice in some areas of Texas; remained stable or mixed in Minneapolis/St. Paul and San Francisco; and remained at low levels in nine areas located in the Northeast and Midwest.
Sharp decreases were reported in small methamphetamine clandestine incidents (e.g., laboratories, dumpsites, chemical/glass/equipment) located in and/or around most CEWG areas, according to the Drug Enforcement Administration’s El Paso Intelligence Center (2006 data). Despite these decreases in the number of incidents, as well as in the number of seizures, the drug was readily available and generally of higher purity than in prior years. Most CEWG areas reported increases in the amounts and purity of methamphetamine smuggled into the United States from Mexico.
National Survey on Drug Use and Health (NSDUH)
NSDUH (formerly known as the National Household Survey on Drug Abuse) is an annual survey conducted by the Substance Abuse and Mental Health Services Administration. Findings from the latest survey are available at www.samhsa.gov.
According to the 2005 NSDUH, 10.4 million Americans age 12 and older had tried methamphetamine at least once in their lifetimes. The rates for annual and 30-day methamphetamine abuse did not change between 2004 and 2005, but the lifetime rate declined from 4.9 to 4.3 percent. From 2002 to 2005, decreases were seen in lifetime (5.3 to 4.3 percent) and annual (0.7 to 0.5 percent) use, but not 30-day use (0.3 percent in 2002 vs. 0.2 percent in 2005).
Other Information Resources
For more information on the effects of methamphetamine abuse and addiction, visit www.drugabuse.gov/drugpages/methamphetamine.html.
To find publicly-funded treatment facilities by state, visit www.findtreatment.samhsa.gov.
PCP (phencyclidine) was developed in the 1950s as an intravenous anesthetic. Its use in humans was discontinued in 1965, because patients often became agitated, delusional, and irrational while recovering from its anesthetic effects. PCP is illegally manufactured in laboratories and is sold on the street by such names as angel dust, ozone, wack, and rocket fuel. Killer joints and crystal supergrass are names that refer to PCP combined with marijuana. The variety of street names for PCP reflects its bizarre and volatile effects.
distorts perceptions of sight and sound; produces feelings of detachment
PCP is a "dissociative drug," meaning that it distorts perceptions of sight and sound and produces feelings of detachment (dissociation) from the environment and self. Dissociative drugs act by altering distribution of the neurotransmitter glutamate throughout the brain. Glutamate is involved in a person's perception of pain, responses to the environment, and memory.
PCP is a white crystalline powder that is readily soluble in water or alcohol. It has a distinctive bitter chemical taste. PCP can be mixed easily with dyes and turns up on the illicit drug market in a variety of tablets, capsules, and colored powders. It is normally abused in one of three ways: snorted, smoked, or ingested. For smoking, PCP is often applied to a leafy material such as mint, parsley, oregano, or marijuana.
PCP is addictive—its repeated abuse can lead to craving and compulsive PCP-seeking behavior. First introduced as a street drug in the 1960s, PCP quickly gained a reputation as a drug that could cause bad reactions and was not worth the risk. After abusing PCP once, many people will not knowingly abuse it again. Others attribute their continued abuse to feelings of strength, power, invulnerability, and a numbing effect on the mind.
people often become violent or suicidal; very dangerous to themselves and others
Many PCP abusers are brought to emergency rooms because of PCP overdose or because of the drug's unpleasant psychological effects. In a hospital or detention setting, these people often become violent or suicidal and are very dangerous to themselves and others. They should be kept in a calm setting and not be left alone.
At low to moderate doses, physiological effects of PCP include a slight increase in breathing rate and a pronounced rise in blood pressure and pulse rate. Breathing becomes shallow, and flushing and profuse sweating occur. Generalized numbness of the extremities and loss of muscular coordination also may occur.
At high doses of PCP, blood pressure, pulse rate, and respiration drop. This may be accompanied by nausea, vomiting, blurred vision, flicking up and down of the eyes, drooling, loss of balance, and dizziness. High doses of PCP can also cause seizures, coma, and death (though death more often results from accidental injury or suicide during PCP intoxication). High doses can cause symptoms that mimic schizophrenia, such as delusions, hallucinations, paranoia, disordered thinking, a sensation of distance from one's environment, and catatonia. Speech is often sparse and garbled.
People who abuse PCP for long periods report memory loss, difficulties with speech and thinking, depression, and weight loss. These symptoms can persist up to a year after stopping PCP abuse. Mood disorders also have been reported. PCP has sedative effects, and interactions with other central nervous system depressants, such as alcohol and benzodiazepines, can lead to coma.
Extent of Use
Monitoring the Future (MTF) Survey*
MTF data show that in 2005, 2.4 percent of high school seniors reported lifetime** use of PCP; annual use was reported by 1.3 percent of seniors, and 30-day use was reported by 0.7 percent. Data on PCP use by 8th- and 10th-graders are not available.
Drug Abuse Warning Network (DAWN)***
PCP mentions in emergency departments for the third and fourth quarters of 2003 were estimated at 4,581; most of these mentions involved males. Approximately 51 percent were Black, 31 percent were White, and 12 percent were Hispanic.
National Survey on Drug Use and Health (NSDUH)****
According to the 2004 NSDUH, lifetime use of PCP went down for those aged 18 to 25. Males in this age group showed significant decreases in lifetime use from 2003. Females in this age group showed significant declines in past year use. Lifetime use among 12- or 13-year-olds, however, was up significantly in 2004, from 0.1 percent in 2003 to 0.3 percent.
Prescription medications such as pain relievers, tranquilizers, stimulants, and sedatives are very useful treatment tools, but sometimes people do not take them as directed and may become addicted. Pain relievers make surgery possible, and enable many individuals with chronic pain to lead productive lives. Most people who take prescription medications use them responsibly. However, the inappropriate or nonmedical use of prescription medications is a serious public health concern. Nonmedical use of prescription medications like opioids, central nervous system (CNS) depressants, and stimulants can lead to addiction, characterized by compulsive drug seeking and use.
popular types include oxycontin, vicodin, demerol, codeine, valium, xanax, and ritalin
Patients, healthcare professionals, and pharmacists all have roles in preventing misuse and addiction to prescription medications. For example, when a doctor prescribes a pain relief medication, CNS depressant, or stimulant, the patient should follow the directions for use carefully, learn what effects the medication could have, and determine any potential interactions with other medications. The patient should read all information provided by the pharmacist. Physicians and other healthcare providers should screen for any type of substance abuse during routine history-taking, with questions about which prescriptions and over-the-counter (OTC) medicines the patient is taking and why. Providers should note any rapid increases in the amount of a medication needed or frequent requests for refills before the quantity prescribed should have been used, as these may be indicators of abuse.
Commonly Abused Prescription Medications
While many prescription medications can be abused or misused, these three classes are most commonly abused:
Opioids - often prescribed to treat pain.
CNS Depressants - used to treat anxiety and sleep disorders.
Stimulants - prescribed to treat narcolepsy and attention deficit/hyperactivity disorder.
Opioids are commonly prescribed because of their effective analgesic, or pain relieving, properties. Studies have shown that properly managed medical use of opioid analgesic compounds is safe and rarely causes addiction. Taken exactly as prescribed, opioids can be used to manage pain effectively.
Among the compounds that fall within this class—sometimes referred to as narcotics—are morphine, codeine, and related medications. Morphine is often used before or after surgery to alleviate severe pain. Codeine is used for milder pain. Other examples of opioids that can be prescribed to alleviate pain include oxycodone (OxyContin—an oral, controlled release form of the drug); propoxyphene (Darvon); hydrocodone (Vicodin); hydromorphone (Dilaudid); and meperidine (Demerol), which is used less often because of its side effects. In addition to their effective pain relieving properties, some of these medications can be used to relieve severe diarrhea (Lomotil, for example, which is diphenoxylate) or severe coughs (codeine).
a large single dose may cause death
Opioids act by attaching to specific proteins called opioid receptors, which are found in the brain, spinal cord, and gastrointestinal tract. When these compounds attach to certain opioid receptors in the brain and spinal cord, they can effectively change the way a person experiences pain.
In addition, opioid medications can affect regions of the brain that mediate what we perceive as pleasure, resulting in the initial euphoria that many opioids produce. They can also produce drowsiness, cause constipation, and, depending upon the amount taken, depress breathing. Taking a large single dose could cause severe respiratory depression or death.
Opioids may interact with other medications and are only safe to use with other medications under a physician's supervision. Typically, they should not be used with substances such as alcohol, antihistamines, barbiturates, or benzodiazepines. Since these substances slow breathing, their combined effects could lead to life-threatening respiratory depression.
can cause physical dependence
Long-term use also can lead to physical dependence—the body adapts to the presence of the substance and withdrawal symptoms occur if use is reduced abruptly. This can also include tolerance, which means that higher doses of a medication must be taken to obtain the same initial effects. Note that physical dependence is not the same as addiction—physical dependence can occur even with appropriate long-term use of opioid and other medications. Addiction, as noted earlier, is defined as compulsive, often uncontrollable drug use in spite of negative consequences.
Individuals taking prescribed opioid medications should not only be given these medications under appropriate medical supervision, but also should be medically supervised when stopping use in order to reduce or avoid withdrawal symptoms. Symptoms of withdrawal can include restlessness, muscle and bone pain, insomnia, diarrhea, vomiting, cold flashes with goose bumps ("cold turkey"), and involuntary leg movements.
Individuals who become addicted to prescription medications can be treated. Options for effectively treating addiction to prescription opioids are drawn from research on treating heroin addiction. Some pharmacological examples of available treatments follow:
Methadone, a synthetic opioid that blocks the effects of heroin and other opioids, eliminates withdrawal symptoms and relieves craving. It has been used for over 30 years to successfully treat people addicted to opioids.
Buprenorphine, another synthetic opioid, is a recent addition to the arsenal of medications for treating addiction to heroin and other opiates.
Naltrexone is a long-acting opioid blocker often used with highly motivated individuals in treatment programs promoting complete abstinence. Naltrexone also is used to prevent relapse.
Naloxone counteracts the effects of opioids and is used to treat overdoses.
Central Nervous System (CNS) Depressants
CNS depressants slow normal brain function. In higher doses, some CNS depressants can become general anesthetics. Tranquilizers and sedatives are examples of CNS depressants.
CNS depressants can be divided into two groups, based on their chemistry and pharmacology:
Barbiturates, such as mephobarbital (Mebaral) and pentobarbitalsodium (Nembutal), which are used to treat anxiety, tension, and sleep disorders.
Benzodiazepines, such as diazepam (Valium), chlordiazepoxide HCl (Librium), and alprazolam (Xanax), which can be prescribed to treat anxiety, acute stress reactions, and panic attacks. Benzodiazepines that have a more sedating effect, such as estazolam (ProSom), can be prescribed for short-term treatment of sleep disorders.
There are many CNS depressants, and most act on the brain similarly—they affect the neurotransmitter gamma-aminobutyric acid (GABA). Neurotransmitters are brain chemicals that facilitate communication between brain cells. GABA works by decreasing brain activity. Although different classes of CNS depressants work in unique ways, ultimately it is their ability to increase GABA activity that produces a drowsy or calming effect. Despite these beneficial effects for people suffering from anxiety or sleep disorders, barbiturates and benzodiazepines can be addictive and should be used only as prescribed.
if combined with other medication, cns depressants can be fatal
CNS depressants should not be combined with any medication or substance that causes drowsiness, including prescription pain medicines, certain OTC cold and allergy medications, or alcohol. If combined, they can slow breathing, or slow both the heart and respiration, which can be fatal.
Discontinuing prolonged use of high doses of CNS depressants can lead to withdrawal. Because they work by slowing the brain’s activity, a potential consequence of abuse is that when one stops taking a CNS depressant, the brain’s activity can rebound to the point that seizures can occur. Someone thinking about ending their use of a CNS depressant, or who has stopped and is suffering withdrawal, should speak with a physician and seek medical treatment.
Therapy has been used successfully
In addition to medical supervision, counseling in an in-patient or out-patient setting can help people who are overcoming addiction to CNS depressants. For example, cognitive-behavioral therapy has been used successfully to help individuals in treatment for abuse of benzodiazepines. This type of therapy focuses on modifying a patient’s thinking, expectations, and behaviors while simultaneously increasing their skills for coping with various life stressors.
Often the abuse of CNS depressants occurs in conjunction with the abuse of another substance or drug, such as alcohol or cocaine. In these cases of polydrug abuse, the treatment approach should address the multiple addictions.
Stimulants increase alertness, attention, and energy, which are accompanied by increases in blood pressure, heart rate, and respiration.
Historically, stimulants were used to treat asthma and other respiratory problems, obesity, neurological disorders, and a variety of other ailments. As their potential for abuse and addiction became apparent, the use of stimulants began to wane. Now, stimulants are prescribed for treating only a few health conditions, including narcolepsy, attention-deficit hyperactivity disorder (ADHD), and depression that has not responded to other treatments. Stimulants may also be used for short-term treatment of obesity and for patients with asthma.
Stimulants such as dextroamphetamine (Dexedrine) and methylphenidate (Ritalin) have chemical structures that are similar to key brain neurotransmitters called monoamines, which include norepinephrine and dopamine. Stimulants increase the levels of these chemicals in the brain and body. This, in turn, increases blood pressure and heart rate, constricts blood vessels, increases blood glucose, and opens up the pathways of the respiratory system. In addition, the increase in dopamine is associated with a sense of euphoria that can accompany the use of stimulants.
Research indicates that people with ADHD do not become addicted to stimulant medications, such as Ritalin, when taken in the form and dosage prescribed. However, when misused, stimulants can be addictive.
The consequences of stimulant abuse can be extremely dangerous. Taking high doses of a stimulant can result in an irregular heartbeat, dangerously high body temperatures, and/or the potential for cardiovascular failure or seizures. Taking high doses of some stimulants repeatedly over a short period of time can lead to hostility or feelings of paranoia in some individuals.
Stimulants should not be mixed with antidepressants or OTC cold medicines containing decongestants. Antidepressants may enhance the effects of a stimulant, and stimulants in combination with decongestants may cause blood pressure to become dangerously high or lead to irregular heart rhythms.
Treatment of addiction to prescription stimulants, such as methylphenidate and amphetamines, is based on behavioral therapies proven effective for treating cocaine or methamphetamine addiction. At this time, there are no proven medications for the treatment of stimulant addiction. Antidepressants, however, may be used to manage the symptoms of depression that can accompany early abstinence from stimulants.
Depending on the patient’s situation, the first step in treating prescription stimulant addiction may be to slowly decrease the drug’s dose and attempt to treat withdrawal symptoms. This process of detoxification could then be followed with one of many behavioral therapies. Contingency management, for example, improves treatment outcomes by enabling patients to earn vouchers for drug-free urine tests; the vouchers can be exchanged for items that promote healthy living. Cognitive-behavioral therapies, which teach patients skills to recognize risky situations, avoid drug use, and cope more effectively with problems, are proving beneficial. Recovery support groups may also be effective in conjunction with a behavioral therapy.
Trends in Prescription Medication Abuse
2005 Monitoring the Future (MTF) Survey*
MTF assesses the extent and perceptions of drug use among 8th, 10th, and 12th grade students nationwide. In 2003, the survey showed that lifetime, annual, and 30-day** use of tranquilizers had declined significantly from 2002 for 10th- and 12th-graders. This was the first year of decline for 12th-graders after a decade of gradual increase. In general, 8th-graders’ rates of reported tranquilizer use have been considerably lower than those observed in the upper grades. These figures remained statistically unchanged in 2005, with 6.8 percent of 12th-graders, 4.8 percent of 10th-graders, and 2.8 percent of 8th-graders reporting annual use of tranquilizers.
Only 12th grade data are reported for use of sedatives. Lifetime use of sedatives among high school seniors remained statistically unchanged between 2004 (9.9 percent) and 2005 (10.5 percent).
Only 12th grade data are reported for abuse of narcotics other than heroin in the MTF. The annual prevalence of this class of drugs had risen considerably, from 3.3 percent in 1992 to 7 percent in 2000 and 6.7 percent in 2001. In 2002, the survey item was changed to incorporate three new specific pain relievers, OxyContin (a controlled-release form of oxycodone that can cause severe health consequences if crushed and ingested), Vicodin (hydrocodone), and Percocet. Following this change, past year use was reported by 9.4 percent of seniors in 2002, 9.3 percent in 2003, 9.5 percent in 2004, and 9.0 percent in 2005.
Beginning in 2002, new items asking specifically about the use of OxyContin and Vicodin were also added to the survey. Annual use of OxyContin by 12th-graders has risen from 4.0 percent in 2002 to 5.5 percent in 2005. Annual OxyContin use has remained more stable in the lower grades since 2002, with 1.8 percent of 8th-graders and 3.2 percent of 10th-graders reporting annual use in 2005. The annual prevalence rate for Vicodin was considerably higher than for OxyContin, at 9.5 percent among 12th-graders, 5.9 percent among 10th-graders, and 2.6 percent among 8th-graders in 2005. Considering the addictive potential of oxycodone and hydrocodone, these are disturbingly high rates of use.
2004 National Survey on Drug Use and Health (NSDUH)***
According to the 2004 NSDUH, an estimated 6.0 million persons, or 2.5 percent of the population age 12 or older had used prescription psychotherapeutic medications nonmedically in the month prior to being surveyed. This includes 4.4 million using pain relievers, 1.6 million using tranquilizers, 1.2 million using stimulants, and 0.3 million using sedatives.
The estimated number of people aged 12 or older abusing OxyContin in their lifetime increased from 1.9 million in 2002 to 3.1 million in 2004. Increased rates of lifetime OxyContin abuse were seen in each age group, with the largest increase (from 2.6 percent to 4.3 percent) occurring among young adults aged 18 to 25. Also among young adults, lifetime abuse of tranquilizers increased from 11.2 percent in 2002 to 12.2 percent in 2004, and the proportions abusing any pain reliever and any prescription drug in their lifetime and during the past month also increased over that period. Among youth aged 12 to 17, past year abuse of prescription stimulants declined from 2.6 percent to 2.0 percent.
2004 Drug Abuse Warning Network (DAWN)****
The Drug Abuse Warning Network (DAWN), which monitors medications and illicit drugs reported in emergency departments (EDs) across the Nation, found that two of the most frequently reported prescription medications in drug abuse-related cases are benzodiazepines (e.g., diazepam, alprazolam, clonazepam, and lorazepam) and opioid pain relievers (e.g., oxycodone, hydrocodone, morphine, methadone, and combinations that include these drugs).
For 2004, DAWN estimates 495,732 ED visits involved in the nonmedical use (i.e., misuse or abuse) of prescription drugs or OTC pharmaceuticals or dietary supplements. Multiple drugs were involved in more than half (57 percent) of these ED visits.
In 2004, benzodiazepines accounted for 144,385 mentions that were classified as drug abuse cases, and opioid pain relievers accounted for more than 132,207 ED mentions. Methylphenidate, a central nervous system stimulant that has recently captured much public attention, occurred much less frequently. DAWN estimates 1,541 ED visits associated with methylphenidate abuse.
For more information on addiction to prescription medications, visit www.drugabuse.gov/drugpages/prescription.html.
Salvia (Salvia divinorum) is an herb common to southern Mexico and Central and South America. The main active ingredient in Salvia, salvinorin A, is a potent activator of kappa opioid receptors in the brain.1,2 These receptors differ from those activated by the more commonly known opioids, such as heroin and morphine.
Traditionally, S. divinorum has been ingested by chewing fresh leaves or by drinking their extracted juices. The dried leaves of S. divinorum can also be smoked as a joint, consumed in water pipes, or vaporized and inhaled. Although Salvia currently is not a drug regulated by the Controlled Substances Act, several States and countries have passed legislation to regulate its use.3 The Drug Enforcement Agency has listed Salvia as a drug of concern and is considering classifying it as a Schedule I drug, like LSD or marijuana.
People who abuse Salvia generally experience hallucinations or delusional episodes that mimic psychosis.4,5 Subjective effects have been described as intense but short-lived; they appear in less than 1 minute and last less than 30 minutes. Effects include psychedelic-like changes in visual perception, mood, and body sensations; emotional swings; feelings of detachment; and importantly, a highly modified perception of external reality and the self, which leads to a decreased ability to interact with one's surroundings.5 This last effect has prompted concern about the dangers of driving under the influence of salvinorin. The long-term effects of Salvia abuse have not been investigated systematically.
Extent of Use
There are no available estimates of Salvia abuse, but a recent increase in Salvia-related media reports and Internet traffic suggest the possibility of an increase in the level of Salvia abuse in the United States and Europe.4 Although information about the user population is limited, users appear to be mostly younger adults and adolescents who are influenced by promotions of the drug on Internet sites.3 Rather than being used as a party drug, Salvia seems to appeal to individual experimentalists.5
For more information on the effects of hallucinogenic drugs, see NIDA’s Research Report on Hallucinogens and Dissociative Drugs at www.nida.nih.gov/ResearchReports/hallucinogens/hallucinogens.html.
For more information on Salvia divinorum and the Controlled Substances Act, visit www.deadiversion.usdoj.gov/drugs_concern/salvia_d/salvia_d.htm.
For street terms searchable by drug name, street term, cost and quantities, drug trade, and drug use, visit www.whitehousedrugpolicy.gov/streetterms/default.asp.
Smoking / Nicotine
smoking / nicotine
Through the use of cigarettes, cigars, and chewing tobacco, nicotine is one of the most heavily used addictive drugs in the United States. In 2004, 29.2 percent of the U.S. population 12 and older—70.3 million people—used tobacco at least once in the month prior to being interviewed.* This figure includes 3.6 million young people age 12 to 17. Young adults aged 18 to 25 reported the highest rate of current use of any tobacco products (44.6 percent) in 2004.
Statistics indicate that tobacco use remains the leading preventable cause of death in the United States...
Findings for high school youth indicate that 25.9 percent of 8th-graders, 38.9 percent of 10th-graders, and 50.0 percent of 12th-graders had ever smoked cigarettes when asked in 2005.** These figures were lower for all three grades from 2004 data, and for 8th-graders and 12th-graders, the decreases were statistically significant.
Statistics from the Centers for Disease Control and Prevention indicate that tobacco use remains the leading preventable cause of death in the United States, causing approximately 440,000 premature deaths each year and resulting in an annual cost of more than $75 billion in direct medical costs attributable to smoking. (See www.cdc.gov/tobacco/issue.htm.) Over the past four decades, cigarette smoking has caused an estimated 12 million deaths, including 4.1 million deaths from cancer, 5.5 million deaths from cardiovascular diseases, 2.1 million deaths from respiratory diseases, and 94,000 infant deaths related to mothers smoking during pregnancy. (See www.cdc.gov/nccdphp/publications/aag/osh.htm.)
Secondhand smoke, also known as environmental tobacco smoke, is a mixture of the smoke given off by the burning end of tobacco products (sidestream smoke) and the mainstream smoke exhaled by smokers. It is a complex mixture containing many chemicals (including formaldehyde, cyanide, carbon monoxide, ammonia, and nicotine), many of which are known carcinogens. Nonsmokers exposed to secondhand smoke at home or work increase their risk of developing heart disease by 25 to 30 percent and lung cancer by 20 to 30 percent. In addition, secondhand smoke causes respiratory problems in nonsmokers such as coughing, phlegm, and reduced lung function. Children exposed to secondhand smoke are at an increased risk for sudden infant death syndrome, acute respiratory infections, ear problems, and more severe asthma.
Since 1964, 28 Surgeon General’s reports on smoking and health have concluded that tobacco use is the single most avoidable cause of disease, disability, and death in the United States. In 1988, the Surgeon General concluded that cigarettes and other forms of tobacco, such as cigars, pipe tobacco, and chewing tobacco, are addictive and that nicotine is the drug in tobacco that causes addiction. Nicotine provides an almost immediate “kick” because it causes a discharge of epinephrine from the adrenal cortex. This stimulates the central nervous system and endocrine glands, which causes a sudden release of glucose. Stimulation is then followed by depression and fatigue, leading the user to seek more nicotine.
Nicotine is absorbed readily from tobacco smoke in the lungs, and it does not matter whether the tobacco smoke is from cigarettes, cigars, or pipes. Nicotine also is absorbed readily when tobacco is chewed. With regular use of tobacco, levels of nicotine accumulate in the body during the day and persist overnight. Thus, daily smokers or chewers are exposed to the effects of nicotine for 24 hours each day. Adolescents who chew tobacco are more likely than nonusers to eventually become cigarette smokers.
Addiction to nicotine results in withdrawal symptoms when a person tries to stop smoking. For example, a study found that when chronic smokers were deprived of cigarettes for 24 hours, they had increased anger, hostility, and aggression, and loss of social cooperation. Persons suffering from withdrawal also take longer to regain emotional equilibrium following stress. During periods of abstinence and/or craving, smokers have shown impairment across a wide range of psychomotor and cognitive functions, such as language comprehension.
...increased anger, hostility, and aggression, and loss of social cooperation.
Women who smoke generally have earlier menopause. Pregnant women who smoke cigarettes run an increased risk of having stillborn or premature infants or infants with low birth weight. Children of women who smoked while pregnant have an increased risk for developing conduct disorders. National studies of mothers and daughters have also found that maternal smoking during pregnancy increased the probability that female children would smoke and would persist in smoking.
In addition to nicotine, cigarette smoke is primarily composed of a dozen gases (mainly carbon monoxide) and tar. The tar in a cigarette, which varies from about 15 mg for a regular cigarette to 7 mg in a low-tar cigarette, exposes the user to an increased risk of lung cancer, emphysema, and bronchial disorders. The carbon monoxide in tobacco smoke increases the chance of cardiovascular diseases. The Environmental Protection Agency has concluded that secondhand smoke causes lung cancer in adults and greatly increases the risk of respiratory illnesses in children and sudden infant death.
Research has shown that nicotine, like cocaine, heroin, and marijuana, increases the level of the neurotransmitter dopamine, which affects the brain pathways that control reward and pleasure. Scientists have pinpointed a particular molecule [the beta 2 (b2)] subunit of the nicotine cholinergic receptor as a critical component in nicotine addiction. Mice that lack this subunit fail to self-administer nicotine, implying that without the b2 subunit, the mice do not experience the positive reinforcing properties of nicotine. This finding identifies a potential site for targeting the development of nicotine addiction medications.
Other research found that individuals have greater resistance to nicotine addiction if they have a genetic variant that decreases the function of the enzyme CYP2A6. The decrease in CYP2A6 slows the breakdown of nicotine and protects individuals against nicotine addiction. Understanding the role of this enzyme in nicotine addiction gives a new target for developing more effective medications to help people stop smoking. Medications might be developed that can inhibit the function of CYP2A6, thus providing a new approach to preventing and treating nicotine addiction.
Another study found dramatic changes in the brain’s pleasure circuits during withdrawal from chronic tobacco use. These changes are comparable in magnitude and duration to similar changes observed during withdrawal from other abused drugs such as cocaine, opiates, amphetamines, and alcohol. Scientists found significant decreases in the sensitivity of the brains of laboratory rats to pleasurable stimulation after nicotine administration was abruptly stopped. These changes lasted several days and may correspond to the anxiety and depression experienced by humans for several days after quitting smoking “cold turkey.” The results of this research may help in the development of better treatments for the withdrawal symptoms that may interfere with individuals’ attempts to quit.
Some individuals simply are able to stop smoking. For others, studies have shown that pharmacological treatment combined with behavioral treatment, including psychological support and skills training to overcome high-risk situations, results in some of the highest long-term abstinence rates. Generally, rates of relapse for smoking cessation are highest in the first few weeks and months and diminish considerably after about 3 months.
Behavioral economic studies find that alternative rewards and reinforcers can reduce cigarette use. One study found that the greatest reductions in cigarette use were achieved when smoking cost was increased in combination with the presence of alternative recreational activities.
Nicotine chewing gum is one medication approved by the Food and Drug Administration (FDA) for the treatment of nicotine dependence. Nicotine in this form acts as a nicotine replacement to help smokers quit smoking. The success rates for smoking cessation treatment with nicotine chewing gum vary considerably across studies, but evidence suggests that it is a safe means of facilitating smoking cessation if chewed according to instructions and restricted to patients who are under medical supervision.
Another approach to smoking cessation is the nicotine transdermal patch, a skin patch that delivers a relatively constant amount of nicotine to the person wearing it. A research team at NIDA’s Intramural Research Program studied the safety, mechanism of action, and abuse liability of the patch that was consequently approved by FDA. Both nicotine gum and the nicotine patch, as well as other nicotine replacements such as sprays and inhalers, are used to help people fully quit smoking by reducing withdrawal symptoms and preventing relapse while undergoing behavioral treatment.
Another tool in treating tobacco addiction is a medication that goes by the trade name Zyban. This is not a nicotine replacement, as are the gum and patch. Rather, this works on other areas of the brain, and its effectiveness is in helping to make nicotine craving, or thoughts about cigarette use, more controllable in people who are trying to quit.
Extent of Use
Monitoring the Future (MTF) Survey
Despite the demonstrated health risks associated with cigarette smoking, young Americans continue to smoke. However, 30-day*** smoking rates among high school students have declined from peaks reached in 1996 for 8th-graders (21.0 percent) and 10th-graders (30.4 percent) and in 1976 for 12th-graders (38.8 percent). In 2005, 30-day rates had dropped to 9.3 percent for 8th-graders, 14.9 percent for 10th-graders, and 23.2 percent for 12th-graders.
The decrease in smoking rates among young Americans corresponds to several years in which increased proportions of teens said they believe there is a “great” health risk associated with cigarette smoking and expressed disapproval of smoking one or more packs of cigarettes a day. Students’ personal disapproval of smoking has risen for some years. In 2005, for example, the percentage of 12th-graders disapproving of smoking one or more packs of cigarettes per day increased significantly, from 76.2 percent in 2004 to 79.8 percent in 2005.
Other Information Sources
For additional information on tobacco abuse and addiction,
please visit smoking.drugabuse.gov.
For more information on how to quit smoking, please visit cdc.gov/tobacco.
Anabolic-androgenic steroids are manmade substances related to male sex hormones. “Anabolic” refers to muscle-building, and “androgenic” refers to increased masculine characteristics. “Steroids” refers to the class of drugs. These drugs are available legally only by prescription, to treat conditions that occur when the body produces abnormally low amounts of testosterone, such as delayed puberty and some types of impotence. They are also prescribed to treat body wasting in patients with AIDS and other diseases that result in loss of lean muscle mass. Abuse of anabolic steroids, however, can lead to serious health problems, some irreversible.
side effects can include liver tumors and cancer
Today, athletes and others abuse anabolic steroids to enhance performance and also to improve physical appearance. Anabolic steroids are taken orally or injected, typically in cycles of weeks or months (referred to as “cycling”), rather than continuously. Cycling involves taking multiple doses of steroids over a specific period of time, stopping for a period, and starting again. In addition, users often combine several different types of steroids to maximize their effectiveness while minimizing negative effects (referred to as “stacking”).
The major side effects from abusing anabolic steroids can include liver tumors and cancer, jaundice (yellowish pigmentation of skin, tissues, and body fluids), fluid retention, high blood pressure, increases in LDL (bad cholesterol), and decreases in HDL (good cholesterol). Other side effects include kidney tumors, severe acne, and trembling. In addition, there are some gender-specific side effects:
For men—shrinking of the testicles, reduced sperm count, infertility, baldness, development of breasts, increased risk for prostate cancer.
For women—growth of facial hair, male-pattern baldness, changes in or cessation of the menstrual cycle, enlargement of the clitoris, deepened voice.
For adolescents—growth halted prematurely through premature skeletal maturation and accelerated puberty changes. This means that adolescents risk remaining short for the remainder of their lives if they take anabolic steroids before the typical adolescent growth spurt.
In addition, people who inject anabolic steroids run the added risk of contracting or transmitting HIV/AIDS or hepatitis, which causes serious damage to the liver.