Module 1: Introduction & Overview
Ch. 1: Psychoactive Substances
In the first three chapters, you will read about:
- the major types of psychoactive substances;
- key epidemiology trends related to substance use and misuse;
- major historical and current trends in policy and practice related to substance use and substance use disorders; and,
- key terms used in the field of substance use, misuse, and addiction.
Psychoactive Substances
Our course focuses on psychoactive substances. Psychoactive substances are chemicals affecting how the brain functions, and thus have the power to affect a person’s mind, mood, and behavior when consumed. The word psychotropic means the same thing. Many of these substances have important medicinal or other positive purposes when used appropriately. Many also are the subject of concern because of the consequences arising from their misuse and the potential for their use evolving into a substance use disorder.
Types of Substances
One way of organizing the very long list of psychoactive substances is in terms of their actions on the human body. It would be impossible to list every one of these drugs because the list is constantly evolving: not only are new nicknames for drugs being invented all the time, new formulations (drugs) are being developed on a regular basis. In addition, some substances do not fit neatly into a single category. For example, it is difficult to know how to classify caffeinated energy drink plus alcohol beverages (e.g., Four Loko®, Joose®, Sparks+®, Jaegerbombs, or vodka with Red Bull®) since their components fall into two very different categories: caffeine and some other ingredients are stimulants; alcohol is a depressant. (Note that premixed beverages of this type no longer are sold in most of the United States but are still produced for consumption in other nations.)
In many sources, there is a distinction made between legal or illegal “street” drugs. However, this distinction has two major flaws. First, we have seen a tremendous upsurge in the illegal use of legal substances in recent years—by now, you have heard about the problem of prescription drug abuse in the news. Second, laws can change, as we have witnessed recently with states legalizing various uses of marijuana, and laws concerning the legal drinking age that have fluctuated in the United States between 21, 18, 19, and back to 21 just since the 1970s.
The way that clinicians and researchers categorize psychoactive substances is in terms of their effects on the human body or behavior. Tables 1-7 present you with just such a list. Considering some of the substances with which you or people you know may have experience, does it surprise you to see how they are classified? Some people are surprised to see alcohol classified as a depressant, or caffeine and tobacco in the same (stimulant) category as cocaine! The different substances in each category have meaningful psychoactive differences from each other. However, it is important to recognize that they also have some shared common features in terms of how they affect the mind, body, and behavior. We will be looking into each of these different types of substances in the second half of our course. For now, we are aiming for a general overview of the picture concerning “what’s what” in the array of psychoactive substances.
Table 1. Stimulants
|
Examples of Stimulant Drugs |
Usual Administration Route & Common Effects |
|
amphetamines (dexadrine, bennies, black beauties, hearts, speed, uppers); attention deficit disorder and narcolepsy medications (e.g., Adderall, Concerta, Ritalin); “bath salts;” caffeine |
Administration: Snorted, smoked, injected, swallowed; caffeine also chewed in gum, absorbed through skin in a patch. Effects: Increased heart rate and blood pressure, elevated body temperature, increased body metabolism, reduced appetite, increased energy, feelings of exhilaration and mental alertness, tremors, irritability, anxiety, panic, paranoia, violence and aggression, psychosis. Increased risk of insomnia, weight loss, cardiovascular complications, stroke, seizures, addiction, fatal overdose. |
|
cocaine and “crack” cocaine (blow, C, candy, coke, flake, rock, snow, toot) |
Administration: Snorted, smoked, injected. Effects: Nasal damage from snorting, exposure to infectious diseases from injection, poor pregnancy outcomes, and see amphetamines effects above. |
|
methamphetamine (meth, ice, crank, crystal, fire, glass, speed) |
Administration: Snorted, smoked, injected, swallowed. Effects: Severe dental problems, poor pregnancy outcomes, explosion/fire risks during production, chemical and environmental contamination from production activities, and see amphetamines effects above. |
|
MDMA (Ecstasy, “club drug” combination of stimulants and hallucinogens of various types) |
Administration: Swallowed. Effects: Feelings of euphoria, enhanced mental and emotional clarity, sensations of lightness and floating and other hallucinations, suppression of appetite, thirst, and need for sleep, anxiety, nausea, blurred vision, faintness, high blood pressure, tremors, seizures, elevated body temperature. Increased risk of exhaustion, severe dehydration, sleep disorders, cognitive impairment, confusion, depression, aggression, impulsive behavior, fatal overdose, possible addiction. |
|
tobacco products, nicotine (cigarettes, bidis, cigars, cigarillos, pipe tobacco, e-cigarettes, hookah tobacco, snuff, chew, nicotine patch or nicotine gum) |
Administration: Smoked, snorted, chewed; absorbed through skin in a patch. Effects: increased blood pressure and heart rate. Increased risk of chronic lung disease, heart disease, stroke, cancers (mouth, throat, stomach, pancreas, cervix, kidney, bladder, acute myeloid leukemia), poor pregnancy outcomes, overdose (young children), addiction. |
Table 2. Depressants and Dissociatives
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Examples of Depressant & Dissociative Drugs |
Usual Administration Route & Common Effects |
|
alcohol (ethanol, ethyl alcohol, etoh) |
Administration: swallowed; some are smoked, chewed, or injected Effects, low dose: euphoria, mild stimulation, relaxation, lowered inhibition; Effects, high dose: drowsiness, slurred speech, nausea, emotional volatility, poor coordination, impaired perception, impaired memory, sexual dysfunction, loss of consciousness, impaired breathing. Increased risk of injury, depression, neurologic and cognitive deficits, memory loss, high blood pressure, liver and heart disease, poor pregnancy outcomes, addiction, fatal overdose. |
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anti-anxiety medications |
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benzodiazepines |
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dextromethorphan (DXM) in large amounts (some cough medicine formulations) |
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pre-anesthesia medications (rohypnol) |
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PCP (phencyclidine; angel dust) |
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salvia |
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sleep medications |
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tranquilizers (“tranqs”) |
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Table 3. Cannabinoids
|
Examples of Cannabinoids: |
Usual Administration Route & Common Effects |
|
marijuana (blunt, dope, ganja, grass, herb, joint, “J,”bud, Mary Jane, pot, reefer, smoke, weed); hashish (“hash”); synthetic marijuana compounds |
Administration: Smoked, swallowed. Effects: Euphoria, relaxation, slowed reactions, distorted sensory perception, impaired balance and coordination, increased heart rate, increased appetite, impaired learning and memory, anxiety, psychosis. Increased risk of respiratory effects and infections, declining mental health, addiction, unknown effect on pregnancy outcomes. Potential harm from additives. |
Table 4. Opiates, Opioids, & Other Pain Relievers (Analgesics)
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Examples of opiates, opioids, & other pain relievers |
Usual Administration Route & Common Effects |
|
heroin, morphine (and morphine derivatives), opium (laudanum, paregoric, gum, big O, block, black stuff), oxycodone, oxyconton, hydrocodone, percodan/percocet, fentanyl, demerol, darvon/darvocet |
Administration: Injected, smoked, swallowed, snorted. Effects: Euphoria, drowsiness and sedation, nausea, impaired coordination, confusion, constipation, slowed breathing. Increased risk of exposure to infectious diseases (hepatitis, HIV), poor pregnancy outcomes, fatal overdose, addiction. Potential harm from inconsistent dosing and additives. |
|
methadone |
Administration: Swallowed, injected Effects: Like opioids, used to treat opioid addiction; overdose risk, slowed breathing rate |
Table 5. Hallucinogens & Psychotomimetics
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Examples of hallucinogenic & psychotomimetic drug |
Usual Administration Route & Common Effects |
|
LSD (lysergic acid diethylamide), mescaline (peyote), psilocybin (“magic” mushrooms) |
Administration: swallowed, absorbed through oral tissues Effects: altered perceptions and feelings; hallucination, increased heart rate, blood pressure, body temperature, numbness, dizziness, sleeplessness, possibly paranoia/panic; may develop “flashback” experiences later |
Table 6. Steroids
|
Examples of Steroids |
Usual Administration Route & Common Effects |
|
anabolic & androgenic steroids (not to be confused with corticosteroids) |
Administration: injected, swallowed, absorbed through the skin Effects: hypertension, changes in blood chemistry, liver damage, aggression, acne, infertility and other reproductive system changes |
Table 7. Inhalants
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Examples of Inhalants |
Usual Administration Route & Common Effects |
|
household & industrial aerosols (paint thinner, gasoline, glue, butane, refrigerant gases) nitrous oxide/laughing gas (“whippets,” “poppers”) |
Administration: inhaled Effects: stimulant followed by depression, impaired memory, nervous system disruption, muscle weakness, damage to the cardiovascular and/or respiratory system, loss of consciousness; risk of sudden death |
