Drug: In medicine, it refers to any substance with the potential to prevent or cure disease or

enhance physical or mental well-being. In pharmacology, drug refers to any agent that alters the
biochemical or physiological processes of tissue or organism. 

Street drug: Drug that is taken for non-medicinal reasons (usually for mind-altering effects); drug
abuse can lead to physical and mental damage and (with some substances) dependence and
addiction. Eg: Alcohol, heroin, methamphetamine, crack, cocaine and marijuana (Cannabis).

Hard drug (lead to severe physical addiction): – Drug that is generally considered to be more
dangerous, with a higher risk of dependence that soft drugs. Eg.: Heroin, methamphetamine,
cocaine

 Soft drug (do not cause physical addiction): – While they do not cause physical addiction, some
of them may still lead to psychological dependency. Psychological dependency is a dependency
of the mind. This means that people feel better when they have the drug. Eg: lysergic acid
diethylamide (LSD), Cannabis

Illicit drug: AN illegal drug, can’t prescribed. Eg.: Cocaine, heroin, LSD, marijuana. 

Designer drug: A synthetic drug very similar in chemical makeup to an existing drug and thus
exerting similar. to mimic the pharmacological effects of the original drug, while avoiding
classification as illegal and/or detection in standard drug tests. The term “designer drugs” refers
to substances that are synthetic, or made in a laboratory. For instance, synthetic marijuana
products like K2 or Spice are created in labs based on the structure of natural cannabinoids, the
compounds found in marijuana.

 Synthetic cannabinoids. These are designer drugs that are supposed to mimic the natural
compounds in the cannabis plant, also known as marijuana. There are many different
street names for these products, including Spice, K2, Bliss, and Scooby Snax. They can
cause a range of adverse effects, including anxiety, violent behaviors, seizures,
hallucinations, and paranoia.
 Synthetic cathinones. Cathinone is a natural substance found in plant called khat.
Designer drugs that are supposed to mimic this substance are stimulants, similar to
cocaine, MDMA, and methamphetamine. The most common street name for these drugs
is bath salts. Potential adverse effects of bath salts include paranoia, hallucinations,
seizures, chest pains, suicidal thoughts, and violent outbursts.
 Synthetic phenethylamines. Phenethylamines made in a laboratory are designed to
mimic hallucinogenic drugs. N-bomb and smiles are two of the street names for them and
they can be found as liquids, powders, and papers soaked in the liquid solution. These
designer drugs may cause seizures, heart attack, and respiratory failure.
Club drug: A drug whose use primarily occurs in clubs, bars and trance parities. E.g: Rohypnol,
ketamine. 

Recreational drugs: – Recreational drugs are those used for non medicinal purposes, in
particular, for fun or leisure. – Eg.: methamphetamine (potent psychostimulant of the
phenethylamine), that is used to treat attention deficit hyperactivity disorder (ADHD), drive long
distances and obesity

ALCOHOL

Alcoholism refers to the use of beverages to the point of causing damage to the individual,
society or both.

CAFFEINE

Caffeine is a central nervous system stimulant that has the ability to enhance concentration,

increase metabolism, and boost mood. Average consumption is about 280 mg/day (APA, 2013)

People can develop a dependence on coffee and other caffeinated beverages quite quickly. This
is due to the chemical changes that sustained consumption produces in the brain. If someone
drinks caffeine on a daily basis, he or she will develop a tolerance, just as one would to
other drugs or alcohol. After a while, the user requires more and more caffeine to produce the
same effects of alertness. Regular caffeine drinkers become acclimated to the wake-up aspect
that the substance produces, and gradually require higher amounts to achieve the same “caffeine
fix.” Similar to other drugs, people who abruptly stop drinking caffeine after prolonged use will
start to suffer from withdrawal symptoms and experience cravings. This causes many individuals
to relapse when attempting to quit and resume drinking caffeine, regardless of the health
problems associated with chronic caffeine use.

The more commonly used word for cannabis is marijuana. Other names are pot, hash, weed,
Buddha grass, dope, ganga, herb, and reefer. Cannabis is a plant that contains
tetrahydrocannabinol (THC). THC is the psychoactive ingredient in marijuana. This ingredient
makes marijuana an addictive substance. The dried marijuana leaves are smoked. The THC
rapidly enters the bloodstream from the lungs producing an immediate "high." People use
cannabis by smoking, eating or inhaling a vaporized form of the drug. Cannabis often precedes
or is used along with other substances, such as alcohol or illegal drugs, and is often the first drug
tried. Marijuana can alleviate the symptoms of some medical disorders. For example, marijuana
has reduced side-effects of chemotherapy; weight loss that accompanies AIDS; and chronic pain.
However, the medical use of marijuana remains controversial. Public misperception and legal
controversies have impeded research progress (Onaivi, 2005).

Signs and symptoms of recent use can include:

 A sense of euphoria or feeling "high"

 A heightened sense of visual, auditory and taste perception

  Increased blood pressure and heart rate

 Red eyes

 Dry mouth

 Decreased coordination

 Difficulty concentrating or remembering

 Slowed reaction time

 Anxiety or paranoid thinking

 Cannabis odor on clothes or yellow fingertips

 Exaggerated cravings for certain foods at unusual times

Long-term (chronic) use is often associated with:

 Decreased mental sharpness

 Poor performance at school or at work

 Reduced number of friends and interests

Opioids

The most common opioids are opium, morphine, heroin, codeine, methadone, oxycodone,
fentanyl, and buprenorphine. Street names for heroin include China white, black tar, horse,
smack, chiva, junk, and dope. People also abuse prescription pain medications such as
Oxycontin® and Vicodin®. Opioids are can be taken orally by mouth, or by injection into veins.
In some cases, opioids are smoked or snorted. We call these different methods of use, routes of
administration. Many people mistakenly believe they aren't "addicts" because they "only" snort,
smoke, or swallow these drugs. Opioid use can easily escalate to addiction regardless of the route
of administration.

 Opioids can be obtained by prescription from a physician, as many of these drugs have a
legitimate use in severe pain management. Usually this requires faking or exaggerating
symptoms, such as back pain. Opioids can also be obtained from the illegal market. 

Barbiturates, benzodiazepines and hypnotics are prescription central nervous system depressants.
They're often used and misused in search for a sense of relaxation or a desire to "switch off" or
forget stress-related thoughts or feelings. SHA addiction often occurs together with other drugs
of abuse. This usually reflects an effort to counteract the effects of those other drugs. For
example, people may abuse benzodiazepines to help them "come down" from the high of
cocaine.

 Barbiturates. Examples include phenobarbital and secobarbital (Seconal).

 Benzodiazepines. Examples include sedatives, such as diazepam (Valium),

alprazolam (Xanax), lorazepam (Ativan), clonazepam (Klonopin) and
chlordiazepoxide (Librium).

 Hypnotics. Examples include prescription sleeping medications such as zolpidem

(Ambien, Intermezzo, others) and zaleplon (Sonata)

Signs and symptoms of recent use can include:

 Drowsiness

 Slurred speech

 Lack of coordination

 Irritability or changes in mood

 Problems concentrating or thinking clearly

 Memory problems

 Involuntary eye movements

 Lack of inhibition

Tobacco products contain the addictive drug nicotine as well as many other toxic chemicals.
Nicotine in tobacco is a powerfully addictive substance with multiple physiologic and
psychological effects. Like many other drugs of addiction, it activates the same brain reward
system involved in pleasurable activities such as eating and sexual activity. Cigarettes include
many other harmful chemicals besides nicotine. These other chemicals make tobacco use so
harmful. These other chemicals cause serious, long-term health problems. These include
bronchitis, emphysema, and many types of cancers. Nicotine can cause serious problems to a
developing fetus.

Stimulants include amphetamines, meth (methamphetamine), cocaine, methylphenidate (Ritalin,

Concerta, others) and amphetamine-dextroamphetamine (Adderall, Adderall XR, others). They
are often used and misused in search of a "high," or to boost energy, to improve performance at
work or school, or to lose weight or control appetite. Severe forms of amphetamine addiction
may lead to significant weight loss, anemia, and poor health due to a lack of personal hygiene. 

Signs and symptoms of recent use can include:

 Feeling of exhilaration and excess confidence

 Increased alertness

 Increased energy and restlessness

 Behavior changes or aggression

 Rapid or rambling speech

 Dilated pupils

 Confusion, delusions and hallucinations

 Irritability, anxiety or paranoia

 Changes in heart rate, blood pressure and body temperature

 Nausea or vomiting with weight loss

Inhalants

Inhalants refer to a wide variety of household products containing hydrocarbons. These

hydrocarbons produce vapors. Intoxication occurs by inhaling these vapors. Users disperse these
products into a paper bag and then inhale the vapors deeply. This practice is known as huffing.
Users "huff" products such as glue, gasoline, paint thinners, cleaners, and various aerosols.
Inhalants reach the bloodstream very quickly. They produce significant psychoactive effects.
These products are inexpensive, legal, and widely available.

Like alcohol and marijuana, inhalants are one of the first drugs used by young people. Inhalants
are readily available and inexpensive. People with inhalant use disorders may neglect
responsibilities. They often continue to use despite their awareness of the harmful effects.
Inhalant use is particularly alarming because people often use the inhalants in situations where
judgment and coordination are critical (e.g., driving a car). Chronic, long-term use may lead to
serious, lasting complications. These include brain damage, liver and kidney disease, and even
death. Moreover, even a single use can result in permanent brain damage.

Signs and symptoms of use can include:

 Possessing an inhalant substance without a reasonable explanation

  Brief euphoria or intoxication

 Decreased inhibition

 Combativeness or belligerence

 Dizziness

 Nausea or vomiting

 Involuntary eye movements

 Appearing intoxicated with slurred speech, slow movements and poor coordination

 Irregular heartbeats

 Tremors

 Lingering odor of inhalant material

 Rash around the nose and mouth

Biologic factors. Children of alcoholic parents are at higher risk for developing alcoholism and
drug dependence than are children of nonalcoholic parents.

 Genetic vulnerability Genes account for 40-60% of the risk for addiction development
 Physiological Differences in metabolic variations by race; for example, Native American
and Caucasian populations more likely than Asian populations to develop a substance use
disorder because of the polymorphism of two liver enzymes.
 Males are more likely than females to develop a substance use disorder

PERSONALITY TRAITS

 Personality traits such as high impulsivity, aggression, and sensation seeking

PSYCHOPATHOLOGY

 The prevalence of other mental health disorders, such as major depressive

disorder, anxiety disorder, schizophrenia, attention-deficit hyperactivity disorder
(ADHD), or post-traumatic stress disorder (PTSD)

FAMILIAL FACTORS
  RISK
 Having a parent or sibling that has a substance use disorder. Children of
alcoholics are four times as likely to develop alcoholism compared with the
general population; some theorists believe that inconsistency in the parent’s
behavior, poor role modeling, and lack of nurturing pave the way for the child to
adopt a similar style of maladaptive coping, stormy relationships, and substance
abuse.
o
o Lack of family involvement, parental supervision, or support
o Poor quality of the child-parent relationship
o Family disruptions such as divorce, acute or chronic stress
o Social isolation
o Abuse (e.g. sexual, physical, emotional)
PEER FACTORS

 RISK
o Substance use among peers and time spent with substance-using peers
o Poor social skills
SOCIOCULTURAL OR ENVIRONMENTAL FACTORS

 RISK
o Accessibility of a substance (e.g., number of liquor stores)
o Community drug use patterns (e.g., individual usage of neighbors)
o Low socioeconomic status or community poverty
o Social and legal policies such as taxes, purchase or use restrictions,
enforcement, legal status, penalties, and school anti-drug policies
o Media influence such as the frequency of exposure and nature of the
representation of alcohol and other drugs
OTHER FACTORS

 RISK
o Exposure to physical, sexual, or emotional abuse or trauma
o Age at first use of alcohol and other drugs
Criteria for Substance Use Disorder
Substance use disorders are classified as mild, moderate, or severe, depending on how many of
the diagnostic criteria a person meets. The 11 DSM-5 criteria for a substance use disorder are:1
1. Hazardous use: You have used the substance in ways that are dangerous to yourself
and/or others, i.e., overdosed, driven while under the influence, or blacked out.
2. Social or interpersonal problems related to use: Substance use has caused relationship
problems or conflicts with others.
3. Neglected major roles to use: You have failed to meet your responsibilities at work,
school, or home because of substance use.
4. Withdrawal: When you stop using the substance, you experience withdrawal symptoms.
5. Tolerance: You have built up a tolerance to the substance so that you have to use more to
get the same effect.
6. Used larger amounts/longer: You have started to use larger amounts or use the
substance for longer amounts of time.
7. Repeated attempts to control use or quit: You've tried to cut back or quit entirely, but
haven't been successful.
8. Much time spent using: You spend a lot of your time using the substance.
9. Physical or psychological problems related to use: Your substance use has led to
physical health problems, such as liver damage or lung cancer, or psychological issues,
such as depression or anxiety.
10. Activities given up to use: You have skipped activities or stopped doing activities you
once enjoyed in order to use the substance.
11. Craving: You have experienced cravings for the substance.

 Alcohol. Alcohol is a central nervous system depressant that is absorbed rapidly into the
bloodstream; initially, the effects are relaxation and loss of inhibition; with intoxication,
there is slurred speech, unsteady gait, lack of coordination, and impaired attention,
concentration, memory, and judgment.
 Sedatives, hypnotics, and anxiolytics. This class of drugs includes all central nervous
system depressants, barbiturates, nonbarbiturate hypnotics, and anxiolytics, particularly
benzodiazepines; the effects of the drugs, symptoms of intoxication, and withdrawal
symptoms are similar to those of alcohol.
 Stimulants (amphetamines, cocaine). Stimulants are drugs that stimulate or excite the
central nervous system; intoxication from stimulants develops rapidly; effects include the
high or euphoric feeling, hyperactivity, hypervigilance, talkativeness, anxiety,
grandiosity, hallucinations, stereotypic or repetitive behavior, anger, fighting, and
impaired judgment.
 Cannabis (marijuana). Cannabis is the most widely used illicit substance in the United
States; research has shown that cannabis has short-term effects of lowering intraocular
pressure; symptoms of intoxication include impaired motor coordination, inappropriate
laughter, impaired judgment, and short-term memory, and distortions of time and
perception.
 Opioids. Opioids are popular drugs of abuse because they desensitize the user to both
physiologic and psychological pain and induce a sense of euphoria and well-being; opioid
intoxication develops soon after the initial euphoric feeling; symptoms include apathy,
 lethargy, listlessness, impaired judgment, psychomotor retardation or agitation,
constricted pupils, drowsiness, slurred speech, and impaired attention and memory.
 Hallucinogen. Hallucinogens are substances that distort the user’s perception of reality
and produce symptoms similar to psychosis, including hallucinations and
depersonalization; hallucinogen intoxication is marked by several maladaptive behavioral
or psychological changes; anxiety, depression, paranoid ideation, ideas of reference, fear
of losing one’s mind, and potentially dangerous behavior such as jumping out the
window in the belief that one could fly.
 Inhalants. Inhalants are a diverse group of drugs that includes anesthetics, nitrates, and
organic solvents that are inhaled for their effects; the most common substances in this
category are aliphatic and aromatic hydrocarbons found in gasoline, glue, paint thinner,
and spray paint; inhalant intoxication involves dizziness, nystagmus, lack of
coordination, slurred speech, unsteady gait, tremor, muscle weakness, and blurred vision.

Substance/medication-induced psychotic disorder, also known as toxic psychosis, alcohol-

induced psychosis, and drug-induced psychosis, is the diagnostic name for a specific mental
health condition where an individual experiences hallucinations, delusions, or both within a
month of using or withdrawing from prescription drugs, illegal drugs, and/or alcohol.

Symptoms of substance/medication-induced psychotic disorder include

experiencing delusions, hallucinations, or both. Individuals experiencing these symptoms may or
may not have insight into whether their delusions and/or hallucinations are real. For example, a
persecutory delusion may be "my former company is monitoring my every move and is out to
get me." An example of an erotomanic delusion may be "Tom Hanks is madly in love with me."
If you have a hallucination, you are experiencing something with one or multiple senses that isn't
based in reality.

If an individual has substance/medication-induced psychosis and their hallucinations are due to

drugs and/or alcohol, this symptom does not count toward their diagnostic criteria.2

Types of hallucinations include:

 Auditory: Hearing voices or sounds that aren't really present

 Visual: Seeing things that aren't really there
 Olfactory: Smelling scents that no one else can
 Tactile: Feeling like you're being touched when no one or nothing is on you
 Gustatory: Tasting something when there's nothing in your mouth

Medication
Medications may be used to help reduce symptoms of substance/medication-induced psychosis
and stabilize the individual's mood. Medications that may be used include:17

 Benzodiazepines
 Selective serotonin reuptake inhibitors (SSRIs)
 Antipsychotics
Psychotherapy

Long-term, it's important to treat any underlying mental health conditions to reduce the chances
of experiencing substance/medication-induced psychosis again.

Substance/medication-induced bipolar disorder is classified as mania, hypomania or a major

depressive episode directly caused by a substance/medication that is or has been taken. This
diagnosis will be dependent on the individual’s personal mental health history, as well as the
nature of the substance/medication taken. These changes in mood must be prominent and
persistent in order to be classified as substance/medication induced. The symptoms must also
start during or soon after the substance/medication was taken, or during withdrawal therefrom.
Common symptoms: Mania or hypomania symptoms such as: 1. Inflated self esteem 2. A
marked decrease in need for sleep 3. Extremely talkative, thoughts racing from one topic to the
next 4. Low levels of concentration, easily distracted 5. Engagement in risky and potentially
dangerous behaviour, for example unrestrained shopping sprees, sexual indiscretions, or
substance use. 6. Engaging in activities or exhibiting behaviour that is uncharacteristic for the
individual Major depressive symptoms such as: 1. Feeling sad, hopeless or empty 2. Diminished
interest or pleasure in all activities 3. Significant weight loss or gain in a short period of time 4.
Sleeping too much or too little 5. Fatigue or a loss of energy 6. Diminished ability to concentrate.
Causes: Substance/medication-induced bipolar disorders are directly caused by a substance or
medication that is or has been taken. There are a number of substances/medications that can
cause substance/medication-induced bipolar disorder, such as: 1. Alcohol 2. Phencyclidine 3.
Hallucinogens 4. Amphetamines

Substance-induced mood disorder is a kind of depression that is caused by using alcohol,

drugs, or medications. Substance/medication-induced depressive disorder is the diagnostic name
for alcohol or drug-induced depression.

Unlike the transient feelings of sadness that are normal and that everyone experiences, or even
the temporary hangover or "crash" that often gets people the morning after alcohol or drug use,
when substance-induced depression hits, it feels considerably worse for much longer. For some
people, it involves a complete loss of interest or enjoyment in life.
Substance or medication-induced anxiety disorder is the diagnostic name for anxiety or panic
attacks that are caused by alcohol, drugs, or medications. While it is normal to have some
feelings of anxiety in stressful situations, and even the transient feelings of anxiety or panic that
can happen spontaneously during intoxication or withdrawal from alcohol or drugs, substance-
induced anxiety disorder causes clinically significant distress or functional impairments.1

Unfortunately, the same drugs that many people use to try and boost their confidence, help them
relax, and lower their inhibitions are the ones most prone to causing substance-induced anxiety
disorder or panic attacks. In some cases, people don't even realize that it is alcohol, drugs, or
medications that are causing anxiety because they only associate those substances with feeling
good.
Substance/medication-induced obsessive compulsive disorder is the diagnostic name for
drug-induced OCD. Obsessive-compulsive behavior is a group of seemingly uncontrollable and
repetitive behaviors that are driven by obsessions. Obsessions are unwanted thoughts, urges or
images that intrude on an individual's consciousness. They are associated with compulsive
behaviors which are actions that the person feels compelled to carry out often in response to, and
in an effort to control an obsession. These behaviors can be body-focused, for example, picking
at one's own skin, or pulling out one's own hairs. Obsessions and compulsions can occur on their
own or in combination and can be part of several different obsessive compulsive disorders, of
which substance-induced OCD is just one.

Unlike the transient feelings and intrusive thoughts that everyone experiences from time to time,
especially during times of stress, or the occasional habitual behaviors we also all engage in from
time to time, substance-induced obsessive compulsive disorder is considerably worse and more
difficult for the individual to control. Although substance-induced OCD is rare, the consequences
can be severe.

The compulsions rarely have any realistic connection to the obsessions they are designed to
neutralize or prevent. Rather, they form a ritualistic behavior that is designed to reduce anxiety
but ultimately worsen the overall condition. 1 And while some people with obsessive compulsive
disorders are aware that the beliefs that are part of their obsessions are probably not true, some
are less certain, and others are convinced that they actually are true, to the point where their
beliefs are delusions.

When physicians or psychologists give a diagnosis of substance/medication-induced obsessive

compulsive disorder, they check to make sure that the obsessions or compulsions were not there
before the use of the drug thought to be responsible. This is because there are different types of
obsessive compulsive disorders, and if the symptoms were there before the substance use, it
probably isn't the substance/medication-induced type of OCD.

Substance or medication-induced sleep disorder is the official diagnostic name for insomnia and
other sleep problems which are caused by the use of alcohol, drugs, or taking certain
medications. Roughly translated, that means that one of the effects of drinking alcohol, using a
drug, or taking a medication, is having a problem with getting to sleep at the time you want to
sleep, staying asleep at the time you want to sleep, excessive sleepiness during the day, or
unusual behaviors when you do sleep.

Substance or medication-induced sleep disorder is different from the occasional difficulty

with getting to sleep or staying asleep that is actually quite normal.

Substance or medication-induced sleep disorder is also different from the temporary insomnia or
exhaustion that often affects people straight after alcohol or drug use, which is a normal response
to the substance, or the activities of people who use alcohol or drugs, such as staying up later
than your usual bedtime or participating in tiring activities during the time that alcohol or drugs
are used (such as dancing). In contrast to these normal responses to alcohol or drugs,
substance/medication-induced sleep disorder interferes with sleep more significantly, and the
negative effects last for much longer.
A wide variety of psychoactive substances can cause substance-induced sleep disorder,
including:

 Alcohol
 Caffeine
 Cannabis
 Opioids
 Sedatives
 Hypnotics
 Anxiolytics
 Amphetamines
 Cocaine
 Tobacco
 Other substances or stimulants

Medications are known to cause substance/medication-induced sleep disorders include:

 Adrenergic agonist or antagonists

 Dopamine agonist or antagonists
 Cholinergic agonist or antagonists
 Serotonergic agonist or antagonists
 Antihistamines

SEXUAL DYSFUNCTION

Incidence of this condition is likely underreported due to a variety of factors, including patient
shame / embarrassment as well as acceptance that these side effects are an unavoidable part of
treatment. It has been cited that as many as 50% of patients taking antipsychotic medications will
have adverse sexual side effects, and somewhere between 25% and 80% of patients taking
antidepressants may as well.

Men may complain of erectile dysfunction, premature or absent ejaculation, anorgasmia, and/or pain
with intercourse. Women may complain of decreased lubrication / dryness, decreased engorgement,
anorgasmia, pain with intercourse, and/or decreased libido.

Substance-induced sexual dysfunction refers to a condition in both men and women in which
patients have difficulties with sexual desire, arousal, and/or orgasm due to a side effect of certain
medications (legal or illicit).

Substance intoxication delirium is the diagnostic name for alcohol or drug-induced delirium. 1
The condition is caused by intoxication from a psychoactive substance.

Disturbances in focus and attention are normal when people are under the influence of alcohol or
drugs, and even when they are overtired. However, loss of focus and attention is usually
temporary.
Substance intoxication delirium is a more serious state that may last longer than the transient
symptoms most people experience when they are intoxicated. In addition, a person who is
experiencing substance intoxication delirium will have additional disturbances in their cognition
and may become completely unable to attend to the external environment.

Alcohol Withdrawal
 Alcohol withdrawal begins 4-12 hours after stopping or reducing heavy use. Symptoms
of alcohol withdrawal are often extremely unpleasant. Symptoms may include sweating;
tremor; insomnia; nausea/vomiting; hallucinations; agitation; anxiety; and even seizures.
In severe cases, alcohol withdrawal may result in death. Consult with a physician prior to
discontinuing heavy alcohol use.
 Effects of Alcohol: Alcohol Intoxication
 Alcohol intoxication is indicated by behavioral and psychological symptoms. This
includes poor judgment and difficulty getting along with other people. Alcohol affects
the cerebral cortex. This makes it difficult to inhibit impulsive urges. Impulsivity can lead
to aggression and risky sexual behavior. Alcohol intoxication causes observable
symptoms. These symptoms include slurred speech; unsteady gait; a lack of coordination;
impaired memory/attention; involuntary rapid eye movements (nystagmus); and even
coma. Heavy alcohol use can cause many health problems. These problems often involve
the gastrointestinal, cardiovascular, and nervous systems. In addition, the interaction
between alcohol and other drugs can be fatal. This is especially true with other drugs that
depress the central nervous system such as sedatives, hypnotics, and anxiolytics LINK.

Caffeine: Withdrawal
Caffeine withdrawal can occur after abrupt cessation of daily use. Withdrawal can occur with
relatively small daily doses. The average consumption in the United States is 280 mg/day. Yet
people experience withdrawal from caffeine with consumption as low 100 mg/day. The
symptoms usually begin 12-24 hours after last use. The symptoms may last for 2-9 days.
Symptoms include headache, fatigue and difficulty concentrating; irritable or depressed mood;
and even flu-like symptoms.

Effects of Caffeine: Caffeine intoxication

Caffeine intoxication includes nervousness, restlessness, and psychomotor agitation. People may
ramble while speaking and their thoughts may not be well organized. More serious effects
include tachycardia and cardiac arrhythmia. Extremely high doses of caffeine can result in death.
Caffeine intoxication can have other serious consequences including the inability to function at
school or work, and poor judgment.

Cannabis (Marijuana): Withdrawal

If cannabis use is discontinued after prolonged (daily or almost daily) use, over a period of
several months, withdrawal may occur. Symptoms include irritability, anxiety, depressed mood,
sleep disturbance, and restlessness. At least one physical symptom is required for diagnosis such
as fever, chills, tremors, sweating, and abdominal pain.
Effects of Marijuana: Cannabis intoxication
Cannabis (marijuana) intoxication develops rapidly. It usually begins with a feeling of euphoria
(a "high"). It then leads to anxiety; a lack of coordination; reduced judgment; memory problems;
decreased alertness; and difficulty engaging in social interactions. Because people intoxicated on
cannabis have impaired memory, they tend to lose their own train of thought. They cannot follow
a conversation very well. Thus, their attempts at conversation can be disjointed and sometimes
nonsensical. Cannabis intoxication may also lead to increased appetite (the "munchies"); dry
mouth ("cottonmouth"); persistent cough; reduced heart rate; and red, blood-shot eyes.

Opioid Withdrawal (e.g., heroin, Oxycontin®, Vicodin®)

Opioid withdrawal occurs after the cessation (or significant reduction) of heavy and prolonged
use. The speed and severity of withdrawal largely depend on the half-life of the drug. The half-
life of a drug refers to how quickly your body can clear the drug from your system. Drugs that
remain in your system a long time have a long half-life. These are called long-acting drugs.
Drugs are cleared fairly quickly have a short half-life. These drugs are called short-acting drugs.
For short-acting opioids such as heroin, withdrawal symptoms begin within 6-12 hours after the
last dose and last for 5-7 days. For long-acting opioids, withdrawal symptoms may take several
days to emerge and may last for several weeks, but with less intense symptoms.

Opioid withdrawal is often very uncomfortable. Withdrawal symptoms may include anxiety;
restlessness; irritability; muscle aches; depressed mood; nausea/vomiting/diarrhea;
sweating/fever; yawning; cravings; and difficulty sleeping. While highly uncomfortable, opiate
withdrawal is usually not life threatening. However, opiate use itself can be fatal.

Effects of Opiates: Opioid Intoxication (e.g., heroin, Oxycontin®, Vicodin®)

Opioid intoxication can be extremely dangerous. The various symptoms include: mood swings
(usually an elevated mood followed by a flattened demeanor); impaired
judgment/attention/memory; change in pupil size; slurred speech; drowsiness; hallucinations;
and even coma. Those who use opioids intravenously may have visible "track marks" at injection
sites. Because needles require a prescription, many IV drug users re-use and share unsterile
needles. As a result, they are at risk for acquiring hepatitis, tuberculosis, and HIV. The death rate
for people who overuse opioids is high. Death may occur because of overdoses, accidents,
medical complications, and violent injuries associated with obtaining the drugs. If a pregnant
woman is a heavy user of opioids, her newborn may have a severe withdrawal syndrome.
 
Sedatives, Hypnotics or Anxiolytics Withdrawal
SHA withdrawal occurs after the abrupt cessation (or significant reduction) of prolonged use.
SHA withdrawal may be particularly uncomfortable and quite dangerous. In general, long-term
use, at higher doses, leads to more intense withdrawal. However, even at low doses of certain
drugs, withdrawal symptoms have been reported.

The speed and severity of withdrawal largely depends on the half-life of the drug. The half-life
of a drug refers to how quickly your body can clear the drug from your system. Drugs that
remain in your system a long time have a long half-life. These are called long-acting drugs.
Drugs are cleared fairly quickly have a short half-life. These drugs are called short-acting drugs.
For short-acting drugs (e.g. lorazepam), withdrawal symptoms begin within 6-8 hours and
typically last about a week. For long-acting drugs (e.g. diazepam), withdrawal symptoms may
not be evident for a week. The intense withdrawal effects subside after 3-4 weeks. However, less
intense symptoms may last much longer.

Withdrawal symptoms may interfere with people's ability to function well. People in withdrawal
also experience physical changes. These may include sweating; increased pulse; hand tremor;
insomnia; nausea/vomiting; anxiety; hallucinations; and even grand mal seizures. Consult with a
medical professional before attempting to discontinue heavy and/or prolonged use of these drugs.

Effects of Sedatives, Hypnotics, or Anxiolytics: Intoxication

Sedative, Hypnotic, or Anxiolytic Intoxication is characterized by significant behavioral
changes. These include aggression, mood swings, and impaired judgment. The disinhibiting
effects of these drugs is similar to alcohol. This may contribute to social blunders, aggression,
and even legal problems. Physical signs involve slurred speech; nystagmus; a lack of
coordination; impaired memory; decreased blood pressure and pulse; and possibly coma. Serious
injuries (due to falls or accidents) and overdoses (intentional or accidental) are not uncommon.

Tobacco withdrawal
Tobacco withdrawal may occur after someone discontinues or significantly reduces tobacco use
following a period of daily use for at least several weeks. Nearly half of all tobacco users will
experience tobacco withdrawal after 2 days of non-use. The withdrawal symptoms usually last 2-
3 weeks. Withdrawal symptoms include depression; difficulty sleeping; irritability, frustration,
and anger; anxiety; problems concentrating; restlessness; slowed heart rate; dry cough; and
increased appetite/weight gain. People often report strong cravings lasting several days to several
weeks.

Withdrawal symptoms generally cause people so much discomfort that they try to avoid them.
People avoid these symptoms by using nicotine as soon as they wake up. Then, they continue to
use at regular intervals throughout the day. One measure of nicotine tolerance is how soon the
first cigarette of the day is smoked. Smoking within minutes of awakening suggests that
tolerance has developed.

Stimulant Withdrawal
After prolonged and heavy use of stimulants, withdrawal may occur after cessation or significant
reduction in drug use. Stimulant withdrawal usually begins within a few hours to several days
after the last use. It often includes symptoms of depressed mood; fatigue; vivid dreams; sleep
difficulties; increased appetite; psychomotor slowing or agitation; and powerful cravings. In
some cases, suicidal ideation may also be present.

While stimulant withdrawal is uncomfortable, it does not usually require medical monitoring.
However, because of the increased risk for suicide, clinicians should evaluate suicide risk and
monitor patients accordingly.

Effects of Stimulants: Intoxication

Stimulant intoxication produces feelings of euphoria, well-being, and confidence. Dramatic
changes in behavior and mood disturbances also occur. People may become highly paranoid,
anxious, irritable, angry, or depressed. In addition dramatic mood swings can occur. People may
exhibit poor judgment and aggression. In more severe cases, people may become delusional
and/or experience tactile or auditory hallucinations. Hyper-vigilance, hyper-activity, confusion,
and talkativeness are also common. Likewise, people may engage in indiscriminate or dangerous
sexual liaisons.

Physical changes include pupil dilation; altered body temperature; nausea or vomiting; weight
loss; psychomotor changes; muscular weakness; chest pain; confusion; and elevated or lowered
blood pressure (different people have different reactions). The acute physical symptoms
generally develop within an hour. The severity of the symptoms depends on the dose taken;
however, death due to overdose is rare. Nonetheless, if someone has received a high dose,
medical attention is advisable. Sudden death, seizures, coma, and stroke can occur in otherwise
healthy people due to the drug's effect on the cardio-vascular system.

Inhalant Intoxication produces various behavioral and/or psychological changes. These may
include aggressiveness; anxiety; impaired judgment; poor social functioning; and even delusions
and hallucinations. Physical effects include dizziness; headaches; nystagmus; poor coordination;
slurred speech; coughing; lack of balance; sleepiness; poor reflexes; slowed movements and/or
tremors; muscle weakness; poor vision; and even coma. Because of the toxic nature of inhalant
products, inhalant use can be fatal on the first use. Death does not appear to be related to dose.

Pharmacologic Management

Pharmacologic treatment in substance abuse has two main purposes: to permit safe withdrawal
from alcohol, sedative-hypnotics, and benzodiazepines and to prevent relapse.

 Benzodiazepines. Alcohol withdrawal is usually managed with a benzodiazepine-

anxiolytic agent, which is used to suppress the symptoms of abstinence.
 Disulfiram. Disulfiram (Antabuse) may be prescribed to help deter clients from
drinking.
 Acamprosate. Acamprosate (Campral), may be prescribed for clients recovering
from alcohol abuse or dependence to help reduce cravings for alcohol and
decrease the physical and emotional discomfort that occurs especially in the first
few months of recovery.
 Methadone. Methadone, a potent synthetic opiate, is used as a substitute for
heroin in some maintenance programs.
 Levomethadyl. Levomethadyl is a narcotic analgesic whose only purpose is the
treatment of opiate dependence.
 Naltrexone. Naltrexone (ReVia) is an opioid antagonist often used to treat an
overdose. It can also be used to treat alcohol abuse.
Treatment
  Detoxification: You stop taking drugs, allowing the drugs to leave the body. You may
need healthcare supervision to detox safely.
 Behavioral therapies: Cognitive behavioral therapy or other psychotherapy (talk
therapy) can help deal with addiction’s cause. Therapy also helps build self-esteem and
teaches healthy coping mechanisms

Preventing a relapse

Once you've been addicted to a drug, you're at high risk of falling back into a pattern of
addiction. If you do start using the drug, it's likely you'll lose control over its use again — even if
you've had treatment and you haven't used the drug for some time.

 Stick with your treatment plan. Monitor your cravings. It may seem like you've
recovered and you don't need to keep taking steps to stay drug-free. But your chances of
staying drug-free will be much higher if you continue seeing your therapist or counselor,
going to support group meetings and taking prescribed medication.

 Avoid high-risk situations. Don't go back to the neighborhood where you used to get
your drugs. And stay away from your old drug crowd.

 Get help immediately if you use the drug again. If you start using the drug again, talk
to your doctor, your mental health professional or someone else who can help you right
away.


Nursing Assessment

Assessment of a client with substance abuse disorder include:

 History. Client with a parent or other family members with substance abuse

problems may report a chaotic family life, although this is not always the case.
 Thought process and content. During the assessment of thought process and
content, clients are likely to minimize their substance abuse, blame others for their
problems, and rationalize their behavior.
 Sensorium and intellectual process. Clients generally are oriented and alert
unless they are experiencing lingering effects of withdrawal.
 General appearance and motor behavior. Assessment of general appearance
and behavior usually reveals appearance and speech to be normal.
 Self-concept. Clients generally have low self-esteem, which they may express
directly or cover with grandiose behavior.
Nursing Interventions

Nursing interventions for a client with substance abuse include:


Providing health teaching for client and family. Clients and family members
need facts about the substance, its effects, and recovery.
 Communicate. Talk to your children about the risks of drug use and misuse.

 Listen. Be a good listener when your children talk about peer pressure, and be supportive
of their efforts to resist it.

 Set a good example. Don't misuse alcohol or addictive drugs. Children of parents who
misuse drugs are at greater risk of drug addiction.

 Strengthen the bond. Work on your relationship with your children. A strong, stable
bond between you and your child will reduce your child's risk of using or misusing drugs.

 Addressing family issues. Without support and help to understand and cope,

many family members may develop substance abuse problems of their own, thus
perpetuating the dysfunctional circle; treatment and support groups are available
to address issues of family members.
 Promoting coping skills. Nurses can encourage clients to identify problem areas
in their lives and to explore the ways that substance use may have intensified
those problems.
 Getting involved in counseling or therapy with a professional therapist or licensed drug
and alcohol counselor
 Continuing to participate in therapy until your counselor or therapist advises that you are
ready to complete the program
 Seeking an evaluation from a mental health professional if you have signs of mental
health problems (dual diagnosis)
 Getting involved with a support group (such as Alcoholics Anonymous or Narcotics
Anonymous) and committing to regular ongoing meetings
 Sharing your experiences with other recovering alcoholics or addicts
 Balancing your schedule to avoid excess amounts of idle time
 Establishing a regular exercise routine (with the approval of your healthcare provider).
Exercise has been shown in some studies to be effective for improving depression; it was
also found to be an effective add-on treatment for those taking anti-depressant
medications.6
 Adopting a stress-reduction program—such as yoga—aimed at helping to cope with daily
stressors
Nursing diagnoses