Drugs. What to Know.

A Parents Guide

We, as parents, are the most important role models in our children’s lives. What we say and do about drugs matters a lot when it comes to the choices our children make. We can:

  • set a positive example and get involved in our children’s lives;
  • get involved in their activities, know their friends, know where they’re going and what they’re doing;
  • create clear, consistent expectations and enforce them;
  • talk early and often about drugs;
  • discuss the consequences of drug use;
  • show we care enormously about what choices our children make about drugs.


Children learn by example. They adopt the values we demonstrate through our actions. As they grow, they’re impressed by our concern for others when we bring soup to a sick neighbor and by our honesty when we admit making a mistake.

Although we believe these traits are important, it’s not always easy to be consistent. Telling a friend you’re younger than you really are sends a confusing message to your child — isn’t it wrong to lie? If you forbid smoking in the house, how can you allow your friends to break the rules? If you say that drinking alcohol is a serious matter, how can you laugh uproariously at TV and movie drunks? Because alcohol is off-limits for children, even asking them to fetch a beer from the refrigerator or to mix drinks at an adult party can be confusing.

Children who decide not to use alcohol or other drugs often make this decision because they have strong convictions against the use of these substances — convictions based on a value system. You can make your family’s values clear by explaining why you choose a particular course of action and how that choice reflects your values. If you’re walking down the street together and spot a blind person attempting to cross, you can both offer to help him and then take the opportunity to discuss why it’s important to support those in need. You can also explore moral issues by posing hypothetical questions at the dinner table or in the car — for example, “What would you do if the person ahead of you in the movie line dropped a dollar bill?” or “What would you do if your friend wanted you to skip class with him and play video games instead?” Concrete examples like these make the abstract issue of values come alive.

Planning for Togetherness
Sometimes it’s frustrating how few chances there are to have conversations about drugs with our children. In our busy culture, with families juggling the multiple demands of work, school, after-school activities, and religious and social commitments, it can be a challenge for parents and children to be in the same place at the same time. To ensure that you have regular get togethers with your children, try to schedule:

  • Family meetings. Held once a week at a mutually-agreed-upon time, family meetings provide a forum for discussing triumphs, grievances, projects, questions about discipline, and any topic of concern to a family member. Ground rules help. Everyone gets a chance to talk; one person talks at a time without interruption; everyone listens, and only positive, constructive feedback is allowed. To get resistant children to join in, combine the get- together with incentives such as post-meeting pizza or assign them important roles such as recording secretary or rule enforcer.
  • Regular parent-child rituals. These eliminate the need for constant planning and rearranging. Perhaps you can take the long way home from school once a week and get ice cream or make a weekly visit to the library together. Even a few minutes of conversation while you’re cleaning up after dinner or right before bedtime can help the family catch up and establish the open communication that is essential to raising drug-free children.

Making your position clear
When it comes to dangerous substances like alcohol, tobacco, and other drugs, don’t assume that your children know where you stand. They want you to talk to them about drugs. State your position clearly; if you’re ambiguous, children may be tempted to use. Tell your children that you forbid them to use alcohol, tobacco, and drugs because you love them. (Don’t be afraid to pull out all the emotional stops. You can say, “If you took drugs it would break my heart.”) Make it clear that this rule holds true even at other people’s houses. Will your child listen? Most likely. According to research, when a child decides whether or not to use alcohol, tobacco, and other drugs, a crucial consideration is “What will my parents think?”

Also discuss the consequences of breaking the rules — what the punishment will be and how it will be carried out. Consequences must go hand-in-hand with limits so that your child understands that there’s a predictable outcome to his choosing a particular course of action. The consequences you select should be reasonable and related to the violation. For example, if you catch your son smoking, you might “ground” him, restricting his social activities for two weeks. You could then use this time to show him how concerned you are about the serious health consequences of his smoking, and about the possibility that he’ll become addicted, by having him study articles, books, or video tapes on the subject.

Whatever punishment you settle on shouldn’t involve new penalties that you didn’t discuss before the rule was broken — this wouldn’t be fair. Nor should you issue empty threats (“Your father will kill you when he gets home!”). It’s understandable that you’d be angry when house rules are broken, and sharing your feelings of anger, disappointment, or sadness can have a powerfully motivating effect on your child. Since we’re all more inclined to say things we don’t mean when we’re upset, it’s best to cool off enough to discuss consequences in a matter-of-fact way.

Contrary to some parents’ fears, your strict rules won’t alienate your children. They want you to show you care enough to lay down the law and to go to the trouble of enforcing it. Rules about what’s acceptable, from curfews to insisting that they call in to tell you where they are, make children feel loved and secure. Rules about drugs also give them reasons to fall back on when they feel tempted to make bad decisions. A recent poll showed that drugs are the number-one concern of young people today. Even when they appear nonchalant, our children need and want parental guidance. It does not have to be preachy. You will know best when it is more effective to use an authoritarian tone or a gentler approach.

Always let your children know how happy you are that they respect the rules of the household by praising them. Emphasize the things your children do right instead of focusing on what’s wrong. When parents are quicker to praise than to criticize, children learn to feel good about themselves, and they develop the self-confidence to trust their own judgment.

What your own alcohol, tobacco, and drug use tells your children
Drinking alcohol is one of the accepted practices of adulthood. It is legal for adults to have wine with dinner, beer at the end of a long week, or cocktails at a dinner party. But drinking to the point of losing control sends the wrong message to children, as does reaching for a drink to remedy unhappiness or tension.

Although it is legal for adults to smoke cigarettes, the negative impact tobacco has on a smoker’s health is well documented. If a child asks his parents why they smoke, they may explain that when they began, people didn’t understand how unhealthy smoking is and that once a smoker starts, it’s very hard to stop. Young people can avoid making the same mistake their parents did by never starting and risking addiction.

When parents smoke marijuana or use other illegal drugs, they compromise not only their children’s sense of security and safety, but the children’s developing moral codes as well. If you use illegal drugs, it is self-deluding to imagine that your children won’t eventually find out. When they do, your parental credibility and authority will go out the window. If their parents — their closest and most important role models — don’t respect the law, then why should they? Parents who abuse alcohol or other drugs should seek professional help. This help is available at treatment centers and from support groups such as Alcoholics Anonymous and Narcotics Anonymous. Their children also may benefit from professional counseling and support from groups such as Families Anonymous, Al- Anon, and Nar-Anon.

What to say when your child asks, “Did you ever use drugs?”
Among the most common drug-related questions asked of parents is “Did you ever use drugs?” Unless the answer is “no,” it’s difficult to know what to say because nearly all parents who used drugs don’t want their children to do the same thing. Is this hypocritical? No. We all want the best for our children, and we understand the hazards of drug use better than we did when we were their age and thought we were invincible. To guide our children’s decisions about drugs, we can now draw on credible real-life examples of friends who had trouble as a result of their drug use: the neighbor who caused a fatal car crash while high; the family member who got addicted; the teen who used marijuana for years, lost interest in school, and never really learned how to deal with adult life and its stresses.

Some parents who used drugs in the past choose to lie about it, but they risk losing their credibility if their children discover the truth. Many experts recommend that when a child asks this question, the response should be honest.

This doesn’t mean that parents need to recount every moment of their experiences. As in conversations about sex, some details should remain private, and you should avoid providing more information than is actually sought by your child. Ask clarifying questions to make sure you understand exactly why and what a child is asking before answering questions about your past drug use, and limit your response to that information.

This discussion provides a good opportunity for parents to speak frankly about what attracted them to drugs, why drugs are dangerous, and why they want their children to avoid making the same mistake. There’s no perfect way to get this message across, only approaches that seem more fitting than others. Some suggestions:

  • “I took drugs because some of my friends used them, and I thought I needed to in order to fit in. In those days, people didn’t know as much as they do now about all the bad things that can happen when you smoke marijuana or do other drugs. If I’d known then what I know now, I never would have tried them, and I’ll do everything I can to keep you away from drugs.”
  • “Everyone makes mistakes, and when I used drugs, I made a big one. I’m telling you about this, even though it’s embarrassing, because I love you, and I want to save you from making the same stupid decision that I made when I was your age. You can learn from my mistakes without repeating them.”
  • “I did drugs because I was bored and wanted to take some risks, but I soon found that I couldn’t control the risks — they were controlling me. There are much better ways of challenging yourself than doing drugs.”
  • “At your age, between homework, friends, sports, and other interests, there are a lot of fun things going on. If you get into taking drugs, you’re pretty much giving up those other things, because you stop being able to concentrate, and you can’t control your moods or keep to a schedule. You’ll miss out on all these great experiences, and you’ll never get those times back.”
  • “You don’t know how your body will react to drugs. Some people can get addicted really quickly and can get really sick even using a drug for the first time.”
  • “I started drinking/doing drugs when I was young, and I’ve been battling them ever since. They made me miss a big part of growing up, and every day I have to fight with myself so they don’t make me miss more — my job, my relationships, and my time with you. I love you too much to watch you set yourself on the same path.”


How grandparents can help raise drug-free children
Grandparents play a special part in a child’s life and, unlike parents, grandparents have had years to prepare for their role. They’ve been through the ups and downs of child-rearing and bring a calmer, more seasoned approach to their interactions with their grandchildren. They, as well as other extended family members, can serve as stable, mature role models, especially if they need to step in to assume some of the responsibilities of the child’s parents.

These important elders have one advantage over parents: Their relationships with their grandchildren are less complicated, less judgmental, and less tied to day-to-day stresses. Grandparents can use their positions of trust and intimacy to reinforce the same lessons in self-respect and healthy living that children are learning from their parents. When grandparents show concern with questions like “Has anyone ever tried to sell you drugs?” or “Why are your eyes so red?” they may be more likely to hear honest answers — especially if they indicate that they are willing to listen in confidence, and will not be quick to judge or punish. Their grandchildren may be less defensive and more likely to listen closely to their advice about avoiding drugs. Grandparents can also help reinforce positive messages and praise their grandchildren when they do well.

Many godly parents have prayed and fasted for their child or a loved one, yet they watch painfully as the person continues down a path of rebellion and destruction. One mother said,”I pray for my children, but why is God so slow to answer?” So what can parents or grandparents do to help their loved ones? For many, the key is to stop enabling the behavior of their loved one by continually rescuing them from the consequences of their actions. Once the loved one begins to feel the pain they are creating through drug abuse or other destructive behavior, the path to health and wholeness can emerge as an alternative to the path of destruction.

Are you an enabler? Take this test:

 1. Works for self-improvement: ” If I were a better parent/grandparent/friend, my loved one wouldn’t be doing this.”
 2. Changes the environment to accommodate the person with the problem: ” Let’s change schools and get our child away from those troublemakers.”
 3. Takes on the whole world in defense of a loved one: ” The whole legal system is corrupt, and my child/grandchild/friend is getting unjust treatment.”
 4. Their pain increases. Because the loved one is still acting irresponsibly, the enabler’s pain and frustration deepens.
 5. Communication deteriorates. Because the issues are unresolved, defenses are high. Both the enabler and the loved one are often deluded about reality.
 6. Enabling is habit-forming. The enabler keeps offering the same kind of help. Sometimes the enabler derives such deep satisfaction from “rescuing” someone that he or she never assesses whether the assistance is helping or hurting the loved one.

Enabling – offering the wrong kind of help
Enabling is rescuing your loved ones so that they do not experience the painful consequences of their irresponsible decisions. Enabling is anything that stands in the way of persons experiencing the natural consequences of their own behavior. Tracy, the young mother of two boys, has mastered the art of manipulating her family into enabling her behavior. Often arrested on drug charges, she would say to her parents, “Do you want to see the mother of your grandchildren locked up in jail?” The last time it happened , the parents were planning to mortgage their home so they could afford the bail payment.

Galatians 6:7-8 speaks to Christians about this with a simple but blunt truth. “Do not be deceived: God cannot be mocked. A man reaps what he sows. The one who sows to please his sinful nature, from that nature will reap destruction; the one who sows to please the Spirit, from that Spirit will reap eternal life.”(NIV) Bad actions have painful consequences, even when our children or loved ones are involved. Thankfully, God can use those consequences for His purposes if we don’t get in His way.

When you stop enabling, get ready for more trouble. When you stop offering the wrong kind of help, your loved ones may get very angry with you – and for a “good” reason. You’ve stopped rescuing them. Now they are beginning to feel the painful consequences of their irresponsible decisions. Just before mortgaging their home, Tracy’s parents were persuaded to stop enabling her. They let her stay in jail for almost a year, feeling the full impact of her irresponsible behavior. Angry and frustrated, Tracy accused them of not loving her. But while she was in jail, the drugs cleared out of Tracy’s system and she began to think clearly again. She joined a Bible study, became a Christian and entered Teen Challenge when she was released.

When you make a decision to stop enabling, like Tracy’s parents did, you must stand on the facts, especially if you have a tender heart. You must continue to rehearse the fact of how your loved one’s actions are destroying his or her life and how enabling this to continue is the worst thing you could do.

God is a loving Father, don’t be afraid to trust Him. When you stop enabling your loved one, he or she may go further down the path of destruction. You may inwardly think, “I can’t bear to see my daughter in such pain and danger.” Or, “My son might get killed! And then I would have his death on my hands. I can’t let that happen!”

But whatever happens, do not be afraid to trust God. Place your hope in the story of the Prodigal Son recorded in Luke 15. This father did not enable his son. He allowed him to leave home, knowing the son would soon waste his inheritance. Before long, the rebellious young man had lost everything, and he ended up in a pig pen eating the food the pigs didn’t want.

But all alone in the pig pen, the Bible says, “He came to his senses.” The young man realized that even the hired men at his fathers household ate better than he did. And the son resolved to go and seek his father’s forgiveness. When he finally meets his father again, the son’s true repentance is seen in his words: “Father, I have sinned against heaven and against you.” (Verse 21) He takes personal responsibility for his actions. It’s time for joyful peace and a celebration.

Learning to be at peace with God. Just like the Prodigal Son’s father, you can rest in the peace that God has the address of your loved ones, no matter how deep they are in sin. His love far surpasses your love. He knows what will work best to bring your loved ones to that point of change. You’ve got to trust God even when things are going from bad to worse. Stop offering the wrong kind of help. Stop feeding the problem. Stop being deceived. Trust Him. Jesus is ready to help us offer the right kind of help. He promises to give us wisdom to make the difficult decisions. He also stands ready and waiting with open arms to help our loved ones who really need His help. Look to Him today for guidance on how best to help those you love.

 


Many people do not understand why individuals become addicted to drugs or how drugs change the brain to foster compulsive drug abuse. They mistakenly view drug abuse and addiction as strictly a social problem and may characterize those who take drugs as morally weak. One very common belief is that drug abusers should be able to just stop taking drugs if they are only willing to change their behavior. What people often underestimate is the complexity of drug addiction—that it is a disease that impacts the brain and because of that, stopping drug abuse is not simply a matter of willpower. Through scientific advances we now know much more about how exactly drugs work in the brain, and we also know that drug addiction can be successfully treated to help people stop abusing drugs and resume their productive lives.

Drug abuse and addiction are a major burden to society. Estimates of the total overall costs of substance abuse in the United States—including health- and crime-related costs as well as losses in productivity—exceed half a trillion dollars annually. This includes approximately $181 billion for illicit drugs, $168 billion for tobacco, and $185 billion for alcohol. Staggering as these numbers are, however, they do not fully describe the breadth of deleterious public health—and safety—implications, which include family disintegration, loss of employment, failure in school, domestic violence, child abuse, and other crimes.What is drug addiction?

Addiction is a chronic, often relapsing brain disease that causes compulsive drug seeking and use despite harmful consequences to the individual who is addicted and to those around them. Drug addiction is a brain disease because the abuse of drugs leads to changes in the structure and function of the brain. Although it is true that for most people the initial decision to take drugs is voluntary, over time the changes in the brain caused by repeated drug abuse can affect a person’s self control and ability to make sound decisions, and at the same time send intense impulses to take drugs.

It is because of these changes in the brain that it is so challenging for a person who is addicted to stop abusing drugs. Fortunately, there are treatments that help people to counteract addiction’s powerful disruptive effects and regain control. Research shows that combining addiction treatment medications, if available, with behavioral therapy is the best way to ensure success for most patients. Treatment approaches that are tailored to each patient’s drug abuse patterns and any co-occurring medical, psychiatric, and social problems can lead to sustained recovery and a life without drug abuse.

Similar to other chronic, relapsing diseases, such as diabetes, asthma, or heart disease, drug addiction can be managed successfully. And, as with other chronic diseases, it is not uncommon for a person to relapse and begin abusing drugs again. Relapse, however, does not signal failure—rather, it indicates that treatment should be reinstated, adjusted, or that alternate treatment is needed to help the individual regain control and recover.What happens to your brain when you take drugs?

Drugs are chemicals that tap into the brain’s communication system and disrupt the way nerve cells normally send, receive, and process information. There are at least two ways that drugs are able to do this: (1) by imitating the brain’s natural chemical messengers, and/or (2) by overstimulating the “reward circuit” of the brain.Some drugs, such as marijuana and heroin, have a similar structure to chemical messengers, called neurotransmitters, which are naturally produced by the brain. Because of this similarity, these drugs are able to “fool” the brain’s receptors and activate nerve cells to send abnormal messages.

Other drugs, such as cocaine or methamphetamine, can cause the nerve cells to release abnormally large amounts of natural neurotransmitters, or prevent the normal recycling of these brain chemicals, which is needed to shut off the signal between neurons. This disruption produces a greatly amplified message that ultimately disrupts normal communication patterns.

Nearly all drugs, directly or indirectly, target the brain’s reward system by flooding the circuit with dopamine. Dopamine is a neurotransmitter present in regions of the brain that control movement, emotion, motivation, and feelings of pleasure. The overstimulation of this system, which normally responds to natural behaviors that are linked to survival (eating, spending time with loved ones, etc.), produces euphoric effects in response to the drugs. This reaction sets in motion a pattern that “teaches” people to repeat the behavior of abusing drugs.

As a person continues to abuse drugs, the brain adapts to the overwhelming surges in dopamine by producing less dopamine or by reducing the number of dopamine receptors in the reward circuit. As a result, dopamine’s impact on the reward circuit is lessened, reducing the abuser’s ability to enjoy the drugs and the things that previously brought pleasure. This decrease compels those addicted to drugs to keep abusing drugs in order to attempt to bring their dopamine function back to normal. And, they may now require larger amounts of the drug than they first did to achieve the dopamine high—an effect known as tolerance.Long-term abuse causes changes in other brain chemical systems and circuits as well. Glutamate is a neurotransmitter that influences the reward circuit and the ability to learn. When the optimal concentration of glutamate is altered by drug abuse, the brain attempts to compensate, which can impair cognitive function. Drugs of abuse facilitate nonconscious (conditioned) learning, which leads the user to experience uncontrollable cravings when they see a place or person they associate with the drug experience, even when the drug itself is not available. Brain imaging studies of drug-addicted individuals show changes in areas of the brain that are critical to judgment, decision-making, learning and memory, and behavior control. Together, these changes can drive an abuser to seek out and take drugs compulsively despite adverse consequences—in other words, to become addicted to drugs.Why do some people become addicted, while others do not?

No single factor can predict whether or not a person will become addicted to drugs. Risk for addiction is influenced by a person’s biology, social environment, and age or stage of development. The more risk factors an individual has, the greater the chance that taking drugs can lead to addiction. For example:Biology. The genes that people are born with––in combination with environmental influences––account for about half of their addiction vulnerability. Additionally, gender, ethnicity, and the presence of other mental disorders may influence risk for drug abuse and addiction.


  • Environment – A person’s environment includes many different influences––from family and friends to socioeconomic status and quality of life in general. Factors such as peer pressure, physical and sexual abuse, stress, and parental involvement can greatly influence the course of drug abuse and addiction in a person’s life.
  • Development – Genetic and environmental factors interact with critical developmental stages in a person’s life to affect addiction vulnerability, and adolescents experience a double challenge. Although taking drugs at any age can lead to addiction, the earlier that drug use begins, the more likely it is to progress to more serious abuse. And because adolescents’ brains are still developing in the areas that govern decision-making, judgment, and self-control, they are especially prone to risk-taking behaviors, including trying drugs of abuse.  
  • Prevention is the KeyDrug addiction is a preventable disease. Results from NIDA-funded research have shown that prevention programs that involve families, schools, communities, and the media are effective in reducing drug abuse. Although many events and cultural factors affect drug abuse trends, when youths perceive drug abuse as harmful, they reduce their drug taking. It is necessary, therefore, to help youth and the general public to understand the risks of drug abuse, and for teachers, parents, and healthcare professionals to keep sending the message that drug addiction can be prevented if a person never abuses drugs.

Resources
For more information on understanding drug abuse and addiction, please the booklet, Drugs, Brains, and Behavior – The Science of Addiction, at http://www.nida.nih.gov/scienceofaddiction/.

For more information on prevention, please visit http://www.nida.nih.gov/drugpages/prevention.html.

For more information on treatment, please visit http://www.nida.nih.gov/DrugPages/Treatment.html.


To find a publicly-funded treatment center in your state, please call 1-800-662-HELP or visit www.findtreatment.samhsa.gov. 1. Office of National Drug Control Policy. The Economic Costs of Drug Abuse in the United States: 1992-2002. Washington, DC: Executive Office of the President (Publication No. 207303), 2004. 2. Centers for Disease Control and Prevention. Annual Smoking–Attributable Mortality, Years of Potential Life Lost, and Productivity Losses — United States, 1997–2001. Morbidity and Mortality Weekly Report 54(25):625–628, July 1, 2005. 3. Harwood, H. Updating Estimates of the Economic Costs of Alcohol Abuse in the United States: Estimates, Update Methods, and Data Report. Prepared by the Lewin Group for the National Institute on Alcohol Abuse and Alcoholism, 2000.

Most abusive substances fall into one of three general categories: stimulants, depressants, or psychedelics. Alcohol is classified as a depressant. Alcohol produces some of its effects by depressing various brain functions. Alcohol is also a chemical solvent, a local anesthetic, and an irritant. Many of alcohol’s side effects are due to these actions rather than to the sedative effect of the agent. Alcohol is found in many different beverages and also in many prescription and nonprescription medications.

Alcohol in low doses causes suppression of inhibitory centers and produces apparent stimulation while impairment of abstract thinking lessens anxiety. At moderate doses, alcohol can cause drowsiness, slowed reflexes and lack of coordination. In large amounts, alcohol decreases vital brain functions, produces sedation, slows the breathing rate, and can cause death.

Alcohol is absorbed from all parts of the gastrointestinal tract. Most of the alcohol enters the bloodstream from the stomach and small intestine. The peak Blood Alcohol Level (BAL) occurs 60 to 90 minutes after ingestion when the stomach is empty. It readily passes from the blood into nearly every tissue in the body, including the brain. The presence of food in the stomach slows the rate of absorption. However the amount of alcohol absorbed remains unchanged.

While no one would get drunk from the alcohol in one or two teaspoons of cough syrup, liver and stomach enzymes cannot deactivate large amounts of alcohol consumed at one time. Alcoholic drinks, including beer cause the amount of alcohol in the blood to rise. Excessive drinking may lead to vomiting and other unpleasant toxic effects. These symptoms are part of the automatic defense systems of the body which are activated to prevent more alcohol from being absorbed. When drinking stops, the liver enzymes will eventually convert excess alcohol into less harmful substances. The final products of alcohol metabolism are carbon dioxide and water.

According to recent news reports, Americans are at risk for a variety of sleep-related health problems. Alcohol use affects sleep in a number of ways and can exacerbate these problems. Because alcohol use is widespread, it is important to understand how this use affects sleep to increase risk for illness. For example, it is popularly believed that a drink before bedtime can aid falling asleep. However, it also can disrupt normal sleep patterns, resulting in increased fatigue and physical stress to the body. Alcohol use can aggravate sleeping disorders, such as sleep apnea; those with such disorders should be cautious about alcohol use.


Most substances commonly abused fall into one of three general categories: stimulants, depressants, or psychedelics. Alcohol is classified as a depressant. Alcohol produces some of its effects by depressing various brain functions. Alcohol is also a chemical solvent, a local anesthetic, and an irritant. Many of alcohol’s side effects are due to these actions rather than to the sedative effect of the agent. Alcohol is found in many different beverages and also in many prescription and nonprescription medications.

Alcohol in low doses causes suppression of inhibitory centers and produces apparent stimulation while impairment of abstract thinking lessens anxiety. At moderate doses, alcohol can cause drowsiness, slowed reflexes and lack of coordination. In large amounts, alcohol decreases vital brain functions, produces sedation, slows the breathing rate, and can cause death.

Alcohol is absorbed from all parts of the gastrointestinal tract. Most of the alcohol enters the bloodstream from the stomach and small intestine. The peak Blood Alcohol Level (BAL) occurs 60 to 90 minutes after ingestion when the stomach is empty. It readily passes from the blood into nearly every tissue in the body, including the brain. The presence of food in the stomach slows the rate of absorption. However the amount of alcohol absorbed remains unchanged.

While no one would get drunk from the alcohol in one or two teaspoons of cough syrup, liver and stomach enzymes cannot deactivate large amounts of alcohol consumed at one time. Alcoholic drinks, including beer cause the amount of alcohol in the blood to rise. Excessive drinking may lead to vomiting and other unpleasant toxic effects. These symptoms are part of the automatic defense systems of the body which are activated to prevent more alcohol from being absorbed. When drinking stops, the liver enzymes will eventually convert excess alcohol into less harmful substances. The final products of alcohol metabolism are carbon dioxide and water.

According to recent news reports, Americans are at risk for a variety of sleep-related health problems. Alcohol use affects sleep in a number of ways and can exacerbate these problems. Because alcohol use is widespread, it is important to understand how this use affects sleep to increase risk for illness. For example, it is popularly believed that a drink before bedtime can aid falling asleep. However, it also can disrupt normal sleep patterns, resulting in increased fatigue and physical stress to the body. Alcohol use can aggravate sleeping disorders, such as sleep apnea; those with such disorders should be cautious about alcohol use.

Club drugs* are a pharmacologically heterogeneous group of psychoactive compounds that tend to be abused by teens and young adults at a nightclub, bar, rave, or trance scene. Gamma hydroxybutyrate (GHB), Rohypnol, and ketamine are some of the drugs in this group; so are MDMA (Ecstasy) and methamphetamine.

  • GHB (Xyrem) is a central nervous system (CNS) depressant that was approved by the Food and Drug Administration (FDA) in 2002 for use in the treatment of narcolepsy (a sleep disorder). This approval came with severe restrictions, including its use only for the treatment of narcolepsy, and the requirement for a patient registry monitored by the FDA. GHB is also a metabolite of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA); thus, it is found naturally in the brain, but at concentrations much lower than doses that are abused.
  • Rohypnol (flunitrazepam) started appearing in the United States in the early 1990s. It is a benzodiazepine (chemically similar to Valium or Xanax), but it is not approved for medical use in this country, and its importation is banned.
  • Ketamine is a dissociative anesthetic, mostly used in veterinary practice.

How are Club Drugs Abused?
Raves and trance events are generally night-long dances, often held in warehouses. Many who attend raves and trances do not use club drugs, but those who do may be attracted to their generally low cost and the intoxicating highs that are said to deepen the rave or trance experience.

  • Rohypnol is usually taken orally, although there are reports that it can be ground up and snorted.
  • GHB and Rohypnol have both been used to facilitate date rape (also known as “drug rape,” “acquaintance rape,” or “drug-assisted” assault). They can be colorless, tasteless, and odorless, and can be added to beverages and ingested unbeknownst to the victim. When mixed with alcohol, Rohypnol can incapacitate victims and prevent them from resisting sexual assault.
  • GHB also has anabolic effects (it stimulates protein synthesis) and has been sought by bodybuilders to aid in fat reduction and muscle building.
  • Ketamine is usually snorted or injected intramuscularly.

How do Club Drugs Affect the Brain?

  • GHB acts on at least two sites in the brain: the GABAB receptor and a specific GHB binding site. At high doses, GHB’s sedative effects may result in sleep, coma, or death. Rohypnol, like other benzodiazepines, acts at the GABAA receptor. It can produce anterograde amnesia, in which individuals may not remember events they experienced while under the influence of the drug.
  • Ketamine is a dissociative anesthetic, so called because it distorts perceptions of sight and sound and produces feelings of detachment from the environment and self. Ketamine acts on a type of glutamate receptor (NMDA receptor) to produce its effects, similar to those of the drug PCP.1 Low-dose intoxication results in impaired attention, learning ability, and memory. At higher doses, ketamine can cause dreamlike states and hallucinations; and at higher doses still, ketamine can cause delirium and amnesia.

Addictive Potential

  • Repeated use of GHB may lead to withdrawal effects, including insomnia, anxiety, tremors, and sweating. Severe withdrawal reactions have been reported among patients presenting from an overdose of GHB or related compounds, especially if other drugs or alcohol are involved.2
  • Like other benzodiazepines, chronic use of Rohypnol can produce tolerance and dependence.
  • There have been reports of people binging on ketamine, a behavior that is similar to that seen in some cocaine- or amphetamine-dependent individuals. Ketamine users can develop signs of tolerance and cravings for the drug.

What Other Adverse Effects do Club Drugs Have on Health?
Uncertainties about the sources, chemicals, and possible contaminants used to manufacture many club drugs make it extremely difficult to determine toxicity and associated medical consequences.

  • Coma and seizures can occur following use of GHB. Combined use with other drugs such as alcohol can result in nausea and breathing difficulties. GHB and two of its precursors, gamma butyrolactone (GBL) and, butanediol (BD), have been involved in poisonings, overdoses, date rapes, and deaths.
  • Rohypnol may be lethal when mixed with alcohol and/or other CNS depressants.
  • Ketamine, in high doses, can cause impaired motor function, high blood pressure, and potentially fatal respiratory problems.

What Treatment Options Exist?
There is very little information in scientific literature about treatment for persons who abuse or are dependent upon club drugs.

  • There are no GHB detection tests for use in emergency rooms, and as many clinicians are unfamiliar with the drug, many GHB incidents likely go undetected. According to case reports, however, patients who abuse GHB appear to present both a mixed picture of severe problems upon admission and good response to treatment, which often involves residential services.
  • Treatment for Rohypnol follows accepted protocols for any benzodiazepine, which may consist of a 3- to 5-day inpatient detoxification program with 24-hour intensive medical monitoring and management of withdrawal symptoms, since withdrawal from benzodiazepines can be life-threatening.
  • Patients with a ketamine overdose are managed through supportive care for acute symptoms, with special attention to cardiac and respiratory functions.

How Widespread is Club Drug Abuse?

Monitoring the Future (MTF) Survey**
According to results of the 2007 MTF survey, 0.7 percent of students in the 8th grade reported past-year*** use of GHB, as did 0.6 percent and 0.9 percent of students in grades 10 and 12, respectively. This is consistent with use reported in 2006.

Past-year use of ketamine did not change significantly from 2006 to 2007—use was reported by 1.0 percent of 8th-graders, 0.8 percent of 10th-graders, and 1.3 percent of 12th-graders in 2007.

There was no significant change in the illicit use of Rohypnol from 2006 to 2007, according to 2007 MTF results, which report consistently low levels of Rohypnol use since the drug was added to the survey in 1996. Annual prevalence of use stands now at around 0.5 percent in all three grades surveyed.



* For more information about club drugs, visit www.clubdrugs.gov,www.teens.drugabuse.gov, and www.backtoschool.drugabuse.gov; or call NIDA at 877-643-2644. For street terms searchable by drug name, street term, cost and quantities, drug trade, and drug use, visit: http://www.whitehousedrugpolicy.gov/streetterms/default.asp. ** These data are from the 2007 Monitoring the Future survey, funded by the National Institute on Drug Abuse, National Institutes of Health, Department of Health and Human Services, and conducted annually by the University of Michigan’s Institute for Social Research. The survey has tracked 12th-graders’ illicit drug use and related attitudes since 1975; in 1991, 8th- and 10th-graders were added to the study. The latest data are online at www.drugabuse.gov. *** “Past year” refers to use at least once during the year preceding an individual’s response to the survey. “Past month” refers to use at least once during the 30 days preceding an individual’s response to the survey. “Lifetime” refers to use at least once during a respondent’s lifetime.


1. 1 Maeng S, Zarate CA Jr. The role of glutamate in mood disorders: Results from the ketamine in major depression study and the presumed cellular mechanism underlying its antidepressant effects. Curr Psychiatry Rep 9(6):467–474, 2007.

2. 2 Maxwell JC, Spence RT. Profiles of club drug users in treatment. Subst Use Misuse 40(9–10):1409–1426, 2005.

3. 3 Jansen KL, Darracot-Cankovic R. The nonmedical use of ketamine, part two: A review of problem use and dependence. J Psychoactive Drugs 33(2):151–158, 2001.

4. 4 Smith KM, Larive LL, Romanelli F. Club Drugs: Methylenedioxymethamphetamine, flunitrazepam, ketamine hydrochloride, and γ–hydroxybutyrate. Am J Health-Syst Pharm 59(11):1067–1076, 2002.


Cocaine is a powerfully addictive stimulant drug. The powdered hydrochloride salt form of cocaine can be snorted or dissolved in water and then injected. Crack is the street name given to the form of cocaine that has been processed to make a rock crystal, which, when heated, produces vapors that are smoked. The term “crack” refers to the crackling sound produced by the rock as it is heated.

How Is Cocaine Abused?
Three routes of administration are commonly used for cocaine: snorting, injecting, and smoking. Snorting is the process of inhaling cocaine powder through the nose, where it is absorbed into the bloodstream through the nasal tissues. Injecting is the use of a needle to insert the drug directly into the bloodstream. Smoking involves inhaling cocaine vapor or smoke into the lungs, where absorption into the bloodstream is as rapid as by injection. All three methods of cocaine abuse can lead to addiction and other severe health problems, including increasing the risk of contracting HIV and other infectious diseases.

The intensity and duration of cocaine’s effects—which include increased energy, reduced fatigue, and mental alertness—depend on the route of drug administration. The faster cocaine is absorbed into the bloodstream and delivered to the brain, the more intense the high. Injecting or smoking cocaine produces a quicker, stronger high than snorting. On the other hand, faster absorption usually means shorter duration of action: the high from snorting cocaine may last 15 to 30 minutes, but the high from smoking may last only 5 to 10 minutes. In order to sustain the high, a cocaine abuser has to administer the drug again. For this reason, cocaine is sometimes abused in binges—taken repeatedly within a relatively short period of time, at increasingly higher doses.

How Does Cocaine Affect the Brain?
Cocaine is a strong central nervous system stimulant that increases levels of dopamine, a brain chemical (or neurotransmitter) associated with pleasure and movement, in the brain’s reward circuit. Certain brain cells, or neurons, use dopamine to communicate. Normally, dopamine is released by a neuron in response to a pleasurable signal (e.g., the smell of good food), and then recycled back into the cell that released it, thus shutting off the signal between neurons. Cocaine acts by preventing the dopamine from being recycled, causing excessive amounts of the neurotransmitter to build up, amplifying the message to and response of the receiving neuron, and ultimately disrupting normal communication. It is this excess of dopamine that is responsible for cocaine’s euphoric effects. With repeated use, cocaine can cause long-term changes in the brain’s reward system and in other brain systems as well, which may eventually lead to addiction. With repeated use, tolerance to the cocaine high also often develops. Many cocaine abusers report that they seek but fail to achieve as much pleasure as they did from their first exposure. Some users will increase their dose in an attempt to intensify and prolong the euphoria, but this can also increase the risk of adverse psychological or physiological effects.

What Adverse Effects Does Cocaine Have on Health?
Abusing cocaine has a variety of adverse effects on the body. For example, cocaine constricts blood vessels, dilates pupils, and increases body temperature, heart rate, and blood pressure. It can also cause headaches and gastrointestinal complications such as abdominal pain and nausea. Because cocaine tends to decrease appetite, chronic users can become malnourished as well.

Different methods of taking cocaine can produce different adverse effects. Regular intranasal use (snorting) of cocaine, for example, can lead to loss of the sense of smell; nosebleeds; problems with swallowing; hoarseness; and a chronically runny nose. Ingesting cocaine can cause severe bowel gangrene as a result of reduced blood flow. Injecting cocaine can bring about severe allergic reactions and increased risk for contracting HIV and other blood-borne diseases. Binge-patterned cocaine use may lead to irritability, restlessness, and anxiety. Cocaine abusers can also experience severe paranoia—a temporary state of full-blown paranoid psychosis—in which they lose touch with reality and experience auditory hallucinations.

Regardless of the route or frequency of use, cocaine abusers can experience acute cardiovascular or cerebrovascular emergencies, such as a heart attack or stroke, which may cause sudden death. Cocaine-related deaths are often a result of cardiac arrest or seizure followed by respiratory arrest.

Added Danger: Cocaethylene
Polydrug use—use of more than one drug—is common among substance abusers. When people consume two or more psychoactive drugs together, such as cocaine and alcohol, they compound the danger each drug poses and unknowingly perform a complex chemical experiment within their bodies. Researchers have found that the human liver combines cocaine and alcohol to produce a third substance, cocaethylene, that intensifies cocaine’s euphoric effects. Cocaethylene is associated with a greater risk of sudden death than cocaine alone.1

How Widespread Is Cocaine Abuse?

Monitoring the Future Survey*
According to the 2008 Monitoring the Future survey—a national survey of 8th-, 10th-, and 12th-graders—cocaine use among students did not change significantly, though it remained at unacceptably high levels: 3.0 percent of 8th-graders, 4.5 percent of 10th-graders, and 7.2 percent of 12th-graders have tried cocaine; 0.8 percent of 8th-graders, 1.2 percent of 10th-graders, and 1.9 percent of 12th-graders were current (past-month) cocaine users. Crack cocaine use, which has been steadily declining since 1990, showed a significant decrease among 12th-graders in the past year.

 

8th-Graders

10th-Graders

12th-Graders

Lifetime**

3.0%

4.5%

7.2%

Past Year

1.8

3.0

4.4

Past Month

0.8

1.2

1.9

Use of Cocaine in Any Form by Students: 
2008 Monitoring the Future Survey

 

 

8th-Graders

10th-Graders

12th-Graders

Lifetime**

2.0%

2.0%

2.8%

Past Year

1.1

1.3

1.6

Past Month

0.5

0.5

0.8

Crack Cocaine Use by Students: 
2008 Monitoring the Future Survey


National Survey on Drug Use and Health (NSDUH)***
According to the 2007 National Survey on Drug Use and Health, 35.9 million Americans aged 12 and older reported having used cocaine, and 8.6 million reported having used crack. An estimated 2.1 million Americans were current (past-month) users of cocaine; 610,000 were current users of crack. There were an estimated 906,000 new users of cocaine in 2007—most were 18 or older when they first used cocaine. Among young adults aged 18 to 25, the past-year use rate was 6.4 percent, showing no significant difference from the previous year.


Other Information Sources

For additional information on cocaine, please refer to the following sources on NIDA’s Web site, www.drugabuse.gov:

For a list of street terms used to refer to cocaine and other drugs, visit: www.whitehousedrugpolicy.gov/streetterms/default.asp.
 

1. Harris DS, et al. The pharmacology of cocaethylene in humans following cocaine and ethanol administration. Drug Alcohol Depend 72(2):169–182, 2003.


* These data are from the 2008 Monitoring the Future survey, funded by the National Institute on Drug Abuse, National Institutes of Health, Department of Health and Human Services, and conducted annually by the University of Michigan’s Institute for Social Research. The survey has tracked 12th-graders’ illicit drug use and related attitudes since 1975; in 1991, 8th- and 10th-graders were added to the study. The latest data are online at www.drugabuse.gov.

** “Lifetime” refers to use at least once during a respondent’s lifetime. “Past year” refers to use at least once during the year preceding an individual’s response to the survey. “Past month” refers to use at least once during the 30 days preceding an individual’s response to the survey.

*** NSDUH (formerly known as the National Household Survey on Drug Abuse) is an annual survey of Americans aged 12 and older conducted by the Substance Abuse and Mental Health Services Administration. This survey is available online at: www.samhsa.gov and from NIDA at 877-643-2644.

MDMA (3,4 methylenedioxymethamphetamine), known on the street as “Ecstasy”, is a synthetic, psychoactive drug that is chemically similar to the stimulant methamphetamine and the hallucinogen mescaline. MDMA produces feelings of increased energy euphoria, emotional warmth, and distortions in time perception and tactile experiences.

How Is MDMA Abused?
MDMA is taken orally, usually as a capsule or tablet. It was initially popular among Caucasian adolescents and young adults in the nightclub scene or at weekend-long dance parties known as raves. More recently, the profile of the typical MDMA user has changed, with the drug now affecting a broader range of ethnic groups. MDMA is also popular among urban gay males—some report using MDMA as part of a multiple-drug experience that includes marijuana, cocaine, methamphetamine, ketamine, and other legal and illegal substances.

How Does MDMA Affect the Brain?
MDMA exerts its primary effects in the brain on neurons that use the chemical serotonin to communicate with other neurons. The serotonin system plays an important role in regulating mood, aggression, sexual activity, sleep, and sensitivity to pain. MDMA binds to the serotonin transporter, which is responsible for removing serotonin from the synapse (or space between adjacent neurons) to terminate the signal between neurons. MDMA also causes excessive release of serotonin from its neurons and has similar but less potent effects on neurons that contain dopamine and norepinephrine.

MDMA can produce confusion, depression, sleep problems, drug craving, and severe anxiety. These problems can occur soon after taking the drug or, sometimes, even days or weeks after taking MDMA. In addition, chronic users of MDMA perform more poorly than nonusers on certain types of cognitive or memory tasks, although some of these effects may be due to the use of other drugs in combination with MDMA. Research in animals indicates that MDMA can be harmful to the brain—one study in nonhuman primates showed that exposure to MDMA for only 4 days caused damage to serotonin nerve terminals that was still evident 6 to 7 years later.1 Although similar neurotoxicity has not been shown definitively in humans, the wealth of animal research indicating MDMA’s damaging properties strongly suggests that MDMA is not a safe drug for human consumption. This is currently an area of active research.

Addictive Potential
For some people, MDMA can be addictive.2 A survey of young adult and adolescent MDMA users found that 43 percent of those who reported ecstasy use met the accepted diagnostic criteria for dependence, as evidenced by continued use despite knowledge of physical or psychological harm, withdrawal effects, and tolerance (or diminished response).3 These results are consistent with those from similar studies in other countries that suggest a high rate of MDMA dependence among users.4 MDMA abstinence-associated withdrawal symptoms include fatigue, loss of appetite, depressed feelings, and trouble concentrating.2

What Other Adverse Effects Does MDMA Have on Health?
MDMA can also be dangerous to overall health and, on rare occasions, lethal. MDMA can have many of the same physical effects as other stimulants such as cocaine and amphetamines. These include increases in heart rate and blood pressure – which present risks of particular concern for people with circulatory problems or heart disease – and other symptoms such as muscle tension, involuntary teeth clenching, nausea, blurred vision, faintness, and chills or sweating.

In high doses, MDMA can interfere with the body’s ability to regulate temperature. On rare but unpredictable occasions, this can lead to a sharp increase in body temperature (hyperthermia), which can result in liver, kidney, and cardiovascular system failure, and death. MDMA can interfere with its own metabolism (breakdown within the body), therefore potentially harmful levels can be reached by repeated MDMA administration within short periods of time.

Other drugs that are chemically similar to MDMA, such as MDA (methylenedioxyamphetamine, the parent drug of MDMA) and PMA (paramethoxyamphetamine, associated with fatalities in the United States and Australia),5 are sometimes sold as ecstasy. These drugs can be neurotoxic or create additional health risks to the user. Furthermore, ecstasy tablets may be mixed with other substances, such as ephedrine (a stimulant); dextromethorphan (DXM, a cough suppressant); ketamine (an anesthetic used mostly by veterinarians); caffeine; cocaine; and methamphetamine. Although the combination of MDMA with one or more of these drugs may be inherently dangerous, users that also combine these with additional substances such as marijuana and alcohol, may be putting themselves at even higher risk.

How Widespread Is MDMA Abuse?

Monitoring the Future (MTF) Survey*
Between 2005 and 2008, past-year abuse of MDMA increased among 12th-graders, from 3.0 percent to 4.3 percent; and between 2004 and 2008, past-year abuse of MDMA increased among 10th-graders, from 2.4 percent to 2.9 percent.

 

8th Grade

10th Grade

12th Grade

Lifetime**

2.4%

4.3%

6.2%

Past Year

1.7

2.9

4.3

Past Month

0.8

1.1

1.8

MDMA Use by Students Monitoring the Future Survey, 2008

For the third year in a row, fewer of the younger students surveyed reported that they perceived great risk associated with MDMA use. The proportion of 8th-graders who perceived risk of harm from using MDMA “occasionally” decreased significantly, from 52 percent in 2006 to 46.8 percent in 2008; this proportion also fell significantly among 10th-graders, from 71.3 percent in 2006 to 66.4 percent in 2008. Perceived risk of MDMA use among 12th-graders decreased slightly, from 59.3 percent in 2006 to 57.0 percent in 2008.

National Survey on Drug Use and Health (NSDUH)
In 2007, an estimated 503,000 people (0.2 percent of the population) in the United States aged 12 or older used MDMA in the month prior to being surveyed. Lifetime use increased among individuals aged 12 years or older, from 4.3 percent (10.2 million) in 2002 to 5.0 percent (12.4 million) in 2007; however, past-year use of ecstasy decreased from 1.3 percent to 0.9 percent during the same 6-year period. Approximately 781,000 Americans used ecstasy for the first time in 2007, which is a significant increase from the 615,000 first-time users reported in 2005. Most (61.2 percent) of these new users were 18 or older; and among past-year initiates aged 12 to 49, the average age at initiation in 2007 was 20.2 years.

Other Information Sources
For more information on MDMA, please visit: www.clubdrugs.gov and www.teens.drugabuse.gov.

For street terms searchable by drug name, street term, cost and quantities, drug trade, and drug use, visit: www.whitehousedrugpolicy.gov/streetterms/default.asp.


* These data are from the 2008 Monitoring the Future survey, funded by the National Institute on Drug Abuse, National Institutes of Health, Department of Health and Human Services, and conducted annually by the University of Michigan’s Institute for Social Research. The survey has tracked 12th-graders’ illicit drug use and related attitudes since 1975; in 1991, 8th- and 10th-graders were added to the study. The latest data are online at www.drugabuse.gov.

** “Lifetime” refers to use at least once during a respondent’s lifetime. “Past year” refers to use at least once during the year preceding an individual’s response to the survey. “Past month” refers to use at least once during the 30 days preceding an individual’s response to the survey.

*** NSDUH (formerly known as the National Household Survey on Drug Abuse) is an annual survey of Americans age 12 and older conducted by the Substance Abuse and Mental Health Services Administration. Copies of the latest survey are available at www.samhsa.gov and from NIDA at 877–643–2644.


1. Ricaurte GA, McCann UD. Experimental studies on 3,4-methylenedioxymethamphetamine (MDMA, “ecstasy”) and its potential to damage brain serotonin neurons. Neurotox Res 3(1):85–99, 2001.

2. Stone AL, Storr CL, Anthony JC. Evidence for a hallucinogen dependence syndrome developing soon after onset of hallucinogen use during adolescence. Int J Methods Psychiatr Res 15:116–130, 2006.

3. Cottler LB, Womack SB, Compton WM, Ben-Abdallah A. Ecstasy abuse and dependence among adolescents and young adults: Applicability and reliability of DSM-IV criteria. Human Psychopharmacol 16:599–606, 2001.

4. Leung KS, Cottler LB. Ecstasy and other club drugs: A review of recent epidemiological studies. Curr Opin Psychiatry 21:234–241, 2008.

5. Kraner JC, McCoy DJ, Evans MA, Evans LE, Sweeney BJ. Fatalities caused by the MDMA-related drug paramethoxyamphetamine (PMA). J Anal Toxicol 25(7):645–648, 2001.


Heroin is an opiate drug that is synthesized from morphine, a naturally occurring substance extracted from the seed pod of the Asian opium poppy plant. Heroin usually appears as a white or brown powder or as a black sticky substance, known as “black tar heroin.”

How Is Heroin Abused?
Heroin can be injected, snorted/sniffed, or smoked—routes of administration that rapidly deliver the drug to the brain. Injecting is the use of a needle to administer the drug directly into the bloodstream. Snorting is the process of inhaling heroin powder through the nose, where it is absorbed into the bloodstream through the nasal tissues. Smoking involves inhaling heroin smoke into the lungs. All three methods of administering heroin can lead to addiction and other severe health problems.

How Does Heroin Affect the Brain?
Heroin enters the brain, where it is converted to morphine and binds to receptors known as opioid receptors. These receptors are located in many areas of the brain (and in the body), especially those involved in the perception of pain and in reward. Opioid receptors are also located in the brain stem—important for automatic processes critical for life, such as breathing (respiration), blood pressure, and arousal. Heroin overdoses frequently involve a suppression of respiration.

After an intravenous injection of heroin, users report feeling a surge of euphoria (“rush”) accompanied by dry mouth, a warm flushing of the skin, heaviness of the extremities, and clouded mental functioning. Following this initial euphoria, the user goes “on the nod,” an alternately wakeful and drowsy state. Users who do not inject the drug may not experience the initial rush, but other effects are the same.

With regular heroin use, tolerance develops, in which the user’s physiological (and psychological) response to the drug decreases, and more heroin is needed to achieve the same intensity of effect. Heroin users are at high risk for addiction—it is estimated that about 23 percent of individuals who use heroin become dependent on it.

What Other Adverse Effects Does Heroin Have on Health?
Heroin abuse is associated with serious health conditions, including fatal overdose, spontaneous abortion, and—particularly in users who inject the drug—infectious diseases, including HIV/AIDS and hepatitis. Chronic users may develop collapsed veins, infection of the heart lining and valves, abscesses, and liver or kidney disease. Pulmonary complications, including various types of pneumonia, may result from the poor health of the abuser as well as from heroin’s depressing effects on respiration. In addition to the effects of the drug itself, street heroin often contains toxic contaminants or additives that can clog the blood vessels leading to the lungs, liver, kidneys, or brain, causing permanent damage to vital organs.

Chronic use of heroin leads to physical dependence, a state in which the body has adapted to the presence of the drug. If a dependent user reduces or stops use of the drug abruptly, he or she may experience severe symptoms of withdrawal. These symptoms—which can begin as early as a few hours after the last drug administration—can include restlessness, muscle and bone pain, insomnia, diarrhea and vomiting, cold flashes with goose bumps (“cold turkey”), and kicking movements (“kicking the habit”). Users also experience severe craving for the drug during withdrawal, which can precipitate continued abuse and/or relapse. Major withdrawal symptoms peak between 48 and 72 hours after the last dose of the drug and typically subside after about 1 week. Some individuals, however, may show persistent withdrawal symptoms for months. Although heroin withdrawal is considered less dangerous than alcohol or barbiturate withdrawal, sudden withdrawal by heavily dependent users who are in poor health is occasionally fatal. In addition, heroin craving can persist years after drug cessation, particularly upon exposure to triggers such as stress or people, places, and things associated with drug use.

Heroin abuse during pregnancy, together with related factors like poor nutrition and inadequate prenatal care, has been associated with adverse consequences including low birthweight, an important risk factor for later developmental delay. If the mother is regularly abusing the drug, the infant may be born physically dependent on heroin and could suffer from serious medical complications requiring hospitalization.

How Widespread Is Heroin Abuse?

Monitoring the Future Survey*
According to the Monitoring the Future survey, there were no significant changes between 2007 and 2008 in the proportions of students in 8th and 12th grades reporting lifetime,** past-year, and past-month use of heroin. There also were no significant changes in past-year and past-month use for the 10th grade; however, lifetime use decreased significantly from 1.5 percent in 2007 to 1.2 percent in 2008.

Heroin use has been steadily declining since the mid-1990s. Recent peaks in heroin use were observed in 1996 for 8th-graders, 1997–2000 for 10th-graders, and 2000 for 12th-graders. Annual prevalence of heroin use in 2008 dropped significantly, by between 40 and 51 percent, from these recent peak use years for each grade surveyed.

 

8th Grade

10th Grade

12th Grade

Lifetime

1.3%

1.5%

1.5%

Past Year

0.8

0.8

0.9

Past Month

0.4

0.4

0.4

Heroin Use by Students, 2007: Monitoring the Future Survey

National Survey on Drug Use and Health (NSDUH)***

According to the 2007 National Survey on Drug Use and Health, the number of current (past-month) heroin users in the United States decreased from 338,000 in 2006 to 153,000 in 2007. There were 106,000 first-time users of heroin aged 12 or older in 2007; the average age at first use of heroin was 21.8 years.

Other Information Sources

For additional information on heroin, please refer to the following sources on NIDA’s Web site, www.drugabuse.gov:

For a list of street terms used to refer to heroin and other drugs, visit: www.whitehousedrugpolicy.gov/streetterms/default.asp.


* These data are from the 2008 Monitoring the Future survey, funded by the National Institute on Drug Abuse, National Institutes of Health, Department of Health and Human Services, and conducted annually by the University of Michigan’s Institute for Social Research. The survey has tracked 12th-graders’ illicit drug use and related attitudes since 1975; in 1991, 8th- and 10th-graders were added to the study. The latest data are online at: www.drugabuse.gov.

** “Lifetime” refers to use at least once during a respondent’s lifetime. “Past year” refers to use at least once during the year preceding an individual’s response to the survey. “Past month” refers to use at least once during the 30 days preceding an individual’s response to the survey.

*** NSDUH (formerly known as the National Household Survey on Drug Abuse) is an annual survey of Americans age 12 and older conducted by the Substance Abuse and Mental Health Services Administration. Copies of the latest survey are available at: www.samhsa.gov and from NIDA at 877–643–2644.

Inhalants are a diverse group of volatile substances whose chemical vapors can be inhaled to produce psychoactive (mind-altering) effects. While other abused substances can be inhaled, the term “inhalants” is used to describe substances that are rarely, if ever, taken by any other route of administration. A variety of products common in the home and workplace contain substances that can be inhaled to get high; however, people do not typically think of these products (e.g., spray paints, glues, and cleaning fluids) as drugs because they were never intended to induce intoxicating effects. Yet young children and adolescents can easily obtain these extremely toxic substances and are among those most likely to abuse them. In fact, more 8th-graders have tried inhalants than any other illicit drug.1

Inhalants generally fall into the following categories:

Volatile solvents—liquids that vaporize at room temperature

  • Industrial or household products, including paint thinners or removers, degreasers, dry-cleaning fluids, gasoline, and lighter fluid
  • Art or office supply solvents, including correction fluids, felt-tip marker fluid, electronic contact cleaners, and glue

Aerosols—sprays that contain propellants and solvents

  • Household aerosol propellants in items such as spray paints, hair or deodorant sprays, fabric protector sprays, aerosol computer cleaning products, and vegetable oil sprays

Gases—found in household or commercial products and used as medical anesthetics

  • Household or commercial products, including butane lighters and propane tanks, whipped cream aerosols or dispensers (whippets), and refrigerant gases
  • Medical anesthetics, such as ether, chloroform, halothane, and nitrous oxide (“laughing gas”)

Nitrites—a special class of inhalants that are used primarily as sexual enhancers

  • Organic nitrites are volatiles that include cyclohexyl, butyl, and amyl nitrites, commonly known as “poppers.” Amyl nitrite is still used in certain diagnostic medical procedures. When marketed for illicit use, organic nitrites are often sold in small brown bottles labeled as “video head cleaner,” “room odorizer,” “leather cleaner,” or “liquid aroma.”

These various products contain a wide range of chemicals such as:

  • toluene (spray paints, rubber cement, gasoline),
  • chlorinated hydrocarbons (dry-cleaning chemicals, correction fluids),
  • hexane (glues, gasoline),
  • benzene (gasoline),
  • methylene chloride (varnish removers, paint thinners),
  • butane (cigarette lighter refills, air fresheners), and
  • nitrous oxide (whipped cream dispensers, gas cylinders).

Adolescents tend to abuse different products at different ages.2 Among new users ages 12–15, the most commonly abused inhalants are glue, shoe polish, spray paints, gasoline, and lighter fluid. Among new users age 16 or 17, the most commonly abused products are nitrous oxide or whippets. Nitrites are the class of inhalants most commonly abused by adults.3

How Are Inhalants Abused?
Inhalants can be breathed in through the nose or mouth in a variety of ways (known as “huffing”), such as sniffing or snorting fumes from a container, spraying aerosols directly into the nose or mouth, or placing an inhalant-soaked rag in the mouth. Users may also inhale fumes from a balloon or a plastic or paper bag that contains an inhalant.The intoxication produced by inhalants usually lasts just a few minutes; therefore, users often try to extend the “high” by continuing to inhale repeatedly over several hours.

How Do Inhalants Affect the Brain?
The effects of inhalants are similar to those of alcohol, including slurred speech, lack of coordination, euphoria, and dizziness. Inhalant abusers may also experience lightheadedness, hallucinations, and delusions. With repeated inhalations, many users feel less inhibited and less in control. Some may feel drowsy for several hours and experience a lingering headache. Chemicals found in different types of inhaled products may produce a variety of additional effects, such as confusion, nausea, or vomiting.

By displacing air in the lungs, inhalants deprive the body of oxygen, a condition known as hypoxia. Hypoxia can damage cells throughout the body, but the cells of the brain are especially sensitive to it. The symptoms of brain hypoxia vary according to which regions of the brain are affected: for example, the hippocampus helps control memory, so someone who repeatedly uses inhalants may lose the ability to learn new things or may have a hard time carrying on simple conversations.

Long-term inhalant abuse can also break down myelin, a fatty tissue that surrounds and protects some nerve fibers. Myelin helps nerve fibers carry their messages quickly and efficiently, and when damaged, can lead to muscle spasms and tremors or even permanent difficulty with basic actions such as walking, bending, and talking.

Although not very common, addiction to inhalants can occur with repeated abuse. According to the 2006 Treatment Episode Data Set, inhalants were reported as the primary substance abused by less than 0.1 percent of all individuals admitted to substance abuse treatment.4 However, of those individuals who reported inhalants as their primary, secondary, or tertiary drug of abuse, nearly half were adolescents aged 12 to 17. This age group represents only 8 percent of total admissions to treatment.5

What Other Adverse Effects Do Inhalants Have on Health?

Lethal Effects
Sniffing highly concentrated amounts of the chemicals in solvents or aerosol sprays can directly induce heart failure and death within minutes of a session of repeated inhalation. This syndrome, known as “sudden sniffing death,” can result from a single session of inhalant use by an otherwise healthy young person. Sudden sniffing death is particularly associated with the abuse of butane, propane, and chemicals in aerosols.

High concentrations of inhalants may also cause death from suffocation by displacing oxygen in the lungs, causing the user to lose consciousness and stop breathing. Deliberately inhaling from a paper or plastic bag or in a closed area greatly increases the chances of suffocation. Even when using aerosols or volatile products for their legitimate purposes (i.e., painting, cleaning), it is wise to do so in a well-ventilated room or outdoors.

Harmful Irreversible Effects

  • Hearing loss—spray paints, glues, dewaxers, dry-cleaning chemicals, correction fluids
  • Peripheral neuropathies or limb spasms—glues, gasoline, whipped cream dispensers, gas cylinders
  • Central nervous system or brain damage—spray paints, glues, dewaxers
  • Bone marrow damage—gasoline

Serious but Potentially Reversible Effects

  • Liver and kidney damage—correction fluids, dry-cleaning fluids
  • Blood oxygen depletion—varnish removers, paint thinners

HIV/AIDS, Hepatitis, and Other Infectious Diseases
Because nitrites are abused to enhance sexual pleasure and performance, they can be associated with unsafe sexual practices that greatly increase the risk of contracting and spreading infectious diseases such as HIV/AIDS and hepatitis.

How Widespread Is Inhalant Abuse?

Monitoring the Future Survey*
According to the Monitoring the Future survey, more 8th-graders (15.7 percent) have tried inhalants in their lifetime than any other illicit drug, including marijuana. Lifetime use (use at least once during a respondent’s lifetime) of inhalants was reported by 15.7 percent of 8th-graders, 12.8 percent of 10th-graders, and 9.9 percent of 12th-graders in 2008; 4.1 percent of 8th-graders, 2.1 percent of 10th-graders, and 1.4 percent of 12th-graders were current users of inhalants (had used at least once during the 30 days preceding response to the survey).

The perception of harm associated with trying inhalants once or twice is at its lowest level among 8th-graders—in 2008, 34 percent of 8th-graders perceived harm, compared to 46 percent in 2001. This change in attitude could signal a subsequent increase in use, an outcome that would be of great concern.

National Survey on Drug Use and Health (NSDUH)**

Data from the National Survey on Drug Use and Health show that the primary abusers of most inhalants are adolescents ages 12 to 17. In 2007, 3.9 percent of adolescents reported using inhalants in the past year. Among young adults aged 18 to 25, past-year use of inhalants decreased from 1.8 percent in 2006 to 1.6 percent in 2007. Of the 775,000 persons aged 12 or older who tried inhalants for the first time within the previous year, 66.3 percent were under age 18 when they first used.

Other Information Sources

For additional information on inhalants, please refer to NIDA’s inhalant-specific Web site: www.inhalants.drugabuse.gov.

For a list of street terms used to refer to inhalants and other drugs, visit: www.whitehousedrugpolicy.gov/streetterms/default.asp.


* These data are from the 2008 Monitoring the Future survey, funded by the National Institute on Drug Abuse, National Institutes of Health, DHHS, and conducted annually by the University of Michigan’s Institute for Social Research. The survey has tracked 12th graders’ illicit drug use and related attitudes since 1975; in 1991, 8th and 10th graders were added to the study. The latest data are online at: www.drugabuse.gov.

** NSDUH (formerly known as the National Household Survey on Drug Abuse) is an annual survey of Americans age 12 and older conducted by the Substance Abuse and Mental Health Services Administration. Copies of the latest survey are available at www.samhsa.gov and from the National Clearinghouse for Alcohol and Drug Information at 800-729-6686.


1. Institute for Social Research. Monitoring the Future, 2008 (Study Results). Ann Arbor, MI: University of Michigan, 2008. Data retrieved 12/11/2008 from: http://www.monitoringthefuture.org.

2. Substance Abuse and Mental Health Services Administration, Office of Applied Studies. The NSDUH Report: Inhalant Use Across the Adolescent Years. Available at: http://www.oas.samhsa.gov/2k8/inhalants/inhalants.cfm. Accessed April 22, 2008.

3. Wu LT, Schlenger WE, and Ringwalt CL. Use of nitrite inhalants (“poppers”) among American youth. J Adolesc Health 37:52–60, 2005.

4. Substance Abuse and Mental Health Services Administration, Office of Applied Studies. Treatment Episode Data Set (TEDS). Highlights—2006. National Admissions to Substance Abuse Treatment Services, DASIS Series S–40, DHHS Publication No. (SMA) 08–4313, Rockville, MD, 2008.

5. Substance Abuse and Mental Health Services Administration, Office of Applied Studies. (March 13, 2008). The DASIS Report: Adolescent Admissions Reporting Inhalants: 2006. Available at: http://www.oas.samhsa.gov/2k8/inhalantsTX/inhalantsTX.htm. Accessed April 22, 2008.


Marijuana is the most commonly abused illicit drug in the United States. It is a dry, shredded green and brown mix of flowers, stems, seeds, and leaves derived from the hemp plant Cannabis sativa. The main active chemical in marijuana is delta-9-tetrahydrocannabinol; THC for short.

How is Marijuana Abused?
Marijuana is usually smoked as a cigarette (joint) or in a pipe. It is also smoked in blunts, which are cigars that have been emptied of tobacco and refilled with marijuana. Since the blunt retains the tobacco leaf used to wrap the cigar, this mode of delivery combines marijuana’s active ingredients with nicotine and other harmful chemicals. Marijuana can also be mixed in food or brewed as a tea. As a more concentrated, resinous form it is called hashish, and as a sticky black liquid, hash oil.* Marijuana smoke has a pungent and distinctive, usually sweet-and-sour odor.

How Does Marijuana Affect the Brain?
Scientists have learned a great deal about how THC acts in the brain to produce its many effects. When someone smokes marijuana, THC rapidly passes from the lungs into the bloodstream, which carries the chemical to the brain and other organs throughout the body.

THC acts upon specific sites in the brain, called cannabinoid receptors, kicking off a series of cellular reactions that ultimately lead to the “high” that users experience when they smoke marijuana. Some brain areas have many cannabinoid receptors; others have few or none. The highest density of cannabinoid receptors are found in parts of the brain that influence pleasure, memory, thoughts, concentration, sensory and time perception, and coordinated movement.1

Not surprisingly, marijuana intoxication can cause distorted perceptions, impaired coordination, difficulty in thinking and problem solving, and problems with learning and memory. Research has shown that marijuana’s adverse impact on learning and memory can last for days or weeks after the acute effects of the drug wear off.2 As a result, someone who smokes marijuana every day may be functioning at a suboptimal intellectual level all of the time.

Research on the long-term effects of marijuana abuse indicates some changes in the brain similar to those seen after long-term abuse of other major drugs. For example, cannabinoid withdrawal in chronically exposed animals leads to an increase in the activation of the stress-response system3 and changes in the activity of nerve cells containing dopamine.4 Dopamine neurons are involved in the regulation of motivation and reward, and are directly or indirectly affected by all drugs of abuse.

Addictive Potential
Long-term marijuana abuse can lead to addiction; that is, compulsive drug seeking and abuse despite its known harmful effects upon social functioning in the context of family, school, work, and recreational activities. Long-term marijuana abusers trying to quit report irritability, sleeplessness, decreased appetite, anxiety, and drug craving, all of which make it difficult to quit. These withdrawal symptoms begin within about 1 day following abstinence, peak at 2–3 days, and subside within 1 or 2 weeks following drug cessation.5

Marijuana and Mental Health
A number of studies have shown an association between chronic marijuana use and increased rates of anxiety, depression, suicidal ideation, and schizophrenia. Some of these studies have shown age at first use to be a factor, where early use is a marker of vulnerability to later problems. However, at this time, it not clear whether marijuana use causes mental problems, exacerbates them, or is used in attempt to self-medicate symptoms already in existence. Chronic marijuana use, especially in a very young person, may also be a marker of risk for mental illnesses, including addiction, stemming from genetic or environmental vulnerabilities, such as early exposure to stress or violence. At the present time, the strongest evidence links marijuana use and schizophrenia and/or related disorders.6 High doses of marijuana can produce an acute psychotic reaction; in addition, use of the drug may trigger the onset or relapse of schizophrenia in vulnerable individuals.

Effects on the Heart
Marijuana increases heart rate by 20–100 percent shortly after smoking; this effect can last up to 3 hours. In one study, it was estimated that marijuana users have a 4.8-fold increase in the risk of heart attack in the first hour after smoking the drug.7 This may be due to the increased heart rate as well as effects of marijuana on heart rhythms, causing palpitations and arrhythmias. This risk may be greater in aging populations or those with cardiac vulnerabilities.

Effects on the Lungs
Numerous studies have shown marijuana smoke to contain carcinogens and to be an irritant to the lungs. In fact, marijuana smoke contains 50–70 percent more carcinogenic hydrocarbons than does tobacco smoke. Marijuana users usually inhale more deeply and hold their breath longer than tobacco smokers do, which further increase the lungs’ exposure to carcinogenic smoke. Marijuana smokers show dysregulated growth of epithelial cells in their lung tissue, which could lead to cancer;8 however, a recent case-controlled study found no positive associations between marijuana use and lung, upper respiratory, or upper digestive tract cancers.9 Thus, the link between marijuana smoking and these cancers remains unsubstantiated at this time.

Nonetheless, marijuana smokers can have many of the same respiratory problems as tobacco smokers, such as daily cough and phlegm production, more frequent acute chest illness, and a heightened risk of lung infections. A study of 450 individuals found that people who smoke marijuana frequently but do not smoke tobacco have more health problems and miss more days of work than nonsmokers.10 Many of the extra sick days among the marijuana smokers in the study were for respiratory illnesses.

Effects on Daily Life
Research clearly demonstrates that marijuana has the potential to cause problems in daily life or make a person’s existing problems worse. In one study, heavy marijuana abusers reported that the drug impaired several important measures of life achievement including physical and mental health, cognitive abilities, social life, and career status.11 Several studies associate workers’ marijuana smoking with increased absences, tardiness, accidents, workers’ compensation claims, and job turnover.

How Widespread is Marijuana Abuse?

National Survey on Drug Use and Health (NSDUH)***

According to the National Survey on Drug Use and Health, in 2007, 14.4 million Americans aged 12 or older used marijuana at least once in the month prior to being surveyed, which is similar to the 2006 rate. About 6,000 people a day in 2007 used marijuana for the first time—2.1 million Americans. Of these, 62.2 percent were under age 18.

Monitoring the Future Survey****

The Monitoring the Future survey indicates that marijuana use among 8th-, 10th-, and 12th-graders—which has shown a consistent decline since the mid-1990s—appears to have leveled off, with 10.9 percent of 8th-graders, 23.9 percent of 10th-graders, and 32.4 percent of 12th-graders reporting past-year use. Heightening the concern over this stabilization in use is the finding that, compared to last year, the proportion of 8th-graders who perceived smoking marijuana as harmful and the proportion who disapprove of the drug’s use have decreased.

 

1995

1996

1997

1998

1999

2000

2001

Lifetime

19.9%

23.1%

22.6%

22.2%

22.0%

20.3%

20.4%

Past Year

15.8

18.3

17.7

16.9

16.5

15.6

15.4

Past Month

9.1

11.3

10.2

9.7

9.7

9.1

9.2

Daily

0.8

1.5

1.1

1.1

1.4

1.3

1.3

Percentage of 8th-Graders Who Have Used Marijuana

 

 

2002

2003

2004

2005

2006

2007

2008

Lifetime

19.2%

17.5%

16.3%

16.5%

15.7%

14.2%

14.6%

Past Year

14.6

12.8

11.8

12.2

11.7

10.3

10.9

Past Month

8.3

7.5

6.4

6.6

6.5

5.7

5.8

Daily

1.2

1.0

0.8

1.0

1.0

0.8

0.9

 

 

1995

1996

1997

1998

1999

2000

2001

Lifetime

34.1%

39.8%

42.3%

39.6%

40.9%

40.3%

40.1%

Past Year

28.7

33.6

34.8

31.1

32.1

32.2

32.7

Past Month

17.2

20.4

20.5

18.7

19.4

19.7

19.8

Daily

2.8

3.5

3.7

3.6

3.8

3.8

4.5

Percentage of 10th-Graders Who Have Used Marijuana

 

 

2002

2003

2004

2005

2006

2007

2008

Lifetime

38.7%

36.4%

35.1%

34.1%

31.8%

31.0%

29.9%

Past Year

30.3

28.2

27.5

26.6

25.2

24.6

23.9

Past Month

17.8

17.0

15.9

15.2

14.2

14.2

13.8

Daily

3.9

3.6

3.2

3.1

2.8

2.8

2.7

 

 

1995

1996

1997

1998

1999

2000

2001

Lifetime

41.7%

44.9%

49.6%

49.1%

49.7%

48.8%

49.0%

Past Year

34.7

35.8

38.5

37.5

37.8

36.5

37.0

Past Month

21.2

21.9

23.7

22.8

23.1

21.6

22.4

Daily

4.6

4.9

5.8

5.6

6.0

6.0

5.8

Percentage of 12th-Graders Who Have Used Marijuana

 

 

2002

2003

2004

2005

2006

2007

2008

Lifetime

47.8%

46.1%

45.7%

44.8%

42.3%

41.8%

42.6%

Past Year

36.2

34.9

34.3

33.6

31.5

31.7

32.4

Past Month

21.5

21.2

19.9

19.8

18.3

18.8

19.4

Daily

6.0

6.0

5.6

5.0

5.0

5.1

5.4

 

“Lifetime” refers to use at least once during a respondent’s lifetime. “Past year” refers to use at least once during the year preceding an individual’s response to the survey. “Past month” refers to use at least once during the 30 days preceding an individual’s response to the survey.

Other Information Sources

For additional information on marijuana, please visit: www.marijuana-info.org.


* For street terms searchable by drug name, street term, cost and quantities, drug trade, and drug use, visit: http://www.whitehousedrugpolicy.gov/streetterms/default.asp.

** These data are from the Treatment Episode Data Set (TEDS) Highlights – 2006: National Admissions to Substance Abuse Treatment Services (Office of Applied Studies, DASIS Series: S-40, DHHS Publication No. SMA 08-4313, Rockville, MD, 2008), funded by the Substance Abuse and Mental Health Services Administration. The latest data are available at 800-729-6686 or online at: www.samhsa.gov.

*** Results from the 2007 National Survey on Drug Use and Health: National Findings (Office of Applied Studies, NSDUH Series H–34, DHHS Publication No. SMA 08–4343. Rockville, MD, 2008). NSDUH (formerly known as the National Household Survey on Drug Abuse) is an annual survey of Americans age 12 and older conducted by the Substance Abuse and Mental Health Services Administration. Copies of the latest survey are available at: www.samhsa.gov and from NIDA at 877–643–2644.

**** These data are from the 2008 Monitoring the Future survey, funded by the National Institute on Drug Abuse, National Institutes of Health, Department of Health and Human Services, and conducted annually by the University of Michigan’s Institute for Social Research. The survey has tracked 12th-graders’ illicit drug use and related attitudes since 1975; in 1991, 8th- and 10th-graders were added to the study. The latest data are online at: www.drugabuse.gov.


1. Herkenham M, Lynn A, Little MD, et al. Cannabinoid receptor localization in the brain. Proc Natl Acad Sci, USA 87(5):1932–1936, 1990.

2. Pope HG, Gruber AJ, Hudson JI, Huestis MA, Yurgelun-Todd D. Neuropsychological performance in long-term cannabis users. Arch Gen Psychiatry 58(10):909–915, 2001.

3. Rodríguez de Fonseca F, Carrera MRA, Navarro M, Koob GF, Weiss F. Activation of corticotropin-releasing factor in the limbic system during cannabinoid withdrawal. Science 276(5321):2050–2054, 1997.

4. Diana M, Melis M, Muntoni AL, Gessa GL. Mesolimbic dopaminergic decline after cannabinoid withdrawal. Proc Natl Acad Sci, USA 95(17):10269–10273, 1998.

5. Budney AJ, Vandrey RG, Hughes JR, Thostenson JD, Bursac Z. Comparison of cannabis and tobacco withdrawal: Severity and contribution to relapse. J Subst Abuse Treat, e-publication ahead of print, March 12, 2008.

6. Moore TH, Zammit S, Lingford-Hughes A, et al. Cannabis use and risk of psychotic or affective mental health outcomes: A systematic review. Lancet 370 (9584):319–328, 2007.

7. Mittleman MA, Lewis RA, Maclure M, Sherwood JB, Muller JE. Triggering myocardial infarction by marijuana. Circulation 103(23):2805–2809, 2001.

8. Tashkin DP. Smoked marijuana as a cause of lung injury. Monaldi Arch Chest Dis 63(2):92–100, 2005.

9. Hashibe M, Morgenstern H, Cui Y, et al. Marijuana use and the risk of lung and upper aerodigestive tract cancers: Results of a population-based case-control study. Cancer Epidemiol Biomarkers Prev 15(10):1829–1834, 2006.

10.   Polen MR, Sidney S, Tekawa IS, Sadler M, Friedman GD. Health care use by frequent marijuana smokers who do not smoke tobacco. West J Med 158(6):596–601, 1993.

11.   Gruber AJ, Pope HG, Hudson JI, Yurgelun-Todd D. Attributes of long-term heavy cannabis users: A case control study. Psychological Med 33(8):1415–1422, 2003.

Methamphetamine is a central nervous system stimulant drug that is similar in structure to amphetamine. Due to its high potential for abuse, methamphetamine is classified as a Schedule II drug and is available only through a prescription that cannot be refilled. Although methamphetamine can be prescribed by a doctor, its medical uses are limited, and the doses that are prescribed are much lower than those typically abused. Most of the methamphetamine abused in this country comes from foreign or domestic superlabs, although it can also be made in small, illegal laboratories, where its production endangers the people in the labs, neighbors, and the environment.

How Is Methamphetamine Abused?

Methamphetamine is a white, odorless, bitter-tasting crystalline powder that easily dissolves in water or alcohol and is taken orally, intranasally (snorting the powder), by needle injection, or by smoking.

How Does Methamphetamine Affect the Brain?

Methamphetamine increases the release and blocks the reuptake of the brain chemical (or neurotransmitter) dopamine, leading to high levels of the chemical in the brain, a common mechanism of action for most drugs of abuse. Dopamine is involved in reward, motivation, the experience of pleasure, and motor function. Methamphetamine’s ability to rapidly release dopamine in reward regions of the brain produces the intense euphoria, or “rush,” that many users feel after snorting, smoking, or injecting the drug.

Chronic methamphetamine abuse significantly changes how the brain functions. Noninvasive human brain imaging studies have shown alterations in the activity of the dopamine system that are associated with reduced motor skills and impaired verbal learning.1 Recent studies in chronic methamphetamine abusers have also revealed severe structural and functional changes in areas of the brain associated with emotion and memory,2,3 which may account for many of the emotional and cognitive problems observed in chronic methamphetamine abusers.

Repeated methamphetamine abuse can also lead to addiction—a chronic, relapsing disease, characterized by compulsive drug seeking and use, which is accompanied by chemical and molecular changes in the brain. Some of these changes persist long after methamphetamine abuse is stopped. Reversal of some of the changes, however, may be observed after sustained periods of abstinence (e.g., more than 1 year).4

What Other Adverse Effects Does Methamphetamine Have on Health?

Taking even small amounts of methamphetamine can result in many of the same physical effects of other stimulants, such as cocaine or amphetamines, including increased wakefulness, increased physical activity, decreased appetite, increased respiration, rapid heart rate, irregular heartbeat, increased blood pressure, and hyperthermia. Long-term methamphetamine abuse has many negative health consequences, including extreme weight loss, severe dental problems (“meth mouth”), anxiety, confusion, insomnia, mood disturbances, and violent behavior. Chronic methamphetamine abusers can also display a number of psychotic features, including paranoia, visual and auditory hallucinations, and delusions (for example, the sensation of insects crawling under the skin).

Transmission of HIV and hepatitis B and C can be consequences of methamphetamine abuse. The intoxicating effects of methamphetamine, regardless of how it is taken, can also alter judgment and inhibition and lead people to engage in unsafe behaviors, including risky sexual behavior. Among abusers who inject the drug, HIV and other infectious diseases can be spread through contaminated needles, syringes, and other injection equipment that is used by more than one person. Methamphetamine abuse may also worsen the progression of HIV and its consequences. Studies of methamphetamine abusers who are HIV-positive indicate that HIV causes greater neuronal injury and cognitive impairment for individuals in this group compared with HIV-positive people who do not use the drug.5,6

How Widespread Is Methamphetamine Abuse?

Monitoring the Future Survey* According to the 2008 Monitoring the Future survey—a national survey of 8th-, 10th-, and 12th- graders, methamphetamine abuse among students has shown a general decline in recent years; however, it remains a concern. Survey results show that 2.3 percent of 8th-graders, 2.4 percent of 10th-graders, and 2.8 percent of 12th-graders have used methamphetamine in their lifetime. In addition, 0.7 percent of 8th-graders, 0.7 percent of 10th-graders, and 0.6 percent of 12th-graders were current (past-month) methamphetamine abusers. Past-year use of methamphetamine remained steady across all grades surveyed from 2007 to 2008.

 

8th Grade

10th Grade

12th Grade

Lifetime**

2.3%

2.4%

2.8%

Past Year

1.2

1.5

1.2

Past Month

0.7

0.7

0.6

Methamphetamine Prevalence of Abuse, Monitoring the Future Survey, 2008

National Survey on Drug Use and Health*** The number of individuals aged 12 years or older reporting past-year methamphetamine use declined from 1.9 million in 2006 to 1.3 million in 2007. An estimated 529,000 Americans were current (past-month) users of methamphetamine (0.2 percent of the population). Of the 157,000 people who used methamphetamine for the first time in 2007, the mean age at first use was 19.1 years, which is down from the mean age of 22.2 in 2006. 

Other Information Resources

For more information on the effects of methamphetamine abuse and addiction, visit: www.drugabuse.gov/drugpages/methamphetamine.html.

To find publicly funded treatment facilities by State, visit: www.findtreatment.samhsa.gov.

For street terms searchable by drug name, street term, cost and quantities, drug trade, and drug use, visit: www.whitehousedrugpolicy.gov/streetterms/default.asp.


* These data are from the 2008 Monitoring the Future survey, funded by the National Institute on Drug Abuse, National Institutes of Health, Department of Health and Human Services, and conducted by the University of Michigan’s Institute for Social Research. The study has tracked 12th-graders’ illicit drug abuse and related attitudes since 1975; in 1991, 8th- and 10th-graders were added to the study. The latest data are online at: www.drugabuse.gov.

** “Lifetime” refers to use at least once during a respondent’s lifetime. “Past year” refers to use at least once during the year preceding an individual’s response to the survey. “Past month” refers to use at least once during the 30 days preceding an individual’s response to the survey.

*** NSDUH (formerly known as the National Household Survey on Drug Abuse) is an annual survey of Americans age 12 and older conducted by the Substance Abuse and Mental Health Services Administration. Copies of the latest survey are available at www.samhsa.gov and from NIDA at 877–643–2644.


1. Volkow ND, Chang L, Wang GJ, et al. Association of dopamine transporter reduction with psychomotor impairment in methamphetamine abusers. Am J Psychiatry 158:377–382, 2001.

2. London ED, Simon SL, Berman SM, et al.. Mood disturbances and regional cerebral metabolic abnormalities in recently abstinent methamphetamine abusers. Arch Gen Psychiatry 61:73–84, 2004.

3. Thompson PM, Hayashi KM, Simon SL, et al. Structural abnormalities in the brains of human subjects who use methamphetamine. J Neurosci 24:6028–6036, 2004.

4. Wang GJ, Volkow ND, Chang L, et al. Partial recovery of brain metabolism in methamphetamine abusers after protracted abstinence. Am J Psychiatry 161:242–248, 2004.

5. Chang L, Ernst T, Speck O, Grob CS. Additive effects of HIV and chronic methamphetamine use on brain metabolite abnormalities. Am J Psychiatry 162:361–369, 2005.

6. Rippeth JD, Heaton RK, Carey CL, et al. Methamphetamine dependence increases risk of neuropsychological impairment in HIV infected persons. J Int Neuropsychol Soc 10:1–14, 2004.

7. Rawson RA, Marinelli-Casey P, Anglin MD, et al. A multi-site comparison of psychosocial approaches for the treatment of methamphetamine dependence. Addiction 99:708–717, 2004.

8. Roll JM, Petry NM, Stitzer ML, et al. Contingency management for the treatment of methamphetamine use disorders. Am J Psychiatry 163:1993–1999, 2006.


Recommended Reading

Other Drug Info Sites


Prescription medications such as pain relievers, central nervous system (CNS) depressants (tranquilizers and sedatives), and stimulants are highly beneficial treatments for a variety of health conditions. Pain relievers enable individuals with chronic pain to lead productive lives; tranquilizers can reduce anxiety and help patients with sleep disorders; and stimulants help people with attention-deficit hyperactivity disorder (ADHD) focus their attention. Most people who take prescription medications use them responsibly. But when abused—that is, taken by someone other than the patient for whom the medication was prescribed, or taken in a manner or dosage other than what was prescribed—prescription medications can produce serious adverse health effects, including addiction.

Patients, health care professionals, and pharmacists all have roles in preventing the abuse1 of and addiction to prescription medications. For example, patients should follow the directions for use carefully; learn what effects and side effects the medication could have; and inform their doctor/pharmacist whether they are taking other medications [including over-the-counter (OTC) medications or health supplements], since these could potentially interact with the prescribed medication. The patient should read all information provided by the pharmacist. Physicians and other health care providers should screen for past or current substance abuse in the patient during routine examination, including asking questions about what other medications the patient is taking and why. Providers should note any rapid increases in the amount of a medication needed or frequent requests for refills before the quantity prescribed should have been finished, as these may be indicators of abuse.1

Similarly, some OTC medications, such as cough and cold medicines containing dextromethorphan, have beneficial effects when taken as recommended; but they can also be abused and lead to serious adverse health consequences. Parents should be aware of the potential for abuse of these medications, especially when consumed in large quantities, which should signal concern and the possible need for intervention.

Commonly Abused Prescription Medications

Although many prescription medications can be abused, the following three classes are most commonly abused:

  • Opioids—usually prescribed to treat pain.
  • CNS depressants—used to treat anxiety and sleep disorders. 
  • Stimulants—prescribed to treat ADHD and narcolepsy.

What Are Opioids?

Opioids are analgesic, or pain-relieving, medications. Studies have shown that properly managed medical use (taken exactly as prescribed) of opioid analgesics is safe, can manage pain effectively, and rarely causes addiction.

Among the compounds that fall within this class are hydrocodone (e.g., Vicodin), oxycodone (e.g., OxyContin—an oral, controlled-release form of the drug), morphine, fentanyl, codeine, and related medications. Morphine and fentanyl are often used to alleviate severe pain, while codeine is used for milder pain. Other examples of opioids prescribed to relieve pain include propoxyphene (Darvon); hydromorphone (Dilaudid); and meperidine (Demerol), which is used less often because of its side effects. In addition to their effective pain-relieving properties, some of these medications can be used to relieve severe diarrhea (for example, Lomotil, also known as diphenoxylate) or severe coughs (codeine).

How Are Opioids Abused?

Opioids can be taken orally, or the pills may be crushed and the powder snorted or injected. A number of overdose deaths have resulted from the latter routes of administration, particularly with the drug OxyContin, which was designed to be a slow-release formulation. Snorting or injecting opioids results in the rapid release of the drug into the bloodstream, exposing the person to high doses and causing many of the reported overdose reactions.

How Do Opioids Affect the Brain?

Opioids act by attaching to specific proteins called opioid receptors, which are found in the brain, spinal cord, and gastrointestinal tract. When these compounds attach to certain opioid receptors in the brain and spinal cord, they can effectively change the way a person experiences pain.

In addition, opioid medications can affect regions of the brain that mediate what one perceives as pleasure, resulting in the initial euphoria or sense of well-being that many opioids produce. Repeated abuse of opioids can lead to addiction—a chronic, relapsing disease characterized by compulsive drug seeking and abuse despite its known harmful consequences.

What Adverse Effects Can Be Associated With Opioids?

Opioids can produce drowsiness, cause constipation, and, depending upon the amount taken, depress breathing. Taking a large single dose could cause severe respiratory depression or death.

These medications are only safe to use with other substances under a physician’s supervision. Typically, they should not be used with alcohol, antihistamines, barbiturates, or benzodiazepines. Because these other substances slow breathing, their effects in combination with opioids could lead to life-threatening respiratory depression.

What Happens When You Stop Taking Opioids?

Patients who are prescribed opioids for a period of time may develop a physical dependence on them, which is not the same as addiction. Repeated exposure to opioids causes the body to adapt, sometimes resulting in tolerance (that is, more of the drug is needed to achieve the desired effect compared with when it was first prescribed) and in withdrawal symptoms upon abrupt cessation of drug use. Thus, individuals taking prescribed opioid medications should not only be given these medications under appropriate medical supervision, but they should also be medically supervised when stopping use in order to reduce or avoid withdrawal symptoms. Symptoms of withdrawal can include restlessness, muscle and bone pain, insomnia, diarrhea, vomiting, cold flashes with goose bumps (“cold turkey”), and involuntary leg movements.

CNS Depressants

CNS depressants (e.g., tranquilizers, sedatives) are medications that slow normal brain function. In higher doses, some CNS depressants can be used as general anesthetics or preanesthetics.

CNS depressants can be divided into three groups, based on their chemistry and pharmacology:

  • Barbiturates, such as mephobarbital (Mebaral) and sodium pentobarbital (Nembutal), are used as preanesthetics, promoting sleep.
  • Benzodiazepines, such as diazepam (Valium), alprazolam (Xanax), and estazolam (ProSom), can be prescribed to treat anxiety, acute stress reactions, panic attacks, convulsions, and sleep disorders. For the latter, benzodiazepines are usually prescribed only for short-term relief of sleep problems because of the development of tolerance and risk of addiction.
  • Newer sleep medications, such as zolpidem (Ambien), zaleplon (Sonata), and eszopiclone (Lunesta), are now more commonly prescribed to treat sleep disorders. These medications are nonbenzodiazepines that act at a subset of the benzodiazepine receptors and appear to have a lower risk for abuse and addiction.

How Are CNS Depressants Abused?

CNS depressants are usually taken orally, sometimes in combination with other drugs or to counteract the effects of other licit or illicit drugs (e.g., stimulants).

How Do CNS Depressants Affect the Brain?

Most of the CNS depressants have similar actions in the brain: they enhance the actions of the neurotransmitter gamma-aminobutyric acid (GABA)—neurotransmitters are brain chemicals that facilitate communication between brain cells. GABA works by decreasing brain activity. Although different classes of CNS depressants work in unique ways, it is ultimately their common ability to increase GABA activity that produces a drowsy or calming effect.

What Adverse Effects Can Be Associated With CNS Depressants?

Despite their beneficial effects for people suffering from anxiety or sleep disorders, barbiturates and benzodiazepines can be addictive and should be used only as prescribed.

CNS depressants should not be combined with any medication or substance that causes drowsiness, including prescription pain medicines, certain OTC cold and allergy medications, and alcohol. If combined, they can slow both heart rate and respiration, which can be fatal.

What Happens When You Stop Taking CNS Depressants?

Discontinuing prolonged use or abuse of high doses of CNS depressants can lead to serious withdrawal symptoms. Because the drug works by slowing the brain’s activity, when one stops taking a CNS depressant, this activity can rebound to the point that seizures can occur. Someone who is either thinking about ending use of a CNS depressant, or who has stopped and is suffering withdrawal should seek medical treatment.

Stimulants

Stimulants (amphetamines [Adderall, Dexedrine] and methylphenidate [Concerta, Ritalin]) increase alertness, attention, and energy. They also increase blood pressure and heart rate, constrict blood vessels, increase blood glucose, and open up the pathways of the respiratory system. Historically, stimulants were prescribed to treat asthma and other respiratory problems, obesity, neurological disorders, and a variety of other ailments. As their potential for abuse and addiction became apparent, the prescribing of stimulants by physicians began to wane. Now, stimulants are prescribed for treating only a few health conditions, most notably ADHD, narcolepsy, and, in some instances, depression that has not responded to other treatments.

How Are Stimulants Abused?

Stimulants may be taken orally, but some abusers crush the tablets, dissolve them in water, and then inject the mixture; complications can arise from this because insoluble fillers in the tablets can block small blood vessels. Stimulants have been abused for both “performance enhancement” and recreational purposes (i.e., to get high).

How Do Prescription Stimulants Affect the Brain?

Stimulants have chemical structures that are similar to key brain neurotransmitters called monoamines, including dopamine and norepinephrine. Their therapeutic effect is achieved by slow and steady increases of dopamine that are similar to the natural production of this chemical by the brain. The doses prescribed by physicians start low and increase gradually until a therapeutic effect is reached. However, when taken in doses and routes other than those prescribed, stimulants can increase the brain’s dopamine levels in a rapid and highly amplified manner—as do most other drugs of abuse—disrupting normal communication between brain cells, producing euphoria, and increasing the risk of addiction.

What Adverse Effects Are Associated With Stimulant Abuse?

Taking high doses of a stimulant can result in an irregular heartbeat, dangerously high body temperatures, and/or the potential for cardiovascular failure or seizures. Taking some stimulants in high doses or repeatedly can lead to hostility or feelings of paranoia in some individuals.

Stimulants should not be mixed with antidepressants, which may enhance the effects of a stimulant; or with OTC cold medicines containing decongestants, which may cause blood pressure to become dangerously high or may lead to irregular heart rhythms.

Dextromethorphan (DXM)

DXM is the active ingredient found in OTC cough and cold medications. When taken in recommended doses, these medications are safe and effective.

How Is DXM Abused?

DXM is taken orally. In order to experience the mind-altering effects of DXM, excessive amounts of liquid or gelcaps must be consumed. The availability and accessibility of these products make them a serious concern, particularly for youth, who tend to be their primary abusers.

What Are the Consequences Associated With the Abuse of DXM?

In very large quantities, DXM can cause effects similar to those of ketamine and PCP because these drugs affect similar sites in the brain. These effects can include impaired motor function, numbness, nausea/vomiting, and increased heart rate and blood pressure. On rare occasions, hypoxic brain damage—caused by severe respiratory depression and a lack of oxygen to the brain—has occurred due to the combination of DXM with decongestants often found in the medication.

Trends in the Abuse of Prescription Drugs and OTC Medications

Monitoring the Future (MTF) Survey2

Each year, the Monitoring the Future (MTF) survey assesses the extent of drug use among 8th-, 10th-, and 12th-graders nationwide. Nonmedical use of any prescription drug is reported only for 12th-graders, and in 2008, 15.4 percent reported past-year use. Prescription and OTC medications were the most commonly abused drugs by high school students after marijuana. In addition, they represent 6 of the top 10 illicit drugs reported by 12th-graders.

Prescription Painkillers. In 2002, MTF added questions to the survey about past-year nonmedical use of Vicodin and OxyContin. For Vicodin, past-year nonmedical use has remained stable at high levels for each grade since its inclusion in the survey.

Drug Name

8th-Grade

10th-Grade

12th-Grade

Vicodin

2.9%

6.7%

9.7%

OxyContin

2.1%

3.6%

4.7%

Rate of Past-Year Use in 2008

CNS Depressants. Nonmedical use of tranquilizers (benzodiazepines and others) by 10th-grade students decreased between 2001 and 2008 for all prevalence periods (lifetime,3 past-year, and past-month use). Use of sedatives (barbiturates), for which data are collected only from 12th-graders, has remained steady.

Drug Name

8th-Grade

10th-Grade

12th-Grade

Tranquilizers

2.4%

4.6%

6.2%

Sedatives

5.8%

Rate of Past-Year Use in 2008

Stimulantss. Nonmedical use of stimulants is broken up by the type of stimulant used: amphetamines, methamphetamine, or Ritalin. For all three stimulants surveyed, rates have decreased significantly among 8th-, 10th-, and 12th-graders in 2001–2008.

Drug Name

8th-Grade

10th-Grade

12th-Grade

Amphetamines

4.5%

6.4%

6.8%

Methamphetamine

1.2%

1.5%

1.2%

Ritalin

1.6%

2.9%

3.4%

Rate of Past-Year Use in 2008

Cough Medicine. In 2006, a question about the use of cough and cold medicines to get high was asked for the first time.

Drug Name

8th-Grade

10th-Grade

12th-Grade

Cough Medicine

3.6%

5.3%

5.5%

Rate of Past-Year Use in 2008

National Survey on Drug Use and Health (NSDUH)4

According to the 2007 NSDUH, an estimated 6.9 million persons, or 2.8 percent of the population, aged 12 or older had used prescription psychotherapeutic medications nonmedically in the month prior to being surveyed. This includes 5.2 million using pain relievers (an increase from 4.7 million in 2005), 1.8 million using tranquilizers, 1.1 million using stimulants, and 350,000 using sedatives.

Past-month nonmedical use of prescription-type drugs among young adults aged 18 to 25 increased from 5.5 percent in 2002 to 6 percent in 2007. This was primarily due to an increase in pain reliever use, which was 4.1 percent in 2002 and 4.6 percent in 2007. However, nonmedical use of tranquilizers remained the same over the 6-year period.

Among persons aged 12 or older who used pain relievers nonmedically in the past 12 months, 56.5 percent reported that they got the drug most recently used from someone they knew and that they did not pay for it. Another 18.1 percent reported that they obtained the drug from one doctor. Only 4.1 percent purchased the pain reliever from a drug dealer or other stranger, and just 0.5 percent reported buying the drug on the Internet. Among those who reported getting the pain reliever from a friend or relative for free, 81 percent reported in a followup question that the friend or relative had obtained the drug from one doctor only.

Other Information Sources

For more information on addiction to prescription medications, visit: http://www.drugabuse.gov/drugpages/prescription.html.


1. A common vocabulary has not been established in the field of prescription drug abuse. Because much of the survey data collected in this area refer to nonmedical use of prescription drugs, this definition of “abuse,” rather than that of the Diagnostic and Statistical Manual of Mental Disorders (DSM), is used. Also, because physical dependence to prescription medications can develop during medically supervised appropriate use, the term “addiction” is used to reflect dependence as defined by the DSM.

2. These data are from the 2008 Monitoring the Future survey, funded by the National Institute on Drug Abuse, National Institutes of Health, Department of Health and Human Services, and conducted annually by the University of Michigan’s Institute for Social Research. The survey has tracked 12th-graders’ illicit drug use and related attitudes since 1975; in 1991, 8th- and 10th-graders were added to the study. The latest data are online at: www.drugabuse.gov.

3. “Lifetime” refers to use at least once during a respondent’s lifetime. “Past year” refers to use at least once during the year preceding an individual’s response to the survey. “Past month” refers to use at least once during the 30 days preceding an individual’s response to the survey.

4. NSDUH (formerly known as the National Household Survey on Drug Abuse) is an annual survey of Americans age 12 and older conducted by the Substance Abuse and Mental Health Services Administration. Copies of the latest survey are available at www.samhsa.gov and from NIDA at 877-643-2644.

Anabolic-androgenic steroids (AAS) are synthetically produced variants of the naturally occurring male sex hormone testosterone. “Anabolic” refers to muscle-building, and “androgenic” refers to increased male sexual characteristics. “Steroids” refers to the class of drugs. These drugs can be legally prescribed to treat conditions resulting from steroid hormone deficiency, such as delayed puberty, as well as diseases that result in loss of lean muscle mass, such as cancer and AIDS.

How Are AAS Abused?
Some people, both athletes and non-athletes, abuse AAS in an attempt to enhance performance and/or improve physical appearance. AAS are taken orally or injected, typically in cycles rather than continuously. “Cycling” refers to a pattern of use in which steroids are taken for periods of weeks or months, after which use is stopped for a period of time and then restarted. In addition, users often combine several different types of steroids in an attempt to maximize their effectiveness, a practice referred to as “stacking.”

How Do AAS Affect the Brain?
The immediate effects of AAS in the brain are mediated by their binding to androgen (male sex hormone) and estrogen (female sex hormone) receptors on the surface of a cell. This AAS–receptor complex can then shuttle into the cell nucleus to influence patterns of gene expression. Because of this, the acute effects of AAS in the brain are substantially different from those of other drugs of abuse. The most important difference is that AAS are not euphorigenic, meaning they do not trigger rapid increases in the neurotransmitter dopamine, which is responsible for the “high” that often drives substance abuse behaviors. However, long-term use of AAS can eventually have an impact on some of the same brain pathways and chemicals—such as dopamine, serotonin, and opioid systems—that are affected by other drugs of abuse. Considering the combined effect of their complex direct and indirect actions, it is not surprising that AAS can affect mood and behavior in significant ways.

AAS and Mental Health
Preclinical, clinical, and anecdotal reports suggest that steroids may contribute to psychiatric dysfunction. Research shows that abuse of anabolic steroids may lead to aggression and other adverse effects.1 For example, although many users report feeling good about themselves while on anabolic steroids, extreme mood swings can also occur, including manic-like symptoms that could lead to violence.2 Researchers have also observed that users may suffer from paranoid jealousy, extreme irritability, delusions, and impaired judgment stemming from feelings of invincibility.

Addictive Potential
Animal studies have shown that AAS are reinforcing—that is, animals will self-administer AAS when given the opportunity, just as they do with other addictive drugs.3,4 This property is more difficult to demonstrate in humans, but the potential for AAS abusers to become addicted is consistent with their continued abuse despite physical problems and negative effects on social relations.5 Also, steroid abusers typically spend large amounts of time and money obtaining the drug: this is another indication of addiction. Individuals who abuse steroids can experience withdrawal symptoms when they stop taking AAS—these include mood swings, fatigue, restlessness, loss of appetite, insomnia, reduced sex drive, and steroid cravings, all of which may contribute to continued abuse. One of the most dangerous withdrawal symptoms is depression— when persistent, it can sometimes lead to suicide attempts. Research also indicates that some users might turn to other drugs to alleviate some of the negative effects of AAS. For example, a study of 227 men admitted in 1999 to a private treatment center for dependence on heroin or other opioids found that 9.3 percent had abused AAS before trying any other illicit drug. Of these, 86 percent first used opioids to counteract insomnia and irritability resulting from the steroids.

What Other Adverse Effects Do AAS Have on Health?
Steroid abuse can lead to serious, even irreversible health problems. Some of the most dangerous among these include liver damage; jaundice (yellowish pigmentation of skin, tissues, and body fluids); fluid retention; high blood pressure; increases in LDL (“bad” cholesterol); and decreases in HDL (“good” cholesterol). Other reported effects include renal failure, severe acne, and trembling. In addition, there are some gender- and age-specific adverse effects:
 • For men—shrinking of the testicles, reduced sperm count, infertility, baldness, development of breasts, increased risk for prostate cancer
 • For women—growth of facial hair, male-pattern baldness, changes in or cessation of the menstrual cycle, enlargement of the clitoris, deepened voice
 • For adolescents—stunted growth due to premature skeletal maturation and accelerated puberty changes; risk of not reaching expected height if AAS is taken before the typical adolescent growth spurt

In addition, people who inject AAS run the added risk of contracting or transmitting HIV/AIDS or hepatitis, which causes serious damage to the liver.

What Treatment Options Exist?
There has been very little research on treatment for AAS abuse. Current knowledge derives largely from the experiences of a small number of physicians who have worked with patients undergoing steroid withdrawal. They have learned that, in general, supportive therapy combined with education about possible withdrawal symptoms is sufficient in some cases. Sometimes, medications can be used to restore the balance of the hormonal system after its disruption by steroid abuse. If symptoms are severe or prolonged, symptomatic medications or hospitalization may be needed.

How Widespread Is AAS Abuse?
Monitoring the Future Survey* Monitoring the Future is an annual survey used to assess drug use among the Nation’s 8th-, 10th-, and 12th-grade students. While steroid use remained stable among all grades from 2007 to 2008, there has been a significant reduction since 2001 for nearly all prevalence periods (i.e., lifetime,** past-year, and past-month use) among all grades surveyed. The exception was past-month use among 12th-graders, which has remained stable. Males consistently report higher rates of use than females: for example, in 2008, 2.5 percent of 12th-grade males, versus 0.6 percent of 12th-grade females, reported past-year use.

  8th Grade 10th Grade 12th Grade
Lifetime** 1.4% 1.4%  2.2%
Past Year   0.9% 0.9% 1.5%
Past Month 0.5% 0.5% 1.0%

2008 Monitoring the Future Survey: Anabolic Steroid Use by Students

Other Information Sources
For a list of street terms used to refer to steroids and other drugs, visitwww.whitehousedrugpolicy.gov/streetterms/default.asp.

For additional information on the effects of anabolic-androgenic steroids and information on healthy alternatives, please visit NIDA’s website on steroids,www.steroidabuse.org.

* These data are from the 2008 Monitoring the Future survey, funded by the National Institute on Drug Abuse, National Institutes of Health, Department of Health and Human Services, and conducted by the University of Michigan’s Institute for Social Research. The survey has tracked 12th-graders’ illicit drug use and related attitudes since 1975; in 1991, 8th- and 10th-graders were added to the study. The latest data are online atwww.drugabuse.gov.

** “Lifetime” refers to use at least once during a respondent’s lifetime. “Past year” refers to use at least once during the year preceding an individual’s response to the survey. “Past month” refers to use at least once during the 30 days preceding an individual’s response to the survey.

1. Pope HG Jr, Kouri EM, Hudson JI. Effects of supraphysiologic doses of testosterone on mood and aggression in normal men: A randomized controlled trial. Arch Gen Psychiatry 57(2):133–140, 2000.
2. Pope HG Jr, Katz DL. Affective and psychotic symptoms associated with anabolic steroid use. Am J Psychiatry 145(4):487–490, 1988.
3. Arnedo MT, Salvador A, Martinez-Sanchis S, Gonzalez-Bono E. Rewarding properties of testosterone in intact male mice: A pilot study. Pharmacol Biochem Behav 65:327–332, 2000.
4. DiMeo AN, Wood RI. Self-administration of estrogen and dihydrotestosterone in male hamsters. Horm Behav 49(4):519–526, 2006.
5. Brower KJ. Anabolic steroid abuse and dependence. Curr Psychiatry Rep 4(5):377–387, 2002. 6. Arvary D, Pope HG Jr. Anabolic-androgenic steroids as a gateway to opioid dependence. N Engl J Med 342:1532, 2000.


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