Health Risks of Alcohol and Drug Use

According to a 2014 National Survey on Drug Use and Health report, 21.5 million American adults (aged 12 and older) battled a substance use disorder. Millions more are affected by the actions of the substance abuser; these include their families, the victims of substance abuse-related crimes, and those injured or killed by intoxicated drivers or in drug-related accidents. The cost to our society in lost productivity, increased health care costs and increased crime is estimated to be $700 billion a year.

Alcohol

Alcohol is a powerful chemical. When it is taken in small amounts it usually produces a pleasant sense of relaxation. In larger amounts, alcohol produces a variety of psychological and physiological changes which can place the person or those around him or her in danger. Alcohol abuse can be characterized by one of three different patterns: (1) regular drinking that affects one’s ability to function at his or her best, (2) drinking large amounts of alcohol at regular times (e.g., getting drunk most Fridays and Saturdays), or (3) periods of heavy daily drinking separated by extended periods of sobriety (i.e., binges). Alcohol dependence, often called alcoholism, usually appears between the ages of 20 and 40, although onset prior to age 20 or after age 40 does occur. It is much more prevalent in people with a family history of alcoholism. The course of the disorder is usually progressive, with adverse effects on one’s work and social life and with the development of physical dependence. The short-term effects of alcohol abuse can include problems with comprehension and memory, slowed motor responses, depression, sexual impotence, severe stomach and pancreas inflammation, coma and respiratory arrest. There may also be behavioral changes and an increase in violent behavior towards strangers as well as family and friends. Chronic alcohol abuse can produce physical complications, including brain damage, liver damage, impotence and infertility, and gastrointestinal bleeding. Memory problems and depression can also occur. In addition, abrupt cessation of drinking can cause serious, sometimes even life threatening problems including high blood pressure, seizures, and hallucinations. Death can occur as a result of coma and respiratory failure, from serious chronic medical complications, or as a result of severe reaction to withdrawal of alcohol. The person may also die from the consequences of impaired judgment and coordination such as in a car accident or suicidal act.

 Marijuana (Cannabis)

Marijuana will increase the risk of accidents and injury. These impairments continue for at least four to six hours after marijuana use because the active chemical in marijuana (THC tetrahydrocannabinol) remains stored in body fat cells long after ingestion. When there has been frequent use of marijuana and then the use of the drug has stopped completely, the above impairments may still last for three to six months. Marijuana use can also be associated with anxiety, depression, and paranoid feelings. It can precipitate or increase underlying emotional problems. Frequent use by children and adolescents may produce motivation difficulties, apathy, and difficulty managing current stresses and responsibilities, and future planning.

Hallucinogens

This category of drugs includes LSD, lysergic acid diethylamide, (also known as “acid”), mescaline, peyote, PCP, and “mushrooms.” The short-term use of these drugs produces illusions, hallucinations, altered sense of time and space, impaired visual perceptions, and disorientation. These effects lead to impaired judgment and may result in dangerous behavior. Hallucinogen use also may lead to a “bad trip” with anxiety, agitation, hallucinations, and paranoia, which may result in self-endangering behavior. After a “bad trip,” the person can experience “flashbacks” which are recurrences of hallucinogenic experiences without actually having taken a hallucinogen. Flashbacks usually occur within weeks or months of the person’s last use of the drug; however, they can occur after longer periods. Long-term use of hallucinogens may lead to impaired thinking and may precipitate psychosis. PCP (also known as “angel dust”) may induce violent or destructive behavior leading to injury to the person who has taken the drug or to other people. PCP use also raises the person’s blood pressure, which may result in a medical emergency.

Cocaine

Cocaine is a highly addictive illegal stimulant drug. Other names for it are coke, C., lady, and snow. Cocaine is a white powder that is snorted, injected into veins, or smoked as freebase or crack. Crack is a crystalline form of cocaine that also is known as “rock” due to its small, white, rock-like appearance. Crack produces the most intense cocaine high and addiction can occur after using it only a few times. Cocaine highs are characterized by feelings of extreme happiness and a sense of limitless power and energy. A cocaine “crash” follows the “high” and often produces symptoms of depression (including thoughts of suicide), dullness, irritability, and paranoia. Serious medical complications may occur with cocaine use. These include heart attacks (even in young people), seizures, and strokes due to high blood pressure. The psychological effects of cocaine use include paranoia, depression, anxiety, confusion, and personality changes and may lead to acts of violence.

Amphetamines, Methamphetamine and Ritalin

Amphetamines are substances (both prescribed medications and illegal drugs) that stimulate the nervous system and are very addictive. Drugs in this group include benzadrine, dexedrine, Adderall, Ritalin, and methamphetamine (“speed,” “meth,” “chalk”). Amphetamines give a person increased energy, increased alertness, and a feeling of exhilaration. When amphetamines are abused, adverse effects such as restlessness, nervousness, tremors, loss of appetite, and insomnia are common. Psychotic symptoms such as paranoia, auditory hallucinations, mood disturbances, and delusions may be precipitated by amphetamine abuse. Tolerance to the euphoric effect of amphetamines may also occur, which may lead the person to take larger amounts of the drug, which in turn may lead to more paranoia and agitation. This state also may be associated with loss of self-control and violence. If the amphetamines are stopped suddenly, withdrawal symptoms (cramps, sweating, headaches, lethargy, and severe depression) may occur.

Methamphetamine, while chemically related to other amphetamines, appears to have particularly potent and toxic effects. Once more common in the western United States, it has become increasingly popular in other parts of the country. In its smoked form, methamphetamine is referred to as “ice,” “crystal,” and “glass.” The use of methamphetamine carries a high risk of psychosis developing and of the person engaging in violent behavior.

Ritalin (methylphenidate) and Adderall are central nervous system stimulants prescribed for Attention Deficit Disorder. Although generally safe when used as prescribed, in recent years they have increasingly become drugs of abuse, particularly among high school and college students. Their use carries the risk of amphetamines as described above.

Designer Drugs Including Ecstasy

According to the National Institute on Drug Abuse, “designer drugs” are substances created by slight alterations of the molecular structure of existing drugs. Ecstasy, or MDMA (methylenedioxymethamphetamine), is perhaps the most widely used of the designer drugs. It is derived from amphetamines, a group of drugs known for their stimulant effects. Ecstasy has both stimulant and hallucinogenic properties. Users report a sense of wellbeing and openness to environmental stimuli. Ecstasy is often used at all night parties called “raves.” When it is used in this setting, severe dehydration and dysregulation of body temperature can occur and can be fatal. Research strongly suggests that permanent neurologic damage may result from Ecstasy use. Narcotics Including Heroin There are a variety of medications that are taken to relieve pain. Most nonprescription pain relievers (such as aspirin, Tylenol, Motrin, and Nuprin) are not considered addictive. However, there is a class of stronger pain-relievers, available only by a doctor’s prescription that can be addictive. These are referred to as narcotics, most of which are derived from opium. Examples of these drugs include morphine, codeine, Darvon, Darvocet, Percocet, Percodan, Demerol, Oxycontin and Vicodin. These drugs differ from the nonprescription pain relievers in their potential for abuse and dependence. With close medical supervision, these drugs may be safely used in specific medical circumstances. However, as narcotics also produce euphoria, a person may not want to stop the drug when the pain has stopped, and addiction may occur. Tolerance to the drug is shown by an increase in the amount of drug necessary for the relief of pain. For the narcotics addict, tolerance leads to the craving and need for larger and larger doses of the drug. Without the drug the person becomes extremely uncomfortable and physically ill with withdrawal symptoms. These symptoms include nausea, diarrhea, cramps, weight loss, irritability, sweating, chills, insomnia, and craving for the drug. The time may come when the person “needs” such a large dose of the drug that it is at a poisonous or lethal level. Under these circumstances, coma, suffocation, and death may ensue. Heroin is a commonly abused illegal narcotic. It may be used by injection into a vein (“shooting up”) or intranasally (“snorting”), and death may occur if the amount used is sufficient to slow or stop breathing. The intravenous use of drugs also carries the additional medical dangers of AIDS and hepatitis from use of unclean needles and syringes. Recently, heroin seems to be available in purer forms and thus the risk of accidental overdose is increased.

Oxycodone

Oxycodone, also known by the brand name Oxycontin, is another opioid prescription analgesic that is highly addictive. Oxycodone has become more widely available through the illegal drug market in the past several years. Some people who become dependent on oxycodone may turn to heroin, morphine, or other opioids when they cannot obtain oxycodone. As with any drug addiction, people may engage in previously unimaginable behaviors in order to obtain the drug(s), often simply to prevent withdrawal. Tolerance to oxycodone builds rapidly, leading to increasing amounts used and the high risk of overdose. Sedatives and Tranquilizers Barbiturates and benzodiazepines are two of the most commonly used drugs in this group and they are both known as depressants. The barbiturates (such as phenobarbital, seconal, and amytal) are highly addictive and can be fatal if taken in excess. Although they still have medical uses, they have been replaced largely by benzodiazepines for the relief of anxiety and insomnia. The benzodiazepine group includes such drugs as Valium, Librium, Ativan, Xanax, Klonopin, and Restoril. Although benzodiazepines have approved medical usage and are safe and effective at moderate doses for short periods of time, all the benzodiazepines have the potential for physical and psychological dependence if used at higher doses for longer periods of time. Benzodiazepines may also be used by some people to get “high.” Intoxication with benzodiazepines may occur and it resembles alcohol intoxication. Drowsiness, slurred speech, unsteady gait, and lack of coordination are common signs of intoxication. The effects of benzodiazepines, barbiturates, and other sedatives add to the effects of alcohol. When they are taken together, there is an increased risk of coma, depressed respiration, and death. Withdrawal from benzodiazepines resembles alcohol withdrawal and it most often occurs when they are stopped abruptly. Withdrawal begins within hours to days of stopping the drug. Because benzodiazepine withdrawal may have life-threatening complications (such as seizures), discontinuing their use should not be attempted without a physician’s supervision.

Anabolic-Androgenic Steroids

Anabolic-Androgenic Steroids (AAS) are a family of hormones, which include the natural male hormone, testosterone, as well as many other synthetically related hormones. They have both anabolic (muscle building) and androgenic (masculinizing) properties. These substances are usually used not for an immediate reward, but rather with long term goal of building up muscle mass. In 1994, the National Household survey on Drug Abuse showed that 1 million men have used these drugs at some point in their lives. Women rarely use these compounds because of the masculinizing effects, though there are health concerns for both men and women in the context of their use. AAS users usually do not seek treatment because they may view their use as healthy, when used in conjunction with a healthy diet and exercise. Also, some AAS users do not believe that health care professionals have proper knowledge and understanding of their use. This group of drugs can be injected or taken orally and can be obtained through prescriptions, diverted from the legal market, or purchased illegally. These drugs when obtained from illegal sources or the internet are often falsely labeled, which means both that dosing is not reliable and that they may be unsterile. Health risks of taking AAS include gynecomastia (enlarged breast tissue) which may require surgical removal, testicular atrophy and sterility, male pattern baldness, hirsutism (excessive hair growth), hypertension, liver disease, enlarged prostate, and premature death. Psychiatric risks include mood symptoms such as depression, anxiety, hypomania, mania, aggression, violent behavior, and rarely psychosis. During the withdrawal phase, the individual may notice depressed mood, tiredness, difficulty sleeping, decrease in appetite, decrease in sex drive, and restlessness. Associated syndromes include muscle dysmorphia, which is an illness in which the individual views himself to be small and weak, though he is muscular. These individuals are preoccupied with their appearance and will avoid situations where their build will be noticed. Another co-occurring illness is opioid use and dependence, including heroin, which has led to many deaths.