Chapter 15: Substance Abuse

Lumen Learning

“An overindulgence of anything, even something as pure as water, can intoxicate.”

– Criss Jami

Introduction

A drug is a chemical substance that can change how your body and mind work. Drugs of abuse are substances that people use to get high and change how they feel. They may be illegal drugs like pot, cocaine, or heroin. Or they may be legal for adults only, like alcohol and tobacco.

Medicines that treat illness can also become drugs of abuse when people take them to get high—not because they’re sick and following their doctor’s orders. People can even abuse cough or cold medicines from the store if they ignore the directions and take too much at one time.

People abuse drugs for many reasons:

  • They want to feel good. Taking a drug can feel really good for a short time. That’s why people keep taking them—to have those good feelings again and again. But even though someone may take more and more of a drug, the good feelings don’t last. Soon the person is taking the drug just to keep from feeling bad.
  • They want to stop feeling bad. Some people who feel very worried, afraid, or sad abuse drugs to try to stop feeling so awful. This doesn’t really help their problems and can lead to addiction, which can make them feel much worse.
  • They want to do well in school or at work. Some people who want to get good grades, get a better job, or earn more money might think drugs will give them more energy, keep them awake, or make them think faster. But it usually doesn’t work, may put their health at risk, and may lead to addiction.

Cigarettes and Tobacco

It might surprise you to learn that cigarettes and other forms of tobacco are drugs. It’s legal to use tobacco once you’re 18 or 19 years old, depending on where you live. But it’s not healthy for you at any age.

Tobacco contains nicotine, a substance that excites the parts of the brain that make you feel good. You can get addicted to nicotine just like other drugs.

When you use tobacco, the nicotine quickly gives you a mild rush of pleasure and energy. But it soon wears off, which makes you want to use it some more. Sometimes, the rush of energy that comes with nicotine can make you nervous and edgy.

Electronic cigarettes: Read NIDA’s DrugFacts: Electronic Cigarettes (e-Cigarettes) for information about electronic cigarettes (sometimes called “vaping”), including how safe they are compared to tobacco cigarettes.

Effects of Cigarettes and Tobacco on the Body and Brain

These are just some of the problems cigarettes and tobacco can cause:

Lung diseases: Cigarette smoke causes lung cancer and painful breathing diseases like emphysema. These diseases can happen to people who smoke, or to others around them who breathe in their smoke.

Bad breath, bad teeth, mouth cancer: Cigarettes and other kinds of tobacco stain teeth and cause bad breath. Chewing tobacco can make teeth fall out and lead to cancer of the mouth.

Heart and blood problems: If you smoke, you are more likely to have a heart attack or stroke (sometimes called a “brain attack”).

Hurts babies: If a pregnant woman uses tobacco, her baby might be born too early or too small. This can cause health problems for the baby.

More diseases: Using cigarettes or other kinds of tobacco can lead to heart disease and many kinds of cancer.

Addiction

The nicotine in tobacco is what makes you addicted. When you smoke, the effects wear off quickly. This makes you want to keep using tobacco again and again throughout the day. The more you do this, the more your body and brain get addicted to the nicotine. Fortunately, there are medicines, other treatments, and hotlines that can help people quit tobacco.

Alcohol

Drinks like beer, malt liquor, wine, and hard liquor contain alcohol. Alcohol is the ingredient that gets you drunk.

Hard liquor—such as whiskey, rum, or gin—has more alcohol in it than beer, malt liquor, or wine.

The following drink sizes contain about the same amount of alcohol:

  • 1 ½ ounces of hard liquor
  • 5 ounces of wine
  • 8 ounces of malt liquor
  • 12 ounces of beer

Being drunk can make a person feel very silly, angry, or sad for no reason. It can make it hard to walk in a straight line, talk clearly, or drive.

Effects of Alcohol on the Body and Brain

Drinking too much–on a single occasion or over time—can take a serious toll on your health.  Here’s how alcohol can affect your body and brain:
  • Brain: Alcohol interferes with the brain’s communication pathways and can affect the way the brain looks and works. These disruptions can change mood and behavior, and make it harder to think clearly and move with coordination.
  • Heart: Drinking a lot over a long time or too much on a single occasion can damage the heart, causing problems such as stroke, high blood pressure, and arrhythmia.
  • Liver: Heavy drinking takes a toll on the liver and can lead to a variety of problems such as alcoholic hepatitis, fibrosis, and cirrhosis
  • Pancreas: Alcohol causes the pancreas to produce toxic substances that can eventually lead to pancreatitis, a dangerous inflammation and swelling of the blood vessels in the pancreas that prevents proper digestion.
  • Cancer: Drinking too much alcohol can increase your risk of developing certain cancers, including cancers of the mouth, esophagus, throat, liver, and breast.
  • Immune system: Drinking too much can weaken your immune system, making your body a much easier target for disease.  Chronic drinkers are more liable to contract diseases like pneumonia and tuberculosis than people who do not drink too much.  Drinking a lot on a single occasion slows your body’s ability to ward off infections—even up to twenty-hour hours after getting drunk.

So how much is “drinking too much?” The following guidelines are from the National Institute on Alcohol Abuse and Alcoholism:

Drinking Levels Defined

  • Moderate alcohol consumption: According to the Dietary Guidelines for Americans, moderate drinking is up to 1 drink per day for women and up to 2 drinks per day for men.
  • Binge drinking: Binge drinking is a pattern of drinking that brings blood alcohol concentration (BAC) levels to 0.08 g/dL. This typically occurs after 4 drinks for women and 5 drinks for men—in about 2 hours. Binge drinking has become a major health and safety issue on college campuses.
  • Heavy drinking: Heavy drinking is defined as drinking 5 or more drinks on the same occasion on each of 5 or more days in the past 30 days.
  • Low risk for developing an alcohol use disorder: For women, low-risk drinking is no more than 3 drinks on any single day and no more than 7 drinks per week. For men, it’s defined as no more than 4 drinks on any single day and no more than 14 drinks per week. NIAAA research shows that only about 2 in 100 people who drink within these limits have an alcohol use disorder.  Even within these limits, you can have problems if you drink too quickly or have other health issues.

Certain people should avoid alcohol completely, including those who

  • Plan to drive a vehicle or operate machinery
  • Take medications that interact with alcohol
  • Have a medical condition that alcohol can aggravate
  • Are pregnant or trying to become pregnant

Canada’s Guidance on Alcohol and Health

Canada’s Guidance on Alcohol and Health  (2023) provides evidence-based advice on alcohol to support people in making informed decisions about their health. The guidance is based on the latest research on alcohol-related risks and replaces Canada’s Low-Risk Alcohol Drinking Guidelines (LRDGs) issued in 2011.

The guidance is based on the principle of autonomy in harm reduction and the fundamental idea behind it that people living in Canada have a right to know that all alcohol use comes with risk.

Key points from the guidance include:

  • There is a continuum of risk associated with weekly alcohol use where the risk of harm is:
    • 0 drinks per week — Not drinking has benefits, such as better health, and better sleep.
    • 2 standard drinks or less per week — You are likely to avoid alcohol-related consequences for yourself or others at this level.
    • 3–6 standard drinks per week — Your risk of developing several types of cancer, including breast and colon cancer, increases at this level.
    • 7 standard drinks or more per week — Your risk of heart disease or stroke increases significantly at this level.
    • Each additional standard drink radically increases the risk of alcohol-related consequences.
  • Consuming more than 2 standard drinks per occasion is associated with an increased risk of harms to self and others, including injuries and violence.
  • When pregnant or trying to get pregnant, there is no known safe amount of alcohol use.
  • When breastfeeding, not drinking alcohol is safest.
  • No matter where you are on the continuum, for your health, less alcohol is better.

CCSA is creating knowledge mobilization products that will be tailored to meet the needs of our audience. Please check back with us in the coming months as we release these new resources.

Marijuana Overview

Marijuana, characterized by its green, brown, or gray mixture of dried, crumbled leaves from the cannabis plant, can be consumed in various ways. It is often smoked, either rolled in papers to create a joint or packed into a pipe. Some individuals also incorporate it into foods or beverages which is a healthier alternative to smoking.

The consumption of marijuana can induce a range of psychological effects, including feelings of relaxation, happiness, or euphoria. However, it may also lead to adverse reactions such as anxiety or paranoia. Users often report altered perceptions of time and sensory experiences.

Effects of Marijuana on the Body and Brain

Potential Risks:

  • Memory Impairment: Short-term use of marijuana can disrupt short-term memory and cognitive functions, making it difficult to form new memories or perform tasks that require focus and concentration.
  • Cardiovascular Risks: Marijuana use can lead to increased heart rate and potentially elevate the risk of heart-related issues, especially in individuals with pre-existing conditions.
  • Respiratory Issues: Similar to tobacco smoke, marijuana smoke can irritate the lungs, leading to a range of respiratory problems, including chronic bronchitis and a higher incidence of lung infections.
  • Impaired Driving: Driving under the influence of marijuana can significantly impair motor coordination, judgment, and reaction times, increasing the risk of accidents.
  • Mental Health Concerns: Heavy or long-term marijuana use has been linked to an increased risk of developing mental health disorders, such as depression or schizophrenia, especially in those predisposed to these conditions.
  • Dependency: Although not as addictive as some other substances, regular use of marijuana can lead to the development of substance use disorder, characterized by a persistent desire to use despite negative consequences.

Recognized Medical Benefits:

Recent studies and clinical trials have highlighted the therapeutic potential of marijuana for various medical conditions, leading to its legalization for medicinal use in many jurisdictions. The recognized medical benefits include:

  • Pain Management: Cannabis is particularly noted for its analgesic effects, making it a valuable option for chronic pain management, including neuropathic pain.
  • Anti-inflammatory: The anti-inflammatory properties of cannabinoids can be beneficial for patients with conditions like rheumatoid arthritis.
  • Neuroprotective Effects: Research suggests potential neuroprotective properties, offering possible benefits for diseases such as multiple sclerosis and epilepsy.
  • Nausea and Vomiting: Medical marijuana is often used to alleviate nausea and vomiting, especially in cancer patients undergoing chemotherapy.
  • Appetite Stimulation: It can stimulate appetite and weight gain in individuals suffering from cachexia associated with cancer, AIDS, and other diseases.
  • Anxiety and Sleep Disorders: In controlled dosages, marijuana has been used to treat anxiety and sleep disorders, such as insomnia.

While the use of marijuana, especially for medical purposes, continues to be the subject of ongoing research and debate, it’s important to consider both its potential health benefits and risks. Users and patients should consult healthcare professionals to understand the implications of its use for their specific health conditions and contexts.

Cocaine (Coke, Crack)

Cocaine is a white powder. It can be snorted up the nose or mixed with water and injected with a needle. Cocaine can also be made into small white rocks, called crack. It’s called crack because when the rocks are heated, they make a cracking sound. Crack is smoked in a small glass pipe.

Cocaine can make a person feel full of energy, but also restless, scared, or angry.

Effects of Cocaine on the Body and Brain

These are just some of the problems cocaine can cause:

  • You feel sick: Cocaine can cause stomach pain and headaches. It can make you shake, throw up, or pass out.
  • No appetite: Cocaine can make you not want to eat. Over time, you might lose a lot of weight and get sick.
  • Heart attack and stroke: Cocaine raises your blood pressure and makes your heart beat faster. This can hurt your heart. It can give you a heart attack or stroke (brain injury from a blood clot). Some people die because of it.
  • HIV/AIDS, hepatitis: People who inject (shoot up) cocaine can get HIV/AIDS and hepatitis (a liver disease) if they share used needles. People also get these diseases by having unsafe sex. They may forget to use condoms because they’re high on the drug.
  • Addiction: It is easy to lose control over cocaine use and become addicted. Then, even if you get treatment, it can be hard to stay off the drug. People who stopped using cocaine can still feel strong cravings for the drug, sometimes even years later.

Heroin

Heroin is a white or brown powder or a black, sticky goo. It can be mixed with water and injected with a needle. Heroin can also be smoked or snorted up the nose.

Heroin causes a rush of good feelings just after it’s taken. But some people throw up or itch after taking it. For the next several hours you want to sleep, and your heart rate and breathing slow down. Then the drug wears off and you may feel a strong urge to take more.

Effects of Heroin on the Body and Brain

These are just some of the problems heroin can cause:

  • Sick and itchy: Heroin can make you throw up and feel very itchy.
  • You stop breathing: Heroin can slow or stop your breathing. It can kill you.
  • HIV/AIDS, Hepatitis: Sharing used needles to inject (shoot up) heroin can give you HIV/AIDS and hepatitis (a liver disease).
  • Overdose: People overdose on heroin because they can’t tell how strong it is until they take it. Signs of a heroin overdose are slow breathing, blue lips and fingernails, cold clammy skin, and shaking. You can die from a heroin overdose. People who might be overdosing should be taken to the emergency room immediately.
  • Coma: Heroin can put you in a coma. That’s when nothing can wake you up, and you may die.
  • Addiction: It is very easy to become addicted to heroin. Then, even if you get treatment, it’s hard to stay away from the drug. People who stopped using heroin can still feel strong cravings for the drug, sometimes years later. Fortunately, there are medicines that can help someone recover from heroin addiction.

Meth (Crank, Ice)

Methamphetamine—meth for short—is a white, bitter powder. Sometimes it’s made into a white pill or a clear or white shiny rock (called a crystal).

Meth powder can be eaten or snorted up the nose. It can also be mixed with liquid and injected into your body with a needle. Crystal meth is smoked in a small glass pipe.

Meth at first causes a rush of good feelings, but then users feel edgy, overly excited, angry, or afraid. Their thoughts and actions go really fast. They might feel too hot.

Effects of Meth on the Body and Brain

These are just some of the problems meth can cause:

  • You overheat: Meth can make your body temperature so hot that you pass out. Sometimes this can kill you.
  • Crank bugs: Meth can make you feel like bugs are crawling on or under your skin. It makes you scratch a lot. Scratching causes sores on your face and arms.
  • Meth mouth: Meth users’ teeth become broken, stained, and rotten. Meth users often drink lots of sweet things, grind their teeth, and have dry mouth. This is called “meth mouth.”
  • You look old: People who use meth start looking old. Meth users burn a lot of energy and don’t eat well. This can make them lose weight and look sick. Their hands or body might shake. Their skin looks dull and has sores and pimples that don’t heal. Their mouth looks sunken as the teeth go bad.
  • HIV/AIDS, Hepatitis: People who inject (shoot up) meth can get HIV/AIDS or hepatitis (a liver disease) if they share used needles. People also get these diseases by having unsafe sex. They often forget to use condoms because they’re high on the drug.
  • Addiction: Meth use can quickly lead to addiction and hurt different parts of your brain. It can cause thinking and emotional problems that don’t go away or that come back again even after you quit using the drug. For instance, you might feel, hear, or see things that aren’t there. You might think that people are out to get you, or start believing strange ideas that can’t really be true.

Prescription Pain Medicine (OxyContin, Vicodin)

Pain medicines relieve pain from surgery or injuries. You need a prescription from a doctor to buy some strong kinds of these medicines. Prescription pain medicines are legal and helpful to use when a doctor orders them to treat your medical problem.

But people sometimes take these without a doctor’s prescription to get high or to try to treat themselves or their friends. Drug dealers sell these pills just like they sell heroin or cocaine. Some people borrow or steal these pills from other people.

Some people think that prescription pain medicines are safer to abuse than “street” drugs because they are medicines. Prescription pain medicine abuse can be as dangerous as heroin or cocaine abuse.

Oxycodone is one pain medicine that people often abuse. Sometimes it goes by the brand names OxyContin® or Percocet®. Another one that is often abused is hydrocodone. One of its brand names is Vicodin®.

Pain medicines are usually white, round, or oval pills. They can be taken whole, smoked, or crushed into a powder that is snorted or injected.

Like heroin, pain pills can cause a rush of good feeling when they’re first taken, but they can also make you want to throw up. They can make you very sleepy, and you can get addicted to them.

Effects of Pain Medicine Abuse on the Body and Brain

These are just some of the problems pain medicine abuse can cause:

  • You stop breathing: Pain medicine abuse can slow down or even stop your breathing.
  • Coma: Pain medicine abuse can put you in a coma. That’s when nothing can wake you up.
  • Addiction: Prescription pain medicines can be as addictive as heroin—especially if they are smoked or injected. Then, even if you get treatment, it’s hard to stay away from the drug. Fortunately, there are medicines that can help someone recover from prescription pain medicine addiction.
  • Overdose: Signs of a pain medicine overdose are cold and sweaty skin, confusion, shaking, extreme sleepiness, trouble breathing, and coma.
  • Death: Many people die from pain medicine overdoses. In fact, more people overdose from pain medicines every year than from heroin and cocaine combined.

Other Drugs of Abuse

There are many other drugs of abuse, including:

Ecstasy (X, E, XTC)

Ecstasy, known as MDMA or Molly, is a synthetic drug that acts as both a stimulant and hallucinogen. It’s known for enhancing sensory perceptions and emotional experiences, often used in party settings. However, it carries risks like increased heart rate, blood pressure, and in some cases, severe health consequences. The DEA offers a comprehensive overview of Ecstasy/MDMA, discussing its effects, risks, and street names. The National Institute on Drug Abuse (NIDA) provides in-depth research on its impact on health, and Get Smart About Drugs discusses its use and potential dangers.

K2 or Spice (fake weed, Skunk)

K2 or Spice refers to synthetic cannabinoids designed to mimic THC, the active component of marijuana. Despite sometimes being sold as “herbal incense,” these substances can lead to unpredictable and potentially harmful effects, including rapid heart rates and vomiting. The DEA and the CDC provide insights into the dangers of these synthetic cannabinoids.

LSD (acid)

LSD, or lysergic acid diethylamide, is a potent hallucinogen known for causing significant alterations in perception, mood, and thought. The DEA and NIDA outline LSD’s effects on the body, potential for abuse, and its legal status, emphasizing its unpredictable impact on users’ mental state and perception of reality.

PCP (angel dust) and Inhalants

For PCP (angel dust) and inhalants, the substances are known for their severe psychoactive effects. PCP can cause users to feel detached from their surroundings and themselves, leading to potentially dangerous behaviors. Inhalants, which include substances found in household products, can be immediately harmful and lead to sudden sniffing death syndrome. The NIDA provides a broad overview of psychedelic and dissociative drugs, which includes information relevant to PCP and other similar substances.

For detailed and authoritative information on “club drugs” such as GHB, Rohypnol, Ketamine, and Bath Salts, including their effects, risks, and legal status, please refer to the resources provided by reputable organizations:

  • The Drug Enforcement Administration (DEA) offers comprehensive fact sheets on various drugs, including their usage, effects, and legal implications. These resources are valuable for understanding the specifics of each substance’s impact on health and behavior.
    • For insights into Rohypnol, a drug known for its misuse in incapacitating victims for sexual assault, the DEA provides an overview on its Rohypnol – Drug Fact Sheet page.
  • The Office of Justice Programs (OJP) also provides in-depth information on substances like Rohypnol, detailing their pharmacological effects, history of use, and the legal landscape surrounding their distribution and consumption.
    • An informative piece on Rohypnol can be found on the OJP’s Rohypnol Fact Sheet, highlighting its classification, potency, and the societal concerns associated with its misuse.

For those seeking further details on GHB, Ketamine, and Bath Salts, including their physiological effects and the contexts in which they are commonly encountered, visiting the official DEA website and searching their extensive fact sheets or exploring the National Institute on Drug Abuse (NIDA) website for research and reports would be highly beneficial. These platforms offer a wealth of information aimed at educating the public about the potential risks and realities of drug use and abuse.

When and Where to Get Help 

Here’s a simple way to think about substance use and abuse: If your use of drugs or alcohol is interfering with your life—negatively affecting your health, work, school, relationships, or finances—it’s time to quit or seek help. People who are addicted to a substance continue to abuse even though they know it can harm their physical or mental health, lead to accidents, or put others in danger. The following video dispels some myths about who is at risk of addiction:

Video: Anyone Can Become Addicted to Drugs

Know that first six weeks of the first semester is an especially critical and vulnerable time for most first-year students. Because lots of students get into the habit of drinking heavily and partying during these early days of college, there’s a risk that excessive alcohol consumption will interfere with successful adaptation to campus life. The transition to college is often difficult, and about one-third of first-year students fail to enroll for their second year.

If you are concerned about your drug or alcohol use, or you need help quitting, visit the student health center or talk with your college counselor. These folks are there to help you—it’s their job to provide information and support.

If you need additional resources or help, the following are good places to check:

Activity: When and Where to Get Help for Substance Abuse

Objectives

  • Explain what substance use and abuse is and identify the warning signs that help may be needed
  • Identify resources for further information and guidance about substance abuse

Directions

  • Pick a topic: Choose alcohol or one of the drugs discussed in this section on Substance Abuse.
  • Consider the following scenario: You suspect that one of your college friends may be abusing this drug. Your goal is to educate yourself about the signs of abuse and collect resources that you can share with him/her.
  • Visit one of the following Web sites to get initial relevant information on your topic. You can research other sites, if you chose a topic that’s not listed here.
  • Research additional sites to identify local resources where someone like your friend might go, or places to call, for help.
  • Creative writing assignment: Write a 2-page letter to the fictional friend in which you share your concerns about his/her behavior and offer to help. Be sure to touch on the following:
    • The type of substance
    • The behavior(s) you’ve noticed your friend engaging in that worry you and cause you to suspect a substance abuse problem
    • The source of your information, which you’re sharing with your friend. For example: “I learned about the signs of heroin abuse from this Web site: . . .”
    • Why you think your friend should quit using or cut down
    • Your suggestions for what your friend should do and where to seek help. Give the names and contact information for at least 3 resources/organizations you found.
  • Follow your instructor’s guidelines for submitting assignments.

Licenses and Attributions:

CC Licensed Content:

  • Substance Abuse: Provided by Lumen Learning, this resource delves into the topic of substance abuse, under a CC BY (Attribution) license, promoting adaptation and sharing with proper attribution.

Public Domain Content:

  • Canadian Centre on Substance Use and Addiction (2023). Canada’s Guidance on Alcohol and Health: A detailed guidance on alcohol and health by the Canadian Centre on Substance Use and Addiction, released into the public domain, thus free of any known copyright restrictions.
  • Drugs That People Abuse: A comprehensive guide provided by the NIH, NIAAA about various commonly abused drugs. This resource is in the public domain, indicating no known copyright restrictions.
  • What Is Addiction: An educational resource by the NIH that offers insights into addiction and its impact. Being in the public domain, it carries no known copyright restrictions.
  • Fall Semester-A Time For Parents To Revisit Discussions About College Drinking: A fact sheet by the NIH and NIAAA aimed at guiding parents on college drinking discussions, available in the public domain and thus free of copyright concerns.

Adaptations to the original materials include the removal of images and the relocation of learning objectives for enhanced educational utility.

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Blueprint for Success in College and Career by Lumen Learning is licensed under a Creative Commons Attribution 4.0 International License, except where otherwise noted.

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