Expert Answer:Substance Use and Abuse

Answer & Explanation:This assessment has two quizzes. Make sure you take both and report back your scores in the format listed below.Take the alcohol addiction quiz here:Link (Links to an external site.)Take the drug quiz here:Link (Links to an external site.)Report back you scored based upon the percentage and recommendation given. This is an example of what your submission should look like:My alcohol results are:”You are at high risk. Please consult a medical professional immediately.”Score 42%21/50 pointsMy drug results are:”You are at no risk”Score 20%11/55PreviousNext

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Section 7.1 Understanding Drug Use and Addiction
Many people don’t understand why or how other people become addicted to drugs.
They may mistakenly think that those who use drugs lack moral principles or willpower
and that they could stop their drug use simply by choosing to. In reality, drug addiction
is a complex disease, and quitting usually takes more than good intentions or a strong
will. Drugs change the brain in ways that make quitting hard, even for those who want
to. Fortunately, researchers know more than ever about how drugs affect the brain and
have found treatments that can help people recover from drug addiction and lead
productive lives. Before further studying addiction and recovery, we must first gain an
understanding of the different types of drugs and substances and their effects on the
Section 7.2 Types of Drugs
Drug abuse is a serious public health problem that affects
almost every community and family in some way. Each
year drug abuse results in around 40 million serious
illnesses or injuries among people in the United States.
Abused drugs include:

Club drugs
Anabolic steroids
Prescription drugs
Drug abuse also plays a role in many major social problems, such as drugged driving,
violence, stress, and child abuse. Drug abuse can lead to homelessness, crime and
missed work or problems with keeping a job. There are different types of treatment for
drug abuse. But the best is to prevent drug abuse in the first place.
Club Drugs
The term club drug refers to a wide variety of dangerous drugs. These drugs are often
used by young adults at all-night dance parties, dance clubs and bars. They include

Methylenedioxymethamphetamine (MDMA), also known as Ecstasy XTC, X, Adam,
Clarity and Lover’s Speed
Gamma-hydroxybutyrate (GHB), also known as Grievous Bodily Harm, G, Liquid
Ecstasy and Georgia Home Boy
Ketamine, also known as Special K, K, Vitamin K, Cat Valium
Rohypnol, also known as Roofies, Rophies, Roche, Forget-me Pill
Methamphetamine, also known as Speed, Ice, Chalk, Meth, Crystal, Crank, Fire,
Lysergic Acid Diethylamide (LSD), also known as or Acid, Boomers, Yellow
Club drugs have become more common in recent years. Sometimes people use them to
commit sexual assaults. Club drugs can cause serious health problems and sometimes
death. They are even more dangerous if you use them with alcohol.
Why Type of Drugs are Club Drugs?
Club drugs are a pharmacologically heterogeneous group of psychoactive drugs that
tend to be abused by teens and young adults at bars, nightclubs, concerts, and parties.
Gamma hydroxybutyrate (GHB), Rohypnol, ketamine, as well as MDMA (ecstasy) and
methamphetamine are some of the drugs included in this group.

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). It exists naturally in the brain,
but at much lower concentrations than those found when GHB is abused.
Rohypnol (flunitrazepam) use began gaining popularity in the United States in the
early 1990s. It is a benzodiazepine (chemically similar to sedative-hypnotic drugs
such as 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?
GHB and Rohypnol are available in odorless, colorless, and tasteless forms that are
frequently combined with alcohol and other beverages. Both drugs have been used to
commit sexual assaults (also known as “date rape,” “drug rape,” “acquaintance rape,” or
“drug-assisted” assault) due to their ability to sedate and incapacitate unsuspecting
victims, preventing them from resisting sexual assault.

GHB is usually ingested orally, either in liquid or powder form, while Rohypnol is
typically taken orally in pill form. Recent reports, however, have shown that
Rohypnol is being ground up and snorted.
Both GHB and Rohypnol are also abused for their intoxicating effects, similar to
other CNS depressants.
GHB also has anabolic effects (it stimulates protein synthesis) and has been used
by bodybuilders to aid in fat reduction and muscle building.
Ketamine is usually snorted or injected intramuscularly.
How Do Club Drugs Affect the Brain?

At high doses, GHB’s sedative effects may result in sleep, coma, or death.
Rohypnol 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. 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.

Like other benzodiazepines, chronic use of Rohypnol can produce tolerance,
physical dependence, and addiction.
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.
Chapter 7: Substance Use and
Abuse (7.2 continued)
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. Nonetheless, we do know that:

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 has 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.
Methamphetamine is a very addictive stimulant drug. It can be smoked, injected,
inhaled or taken by mouth. It has many street names, such as speed, meth, and chalk.
Methamphetamine hydrochloride, the crystal form inhaled by smoking, is referred to as
ice, crystal, glass and tina.
Methamphetamine affects the brain and can create feelings of pleasure, increase
energy and elevate mood. Abusers may become addicted quickly, needing higher
doses more often. Adverse health effects include irregular heartbeat, increased blood
pressure and a variety of psychological problems. Long-term effects may include severe
mental disorders, memory loss and severe dental problems.
What Type of Drug is Methamphetamine?
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 release dopamine rapidly 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. Recent studies in chronic methamphetamine abusers have also revealed
severe structural and functional changes in areas of the brain associated with emotion
and memory, 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).
What Other Adverse Effects Does Methamphetamine Have on Health?
Taking even small amounts of methamphetamine can result in many of the same
physical effects as those 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 can lead people to engage in unsafe behaviors,
including risky sexual behavior. Among abusers who inject the drug, HIV/AIDS 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/AIDS 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.
Anabolic Steroids
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
How Do AAS Affect the Brain?
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, longterm 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
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. 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. 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 selfadminister AAS when given the opportunity, just as they do with other addictive drugs.
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. 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 agespecific 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.
Cocaine is a powerful drug that stimulates the brain. People who use it can form a
strong addiction. They may have to use more and more of the drug to get high. It’s sold
on the street as a fine, white powder. There are two forms of cocaine: hydrochloride salt
and freebase. The salt dissolves in water. People can take it in a vein or in the nose.
The freebase form can be smoked. Crack is the street name of a smokable form of
No matter how cocaine is taken, it is dangerous. Some of the most common serious
problems include

Heart problems, including heart attacks
Respiratory effects, including respiratory failure
Nervous system problems, including strokes
Digestive problems
Any of these can be fatal. Using cocaine with alcohol is a common cause of drugrelated death.
What Type of Drug is Cocaine?
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 it is by injection. All three methods of cocaine abuse can lead to addiction and
other severe health problems, including increasing the risk of contracting HIV/AIDS 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 cha …
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