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Substance Use Science
Important Information about
Substance Use Science
Substance Abuse is defined as a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences. When substance abuse began to be studied in the 1930s, people misusing alcohol or other drugs were thought to be morally flawed and lacking in willpower.
Now research tells us that severe substance misuse is a brain disease because drugs change the brain—they change its structure and how it works. These brain changes can be long lasting, and can lead to the harmful behaviors seen in people who abuse drugs.
Abuse of alcohol, nicotine, and illegal substances cost Americans upwards of half a trillion dollars a year, considering their combined medical, economic, criminal, and social impact. Every year, abuse of illicit drugs and alcohol contributes to the death of more than 100,000 Americans, while tobacco is linked to an estimated 440,000 deaths per year.
Which biological factors increase risk of developing a substance abuse problem? Scientists estimate that genetic factors account for between 40-60% of a person’s vulnerability to substance misuse, including the effects of environment on gene expression and function. Adolescents and individuals with mental disorders are at greater risk of drug abuse than the general population.
Introducing the Human Brain The human brain is the most complex organ in the body. This three-pound mass of gray and white matter sits at the center of all human activity—you need it to drive a car, to enjoy a meal, to breathe, to create an artistic masterpiece, and to enjoy everyday activities. In brief, the brain regulates your basic body functions; enables you to interpret and respond to everything you experience; and shapes your thoughts, emotions, and behavior.
The brain is made up of many parts that all work together as a team. Different parts of the brain are responsible for coordinating and performing specific functions. Drugs can alter important brain areas that are necessary for life-sustaining functions and can drive the compulsive drug abuse that marks addiction. Brain areas affected by drug abuse:
1. The Brain Stem controls basic functions critical to life, such as heart rate, breathing, and sleeping.
2. The Limbic System contains the brain’s reward circuit—it links together a number of brain structures that control and regulate our ability to feel pleasure. Feeling pleasure motivates us to repeat behaviors such as eating—actions that are critical to our existence. The limbic system is activated when we perform these activities— and also by drugs of abuse. In addition, the limbic system is responsible for our perception of other emotions, both positive and negative, which explains the mood-altering properties of many drugs.
3. The Cerebral Cortex is divided into areas that control specific functions. Different areas process information from our senses, enabling us to see, feel, hear, and taste. The front part of the cortex, the frontal cortex or forebrain, is the thinking center of the brain; it powers our ability to think, plan, solve problems, and make decisions.
How does the brain communicate? The brain is a communications center consisting of billions of neurons, or nerve cells. Networks of neurons pass messages back and forth to different structures within the brain, the spinal column, and the peripheral nervous system. These nerve networks coordinate and regulate everything we feel, think, and do.
1. Neuron to Neuron Each nerve cell in the brain sends and receives messages in the form of electrical impulses. Once a cell receives and processes a message, it sends it on to other neurons.
2. Neurotransmitters—The Brain’s Chemical Messengers The messages are carried between neurons by chemicals called neurotransmitters. (They transmit messages between neurons.)
3. Receptors—The Brain’s Chemical Receivers The neurotransmitter attaches to a specialized site on the receiving cell called a receptor. A neurotransmitter and its receptor operate like a “key and lock,” an exquisitely specific mechanism that ensures that each receptor will forward the appropriate message only after interacting with the right kind of neurotransmitter.
4. Transporters—The Brain’s Chemical Recyclers Located on the cell that releases the neurotransmitter, transporters recycle these neurotransmitters (i.e., bring them back into the cell that released them), thereby shutting off the signal between neurons.
To send a message a brain cell releases a chemical (neurotransmitter) into the space separating two cells called the synapse. The neurotransmitter crosses the synapse and attaches to proteins (receptors) on the receiving brain cell. This causes changes in the receiving brain cell and the message is delivered.
How do drugs work in the brain?
Drugs are chemicals. They work in the brain by tapping into the brain’s communication system and interfering with the way nerve cells normally send, receive, and process information. Some drugs, such as marijuana and heroin, can activate neurons because their chemical structure mimics that of a natural neurotransmitter. This similarity in structure “fools” receptors and allows the drugs to lock onto and activate the nerve cells. Although these drugs mimic brain chemicals, they don’t activate nerve cells in the same way as a natural neurotransmitter, and they lead to abnormal messages being transmitted through the network.
Other drugs, such as amphetamine or cocaine, can cause the nerve cells to release abnormally large amounts of natural neurotransmitters or prevent the normal recycling of these brain chemicals. This disruption produces a greatly amplified message, ultimately disrupting communication channels. The difference in effect can be described as the difference between someone whispering into your ear and someone shouting into a microphone.
How do drugs work in the brain to produce pleasure? Most drugs of abuse directly or indirectly target the brain’s reward system by flooding the circuit with dopamine. Dopamine is a neurotransmitter present in regions of the brain that regulate movement, emotion, cognition, motivation, and feelings of pleasure. The over stimulation of this system, which rewards our natural behaviors, produces the euphoric effects sought by people who abuse drugs and teaches them to repeat the behavior.
How does stimulation of the brain’s pleasure circuit teach us to keep taking drugs? Our brains are wired to ensure that we will repeat life-sustaining activities by associating those activities with pleasure or reward. Whenever this reward circuit is activated, the brain notes that something important is happening that needs to be remembered, and teaches us to do it again and again, without thinking about it. Because drugs of abuse stimulate the same circuit, we learn to abuse drugs in the same way.
Brain Reward (Dopamine) Pathways These brain circuits are important for natural rewards such as food, music, and sex. Drugs of abuse increase dopamine
What happens to your brain if you keep taking drugs? Just as we turn down the volume on a radio that is too loud, the brain adjusts to the overwhelming surges in dopamine (and other neurotransmitters) by producing less dopamine or by reducing the number of receptors that can receive signals. As a result, dopamine’s impact on the reward circuit of a drug abuser’s brain can become abnormally low, and the ability to experience any pleasure is reduced. This is why the abuser eventually feels flat, lifeless, and depressed, and is unable to enjoy things that previously brought them pleasure. Now, they need to take drugs just to try and bring their dopamine function back up to normal. And, they must take larger amounts of the drug than they first did to create the dopamine high—an effect known as tolerance.
What are the medical consequences of drug addiction? Individuals who suffer from addiction often have one or more accompanying medical issues, including lung and cardiovascular disease, stroke, cancer, and mental disorders. Imaging scans, chest X-rays, and blood tests show the damaging effects of drug abuse throughout the body. For example, tests show that tobacco smoke causes cancer of the mouth, throat, larynx, blood, lungs, stomach, pancreas, kidney, bladder, and cervix. In addition, some drugs of abuse, such as inhalants, are toxic to nerve cells and may damage or destroy them either in the brain or the peripheral nervous system.
Does drug abuse cause mental disorders, or vice versa? Drug abuse and mental disorders often co-exist. In some cases, mental diseases may precede addiction; in other cases, drug abuse may trigger or exacerbate mental disorders, particularly in individuals with specific vulnerabilities.
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Central Nervous System Depressants These substances produce a sedative and anxiety-reducing effect, which can lead to dependence. These drugs include:
- Barbiturates (amobarbital, pentobarbital, secobarbital, "yellow jackets", "downers")
- Benzodiazepines (Valium, Ativan, Xanax)
- Chloral hydrate
Signs and symptoms of alcohol or other depressant use:
- Lack of coordination
- Decreased attention span
- Impaired judgment
- Slurred speech
- Lower inhibitions
- Affected thoughts, emotions and judgment
- Accidents, domestic problems, poor performance at work or school
- Increased likelihood of committing violent crimes, drowning, suicides and homicides, unprotected sex, & sexual abuse or rape
Health problems caused by excessive use:
- Liver disease
- Digestive problems such as gastritis, ulcers, or pancreatitis
- Heart problems like high blood pressure, heart failure, or stroke
- Diabetes complications such as hypoglycemia
- Sexual function and menstruation problems
- Eye problems such as involuntary rapid eye movement as well as weakness and paralysis of your eye
- Birth defects may be caused by a pregnant woman drinking alcohol
- Bone loss like osteoporosis
- Neurological complications that affect your speech, cause pain in your hands & feet, dementia and memory loss
- Weakened immune system making you more susceptible to illnesses and possible death
- Increased risk of cancer such as mouth, throat, liver, colon and breast cancer
- Overdose or death
Marijuana Marijuana is also called "pot," "reefer," "joint," "weed," "blunt". Marijuana comes from a plant called hemp. The main, active ingredient is THC. This and other ingredients, called cannabinoids, are found in the leaves and flowering parts of the marijuana plant. Marijuana acts on your central nervous system. Low-to-moderate amounts of the drug may cause:
- Increased appetite ("the munchies")
- Feeling of joy (euphoria)
- Relaxed feeling
- Increased sensations of sight, hearing, and taste
- Feelings of panic, or rarely severe paranoia
- Decreased ability to perform tasks that require a lot of coordination (such as driving)
- Decreased interest in completing tasks
- Delirium or seeing or hearing things that aren't there (hallucinations)
- Bloodshot eyes
- Increased heart rate and blood pressure
- Infections such as sinusitis, bronchitis, and asthma in heavy users
- Irritation of the airways causing narrowing or spasms
- Possibly weakening of the immune system
- Sore throat
- Trouble concentrating and paying attention, which can interfere with learning
Medical Marijuana THC has been approved by the U.S. Food and Drug Administration (FDA) for the following medical purposes:
- Relieving chronic pain and spasticity
- Stimulating appetite in patients with AIDS or who have undergone chemotherapy
- Treating glaucoma
- Treating nausea caused by chemotherapy in cancer patients
Opiates, Opioids, and Narcotics Opiates come from opium poppies. These drugs include morphine and codeine. Opioids are artificial substances that have the same effect as morphine or codeine. The term "narcotic" refers to either type of drug. Narcotics are powerful painkillers that cause drowsiness (sedation) and sometimes, feelings of euphoria. These drugs include:
- Hydromorphone (Dilaudid)
- Meperidine (Demerol)
- Oxycodone (Percocet or Oxycontin)
- Coma, respiratory depression leading to coma, and death in high doses
- Needle marks on the skin ("tracks") if drug use is by injection
- Rapid heart rate
- Relaxed or euphoric state
- Scars from skin abscesses if drug use is by injection
- Small "pinpoint" pupils
Because heroin is commonly injected into a vein (used intravenously), there are health concerns about sharing contaminated needles among IV drug users. Complications of sharing contaminated needles include hepatitis. HIV infection, and AIDS.
Cocaine The abuse of cocaine increased dramatically in the late 1980s and early 1990s, but is now on the decline. Other names to describe different forms of cocaine include "crack," "coke," "snow," and "speedball."
Cocaine may be taken in different ways:
- Snorting: Inhaling it through the nose
- Shooting up: Dissolving it in water and injected it into a vein
- Speedball: Mixed with heroin and shot into a vein
- Smoked: Cocaine may be changed into a smokeable form known as freebase or crack
Smoking cocaine produces a nearly instant and intense sense of joy (euphoria), which is attractive to abusers. Other effects include:
- Feelings of increased confidence and energy
- Less inhibition
- Local numbness
- Powerful stimulation of the central nervous system
Regular users of cocaine may need larger amounts of the drug to feel these effects. Regular users of cocaine may have:
- Loss of interest in school, work, family, and friends
- Memory loss
- Mood swings
- Sleep problems
- Social withdrawal
Heavy use may cause paranoia, which can lead to violence.
Phencyclidine (PCP) PCP is an illegal drug that comes as a white powder, which can be dissolved in alcohol or water. PCP may be smoked, shot into a vein, or taken by mouth. How quickly it affects you depends on how you take it.
- Shooting up: If given through a vein, PCP's effects start within 2-5 minutes.
- Smoked: The effects begin within 2 - 5 minutes, peaking at 15 - 30 minutes.
- Taken by mouth: In pill form, or mixed with food or drinks, PCP's effects usually start within 30 minutes. The effects tend to peak in about 2 - 5 hours.
Different doses of PCP will cause different effects:
- Lower doses of PCP typically produce feelings of joy (euphoria) and less inhibition, similar to being drunk.
- Higher doses cause numbness throughout the body, and perception changes that may lead to extreme anxiety and violence.
- Large doses may produce paranoia, "hearing voices" (auditory hallucinations), and psychosis similar to schizophrenia.
- Massive doses, usually from taking the drug by mouth, may cause acute kidney failure, heart arrhythmias, muscle rigidity, seizures, and even death.
Because of the pain-killing properties of PCP, users who get seriously injured may not feel any pain.
Club Drugs A number of other illegal drugs have become popular recently. Their use causes changes in perception and/or loss of memory.
- Ketamine (related to PCP) called "Special K"
- MDMA or "Ecstasy"
- GHB and Rohypnol, also called "date rape drug"
LSD and other Hallucinogens LSD (lysergic acid diethylamide) is a very strong hallucinogen. Only tiny amounts are needed to cause effects, such as hallucinations. Other commonly abused hallucinogens are Psilocybin (mushrooms, "shrooms") and Peyote (a cactus plant containing mescaline). LSD use may cause Anxiety, Blurred vision, Paranoid delusions, Seeing things that aren't there. Hallucinogens can lead to extreme anxiety and lack of reality, called "bad trips". These experiences can come back as a "flashback," even without using the drug again. Such experiences typically occur during times of increased stress, and tend to occur less often and intensely after stopping the drugs.
- Dilated pupils
- Exaggerated feeling of well-being (euphoria)
- Fast heart rate
- Restlessness and hyperactivity
- Skin flushing
- Sleep disturbances
- Weight loss
- Sores from scratching
- Dental problems
Inhalants Inhalant use became popular with young teens in the 1960s with "glue sniffing." Since then, a greater variety of inhalants have become popular. Inhalant use typically involves younger teens or school-age children. Commonly abused inhalants include: Aerosols for deodorants or hair sprays, Cleaning fluids, Gasoline, Liquid typewriter correction fluid, Model glue, Spray paints.
Negative effects of inhalant abuse include:
- Brain damage
- Liver or kidney damage
- Nerve damage
- Sudden death