The Effects of Parental Alcohol and Drug Abuse
on Children
Trainer’s Manual
Stephen Webster, Pharm.D. Candidate
University at Buffalo School of Pharmacy and Pharmaceutical Sciences
William A. Prescott Jr., Pharm.D.,
Clinical Assistant Professor
University at Buffalo School of Pharmacy and Pharmaceutical Sciences
James Brustman, CDHS Child Welfare Trainer
Phyllis Harris, CDHS UB Partnership Coordinator
William Rea, CDHS Child Welfare Trainer
David Peters, CDHS Senior Child Welfare Trainer
Funding for this research project was provided by NYS Office of Children and Family
Services, Contract year 2005: Project 1044698, Award: 34851; Contract year 2006:
Project 1052594, Award 38452, through the Center for Development of Human Services,
College Relations Group, Research Foundation of SUNY, Buffalo State College.
© 2005-2006 CDHS/Research Foundation of SUNY/BSC College Relations Group
Table of Contents
Page(s)
Section
1
Introduction
2
Explanation of Terms
3-4
Frequently Asked Questions (FAQs)
5-9
Trends and Statistics
10
Signs and Symptoms of Drug Intoxication and
Withdrawal
11-15
Commonly Abused Substances Quick Reference Chart
16-36 Drug Sections
16-18 Alcohol
18-20 Cannabinoids
20-22 Cocaine/Crack
22-24 Dissociative Drugs
24-25 Ecstasy/MDMA
26-27 Hallucinogens
27-29 Heroin
29-31 Methamphetamine/Amphetamine
31-33 Prescription Opioids
34-36 Prescription Depressants
37
Family-related Consequences of Parental Substance Abuse
38-39 Website Resource Table
40-41 References
© 2005-2006 CDHS/Research Foundation of SUNY/BSC College Relations Group
Introduction
Overview: Child welfare workers are faced with decisions regarding the
current safety of and future risk to children. When parents are actively
involved in the use of drugs and/or alcohol, their behavior may cause the
children to be in immediate danger of serious harm. Such behavior may
result in interventions that include removal of children from their home. In
order to strengthen decision making so that children are not being removed
when they can remain at home and that they are not being left in situations
that leave them in danger of serious harm, workers need to understand the
behavioral and psychological aspects of drug/alcohol abuse.
When children have been placed in out of home care, child welfare workers
are required to pursue diligent efforts to reunite the family. Under the
Adoption and Safe Families Act (ASFA), child welfare caseworkers are
required to file for termination of parental rights if the children have been in
foster care for 15 of the past 22 months. As a result, child welfare workers
are making decisions regarding family reunification fairly early in the
treatment process, often after only 12 months of foster care. If the risk to the
children is high, parental rights may be terminated. However, where risk
can be reduced to acceptable levels, children may be returned home. In
order to better assess the risk presented by parents with alcohol and/or other
drug abuse or addiction, caseworkers can benefit from knowledge of the
behavioral and physical changes that occur during the treatment period.
Purpose: CDHS trainers and child welfare workers will be educated on
the cognitive, affective, behavioral and physiological changes that occur
during alcohol and/or other drug abuse or addiction and the recovery
process. This manual for CDHS trainers is given to improve the quality and
efficiency of child welfare interventions. The main goal of this project is to
provide the children of parents either abusing psychoactive substances or in
recovery with the safest and most developmentally beneficial living
environment attainable.
© 2005-2006 CDHS/Research Foundation of SUNY/BSC College Relations Group
1
Explanation of Terms
Drug Abuse: The use of a drug that results in cognitive, physical, or emotional
impairment and adverse consequences.
Drug Addiction: A behavioral pattern of compulsive drug use, characterized by
overwhelming involvement with the use of a drug, the securing of its
supply and a high tendency to relapse after withdrawal.
Psychological Drug Dependence: Refers to compulsive drug-using behavior in which a
person uses a drug for that’s drug’s effect, not necessarily due to a physical dependence,
often in the face of known health risks.
Physical Drug Dependence: The physiological adaptation of the body to a drug when
that drug is used for an extended period of time, such that when use is abruptly
discontinued, certain withdrawal symptoms appear.
Tolerance: The body's need for increasing amounts of a drug to attain the desired effect
and avoid withdrawal.
Withdrawal: Symptoms that occur after the use of specific addictive drugs are reduced
or discontinued. The duration and type of withdrawal symptoms vary with the type of
drug.
Relapse: The abuse of drugs and/or alcohol or the return of drug abusing behavior after
a period of abstinence or recovery planning.
Potentiation: Occurs when the combined action of two or more drugs is greater than the
sum of the effects of each drug taken alone.
Abused Child: A child less than eighteen years of age whose parent/caregiver inflicts or
allows to be inflicted upon such a child physical or emotional injury by other than
accidental means, or creates or allows to be created a substantial risk of physical or
emotional injury to such a child by other than accidental means.
(see NYS law section 412)
Child Neglect: Failure to provide for a child’s basic needs. Neglect can be physical,
educational, or emotional. Neglect includes withholding of medically indicated
treatment.
Child Maltreatment: An act or the failure to act on the part of a parent/caregiver that
results in either death, serious physical or emotional harm, sexual abuse or exploitation,
or an imminent risk of serious harm to a child.
© 2005-2006 CDHS/Research Foundation of SUNY/BSC College Relations Group
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Frequently Asked Questions
Why do individuals use mood-altering substances?
People start using illicit substances for a variety of reasons including but not limited to,
depression, stress, boredom, peer pressure, traumatic life experiences, and curiosity.
These individuals may continue to use mood-altering substances as a result of addiction
and physical dependence.
How quickly can someone become addicted to a drug?
If and how quickly someone may become addicted to a drug depends on many factors
including a person’s genetic make-up, the type of drug used, the dose of drug used, and
the frequency of drug usage.
Why do some individuals become dependent/addicted and others not?
The likelihood that an individual user will advance to addiction is difficult to predict.
Some people may experiment with drugs and then stop, while others may continue to use.
The genetic predisposition to alcoholism has been well established, while genetic
involvement with respect to addiction to other drugs has been less well-defined.
Why does recovery from substance dependency/addiction vary from individual to
individual?
The ability of an individual to recover from addiction is difficult to predict. While certain
persons may remain abstinent for life after a single treatment episode, others may
experience a lifelong cycle of relapse and treatment. The type of drug addiction may play
a role as certain drug addictions may be more difficult to overcome than others, namely
drugs that lead to physical dependence as well as a psychological addiction.
Can individuals addicted to drugs quit without medical treatment?
A small proportion of persons addicted to drugs may be able to quit without medical
treatment. However, those addicted to drugs suffer from a compulsive drug craving and
usage, and most often cannot quit by themselves. Thus, treatment is generally necessary
to end this compulsive behavior.
Are substance dependent parents more likely to abuse/neglect their children?
Research has demonstrated that compared with children in non-substance abusing
households, children of substance abusing parents are more likely to experience neglect
or physical, sexual, or emotional abuse. A parent’s inability to function in a parental role
may be due to a disproportionate amount of time and money spent acquiring and using
drugs.
© 2005-2006 CDHS/Research Foundation of SUNY/BSC College Relations Group
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What dangers are posed to children residing near drugs of abuse?
The presence of drugs and drug paraphernalia (syringes, razors, etc.) in the household
pose a significant risk to children. Most illicit and prescription drugs are toxic when
orally ingested, especially by a small child. The effect on a small child could be fatal.
Needles, syringes, and razor blades are types of drug paraphernalia that pose another
danger to children. Households involved in drug production place children at risk as
well, as the preparation of many drugs requires the use of highly volatile chemicals.
Are there effective treatments for all types of drug addiction?
All types of drug addiction can be effectively treated with behavioral-based therapies.
Treatment will vary for each person depending on the type of drug(s) being used, and
multiple courses of treatment may be needed to achieve success. Medications may assist
in the recovery from physical dependence to certain.
How can the risk of relapse be lessened?
Cognitive-behavioral therapy based on the theory that learning processes play a critical
role in the development of maladaptive behavioral patterns, is used to prevent relapse.
The use of this therapy helps individuals to learn to identify and correct problematic
behaviors. Relapse prevention encompasses several cognitive-behavioral strategies that
facilitate abstinence as well as provide help for people who experience relapse.
Prescription medications may also be useful to help prevent relapse.
How does a family history of substance abuse affect children?
Substance abuse by any member places a burden on the household. A family history of
substance abuse places future generations at greater risk to develop substance abuse
problems themselves.
Is it possible to be an effective parent while abusing drugs?
This question may be unanswerable. The central issue is that addiction to alcohol and
other drugs can be a chronic relapsing disorder. Recovery can be a long term process. At
the same time, children have an immediate need for a safe and stable home in which to
live. Balancing these factors, as parents make sincere efforts to provide safe and loving
homes for their children, represents a key challenge for the child welfare field and for
judges making critical custody decisions.
© 2005-2006 CDHS/Research Foundation of SUNY/BSC College Relations Group
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Trends and Statistics
Key: Bold = Important/Relevant
Drugs
Cocaine
Crack cocaine is readily available in economically depressed areas of all major cities
in New York State, along with some suburban and semi-rural areas, and is occasionally a
source of violence in upstate cities. Powder and crack cocaine prices are typically
higher in upstate New York than in New York City, while purity levels are generally
higher in New York City than upstate. Purity levels for powder cocaine average 75%
throughout New York State and crack cocaine purity levels average 58%.
Heroin
South American heroin is the most prevalent form found in New York State. However,
Southeast and Southwest Asian heroin, and to a lesser extent Mexican heroin, are also
available. Retail heroin prices are typically higher in upstate New York than New York
City. Heroin purity levels in New York State are among the highest in the nation. South
American heroin ranges in purity from 85-96% in New York City and 20-96% in upstate
New York. Purity levels for Asian heroin have reached 90% in New York City and 85%
in upstate New York.
Marijuana
Marijuana is the most widely available and frequently abused drug in New York State.
Commercial-grade marijuana prices ranged from $200-$2,000/pound and $100$200/ounce in New York during the first quarter of 2002. Hydroponic-produced
marijuana sold for $1,000-$5,000/pound and $250-$1,200/ounce. “Purple haze,” a
form of marijuana reported to be more potent than the hydroponic-produced form, sold
for $300/ounce in upstate New York.
Methamphetamine
While methamphetamine trafficking and abuse in New York State is a less serious
problem when compared to other drugs, there are indicators that its use and abuse is
increasing. In New York City, the methamphetamine market is primarily for crystal
methamphetamine from the U.S. West Coast. Use is not widespread but is increasing
among some subculture groups, particularly gay males. The upstate market is primarily
methamphetamine powder supplied by local clandestine labs, which are becoming more
common. During 2004, authorities reported that there were 7 children affected (in what
way?) by methamphetamine laboratories in New York State.
© 2005-2006 CDHS/Research Foundation of SUNY/BSC College Relations Group
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MDMA / LSD / Ketamine
MDMA is widely available and abused at nightclubs, raves, techno parties, and on
college campuses throughout New York State. In the first quarter of 2002, MDMA sold
for $5-$13/dosage unit at the wholesale level and $25-$38 at the retail level. GHB is
also available at New York clubs. In 2001, a dosage unit of GHB sold for $10.
LSD is readily available at concerts, raves, and techno parties in New York State.
Ketamine presents a low threat to the state but is increasingly available at raves. In 2001,
ketamine sold for $20-$50/dosage unit.
Additional 2002-2003 data from the NSDUH indicate that 2.10% of New York State
residents reported past year dependence on illicit drugs.
© 2005-2006 CDHS/Research Foundation of SUNY/BSC College Relations Group
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Juveniles
Approximately 37% of New York high school students surveyed in 2003 reported
using marijuana at least once in their lifetimes.
Crime and Drug-Related Crime
During 2004, the Drug Enforcement Administration (DEA) reported making 2,121arrests
for drug violations in New York State.
© 2005-2006 CDHS/Research Foundation of SUNY/BSC College Relations Group
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During 2004, the DEA reported making 36,809 adult arrests in New York State for felony
drug violations.
During 2002, approximately 45% (45.9%) of the Federally-sentenced defendants in New
York had committed drug offenses. Almost 62% of the drug offenses (3,085 offenses)
involved marijuana. (I would move the topic on drug-related crime to this section)
© 2005-2006 CDHS/Research Foundation of SUNY/BSC College Relations Group
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Treatment
During 2001, there were 301,768 drug/alcohol treatment admissions in New York.
This number increased to 313,162 admissions during 2002. During 2003, there were
309,172 treatment admissions in New York State. The majority ofadmissions to
treatment in New York State involve Alcohol with a second drug.
Source: The Office of National Drug Control Policy
Drug Policy Information Clearinghouse
http://www.whitehousedrugpolicy.gov/statelocal/ny/ny.pdf
© 2005-2006 CDHS/Research Foundation of SUNY/BSC College Relations Group
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Signs and Symptoms of Drug Intoxication and Withdrawal
Note: These are only possible signs and symptoms of drug use. All signs and symptoms listed may have a variety of other causes.
Mood
Calm
Excited
Thought
Thought
Not Psychotic
Psychotic
Not Psychotic
Psychotic
Pupils
Pupils
Pupils
Pupils
Constricted
Constricted
Dilated
Dilated
1
2
3
4
Key: 1 = Opiate (Heroin) or Sedative (Benzodiazepine, Barbiturate) Intoxication
2 = Stimulant (Cocaine, Methamphetamine) Withdrawal
3 = Opiate (Heroin) or Sedative (Benzodiazepine, Barbiturate) Withdrawal
4 = Stimulant (Cocaine, Methamphetamine, Ecstasy), Hallucinogen (LSD), Dissociative (Ketamine, PCP) Intoxication
© 2005-2006 CDHS/Research Foundation of SUNY/BSC College Relations Group
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Commonly Abused Substances Quick Reference Chart
This reference can be used by CDHS trainers and child welfare workers when quick access to basic information
on commonly abused substances is needed.
Key: Bolded = Most common intoxicating effects
Italicized = Parenting implications
Cannabinoids
Abused
Substance
Street Names
Administered
Intoxication
Effects
Health Consequences
Hashish
boom, chronic,
gangster, hash,
hash oil, hemp
smoked
swallowed
euphoria; slowed
thinking and
reaction time;
confusion;
impaired balance
and coordination
Marijuana
blunt, dope,
ganja, grass,
herb, joint,
mary jane, pot,
reefer, weed
smoked
swallowed
cough, frequent
respiratory infections;
impaired memory and
learning; increased heart
rate; anxiety; panic
attacks; tolerance;
addiction
Hallucinogens
Abused
Substance
LSD
(lysergic acid
diethylamide)
Mescaline
Psilocybin
Street Names
Administered
acid, blotter,
boomers, cubes,
microdot, yellow
sunshines
buttons, cactus,
mesc, peyote
magic
mushroom,
shrooms
swallowed
absorbed through
mouth tissues
swallowed
smoked
swallowed
Intoxication
Effects
altered states of
perception and
feeling; nausea
Health
Consequences
flashbacks; paranoia
Also for LSD and
Mescaline:
increased heart rate,
blood pressure;
sleeplessness;
numbness; weakness;
tremors; persistent
mental disorders
© 2005-2006 CDHS/Research Foundation of SUNY/BSC College Relations Group
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Depressants
Abused Substance
Street Names
Administered
Intoxication
Effects
Health
Consequences
Barbiturates
barbs, reds,
red birds,
phennies,
tooies,
yellows,
yellow
jackets
candy,
downers,
sleeping
pills, tranks
injected
swallowed
sedation;
drowsiness;
dizziness;
reduced
anxiety; feeling
of well-being;
lowered
inhibitions;
slowed pulse
and breathing;
lowered blood
pressure; poor
concentration
fatigue;
confusion;
impaired
coordination,
memory,
judgment;
addiction;
respiratory
depression and
arrest, death
(Amytal,
Nembutal,
Seconal,
Phenobarb)
Benzodiazepines
(Ativanlorazepam,
Halciontemazepam,
Libriumchlordiazepoxide,
Valiumdiazepam,
Xanaxalprazolam)
Flunitrazepam
(Rohypnol)
GHB
(gammahydroxybutyrate)
forget-me
pill,
Mexican
Valium,
R2, Roche,
roofies,
roofinol,
rope,
rophies
G, Georgia
home boy,
grievous
bodily
harm,
liquid
ecstasy
injected
swallowed
swallowed
snorted
swallowed
Also for
Barbiturates:
depression;
unusual
excitement; fever;
irritability; poor
judgment; slurred
speech; lifethreatening
withdrawal
Also for
Flunitrazepam:
visual and
gastrointestinal
disturbances;
urinary retention;
memory loss for
the time under the
drug's effects
Also for GHB:
nausea/vomiting;
headache; loss of
consciousness;
loss of reflexes;
seizures; coma;
death
© 2005-2006 CDHS/Research Foundation of SUNY/BSC College Relations Group
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Opioids and Morphine Derivatives
Abused
Substance
Street
Names
Administered Intoxication
Effects
Health
Consequences
Codeine
Captain Cody,
schoolboy;
doors & fours,
loads,
pancakes and
syrup
Apache,
China girl,
China white,
dance fever,
friend,
goodfella,
jackpot,
murder 8,
TNT, Tango
and Cash
brown sugar,
dope, H,
horse, junk, ,
skunk, smack,
white horse
M, Miss
Emma,
monkey,
white stuff
injected
swallowed
nausea;
constipation;
confusion;
sedation;
respiratory
depression and
arrest; tolerance;
addiction;
unconsciousness;
coma; death
big O, black
stuff, gum
Hillbilly
heroin,
Kickers, Blue,
Oxy, O.C.,
Killer, Percs,
Percodoms
swallowed
smoked
injected
swallowed
snorted
(Robitussin AC, Tylenol w/
Codeine (#3
and #4)
Fentanyl
(Actiq,
Duragesic,
Sublimaze)
Heroin
Morphine
(Kadian, MS
Contin,
Roxanol)
Opium
Oxycodone
(Endocet,
Oxycontin,
Percocet,
Roxicet,
Roxicodone)
Hydrocodone
bitartrate
buccal
injected
smoked
snorted
transdermal
pain relief;
euphoria;
drowsiness
Also for
Codeine: less
analgesia;
sedation; and
respiratory
depression than
morphine
Also for
Heroin:
staggering gait
injected
smoked
snorted
injected
swallowed
smoked
Vike, Watson- swallowed
387
(Lorcet,
Norco, Lortab,
Vicodin)
© 2005-2006 CDHS/Research Foundation of SUNY/BSC College Relations Group
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Stimulants
Abused
Substance
Street
Names
Administered Intoxication Health
Effects
Consequences
Amphetamine
bennies,
black
beauties,
crosses,
hearts, LA
turnaround,
speed, truck
drivers,uppers
blow, bump,
C, candy,
Charlie, coke,
flake, rock,
snow, toot
Adam,
clarity, Eve,
lover's speed,
peace, STP,
X, XTC
chalk, crank,
crystal, fire,
glass, go fast,
ice, meth,
speed
JIF, MPH, Rball, Skippy,
the smart
drug, vitamin
R
injected
swallowed
smoked
snorted
(Biphetamine,
Dexedrine,
Adderall)
Cocaine/Crack
MDMA/Ectasy
(methylenedioxymethamphetamine)
Methamphetamine
(Desoxyn)
Methylphenidate
(Ritalin, Metadate)
Increased
heart rate;
blood
pressure;
metabolism;
feelings of
exhilaration,
energy;
increased
mental
alertness
irregular heart
beat; weight loss,
heart failure,
nervousness,
insomnia;
tolerance;
addiction
injected
swallowed
smoked
snorted
Also for
Cocaine:
increased
temperature
injected
swallowed
snorted
Also for
MDMA: mild
hallucinogenic
effects;
increased
tactile
sensitivity;
empathic
feelings
Also for
Cocaine: chest
pain; respiratory
failure; nausea;
strokes; seizures;
panic attacks
injected
smoked
snorted
swallowed
Also for
Amphetamine:
tremor; loss of
coordination;
Also for
panic; paranoia;
Amphetamine: impulsive
rapid
behavior;
breathing;
aggressiveness;
tremor
psychosis
Also for
Methamph:
aggression;
violence;
psychotic
behavior
Also for
MDMA:
impaired
memory and
learning,
cardiac, renal
and liver toxicity
Also for
Methamph:
memory loss;
cardiac and
neurological
damage;
impaired
memory and
learning
© 2005-2006 CDHS/Research Foundation of SUNY/BSC College Relations Group
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Dissociative Anesthetics
Abused
Substance
Street
Names
Administered Intoxication
Effects
Health
Consequences
Ketamine
cat Valiums,
K, Special K,
vitamin K
angel dust,
boat, hog,
love boat,
peace pill
injected
snorted
smoked
injected
swallowed
smoked
snorted
memory loss;
numbness;
nausea/vomiting
(Ketalar SV)
PCP and
analogs
(phencyclidine)
increased heart
rate and blood
pressure;
impaired motor
function
Also for
Ketamine:
delirium;
depression;
respiratory
depression and
arrest
Also for PCP:
Loss of appetite;
depression
Also for PCP:
possible
decrease in
blood pressure
and heart rate;
panic;
aggression;
violence
Inhalants
Abused
Substance
Street
Names
Administered Intoxication
Effects
Health
Consequences
Solvents
(paint thinners,
gasoline,
glues),
Gases
(butane,
propane,
aerosol
propellants,
nitrous oxide),
nitrites
(isoamyl,
isobutyl,
cyclohexyl)
laughing gas,
poppers,
snappers,
whippets
stimulation;
inhaled
through nose or loss of
inhibition;
mouth
headache;
nausea or
vomiting;
slurred speech;
loss of motor
coordination;
wheezing
unconsciousness;
cramps; weight
loss; muscle
weakness;
depression;
memory
impairment;
damage to
cardiovascular
and nervous
systems; sudden
death
© 2005-2006 CDHS/Research Foundation of SUNY/BSC College Relations Group
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Alcohol
History
Consumption of alcoholic beverages dates back to ancient Greece, Egypt, and Babylonia. While the
social use of alcohol is commonplace, it is not without consequence. The routine use of alcohol has long been
known to result in physiologic dependence. Alcohol dependence has both genetic and environmental factors. It
is defined in the DSM IV as; maladaptive alcohol use with clinically significant impairment as manifested by at
least three of the following within any one-year period: (1) tolerance (2) withdrawal (3) consumption of greater
amounts or use over a longer period of time than intended (4) desire or unsuccessful attempts to cut down or
control use (5) excessive amount of time spent obtaining, using, or recovering from use (6) reduction in time
spent within social, occupational, or recreational activities (7) continued use despite knowledge of physical or
psychological sequelae. Support groups related to alcohol dependence exist to assist both the abuser and their
family members.
Physiological Effects
Alcohol is a depressant that slows central nervous system functioning, causing drowsiness, delayed
reaction time, impaired speech, poor memory recall, and altered emotions. Heart and breathing rate decrease in
correlation with the amount of alcohol consumed.
Alcohol is immediately absorbed into the blood stream from the stomach and small intestine resulting in
a rapid onset of effect. The duration of effect is patient specific, with the average person eliminating
approximately one drink per hour. The effects of alcohol are influenced by many variables; a person with a long
history of alcohol use will ultimately develop tolerance, and as time passes, will consequently need to consume
more alcohol to obtain the same effect; females generally require less alcohol than males to become intoxicated;
a person who weighs less may experience the intoxicating effects of alcohol after a smaller dose than what
would be required for a larger person; a more muscular person tends to be less affected by alcohol compared
with a person of the same weight with a higher % body fat.
The immediate physiological effects of alcohol include:
Drowsiness
Decreased blood pressure
Slowed respiration Feeling of well-being
Slowed cognition
Decreased coordination
Decreased heart rate Decreased body temperature
Signs and Symptoms of Intoxication
There are varying levels of alcohol intoxication, and the amount consumed is the most important factor
in determining this level of intoxication. As a person’s blood alcohol content (BAC) rises, the central nervous
system becomes increasingly depressed, cognition becomes progressively more inhibited, and heart and
breathing rate slow significantly. A BAC of 0.1 results in impairment of reflexes, vision, and reasoning. A
BAC of 0.2 results in impairment of speech and motor control. A BAC of 0.25 results in memory impairment
and potentially loss of consciousness. A BAC greater than or equal to 0.30 results in severe CNS depression
and potentially death secondary to respiratory collapse.
© 2005-2006 CDHS/Research Foundation of SUNY/BSC College Relations Group
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Signs and Symptoms of Intoxication include:
Severe drowsiness
Severe respiratory depression
Confusion
Aggression
Emotional blunting
Hypotension
Memory impairment
Poor coordination
Slurred speech
Decreased heart rate
Increased irritability
Decreased body temperature
Complications of Abuse/Addiction
The most serious complication of alcohol abuse is addiction and physical dependence. Alcohol
addiction can dominate a person’s life, such that all aspects of everyday living become increasingly affected.
After many years of heavy alcohol abuse, the liver becomes damaged and full of scar tissue.
Subsequently, a person may develop liver cirrhosis, kidney damage, impairment of the immune system, gastric
ulceration and cancer, heart disease, and high blood pressure. When alcohol is abruptly discontinued in patients
with a long history of abuse, severe withdrawal symptoms result. Alcohol withdrawal is a serious medical
condition, and can be life-threatening without medical supervision.
The combination of alcohol and other drugs can be extremely dangerous as alcohol may intensify the
effects of other drugs.
Alcohol impairment can lead to a variety of mishaps that endanger the lives of the user/abuser and
innocent bystanders. Within the United States, alcohol is a major cause of traffic accidents and on-the-job
injuries.
Withdrawal
Onset: A person with a long history of regular alcohol intake who abruptly
discontinues or drastically reduces alcohol consumption may experience
withdrawal symptoms within 12 hours of their final drink. Major
withdrawal symptoms peak between 24 and 72 hours after the last drink
and last between 5 and 7 days.
Symptoms:
Alcohol craving
Paranoid delusions
Tremors
Pupil dilation
Agitation
Anxiety
Disorientation
Headache
Nausea
Vomiting
Diarrhea
Elevated blood pressure
Elevated body temperature
Elevated pulse
Increased respiration
Auditory hallucinations
Visual hallucinations
Seizures
Delirium tremens (DT’s)
Increased light sensitivity
Increased audio sensitivity
© 2005-2006 CDHS/Research Foundation of SUNY/BSC College Relations Group
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Severity: Alcohol withdrawal is one of the few withdrawal syndromes that has
the potential to be life-threatening. Approximately 25% of people
experiencing alcohol withdrawal will have seizures. Approximately
10% of people will experience hallucinations. Delirium tremens, the
most serious alcohol withdrawal syndrome, occurs in 5% of cases. It is
characterized by hyperagitation, disorientation, tremor, persistent
hallucinations, and marked increases in heart and respiratory rates and
blood pressure. Roughly 5% of those experiencing Delirium tremens
die from complications.
Cannabinoids
Includes:
Marijuana
Hashish
History:
Marijuana and hashish are two drugs derived from different parts of the plant, Cannabis sativa.
Cannabis has been utilized for thousands of years for its psychoactive and medicinal properties. Until 1937,
cannabis sale and use was legal in the United States. Marijuana is the most commonly used illicit drug in the
United States. Approximately 40% of Americans over the age of 12 have tried marijuana at least once. Billions
of dollars are spent each year on education, law enforcement, seizure operations, and eradication of Cannabis by
the U.S. government.
The major active chemical in cannabis, delta-9-tetrahydrocannabinol (THC), causes the psychoactive
effects, including a euphoric sensation or “high”. The amount of THC in the inhaled or orally ingested product
determines the intensity of the “high”. The potency of marijuana and hashish has dramatically increased in the
past twenty years. Cannabis is generally used in one of two ways, through inhalation or oral ingestion.
Cannabis may be inhaled by several different methods, including via hand-rolled joints, cigar blunts, small
pipes (bowls), and water-pipes (bongs). The most common methods of orally ingesting cannabis is by adding it
to food or by preparing a cannabis-based tea. The psychoactive effect of cannabis is independent of the route of
administration.
Cannabis can be grown both indoors and outdoors, but forms grown indoors are often more potent.
While some marijuana and hashish used in the U.S. is grown domestically, most is grown and exported from
Mexico. Canada is the major source country for indoor-grown, high-potency cannabis.
Physiological Effects
The major active chemical in cannabis is THC. THC affects the brain by binding to specific sites called
cannabinoid receptors on nerve cells, influencing the activity of those cells. While cannabinoid receptors are
located throughout the brain, specific areas have higher concentrations than others. The areas of the brain with
a high concentration of cannabinoid receptors include those areas that influence pleasure sensation, memory,
thought, concentration, sensory and time perception, and coordination. A cannabis user may therefore
experience pleasant sensations, intense colors and sounds, altered time perception, disrupted coordination and
balance, increased appetite, difficulty concentrating, increased heart rate, and anxiety. The addition of alcohol
or other substances can lead to a variety of other effects.
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The immediate physiological effects of cannabis include:
Euphoric feeling
Increased heart rate
Increased anxiety
Drowsiness
Altered sensation
Loss of time perception
Increased hunger
Eye redness
Signs and Symptoms of Intoxication
The onset and duration of action of cannabis depends upon the route of administration. Inhalation of
cannabis delivers several times the amount of THC into the bloodstream than does oral ingestion, and results in
a more immediate onset of effect. The duration of effect with inhaled cannabis is one to three hours. Oral
ingestion of cannabis results in an onset of effect of a half hour to an hour, with the effect lasting up to four
hours.
A cannabis user experiences a euphoric “high” as THC enters the brain. Often, the user’s senses and
time perception become altered. Physically, the heart rate may increase more than 25 beats per minute and the
hands may tremble and feel cold to touch. The mouth may feel dry, and the person may feel very hungry and
thirsty. As the euphoric effect subsides, the person may feel very drowsy or even depressed.
There is little evidence that you can overdose on cannabis. However, users who take very high doses
have experienced acute toxic psychosis, including hallucinations, delusions, and a loss of the sense of personal
recognition. There are no reported deaths that are attributed directly to cannabis overdose.
Symptoms of intoxication include:
Altered sensation
Loss of time perception
Intense hunger
Eye redness
Hallucinations
Poor coordination
Poor judgment
Poor reaction time
Rapid heart beat
Anxiety/Confusion
Euphoric feeling
Short-term memory impairment
Complications of Abuse/Addiction
Long-term cannabis use may lead to addiction in some people, and is usually limited to individuals who
use the drug very frequently over prolong periods of time. The use of cannabis becomes compulsory and often
interferes with daily life. Long-time Cannabis users report craving and withdrawal symptoms including
irritability, difficulty sleeping, anxiety, and aggression. Ongoing research is being conducted to determine if
cannabis causes physical dependence.
The most serious effect of long-term cannabis use is the resulting cognitive symptoms, including
depression, anxiety, and personality disturbances. Users may become withdrawn from relationships, and may
lack motivation to perform school or job related activities. Heavy cannabis use impairs the ability to form
memories, recall events, and shift focus, sometimes making it very difficult to learn. This impairment can last
for days or weeks following use.
The long-term physiological consequences of inhaling cannabis specifically include increased risk of
lung infections, chronic cough, bronchitis, emphysema, and lung cancer.
Another danger of cannabis use is that product bought on the street are often mixed with other
dangerous substances, often times without the knowledge of the buyer. These additives include but are not
limited to codeine, cocaine, PCP, and formaldehyde. The risks are those which are associated with these
substances and may be found in their respective sections of this text.
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There has been much discussion about cannabis being considered a “gateway drug”, meaning that after
experimenting with cannabis, a person is more likely to try “harder” drugs like cocaine or heroin. While it is
true that frequent users of more intense illicit drugs also have cannabis in their system, the correlation is open
for interpretation. It is worth noting that approximately 50% of arrestees have used cannabis within the past
year.
Withdrawal
Long-term cannabis users can experience mild to moderate withdrawal symptoms when they abruptly
stop using the drug. The withdrawal symptoms include irritability, increased aggression, difficulty sleeping,
decreased appetite, drug craving, and anxiety. Peak severity of symptoms occurs approximately one week
following the last use of the drug.
Cocaine/Crack
History
Cocaine is a powerfully addictive stimulant that directly affects the brain. Pure cocaine is extracted
from the leaves of the coca bush. The stimulant property of cocaine has been utilized for over a hundred years.
In the early 1900’s, tonics and elixirs containing cocaine were marketed as “cure alls”. Cocaine is still utilized
in the medical field today as a local anesthetic.
There are two chemical forms of cocaine; a hydrochloride salt and freebase. The salt form is a powder
that is either snorted or dissolved and injected, while the freebase or crack, is smoked.
Cocaine is the second most commonly used illicit drug in the United States. Roughly 10% of Americans
over the age of 12 years have tried cocaine at least once in their lifetime. The price of cocaine has remained
low and stable over the past 10 years suggesting a steady supply entering the United States. Cocaine is almost
exclusively produced in Colombia and shipped to Mexico, thus making the U.S. – Mexico border the primary
point of entry for cocaine into the U.S.. Once in the U.S., cocaine is generally trafficked to major cities where
major distribution networks are established.
Physiological Effects
Cocaine is abused by snorting, injecting or smoking. The intensity and duration of effect caused by
cocaine depends on the dose and route of administration. The most intense high is obtained by smoking crack
cocaine. The euphoric effect is obtained in a matter of seconds and lasts between 5 and 10 minutes. Snorting
cocaine has a slower onset of action, but the effects last between 15 and 30 minutes. Cocaine’s euphoric effect
is attributed to its inhibition of dopamine removal and subsequent accumulation in the central nervous system.
The immediate physiological effects of cocaine include:
Increased blood pressure
Increased heart rate
Dilated pupils
Increased body temperature
Decreased appetite
Increased energy
Increased alertness
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Signs and Symptoms of Intoxication
Cocaine intoxication symptoms vary according to the dose of cocaine administered. Low doses of
cocaine generally result in a heightened state of alertness, increased energy, and a feeling of euphoria. High
doses or repeated doses of cocaine intensify the euphoria, but also can lead to bizarre, erratic, and violent
behavior. People who use high doses of cocaine may also experience tremors, vertigo, muscle twitches, and
paranoia.
Overdose of cocaine resembles that of amphetamine overdose, including a dangerous increase in body
temperature leading to convulsions and sometimes death. Stroke, heart attack, respiratory failure, kidney
failure, and tremors are also symptoms of cocaine overdose.
Symptoms of intoxication include:
Intense euphoria
Erratic and violent behavior
Muscle twitches
Paranoia
Tremors
Increased alertness
Increased energy
Heavy sweating
Increased Irritability
Complications of Abuse/Addiction
As a result of the tolerance that develops to its euphoric effect, cocaine is often abused in a “binge and
crash” pattern.. While tolerance to the euphoric effect occurs, repeated abusers actually become more sensitive
to cocaine’s anesthetic and convulsant effects. For this reason, abusers who frequently increase their doses to
intensify and prolong their high, put themselves at tremendous risk for long-term detrimental effects and sudden
death. The frequent use of high-dose cocaine ultimately leads to a state of heightened irritability, restlessness
and paranoia, which may result in a full-blown paranoid psychosis. Other long-term psychological effects of
cocaine use include addiction, mood disturbances, auditory hallucinations, and personality changes.
Long-term physiological effects of cocaine abuse include heart attacks, ventricular fibrillation, chest
pain, respiratory failure, strokes, seizures, abdominal pain, weight loss, loss of the sense of smell, and
nosebleeds.
Taken in combination, cocaine and alcohol are converted by the body to cocaethylene, a more toxic
substance which has a longer duration of action. Cocaine and alcohol is the most common two-drug
combination that results in drug-related death.
Additional complications of using cocaine intravenously include severe allergic reactions, and
acquisition of HIV and/or hepatitis B and C through the sharing of contaminated drug paraphernalia and risky
sexual behavior during drug use.
Withdrawal
Onset: The peak severity of cocaine-related withdrawal symptoms occurs
between 1 to 3 days after the last administered dose. Mild withdrawal
symptoms may continue for approximately 2 weeks.
Symptoms:
Severe depression
Drug craving
Excessive eating
Paranoid delusions
Slowed motor response
Hypersomnia
Social withdrawal/Emotional blunting
Suicidal thoughts and behavior
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Severity: Cocaine-withdrawal syndrome is similar to severe depression. The
withdrawal symptoms are not life-threatening, but may require
hospitalization due to precipitating psychiatric disturbances.
Dissociative Drugs
Includes:
Phencyclidine (PCP)
Ketamine
Dextromethorphan
History:
Dissociative drugs are those that produce a distortion of senses and a feeling of detachment from the
environment and self. They may cause euphoria, amnesia, or an “out-of-body” type experience. Dissociative
drugs include phencyclidine (PCP), ketamine, and dextromethorphan.
PCP and ketamine were originally developed for use as anesthetics during surgical procedures. PCP
was never approved for use in humans because early clinical studies showed a high incidence of delirium and
extreme agitation upon awakening. Ketamine is approved for human use, but because it also has a high
incidence of adverse effects, it is more commonly used in veterinary medicine. Most of the ketamine sold on
the street has been diverted from veterinarian and animal hospitals.
Dextromethorphan is a cough suppressant present in many over-the-counter cold and cough
preparations. The most common source of abused dextromethorphan is extra-strength cough syrups. To obtain
the dissociative effects with this drug, a person must ingest 10 to 30 times the recommended dosage.
Physiological Effects
Dissociative drugs have sedative and anesthetic effects. The user may experience distortion of the
senses and feelings of detachment from environment and self. The physical effects of dissociative drugs
include dangerous increases in blood pressure, heart and breathing rate, and body temperature. Nausea, blurred
vision, dizziness, and a decreased awareness of pain are also common effects of these drugs.
PCP and ketamine have various routes of administration, while dextromethorphan is usually only
ingested orally. PCP may be injected intravenously, snorted, inhaled, or orally ingested. The most common
routes of abuse are ingestion in tablet form or inhalation of PCP laced tobacco or marijuana cigarettes.
Ketamine may be injected intravenously, but the most common routes of abuse are snorting of ketamine powder
or oral ingestion of compressed tablets.
The dose and route of administration determine the onset, duration, and intensity of the physiologic
effect. Snorting and inhalation results in an onset of effect within seconds, while the effects onset after oral
ingestion takes approximately five to fifteen minutes. PCP is much more potent than ketamine, with effects
lasting for several hours. The oral ingestion of large doses of dextromethorphan result in dissociative effects
that typically last approximately six hours.
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The immediate physiological effects of dissociative drugs include:
Increased blood pressure
Rapid/Shallow breathing
Increased heart rate
Random muscle contractions
Increased body temperature Decreased sense of pain
Blurred vision
Dizziness
Signs and Symptoms of Intoxication
Dissociative drugs act by disrupting the activity of the chemical glutamate, which plays a large role in
learning, memory, emotion, and pain perception. PCP also affects the action of the chemical dopamine, which
is responsible for the euphoric feeling associated with this class of drugs.
The effects of dissociative drugs are unpredictable, varying from person to person and even from one
drug-taking episode to another. An intoxicated person may experience euphoria, distortions of space, time, and
self-image, hallucinations, feelings of invulnerability or exaggerated strength, panic, and fear.
An overdose of a dissociative drug can lead to convulsions, hyperthermia, coma, kidney failure, and
possibly death.
Symptoms of intoxication include:
Uncoordinated movements Euphoria
Sensory detachment
Hallucinations
Panic
Aggression
Feeling of Vulnerability
Feeling of increased strength
Hyperthermia
Dizziness
Disorientation
Suicidal thoughts
Complications of Abuse/Addiction
Long-term use of dissociative drugs can lead to addiction, in which a user’s priorities are shifted so that
obtaining the drug becomes a main goal of everyday life. Withdrawal symptoms precipitate if the drug use is
abruptly discontinued.
Long-term abuse of dissociative drugs is associated with memory loss, numbness, and depression which
can persist for up to a year after drug use stops.
Withdrawal
Onset: The peak severity of dissociative drug-related withdrawal can occur
from days to weeks following the last administered dose. Withdrawal
symptoms can persist for months.
Symptoms:
Hyperactivity
Hyperreflexia
Agitation
Depression
Delusions
Memory loss
Increased pain threshold
Violent behavior
Increased blood pressure
Increased heart rate
Visual hallucinations
Auditory hallucinations
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Severity: While dissociative drug-related withdrawal is not considered lifethreatening, medical attention may be necessary because of
precipitating psychiatric disturbances.
Ecstasy/MDMA
History
MDMA (3,4–methylenedioxymethamphetamine) is a psychoactive drug containing both stimulant and
hallucinogenic properties. MDMA contains chemical variations of the stimulant methamphetamine and a
hallucinogen, mescaline. Although MDMA is the main ingredient in ecstasy tablets, recent studies have
indicated a number of other dangerous substances including methamphetamine, cocaine, and caffeine are also
present. Ecstasy is known as a club drug because it first became popular in the all-night party scene and
continues to be widely used by people under the age of 25 years.
During the 1970’s, MDMA was used by a small sector of American psychiatrists as an unapproved
psychotherapeutic tool. The DEA has placed MDMA on its list of Schedule I drugs, meaning that it has no
proven therapeutic value. Recently, a small clinical trial was initiated to investigate the utility of MDMA in the
treatment of post-traumatic stress disorder.
The majority of ecstasy is produced in clandestine laboratories all throughout Western Europe and then
smuggled into the United States. Ecstasy tablets are manufactured in a variety of colors and are generally
inscribed with a shape, letter, or symbol. While oral ingestion of ecstasy tablets is the most common route of
abuse, ecstasy powder may also be snorted or occasionally smoked.
Physiological Effects
MDMA generally gives the user positive effects within an hour of ingestion. It is rapidly absorbed into
the bloodstream, and once in the blood stream interferes with the body’s ability to further metabolize the drug.
Thus, additional doses of MDMA can produce unexpectedly high drug concentrations, leading to increased side
effects and potentially a fatal overdose.
MDMA affects the brain by increasing the activity of at least three chemicals; serotonin, dopamine, and
norepinephrine. Serotonin plays a role in the regulation of mood, sleep, pain, emotion, and appetite. Dopamine
has an important role in pleasure regulation in the brain. The release of norepinephrine is associated with
adrenaline secretion leading to increase heart rate.
Some short-term positive effects of MDMA are feelings of emotional warmth and general well-being.
Users also report enhanced sensory perception and increased energy.
The immediate physiological effects of MDMA include:
Mental stimulation
Decreased anxiety
Nausea
Chills
Sweating
Muscle cramping
Blurred vision
Increased body temperature
Increased energy
Increased heart rate
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Signs and Symptoms of Intoxication
MDMA is often associated with vigorous physical activity which can lead to a dangerous rise in body
temperature and hypertension. Emotionally, MDMA use is associated with a sense of well-being, empathy for
others, and decreased anxiety.
The symptoms of MDMA overdose can include high blood pressure, panic attacks, hyperthermia, loss of
consciousness and seizures.
Symptoms of intoxication include:
Sense of well-being
Decreased anxiety
Hypersexuality
Empathy towards others
Heavy sweating
Altered time perception
Intense thirst
Enhanced sensory perception
Complications of Abuse/Addiction
Within hours of taking the drug, MDMA significantly reduces mental ability. These changes,
particularly those affecting memory, can last for up to a week and sometimes longer. MDMA impairs
information processing, which is why performing skilled activities such as driving an automobile under the
influence of this drug is very dangerous.
Within days of taking MDMA, a person experiences negative behavioral effects because the brain has
been significantly depleted of the chemical serotonin. These negative behavioral effects include depression,
anxiety, and agitation.
Regular users of MDMA report feeling a variety of emotions, sleep disturbances, memory loss,
impulsiveness, aggression, lack of interest in sex, and decreased appetite.
Long-term psychological effects of heavy MDMA use can result in increased incidences of confusion,
depression, selective impairment of working memory and attention processes, changes in cognition and motor
function, and possibly addiction.
Long-term physiological effects of MDMA use include weight loss, and heart, kidney, and liver toxicity.
Recent studies have concluded that MDMA may be addictive for some people. Roughly 50% of
MDMA users surveyed reportedly met the criteria for dependence, as evidenced by withdrawal effects,
tolerance, and continued use despite knowledge of physical or psychological harm.
Withdrawal
Withdrawal from MDMA is controversial. It is nearly impossible to discern between symptoms related
to withdrawal and those attributed to neurologic damage caused by prolonged MDMA use. Chronic, heavy
users of MDMA who abruptly discontinue use, are likely to have depressive symptoms similar to amphetamine
and cocaine withdrawal.
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Hallucinogens
Includes:
D-Lysergic Acid (LSD)
Mescaline
Psilocybin
History
Hallucinogens are drugs that cause profound distortions in a person’s perception of reality. People
under the influence of hallucinogens experience altered sensations, sounds, and visions. Three chemical
compounds known for their hallucinogenic properties are LSD, mescaline, and psilocybin.
Mescaline, found in the peyote cactus, and psilocybin, found in the psilocybe mushroom, were each
used by ancient cultures of Central America during spiritual rituals for their psychedelic effects to induce
“visions” and experiences of deep insight. Psilocybin-containing mushrooms are orally ingested. Mescalinecontaining peyote cacti can be either smoked or orally ingested. LSD is a semi-synthetic compound initially
synthesized in 1938 for medicinal purposes. LSD was never approved for medical use in the United States, but
during the 1960’s, recreational use of the drug was widespread. Pure crystal LSD is usually dissolved, diluted,
and then applied to blotter paper and sold in 1/4-inch squares. LSD use today is very uncommon, usually
limited to the rave party scene.
Physiological Effects
The physiologic effects of a hallucinogen depend on their unique properties. LSD, psilocybin, and
mescaline can produce altered sensations, increased blood pressure and heart rate, dizziness, sweating, dry
mouth, nausea, and muscle weakness and tremors. The user’s emotions may rapidly change between euphoria
and fear, so rapidly in fact that the user may seem to experience several emotions simultaneously. Sensory
perception may blend in a phenomenon known as synesthesia, in which a person perceives to hear or feel colors
and see or smell sounds. LSD, psilocybin, and mescaline all work by acting on specific serotonin receptors in
areas of the brain that control mood, cognition, and sensory perception. The disruption of the serotonin
receptors is thought to be the cause of hallucinations, which are known to cause distortion and transformation of
shapes and movements. Each hallucinogenic experience is unique. The type of experience is unpredictable,
and may range from enjoyable or enlightening, to terrifying in nature.
The physiologic effects of LSD begin within 30 to 90 minutes of administration and persist between six
and twelve hours. Following oral ingestion of psilocybin-containing mushrooms and mescaline-containing
peyote, physiologic effects are seen within a half hour, and persist between six and twelve hours, respectively.
Mescaline, when inhaled, results in an onset of effects within 15 minutes and persists for approximately six
hours.
The immediate physiological effects of hallucinogens include:
Dizziness
Loss of appetite
Dry mouth
Increased blood pressure
Sweating
Increased heart rate
Nausea
Tremors
Altered emotions
Altered senses
Pupil dilation
Increased body temperature
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Signs and Symptoms of Intoxication
There is little evidence of life-threatening overdoses with the use of these hallucinogens. However, a
person’s actions while they are under the influence of these drugs can easily cause harm to themselves or to
others.
Symptoms of intoxication include:
Emotional instability
Increased heart rate
Increased blood pressure
Violent outbursts
Euphoria
Hallucinations
Sweating
Altered sensory perception
Nausea
Dizziness
Anxiety
Tremors
Pupil dilation
Increased body temperature
Complications of Abuse/Addiction
Hallucinogen use is generally not considered to be habit forming. However, rapid tolerance does
develop with repeated use of LSD, necessitating dose increases to attain desired effects. LSD use also produces
tolerance to mescaline and psilocybin as they each work through similar mechanisms. The tolerance is of short
duration, and dissipates following several days of abstinence.
There are two serious long-term psychological effects of hallucinogen use that may occur after just a
single use. First, a person may develop drug-related psychosis characterized by frequent mood swings and
visual disturbances which can potentially persist for years. Second, a user may develop hallucinogen persisting
perception disorder (HPPD), better known as “flashbacks”, in which the user experiences spontaneous recurrent
episodes of sensory distortion similar to that which was originally caused by the hallucinogen. The visual
disturbances usually consist of halos or tails attached to moving objects.
Driving or the use of machinery under the influence of a hallucinogen is an obvious danger to the user
and to others.
Withdrawal
There is no withdrawal syndrome associated with hallucinogens.
Heroin
History
Heroin is a semi-synthetic opioid derived from morphine, a naturally occurring substance extracted
from poppy plants. In the late 1890’s, the Bayer Company of Germany trademarked heroin and sold it as a nonaddictive morphine substitute and children’s cough syrup for approximately 15 years. In 1914, a law was
passed that made it illegal to manufacture or possess heroin in the United States.
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Heroin is produced for the black market through opium refinement processes. While many drugs
require a vast knowledge of chemistry and access to unusual ingredients, the refinement of heroin from opium is
a relatively simple process. The U.S. heroin market is supplied entirely from foreign sources of opium. There
are four distinct geographical areas responsible for the production of heroin; South America, Mexico, Southeast
and Southwest Asia. According to the DEA, South American produced white heroin, considered to have by far
the highest average purity, dominates the heroin market in the eastern half of the United States. Mexican
produced black tar and brown heroin, considered to be of lower average purity, dominates the heroin market in
the western half of the country.
Physiological Effects
Heroin, a powerfully addictive drug abused for its intense euphoric effect, may be injected, snorted, or
inhaled. The route of administration determines the onset of the euphoric effect. An intravenous injection will
deliver euphoria extremely quickly in 7 to 8 seconds, while the onset when it is either snorted or inhaled is 10 to
15 minutes.
Heroin binds to and activates receptors in the brain, spinal cord, and gastrointestinal tract. When heroin
enters the body, it quickly enters the brain, where it is converted to morphine, causing increased feelings of
pleasure and blockage of pain messages from the spinal cord. The powerfully addictive nature of heroin is a
consequence of the rapidity in which heroin enters the brain.
The immediate physiological effects of heroin use include:
Pain relief
Decreased cardiac function
Intense euphoria
Alternating wakeful and drowsy states
Decreased respiration
Spontaneous abortion
Signs and Symptoms of Intoxication
Heroin abusers typically report feeling a surge of pleasurable sensation. The intensity of the “rush” is
determined by the dose and route of heroin administration. After the initial euphoric effect, users generally
enter a stage of severe drowsiness and impaired cognition. Cardiac and respiratory functions may be affected,
potentially resulting in death of the user.
Heroin overdose can result in total respiratory failure, convulsions, coma, and possibly death.
Symptoms of intoxication include:
Intense euphoric state
Alternating wakeful and drowsy states
Impaired mental function
Heavy-feeling extremities
Staggering gait
Dry mouth
Warm flushing of the skin
Nausea
Vomiting
Severe Itching
Pupil Constriction
Complications of Abuse/Addiction
The most ominous long-term effect of heroin use is addiction. Heroin produces profound degrees of
tolerance and physical dependence. Once addicted, the behavioral habits of a person become extremely altered,
and their primary purpose in life becomes seeking and using heroin, to the detriment of their personal health,
family, and occupation. With physical dependence, the body adapts to the presence of the drug, with the
precipitation of withdrawal symptoms seen if the drug is abruptly removed.
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The long-term physiological effects of heroin use include collapsed veins, bacterial infections of blood
vessels and cardiac tissue, liver and kidney disease, lung complications including pneumonia and tuberculosis,
arthritis, and constipation.
Although purity levels are rapidly increasing, most street heroin is “cut” with other substances such as
sugar, starch, quinine, and even poisons like strychnine. Often times, heroin abusers do not know the purity of
heroin they are using, increasing their risk for overdose as well as complications from unknown additives.
Heroin abusers often share and reuse syringes and injection paraphernalia, and are therefore at increased
risk of contracting HIV and Hepatitis B and C. Injection drugs users represent 70-80% of all new Hepatitis C
infections worldwide.
Heroin abuse during pregnancy can lead to many adverse consequences to a fetus, including low birth
weight and spontaneous abortion.
Withdrawal
Onset: For chronic abusers, withdrawal symptoms may occur within a couple
hours after the last administered dose. Major withdrawal symptoms peak
between 48 and 72 hours after the last dose and subside after 7 to 10 days.
Symptoms:
Drug craving
Nausea
Restlessness
Diarrhea
Cold flashes
Pupil dilation
Vomiting
Bone and muscle pain
Malaise
Insomnia
Severity: Heroin withdrawal resembles a severe case of influenza and is not
considered life-threatening. Heroin withdrawal symptoms are regarded
as the most severe of all opioid-related substances.
Methamphetamine/Amphetamine
History
Methamphetamine is a powerfully addictive stimulant that dramatically affects the central nervous
system. Amphetamines were widely used for energy by American forces during WWII and the Vietnam War.
Amphetamines have been used since the 1950’s by athletes, college students, and truck drivers to optimize
performance and counteract fatigue. The use of amphetamines was substantially decreased after the
implementation of the 1970 Controlled Substances Act which severely restricted its legal production.
Methamphetamine trafficking and abuse in the United States have been on the rise over the past few
years, and is having a devastating impact in many communities across the nation. Although more common in
the western U.S., the impact of methamphetamine is reaching areas of the country not previously affected.
Clandestine labs account for the vast majority of methamphetamine abused in the U.S. Law enforcement
agencies have focused their efforts on decreasing the production of methamphetamine by limiting the
availability of supplies needed for the manufacturing of the drug, such as ephedrine and pseudoephedrine.
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Physiological Effects
Methamphetamine is smoked, snorted, orally ingested, or injected creating different effects depending
on the route of administration. Smoking or injecting methamphetamine results in an immediate intense
pleasurable rush that lasts only a few minutes. Snorting and orally ingesting methamphetamine creates a less
immediate and intense high, but its effects can last for over 12 hours when taken through these routes. The
desired effects of this drug are created by a release of excess the chemical dopamine, which plays an important
role in pleasure regulation in the brain. Pleasurable effects disappear before the drug concentration in the blood
decrease significantly, and users attempt to maintain the high by binging on the drug.
The immediate physiological effects of methamphetamine abuse include:
Increased attention
Decreased fatigue
Increased blood pressure
Decreased appetite
Increased heart rate
Dry mouth
Increased breathing rate
Dilated pupils
Increased body temperature
Increased energy
Signs and Symptoms of Intoxication
The psychological impact of methamphetamine creates variable intoxication symptoms. After the
intense sense of well-being, some users become extremely agitated and violent. Combined with the intense
sense of energy users feel, a very dangerous situation can quickly arise.
Overdose of methamphetamine causes hyperthermia and convulsions, which if left untreated, can result
in death.
Symptoms of intoxication include:
Heavy sweating
Intense irritability
Chills
Euphoria
Hyper-sexuality
Increased self-esteem and confidence
Heavy breathing
Paranoia
Complications of Abuse/Addiction
Methamphetamine, like many other stimulants, is used in a “binge and crash” pattern. Tolerance
develops within minutes of administration, leading to a decrease in pleasurable effects before a significant
decrease in drug concentration in the blood. As a result, abusers may attempt to maintain the high by binging
on the drug, which leads to an increased risk of overdose. Overdose elevates body temperatures to dangerous
levels which can cause convulsions and death.
Long-term methamphetamine abuse results in many physiological effects, including addiction psychosis,
irreversible heart damage, stroke, and weight loss. Chronic abusers exhibit symptoms that include violent
behavior, anxiety, confusion, and insomnia. Heavy users also show progressive social and occupational
deterioration.
Chronic methamphetamine use has been associated with psychosis, most resembling paranoid
schizophrenia. Visual and auditory hallucinations, intense paranoia, mood disturbances, repetitive motor
activity, and out-of-control rages that can be coupled with extremely violent behavior are all symptoms of
methamphetamine addiction psychosis.
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Additional complications of using methamphetamine intravenously include the acquisition of HIV
and/or hepatitis B and C through the sharing of contaminated drug paraphernalia and risky sexual behavior
during drug use.
Withdrawal
Onset: For chronic abusers, withdrawal symptoms may occur within
hours of the last administered dose. Major withdrawal symptoms peak between 48 and 72
hours after the last dose and subside after 5 to 7 days.
Symptoms:
Severe depression
Emotional blunting
Excessive eating
Paranoid delusions
Drug craving
Slowed motor response
Hypersomnia
Social withdrawal
Suicidal thoughts and behavior
Severity: Methamphetamine-withdrawal syndrome is similar to severe
depression. The withdrawal symptoms are not life-threatening, but
may require hospitalization due to precipitating psychiatric
disturbances. The severity of methamphetamine withdrawal symptoms
are relatively equivalent to those of cocaine-withdrawal syndrome.
Prescription Opioids
( ) = brand names
[ ] = main indication
Includes:
Opiates (Opium alkaloids)
Codeine (Robitussin A-C, Tylenol #3 & #4) [suppress cough, pain]
Morphine (Avinza, Kadian, MS Contin, Roxinol) [pain]
Semi-synthetic Opioids
Hydrocodone (Lorcet, Lortab, Norco, Vicodin, Vicoprofen) [pain]
Hydromorphone (Dilaudid) [pain]
Oxycodone (Endocet, Oxycontin, Percocet, Roxicet) [pain]
Synthetic Opioids
Fentanyl (Actiq, Duragesic) [pain]
Meperidine (Demerol) [pain]
Pentazocine/Naloxone (Talwin Nx) [pain]
Propoxyphene (Darvocet, Darvon) [pain]
Tramadol (Ultram, Ultracet) [pain]
Buprenorphine (Subutex) [pain]
Buprenorphine/Naloxone (Suboxone)[narcotic addiction treatment]
LAAM [narcotic addiction treatment]
Methadone (Methadose) [narcotic addiction treatment, pain]
Diphenoxylate (Lomotil) [diarrhea]
Loperamide (Imodium) [diarrhea]
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History
Opium is an analgesic derived from the seeds of the unripe poppy plant. The human use of opium spans
thousands of years, including ingestion by the ancient Babylonians and smoking by the ancient Chinese, where
it was used for its euphoric effects and analgesic properties. Opium was so important to society that in the 19th
century it was the cause of two wars between Britain and China, known as the Opium Wars. In the United
States, opium was widely used in tinctures and syrups which claimed to treat a variety of symptoms. Until
1914, there were no restrictions on the importation or use of opium in the United States.
The term opiate refers only to the natural opium alkaloids (codeine, morphine) and the semi-synthetics
derived from them (hydrocodone, hydromorphone, and oxycodone). The full-synthetic drugs and the opiates
make up the class of opioids. An opioid is any agent that acts on the brain and body by binding to opioid
receptors located in the brain, spinal cord, and gastrointestinal tract. Opioids are used clinically for pain relief,
cough suppression, and diarrhea. Unfortunately, opioids are also one of the most commonly abused
prescription drug classes.Opioids are also commonly used to treat narcotic addiction. Methadone is the most
common treatment for heroin addiction. Buprenorphine combined with Naloxone (Suboxone) is commonly
used to treat opioid addiction. Sadly, even these drugs are abused.
Physiological Effects
Opioids are administered by a variety of ways including orally, rectally, inhalation, sublingually,
bucally, intravenously, intranasally and transdermally. There are many variables to consider when discussing
the effects of opioids. The type of drug, dose of drug, and route of administration determine the onset, intensity,
and duration of effects.
Fortunately, because all opioids work on opioid receptors, the overall outcome of administration is
predictable. There are four classes of opioid receptors. The pharmacodynamic response to an opioid is
dependent on the receptor it binds to and the affinity for the receptor. The desired effects of opiates are pain
relief, cough suppression, relief of anxiety, and sedation. The undesirable effects of opiates are respiratory
suppression, confusion, constipation, vomiting, nausea, urinary retention, and pupil constriction.
The immediate physiological effects of opiates include:
Pain relief
Drowsiness
Pupil Constriction
Flushing
Vomiting
Nausea
Euphoric feeling
Decreased body temperature
Confusion
Decreased respiration
Signs and Symptoms of Intoxication
Opioid drugs block the perception of pain to varying degrees. Some opioids can also produce a euphoric
effect by affecting the pleasure centers of the brain. The euphoric feeling is never the intended effect of opioid
drugs, but is often an effect utilized by abusers. This feeling of euphoria can be augmented when these drugs
are administered by routes other than those recommended, a practice that can also lead to increased side effects
and overdose.
Symptoms of opioid overdose include respiratory failure, convulsions, coma, and hypothermia. In
severe cases, the respiratory depression can lead to death.
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Symptoms of intoxication include:
Decreased respiration
Hypothermia
Drowsiness
Vomiting
Confusion
Pupil constriction
Euphoria
Warm flushing of the skin
Dry mouth
Itching
Complications of Abuse/Addiction
When taken as directed and used over a short period of time, opioids rarely cause long-term problems.
However, when opioids are legitimately used for long periods of time or illegally abused, complications are
common. The most severe complication of long-term opioid use is physical dependence and addiction. The
physical dependence leads to withdrawal symptoms if the drug is abruptly discontinued. Consequently, patients
in a clinical setting are tapered off of opiates or given medications to decrease their withdrawal symptoms.
Addiction leads to a compulsive psychological urge to use the offending drug. Overtime, a person’s
behavior changes, more time and energy is placed of obtaining the drug, and the addiction will ultimately
dominate the person’s life, to the detriment of their health, family, and occupation.
Tolerance is another complication of long-term opioid use. The body develops tolerance to prescription
opioids as it does to many illicit drugs. With long-term use, the dose must be increased to obtain the same pain
relief, euphoria, and sedation. Increasing doses of opioids can lead to severe constipation and progress to bowel
obstruction.
The long-term physiological effects of opioid use include confusion, constipation, and immune system
impairment.
Combining opioids with alcohol and/or other drugs can also have serious implications. Large doses of
opioids taken with alcohol or other depressants can lead to rapid respiratory failure, coma, and death.
Withdrawal
Onset: For chronic abusers, withdrawal symptoms may occur within a day
of the last administered dose. . Major withdrawal symptoms peak
between 48 and 96 hours after the last dose and may endure for more than
14 days.
Symptoms:
Drug craving
Nausea
Restlessness
Diarrhea
Cold flashes
Pupil dilation
Vomiting
Bone and muscle pain
Malaise
Insomnia
Severity: Opioid withdrawal resembles a severe case of influenza and is not
considered life-threatening. Withdrawal symptoms related to
prescription opioids are regarded as less severe than those related to
heroin withdrawal, however the duration is longer.
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Prescription Depressants
( ) = brand name
Includes:
Barbiturates
-Short/Intermediate-acting
Amobarbital (Amyta)
Butalbital (Fiorinal)
Pentobarbital (Nembutal)
Secobarbital (Seconal)
-Long-acting
Mephobarbital (Mebaral)
Phenobarbital (Luminal)
Benzodiazepines
-Short-acting
Alprazolam (Xanax)
Lorazepam (Ativan)
Oxazepam (Serax)
Temazepam (Restoril)
Triazolam (Halcion)
-Long-acting
Chlordiazepoxide (Librium)
Clonazepam (Klonopin)
Clorazepate (Tranxene)
Diazepam (Valium)
Flurazapam (Dalmane)
Non-Benzodiazepine Sleep Aids
Eszopiclone (Lunesta)
Zaleplon (Sonata)
Zolpidem (Ambien)
History
Depressants are used to suppress the activity of the central nervous system (CNS). Depressants can be
used as anti-anxiety agents, anesthetics, sedatives, anticonvulsants, anti-migrane agents, muscle relaxants, and
in alcohol detoxification. Most depressants cause CNS depression by either increasing the activity or
production of gamma-aminobutyric acid (GABA). GABA is the most important inhibitory neurotransmitter in
the CNS, and is also the site of action of alcohol’s CNS depressant effects.
Barbiturates were the most common depressants used during the early and mid 1900’s. During the
1950’s, it was noted that barbiturates were related to high incidences of side effects and abuse. During the
1960’s, benzodiazepines appeared on the market and rapidly replaced barbiturates as the class of choice for
sedative-hypnotics given their similar effectiveness and reduced frequency of serious side effects.
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Within the past 20 years, new drugs indicated for sleep aid which have come to market include zolpidem
(Ambien), zaleplon (Sonata), and eszopiclone (Lunesta). Unfortunately, these new sleep aids share some of the
same problems as that of older sedatives; they can be habit-forming and long-term use can lead to withdrawal
symptoms after abrupt discontinuation.
Physiological Effects
Depressants are most commonly orally ingested in tablet, capsule, or liquid form, but intravenous
injection is also utilizedTheir potency, time to onset of effect, and duration of action are variable depending on
the type of drug, dose, and route of administration.
Since all depressants suppress the central nervous system, the overall effects are fairly predictable.
When a depressant is administered for the first time it will likely cause moderate drowsiness, slowed muscle
response, and decreased anxiety. Some undesirable effects of depressants are confusion, slowed respiration,
decreased blood pressure, and poor coordination. .
The immediate physiological effects of depressants include:
Slowed respiration
Decreased blood pressure
Decreased heart rate
Feeling of well-being
Drowsiness
Slowed muscle response
Pupil constriction
Dizziness
Signs and Symptoms of Intoxication
The symptoms of depressant intoxication mimic that of alcohol intoxication, and include impaired
decision making, balance, and motor coordination. Speech may become slurred and incoherent. Short-term
memory loss is very common in depressant intoxication. Mixing prescription depressants and alcohol is
extremely dangerous and leads to enhanced side effects, including severe drowsiness and increased respiratory
depression. Specific to benzodiazepine and barbiturate intoxication, a phenomenon called paradoxical
disinhibition may occur, in which a user becomes overly excited, irritated, aggressive, or impulsive rather than
the usual dulled emotional state caused by depressant use.,.
While overdose of benzodiazepines or the new sleep aids is rarely life-threatening, barbiturate overdose
is ominous. Barbiturate overdose leads to severe respiratory depression, coma, and often death.
Symptoms of intoxication include:
Severe drowsiness
Severe respiratory
Confusion
Aggression
Emotional blunting
Hypotension
Memory impairment
Poor coordination
Slurred speech
Decreased heart rate
Fever
Increased irritability
Complications of Abuse/Addiction
Depressants can be effectively used short-term to relieve a variety of symptoms. However, long-term
use of depressants causes a multitude of complications, the most serious of which is addiction and physical
dependence. When physical dependence develops, the abrupt discontinuation of a drug precipitates withdrawal
symptoms. While withdrawal from benzodiazepines and new sleep aids can be symptomatically problematic,
withdrawal from barbiturates can be fatal.
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Tolerance is the second most important consequence of long-term depressant use. All depressants result
in tolerance, some more rapidly than others. As tolerance develops to barbiturates, the margin of safety
between the effective dose and the lethal dose becomes very narrow. Benzodiazepines rarely retain efficacy
after continual use over four to six months, and therapy is often continued solely to suppress withdrawal
symptoms.
Depressants are rarely the sole drug of abuse. Benzodiazepines are used to enhance the euphoric effects
of opioids like methadone, to alleviate withdrawal symptoms of alcohol dependence, or to counteract abstinence
syndromes between heroin “fixes”. Thus, benzodiazepine abuse is very common in those who abuse alcohol
and opioids. The mixing of depressants and alcohol is very dangerous. The cocktail of barbiturates and alcohol
is particularly dangerous, and may lead to rapid respiratory collapse, coma, and often times death.
Withdrawal
Onset: Long-term benzodiazepine or barbiturate use is associated with acute
withdrawal symptoms that precipitate within 24 hours following the last
administered dose. For short-acting depressants, major withdrawal
symptoms peak between 2 and 4 days following the last administered
dose and last for about 7 days. For long-acting depressants, major
withdrawal symptoms peak between 4 and 7 days following the last dose
and last for about 2 weeks.
Symptoms:
Depression
Paranoid delusions
Tremors
Pupil dilation
Agitation
Anxiety
Disorientation
Headache
Nausea
Sleep disturbances
Convulsions
Elevated blood pressure
Elevated body temperature
Elevated pulse
Increased respiration
Auditory hallucinations
Visual hallucinations
Seizures
Delirium tremens
Muscular weakness
Increased light sensitivity
Increased audio sensitivity
Severity: Depressant-withdrawal syndrome resembles stimulant intoxication.
Barbiturate withdrawal is more severe than benzodiazepine
withdrawal, but both are potentially life-threatening. Seizures,
hallucinations, and delirium tremens are possible serious symptoms of
both barbiturate and benzodiazepine withdrawal.
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Family-related Consequences of Parental Substance Abuse
Parental substance abuse may lead to a variety of detrimental outcomes including poor parental and family functioning. It
may also have a wide range of effects on children including an increased incidence of attention deficit hyperactivity disorder (ADHD),
oppositional defiant disorder (ODD), and other conduct disorders. The following list details possible family-related consequences of
parental substance abuse and in no way is an all-inclusive list.
Parental Effect
Effect on the Family
Effect on the Child






















Alcohol Abuse
Decreased parental monitoring
Poor problem-solving ability
Increased incidence of aggression
Less emotional sensitivity
Lower positive engagement with the child
Antisocial behavior including child
avoidance
Poor intellectual stimulation of the child
Negative parent/child relationship
Poor family functioning
Increased levels of conflict
Poor communication
Increased incidence of domestic violence
Unpredictable home life
Poor organization, including cleaning,
timeliness, planning
Increased incidence of physical, sexual,
and verbal abuse
Increased risk of neglect
Increased risk to develop alcoholism
Increased incidence of disruptive
behavior problems
Increased incidence of low self-esteem,
depression, aggression, and anxiety
Increased risk of developing psychiatric
disorders
Increased incidence of impaired cognitive
and verbal skills
Poor school performance



Illicit Drug Abuse
Increased parental stress
Poor and inconsistent family management
Increased incidence of aggression
Increased incidence of child neglect
versus child abuse
Ineffective socialization and discipline
Negative parent/child relationship
Increased incidence of child abandonment






Poor family functioning
Increased levels of conflict
Poor communication
Increased incidence of domestic violence
Unpredictable home life
Poor organization

Increased incidence of physical, sexual,
and verbal abuse
Increased risk of neglect
Increased risk of early drug/alcohol abuse
Increased incidence of emotional
disorders including chemical dependence,
eating disorders, depression, anxiety,
aggression, suicidal behavior, phobias,
low self-esteem
Increased incidence of disruptive
behavior disorders
Increased incidence of physical problems
including asthma, hypertension,
headaches, and allergies
Increased incidence of learning
disabilities










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Website Resource Table
Organization Name
National Institute on
Drug Abuse
Website Address
http://www.nida.nih.gov/
http://www.clubdrugs.gov/
http://www.marijuana-info.org/
http://inhalants.drugabuse.gov/
Description
This website provides general information on all
illicit drugs, including a brief description of how
the drug is abused, street names, effects,
statistics, and treatment options. The website
provides links that cater to different groups
including parents and teachers, researchers and
health professionals, even young adults and
students. The website covers important topics
like drug use trends, medical consequences of
drug abuse, and also the linkage of stress and
drug abuse.
This website is a branch off of the NIDA website
and provides specific information on Ecstasy,
GHB, Rohypnol, Ketamine, Methamphetamine,
and LSD; the “Club Drugs”. The information
provided includes statistics and trends, effects,
updated research reports.
This website is a branch off of the NIDA website
and provides specific information on Marijuana.
The information provided includes statistics and
trends, effects, updated research reports, and
facts for parents.
This website is a branch off of the NIDA website
and provides specific information on inhalant
abuse. The information provided includes
statistics and trends, effects, updated research
reports, and press releases.
© 2005-2006 CDHS/Research Foundation of SUNY/BSC College Relations Group
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Office of National
Drug
Control Policy
http://www.whitehousedrugpolicy.
gov/index.html
National Institute on
Alcohol Abuse and
Alcoholism
http://www.niaaa.nih.gov/
National Association
for Children of
Alcoholics
http://www.nacoa.net/
U.S. Department of
Health and Social
Services
http://www.health.org/
U.S. Drug
Enforcement
Administration
http://www.usdoj.gov/dea/
This website provides a variety of information
on all types of illicit drugs; including
background, effects, prevalence estimates,
availability, treatment, legislation,
enforcement, and consequences of use. The
website also provides links to state and local
resources that give a regional perspective on
drug use and abuse. This website gives the
ability to focus on a specific city and view
local trends of abuse, city initiatives, federal
funding, drug trafficking and seizure statistics,
emergency department episodes and deaths
associated with each illicit drug. The website
also provides a link to an overview of Drug
Endangered Children (DEC) programs.
This website provides a variety of information
on alcohol abuse and alcoholism; including
frequently asked questions, news releases, and
links to research databases.
The website provides research information,
information for healthcare professionals, and
press releases pertaining to children of
alcoholics. The website also provides many
links, including those to government agencies
and family support websites.
The website provides a vast amount of
information catering to variety of groups.
There is information for families, youth,
schools, work place, community, researchers,
and healthcare professionals. This website
also has multimedia resources including a
library of informative web casts.
The website provides information on all types
of illicit drugs and even prescription drugs;
including background, effects, street names,
and availability. The website also has a vast
amount of legal information on consequences
of drug abuse.
© 2005-2006 CDHS/Research Foundation of SUNY/BSC College Relations Group
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