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Home > Protecting Children in Substance-Abusing Families > Protecting Children in Substance-Abusing Families : Appendix I : The Nature of Substances of Abuse
Protecting Children in Substance-Abusing Families
Appendix I : The Nature of Substances of AbuseFor many professionals, the terminology and lifestyle associated with the abuse of alcohol and other drugs are unfamiliar, creating barriers to identifying, interviewing, and helping chemically involved families. This appendix provides a basic introduction to substances of abuse, important terminology for effective interviewing, and associated paraphernalia that can alert a professional to substance abuse within a client's home. For additional information, the reader is referred to the Substance Abuse Identification Guide published by the Drug Enforcement Administration, U.S. Department of Justice. Although various substances and their effects are described individually, it is important to recognize that the use of multiple substances (polysubstance abuse) is often the norm. The effects of polysubstance abuse are not currently known, but it is important to note that the acute effects of each substance may be altered when used in combination. Major Substances of AbuseAlcohol (Ethyl Alcohol) Alcohol is unique in that its use by adults is legal and widely accepted in our society. In fact, alcohol is one of the most popular drugs among adults in the United States. Alcohol addiction strikes all age, ethnic, and socioeconomic groups, and some studies estimate that about 10 percent of the population suffers from alcohol abuse and alcoholism. Research suggests that there may be a genetic predisposition to alcoholism and that a child of an alcoholic parent is at a greater risk of becoming an alcoholic than a child of a nonalcoholic parent. Alcoholic beverages vary in alcoholic content. Beer is generally 4 percent, wine 12 percent, and "hard liquor" up to 50 percent alcohol. Once absorbed into the blood stream, alcohol acts on the central nervous system (CNS) as a depressant affecting speech, vision, and coordination. As with all drugs, the effects of alcohol use depend on many factors, including the user's age and gender, the concentration of the drink, the amount of alcohol consumed over time, the body weight and metabolism of the drinker, and the drinker's emotional state.
Stimulants Stimulants are drugs that stimulate the CNS and produce an increase in alertness and physical activity. Cocaine and amphetamines are two of the most widely abused stimulants. Cocaine The most potent stimulant of natural origin, cocaine, is extracted from the leaves of the coca plant (Erythroxylon coca). This plant has been grown since prehistoric times in the highlands of the South American Andes, where its leaves are chewed for refreshment and relief from fatigue. Pure cocaine, the principal psychoactive ingredient, was first isolated in the 1880's. Cocaine is usually distributed illicitly as an odorless white crystalline or chunky powder (cocaine hydrochloride). Sometimes, other substances (baking soda, sugars such as lactose and mannitol, or local anesthetics such as lidocaine) are used to "cut" cocaine in order to dilute the drug and increase the quantity for sale. Most often, cocaine is sold in aluminum foil, plastic or paper packets, or small vials. Cocaine may be inhaled into the nose. It usually is chopped into a fine powder with a razor blade on a small mirror or some other hard surface, arranged into small rows called "lines," and then quickly inhaled ("snorted") into the nose through a short straw. Powdered cocaine also can be dissolved in water and injected into the blood stream. Conversion of powdered cocaine to cocaine base ("crack" or "rock" cocaine) yields a substance that can be heated and smoked. Generally, this cocaine base, in the form of white or tan pellets, chips, chunks, or "rocks," is vaporized in a pipe or smoked with plant material, such as marijuana, in a "geek joint." When smoked, "crack" cocaine makes a crackling sound when ignited.
Amphetamines Amphetamines were first used medically in the mid-1930's to treat narcolepsy. Currently they are used primarily in the treatment of obesity in adults and attention deficit disorders with hyperactivity (ADDH) in children. Pharmaceutical amphetamines include Dexedrine (capsules, tablet, and liquid); Dexamyl (capsules, tablets, liquid); Benzedrine (capsules, tablets); Eskatrol (capsules); Biphetamine (capsules); Desoxyn (tablets); Preludin (tablets); and Ritalin (tablets). Methamphetamine (or methedrine) is one of the most widely abused amphetamines. Generally, it is found in powder or crystal form, in colors ranging from white to tan. It can be swallowed, inhaled through the nose, or injected. Manufactured in clandestine laboratories, usually it is sold illicitly in small plastic or paper packets or in plastic bags. "Ice" is a smokable form of methamphetamine. The street term Ice refers to the drug's transparent appearance; its shiny crystals may be as small as rice grains or as large as peas. Although it is usually smoked, Ice can be injected or ground into a powder and snorted.
Narcotics Narcotics (opioids) are drugs that dull the senses. Examples of narcotics include drugs such as morphine, codeine, and heroin that are derived from the opium poppy, as well as synthetic chemicals such as Darvon, Demerol, and methadone (used in the treatment of heroin addicts). Medicinal uses for narcotics include relief of pain, cough suppression, and the control of severe diarrhea. When a person uses narcotics regularly, the body eventually demands more of the drug in order to achieve the same effects. This is called drug tolerance. When chronic use is abruptly stopped, withdrawal symptoms such as runny nose, watery eyes, perspiration, and yawning can develop 6 to 8 hours following the last use of the drug. Thereafter, depending on the duration of activity of the particular narcotic used, more severe withdrawal symptoms develop, including restlessness, irritability, tremors, loss of appetite, stomach cramps, diarrhea, and chills alternating with heavy sweating. Typically, it can take 10 to 14 days for these acute symptoms to abate. Narcotics may be injected, sniffed (heroin), or ingested in tablet, capsule, or liquid form. Codeine, for instance, is frequently abused in the form of Tylenol with codeine or in cough syrups. Heroin Heroin was first produced in 1874 as an alternative to morphine, but it proved even more addictive. On the street, heroin generally is sold as a white to very dark brown powder or as a brown or black chunky, tarlike substance that smells like vinegar. Heroin is packaged in small foil or cellophane packets or in small rubber or plastic balloons that have been closed off and folded over into a ball (known as a "spoon" or "balloon"). The most common form of use is by injection (called "mainlining" or "shooting"), but in its powder form, heroin can be snorted or smoked. It also can be taken orally or by rectal suppository. A heroin addict may administer the drug as many as four to six times a day. Many addicts will "chip" (use infrequently) for extended periods of time before becoming "righteously" (severely) addicted.
Methadone German scientists first synthesized methadone during World War II because of a morphine shortage. Methadone was introduced as an analgesic in the United States in 1947 and became widely used in the 1960's as a treatment for narcotic addicts. When used to treat heroin addiction, methadone is administered orally. Methadone is considered to be a safe and effective treatment for opiate addiction when used as prescribed by a physician. Methadone differs significantly from heroin in that it has a longer duration of action. Because a single dose can last up to 24 hours, methadone can be administered once a day in heroin detoxification and maintenance programs.
Sedatives Sedatives are commonly known as tranquilizers and sleeping pills. They have legitimate therapeutic uses when prescribed by physicians to treat anxiety, tension, insomnia, and muscle spasms. However, sedatives are often abused because of their intoxicating effects, as self-medication to allay the effects of stimulant drugs, to ease the anxiety of flashbacks associated with prior hallucinogen use, to treat heroin withdrawal symptoms, or, in some cases, as a means to commit suicide. The various drugs included in this classification include barbiturates (Nembutal, Seconal, and Amytal), chloral hydrate, glutethimide (Doriden), benzodiazepines (Valium, Librium, and Xanax), and antianxiety medications such as Placidyl, Miltown, and Equanil. Although they occasionally may be intravenously injected, sedatives are most frequently ingested as pills, tablets, or capsules that generally are sold illicitly in plastic bags or bottles. Tolerance to the effects of sedatives can develop rapidly, leading to a progressive narrowing of the margin of safety between an intoxicating and a lethal dose. The risk is compounded when depressants are used in combination with alcohol or other substances. Withdrawal from barbiturates and benzodiazepines can be serious and should be treated as a medical emergency. Withdrawal from sedatives and hypnotics can lead to convulsions, delirium, and, in some instances, death; therefore, medical supervision is often required. Unrecognized and untreated withdrawal may be fatal.
Hallucinogens Hallucinogens are psychotropic drugs that cause hallucinations by distorting the perception of objective reality. They include phencyclidine (PCP), the synthetic drug lysergic acid diethylamide (LSD), certain psychoactive mushrooms, and mescaline (present in the peyote cactus). PCP PCP was investigated in the 1950's as an anesthetic, but because of extreme side effects (including topic psychosis schizophrenia), it was discontinued for human use. In its pure form, PCP is a white crystalline powder that readily dissolves in water. Because of contaminants resulting from its illicit manufacture, street PCP color ranges from tan to brown; its consistency can vary from a powder to a gummy mass. PCP is frequently misrepresented as mescaline, LSD, or tetrahydrocannabinol (THC). Although it is sold in tablets, pills, and gelatin capsules, PCP is most commonly found in powder and clear liquid form. It may be inhaled, injected, or ingested, and frequently is applied to dark brown cigarettes ("Shermans") or a leafy material (parsley, mint, oregano, or marijuana) and smoked. PCP is also readily absorbed through the skin. In its liquid form, PCP is packaged and stored in small vials or other small glass containers.
LSD First synthesized in 1938, LSD is an odorless and colorless substance derived from the ergot fungus that grows on rye and from a chemical found in morning glory seeds. Because LSD is so potent, the dosage can be incredibly small. A microscopic drop can be put on any absorbent material and swallowed. LSD is generally sold in tablet or capsule form or placed into thin squares of gelatin (called "window panes"), paper ("blotter acid"), sugar cubes, chewing gum, hard candy, or crackers.
Psilocybin and Psilocyn (Mushrooms) Mushrooms have been used for centuries in traditional North American Indian religious rites. When certain types of mushrooms are eaten, they affect mood and perception in a manner similar to that of LSD. The active ingredients, psilocybin and psilocyn, are chemically related to LSD. These mushrooms can be chewed, smoked, or infused in hot water to make tea.
Mescaline (Peyote) Mescaline, a hallucinogen, is the primary ingredient in the peyote cactus (Lophophora williamsii), and is present to a lesser degree in the San Pedro cactus (Trichocereus pachanoi). Derived from the dried or fresh flowering heads (mescal buttons or buttons) of the cactus, mescaline, like mushrooms, has been used from the earliest recorded time as part of traditional Indian religious rites. Typically, mescaline is a brown, disc-shaped cactus "button," but it also can be produced synthetically in the form of a capsule or pill the size of a large aspirin. Usually ingested orally, peyote buttons may be chewed or ground into a powder and used to make tea. The average dose is 3 to 10 buttons. Mescaline, in crystalline form, also may be snorted, but it is rarely taken intravenously. Mescaline reportedly has an intensely bitter taste.
Cannabis Cannabis refers to the Indian hemp plant, Cannabis sativa. The ingredient responsible for its psychoactive effect (the high) is THC, which is concentrated in the resin of the plant. Most of the resin is found in the flowering tops, with less in the leaves, and almost none in the fibrous stalks. The amount of THC determines the potency of the drug. Both marijuana and hashish are produced from the hemp plant.
Marijuana Marijuana consists of the leaves, flowers, stems, and seeds of the Indian hemp plant, which are dried and crushed or chopped into small pieces. Marijuana appears on the street as a greenish or brownish material that may be full of seeds or stems, or it may be cleaned and "manicured" (seeds and stems removed). Marijuana also can be found as sinsemilla, the potent flowering tops of the female plant. Marijuana usually is sold and stored in plastic bags, aluminum foil, or small hand-rolled cigarettes called "joints" or "reefers." Generally smoked in cigarettes or in pipes, marijuana has a strong, pungent odor when ignited. However, it also can be blended into food and then cooked and eaten. The average period of intoxication following use of one marijuana cigarette is approximately 2 hours, although the residual chemicals may remain in the body for up to 1 month. Hashish Hashish and hashish oil are other forms of cannabis. Hashish is a compressed form of the resinous secretions of the flowering parts of the plant. It is a gummy substance ranging in color from light green to gold to dark brown to black in color, and may appear in ball, cake, or cookielike sheet form. Hashish oil (hash oil) is produced by the repeated extraction of the resin through the use of alcohol and heat, and the resulting product is a viscous light to very dark brown liquid with the consistency of molasses. Because hashish contains a higher concentration of THC than marijuana, hashish and hashish oil are more potent and are sold and used in smaller quantities. Hashish is most often packaged in aluminum foil, and hash oil is stored in small vials. As with marijuana, both hashish and hashish oil are smoked in pipes, but they also may be mixed with tobacco in cigarettes or pipes. Inhalants Inhalants are a diverse group of substances that normally may not be thought of as drugs. Most are legal substances found in everyday household products, and they are sniffed or inhaled. Fumes from aerosol sprays such as spray paint and cleaning fluid as well as hydrocarbons such as model airplane glue, gasoline, paint thinner, and dry cleaning solution may be abused. Some abusers also inhale the vapors from lighter fluid, hair spray, whipped cream canisters, typewriter correction fluid, paint, rubbing alcohol, and nail polish remover.
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