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Substance Use Disorder Treatment

Information on Commonly

Abused Substances

Treatment for Alcohol & Substance Use Disorders A Training Resource

By Jim Messina, Ph.D., CCMHC, NCC, DCMHS-T

Common Abused Substances Covered in this Site
  • Alcohol
  • Marijuana-Cannabis
  • Inhalants
  • Cocaine
  • Crack
  • Methamphetamine
  • Ice
  • Sedatives/Depressants
  • Hallucinogens
  • Narcotics
  • Oxycontin
  • Steroids
  • Designer Drugs
  • Club Drugs
(Booze, Juice, Vino, Sauce)
  • Alcohol is a liquid distilled product of fermented fruits, grains and vegetables
  • Alcohol is used as solvent, antiseptic and sedative
  • Alcohol is a depressant that decreases the responses of the central nervous system
  • Excessive drinking can cause liver damage and psychotic behavior
  • As little as two beers or drinks can impair coordination & thinking.
  • Alcohol is often used by substance abusers to enhance the effects of other drugs
  • Alcohol continues to be the most frequently abused substance among young adult for relaxation, sociability and cheap highs 
Indications of Possible Misuse of Alcohol
  • Reduced ability to perform tasks requiring concentration and coordination, such as driving a car
  • Confusion, disorientation, loss of motor nerve control
  • Convulsions, shock, shallow respiration
  • Involuntary defecation, drowsiness
  • Respiratory depression and possible death

Negative Health Effects of Alcohol Use Disorder
  • Decreased sexual functioning
  • Liver disease
  • Increased cancers of the mouth, tongue, pharynx, esophagus, rectum, breast & skin
  • Kidney disease
  • Ulcers
  • Spontaneous abortion
  • Birth defects – leading cause of preventable retardation
Symptoms of Over use of Alcohol
  • Dulled mental processes
  • Slowed reaction time
  • Staggering
  • Poor judgment
  • Reduced inhibitions
  • Odor of alcohol on breath
  • Loss of coordination
  • Slurred speech, dilated pupils
  • Nerve and liver damage
Withdrawal Syndrome from Alcohol
  • Sweating
  • Tremors
  • Altered perception
  • Psychosis, fear, auditory hallucinations
                  (Pot, Grass, Joints, Blunts, Roaches, Reefer, Weed, Mary Jane)
  • Hemp plant from which marijuana and hashish are produced
  • Hashish consists of resinous secretions of the cannabis plant
  • Marijuana is a tobacco-like substance
  • Forms of marijuana have negative physical and mental effects
  • Active ingredient in marijuana is Delta-9-Tetrahydrocannabinol, or THC and is present in all forms of the drug

Indications of Misuse of Marijuana
  • Loss of appetite
  • Impaired memory, concentration, knowledge retention
  • Loss of coordination
  • More vivid sense of taste, sight, smell, hearing
  • Stronger doses cause fluctuating emotions, fragmentary thoughts, disoriented behavior, psychosis
  • May cause irritation to lungs, respiratory system
  • May cause cancer 
Mental Symptoms of Marijuana Use
  • Impaired or reduced short-term memory and comprehension
  • Altered sense of time, relaxed inhibitions, disoriented behavior
  • Changed sensory perception - sight, smell, hearing, touch
  • Possible hallucinations
  • Delayed reflexes & reduced ability to perform tasks requiring concentration and coordination, such as driving a car 
Health and Legal Effects of Marijuana
  • Emphysema-like symptoms & breathing problems
  • Respiratory track & sinus infections
  • Lowered immune system response
  • During pregnancy, marijuana may cause birth defects
  • Possession of marijuana is a illegal by Federal law and in all states except for Oregon and Colorado
Symptoms of Marijuana Overdose
  • Fatigue
  • Lack of coordination
  • Paranoia
  • Psychosis
Withdrawal Syndrome from Marijuana
  • Insomnia
  • Hyperactivity
  • Sometimes decreased appetite
Mood-altering substances that are voluntarily inhaled
  • Butyl nitrite 
  • Amyl nitrite (Gas in aerosol cans),
  • Gasoline and Toluene vapors (Correction fluid, glue, marking pens)
  • Most substances used are commercial and household products, such as solvents and aerosols, which are easily obtained and typically not harmful, if used for the purpose intended and as directed
  • Because they are common products, inhalants often are a young person’s first attempt at “getting high” 

Symptoms of Abuse of Inhalants
  • Nausea
  • Sneezing
  • Coughing
  • Nosebleeds
  • Fatigue
  • Poor coordination
  • Loss of appetite 

Health Effects of Inhalants
  • Brain damage
  • Slurred speech
  • Debilitating or permanent effects on central nervous system
  • Drowsiness or loss of consciousness
  • Weight loss
  • Fatigue and loss of muscle control
  • Electrolyte imbalance
  • Damage to lung cells
  • Hepatitis 
  • Most potent stimulant of organic origin and most widely used stimulant
  • Although cocaine has been used in past as a topical anesthetic, its therapeutic uses have almost been eliminated due to the development of safer anesthetics
  • Cocaine is a powerfully addictive drug leading to physical and psychological dependence
Why People Abuse Cocaine 
People use Cocaine to attain:
  • Carefree Feeling
  • Euphoria
  • Relaxation
  • Feeling of being in control 
  • Cocaine "high" lasts only about 5 to 20 minutes
  • Cocaine use may cause severe "mood swings" and irritability
  • One needs more and more cocaine each time one wants a "high"
  • Cocaine increases one's blood pressure and heart rate - Particularly dangerous if one has a heart condition
  • One use can cause death
  • Possession and use are illegal and can result in fines and arrest

Signs and Symptoms of Cocaine Abuse
  • Dilated pupils
  • Increased pulse rate
  • Elevated blood pressure
  • Insomnia
  • Loss of appetite
  • Tactile hallucinations
  • Paranoia
  • Seizures
  • Anxiety, agitation
  • Periods of increased activity followed by fatigue and depression
  • Wide mood swings
  • Difficulty in concentration
Health Effects of Cocaine
  • Cocaine stimulates the central nervous system
  • Immediate effects include dilated pupils and elevated blood pressure, heart rate, respiratory rate and body temperature.
  • Cocaine use can lead to death by cardiac arrest or respiratory failure
  • Cocaine can produce psychological and physical dependency, a feeling that the user cannot function without the drug 
  • Tolerance develops rapidly
  • Many users become extremely depressed when not using the drug and craving for the drug is intense
Health Effects of Cocaine Powder if Sniffed or Snorted
  • Its euphoric high lasts for approximately 30 minutes
  • Occasional use can cause a stuffy or runny nose
  • Chronic use can ulcerate mucous membrane of the nose

Health Effects of Cocaine Powder if Injected
  • Cocaine Powder can be injected into the bloodstream when it is mixed with water
  • Using contaminated equipment to inject cocaine, or any other substance, can transmit HIV and cause HIV/AIDS, hepatitis and other infectious diseases   

Health Effects of Freebase Cocaine Use
  • Preparation of freebase, which involves use of volatile solvents, can result in death or injury from fire or explosion
  • Inhalation of cocaine fumes from freebasing produces effects that are very fast in onset, very intense and momentary in duration
("Crack cocaine", Freebase rocks, Rock)
  • Crack is cocaine that is processed into tiny chips having the appearance of slivers of soap
  • Crack is a very popular form of cocaine, since it is inexpensive and relatively easy to use
  • It is smoked in a pipe or rolled with tobacco in a cigarette
Why People Use Crack 

Crack is used for:

  • Quick high
  • Power
  • Euphoria 
  • Crack is almost instantly addictive
  • One use could cause a fatal heart attack
  • Repeated use may cause insomnia, hallucinations, seizures, paranoia
  • The euphoric effects of crack last only a few minutes
  • Crack possession and use are illegal in all fifty states
  • There are more hospitalizations per year resulting from crack and cocaine use than any other illicit substance
(Crank, Speed, Meth, Chalk including Ice)
  • Drug that stimulates the central nervous system and excites bodily activity
  • Methamphetamine or crank is one of the fastest growing drugs of abuse
  • These drugs create less intense and are less expensive 
  • Provide  "cocaine-like" effects in the body

Why People use Methamphetamines
Methamphetamines are used to: 
  • Increase alertness
  • Relieve fatigue
  • Feel stronger
  • Feel more decisive
  • and are used for euphoric effects or to counteract the "down" feeling of tranquilizers or alcohol

(Meth, Crystal, Crank, Glass)
Ice is Methamphetamine hydrochloride, clear chunky crystals resembling ice 

People use Ice for:
  • Temporary mood elevation
  • Exhilaration (high)
  • Increased mental alertness
  • Upper-increase wakefulness 
  • Ice is extremely addictive - sometimes with just one use!
  • Ice can cause convulsions, heart irregularities, high blood pressure, depression, restlessness, tremors, severe fatigue.
  • An overdose can cause coma and death
  • When one stops using ice one may experience a deep depression.
  • Ice causes a very jittery high, along with anxiety, insomnia, sometimes paranoia

Signs and Symptoms of Methamphetamine and Ice Abuse
  • Mood changes
  • Impaired concentration
  • Impaired mental functioning
  • Swings between apathy and alertness 
Methamphetamine and Ice Health Effects
  • Increased heart and respiratory rates or irregular heartbeat
  • Elevated blood pressure
  • Sweating
  • Headaches
  • Blurred vision and diluted pupils
  • Dizziness
  • Sleeplessness and anxiety
  • Tremors
  • Poor coordination
  • Physical collapse 
  • Decreased appetite
High doses
  • may cause rapid or irregular heartbeat, loss of coordination, collapse
  • may cause perspiration, blurred vision, dizziness, a feeling of restlessness, anxiety, delusions
Indications of Possible Misuse of Methamphetamine and Ice
  • Excessive activity
  • Talkativeness
  • Irritability
  • Argumentativeness or nervousness
  • Increased blood pressure or pulse rate, dilated pupils
  • Long periods without sleeping or eating
  • Euphoria
Symptoms of Overdose from Methamphetamine and Ice
  • Agitation
  • Increase in body temperature
  • Hallucinations
  • Convulsions
  • Possible death

Withdrawal Syndrome from Methamphetamine and Ice
  • Apathy
  • Long periods of sleep
  • Irritability
  • Depression
  • Disorientation
Sedatives/ Depressants
(Barbiturates & Benzodiazepines, Methaqualone, 
Tranquilizers, Chloral Hydrate, Glutethimide)
Drugs that depresses central nervous system
  • Resulting in sedation and Decrease in bodily activity
  • High potential for abuse and development of tolerance
  • Produces state of intoxication similar to that of alcohol
  • Combined with alcohol, increases effects
  • Multiply risks with alcohol
Sedatives/Depressants, taken as prescribed by physicians, can be beneficial for relief of anxiety, irritability, stress and tension
Signs and Symptoms of Abuse of Sedatives/Depressants
  • Sensory alteration, anxiety reduction, intoxication
  • Small amounts cause calmness, relaxed muscles
  • Larger amounts cause slurred speech
  • Impaired judgment
  • Altered perception
  • Staggered walk, loss of motor coordination
  • Very large doses may cause respiratory depression, coma, death

Health Effects of Abuse of Sedatives/Depressants
  • The use of sedatives/depressants can cause both physical and psychological dependence
  • Regular use over time may result in a tolerance to the drug, leading the user to increase the quantity consumed
The main classes of medical sedatives depressants are barbiturates and benzodiazepines
When regular users suddenly stop taking large doses, they can develop withdrawal symptoms ranging from:
  • restlessness
  • insomnia
  • anxiety
  • possible convulsions and death
Symptoms of Overdose of Sedatives/Depressants
  • Shallow respiration
  • Clammy skin
  • Dilated pupils
  • Weak and rapid pulse
  • Coma
  • Death

Withdrawal Symptoms from Sedatives/Depressants
  • Anxiety
  • Insomnia
  • Muscle tremors
  • Loss of appetite
  • Abrupt cessation or reduced high dose may cause convulsions, delirium, death 

Types of Hallucinogens
  • LSD (Acid, Red/Green Dragon)
  • Ecstasy (designer drug) - PCE Phencyclidine analogs, Amphetamine variants
  • PCP (Angel Dust, Loveboat)
  • PCP & Cocaine (Beam me up Scottie)
  • Mescaline
  • Psilocybin

What are Hallucinogens?
  • Drugs that produce behavioral changes that are often multiple and dramatic
  • They have no known medical use, but some block sensation to pain and use may result in self-inflicted injuries
  • "Designer Drugs", made to imitate certain illegal drugs, are often many times stronger than drugs they imitate

Physical Effects of Hallucinogens
  • Hallucinogenic drugs distort the senses
  • Often produce hallucinations-experiences that depart from reality
  • Phencyclidine (PCP) interrupts the function of the neurocortex, the section of the brain that controls the intellect and keeps instincts in check, because the drug blocks pain receptors
  • Violent PCP episodes may result in self-inflicted injuries. 

Why People Use Hallucionogens
  • Fun
  • Stimulation or depression
  • Behavioral changes 
  • A single use of LSD or PCP can cause multiple and dramatic behavioral changes
  • Large doses of hallucinogens may cause convulsions, ruptured blood vessels in brain and irreversible brain damage
  • Many hallucinogens cause unpleasant and potentially dangerous "flashbacks," long after the drug was used
  • Most hallucinogens cause "hallucinations," i.e., changes in perception of time, smell, touch, etc. 

Signs and Symptoms of Use of Hallucinogens
  • Impaired concentration
  • Confusion and agitation
  • Muscle rigidity
  • Profuse sweating 

Indications of Misuse of Hallucinogens
  • Extreme changes in behavior & mood
  • Person may sit or recline in a trance-like state
  • Person may appear fearful
  • Person may experience chills, irregular breathing, sweating, trembling hands
  • Person may experience changes in sense of light, hearing, touch, smell and time
  • Increase in blood pressure, heart rate and blood sugar

Health Effects of Hallucinogens
  • Chronic users of PCP report persistent memory problems and speech difficulties
  • Some of these effects may last 6 months to a year following prolonged daily use
  • Mood disorders, such as depression, anxiety and violent behavior, also occur
  • In later stages of chronic use, users often exhibit paranoid and violent behavior and experience hallucinations
  • Large doses may produce convulsions and coma, as well as heart and lung failure

Symptoms of Overdose of Hallucinogens
  • Longer, more intense "trip" episodes
  • Psychosis
  • Coma
  • Death
Narcotics also known as Narcotic analgesics include:
  • Opium, Opiates (morphine, codeine, percodan, heroin and dilaudid)
  • Opioids (synthetic substitutes such as vicodin, darvon, demerol and methadone

What do Narcotic do?
  • Narcotic analgesics are the most effective compounds used for pain relief
  • Cause relaxation with an immediate "rush“
  • Initial unpleasant effects - restlessness, nausea 

Signs and Symptom of Use of Narcotics
  • Drowsiness
  • Nausea and vomiting
  • Constricted pupils
  • Watery eyes and itching
  • Low and shallow breathing
  • Clammy skin
  • Impaired respiration
  • Convulsions
  • Coma
  • Possible death 

Signs of Misuse of Narcotics
  • Scars (tracks) caused by injections
  • Constricted (pin-point) pupils
  • Loss of appetite
  • Sniffles, watery eyes, cough, nausea
  • Lethargy, drowsiness, nodding
  • Syringes, bent spoons, needles, etc.

Health Effects of Narcotics
  • Tolerance to narcotics develops rapidly and addiction is likely
  • Use of contaminated syringes may result in diseases such as HIV/AIDS, endocarditis (heart deterioration) and hepatitis
  • Addiction in pregnant women can lead to premature, stillborn or addicted infants who experience severe withdrawal symptoms. 

Symptoms of Narcotics Overdose
  • Slow, shallow breathing
  • Clammy skin
  • Convulsions
  • Coma
  • Possible death

Withdrawal Symptoms from Narcotics
  • Watery eyes
  • Runny nose
  • Yawning
  • Cramps
  • Loss of appetite
  • Irritability
  • Nausea
  • Tremors, panic, chills, sweating
(Oxy, Oxy's, Oxies, Oxycotton, OC's, Killers, Oceans, O's,Oxycoffins, Hillbilly Heroin)
  • There are indicators of growing abuse of and addiction to the synthetic narcotic painkiller Oxycontin
  • Oxycontin is a form of synthetic morphine taken in tablet form designed to kill pain over several hours
  • It is primarily used by cancer patients
  • Abused by addicts who intensify it’s euphoric "heroin-like" effects by injecting or snorting it

How Oxycontin works
  • Getting the full effect of one tablet is like shooting high grade heroin but it is more addictive and more dangerous
  • Oxycontin suppresses the respiratory system and when combined with alcohol or other depressants it is often deadly
  • Often the user goes to sleep and his respirations slowly decrease until breathing stops completely 

Signs of Overdose of Oxycontin
  • Tiredness & weakness
  • Cold & clammy skin
  • Nausea
  • Vomiting
  • Respiratory depression
  • Slow breathing
  • Shortness of breath
  • Constipation
  • Dizziness
  • Confusion
  • Loss of consciousness
  • Seizures
  • Coma
  • Death

How much Oxycontin will cause an overdose?
  • Everyone's body is different but as little as half a pill when combined with alcohol or other sedatives/depressants can lower respiratory system enough to kill a person
  • Taken in high doses Oxycontin alone can kill a person
  • Synthetic compounds available legally and illegally
  • Drugs that are closely related to the male sex hormone, testosterone
  • Moderate potential for abuse, particularly among young males

Types of Steroids

  • Anabolic (male hormone)- steroids most frequently abused
  • Cortical
  • Estrogenic (female hormone)

Used for:

  • Increased strength
  • Increased muscle size
  • Help muscle recover 

Steroids Negative Physical and Health Effects
  • Severe acne, rashes, stunted growth
  • Sexual function problems
  • Behavioral changes, aggressiveness ("roid rages")
  • Long-term effects, such as cholesterol increases, heart disease, liver tumors, cancer and death 

Possible Postive Results from Use of Steroids
  • Increase in body weight
  • Increase in muscle strength
  • Enhance athletic performance
  • Increase physical endurance

Indications of Misuse of Steroids
  • Increased combativeness and aggressiveness
  • Jaundice
  • Purple or red spots on body
  • Unexplained darkness of skin
  • Persistent unpleasant breath odor
  • Swelling of feet or lower legs

Symptoms of Overdose of Steroids
  • Quick weight and muscle gains
  • Extremely aggressive behavior or "Roid rage“
  • Severe skin rashes
  • Impotence, withered testicles
  • In females, development of irreversible masculine traits

Withdrawal Syndrome from Steroids
  • Significant weight loss
  • Depression
  • Behavioral changes
  • Trembling

Designer Drugs
Some designer drugs are:
  • Synthetic Heroin White
  • MPTP (New Heroin)
  • Analogs of MDMA (Ecstasy, XTC, Essence)
  • Hallucinogens (STP, PMA, EVE)
  • Analogs of PCP 

What are Designer Drugs?
  • Illegal drugs are defined in terms of their chemical formulas, but underground chemists can modify the molecular structure of certain illegal drugs to produce analogs known as designer drugs, which do not meet these definitions
  • These drugs can be several hundred times stronger than the drugs they are designed to imitate
  • Many designer drugs are related to and have mild stimulant properties but are mostly euphoriants
  • Designer drugs can produce severe neurochemical damage to brain
  • Narcotic analogs can cause symptoms such as those seen in Parkinson’s disease, including uncontrollable tremors, drooling, impaired speech, paralysis and irreversible brain damage
  • Analogs of amphetamines and methamphetamines cause nausea, blurred vision, chills or sweating and faintness

Mental Effects of Designer Drugs
  • Anxiety
  • Depression
  • Paranoia
  • As little as one dose can cause brain damage
  • Cause illusions, hallucinations and impaired perception
Club Drugs
(MDMA (Ecstasy), GHB, Rohypnol, ketamine, Methamphetamine, and LSD 
are some popular club or party drugs)
  • Club drugs are being used by young adults at all-night dance parties such as "raves" or "trances," dance clubs, and bars
  • Research has shown that use of club drugs can cause serious health problems and, in some cases, even death
  • Used in combination with alcohol, these drugs can be even more dangerous

Date Rape Drugs
  • Because some club drugs are colorless, tasteless, and odorless,they are easy for people to slip into drinks
  • Some of these drugs have been associated with sexual assaults and for that reason they are referred to as "date rape drugs"

Danger of Club Drugs
Research has shown that club drugs can produce a range of unwanted effects, including:
  • Hallucinations
  • Paranoia
  • Amnesia
  • In some cases, death

Danger of Combine Club Drugs with Alcohol
  • When used with alcohol, these drugs can be even more harmful
  • Some club drugs work on the same brain mechanisms as alcohol
  • Therefore, can dangerously boost the effects of both substances

Individual Differences as to Use of Club Drugs
  • There are great differences among individuals in how they react to these substances
  • No one can predict how he or she will react
  • Some people have been known to have extreme, even fatal, reactions the first time they use club drugs
  • Studies suggest club drugs found in party settings are often adulterated or impure and thus even more dangerous

Ecstasy: X, Adam, MDMA
  • A stimulant & hallucinogen
  • Used to improve mood or get energy to keep dancing
  • Chronic abuse of Ecstasy appears to damage the brain's ability to think and regulate emotion, memory, sleep, and pain

GHB: G, Liquid Ecstasy, Georgia Home Boy, Gamma-hydroxybutyrate
  • May be made in homes by using recipes with common ingredients
  • At lower doses, GHB can relax the user, but, as the dose increases, the sedative effects may result in sleep and eventual coma or death

Rohypnol: roofie, roche
  • Tasteless and odorless
  • Mixes easily in carbonated beverages
  • Rohypnol may cause individuals under the influence of the drug to forget what happened
  • Other effects include low blood pressure, drowsiness, dizziness, confusion & stomach upset

Ketamine: Special K, K
  • Ketamine is an anesthetic
  • Use of a small amount of ketamine results in loss of attention span, learning ability and memory
  • At higher doses, ketamine can cause delirium, amnesia, high blood pressure, depression and severe breathing problems

Methamphetamine: speed, ice, chalk, meth
  • Is often made in home laboratories
  • Methamphetamine use can cause serious health concerns, including memory loss, aggression, violence, psychotic behavior & heart problems

Lysergic Acid Diethylamide (LSD): Acid
  • May cause unpredictable behavior depending on the amount taken, where the drug is used, and on the user's personality
  • A user might feel the following effects: numbness, weakness, nausea, increased heart rate, sweating, lack of appetite, "flashbacks" and sleeplessness