Addiction Studies Unit 1

Ati
PSYCHOLOGY INSTITUTE
Distance Learning
Diploma
In
Addiction Studies
Unit 1:
Types of Addiction
ATI Psychology Training Institute, 38 Lower Leeson Street, Dublin 2. 01-6629737 www.psychology.ie
Table of Contents:
Page:
Introduction
l
Understanding Addiction
1-3
Defining Addiction
4-6
DSMIV Criteria for Addiction
6-8
The Words We Choose Matter
9
The Hazards of Drug Abuse
10
Dependence and Addiction
10-12
Atmosphere of Change
13-21
Drug Classification
22-33
Types of Drugs
34~35
Depressants: Opiates
43_44
Benzodiazepines
45_47
Alcohol
47-49
Stimulants: Cocaine & Crack
50-53
Amphetamines
53-59
Caffeine
Nicotine
60
60-61
Stimulatory Hallucinogens
Psychogenics: LSD
Magic Mushrooms, Mescaline
Cannabis
Miscellaneous: Nitrates-Inhalants
Poppers
Sports Drugs
Sources:
36-43
Barbiturates
62-64
64
65
65-68
68-69
69-70
70-71
72
Introduction
It is rare to come across anybody who feels neutral or unconcerned about
the issues surrounding addiction and drugs. This is because you don't have to
be a user to be profoundly affected by them on a personal level. Parents are
concerned about what their children are up to; teachers, doctors, lawyers
come into contact with drug use in the course of their work; and almost
anyone who opens a newspaper can read about the consequences, the victims,
the crimes and the horror stories.
This first unit introduces you to the types of addiction - what are the
substances used and what do they do.
Understanding addiction
The word 'addiction' conjures up many different images and often strong
emotions. It is rare to come across anybody who feels neutral or unconcerned
about the issues surrounding addiction. We have all seen horrendous images
of addiction on the news, in the papers, and on the streets around us. We may
have personal experiences to add to these views - family members, family
stories, friends, or ourselves, which cause emotional reactions when we think
of addiction. But what are we reacting to? Too often we focus on the
symptoms rather than the causes. We look at the consequences on health and
associated crime, and we are frightened. To understand addiction it is
important to understand who is addicted and what the root problems are
which underlie the addiction.
Domestic violence is often linked to substance abuse: Men who beat up their wives often drink or
do drugs; parents who abuse and neglect their children are often alcoholics or dependent upon
drugs; those who sexually exploit children are often drunk or high when they do so. Drugs and
alcohol are also used to perpetuate the cycle of violence and abuse: Sometimes, abusers use
alcohol and other drugs as a way of luring and manipulating their victims.
In the bigger picture, addiction is blamed for broken families and weakened communities, lost
wages and soaring health care costs. Intravenous drug use is also faulted for fuelling the rapid
spread of HIV/AIDS, another huge and intractable global problem.
Drug cartels undermine governments and corrupt legitimate businesses. Revenues from illicit
drugs fund some of the most deadly armed conflicts. Parents are concerned for their children,
people are concerned for their partners, and maybe we are all concerned for how society is
going.
Now we understand that addiction can fuel multiple behaviors and negative
outcomes. But consider for a moment who these people are who have
substance addictions.
Images of Addiction
Look at the 4 images on the following page. Which do you think might portray
an image of addiction?
(c)
(d)
In reality, all, any or none of the above could show pictures of addiction.
That could be one of the more difficult aspects about the subject - we
sometimes just don't know who has an addiction.
View / Interact:
National Geographic Channel, (n.d.). Addiction speaks. Available from,
http://www.encyclopedia.com/video/kOPOK24g9Cc-addicts-speak.aspx
One facet of addiction is that the person feels a compulsion to use a substance,
even though they know that using that substance is causing problems in other
areas of their lives. This may leave you to wonder what types of emotions must
be present in order to allow this spiral of abuse.
Read a bit about the feeling's of various drug and alcohol abusers. You can
conduct an internet search for abuse recovery stories, or choose a story here
from the "Alcoholics" or "Addicts" sections:
http://www.anonymousone.com/stories.htm. Read at least two personal
accounts, paying close attention to the emotions of the writer before, during
and after addiction or use.
^mtrnm
Think about it:
P'cfc three words from the following list that you think could most closely
describe the feelings of people caught up in addiction:
Enthusiastic
Moody
Excited
Helpless
Troubled
Courageous
Happy
Tired
Hopeful
Patient
Regretful
Lonely
Popular
Confused
Intelligent
Anxious
Unhappy
Friendly
Warm
Bitter
It is not a trick question, but the answer is that any of the above list can
describe the feelings. Just as in the previous pictures, it is important to
try to let go of any stereotypes we might have, so that we can approach
addiction with an open mind.
r
Defining Addiction
Take a moment to close your eyes and relax. Consider what you truly believe
that addiction is. Ask yourself, what is addiction? What does it mean to be
addicted? The answers are not always straight forward, however, it is
important, for the purpose of learning, to have basic definitions to work from.
Refer to the Glossary of Terms. Read the definition for "addiction" and
"addict", and skim over the other definitions.
Also, read the definitions below, noticing how different communities may
emphasise different aspects of the issue.
ad«dic«tion —noun: Dictionary.com
the state of being enslaved to a habit or practice or to something that is psychologically or
physically habit-forming, as narcotics, to such an extent that its cessation causes severe
trauma.
Medical Dictionary:
Merriam-Webster's Medical Dictionary
ad-dic-tion - noun
compulsive physiological need for and use of a habit-forming substance (as heroin, nicotine,
or alcohol) characterised by tolerance and by well-defined physiological symptoms upon
withdrawal
broadly: persistent compulsive use of a substance known by the user to be physically,
psychologically, or socially harmful
Science Dictionary:
The American Heritage Science Dictionary
ad«dic*tion - noun
1. A physical or psychological need for a habit-forming substance, such as a drug or
alcohol. In physical addiction, the body adapts to the substance being used and
gradually requires increased amounts to reproduce the effects originally produced by
smaller doses
2. A habitual or compulsive involvement in an activity, such as gambling
Legal Dictionary: Merriam-Webster's Dictionary of Law
ad«dic«tion - noun
compulsive physiological need for a habit-forming drug (as heroin)
Definitions do have certain aspects in common. They talk of addiction in
terms of:
Compulsions
Habits
Needs
Harm
Withdrawal
Being 'addicted' is to be caught up in the following sequence:
•
•
•
An increasing pressing desire to carry out some activity
Growing anxiety and ever increasing
mental preoccupation if this is
prevented
A sudden and highly rewarding
elimination of tension and desire as
•
the act is carried out
As the glow of satisfaction wears off, a
resumption of the cycle over again.
sleeping not an addictive
r
Supplementary Reading:
Stanton Peele is a well known addiction psychologist. Read his view of
addiction, from the following website:
Peele, S. & Brodsky, A. (1976, Winter), Addiction is a Social Disease.
Addictions, pp. 2-21. Available at, http://www.peele.net/lib/sociald.html
The Origin of the Word Addiction
A person's opinion as to the meaning of addiction is bound up in the dominant
attitudes of the culture and the time they inhabit. Since these attitudes are not
consistent across time, nation or even within quite small sub-groups within
society, the concept of addiction is a slippery one.
Understanding a concept often involves looking at the history of the
phenomenon. Let us take a few minutes to look at the history of addiction and
its place in psychology.
Addictus was a citizen of ancient Rome who had acquired more debt than he
could repay. He was sentenced by the courts into slavery by his creditor. To be
enslaved, therefore, became linked with the notion of addiction - true clinical
addiction makes a person a slave to the substance or behavior to which they
are addicted.
Any individual's opinion as to the meaning of addiction is bound to be
coloured, to a large extent by the dominant attitudes within the culture he or
she inhabits. Since these attitudes are by no means consistent across time,
nation, or even quite small sub-groups within society, the concept is certain to
be a slippery one. Just like our beliefs about the drugs themselves, it is based
on value judgements rather than any serious grip on 'the facts'.
Many definitions of addiction have been written, and there are some common
strands.
Being 'addicted' is to be caught up in the following sequence:
•
an increasingly pressing desire to carry out some activity;
•
growing anxiety and ever-increasing mental preoccupation if this is
resisted or prevented;
a sudden and highly rewarding elimination of tension and desire as the
•
act is carried out;
•
as the glow of satisfaction wears off, a resumption of the cycle all over
again.
It will immediately be recognized that most biological drives conform to this
sequence: eating, drinking, sleeping, and having sex. But leaving aside natural
functions essential for life, there are quite a lot of human activities that fulfil
the addictive sequence but do not involve the ingestion of any substance.
People can get over-involved in all sorts of activities from train-spotting to
hang-gliding, and suffer as a result. There are people whose work compulsion
is as devastating to family life as any heroin habit. All these out-of-control
behaviours can be managed in the same way as drug dependence.
The 'Official' Definitions of Addiction
The American Psychological Association publishes the Diagnostic and
Statistical Manual of Mental Disorders (DSM). This is now on its fourth
version - so is known as DSM -IV, and more specifically DSM -IV TR
(standing for Text Revision). This most recent version was published in 2002.
DSM - V is due out in 20i3.The DSM-IV provides a complete description of
all mental disorders currently recognized by the American Psychological
Association as well as diagnostic criteria. The World Health Organisation
(WHO) also publishes diagnostic guidelines for 'Dependence Syndrome'.
Their classification is known as ICD-10.
DSM-IV- Definitions ofSubstance Abuse and Dependence
On the continuum of drug/alcohol use,
abuse, dependence
(addiction/alcoholism) the criteria for determining addiction to drugs or
alcohol and/or alcoholism is clearly spelled out by the American Psychological
Association in their Diagnostic and Statistical Manual of Mental Disorders
(DSM-IV). The definition is key to intervention with drug/alcohol abusers as
it classifies abusive drug/drinking behaviours and impacts on the type of
treatment that medical insurance will cover.
The term drug encompasses alcohol and, from this point forward, alcohol is
included in the term 'drug'. In turn, the DSM-IV uses the term 'substance' to
encompass drugs of abuse, medication or a toxin.
The term substance abuse involves one or more ofthe following:
• Failure to fulfil major obligations
• Use when physically hazardous
• Recurrent legal or career problems
• Recurrent social or interpersonal problems
With substance abuse the user has a choice: he/she uses in spite of illegal,
unsafe consequences, or inappropriateness ofthe drinking/drugging
experience.
The DSM-IV provides the following substance dependence Criteria (Addiction
/ Alcoholism)
Addiction (termed substance dependence by the American Psychiatric Association) is defined as a maladaptive pattern of
substance use leading to clinically significant impairment or distress, as manifested by three (or more) of the following,
occurring any time in the same 12-month period:
1. Tolerance, as defined by either of the following:
(a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect
or
(b) Markedly diminished effect with continued use of the same amount of the substance.
2. Withdrawal, as manifested by either of the following:
(a) The characteristic withdrawal syndrome for the substance
or
(b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms.
3. The substance is often taken in larger amounts or over a longer period than intended.
4. There is a persistent desire or unsuccessful efforts to cut down or control substance use.
5. A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its
effects.
6. Important social, occupational, or recreational activities are given up or reduced because of substance use.
7. The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely
to have been caused or exacerbated by the substance (for example, current cocaine use despite recognition of cocaineinduced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption).
DSM-IV criteria has been developed to include various specifiers, including a
category that defines substance dependence that includes physiologic
dependence (where tolerance can be built up and withdrawal symptoms occur
upon cessation) and those without physiologic dependence (where there is no
evidence that tolerance builds or withdrawal occurs upon quitting). This
definition allows cocaine, which has no real physical withdrawal symptoms, to
still be categorized as a substance to be abused.
The DSM-IV-TR defines this by specifying the following:
With Physiological Dependence -evidence of tolerance or withdrawal
(i.e. item #1 or #2 is present)
Without Physiological Dependence - no evidence of tolerance or withdrawal
(i.e. neither item #1 nor item #2 is present) (DSM-IV-TR p. 198.)
In addition, remission categories are classified into four subtypes:
(i)full
(2) early partial
(3) sustained, and
(4) sustained partial
Dependence syndrome
The Tenth Revision of the International Classification of Diseases and Health
Problems (ICD-10) specifies that dependence syndrome is made up of a
number of attributes, encompassing physical, behavior-based and mental
processes which allow the user to placetheir drug, and the need to procure the
drug, above everything else in their life. According to the ICD-10, "A central
descriptive characteristic of the dependence syndrome is the desire (often
strong, sometimes overpowering) to take the psychoactive drugs (which may
or not have been medically prescribed), alcohol, or tobacco." Furthermore, the
ICD-10 believes that if a person is addicted, then abstains or "recovers" for
some period of time, it is easier for them to have a relapse than it is for a nonaddicted person to develop a new addiction.
In the 1960s, the term "dependence" began to replace terms such as
"addiction." This dependence refers to both psychological and physical need.
ICD-10 Diagnostic guidelines
A definitediagnosisof dependenceshould usually be made onlyif three or more of the following
have been present together at some time during the previous year (WHO, 2010):
• A strong desire or sense of compulsion to take the substance;
•
Difficulties in controlling substance-taking behaviour in terms of its onset, termination, or
levels of use;
•
A physiologicalwithdrawal state when substance use has ceased or have been reduced, as
evidenced by: the characteristic withdrawal syndrome for the substance; or use of the same
(or closelyrelated) substance with the intention of relievingor avoidingwithdrawal
symptoms;
•
Evidence of tolerance, such that increaseddoses of the psychoactive substance are required
in order to achieve effects originallyproduced by lower doses (clear examples of this are
found in alcohol-and opiate-dependent individuals who maytake daily doses sufficientto
incapacitate or kill non-tolerant users);
•
Progressiveneglect of alternative pleasures or interests because of psychoactive substance
use, increased amount of time necessary to obtain or take the substance or to recover from
its effects;
•
Persisting with substance use despite clear evidenceof overtlyharmful consequences,such
as harm to the liverthrough excessive drinking, depressive mood states consequentto
periods of heavy substance use,or drug-related impairment ofcognitive functioning;
efforts shouldbe madeto determinethat the user wasactually, or couldbe expected to be,
aware of the nature and extent of the harm.
-
Think about:
Perhaps you have difficulties with the above
categorisations.
The language might not fit your understanding?
It might be unnecesarily medical?
What, if anything do you find difficult?
One final set of definitions - and this time, perhaps more easily
understandable:
Prominent addiction specialist Charles Roper (n.d.) conceptualized addiction
in a meaningful way, breaking drug and alcohol use into a variety of
categories: Social user, substance abuser, and addict.
According to Roper, a social user uses intoxicating substances infrequently, as
a means of enhancing enjoyment in normally pleasurable, social situations.
This type of user experiences no negative consequences from their imbibing,
no loss of control and no need to limit their use of the substance.
An abuser, however, uses intoxicating substances to enhance their pleasure in
life, but also to make up for negatives in their life including physical or
emotional pain, fear or anger. The abuser may have occasional negative
occurrences as a result of their use and may feel the need to limit their
substance use in some way.
An addict is one who uses intoxicating substances frequently, for every
occasion from celebration to dealing with negative life issues. The addict often
experiences repeatedly negative consequences as a result of their use, tries to
limit their use but fails, does not listen when others express concern over the
drug use, engages in unpredictable behaviour when intoxicated or seeking
their substance, experiences memory loss or confusion as wrell as withdrawal
symptoms if they go without the substance.
The Words We Choose Matter
How a person or behaviour is labelled has an impact on how society views that
person or behaviour. Thus, it is important that psychology workers use
language that does not judge or stigmatize the person, but rather words which
effectively describe the behaviour or situation. The right word can inform,
educate, support and unify people in their efforts to deal with problems.
However, the wrong word can shame, discourage, misinform and embarrass
people.
By choosing language that is not stigmatizing, we can begin to dismantle the
negative stereotype associated with addiction.
The National Alliance ofAdvocates for Buprenorphine Treatment has a
comprehensive listing of acceptable terms and those to be avoided, with
descriptions of why each is to be used or avoided. Read their suggested terms
at: http://www.naabt.org/documents/Languageofaddictionmedicine.pdf
The Hazards of Drug Abuse
The hazards associated with drug abuse have traditionally been described in
terms of the risk of a fatal overdose combined with the risk of addiction.
Overdoses
It is usual to describe the hazards of a given drug in terms of physical toxicity
with the associated risk of fatal overdoses. Many drugs have a high overdose
potential, e.g. Heroin and other opiates
Cocaine,
Barbiturates
Alcohol
Solvents
However many other harmful drugs are not poisonous, e.g. LSD.
Dependence and Addiction
Another well-recognised hazard is the risk of 'addiction' or more properly
dependence. The term 'drug dependence' was introduced in 1964 by the World
Health Organisation WHO) in an attempt to break away from a narrow
extreme view of addiction centred almost exclusively on morphine and where
other forms of drug addiction were downgraded in importance. The 1964
approach proposed that each drug type should be seen as giving rise to its own
particular type of dependence, e.g. dependence of the opiate-type and
dependence of the cocaine-type etc.
Physical dependence may result from the body's adaptation to the repeated
use of the drug and if the drug is abruptly stopped there is a rebound effect
resulting in physical symptoms of illness ("Withdrawal'). Psychological factors
play a very important role in dependence through the reinforcing nature of
many drugs, i.e. the reward in terms of pleasure, feeling of well-being,
calmness etc., which may be obtained when the drug is taken.
Many drugs are known to result in compulsive addictive use after repeated
and sometimes even occasional use.
10
Physical and Psychological Dependence:
Heroin and other opiates
Alcohol
Barbiturates
Minor Tranquillisers
Psychological Dependence:
Nicotine
Cocaine
Amphetamine
Cannabis
Terms such as Addiction or 'Dependence' are too broad to adequately describe
the variety of compulsive drug using behaviours which are now recognised.
Instead, attempts have been made to describe a series of 'Drug Dependence
Syndromes' which could include some or all of the following elements:
• Tolerance.
As a result of repeated drug use, the human body adapts to the drug in
different ways. It could eliminate the drug more quickly or the cells of the
brain could adapt to the drug with the result that it is necessary to increase the
amount of drug consumed to obtain the same level of drug effect. As a result of
this tolerance to the drug, a heroin addict can take up to loomg or more in
one injection which is 10 times the normal medical dose and is a dose which
would probably kill an ordinary person.
• Withdrawal Symptoms.
These are the body's reaction to the sudden absence of a drug to which it has
adapted. Withdrawal symptoms tend to be the opposite of the effects of the
drug itself, e.g. withdrawal of a depressant drug can cause excitement,
whereas withdrawal from a stimulant may result in depression. Such effects
vary from the alcohol 'hangover' to the fatigue and depression associated with
stimulants and the chills, pains and influenza-like symptoms of heroin
withdrawal. With some drugs, e.g. barbiturates, there is the risk of
convulsions and even sudden death during withdrawal.
• Withdrawal Relief
There are only two ways of abolishing withdrawal symptoms, one is time, as
the body returns to normal functioning without the drug and the other is to
take another dose of the drug or a substitute for it such as Methadone in the
case of heroin. Common examples of the latter approach include the use of
alcohol in the form of the so-called 'hair of the dog* to cure a hangover or the
smoking of an early morning cigarette to abolish the irritability and mild
agitation associated with nicotine withdrawal. In the case of opiates, the use of
the next 'fix' of heroin to abolish withdrawal is a key reinforcing element in the
addiction process.
11
• Relapse
The tendency for drug dependent persons who have abstained from drug use
for a period of time to resume drug taking after treatment is extremely high.
This is one of the reasons why treatment of addiction is so difficult.
Dependence is more likely when a drug is injected than when taken in other
ways. This is partly due to the fact that high doses are common, partly due to
the 'rush' with its immediate satisfaction, and partly connected with the
meaning of the injection ritual to the user. For some, the injection routine may
become as important as the effect of the drug, and if no drugs are available
almost anything will be injected. Nevertheless, dependence can occur with any
method of drug-taking. Dependence does not always occur or may take some
time to develop.
Obtaining consensus as to what constitutes a 'drug' is not easy. A
pharmacologist might define it as any substance capable of modifying one or
more of the functions within a living organism. Many people have difficulty in
seeing their enjoyment of alcohol in the context of drug use, let alone the
caffeine-containing drinks. Yet in Britain 200 years ago, people generally
viewed coffee as a substance with a powerful psychoactive effect, and its
regular users were often looked upon with disapproval; rather similar to the
way cannabis is seen today.
Criteria for severity of psychoactive substance dependence
Mild: Few, if any, symptoms in excess of those required to make the
diagnosis, and the symptoms result in no more than mild impairment in
occupational functioning or in usual social activities or relationships with
others.
Moderate: Symptoms or functional impairment between 'mild' and 'severe'.
Severe: Many symptoms in excess of those required to make the diagnosis,
and the symptoms markedly interfere with occupational functioning or with
usual social activities or relationships with others.
In Partial Remission: During the past 6 months, some use of the
substance and some symptoms of dependence.
In Full Remission:
During the past 6 months, either no use of the
substance, or use of the substance and no symptoms of dependence.
Because of the availability of cigarettes and other nicotine-containing
substances and the absence of clinically significant nicotine intoxication
syndrome, impairment in occupational or social functioning is not necessary
for a rating of severe Nicotine Dependence.
12
It is an essential characteristic of the dependence syndrome that either
substance taking or a desire to take a particular substance should be present;
the subjective awareness of compulsion to use drugs is most commonly seen
during attempts to stop or control substance use. This diagnostic requirement
would exclude, for instance, surgical patients given opiate drugs for the relief
of pain and who may show signs of an opiate withdrawal state when drugs are
not given, but who have no desire to continue taking drugs.
The dependence syndrome may be present for a specific substance (e.g.
tobacco or diazepam); for a class of substances (e.g. opiate and opioid drugs);
or for a wider range of different substances (as for those individuals who feel a
sense of compulsion regularly to use whatever drugs are available and who
show distress, agitation, and/or physical signs of a withdrawal state upon
abstinence).
Atmosphere of Change:
Men's courses will foreshadow certain ends, to which, if persevered in,
they must lead...But ifthe courses be departedfrom, the ends will change.
Say it is thus with what you show me!
- Ebenezer Scrooge to the Ghost of Christmas Yet to Come, in
Charles Dickens, A Christmas Carol
Healers in all ages have sought to understand and to create the conditions that
lead to beneficial change. Precisely what therapeutic steps are taken depend
upon the assumptions of those involved. In the pre-scientific history of
medicine, a wild array of cures were prescribed, including bleeding, heating or
chilling the body, applying leeches, inducing insulin shock, dunking or
spinning the person, inducing vomiting, raising blisters, exorcism, and
administering many natural powders and potions. Some of these treatments
were effective in some cases. It happened on occasion that the prescribed cure
was appropriate for the particular affliction because of biomedical principles
that had not yet been discovered. Most of the benefit from such ministrations,
however, is not thought to be attributable to o" factors underlying treatment.
Yet simply to rename certain healing effects as 'placebo' or 'non-specific' is not
to understand or explain them. Substantial changes are often observed
following the administration of a placebo or minimal intervention, often
rivalling in magnitude the effects of 'treatment.' Faithful compliance with
placebo treatment has been found to be predictive of favourable outcome.
What is going on here? If benefit is not due to the 'specific' effects of
treatment, what accounts for change?
Consider another piece of the puzzle. Research indicates that across a broad
range of schools of therapy, certain characteristics of therapists are associated
with successful treatment. Therapistsworking in the same setting and offering
the same treatment approaches show dramatic differences in their rates of
client dropouts and successful outcomes. The apparent variations in
effectiveness among therapists within specific treatment approaches
13
sometimes exceed those among different treatment modalities. A majority of
client dropouts at a particular clinic may occur within the caseloads of a few
staff members, and therapist characteristics predicting high dropout rates
may be as subtle as vocal tone. In sum, the way in which a therapist interacts
with clients appears to be nearly as important as - perhaps more important
than - the specific approach or school of thought from which she or he
operates.
This suggests that therapist style, a variable often ignored in outcome
research, is a major determinant of treatment success. A majority of variance
in treatment outcome cannot be accounted for, even by a combination of
client pre-treatment and post-treatment characteristics and the specific
treatment events offered. Recent studies suggest that a substantial proportion
of this unexplained variance may be related to therapist style characteristics. A
study at the University of New Mexico found that about two-thirds of the
variance in 6-month drinking outcomes could be predicted from the degree of
empathy shown by therapists during treatment. Therapist empathy still
accounted for half of the variance in outcomes at 12 months, and a quarter of
variance at 24 months after treatment. Similar effects of therapist empathy
have been reported in other studies.
Specifying Non-specifics
This is not a new insight. For decades it has been recognised that 'non-specific'
factors contribute to treatment. The original use of this term implied that such
factors are not specific to particular treatment methods, but cut across all
styles of therapy. They are, in essence, those mysterious common healing
elements presumed to be present in all forms of therapy.
But there is nothing necessarily mysterious about 'non-specifics.' Viewed in
another way, this term simply means that these determinants of outcome have
not yet been adequately specified. 'Non-specifics' are unspecified principles of
change. If these factors account for a large part of treatment success, then it is
important that they be specified, researched, discussed, and taught. In fact,
therapists vary dramatically in their effectiveness, and specific treatment
approaches or philosophies differ in the extent to which they foster certain
therapist styles.
It appears that therapist style characteristics manifest themselves relatively
early in the treatment process, and indeed can have a significant impact
within a single session. The therapeutic relationship tends to stabilise
relatively quickly, and the nature of the client-therapist relationship in early
sessions predicts treatment retention and outcome.
Critical Conditions ofChange
The most clearly articulated and tested theory regarding critical therapist
conditions for change is that of Carl Rogers (1959). Rogers asserted that a
client-centred interpersonal relationship, in which the therapist manifests
three crucial conditions, providesthe ideal atmosphere for change. Within the
context of such a safe and supportive atmosphere, he maintained, clients are
14
able to explore their experiences openly and to reach resolution of their own
problems. The therapist's role, in this view, is not a directive one of providing
solutions, suggestions, or analysis. Instead, the therapist need only offer the
three critical conditions to prepare the way for natural change: accurate
empathy, non-possessive warmth, and genuineness. The key insights of
Rogers have been well translated into practice by his students and by other,
more recent writers - e.g. Egan, Gordon, Ivey; Truax & Carkhuff.
Subsequent evidence has supported the importance of these conditions of
change, particularly accurate empathy. This condition should not be confused
with the meaning of 'empathy' as identification with the client, or as the
sharing of common past experiences. In fact, a recent personal history of the
same problem area (e.g. alcoholism) may compromise a counsellor's ability to
provide the critical conditions of change, because of over-identification. What
Rogers defines as 'accurate empathy' involves skilful reflective listening that
clarifies and amplifies the client's own experiencing and meaning, without
imposing the therapist's own material.
Manifestation of these critical conditions - especially accurate empathy has
been found to promote therapeutic change in general and recovery from
addictive behaviours in particular.
The Evolution ofConfrontation: Where Did We Go Wrong?
This picture of the conditions that create a favourable atmosphere for change
stands in sharp contrast to approaches often advocated (particularly in the
United States) for treating people with alcohol problems and other addictive
behaviours. Consider this quote, from the front page of The Wall Street
Journal, describing a representative confrontational intervention directed at
an executive:
They called a surprise meeting, surrounded hint with
colleagues critical of his work and threatened to fire him if he
didn't seek help quickly. When the executive tried to deny that
he had a drinking problem, the medical director came down
hard. 'Shut up and listen' he said. 'Alcoholics are liars, so we
don't want to bear what you have to say.' (Greenberger, 1983, p.i)
Some therapy groups, particularly those organised around a Synanon
therapeutic community model, have employed what is called 'attack therapy,*
'the hot seat,' or 'the emotional haircut.' Here is a sample from the lips of
Chuck Dederich, founder of Synanon, to a Mexican-American addict:
'Now, Buster, I'm going to tell you what to do. And 111 show
you. You either do it or you'll get the hell offSynanon property.
You shave off the moustache, you attend groups, and you
behave like a gentleman as long as you live here. You don't like
it here? God bless you, III give you the same good wishes that I
gave other people like you when they left and went off to jail.
That's the way we operate in Synanon; you see, you're getting
a little emotional surgery. If you don't like the surgery, fine, go
15
and do what you have to. Maybe well get you again crfter you
get out of the penitentiary or qfter you get a drug overdose.
'Nobody tells me what to dot' Nobody in the world says that
except dingbats like dope fiends, alcoholics, and brush-facecovered El Gatos'. (Yablonsky, 1989, p. 122)
Approaches such as these would be regarded as ludicrous and unprofessional
treatment for the vast majority of psychological or medical problems from
which people suffer. Imagine these same words being used as therapy for
someone suffering from depression, anxiety, marital problems, sexual
dysfunction, schizophrenia, cancer, hypertension, heart disease, or diabetes.
Aggressive confrontational tactics have been largely reserved for those
suffering from alcohol and other drug problems, and for certain other groups
such as criminal offenders.
It is commonly believed that such individuals need this different kind of
treatment, and are not affected by ordinary therapeutic principles and
processes. Confrontation of this harsh variety has been believed to be uniquely
effective perhaps the only effective strategy for dealing with alcoholics and
addicts. Yet confrontational strategies of this kind have not been supported by
clinical outcome studies. Therapist behaviours associated with this approach
have been shown to predict treatment failure, whereas accurate empathy - an
almost exact opposite of hostile confrontation - is associated with successful
outcomes. Confrontational therapy, in fact, has been found to yield more
harmful and adverse outcomes than alternative approaches, and may be
particularly damaging for individuals with low self-esteem. There is, in short,
no persuasive evidence that aggressive confrontational tactics are even
helpful, let alone superior or preferable strategies in the treatment of addictive
behaviours or other problems.
Where did we go wrong? How did we come to believe that a certain class of
human beings is possessed of a unique condition that requires us to use
aggressive confrontation if we wish to help them? How did it become
believable, justifiable, and acceptable to rely upon such hostile tactics for
addressing certain addictive behaviours, when these same approaches would
be seen as reflecting at best poor judgement (if not malpractice) in treating
most other psychological and medical problems?
These tactics are sometimes associated with and attributed to the Twelve-Step
fellowships, perhaps because treatment programs that have used them have
also commonly embraced the philosophy of Alcoholics Anonymous (AA) or
Narcotics Anonymous (NA). Yet this kind of coercive confrontation is wholly
at odds with the origins of AA, as reflected in the writings of Bill Wilson
(Alcoholics Anonymous, 1976). AA is meant to operate by attraction and
support: 'Recovery begins when one alcoholic talks with another alcoholic,
sharing experience, strength, and hope'.
Wilson advocated an approach to life that 'would contain no basis for
contention or argument... Most of us sense that real tolerance of other
people's shortcomings and viewpoints and a respect for their opinions are
attitudes which make us more useful to others'.
16
Writing on how to work with alcoholics, Wilson advised:
Let him steer the conversation in any direction he likes... You will be most
successful with alcoholics if you do not exhibit any passion for crusade or
reform. Never talk down to an alcoholic... He must decide for himself whether
he wants to go on. He should not be pushed or prodded... If he thinks he can
do the job in some other way, or prefers some other spiritual approach,
encourage him to follow his own conscience. We have no monopoly on God;
we merely have an approach that worked with us. (Alcoholics Anonymous,
1976, p.95)
Clearly, Bill Wilson did not favour coercive, directive, and authoritarian tactics
in dealing with alcoholics. These are, in fact, anathema to the 'gentle approach
and spiritual way' of life he outlined in 'the big book.'
Motivation as a Personality Problem
A key assumption underlying aggressive confrontational strategies is that
alcoholics (drug addicts, offenders, etc.) - as a class and as an inherent part of
their condition - possess extraordinarily high levels of certain defence
mechanisms, which render them inaccessible by ordinary means of therapy
and persuasion. It has been believed that these are deeply ingrained in such
individuals' personality and character. This assumption appears to have arisen
from psychodynamic thinking, which viewed alcohol and other drug problems
as symptomatic of a personality disorder. The disorder was believed to be
reflected in excessive reliance upon some of the more primitive ego defence
mechanisms described by Anna Freud (1948). This view was adopted and
espoused by influential early professionals in the alcoholism field, such as
psychiatrist Ruth Fox (1967), who summarised her clinical experience in
psychodynamic terms: 'Most patients refuse to face their alcoholism for many
years, using the defence mechanisms of denial, rationalisation, regression,
and projection' (p. 772). The alcoholic, she wrote, 'builds up an elaborate
defence system in which he denies that he is alcoholic and ill, rationalises that
he needs to drink for business or health or social reasons, and projects the
blame for the trouble he is in' (p.771). These alleged attributes came to be seen
as universal, inherent elements of the character structure of alcoholics and
drug addicts, and substantial impediments to recovery. 'The layers of denial in
alcoholism run deep and present an almost impenetrable wall'.
Once the assumption of pernicious inherent defence mechanisms is accepted,
the question follows: How should one deal with such robust and formidable
defences? The processes through whichthe recovering person must pass came
to be described in such terms as 'surrender,' 'accepting powerlessness,' and
'reduction of ego'. These concepts arose with or evolved from the AAidea that
an alcoholic naturally 'hits bottom' in the course of his or her drinking career.
Gradually this idea of hitting bottom came to be reformulated as a
developmental crisis that might be precipitated or hastened by intervention
strategies. The perceived need for 'surrender' suggestedthe tactic of attacking
defences. The stage was set for the entry of confrontation.
17
This idea of using confrontation to crush defences was particularly
championed by Vernon Johnson (1973), and came to be associated with a
broad and influential treatment philosophy known as 'the Minnesota model.'
Legitimate interest in the biomedical 'disease' aspects of addictive behaviours
became confused with the belief that chemical dependency represents a
unique personality disease that renders sufferers qualitatively different from
normal individuals or those with other problems, and incapable (by virtue of
denial) of seeing reality.
The primary factor within (alcoholism) is the delusion, or
impaired judgement, which keeps the harmfully dependent
person locked into his self-destructive pattern... The alcoholic
evades or, denies outright any need for help whenever he is
approached. It must be remembered that he is not in touch with
reality". (Johnson, 1973, p.44)
This condition can be seen as justifying the use of unusually aggressive
treatment strategies and, by virtue of the poor judgement supposed to inhere
in the condition, coercive intervention.
However, the approach espoused by Johnson (1973) is in fact a broad one, and
described a form of counselling that is more compassionate than aggressive.
Programs espousing the Minnesota model have more recently repudiated
aggressive confrontation and emphasised gentler approaches (Hazelden
Foundation, 1985; Johnson Institute, 1987). It appears, then, that
responsibility for the practice of aggressively confrontational counselling
tactics cannot be assigned to Johnson, the Minnesota model, or AA.
There seems to be no single clear historic source for the aggressively
confrontational
tactics
that
sometimes
dominate
addiction
treatment
programs. Certainly a strong emphasis on ego reduction through
confrontation is found in Synanon, which was founded by an alcoholic
recovering through AA, and became a prototype for therapeutic communities.
Proponents of Synanon and the similar Daytop model, working with younger
drug addicts, developed and promoted approaches that manifest the more
authoritarian, aggressive, and coercive meanings often associated with the
term 'confrontational.'
Such confrontational approaches, reflected in the examples provided earlier,
do not arise from any coherent theoretical understanding of the addictive
behaviours. They are inconsistent with the precepts of AA (Alcoholics
Anonymous, 1976) as outlined by Bill Wilson, and violate the empathic tone of
Johnson's (1973) writings. They appear to have arisen gradually in practice,
guided in part by the vaguely psychodynamic belief that alcoholics and others
with drug problems are characterised by 'an addictive personality' or
unusually 'strong defences.'
18
The Search for an Addictive Personality
Curiously, this idea of a common alcoholic or addictive personality is
supported neither in the original writings of AA, nor by five decades of
psychological research. Vaillant (1983), tracing a group of men over 40 years
of development, found no distinctive personality traits predictive of adult
alcoholism. When defence mechanisms have been operationally defined and
specifically examined, denial has been found to be no more characteristic of
alcoholics than of non-alcoholics. Individual-difference measures of denial
within alcoholic populations have also yielded curious results. Successful
outcomes have sometimes been related to higher levels of pre-treatment
denial and non-acceptance of the label 'alcoholic'. Trait denial has been
reported to increase from the beginning to the end of treatment. In sum, there
is not and never has been a scientific basis for the assertion that alcoholics (let
alone people suffering from all addictive behaviours) manifest a common
consistent personality pattern characterised by excessive ego defence
mechanisms.
Denial need not be defined as a personality trait. It may, alternatively, be seen
merely as refusal to admit problems, even conscious deception and lying. Is
problem recognition prognostic of good outcome? Studies have found
acceptance of self-labelling as 'alcoholic' to be unrelated to treatment
outcome, or even negatively related to recovery. A high level of problem
recognition is common among unremitted alcoholics. Again it has not been
shown that individuals with alcohol and other drug problems display
pathological lying or an abnormal level of self-deception; nor does it appear to
be the case that self-labelling promotes recovery.
To summarise, research does not support the belief that there is a common
personality core or set of robust defences that is characteristic of people
suffering from alcohol and other drug abuse. If such people show
consistencies of behaviour (such as resistance or defensiveness) in the
counsellor's office, it appears that they do not possess these consistencies
before walking through the door. Importantly, the combative intervention
strategies suggested by this model appear to be generally ineffective.
The Self-Fulfilling Prophecy
How, then, have professionals become so convinced that alcoholics and other
drug abusers are characterologically denying, lying, rationalising, evasive,
defensive, and resistant people and need to be treated as such? Yablonsky
(1989), for example, opined: 'Almost all substance abusers in the early phase
of the addiction process, when confronted about their addiction deny they are
addicted'. If the consistency does not result from pervasive personality
pathology within this population, then how do these perceptions arise?
There are several possibilities. One is that the observation is simply erroneous,
but is maintained by processes of selective (mis)perception. Chapman and
Chapman (1967) described the phenomenon of 'illusory correlation,' whereby
people can form an inaccurate conviction that two events are associated with
each other. A common example is the mistaken belief that a particular
19
response to Rorschach's inkblot test is indicative of a certain pathological
condition. Thus it was incorrectly believed for some time that people who
reported water precepts in Rorschach's test had alcoholic tendencies (Griffith,
1961). Such beliefs are notoriously difficult to remove. Once the belief has
been established, it is reconfirmed by at least occasional observation of cases
where the two events do coincide, while inconsistent cases are ignored or
forgotten. Racial prejudices can be maintained by this same process. Thus the
belief in the stereotypic 'resistant, denying alcoholic' may be maintained by
the salient memory of particular cases who illustrate these characteristics. The
anecdotal basis of much clinical instruction in this area readily lends itself to
such error. An example becomes a principle.
But selective perception is not the only means by which the denial myth may
be perpetuated. Such perceptions may be based upon regular, repeated
observations of actual behaviours that conform to the belief system. That is,
clients may truly and frequently show behaviours consistent with the clinical
impression of 'denial.' One way in which this may occur is that normal
behaviours may be misinterpreted as abnormal and indicative of pathology.
Oxford (1985) for example maintained that experiences and behaviours that
follow ordinary principles of psychology are mistakenly interpreted as special
symptoms indicative of unique addictive pathology (e.g. denial, craving, loss
of control).
Still another possibility is that the interpersonal style and context of
addictions counselling create behavioural consistencies in clients through
predictable psychological processes. Psychological 'reactance,' for example, is
a predictable pattern of emotion and behaviour that occurs when an
individual perceives that his or her personal freedom is being reduced or
threatened. When a person is accused of possessing an undesirable
characteristic or identity CYou're a liar' or You are an alcoholic'), or is told
that he or she must, should, or cannot do something, the response is
predictable. The person is likely to argue with (deny) the accuracy of what has
been said, and to assert his or her personal freedom. This reaction may be
particularly strong when the topic is one about which the person is
ambivalent. This phenomenon is by no means unique to the addictive
behaviours; it is a general psychological principle.
The point, however, is that certain kinds of counselling strategies particularly
those that are more directive, coercive, or confrontational - are quite likely to
evoke reactance in most people. Consider what happens if these strategies are
employed by a counsellor who suspects clients to be 'in denial.' The
counselling tactics in themselves pull for resistance in a client. When such
reactance is shown, however, it confirms in the counsellor's mind both the
client's diagnosis and the counsellor's general belief that clients of this type
characteristically deny and resist. This is the familiar psychological
phenomenon of 'self-fulfilling prophecy'.
That this is a very real possibility was demonstrated by Patterson and
Forgatch (1985). Observing a recorded series of family therapy sessions, they
classified all therapist and client behaviours and examined interrelationships.
They found that therapist attempts to teach and confront were associated with
20
higher levels of client resistance. In a subsequent experiment, they had
therapists switch back and forth between high and low levels of confrontation,
alternating these styles in blocks of about 12 minutes within sessions. Clients'
resistance behaviours increased substantially during the confrontational
periods, and dropped when the therapists changed style. Using this same
system for recording behaviours of therapists and clients, Miller and
Sovereign (1989) found that problem drinkers randomly assigned to
confrontational counselling showed much higher levels of resistance (arguing,
changing the subject, interrupting, denying a problem) than did those given a
more client-centred motivational interviewing approach. In this same study,
therapist behaviours during a single session were highly predictive of clients'
drinking more than a year later. The more a therapist had confronted, the
more a client was drinking a year later; the more the therapist had been
supportive and listening, the more the client changed.
This, then, offers a rather disturbing alternative explanation of how it is that a
particular client population may show high levels of 'denial', even though this
is not generally characteristic of such clients outside the treatment context.
From the research evidence available, the denial hypothesis - that alcoholics
or 'chemically dependent' people as a class evidence particular personality
abnormalities or unusually high levels of certain defences - is a myth. Whether
it is maintained by illusory correlation, misconstrual of normal ambivalence,
or self-fulfilling prophecy, the evidence simply does not support it. What a
client does typically bring to counselling is ambivalence, and it is the
therapist's handling of such ambivalence that influences the degree of client
resistance and change. The powerful denial myth from the drug counselling
field offers a more general and humbling warning to clinicians: that it is
possible to become quite convinced of mistaken beliefs, even ones that
ultimately lead toward counter-therapeutic attitudes and approaches.
Confrontation: A Goal, Not a Style
Some of the confusion in this area probably arises from the multiple ways in
which people have used the term 'confrontation.' In one sense it connotes the
heavy-handed and coercive tactics of Synanon, Daytop, and Scared Straight. It
suggests uneven power - an authoritarian one-up pounding the truth into a
defiant one-down. This is a style that complements personal or societal
attitudes of anger toward the one-downs, and individual needs for power or
abasement.
Yet in a different sense, confrontation is a goal of all counselling and
psychotherapy, and is a prerequisite for intentional change. 'The goal of the
intervention,' says Johnson, 'is to have him see and accept enough reality so
that, however grudgingly, he can accept in turn his need for help'. More
generally, the purpose of confrontation is to see and accept reality, so that one
can change accordingly. This may or may not happen in the context of
counselling. Certainly it occurs outside treatment. Coming face to face with a
disquieting image of oneself may be the precipitating force in many changes
that occur without formal intervention.
21
In this larger sense, confrontation is a goal, a purpose, an aim. It is part of the
change process, and therefore part of the helping process. Viewed in this way,
confrontation is a goal in many different forms of treatment for a wide variety
of problems (Prochaska & DiClemente, 1984). This kind of awareness-raising
'confrontation' is quite consistent with the client-centred philosophy of Carl
Rogers, who sought to provide people with a therapeutic atmosphere in which
they could safely examine themselves and change. It is found in schools of
psychotherapy that emphasise insight. To see one's situation clearly is a first
step in change. This is the goal of confrontation.
The question, then, is this: What are the most effective ways for helping
people to examine and accept reality, particularly uncomfortable reality?
Drug Classification
This section describes several common schemes for classifying drugs with
psychoactive properties.
Chemical Structure
Compounds are often classified according to their chemical structures.
Although this is useful for medicinal chemists, it does not provide a
meaningful classification scheme for categorizing drug effects. Some
compounds with similar chemical structures produce very similar biological
effects (e.g. morphine, heroin), but others which belong to the same chemical
class often produce much different effects (e.g. apomorphine, nalorphine).
Furthermore, compounds which differ in chemical structure often produce
similar biological effects (e.g. amphetamine, cocaine).
Pharmacological Activity
This scheme classifies drugs according to their primary pharmacological
activity. All compounds produced multiple effects, so what is considered the
primary effect and what is considered the secondary effect varies as a function
of reference point. Often the primary therapeutic use of a compound is
considered its primary effect and thus used to classifyit pharmacologically.
The classification scheme given below focuses on each compound's main
psychotropic effects which in some cases classifies it differently from what
might be considered its primary pharmacological effect (i.e. based on
therapeutic use). For example, pseudoephedrine is a popular decongestant
that has mild stimulatory properties. Pseudoephedrine's decongestant effect
might be considered its primary effect, while its stimulatory effect would be
considered a secondary side-effect. However, from a psychopharmacological
perspective, pseudoephedrine's stimulatory effect is its primary effect and its
decongestant action is a secondary (although therapeutically more useful)
effect. Therefore, pseudoephedrine is classified below as a mild stimulant like
caffeine and nicotine.
22
Abbreviations: ADHD, attention deficit hyperactivity disorder; AIDS
acquired immune deficiency syndrome; CNS, central nervous system; OTC,
over the-counter (non-prescription) medicines.
Drug Class
Opiates/ Opioids/Narcotic
Analgesics
Primary Effects/
Approved Medicinal Uses
Examples
analgesia, cough suppression
anti-diarrhoea, suppression of
opiate withdrawal, sedation;
currently used therapeutically
opium, morphine,
codeine, heroin (diacetyl
morphine), fentanyl,
methadone, meperidine,
L-alpha- acetylmethadol
for the first four effects
(LAAM)
Narcotic/Opiate
Antagonists
block the effects of narcotics,
Psychomotor Stimulants
stimulate psychological and
sensory- motor functioning;
used therapeutically to treat
ADHD and narcolepsy,
sometimes as an appetite
suppressant, occasionally antifatigue formerly for asthma
and for sinus decongestion
amphetamine,
methamphetamine,
similar to psychomotor
caffeine, nicotine,
ephedrine,
pseudoephedrine
Other Stimulants
naloxone,naltrexone
used to treat opiate overdose
stimulants but with much less
efficacy; various therapeutic
effects including caffeine
compounded with aspirin in
some OTC pain relievers,
ephedrine in OTC asthma
medicines, pseudoephedrine
in OTC sinus decongestants
and OTC appetite
cocaine,
methylphenidate
suppressants
Barbiturates
general decrease in CNS
arousal/excitability level; used
therapeutically for anaesthetic
anticonvulsant, sedative, and
hypnotic effects
thiopental, secobarbital,
pentobarbital,
phenobarbital
Minor Tranquillisers
general decrease in CNS
arousal/excitability level, but
includes two subclasses:
benzodiazepines (e.g.
diazepam,
selective for anxiety and much chloridiazepoxide,
less sedative than barbiturates; flunitrazepam
low dose are somewhat
23
used therapeutically as
anxiolytics, benzodiazepines
also as anaesthetics and
anticonvulsants
(Rohypnoll) and muscle
relaxants (e.g.
meprobamate)
Major Tranquillisers
(andtipsychotics/
neuroleptics)
general sedation at high doses,
with selective anti-psychotic
activity at lower doses; used
therapeutically to treat
schizophrenia and other major
psychotic disorders
Haloperidol, pimozide,
flupenthixol,
chlorpromazine,
spiroperidol, clozapine
Antidepressants
no perceptible CNS effects in
normals but effectively
alleviate depression in many
depressives; used
therapeutically to treat
depression
includes three
subclasses: monoamine
oxidase inhibitors (e.g.
pargyline), tricyclic
antidepressants (e.g.
amitriptyline,
desmethylimipramine),
and selective serotonin
reuptake inhibitors
(SSRIs: e.g. sertaline)
Anti-manic
dampens extreme mood
swings in some people; used to
treat manic-depressive
(bipolar) disorders
lithium
Alcohol
general decrease in CNS
arousal/excitability level; no
current therapeutic uses, but
formerly used as an
ethyl alcohol (other
anaesthetic and a sedative
alcohols have similar
actions but are
associated with very
toxic effects, e.g.
methanol)
Volatile Anaesthetics
Volatile Solvents
general decrease in CNS
arousal/excitability level; used
therapeutically for anaesthesia
produce feelings of
intoxication, can produce
hallucinations at high doses;
no therapeutics uses (all can
nitrous oxide, halothane,
ether
toluene, benzene,
naphtha
cause marked brain damage in
moderately low concentrations
Psychogenics
produce altered states of
consciousness; hallucinogenics
reported as 'mystic'
experiences; cannabinoids
usually produce increased
24
includes two subclasses:
hallucinogenics (e.g.
lysergic acid
diethvlaminde (LSD)
mescaline, and
feelings of 'well being' and
'mellow' intoxication, the
cannabinoids (e.g.
marijuana)
'pleasantness' probably
depends partially on
expectancies; no approved
therapeutic uses, but
cannabinoids are being
increasingly used for their
anti-nausea, anxiolytic, and
appetite-stimulating effects in
severely ill patients (e.g. AIDS)
Stimulatory
Hallucinogenics (cf.former
psychotomimetics)
produce a mixture of
psychomotor stimulant and
hallucinogenic effects,
depending on dose and other
factors; no therapeutic uses,
except phencyclidine as a
veterinary anaesthetic
MDMA (ecstasy),
phencyclidine (PCP),
ketamine (?)
Addiction Liability
It is virtually impossible to reach consensual agreement regarding the relative
addiction liability of most drugs. However, scientific agreement is generally
good regarding the drugs that produce the strongest indications of addiction.
These drugs belong to two pharmacological classes - psychomotor stimulants
and opiates - and can be considered the prototypical addictive drugs.
Agreement is also good regarding the relatively low addiction liability of some
over-the-counter medicines, such as aspirin, diphenhydramine (an
antihistamine), and pseudoephedrine (a decongestant). Some commonly used
substances have controversial addiction liabilities (e.g., caffeine, nicotine).
Classes and Schedules
Introduction
The division of controlled drugs into three Classes is a central feature of the
Misuse of Drugs Act 1971 (MDA)(UK). The Classes are linked to maximum
penalties in a descending order of severity, from A to C. The three-tier
classification was designed to make it possible to control particular drugs
according to their comparative harmfulness either to individuals or to society
at large when they were misused. This was a new departure. In introducing
the legislation in 1970, the Home Secretary, Mr. Callaghan,said:
'The object here is to make, so far as possible, a more sensible
differentiation between drugs. It will divide them according to their
accepted dangers and harmfulness in the light of current knowledge and it
25
will provide for changes to be made in the classification in the light of new
scientific knowledge.'
The main drugs in Classes A, B and C
Class A
Includes:
cannabinol and cannabinol derivatives
cocaine (including 'crack'), dipipanone, ecstasy and related
compounds
heroin, LSD, magic mushrooms, methadone, morphine, opium,
pethidine and phenylcyclidine.
Class B drugs which are prepared for injectionare classedas Class A.
Class B
Includes:
amphetamines,
barbiturates,
cannabis (herbal), cannabis (resin),
codeine,dihydrocodeine
methylamphetamine.
Class C
Includes:
anabolic steroids,
benzodiazepines, buprenorphine,
diethylpropion, mazindol
pemoline and phentermine.
Developments since 1971
When the United Nations Convention of Psychotropic Drugs was adopted in
1971, the main drugs brought under international control were already [insert
missing text]. They had been controlled under United Kingdom legislation
since the passage of the Drugs (Prevention of Misuse) Act 1964. Nevertheless
numerous additions have been made to the Classes over the years by order.
Among these are the inclusion of ecstasy in Class A in 1977, barbiturates in
Class B in 1984, certain tranquillisers, particularly the benzodiazepines
(temazepam is probably the most often used illicitly) in Class C in 1985 and
anabolic steroids in Class C in 1996.
Transfers between Classes on the other hand have occurred only twice. The
first occasion was the transfer of nicodicodine from Class A to Class B in 1973.
The second followed the only full review of the Classes carried out since 1971
by the Advisory Council on the Misuse of Drugs. The Council was broadly
satisfied with the classification of controlled drugs. It made only two
recommendations: that cannabis and cannabis resin be transferred from Class
B to Class C, which was not implemented, and that methaqualone (a sedative)
be moved from Class C to Class B, which was.
26
Criteria for classifying drugs
The explicit criteria of the MDAare
(1) whether the drug is being misused or
(2) whether it is likely to be misused and
(3) whether the misuse in either case is having or could have harmful
effects sufficient to constitute a social problem.
There appears to be no explicit criterion for deciding which drugs are more
harmful than others and so should go in Class A rather than B or C. The
Council, however, deduced that the nature of the mischief to which misuse
might give rise was a criterion implicit in the threefold classification and its
link to penalties
Other European countries
Although not required by the international conventions, most other European
countries divide illicit drugs into Classes but none use the precise division
found in the MDA and only three (Italy, the Netherlands and Portugal) relate
the Classes to maximum penalties. It seems that it is usually left to the courts
to reflect the relative harm of the drug in the sentences passed. In such cases
the main purpose served by the classification seems more akin to that of the
Schedules to the Misuse of Drugs Regulations 1985.
Classification systems in other European countries
Austria, Belgium, Luxembourg - no formal legal classes.
Denmark - Five Classes
a. Cannabis, heroin, prepared opium
b. Cocaine, ecstasy, amphetamines, methadone
c. Codeine
d. Barbiturates
e. Tranquillisers
Finland - Ten Classes
Narcotics
I.
II.
III.
Heroin, cannabis, methadone, morphine, etc.
Propiram, codeine, etc.
Preparations containing drugs
IV.
Drugs in Class I with no medical uses
Psychotropic substances
I.
MDA, LSD, MDMA, etc.
II.
Amphetamines, THC, etc.
III.
Barbiturates
IV.
Benzodiazepines etc.
Precursors
I.
II.
Ephedrine, lysergic acid
Acetone, piperidine
27
France - Four Classes
I.
II.
III.
IV.
Hallucinogens
Amphetamines
Barbiturates and buprenorphine
Benzodiazepines
Germany - Three Classes
I.
Not for medical or industrial use: heroin, cannabis, LSD
II.
III.
For industrial use but not available on prescription: coca leaves
For industrial use and medical use on special prescription:
morphine, methadone.
Greece - Four Classes
I.
Cannabis, heroin, LSD and other hallucinogen
II.
III.
IV.
Cocaine, methadone, opium
Amphetamines
Barbiturates, tranquillisers
Ireland - Five Classes
I.
II.
III.
Cannabis, LSD, mescaline, opium
Cocaine, heroin, methadone, morphine
& IV. Other Psychotropic substances
V.
specific preparations of Drugs
Italy - Six Classes
I.
Opium, cocaine, hallucinogens, some amphetamines
II.
III.
IV.
Cannabis
Barbiturates
Medicinal substances
V.
Preparations of substances mentioned at I to III
VI.
Antidepressants, stimulants
The Netherlands - Two Main Classes
I.
Drugs which pose unacceptable risks - opiates, coca derivatives,
cannabis oil, codeine, ecstasy, amphetamine, LSD, etc
II.
Other drugs - cannabis, barbiturates, tranquillisers
Portugal - Six Main Classes
I.
II.
Opiates, coca and derivatives, cannabis and derivatives
Hallucinogens, amphetamines, barbiturates
III.
IV.
Specific preparations
Tranquillisers and analgesics
V.
&
VI.
Precursors
Spain - Drugs placed under control as in UN Conventions
Sweden - Five Classes
I.
Narcotics with no medical uses
II.
Narcotics with medical uses
28
III.
Codeine
IV.
Barbiturates, benzodiazepines
V.
Narcotics as defined by Swedish law but not restricted by
international conventions
Source: 'Annual Report on the State of the Drugs Problem in the European
Union 1997', European Monitoring Centre for Drugs and Drug Addiction,
Luxembourg 1997.
Illicit Drug Index
Common Street Names ofVarious Drugs
The following tables cross reference some frequently abused drugs by their
generic, trade (commercial, proprietary), and common/street names.
Trade Name
Anadrol
Android
Benzedrine
Dexedrine
Generic Name
Anabolic steroid
Anabolic steroid
Dolophine
Methadone
Anabolic steroid
Durabolin
Amphetamine (racemic)
Amphetamine (dextro isomer)
Duramorph
Morphine
Halcion
Ketalar
Librium
Methedrine
Nembutal
Triazolam
Ketamine
Oxandrin
Primatone
Ritalin
Rohypnol
Chlordiazepoxide
Methamphetamine
Pentobarbital
Anabolic steroid
Ephedrine
Methylphenidate
Flunitrazepam
Morphine
Roxanol
Seconal
Sudafed
Valium
Winstrol
Anabolic steroid
Xanax
alprazolam
Secobarbital
Pseudoephedrine
Diazepam
29
Narcotic/Opiate Class Drugs:
Generic Name
Common/Street
Trade Name
Name:
Fentanyl
Sublimaze
Heroin
None (Banned in U.S.)
(Diacetyl morphine)
China Girl, dance fever,
friend, goodfellas, king
ivory.
Brown sugar, H, Henry,
horse, junk,skag, smack.
Frizzies, phy,
Methadone
Dolophine
Morphine
Duramorph,
Roxanol, Dreamer, hows, M, Miss
generic
Emma.
Stimulant Class Drugs:
Generic Name
Common/Street
Trade Name
Name:
Stimulants:
Amphetamine:
Dexedrine, Benzedrine, Bennies, uppers.
(racemic mixture)
Cocaine:
Generic
Coke,
crank,
snow,
crack (crystalline freebase form), zip.
Methamphetamine:
Methedrine
Chalk,
crystal,
ice,
meth, methiles quik,
Methylphenidate
speed
Uppers, west coast
Ritalin
Mild Stimulants:
Ephedrine
Contained
OTC
in
various
medicines
(e.g.
Herbal Esctasy,
Ma Huang.
Primatene)
Pseudoephedrine
Contained in various
OTC Medicines
(e.g. Sudafed)
Phenylpropanolamine
Contained
(PPA)
OTC
in
various
Medicines
(e.g.
Dexatrim)
Stimulatory Hallucinogens:
MDMA
Adam , Ecstasy, Eve,
None
XTC.
30
Phencyclidine
Angel Dust, crazy coke,
gorilla biscuits, ozone,
PCP, Peter Pan, Rocket
None
Fuel, Wack
Sedative- Hypnotic (Depressant) Class Drugs
Common/Street
Trade Name
Generic Name
Name:
Barbiturates:
Secobarbital
Seconal
Downers
Pentobarbital
Nembutal
Downers
Benzodiazepines:
Alprazolam
Chlordiazepepoxide
Xanax
Librium
Lib
Diazepam
Valium
V
Flunitrazepam
Rohypnol, Robutal,
Forget me Drug,
Mexican Valium,
Rootles, Rope.
(banned in U.S.)
Triazolam
Halcion
Volatile Anesthetics:
Ether
Generic, also contained
in
Nitrous Oxide
some
consumer
products.
Generic, also contained Buzz
in
various
consumer
bomb, laughing
gas, whippets.
products
Other:
Ketamine
Ketalar,
mainly Jet special K, vitamin K.
veterinary medicine in
U.S.
Methaqualone
Quaalude
(banned
U.S.)
31
in
Ludes
Miscellaneous Drugs:
Trade Name
Generic Name
Common/Street
Name:
Anadrol, Juice, roids.
Oxandrin,
Android,
Durabolin,
Anabolic Steroids
Winstrol
None (Banned in U.S.)
Gamma-
hydroxybutyrate
(GHB)
Contained
Nitrates
in
Georgia home boy,
grievous bodily harm,
liquid ecstasy, Liquid X
various
consumer products (e.g.
air fresheners)
Common Illicit Drug Combinations:
Common/Street Name:
Generic Name
Belushi, Dynamite, eightball, H & C,
Moonrock, speedball, murder one.
Cocaine & Heroin
Cocaine
&
Heroin
in
Flamethrower
tobacco cigarette
Cocaine, Heroin & LSD
GHB & Amphetamine
GHB, Ketamine & Alcohol
Marijuana
Frisco Special, Frisco Speedball.
Max
Special K Lube
crack 3750's diablitos, lace, primos, oolies,
&
cocaine
torpedo, turbo, woolies.
Marijuana
&Phencyclidine
Happy sticks, illies, love boat, wet,
wicky sticks, zoom.
Marijuana, phencyclidine
Jim Jones
& cocaine
Phencyclidine
&
crack Missile bassing, parachute, spaceballs,
cocaine
space base, tragic magic.
Pentazocine &
T's & Blues.
Tripelennamine
32
Trade names and common/street names listed above for each compound are
exemplary not exhaustive. The tables listsome ofthe more popular drugs and
drug combinations, giving examples of common/ street names used across
different geographic regions. Common/street names for marijuana and the
hallucinogens have been omitted.
Trade Names
Some medicinally sold compounds are marketed exclusively by trade names
(e.g., diazepam as Valium), while other drugs are sold under their generic
names \\-ith no current proprietary names in use (e.g., cocaine). Still other
drugs employ both generic and proprietary names, depending on the drug
manufacturer or distributor (e.g., Duramorph and Roxanol which are brands
of morphine, and U.S.P. morphine which is generic).
Common/Street Names
Street names can vary not only across countries but also across regionswithir!
the Same country or even individual locations in a small geographic region.
The specific use of street names sometimes varies over time. For example,
'speed' referred almost exclusively to methamphetamine (as opposed to
uppers which referenced other amphetamines) during the 1960s, but this term
is becoming used increasingly to reference all amphetamine and even nonamphetamine stimulants (e.g., methylphenidate).
Drug Abuse vs. Drug Addiction
Abused drugs are not always highly addictive drugs. In some cases factors
other than drug reinforcement are likely to be important in motivating drug
use. When ease of availability is an important determinant of drug use,
psychosocial factors are likely to be important mediators. For example,
experimental drug use is largely influenced by psychosocial factors and is
widespread during adolescence and usually subsides with maturity. Similarly,
underlying psychopathology maybe an important factor in the adult abuse of
some commonly prescribed medications. This does not mean that these
compounds lacksignificant addiction potential, but rather, that most casesof
their abuse probably involve experimental or circumstantial drug use not
addiction
and
that
cases
of
true
addiction
are
associated
with underlying psychopathology and not simple drug reinforcement. Many of
the drugs listed above are prescription drugs that arc often abused mainly
because of their widespread availability and motivated primarily by
psychosocial factors.
33
Types of Drugs:
DEPRESSANTS:
Barbiturates:
Tranquillisers:
(Narcotic Analgesics
Pentobarbital
Painkillers)
Secobarbital
Benzodiazepines
Diazepam: e.g. Valium
Rohypnol
Opiates
Alcohol
Heroin
Methadone
Morphine
Codeine
Fentanyl
Stimulants:
Stimulatory
Hallucinogens:
MDMA- Ecstasy
Phencylidine- PCP
Amphetamines:
Eg: Dexidrine. Benzidine.
Metamphetamines:
(Speed) Eg: Meihedrine
Cocaine
Ketamine
Caffeine
Nicotine
Ephedrine
Psychogenics:
Cannabinoids:
Hallucinogens:
Cannabis
Eg LSD, Mescaline
Derivatives
Miscellaneous Others:
Anabolic Steroids
Nitrites:
Inhalants
Poppers
34
The Drug Scene Today (UK)
One of the challenges facing treatment agencies today is the increasing
number of cocaine/crack and poly-drug users. Most agencies have developed a
service that is mainly geared towards an ageing group of opiate users, which is
in many ways inappropriate for cocaine/crack users.
While the research into the degree of physical dependence to cocaine/crack is
still ongoing, there is undoubtedly strong psychological dependence. Yet the
slight increase in treatment episodes for cocaine (60/0 of all treatment
episodes up from 4% in 1996), suggests that the majority of cocaine use
remains occasional.
The rapid increase in availability, suggested by a 25% increase in seizures,
stable prices and rising purity, points towards significant shifts in the cocaine
user profile. Once the preserve of the wealthy, cocaine has come within the
reach of a much wider client group, and is enjoying unprecedented popularity,
with 7010 of 16 to 24 year olds having taken it at least once.
By contrast, ecstasy and amphetamine use has levelled off and there are
indications that it is falling, especially among the under twenty year olds.
The most popular illicit drug among all age groups is cannabis, which 44ofo of
16 to 24 year olds have tried. The use of heroin is stable, bu t the significant
changes in risk behaviour among injecting drug users have led to a sharp cut
in the number of HN infections attributed to intravenous drug use.
The Statistics
Around a third of adults aged 16 to 59 in England and Wales have used illicit
drugs and solvents at some point in their lives, rising to half of 16 to 24 year
olds.
In Northern Ireland 400/0 of respondents aged between 16 to 29 years report
having tried illicit drugs at some time in the past.
Around one in three 15 year olds in England, and two in five in Scotland,
report ever using drugs Cannabis The proportion of people reponing cannabis
use, as for most drugs, is highest for young people.
Thirty to forty per cent of 15 to 16 year olds in England, Scotland and Wales
report ever using cannabis, rising to nearly half of 16 to 24 year olds in
England and Wales.
35
The following section contains information about the major drugs that are
used/misused. It is hoped this may be a valuable resource for you.
Rather than trying to plough right through it all, try keeping the following
questions in mind whilst reading:
Could recognise the drugs ifyou came across them?
Could you recognise thesymptoms ofparticular drugabuse?
How much ofthe information did you know previously?
What, ifanything, surprises / shocksyou?
DEPRESSANTS
Depressants are drugs whichcalmyou downor send youto sleepby
depressingthe central nervous system (which includesthe brain). Theyare
also known as sedatives or hypnotics. Hypnotics are drugs that induce sleep.
Depressants are used to treat stress, anxiety, sleeplessness, mental disorders
and some cases of epilepsy. They are frequently known as 'downers'. Opiates,
tranquillisers, barbiturates, benzodiazepines and alcohol all belongto this
group.
Opiates/Narcotics
'Within this category lie all those drugs which are derived from opium which
comes from the milky sap of the opium poppy Papaverum Somniferum. The
sap is collected and dried to form a gum. The gum is '"lashed and becomes
Opium. Opium contains two painkilling alkaloids, codeineand morphine.
Morphinethat has been extracted from Opiumcan be further refined to create
diamorphine, or heroin. Weightfor Weight, heroin is about forty times more
powerful than raw opium.
What does it do?
All opiates - drugs [hat come from the opium poppy - are painkillers (or
analgesics). They are extremelypotent and highlyaddictive. People who use
heroin describe feelings of relaxation, warmth and a sense of well-being.
Nothing matters. Wrapped up in cotton wool. Initially, most people who use
heroin feel nauseous and often vomit. This is followed by a period when the
user is conscious but looks like they're falling asleep. Breathing and heart rate
decrease. Once this has passed the user is able to interact normally with other
people, although to them their experience willhave taken on a dream-like
quality.
Heroin is used in medicine (it's called diamorphine when it's prescribed) as an
anaesthetic and powerful analgesic (for relief from severe pain). Regular use
will cause dependence and constipation. Female users may have interrupted
periods.
36
* Opium
Opium is usually smoked. Thisis called 'chasing the dragon*. Asmall piece is
placed in a roll oftinfoil and heatedwhile the fumes are inhaled. Initially there
is enhanced imagination and stimulation, which changes quickly into
confused thinking, sleep and even coma.
* Morphine
This is found in powder, tablet and liquid or ampoule form. Users take it by
swallowing, drinking, injecting, inhaling and even as a suppository. Morphine
powder is white. Napps come in various colours accordingto dosage.
The euphoria produced by morphine can quicklydevelop into an
overwhelming urge to continue using it. Sometimes an individualwill suffer
nausea, vomiting, constipation, confusion and sweating. This can be
accompaniedby fainting, palpitations, restlessness and mood changes,dry
mouth and high facial colours. An overdose leads to respiratory arrest and
even to coma and death. Withdrawal varies according to individual and their
degree of dependence, but has similar symptoms to heroin.
*Heroin
Heroin is the strongest analgesic known, five to eight times more powerful
than morphine.
Street Names:
H, Smack, Gear,
Junk, Horse,
Golden Brown
Heroin comes in three forms: brown, china white and pharmaceutical heroin.
Brown: The most common form, this is diamorphine base, the hydrochloride
part has been removed. It's a brown powder, although the colour can vary
from creamy white to dark coffee. The lighter the colour, the higher the heroin
content. Brown is low-grade heroin. The content varies from 10 to 60%.
Brown is smoked
China white: This is found as grey granules that look a little like instant
coffee.Although china white is smoked, it can also be injected.
Pharmaceutical heroin: Pure heroin for medical use. It comes as a pure
white powder or tablets, or as ampoules of clear liquid.
The purity of heroin bought on the street is an unknown quantity to the user.
It may contain drugs such as phenobarbitone, paracetamol or caffeine. It is
also cut or bulked to increase profit, with such substances as flour, lactose,
talcum powder, glucose, plaster or brick dust.
Heroin paraphernalia terms:
Barrel -Tube ofsyringe
Works, Gizmo -Syringe
Jimmy Doyle - Tinfoil
Spike - Needle ofsyringe
37
A bag ofA.Q - Deal ofheroin
Filter - End ofcigarette used tofilter heroin
Citric - Substance used to break down
Effects:
The effects of any drug (including heroin) vary from person to person. It
depends on many factors including an individual's size, weight andhealth,
howthe drug is taken, how much is taken, whether the personis used,to
taking it, the person's mood andwhether otherdrugs aretaken. Theeffects
also depend on the environment in which the drugis used- for example,
whether the person is alone, with others, or in a social setting.
The effects of heroin may last three to four hours.
Immediate effects:
Intense pleasure: Heroin may cause a rush ofintense pleasure-and a strong
feeling ofwell-being. Heroin is the most fast-acting ofallthe opiates. When
injected, heroin reaches the brain in 15-30 seconds; smoked heroin reaches
the brain in around 7 seconds.
Pain relief: Heroin relieves physical pain. After using heroin, feelings or'
pain, hunger or sexualurges are diminished.
Physical symptoms: Breathing, blood pressure and pulse become slower.
The pupilsofthe eyes also get muchsmaller. ('Pinned'). The mouth dries out.
Drowsiness: Asthe quantity used increases,the user may feel warm, heavy
and sleepy.
Nausea and vomiting can occur.
In greaterquantities the above immediate effects intensify and last longer
withhigherquantities of heroin.As the quantityused increases, the following
effects are also likely to occur:
1. Concentration: The ability to concentrate is impaired.
2. Likelihoodof sleep: The user is likelyto fall asleep ('on the nod').
3. Breathing: Breathing becomes shallower and slower.
4. Nausea: With higher quantities, nausea and vomiting are more likelyto
occur.
5. Bodily effects: Sweating, itching and increased urinary output is alsolikely.
Overdose
Using a large quantity of heroin can kill. Breathing becomesveryslow, body
temperature drops, and heartbeat becomes irregular.
Overdose may occur if:
Too much heroin is injected, or it is a strong batch
Heroin is used with alcohol or sedatives (benzodiazepines).
Most overdoses occur as a result of poly-drug use (i.e. heroin with another
drug).
38
Short-term use
Apart from overdosing, the major problem ofshort-term use ofany opiate is
the way it is used.
Under medical supervision, short-term use ofopiates should not produce
problems. Many people aregiven pethidine for two orthree days after an
operation and do not experience any health problems.
Butillicit drugs likeheroin often leadto complicated health problems.
Some oftheseproblems are more likely to occur ifthe drug is injected, for
example skin, heartandlung infections anddiseases like hepatitis and HIV.
Mainlining is injecting intotheveins; 'skinpopping' isinjecting just below the
skin).
Long term use
In its pureform, heroin is relatively non-toxic to the body, causing little
damage to body tissue andother organs. However, it ishighly addictive and
regular users arevery likely to become dependent onit, even after a few days.
Some long-term effects include constipation, menstrual irregularity and
infertility in women and loss of sex drive in men.
Users often spendlesson otherthings like housing andfood and, combined
with reducedappetite, this can lead to malnutrition and susceptibility to
infections.
Impure heroin: Street heroin is usually a mixture ofpureheroin andother
substances such as caffeine and sugar.
Additives can be very poisonous. Theycan cause collapsedveins, tetanus,
abscesses and damage to the heart, lungs, liver and brain. Because the users
don't knowthe purity and as a consequence the amount to take, it is easyto
accidentally overdose and even die.
Hepatitis & HIV:
Sharing needles, syringes and other injecting equipment cangreatly increase
the risk of contracting bloodborne viruses such hepatitis B, hepatitis Cand
HN (Human- Immunodeficiency Virus - the virus that causes AIDS). Heroin
users mayalso put themselves at riskthrough unsafesex. HIV is also
transmitted through unsafe vaginal and anal sex.The correct 'use of a
condom' can prevent infection,
i
9
Heroin and other drugs:
Combining heroin with other depressant drugs (such as alcohol,
benzodiazepines or other opiates) greatly increases the effects. A relatively low
quantity ofheroin can quickly become a equivalent to a higher quantity (or an
overdose) if it is combined with other drugs.
Tolerance and dependence:
Tolerance
Peoplewho are physically dependent on heroin usuallydevelop tolerance to
the drug, making it necessary to take moreand moreto get the desiredeffects.
Eventually, a usage plateau is reached, at which no amount of the drug is
sufficient. When this level is achieved, dependent users continue to administer
the drug, but largelyfor the purpose of delaying withdrawal sickness.
39
Dependence
Dependence on heroin canbe psychological or physical or both.
Psychological dependence: People who are psychologically dependent on
heroin find that using it becomes far more important than other activities in
their lives. Theycrave the drug and will find it verydifficult to stop usingit, or
even to cut down on the amount they use.
Physical dependence: Physical dependence occurs When a person's body
adaptsto heroinand the bodygetsusedto functioning withthe drug present.
Forsomepeople this dependence leadsto bad eatinghabits, poor hygiene and
housing problems. Poor nutritionand living conditions increase the riskof
infections and other health problems. Maintaining the 'habit' can sometimes
lead to users turning to crime to get enough money to pay for it.
Withdrawal
If a dependent person suddenly stopstaking heroin, or severely cutsdown the
amount they use, they will experience physical withdrawal symptoms because
their bodyhas to readjust to functioning withoutthe drug.Thisusually occurs
within a few hours after last use.
Withdrawal symptoms from heroin include a cravingfor the drug,
restlessness, yawning, tears, diarrhoea, lowbloodpressure, stomach and leg
cramps, vomiting, goose bumps, and a runny nose. ('Cold turkey')
These withdrawalsymptoms get stronger and usuallypeak around 2 to 4 days
after last use. They also include increased irritability, insomnia, loss of
appetite, vomiting, elevated heart rate, muscle spasmsand emotional
depression. Then they begin to get weaker. Theyusuallysubside after 6 to 7
days. Butsomesymptoms such as chronic depression, anxiety, insomnia, loss
of appetite, periodsof agitation and a continued craving for the drug maylast
for periods of months and even years. Sudden withdrawal from heroin never
causes direct death, unless the user is also using other drugs and is in poor
health. Withdrawal from heroin or other narcotic analgesics is much less
dangerous than withdrawalfrom some other drugs like alcohol or
benzodiazepines.
How had is Heroin Withdrawal?
An excerpt from: Heroin, Myths and Reality
Jara A. Krivanek
The development of physicaldependence depends as much on regularity of
use as on the amount actually used. In practice, the vast majority of addicts do
not use heroin consistently on an ongoing basis. Less than half of the addicts
who have been on the streets for more than a year will have used daily for that
period. They may voluntarily withdrawto reduce their tolerance, or the scene
may be temporarily too much of a hassle, or they may have an important
engagementsuch as a trial, at which an appearance of addiction wouldbe
undesirable. Or they may simply need a rest. During such times, physical
dependence mayvirtuallydisappear, yet they will still think of themselvesand
describe themselves as addicts. In other cases, the users may never use
enough drug to develop significant physical dependence. Senay (1986)
estimates that between 25 per cent and 40 per cent of street addicts are not
physicallydependent. Nevertheless, such 'chippers' may wish to see
40
themselves as addicts for reasons of their own, and will so describe
themselves.
The withdrawal syndrome is what is termed 'primary' or 'earlv' abstinence.
Asubstantial portion of the physical symptomsofthis stage seem to depend
on the activity of a part of the brainstem called the locus coeruleus. Opiates
depress this area and it wouldtherefore be expected to become hyperactive
duringwithdrawal. The locuscoeruleus is an important centre in the brain's
fear-alarm system, and such hyperactivity wouldbe consistent with the
marked anxiety and agitation withdrawingaddicts report. Fortunately for
withdrawing addicts, other drugs beside the opiates can depress this region
and one of them is clonidine.
Clonidine is generally used as an anti-hypertensiveagent, but in 1978Gold
and his colleagues reported that it could suppress or reverse the symptoms of
opiate withdrawal. Subsequent work has shownthat this reversal is by no
means complete, but there seems no doubt that clonidine can make opiate
withdrawal much more comfortable.
Even if clonidine is not used, medical detoxification is usually accomplished
by giving decreasing doses of a long-acting opiate like methadone. After a
few weeks of this, the patient is usually opiate-free without having suffered
any appreciable physical discomfort. Since a percentage of the methadone
marketed for medical use finds its way into the streets, many addicts also
detox themselves this way without formal medical help. Still others detox 'cold
turkey' - without any pharmacological help at all. They simply tell their friends
they have the flu, go to bed, and suffer in relative silence.
Medical supervision and assistance is certainly not essential for successful
withdrawal.
The duration of early abstinence depends on the drug's rate of elimination and
in the case of heroin most major symptoms should be gone within seven to ten
days.
A protracted abstinence syndrome follows withdrawal from both heroin and
methadone and... lasts at least 31 weeks after withdrawal, and perhaps longer.
Blood pressure, pulse rate, body temperature and pupil diameter seem to be
the main physiological variables affected. Behaviourally, the subject shows an
increased propensity to sleep and there are negative changes in mood and
feeling state.
Methadone
Methadone is a man-made chemical that has similar properties to opiates
such as heroin. Methadone comes as tablets and ampoules (avail in the UK
only) of clear liquid. Both are prescribes under the trade name ofPhyseptone.
It's also found as a brown, orange or green linctus of varying strengths or as a
mixture known as DTF, which comes in the same colours as the linctus, but is
stronger.
41
Physeptone linctus is usedto wean heroin addicts from heroin byblocking
withdrawal symptoms. It is alsousedas part of programmes where addicts are
maintained on a dose which keeps withdrawal symptoms at bay in order for
them to minimise the risk to them and others by preventing the need to buy
illegal drugs and the need to resort to crime.
Synthetic opiates
Many synthetic opiatesare misused at street level. Pethidine, oftenused in
childbirth, was widelyabused in Ireland at one stage. Dipipanone is another
painkiller soldunder the name of Diconol, which has been abusedhere.
Two new syntheticopiates are dihydrocodeine DF118 and buprenorphine
Temgesic, and both are frequently abused.
Morphine sulphate tablets knownas Nappsor MSTs havebecome widely
available and abused. These are additionally dangerous because the addicts
crush and inject them even though additivesin their manufacture make
injection more hazardous.
Historical Background
For thousands of years people have eased their lives through the power opium
has to soothe and sedate. Opiates are central to pain control in Western
medicine. Although the possibility of addiction was recognised from the
earliest times, it was probably first in 18th century China that a high-profile
problemsurfaced. Atthis time, Britain had a growing needfor qualitytea, and
the Chinese produced the best available. Britain, however, was short of
anythingthe Chinese might wishto trade for. Thisdilemmawas solved in 1773
when the British conquered Bengal, givingthem a monopoly in Indian opium.
The East India Company exported this in large amounts to China.
Up until then recreational use of opium had not been significant, but it took
off in a big way. The Chinese made many attempts to ban opium smoking,
and limit imports, but were driven to more active steps with seizure and
destruction of large amounts of the drug in Southern China. The British
responded by besiegingNanjing, and what later became known as the First
Opium War started. It ended in 1842 withmassive concessions to the British,
including the ceding of Hong Kong islands as a colony.
Two 19th century advances paved the way for the scale of the problems faced
today. First, the active ingredients of opium were identified, and second the
technique of intravenous injection was perfected.
Despite the widespread use of opium in 19th century America, opium
smoking remained sociallyunacceptable in Britain. This was largely due to the
negative attitude of the British towards the Chinese immigrants.
In the US attempts to regulate the opiate medical business were slow.
Public concern increased in the early 20th century and action to limit opiate
misuse became a political vote-winning issue. In 1906 the Federal Pure Food
& Drug Act required ingredients to be labelled. In 1909 importation of
smoking opium became illegal.
42
In Britain legislation was even slower - perhaps connected to the fact that
Britain produced most of the world's supply of morphine at that time. This
approach changed during the First World Warwhenit becameclearthat
British soldiers were keen to get hold of drugs. Harrods sold morphine and
cocaine kits complete with syringe and spare needles labelled' A Useful
Present For Friends At The Front'.
From the 1920s through to the 1960s most opiate addicts came from the
professional classes - morphine injecting being most prevalent among
respectable housewives. Long-term maintenance on a prescription of opioids
was recommended for those addicts who were unable to give up but who could
lead a useful life when so maintained.
In the United States after the First World War things were very different.
There was a very visible problem with opiate addicts. Addiction clinics were
set up and a large number of patients were maintained. In 1922 a clamp-down
on the clinics began and prosecutions were taken against addicts, doctors and
pharmacists. By1925 the medical profession had withdrawn from the
addiction field, heroin had been banned from use in medicine and its legal
manufacture in the US stopped completely.
Half a million opiate addicts were thus abruptly cut off from their drug supply.
The racketeers who had already profited from alcohol Prohibition couldn't
believe their luck. Opium supplies were cheap, morphine and heroin were
simple to manufacture.
From then addiction rates rose steadily. Heroin use became endemic in
provincial cities during the 1970s and 1980s.
Barbiturates
Barbiturates come as tablets or capsules in various sizes and colours. They all
depress the central nervous system, but effect, duration and toxicity may vary.
They build up in the body and result in a 'hangover' which is dangerous as it
can impair skill and concentration. There is a fine line between the dosage
that produces sleep and that which kills.
The prescribing of barbiturates is now discouraged and so they find their way
on to the black market. They include Amytal, sometimes known as Lilly;
Soneryl, Seconal and Tuinal.
Street Names:
Birds
Sleepers
Angels
Blue Heavens
Red Devils
Candy
43
Downers
Rainbows
Barbs
Goofballs
Reds
Users feel relieved of worry and tension. They act unpredictably or show signs
of mental confusion, though some look happy and relaxed. Even in small
doses, barbiturates cause slurred speech, staggering walk, poor judgement and
reflexes.
Historical Background
In modern Britain, up to 15% of men, and 25%of women visiting their doctors
will be complainingof inadequate sleep. Herbal potions, opium and alcohol
have all served as sleeping-draughts in their time. In the middle of the 19th
century, the sleep-inducing property of bromide was discovered, and its
derivatives became very popular. The most significant was barbituric acid
(named by its originator after 'a charming lady named Barbara').
The marketing of barbitone occurred in 1903,phenobarbitone quickly
followed, and quite soon there were more than 50 'Barbiturates' on the
market. They were prescribed for insomnia and anxiety and later, in
combination with amphetimine, for depression. Cases of dependence were
reported in Europe in 1912, but it was not until 1950that the possibility of
becoming physically dependent upon barbiturates was fully acknowledged.
Bythe late 1960s, there were more than 2000 barbiturate-related deaths each
year in Britain (among them Brian Jones, Jimi Hendrix, Janis Joplin, Elvis
Presley).
British doctors wrote 16 million prescriptions for barbiturates in 1964.
Five hundred thousand people were thought to be taking them legitimately,
with, almost a quarter of these people dependent on them. It was only the
appearanceand ready availability of a safer alternative, the benzodiazepines,
(discussed next) that stemmed the tide.
Barbiturates are highly addictive, both physically and mentally. They are
thought to be even more addictive than drugs such as heroin. After only a tew
days use, a user may be unable to go to sleep without them.
Effects
Barbiturates are highly addictive, both physically and mentally. They are
thought to be even more addictive than drugs such as heroin. After only a few
days, a user may be unable to go to sleep without them.
Withdrawal
Severe craving for barbiturates
Painful stomach cramps
Fits or convulsions
Insomnia, depression, panic attacks and hallucinations
Death has occurred - not even heroin has been known to cause a
withdrawal death
44
Benzodiazepines
There are major tranquillisers and minor tranquillisers. Major tranquillisers
are used to treat severe mental illness and do not produce physical
dependence. It is the minor tranquillisers and hypnotics which come from a
group of drugs calledbenzodiazepines which are often abused.
The benzodiazepines are hugely successful drugs prescribed in vast quantities
throughout the world. Theyform the major part of a world-wide anti-anxiety
and anti-depression drug marketworth morethan billions yearly. Most people
who take them do so legally. There are no illegal manufacturers, the extensive
black market being supplied entirely by diversion from legal supplies.
They are used to treat restlessness, depression, tension and anxiety.
Benzodiazepines are not easilyrecognisable by their shape and colour because
there are so many different manufacturers.
Common brand names ofbenzodiazepines include:
Normison
Ativan
Nobrium
Tranxene
Rohypnol
Dalmane
Librium
Xanax
RocheMogadon
Halcion
Roche Serenid
Valium
These drugs became immensely popular, indicating that a great many people
felt the need for such medication, or their doctors did. However they have
caused great concern because large portions of the population are needlessly
and harmfully placing a chemical barrier between themselves and the stresses
of life. When individuals try to stop after long-term usage, withdrawal causes
jitteriness, panic attacks, loss of appetite and body weight, nausea, strange
tastes and smells, tremors, perspiration and even convulsions.
Streetnames:
Tranx
Benzos
Blockers
Blockbusters
Chewies Jellies
Eggs
Rugby Balls Temazzies
M&Ms
Injections & Infections
Some users take tranquillisers by grinding up the pills into powder, dissolving
it in water and injecting the liquid. Heavy users and heroin users who cannot
get their habitual drug are more likely to inject the jelly-filled temazepam
capsules.
Temazepam may give a faster hit when injected, but the liquified gel can
reform once it's inside the veins. Vein blockage can easily occur, leading to
abscesses, ulcers, blocked blood vessels and gangrene.
45
Tranquillisersreduce control and judgement, so users are more likelyto be
careless when injecting - increasing the risk of infection with HIV/AIDS and
hepatitis B or Cfrom shared needles.
Agreat deal has been written on the subject of benzodiazepines dependence
since it was demonstrated, around 10 years ago, that physical dependence
could occur after use of ordinary therapeutic dosages of these drugs. This
contrasted with the previous belief that a lack of physical dependence was one
of the great advantages which the benzodiazepines conferred over their
predecessors the barbiturates, and the subject has been one of great medical
and public concern.
Recently, however, drug workers in many countries have been seeing a form of
benzodiazepine usage which is simply not in the text books, i.e. their use,
often in extreme dosage, by illicit drug users in the context of poly-drug use.
There have been some studies undertaken of the use of benzodiazepines by
illicit drug users, but these have usually been small in scale and have
investigated highly selected patient groups, such as patients in methadone
maintenance clinics or individuals specifically referred for benzodiazepine
abuse. Klee et al. (1990) who demonstrated, within a study of polydrug use,
very strong associations between the use of the benzodiazepine drug
temazepam and a wide range of high HIV-risk, injecting and sexual
behaviours. Exactly why temazepam and risky practices are associated in that
way is not yet clear, although it is possible to speculate regarding the amnesia
and confusion that appear to be induced by high-dose use of that drug, but
this is a clear indication that the use of benzodiazepines must be carefully
attended to in programmes oftreatment of drug addiction that are based upon
a harm-reduction approach.
Rohypnolhas become known as the 'Date-Rape' drug as it is notorious for
being used to spike the drinks of unknowing females. This way a man can have
sex without the woman remembering of being in control of what's happening
Historical background
Extensive research in the 1950s fuelled by growing awareness of the toxicity of
barbiturates led to the manufacture of chlorodiazepide in 1957. This was
shown to have a 'taming' effect in animals. It was unveiled as Librium in i960,
and was soon followed by diazepam (Valium) in 1963. Both products were
marketed aggressively by their manufacturer, Hoffman La Roche, and
prescription sales accelerated as more variations appeared and the
barbiturates were swept aside.
Repeat prescriptions became commonplace. Since their zenith in the mid
1970s a slow decline has been noted. Even so, averaging across Western
nations, around 20% of adults use benzodiazepines each year, and 9% use
them daily for a year or more.
Since the mid 1970s there has been growing concern at the prevalence of
benzodiazepine dependence and misuse, and questions as to their continuing
benefit when used long-term. This has led to a general decline in
prescriptions, a process that will no doubt gather momentum, as more
46
lawsuits are brought against doctors and pharmaceuticalcompanies by
individuals who feel they have been turned into 'addicts'.
Alcohol
One ofthe basic facts about alcohol that many people fail to grasp is that it is a
drug. It is a sedative. Ethyl alcohol was the first ofthe sedatives to be
discovered and it is easily available in our culture without a prescription. It is
the onlydrug which is absorbedin significant quantitiesthrough the stomach
and so it reaches bloodstream faster than most other sedatives.
Street Names:
Booze, Drink, Jar, Bevvies,
Tinnies, Scoop, Liquor
The alcohol effect
Drinking alcohol makes people:
Feel like they're having more fun
Feel confident
Feel relaxed and calms their nerves
Feel able to open up and talk more
Let go and lose their inhibitions
Feel they fit in socially
Feel really happy and laugh more
Forget their worries for a while
Think they have the courage to overcome their fears.
The downside
Ethyl alcohol depresses the various centres in the brain. Like all sedatives, it
diminishes or stops normal functioning. It works first on the cerebrum, which
controls intellectual and rational thought and judgement, then on the spinal
cord, then on the vital centres, for example breathing and the heart. Alcohol
first leaves you confused, then unable to walk, then unconscious with no
reflexes, then dead.
Alcohol has two effects:
1. It diminishes psychomotor activity, leaving the individual relaxed, less
anxious, less worried then before
2. It increases psychomotor activity. Because of the first effect, the second
effect is not experienced immediately.
47
The first effect lasts for two to three hours and starts to decrease as bloodalcohol levels start to fall. The second effect lasts for about twelve hours. This
means that you can't take a drink without an agitating effect that wears off
slowly so that you end up more tense than you began. If someone has been
drinking heavily it may take days for his/her psychomotor activityto return to
normal. He/she will be anxious, shaking, sweating, restless. This accounts for
hangovers, withdrawal symptoms and eventually delirium tremens (DTs)
where the individual is so agitated and anxious that he is in a state of terror
and may even get convulsions.
The effects of alcohol are not all reversible.
•
Brain cells once destroyed, cannot regenerate themselves. When
enough of the brain is damaged, there are irreversible changes in a
person's behaviour and psychological status.
•
Alcohol affects the stomach. It is an irritant and causes loss of appetite,
disturbed digestion, impaired absorption and vomiting. It can irritate
the stomach lining leading to ulcers to chronic inflammation.
•
In cases of excessive drinking, fat accumulates the liver, impairing
functioning, and where there is consistent damage, cirrhosis of the liver
occurs with parts of the liver dying and being replaced by scar tissue
• Heavy alcohol use is a leading cause of heart disease and circulatory
disorders.
•
One of the greatest causes of death in young people are accidents
occurring after drinking.
Historical background
Nobody knows how long ago it was that humans first learnt to ferment sugars
into alcohol, but the founders of the Babylonian Empire were brewing beer
4000BC. The Greeks invented the tavern and were the first to organise mass
production and systematic export of wine. Plato and Socrates drew attention
to the darker side of boozing, including its association with public disorder
and violence and failure to fulfil a useful role within the family, difficulties in
work and productivity, and accidents.
The small Roman vineyards that sprang up around 700BC were insufficient
for home consumption, so trade routes for importation developed rapidly. By
AD20 heavy daily drinking had become the norm.
The Bible veers from condemnation to endorsement, but generally there has
been a tendency down the age for Christian theologians to be indulgent
towards over-imbibers. After the decline of the Roman Empire it fell to the
Christian monasteries in many countries to safeguard the traditions of
brewing. Around the same period, approximately AD616, the adherents of
Islam were forbidden alcohol by the law laid down in the Koran.
In medieval Britain, beer was often safer to drink then water from the local
river or well, and was also seen as an important source of energy and
nutrition. Taverns appeared around the beginning of the 12th century. From
48
the 15th century onwards, alcohol consumption became increasingly located
outside the family home, and the alehouse or tavern evolved as the centre of
the working man's social life. This considerably reduced women's access to
alcohol.
The popular belief that alcohol was generally beneficial was endorsedby 17th
century doctors who recommended it for a wide range of conditions, from
depression to venereal disease to gout.
The 18th century saw the peak of both British and American drinking, but it
was also a period when organised opposition to the habit began to emerge.
Doctors began to refer to drunkenness as a disease. This medical attitude
towards alcohol abuse was greatly accelerated by the writings of such
physicians as Benjamin Rush (1790) in the US and Thomas Trotter in Britain,
who in 1804 declared that the 'habit of drunkenness is a 'disease of the mind'.
The acute withdrawal syndrome was named 'delirium tremens' in 1813 and
the term'alcoholism' was coined in 1849 by the Swedish physician Magnes
Huss.
The earliest pioneers of the Temperance Movement were not so much
concerned with abstinence, but rather the concept of moderation. They were
much less concerned about beer, wine and cider than punch, rum and whisky.
As the alcoholic came to be seen as ill and needy rather than immoral and
degenerate, so the argument for complete abstinence began to take centre
stage. Restrictions on ale-house opening hours were introduced in 1828 and
tightened further in 1848 and 1854.
In America an 'Anti-saloon League' emerged, which joined the political
movement calling for national prohibition, which was duly enacted in 1919.
Initially this had quite wide support, but a combination of pressure from the
voters and a desperate need for taxation income led to the repeal of
Prohibition in 1933.
Attempts to ban juvenile drinking are a modern phenomenon. In the Middle
Ages, infants received ale as a part of their normal diet. In 1908 it became
illegalfor children under 14to enter bars, and in 1923sale of alcoholto under18s was forbidden.
Stimulants
These drugs stimulate the central nervous system and are called uppers
because they produce almost immediate strength and energy.
These are mild socially acceptable stimulants such as caffeine which are often
not thought of as drugs. Caffeine is contained in tea, coffee, Coke, Red Bull
and Lucozade. Nicotine is also a stimulant.
Cocaine is probably one of the best known and powerful of stimulants. Ecstasy
is also part stimulant. Stimulants produce euphoria, excitement and increased
periods of activity and the user can go without sleep for longer periods.
49
Serious psychological dependency can easily develop because of the euphoria
and pleasurable feelings involved.
Cocaine
Cocaine is sometimes known as the 'champagne of drugs'. It is a bitter-tasting
white crystalline powder, made by refining the leaves of the coca bush which
grows mainly in Bolivia, Columbia and Peru.
Street Names:
Coke, Charlie, Toot, Snow,
White Lady, Chang,
A coca leaf typically contains between o.i and 0.9 percent cocaine. If chewed
in such form, it rarely presents the user with any social or medical problems.
When the leaves are soaked and mashed however, cocaine is extracted as a
coca-paste. The paste is 60 to 80 per cent pure. It is usually exported in the
form of the salt, cocaine hydrochloride. This is the powdered cocaine most
common, until recently, in the West.
When it is sold on the street it can be adulterated by any one of numerous
cutting agents, the product ending up at anything from 30 to 60% cocaine
hydrochloride. Usually these agents are lactose or mannitol, a local
anaesthetic which gives a similar localised anaesthesia as cocaine. However,
the cocaine is sometimes adulterated with dangerous substances such as rat
poison.
Since the hydrochloride salt decomposes at the temperature required to
vaporise it, cocaine is instead converted to the liberated base from.
Initially, 'free-base' cocaine was typically produced using volatile solvents,
usually ether. Unfortunately, this technique is physically dangerous. The
solvent tends to ignite. Hence a more convenient method of producing smoke
able free-base became popular. Its product is crack.
To obtain crack-cocaine, ordinary cocaine hydrochloride is concentrated by
heating the drug in a solution of baking soda until the water evaporates. This
type of base-cocaine makes a cracking sound when heated; hence the name
'crack'. This solid substance, crack cocaine, is removed and allowed to dry. The
crack cocaine is then broken or cut into 'rocks', each typically weighing from
one-tenth to one-half a gram. One gram of pure powder cocaine will convert to
approximately 0.89 grams of crack cocaine. Crack rocks are between 75 and
90 percent pure cocaine.
Cocaine base (including coca paste, freebase cocaine, and crack cocaine)
typically is smoked in pipes constructed of glass bowls fitted with one or more
fine mesh screens that supports the drug. The user heats the side of the bowl
(usually with a lighter) and the heat causes the cocaine base to vaporise. The
user inhales the cocaine-laden fumes through the pipe. Alternatively, crack
cocaine can be sprinkled in cigarettes and smoked.
50
Smoking cocaine combines the efficiency of intravenous administration with
the relative ease of consumption or ingestion and insufflations. Facilitated by
the large surface area of the lungs' air sacs, cocaine administered by inhalation
is absorbed almost immediately into the bloodstream, taking only 19 seconds
to reach the brain. However, only 30 to 60 percent of the available dose is
absorbed due to incomplete inhalation of the cocaine-laden fumes and
variations in the heating temperature.
Cocaine smokers achieve maximum physiological effects approximately two
minutes after inhalation. Maximum psychotropic effects are attained
approximately one minute after inhalation. Similar to intravenous
administration, the physiological and psychotropic effects of inhaled cocaine
are sustained for approximately 30 minutes after peak effects are attained.
Cocaine powder is snorted or sniffed, or injected. Usually a small quantity is
placed on a mirror, chopped into a fine powder and put into a 'line' with a
razor blade. This is then sniffed into the nostrils trough a straw, tube or rolled
banknote.
Street Names:
Rock, Wash, Stone, Roxanne,
Freebase, Nuggets, Baseball, Flake.
The Effects
Cocaine brings with it a feeling of exhilaration, well-being and euphoria,
which can be followed by agitation. The vaso-constrictive properties of cocaine
actually diminish the possibility of absorption, though the nasal tissues as the
user continues to inhale. On the other hand, when cocaine is smoked as
freebase or crack, the self-limiting property is lost as the drug is absorbed
directly into the lungs. Also, street cocaine is usually only 15 - 25% pure, while
crack can be 90% pure. Crack has a short, intense high, produced in four to six
seconds with the euphoria lasting only five to six minutes. This intense
euphoria is the hook which leads to psychological dependency. When cocaine
is snorted and effect occurs within one to three minutes and lasts up to half an
hour.
Long-term cocaine users lose weight, develop skin problems, experience
convulsions, have difficulty breathing and often spit up black phlegm. Longterm snorting can ulcerate the mucous membrane of the nose. Smoking
cocaine can lead to emphysema. Cocaine slows digestion, masks hunger,
stimulates the central nervous system and induces agitation, restlessness,
apprehensiveness and sexual arousal. Its immediate effects are elevated blood
pressure, temperature, pulse, blood sugar and breathing rate. This can lead to
cardio-vascular problems.
Paranoia is another frequent result of abuse. There is no safe dose of cocaine.
Users can get a sensation like insects crawling over their skin (cocaine bugs)
or visual disturbances (snow lights). Freebasing has increased risks including
confusion, slurred speech and anxiety.
51
Withdrawal
After the almost instant high of the crack or cocaine hit, the comedown or
'crash' begins:
•
•
Users shake and twitch uncontrollably
They are shivering
•
•
They are weak and tired
They are paranoid and depressed
• Theyfeel alone and isolated, and threatened by those around
•
They're irritable and aggressive
•
They crave more
Crack users say you can't begin to describe how awful the low is. It's not so
much like jumping off a cliff as tumbling down a slope covered in broken
glass. Some users take heroin to ease the comedown.
Historical background
For centuries the leaves of the coca plant have been chewed by South
American Indians. Fore millions of people the habit continues to fulfil a
comparable role to that of coffee or tobacco elsewhere in the world.
The coca plant was considered to be a gift of the gods and was used during
religious rituals, burials and for other special purposes. By the time the
Spaniards arrived in the 16th century,the Incan Empire was in decline. By this
time, coca was no longer used only by the ruling class or only in association
with ritual. The Spaniards, at first, tried to prevent the Indian from using coca,
because they believed it was a barrier to conversion to Christianity. Later, it
became a practise to pay the Indians in coca leaves for their work. The
Spaniards could thereby force enormous amounts of work from them in the
gold and silver mines despite difficultconditions and high altitudes.
Coca leaves, along with coffee, tea, and tobacco, were brought to Europe from
South America by the explorers in the 16th century, but unlike the others, coca
leaves were unpopular until the 19th century. This may have been due to
deterioration of the leaves during the journey, causing a great loss of potency.
In 1862, Albert Niemann finally extracted a purified cocaine from a crystalline
substance derived from coca leaves.
Cocaine was highly regarded in the 1880's and 1890's, and many prominent
figures advocated the therapeutic use of cocaine. Pope Leo XII, Sigmund
Freud, Jules Verne, and Thomas Edison all endorsed its use. A frequently
quoted advertisement of 1885 described coca as
'a drug which through its stimulantproperties can supply theplace offood,
make the coward brave, the silent eloquent,free the victims of alcohol and
opium habitfrom their bondage, and as an anaesthetic, render the sufferer
insensitive to pain
'
52
In 1888, Coca-Cola, which originally contained cocaine, advertised itself as
'the drink that relieves exhaustion'. (Coca-Cola has since removed cocaine
from the contents of their drink and replaced it with caffeine).
The abuse of cocaine was largely non-existent in the United States until the
1960's, except among entertainers and jazz musicians. The use of the drug has
been prohibited, both in patent medicines and for recreational use, since 1914.
In many countries, regular cocaine use is the domain of two very disparate
social groupings that also have very difficult profiles of use.
1. Young professionals, wives, husbands, single male/females in their late
twenties, thirties, forties etc. They rarely present to doctors or drug services
with cocaine-related problems - so are often 'invisible' users.
2. The hard drug scene - men and woman of low socio-economic status,
unemployed often, and would frequently inject the drug or smoke in the form
of crack. They are more likely to be involved in criminal activities to support
their drug habit, and would experience a lot of high-profile, drug-related
problems.
Amphetamines
Amphetamine is short for AlphaMethylphenethylamine, a man-made drug
first created over 100 years ago. It is a powerful stimulant.
The most common home-made amphetamine is amphetamine sulphate,
which is found in tablets, loose powder with a selection of colours, and
textures and capsules. It is bulked up with whole ranges of substances ranging
from lactose to caffeine to paracetamol. It is easily produced and readily
available on the street.
Amphetamine stimulates the nervous system. It acts like adrenaline: blood
pressure goes up, the heart thumps and the body temperature rises. It comes
as a white powder that looks like salt, or sometimes as a pill or paste. The
powder usually comes in a folded paper envelopecalled a 'wrap' that contains
about lgram of powder. However, most wraps only contain about smg of
actual amphetamine. The purity of drugs at street level is extremely low, about
6%. It can be swallowed, injected, smoked or snorted. Sometimes it is
dissolved in a drink, rubbed on gums or sucked from a finger. The 'buzz' or
'rush' produces an overwhelming sense of euphoria or happiness. There may
also
be
nervous
excitability,
sleeplessness,
agitation,
talkativeness,
aggressiveness, lack of appetite, unlimited energy, dry mouth and thirst,
sweating, palpitations, increasedblood pressure, nausea, sickness, headaches,
dizziness, tremors.
The effects usually wear off in three to four hours when the user becomes
tired, irritable, depressed and unable to concentrate. Often there are feelings
of confusion, persecution, even violence.
53
Physical side effects
•
Overheating A rocketing body temperature over 38 C will make you
delirious. If you're dehydrated, you risk getting heatstroke, which can
result in unconsciousness.
•
Brain swelling If you drink too much water too quickly your brain
may suffer water poisoning.
•
Pain & sickness You may get body cramps, a splitting headache and
•
be sick.
Increased heart-rate
•
•
•
•
Liver & kidney failure Can occur if a high dose is mixed with alcohol
High blood pressure Small blood vessels may burst in your brain,
leading to paralysis or coma
Hyperventilation
Life-threatening condition An extreme reaction, sometimes called
sledging, to mixing amphetamine with other drugs such as ecstasy,
ketamine or alcohol. You'll be freezing- cold and shivering violently,
you'll be unable to speak or move your body. You'll feel as though
you're drifting into a sleep.
Dexedrine
Known as 'dexies' these are white-scored tablets made from another
amphetamine salt. Methylamphetamine is a similar amphetamine in
appearance but is much more potent. It's to amphetamine what crack is to
cocaine - it can be 90 - 100% pure.
Street Names
Ice
Crystal Glass
Ice-cream
Meth
It comes as creamy-white or sandy coloured powder sold in wraps, or as
tablets in different shapes, colours and sizes, or as clear and colourless
crystals, like glass. Large crystals (bombs) are bought individually wrapped.
Users get an intense rush with a euphoria lasting from two to sixteen hours.
This has many adverse side-effects: fever and nausea, increased blood
pressure, paranoid delusions, auditory hallucinations, bizarre and aggressive
behaviour. Overdose of ice leads to convulsions, coma and death. Fatalities
can occur after only small doses.
Historical Background
Amphetamine was first synthesized in 1887. First popularized by
pharmaceutical company Smith Kline &French as the nasalinhaler,
Benzedrine, in 1932. (Amphetamine is widely known as a bronchio dialator,
allowing asthmatics to breathe more freely.) The unwanted effect of
sleeplessness was recognised quickly, but this did not slow the ever-widening
54
range of applications from Parkinson's disease, migraine, addictions,
seasickness to mania, schizophrenia, impotence and apathy in old age.
Methamphetamine, more potent and easy to make, was discovered in Japan in
1919. The crystalline powder soluble in water, making it a perfect candidate
for injection. Also smoking the drug creates a similar rush. It is still legally
produced in the U.S., most often prescribed for weight loss, sold under the
name Desoxyn. As the name 'speed' suggests, amphetamines elevate mood,
heighten endurance and eliminate fatigue, explaining the drug's popularity
with the military. Hitler was supposedly injected with methamphetamine. The
first non-medical application was to counter fatigue among soldiers in the
Spanish Civil War, and in the Second World War, this became a common
practice.
The first recorded outbreak of widespread misuse occurred in Japan
Immediately after the war when large military stocks of methamphetamine
were dumped onto the civilian marketplace. By the 1950s, pill misuse was
commonplace in the US, and the term 'speed freak' was coined. It wasn't until
1956 that the first restrictions were placed on its use, but this did little to slow
demand. In 1964, nearly 4 million prescriptions for amphetamine were issued
in Britain, making up 2% of all prescriptions written that year.
In Britain as in the US the progressive withdrawal of pharmaceutical products
from the marketplace encouraged the emergence of a succession of illicit local
manufactures. The volume of this production has been sufficient to maintain
amphetamine as the most widely used illegal drug in Britain after cannabis.
Speed rose to popularity in California, home of many of the largest meth labs
in the country, riding on the back of biker gangs. Bikers have been historically
blamed for introducing the drug into the psychedelic '60s, subsequently
bringing down a whole Summer of Love with violence and angst. Since then,
speed has been given a bad rap. It has been called a trailer park drug for
decades, due to the fact that it can be cooked up so cheaply and easily. It's the
drug of choice for long-distance truckers and college students pulling allnighters. Over the counter ephedrine, or 'white crosses,' has taken the place of
pharmaceutical amphetamine as an easy-to-get alternative.
One major misconception is the link between methamphetamine and ecstasy
(MDMA). Ecstasy does not necessarily contain speed, yet both contain the
methamphetamine structure. However, each affects a far different region of
the brain resulting in different psychological effects. Ecstasy primarily effects
serotonin in the brain ~ the centre for self-satisfaction and emotional systems.
Speed affects dopamine primarily, a neurotransmitter linked to pleasure and
reward. (Alcohol also affects a dopamine centre.) Often, MDMA is 'cut' with
speed to lower the street price of the drug, thus changing the overall effect.
The two are similar in chemical makeup but one cannot be made from the
other. Slightly changing the chemical makeup produces a wholly different
effect in the human brain. While both have addictive potential, speed, because
of its dopamine ties, is much more profoundly addictive. Qualitatively, speed
and ecstasy supposedly give off 'glows' that is far different.
55
Ephedrine
This is often sold as amphetamine as it looks similar and acts in the same way
on the central nervous system. Ice is made from this also.
Ritalin
This is a white-scored tablet which is prescribed for rarcolepsy, fatigue
associated ,with depression, and for hyperactive children. It causes
amphetamine-like dependency.
Pemoline and Volatile are other tablets which are amphetamine-like drugs
with similar effects.
Slimming tablets
These are prescribed for the obese and are abused regularly. They also
stimulate the central nervous system;
Tenuate Dospan: white elongated tablets marked 'merrell'
Duromine: grey / green or maroon/grey capsules
Teronac: white tablets
Preludin, Ponderax: clear and blue tablets.
These have similar effects to amphetamines.
Built for Speed?
Methamphetamine has reclaimed a plate in the lexicon of 'party' drugs.
Hailed by nocturnal adventurers, condemned by raver idealists, is speed a
sleepless dream or an addictive nightmare?
(Todd C. Roberts)
Here at the end of the millennium, the pace of modern life seems fleeting- a
whirl of minutes, hours and days. In dealing with the changes, humans have
equipped themselves with the tools to move faster, more efficiently. At the
same time dependence for the marketing, high-speed transportation and
pharmacology of this modern age has evolved. In a race to outdo ourselves, we
have moved dangerously toward the fine line between extinction and
evolution. Therefore, the human capacity to handle the velocity becomes a
fragile balance.
The machines of this age have in a way enabled us to create a 24-hour lifestyle.
We have pushed the limits of the modern world further - ATM's, high-speed
modems, smart bombs and bullet trains. However, the limitations of human
existence, like sleep, may still provide the stumbling block for infinite
realization. That is, without chemical aid.
Our society is based upon the mass consumption of these substances.
Cultural ideals, while seemingly benevolent as 'Have a Coke and a smile' have
sold the link to chemical substances like caffeine and nicotine to 'the good life.'
Today, stimulants are the bedrock for consumer culture. For our generation,
56
this appeal was heightened by raising the stakes in the 8o's on what it meant
to have fun.
"My experience with speed-like substances really begins with coffee*, says
Mark, an addict that relates his experiences back to an early age. Vve been
drinking the stuff since Junior High School as my get me up and go thing.
But the relationship with amphetamines starts six or seven years ago with
poppers ephedrine, mini-thins. I started taking them to stay awake in college
to finish papers and the like.
'Things got really serious when I started doing CAT, a local low-grade speed
that was in vogue about six years ago.' CAT, or methacathinone, is a popular
substance made from common household chemicals like drain-cleaner,
Epsom salts and battery acid. 'I realised how bad my problem was when
right around the time the land war in Iraq began. I had stayed up for days
on end, watching the planes bomb the Iraqis. It's the only drug I've done at
work. To this day what was a six-month period still seems to me to be several
weeks. It's also the only drug I've done where my peers at work noticed
mood swings, irritability, and sleeplessness'. CAT is notorious for its
addictive potential, apparently strong enough to hook users after just one
sample.
'Even after I kicked the CAT habit, I would usually indulge my speed
addiction by crushing up mini-thins and snorting them. This continued for
about another year. Most recently (for about a year) I moved to MDMA as
the speed kick. Atfirst I did it about once a month, but that has fallen off to a
much less frequent, but still regular usage'.
'What caught me about speed, and what catches me now, is the feeling of
invulnerability. I think I get from speed what most cocaine users get from
coke. The feeling of being on 'top of the world'. As a raver, speed is also a
convenient way to keep dancing long after your body has gone to sleep.'
Asked if the drug has improved his life, he answers, 'What a joke. Improve?
Beyond the nominal gain of being able to dance until the wee hours of the
morning, it doesn't And productivity? Any gains are ephemeral and shortlasted'.
'I do in fact know some people who skate through life without problems with
drugs. But I think more people than not overestimate their ability to handle
drugs. Drugs can be fun, but they also tend to get in the way of being a
functional human being with multi-dimensional interests, as opposed to
being a full-time club kid, which gets you nowherefast'
Like a space capsule falling to earth, the destruction that comes from the
come-down can be severe. The come-down is what many users refer to as 'the
crash.' Usually symptoms like chills, nervous twitching, sweats and exhaustion
are prevalent. The 'high' produced is a result of extra activation chemicals in
the brain.
57
Simply put stimulants cause their effectsby blocking re-uptakeof
Neurotransmitters at a pre-synaptic membrane. The cell secretes activation
chemicals, but cannot re-absorb them in the presence of cocaine or speed. The
user feels 'wired', full of energy, because their cells are receiving massive
stimulation. The more concentrated the drug is, the more intense the rush is,
and the more damaging the effects. In worst case scenarios, heart attacks
occur from over stimulation and energy depletion.
The come down is a result of the chemical being released all at once, making
you high, but then is subsequently degraded in the synapse. So once you
come down, there's not as much as there normally should be, creating the
'comedown blues.'
Prevalent discussion between users on either side of the methamphetamine
argument involves addiction. According to several studies, criteria for
addiction includes: unsuccessful attempts to quit, persistent desire and
craving, continued use despite knowledge of harm to oneself or others, taking
the drug to avoid or relieve withdrawal. While the social definition for
addiction is debatable, the chemical and physical activity in the body is
founded in one of several compounds in the brain.
'Many drugs that are addictive, have primary or major effects on the
dopamine system (nicotine, amphetamine, cocaine, alcohol, heroine),' says
Plunkett. 'Drugs that don't have a major effect on dopamine generally aren't
'addictive' in the same way - marijuana, MDMA, LSD, psilocybin, etc.
Although abuse potential is there, it doesn't generate the same kind of
craving. Dopamine is normally involved with pleasure and reward, among
many other biochemical roles.'
With long-term abuse, the effects of methamphetamine become much more
severe. Tolerance is an issue, like in most drugs, where more of the drug is
needed to get 'high.' Psychosis, specific to methamphetamines usually sets in
after a time which is said to include 'suspicion, anxiety and auditory
hallucination.' Though reportedly, much more acute are the changes in
lifestyle and eventually in personality that manifest. Users exhibit an affective
disorder and subtle change in psychological temperament. Apparently, these
symptoms can last up to five years. Many who have witnessed the changes in
habitual users report the shift to aggressive or non-affectionate behaviour
which may also be attributed to methamphetamine. Also apparent is some
nerve damage in habitual users (primarily crystal smokers) — jaw clenching
and facial ticks. However, how much can be attributed to the drug and how
much to sleep deprivation is unclear.
Meth is one of the most addictive drugs of today's commonly used drugs.
According to one study that appeared in 'In Health' magazine, the addictive
potential inherent in the drug, methamphetamine, taken nasally ranks over
cocaine, caffeine and pep (angel dust) in addictive qualities. MDMA,
marijuana, psilocybin and LSD ranked at least 50 points lower than meth on a
100 point scale, nicotine being the highest above both crack and crystal meth.
58
Ethnobotanist, drug theorist and author Terence McKenna calls them
'dominator' drugs - synthetic drugs that have been refined and concentrated,
therefore losening their natural link to the planet and to human-kind.
'Dominator' drugs have been established and validated by 'dominator
culture', a culture interested in the mass consumerism of these legitimate
substances - sugar, nicotine, caffeine'. He relates the emergence of drugs like
methamphetamine back to the institutionalised abuse of these substances.
'The history of commercial drug synergies —the way in which one drug has
been cynically encouraged and used to support the introduction of others over the past five hundred years is not easy to contemplate,' he writes in his
book Food of the Gods.
The hypocrisy of dominator culture as it picks and chooses the truths and
realities that it finds comfortable,' he continues. Some drugs like alcohol and
nicotine have long been legal and subsidised by dominator culture, however
their qualitative separation from drugs like cocaine or speed is still unclear.
'{These drugs} are still at the depths ofdrug depravity especially considering
the violent or illegal acts that the craving may induce (because oftheir illegal
status), however tobacco addicts (smokers) might kill for their fix too if they
had to, but instead they simply walk out to a y-Eleven and buy cigarettes.'
'While I am no proponent of speed or drug abuse, I have become glaringly
aware of the hypocrisy prevalent in mainstream and underground culture
regarding the legitimation of certain drugs. When finger-pointing, it is
important to remember the glass houses we all live in. Addiction is a
problem, but the bigger problem is sweeping it into a closet, pretending it
isn't real, pretending that our own addictions are more manageable'.
Speed is a potentially dangerous substance. It can be used as a tool, like latenight coffee drinkers. It can also be used as a recreational drug. However, it
can also be abused and exploited to the point where the need for it besides
soothing a craving is the only point. And then, there is no point. Some may
argue that there is an aesthetic, a qualitative high, however, by
methamphetamine's nature - as a refined, concentrated addictive substance it only perpetuates the cycle for needing more.
Many other drugs have been part of the rave community over the years nitrous oxide, Special K (ketamine) and especially ecstasy (MDMA) but none
have
exhibited
the
burn-out
or
addiction
rate
associated
with
methamphetamine. While meth (or any drug) is an inert substance that we
cannot attribute blame to, by its nature it has raised the question 'Are we
really built for speed?' It seems that the human body, while naturally resilient
to much self-inflicted abuse, may not be a reliable container for the soul at
high speeds. Methamphetamine may have the ability to chemically fuel the
ride, physically it may just prove the limitations for human society.
59
Caffeine
This is the most widely used drug world-wide. It is found in coffee, tea, cola
drinks, red bull, in some tonics and many painkillingtablets. A similar drug is
found in cocoa and chocolate.
1. One cup of tea gives approximately somgs of caffeine.
2. One cup freshly brewed coffee gives 100 - isomgs of caffeine
3. Instant coffee gives 70mgs of caffeine
4. Cola gives 15 - 55mgs of caffeine per can
5. Headache tablets give approximately somgs per tablet
When people use caffeine extensively or continuously, they may experience
hand tremors, loss of appetite, poor co-ordination and delayed or difficult
sleep. Extensive use of extremely high doses of caffeine may cause nausea,
diarrhea, trembling, headache, nervousness and sleeplessness. Poisonous
doses lead to convulsions, though these and death can only occur through use
of tablets, (log caffeine is the lethal dose).
Nicotine
Nicotine is one of the most toxic of all poisons. It enters the body through the
lungs (when smoked), through the mouth (when chewed), or through the
stomach and intestines (when swallowed). It is habit-forming and
psychologically addictive. The user craves nicotine and high tolerance builds
up quickly. It leads to loss of appetite, restlessnessand irritability.
The hit from nicotine happens in seconds and lasts half an hour.
•
When nicotine reaches the brain, it makes the head spin. It makes
people feel stimulated and alert.
•
Nicotine makes the heart beat faster, so more blood circulates around
the body per minute. Users say they feel ready to get up and go.
•
Nicotine reduces tension in muscles, which makes people feel relaxed
and seems to relieve stress.
•
Nicotine seems to help people work by improving concentration. It can
stave off boredom and fatigue.
The Dangers of Smoking:
Lung cancer
Fatal heart disease
Stroke
Gangrene
Emphysema & Bronchitis
Cancer of the mouth, throat, oesophagus, bladder pancreas, kidney,
cervix and breast can all be smoking-related.
60
Historical Background
Christopher Columbus found the custom of smoking tobacco well established
by the time of his arrival into Americatowards the end of the 15th century. The
dried plant was smoked in pipes or roll-ups made from leaves. Its reputation
as a medicinal plant spread quickly through mainland Europe. Sir Walter
Ralegh is credited with introducing it to the fashionable world in London
towards the end of the 16th century.
The popularity of tobacco soared during the 17th century, and the first
commercial plantation was established in Jamestown, Virginia in 1612.
Chewing tobacco and inhaling it as snuff also caught on. However, the
possibility of harmful effects and the difficulty of consuming it in moderation
were appreciated right from the start, and it had some influential opponents.
King James I published his view in 1604 that the customs of tobacco 'were
loathsome to the rye, hateful to the nose, harmful to the brain, dangerous to
the lungs'. The realisation that massive tax revenues could be extracted from
users soon overcame such considerations, and James' government became the
first beneficiary of a massive bonanza, which continues to the present day.
The first machine-made cigarettes appeared in Havana in 1853 and factories
were established in London in 1856, and the US in 1872. By the end of the
First World War it had become the most popular way of taking tobacco.
UK cigarette sales soared from 11000 million in 1905 to 74000 million in
1939> of which less than 1 % were filtered. Up to this point smoking was a
more or less exclusively male habit but it became much more popular among
women during the Second World War.
There have been striking shifts in patterns of smoking over the years: age, sex,
socio-economic groups and combinations of these factors.
Although there was a trend in many developed countries for a reduction in the
prevalence of smoking between 1970 and 1985, overall world consumption
increased by 7% over this time. This has come about because of large increases
of smoking in the Third World.
•
Nicotine is more addictive then heroin
•
You inhale over 3000 different chemicals in every puff
•
Smoking kills more people than AIDS, alcohol, drug abuse, car crashes,
murders, suicides & fires combined.
•
If tobacco were reaching the market today for the first time, it would,
without question, be banned outright
61
Stimulatory Hallucinogens
Methylenedioxtmethylamphetamine (MDMA) or Ecstasy
This is a drugwhich is related to amphetamine and mescaline, withboth
stimulant and hallucinogenicproperties. It was originally designed in 1914 as
an appetite suppressant. It is very much associatedwith the rave scene.
Ecstasy is available in tablets and capsules of every colour and size. New forms
are being manufactured and appearingon the street every day.
Street names
Love Doves, CreySparkles, Burgers, CaliforniaSunrise,
BigBrown Ones, New Yorkers, Yellow Submarines, Clarity
Dennis the Menace, Adam, E
When Ecstasy is taken, the 'buzz' is not immediate, it may take thirty minutes
to an hour before the dose takes effect. Users may experience an
amphetamine-like rush of euphoria, followed by several hours of peacefulness
and heightened sensual awareness. Ecstasy is described as an empathogen as
it releases mood-altering chemicals such as serotonin and L-dopain the brain,
and generates feelings of love and friendliness.
Also in evidence are the other effects of stimulation on the central nervous
system: excitement, increased activity and feeling wide awake. The pupils
dilate and the mouth may go dry. The heart can become over-stimulated,
increasing blood pressure and the heart rate. There can be tightening of the
jaw, feelings of nausea, dizziness and lack of co-ordination. Another aspect is
that the person may undergo flashback of the experience. This is where they
have similar feelings, hear and see things long after they have stopped using
the drug. This is particularly likely to happen when they have used Ecstasy for
a prolonged period. The high is followed by exhaustion, anxiety and
depression which may last several days.
Deaths have been attributed to Ecstasy. Respiratory distress, heart failure,
kidney failure and internal bleeding may all occur. Dehydration and
exhaustion are other causes of fatalities, also strokes. Ecstasy causes calcium
deficiency, crumbling teeth, receding gums, brittle bone disease. It has been
linked with infertility, brain damage and psychological disorders.
Historical Background
Methylenedioxyampheamine (MDA) was synthesised in 1910, then lay
dormant until 1939 when it underwent testing in animals. It was launched as a
treatment for Parkinson's disease in 1941. without much success.
Methylenedioxymethamphetamine (MDMA, Ecstasy) was created in 1912 and
patented two years later. It underwent toxicology studies by the US military in
the 1950s, and was available quite legally, for recreational use from around
1970. This non-medical use grew steadily, and had a particular focus in Texas
and California. In 1976, reports were appearing of the successful use of
MDMA as an adjunct to individual, group and marital psychotherapy. It was
also said to be helpful in the treatment of alcohol and drug abuse.
62
At the same time, concern about MDMA's abuse potential was growing. In
1985 the American Drug Enforcement Agency brought MDMA under
Schedule 1 control - the toughest restriction available. The ban in 1985 led to a
flurry of 'designer drugs', having chemical variations on MDMAbut not falling
within the scope of the law.
Ecstasy took off in Britain in the mid-1980s through its association with the
acid-house music phenomenon, from which the rave culture and modern club
scene evolved.
Precautions & Warnings
Most recorded ecstasy deaths have happened because the tablet was not
'pure'. Ecstasy may be cut with other rubbish such as dog-worming pills or
talcum powder, to bulk out the tablet. Powerful drugs such as ketamine (an
hallucinogenic anaesthetic) or segaline (used to treat Parkinson's disease) are
also added giving horrible unexpected side effects. Even some reliable brands
turn out to be fake; in fact when 'Doves' were analysed in a particular survey,
one contained as little as 29mg MDMA, another had as much as I70mg, and
one had none at all - it contained pure ketamine.
Another cause of death may be because of a failure to counteract overheating
correctly. It's tempting to drink too much water too quickly when trying to
cool down, but it' better to keep sipping water slowly over a long period of
time - such as sipping a half-pint of liquid every half an hour. High energy
drinks are best, then fruit juices or water. Salt levels should be kept up by
eating salted crisps or nuts.
PCP
This is phencyclidine and was manufactured as a veterinary anaesthetic
Street names
Angel Dust, Peace Pill,
Elephant Tranquillizer, RocketFuel,
Zombie, Whack, Embalming Fluid
It gives feelings of weightlessness, diminished body seize and distortion of
perception. Overdosing results in vomiting, agitation, disorientation,
respiratory problems and convulsions. It can cause prolongedcoma.
Ketamine Hydrochloride
This is a white crystalline powder, usuallyknown as 'K' or 'Special K*. It can be
obtained in tablet form. It is chemically related to PCP and is used for its
hallucinogenic properties. It is a short acting anaesthetic. Recovery is slowand
may be accompanied by nausea and vomiting. Headache, dizziness and
confusion occur. It can cause numbness, blackouts and temporary blindness.
63
GBH
This is another anaesthetic often sold as another drug, for example Ecstasy,
with similar side effects and danger of convulsions and respiratory arrest.
PSYCHOGENIC^
These drugs work directly on the brain. They cause a 'trip' involving changes
in the perception of time and space which results in unreal sensations, the
appearance of 'visions, the hearing of voices and delusions.
LSD (Lysergic Acid Diethylamide)
This is an extremely potent drug and minute quantities are formed into very
small tablets or microdots and absorbed onto blotting paper, peel-off stars or
cartoon figures.
Street Names:
Acid, Blotters
Mellow, Tab,
Batman, Strawberry, Double Dip, Penguin
The effects of LSD begin within an hour, build up for 2 - 8 hours and slowly
fade after about 12 hours. Physical effects include increased heart rate and
blood pressure, widening of the pupils and rise in temperature. Mental and
emotional effects can be strong. These involve loss of emotional control,
disorientation, depression, dizziness, panic and extreme fear. Other users feel
invincible and try to walk on water or fly. Flashback may occur weeks or
months later. There are psychological dangers as psychoses can occur.
Historical Background
Hallucinogenic plants have been used for thousands of years in social and
religious rituals, for healing, and for escape. The key event occurred in 1943
when Albert Hofman, a Swiss research scientist, accidentally ingested a
microscopic amount of a chemical he had isolated 5 years earlier while
searching for a new heart stimulant. Hofman's report of his experience
unleashed a flood-tide of scientific articles, books and conferences. The
medical and psychiatric use of LSD expanded rapidly after it was first
marketed in 1949 with well over 1000 000 patients in the US and Europe
receiving it during the 1950s. It was used for depression, alcoholism,
neuroses, tiredness, chronic pain and most frequently of all, as an adjunct to
various forms of therapy.
The CLA became interested, since this seemed to be a substance which might
facilitate interrogation. Many words were coined to describe these new drugs the one that stuck was Humphrey Osmond's psychodelics.
The use of psychodelics soon spread. Timothy Leary, an unconventional
Harvard psychologist, began a series of psychodeiic experiments with friends,
64
colleagues and students. His catchphrase 'turn on, tune in, drop out' became a
mantra for the hip generation. He also drew attention to the importance of
'set' and 'setting' in determining the effects of drugs. That is the attitudes,
personality and expectations of the user, and the nature of the environment in
which the drug is taken. The consumption of LSD rocketed within this
Cultural Revolution. In 1962 it was estimated that 25 000.\mericans had
tried LSD, and by 1965 this figure had gone to 4 million. In the same year, the
first federal law controlling its manufacture came in, and it was banned in
1966 in Britain. Scare stories surrounding LSD gathered pace in the media.
Enforcement of the law became more determined. From the middle of the
1970s to the early 1980s LSD was in short supply and the trade in mushrooms
and mescaline took over.
Magic Mushrooms
These contain psilocybin, a hallucinogenic drug. They can be eaten or boiled
for a drink. One of the major dangers is that poisonous mushrooms may be
gathered and eaten. As with other hallucinogens the mental state of the user
is the core issue and some individuals can move into short and long-term
psychosis.
Mushrooms Used:
•
•
Liberty Cap: A small pale yellow to light brown fungus with a slender
stem and conical cap.
FlyAgaric: A larger bright red mushroom with white spots and a thick
white
stalk.
Mescaline
Derived from the peyote cactus, this is dried and cut into slices. It is also
refined into powder. It is commonly used in Ireland and the UK.
Cannabis
Cannabis is a mild hallucinogen. The active mind-altering ingredient is THC
('terra hydro cannabinol). The amount of THC determines how strong the
effects will be. Cannabis comes from a large plant, called Cannabis Sativa,
and has various forms:
•
Marijuana (pot, grass, reefer): the leaves and fruiting tops ofthe plant 5
-10% THC
•
Hashish (hash, blow): resin extracted from the plant hairs. Up to 20%
THC
•
Hash oil: a concentrated extract. As high as 85 % THC.
Hashish comes in a variety of forms and colours, depending on the country of
origin. This leads to nicknames, for example Lebanese Gold or Afghan Black.
Commonly used slang names for cannabis in various forms also include:
65
Street Names:
Grass, Hash, Charge, Smoke, Shit,
Pot, Hay, Blow, Stuff, Mary
Joint, Weed, Dope, Splif
The most common way of consuming cannabis is by smoking. A joint is made
by rolling a cigarette using marijuana or herbal cannabis in place of, or with
tobacco. Cannabis smoke is very hot and can burn the throat, so often long
joints, or filters, or pipes of various sizes are made. Cannabis can also be
swallowed and is sometimes made into a tea-like drink or cooked in
homemade cakes and sweets.
The effects then obviously depend on the type and quantity used, also on the
users' mood and expectations and the situation. Almost immediately after
intake the heart beats faster, pulse rate quickens, and mouth and throat gets
drier. Cannabis removes inhibitions and the user becomes excitable, talkative
and relaxed. Some people have trouble remembering events that occurred
during the high and experience difficulty in performing functions that require
concentration, rapid reactions and co-ordination. Reflexes are slowed and
judgement impaired even up to six hours after using.
Acute intoxication can result in anxiety, paranoia and panic. Sometimes users
become aggressive, even violent. Once the drug wears off, there may be a
'hangover' of headache, nausea and general disability and fatigue. Regular
smoking causes sleep-loss or disturbance, irritability and restlessness,
decreased appetite, sweating, weight loss and depression. Cannabis is not
water soluble, so it accumulates in the body fat, tissues and organs, leading to
build up of THC.
Cannabis smoke contains approximately 2,000 chemicals and has a quicker
and more damaging effect on the lungs than tobacco. The risk of lung cancer is
greater. The amount of carcinogen retained after one joint of cannabis is
probably greater than that from five normal tobacco cigarettes because
cannabis smoke is inhaled deeply and held for as long as thirty seconds.
Cannabis can also cause emphysema. THC reduces the body's capacity to
resist infectious diseases. Evidence also exists that cannabis negatively affects
the human reproductive system, causing irregular menstrual cycles in women
and temporary loss of fertility in men.
Historical Background
The cannabis plant was probably the first plant to be grown for reasons other
than food production. The use of cannabis as a medicine was described in an
Egyptian papyrus of the 16th century BC. The first systematic account of the
pain-killing, anti-inflammatory and anti-emetic properties of cannabis
appeared in China nearly 5000 years ago. It was probably first introduced to
Europeans about 1000 years ago by the Moor invaders.
66
It was known as Indian hemp until it was renamed by Linnaeus in 1753, and it
only began to emerge as a herbal remedy on any scale in the 18th century. The
person who is credited with making cannabis respectable was the Irish
scientist and physician W.B. O'Shaughnessy. He observed its use in India.
After carrying out experiments on goats and dogs to convince himself of its
safety, O' Shaughnessy began giving it to patients suffering from a variety of
conditions. When O' Shaughnessy returned to England in 1842 bringing a
substantial supply with him, he published an account of his findings and the
medical use of cannabis expanded rapidly.
Recreational use does not seem to have been widespread in ^^jentury
Europe and North America, but it became a firm favourite among artists and
intellectuals in the bigger cities.
Cannabis was outlawed in Britain in 1928, though it did remain available in
pharmacies for use in psychiatric indications, until its absolute prohibition
under the terms of the Misuse of Drugs Act (1971).
In the
1960s cannabis became integral to developing hippy and
psychedelic movements, but also found its way into student life and the homes
of otherwise quite unrebellious people. By 1970, upwards of 25 million
Americans had tried it, and there were 10 million regular smokers.
Myths & Truths
Does cannabis lead to harder drugs?
•
Hardly ever. There's no concrete evidence that cannabis is the 'gateway
drug'.
•
•
People who abuse hard drugs are usually psychologically damaged and
probably would have escalated to hard drugs with or without cannabis.
It's probably true to say that people who use cannabis are more likely to
be in situations where they'll be offered other types of drugs.
Does cannabis lead to memory loss?
Cannabis can cause short-term memory loss after long-term or heavy use
Does cannabis cause cancer?
Because of its high tar content it's likely that smoking cannabis can cause
cancer of the throat and lungs. This is difficult to prove as most users who
develop cancer also smoke cigarettes, and cigarette smoke is associated with
several cancers.
Can cannabis cause birth defects?
There's a strong link between smoking cannabis while pregnant and a baby
having abnormalities as well as stillbirth, miscarriage or early death of a baby.
67
Miscellaneous Others
Nitrites
Inhalants/Solvents
The gases, fumes or vapours are inhaled to get a high or a buzz similar to the
intoxication caused by alcohol. The term in general use is 'glue-sniffing', but
this more accurately is known as 'volatile substance abuse' or 'solvent abuse'.
Substances abused:
Antifreeze
Cigarette lighterfuel/Butane gas, Dry-cleaningfluids, Petroleum
products, Hair lacquer, Surgical spirit, Nail varnish remover, Gas canisters and
bottles, Shoe polish, Metal cleaners and polish dyes,
Shoe conditioners, Room deodorants, Paints,
Thinners,
Paint andplaster
removers,
Typewriter correctingfluid, Painkilling spray, Glues,
Cement contact adhesive, airfresheners, Fire extinguishers.
A volatile substance is one that is usuallv a liquid but will become a
vapour or gas under normal conditions at room temperature. In a gaseous
state a substance is absorbed through the lungs and into the blood stream, in
which it rapidly travels to the brain. Abusers inhale or sniff the product from a
soaked rag, coat sleeve, cotton wool or from a bottle. Material is sometimes
placed in a plastic or paper bag, and held over the face, nose or head
('Huffing'), this concentrates the fumes.
Inhalants work by slowing down the body's functions much like an
anaesthetic. Initially users feel slightly stimulated; they then lose inhibitions
and control. Because the central nervous system also becomes anaesthetised,
breathing can become slow and difficult and judgement may be impaired. The
users often appear 'drunk' and may stagger and appear uncoordinated.
Nausea, coughing, sneezing, dizziness and lack of appetite are some of the
rapid side effects. Hallucinations may also occur. Behaviour can become
aggressive or even violent. Effects are short-lived, ranging from a few minutes
to half an hour.
Volatile organic solvents produce more unwanted or toxic effects than do most
other drugs. The effects are rapid because the substances enter the blood
stream through the lungs. Sometimes users may lose consciousness and may
even die if their breathing rate drops too low or if they inhale vomit or
suffocate because of the plastic bag. Sudden death may result from the direct
toxic effect of some solvents. Cardiac arrest may also occur. Even brief
exposures can disrupt the normal functioning of the heart, sometimes causing
death. Over an extended period inhalants can cause permanent damage to the
central nervous system, muscle fatigue, cardiac irregularities, conjunctivitis,
liver and kidney damage, adverse effects on blood and bone marrow, and a
permanent 'sniffer's rash' around the nose and throat.
68
Accidents are a common cause of fatalities; falls, burns or drownings that
occur when the person is intoxicated, often alone.
Historical background
It is clear from cave drawings in Australia and Mexico, and from the writings
of Greek and Persian scholars, that people have taken the opportunity to
inhale mind-altering gases which occur in nature. Mystics, including the
Delphi Oracle, used such emissions to induce visions and enhance contact
with the spirit world.
Modern recreational enjoyment of inhalants has its roots in the 19th century.
At this time pain relief in surgery relied upon alcohol, opium, cannabis or
even, for some unfortunate patients, concussion or partial suffocation. Sir
Humphrey Davy was the first to propose the use of nitrous oxide gas as
anaesthetic and painkiller. He also described the experience of inhaling this
gas for pleasure. News of the recreational possibilities of these substances
quickly spread among the upper classes, and nitrous oxide or chloroform
parties became quite the thing during the remainder of the century.
Petrol sniffing was first reported in the newspapers in 1942, but it wasn't until
the late 1950s that the practice became increasingly popular among teenagers
throughout America.
Volatile substance abuse was being reported throughout the British Isles by
1970. By 1980, surveys indicated that as many as 15% of people aged between
14 and 17 in both Britain and the US had used inhalants at some time.
Alongside these reports came the awareness that this could be a risky pastime.
Nearly 300 deaths were recorded in Britain between 1971 and 1983, and by
1990 this figure had passed the 1000 mark. More than 80% of solvent-related
deaths occur in teenagers, with 60% of them less than 17. The youngest fatality
on record was only 10. In the early 1980s, three teenagers were dying weekly
in the UK as a direct result of solvents, but the mortality has been steadily
reducing over the past 10 years to a yearly average of about 50.
•
•
Solvents kill more people under 16 than any other recreational drug.
The average household contains at least 30 different products capable
of producing intoxication on inhalation.
Poppers
Poppers are a group of quick-acting drugs (alkyl nitrites), of which amyl
nitrite, butyl nitrite and isobutyl nitrite are the most widely available. Poppers
evaporate at room temperature and are inhaled. They are stimulants but the
rush lasts minutes, hence the name poppers.
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Street Names:
Amyl, Stage, Stud, Rush, Rave,
Liquid Gold, Ram
The effects from inhaling poppers are instantaneous, but short-lived. There
maybe:
•
•
A burst of energy, and a rushing sensation because the heart starts
beating faster
A feeling of light-headedness after the initial rush because blood
pressure is reduced. This can lead to dizziness, loss of balance and
fainting
•
A sense that time has slowed down
•
A lowering of sexual inhibition and possibly feeling- sexually aroused.
Apart from these effects alkyl nitrates speed up heart rate and lower blood
pressure, making them dangerous for anyone with a heart condition. Regular
use can lead to skin problems around the mouth and nose. Nitrates are caustic
and so burn the skin if they are split.
Amyl nitrite has been associated with the gay scene.
Sports Drugs
Anabolic steroids are the main sports drugs used to improve athletic
performance. The anabolic part of the name means 'promoting positive
metabolism'. Anabolics shorten the recovery time of muscles allowing a more
rigorous regimen to be followed.
Anabolic steroids come as tablets, injections or implants. The most common
types are Anavar, Sustanon and Dianabol.
Many athletes and keep-fit fanatics are keen to excel in their field and develop
the best body they can in the shortest possible time.
Physical effects - women become masculine (often irreversibly) with
changes such as loss of breasts, deep voice, excess facial and body hair and
infertility. Steroids can also cause feminising effects in men. Anabolic steroids
can lead to acne, liver damage, raised cholesterol, heart attack, stroke and a
lowered sex drive. Users can become aggressive and paranoid.
Long-term users do experience cravings and withdrawal symptoms, but this
may relate to psychological not physical dependency.
When one anabolic steroid is combined with another or with recreational
drugs, such as cocaine, it's known as stacking. This can be fatal.
Other sports drugs
Amino acids
These arc the building blocks of proteins, but in high doses they can be just as
dangerous as anabolic steroids. They come as tablets or capsules and because
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they're seen as natural, 300 the daily requirement is often taken. Kidney
failure can result.
Growth hormones (L9H)
Responsible for healthy body growth, but only when you're growing. Once
you've stopped growing, it instead distorts the body.
EPO (Erythopoietin)
Stimulates the formation of red blood cells, increasing the oxygen-carrying
power ofthe blood. Because it thickens the blood it can cause a heart attack.
Historical Background
The effects of testosterone on muscle grOWTh \vere first reported in 1938,
and the idea soon developed that this may have applications in sports
performances.
Derivatives were used by the German military in World War II to enhance
aggression among new recruits. In the 1940s and 1950s body builders began
to give public endorsements to various brands of anabolic steroids, and they
were openly used by Olympic weight-lifting teams at this time. Since then
official sporting bodies have attempted to eliminate their use, with success.
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Sources:
Drug Related Deaths in Ireland Twice EU Average
Eoin Burke Kennedy
Irish Times
Facts about Drug Abuse in Ireland
Dr. Desmond Corrigan (Complied by)
Health Promotion Unit
Ireland: Drugs Toll Haunts Coroners Court
Martin Cooke
Irish Examiner 2001
Addictions- A Family Guide
T.A. Cronin
M.TM. Publications, Cork.
Danny Danziger
The Sunday Times Magazine
The Truth about Drugs
Dr. Patrick Dixon
Hodder & Stoughton, London.
Growing Numbers More Affluent Drug Users Taking Crack Cocaine
Conor Griffin
Irish Examiner
Addictive States- Current Concepts ofAddiction
Ed. Jerome H Jaffe, C.P. O'Brien
Heroin, Myths & Reality
Jara A Krivanek
Motivational Interviewing : Preparing People to Change Addictive
Behaviour
William R. Miller & Stephen Rollnick
The Guildford Press, 1991
Ireland: Heroin Addiction Spreads Beyond Cities & Towns.
Cormac 0' Keeffe
Irish Examiner
Built for Speed
Todd. C. Roberts.
URB Magazine.
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