Cliff Straehley III MD

Psychiatrist

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Addictions

A great book about addictions is the multi-author book called Buzzed, and it is published by W.W. Norton. It is scientifically sophisticated, factual, unbiased, and it also explains jargon and street terminology. Addictions are characterized by repetitive, compulsive use of something, despite the fact that such use causes negative consequences for the user. Commonly the addict can’t or won’t admit to the harm they are causing. Addicts usually also cause harm to nonusers around them. Most people probably think only of drugs as addictions. However, what about gambling, shoplifting, and misusing sex (for example compulsive affairs)? There is still a debate among addiction experts about how to classify these so-called, "behavioral addictions". As for me, I consider them to be addictions. There are also 12-step groups available to deal with these behavioral addictions.

Addicted people cannot consistently control their use of their "drug of choice". They often fool themselves, because they may be able to temporarily control their use of it. However, over the long haul, the fact that they become out of control of the use of their drug is obvious to anyone but themselves.

When thinking about the various addictions, many people overlook what is probably the worst one of all in terms of causing health problems. I'm referring to nicotine addiction. Many smokers with other addictions report that it also is the hardest drug "to kick or quit. The negative health consequences for the population at large from nicotine dependence is obviously huge. Three basic categories include most addicting drugs. These are Stimulants (Uppers), Downers, and what I call "Spacers." The two main stimulants in the United States are cocaine and amphetamines. Downers include alcohol, opiates, and sedatives. Spacers include LSD, mushrooms, mescaline, and marijuana. Because of their unique features, I put Ecstasy by itself in a fourth group, and PCP in a fifth group by itself. The way an addict takes their drug of choice has a large effect on the severity of their addiction and on the danger of the addiction. Injecting drugs and inhaling drugs are the most dangerous methods. Injecting drugs can cause death from an overdose. Inhaling drugs can cause a stronger addiction and sometimes death.

Both cocaine and amphetamines can cause death from overdose. Prolonged use of high doses of these two drugs can cause paranoia, agitation, and hostility. The withdrawal symptoms from stimulants (Uppers) are essentially the opposite of the symptoms of intoxication. In other words the user gets depressed and has very low energy. Withdrawal from stimulants is not lethal. There is also no specific treatment for the symptoms of withdrawal from stimulants. Helpful measures include good nutrition, adequate rest, and emotional support. The question of whether or not chronic use of these two drugs causes any permanent damage is still the subject of debate. Some chronic users develop prolonged paranoia, but usually it eventually resolves.

Overdoses of the Downers (including alcohol) can also be lethal. Alcohol when ingested rapidly, on an empty stomach, and in large quantity, can cause death from respiratory arrest. By the way, drinking coffee does not sober you up. You just become a "nervous drunk." Especially if an addict is unhealthy, alcohol withdrawal can be lethal. There are many different kinds of benzodiazepines, which are also Downers. These include Valium, Librium, Ativan, Xanax, and Klonopin to name just a few. If benzodiazepines are taken by themselves in overdose, the person usually just sleeps a long time. When mixed with alcohol, the combination can be lethal. There are many other sedatives, all of which can be lethal in overdose. These include barbiturates, chloral hydrate, doriden, miltown and Placidyl, to name just a few.

Opiates, another Downer, can be injected (for example heroine), smoked (like opium), or swallowed in pill form (Oxycontin, Vicodin, etc.) An overdose of opiates can cause death. Any form of prolonged administration is associated with a high risk of addiction. Again, the withdrawal from Downers causes basically the opposite symptoms of the intoxication, i.e. agitation. Contrary to common believe, people cannot die from opiate withdrawal. They just wish that they would die. Moreover, there are prescription drugs which can lessen the severity of the withdrawal symptoms.

All the drugs that I've discussed so far are associated with tolerance. This means that if you continue to take the drug, it eventually takes a higher and higher dose to cause the same effects. Moreover, the initially enjoyable part of the intoxication, usually decreases or disappears with chronic use. As I've already mentioned, the above drugs also have symptoms when chronic use is discontinued, called withdrawal.

The hallucinogens include LSD, mescaline, psilocybin, Marijuana, and others. I'm not going to discuss the issues of medical marijuana and the questions about legalization of various drugs in this essay. Obviously, not all people always have bad reactions, all the time, to addicting drugs. However, some people clearly have temporary paranoia or severe anxiety reactions caused by Hallucinogens. Sometimes these seem to hasten the onset of more severe psychiatric disorders. Other people become socially awkward and very ill at ease from the use of these drugs. Others become nonproductive in their lives, at least from a conventional point of view. For example the so called, “amotivational syndrome" can be caused by chronic use of marijuana. Bad trips and flashbacks can also occur, and it's not possible to predict who will get such reactions or how long they will last.

I put PCP in a class by itself, because of the severity of the intoxication, that occurs sometimes for some people. People can experience temporary psychosis (i.e. becoming crazy or being out of touch with reality) from a single dose. There also can be relatively long-lasting psychosis. Other people experience dangerous, irrational, and even very aggressive behavior, or self-injurious behavior.

That leaves a few additional considerations. If you buy your drugs on the street, you can't really know what you are purchasing. Lots of street drugs have been “cut” with other drugs. Therefore you may have really purchased a mixture of drugs. There may be harmful impurities. I'm not trying to frighten you. These facts are simply true. Cheaper drugs which cause similar symptoms can be substituted. You also can't know the potency of what you have purchased. This can have deadly consequences. Every time a higher potency form of heroine becomes available on the street, many addicts die of accidental overdose. In addition all the above drugs impair a person's ability to drive, with the exception of cigarettes. Even people who definitely know the identity of the drugs they are purchasing may kill themselves by mixing drugs in a way that is dangerous.

I hope that this oversimplified discussion proves useful. I can't say enough about the book, Buzzed, if you are interested in more information. It's one of the most informative and yet enjoyable books that I've ever read.