Substance use disorders, previously referred to as substance abuse or substance dependence, arise when the repeated consumption of alcohol and/or drugs leads to significant impairment both clinically and functionally. This impairment can manifest as health complications, disability, and an inability to fulfill important obligations in various domains such as work, school, or home.
Substance
Substance
Opioid
Opioid use disorder refers to a condition where individuals become dependent on opioids, leading to significant distress and impairment. Many individuals initially start using opioids for pain management but gradually increase their dosage to achieve the same level of pain relief, eventually becoming reliant on high and destructive doses within a short period of 1 to 8 weeks. Misuse of opioids can quickly result in physical and mental disability, as well as death, depending on the potency of the opioid involved.
Opioids primarily target pain receptors in the central and peripheral nervous systems, as well as the gastrointestinal tract. These receptors play a role in both the mind-altering and physical effects of opioids.
Opioids are commonly prescribed for pain relief and may also be used to treat diarrhea or suppress coughing. However, they are frequently misused for their euphoric effects. Opioids can be taken orally, injected, or snorted. Examples of opioids include fentanyl, oxycodone, and hydrocodone. Common side effects of opioids include itchiness, sedation, nausea, respiratory depression, constipation, and a profound sense of happiness.
Prevalence
According to the Centers for Disease Control and Prevention (CDC), there were approximately 47,000 deaths related to prescription or opioid overdose in the United States in 2018. This number was 194% higher than deaths resulting from heroin use and 213% higher than deaths caused by prescription painkillers. The opioid crisis was declared a nationwide public health emergency in late 2017.
Around 4% of individuals develop long-term opioid use following trauma, surgery-related pain, or cancer treatment. Onset of opioid use disorder often occurs during young adulthood, and males are affected more frequently than females.
Preventive measures in the United States to address the opioid crisis include monitoring prescriptions through insurance claims, pharmacy records, and licensed healthcare practices, as well as educating healthcare providers, patients, and the general public about the risks associated with the misuse of prescribed opioids.
Diagnosis of Opioid Dependency:
OUD is a problematic pattern of opioid use leading to distress, with at least two of the following occurring within a 12-month period:
- Taking higher doses to get the desired effect
- Wanting to quit or to control amount used / frequency of use but never succeeding
- Spending a lot of time each day to get, use, or recover from using the opioid
- Strongly craving opioids
- Difficulty fulfilling responsibilities at work, school, or home
- Continuing to use opioids in spite of the social and relational consequences
- Giving up previously enjoyed activities in order to spend more time using opioids
- Putting others in danger by performing life-endangering activities while high — driving, operating heavy machinery, etc.
- Continuing to use opioids despite the obvious physical or mental problems caused by using them
- Tolerance – need for increased amounts to get the same “high”
- Experiencing withdrawal – opioid withdrawal syndrome
- Taking opioids or a similar substance to lessen or avoid withdrawal symptoms
Opioid withdrawal syndrome is characterized by:
- Nausea, vomiting
- Muscle aches, chills, cramps
- Diarrhea
- Trouble sleeping, yawning, restlessness
- Runny nose
- Dilated pupils
- Agitation, irritability, low mood, anxiety, goosebumps
- Severe cravings
Alcohol
Alcohol use disorder (AUD) encompasses both dependence on and abuse of alcohol, leading to various mental and physical health issues. According to the 2018 National Survey on Drug Use and Health (NSDUH), approximately 14.4 million adults aged 18 and above, as well as 401,000 adolescents aged 12-17, were affected by AUD.
Determining the threshold for excessive alcohol consumption:
The National Institute on Alcohol Abuse and Alcoholism (NIAAA) defines a standard drink as one 12-ounce bottle of beer, one 5-ounce glass of wine, or 1.5 ounces of distilled spirits. Men may be at risk of developing AUD if they consume more than 14 standard alcoholic drinks per week, while women may be at risk if they exceed seven drinks.
Prevalence
In the United States, approximately 7% of adults and 3% of individuals aged 12 to 17 are affected by AUD, with a higher prevalence among males compared to females.
The Positive Outlook
Recovery from AUD is possible. Around 33% of individuals treated for AUD experience no further symptoms, and many have successfully reduced their alcohol consumption to healthier levels, even if they experienced occasional relapses on their journey towards recovery.
Symptoms
AUD is often used interchangeably with alcoholism. AUD is now seen as one disorder consisting of alcohol abuse and/or alcohol dependence, with mild, moderate, and severe subclasses.
- Alcohol abuse = repeated alcohol use despite recurrent adverse consequences.
- Alcohol dependence = alcohol abuse + at least three of the following over a one-year period:
- Tolerance – increasingly more amounts of alcohol needed to have the “hit”
- Physiological withdrawal symptoms – excessive sweating, nausea and vomiting, generalized aches and pains, shaking, and sleep disturbances
- Drinking greater amounts of alcohol or over a longer period of time than originally intended
- Unproductive efforts to reduce the amount of alcohol taken or an inability to control use — an intense or strong craving to drink alcohol
- A lot of the day/night spent getting, drinking, or recovering from alcohol use
- Social-, work-, or leisure-related activities ended or lessened – to the extent that one is unable to fulfill one’s responsibilities
- Continued drinking despite awareness of harmful physical, relational, or psychological consequences such as depression or gastrointestinal issues
- Alcohol usage that compromises safety such as when driving, swimming, walking in unsafe areas, operating machines or power tools, or spending time with unknown people
Amphetamines
Amphetamines are stimulants that target the central nervous system (CNS) and can be prescribed to treat various health conditions such as attention deficit hyperactivity disorder (ADHD), narcolepsy, and obesity. It is important to note that amphetamine addiction and dependence do not refer to the misuse or abuse of these substances, but rather the reliance on them. Quitting or controlling their use can be extremely challenging, but with professional assistance, many individuals have been able to overcome this dependence.
Commonly prescribed amphetamines include medications like Adderall, methylphenidate (Ritalin), dextroamphetamine, or lisdexamfetamine, which is an inactive prodrug. On the street, amphetamines are known by various names such as uppers, wake-ups, whizz, whites, crystal meth, crank, glass, Tina, Christine, and ice. Methamphetamine, a more potent form of amphetamine, is highly addictive and can be life-threatening. Some variations of methamphetamine are referred to as ecstasy, Molly, and MDMA. Amphetamines can be consumed through methods such as snorting, injecting, oral ingestion, or smoking.
When used within therapeutic doses, amphetamines can increase alertness and boost self-confidence. However, despite students believing it helps them concentrate and perform better on exams, studies indicate that it often leads to poorer outcomes, especially for those who are already academically inclined.
At chronic dependence levels, amphetamines can pose serious physical risks and give rise to delusions, paranoia, and hallucinations.
According to the Substance Abuse and Mental Health Services Administration (SAMHSA), in 2015, amphetamine products were the most commonly used subtype of prescription stimulants among individuals aged 12 or older, with 11.3 million individuals (4.2%) out of the 17.2 million past-year users of stimulants falling into this category.
Symptoms:
Signs and Symptoms of Amphetamine Addiction:
Early signs of amphetamine addiction include:
- Tolerance
- Physical dependence
- An urge to use amphetamines
It is considerably less difficult to quit in this early stage than later on when the mental instability associated with amphetamine addiction sets in.
Amphetamine withdrawal signs and symptoms can include:
Mental
- Irritability and short-temper
- Anxiety
- Depression
- Extreme mood swings similar to bipolar disorder
- Suicidal ideation
- Sensory misperception
- Auditory and visual hallucinations and realistic nightmares
- Psychosis that is similar to schizophrenia
- Drug cravings
Physical
- Irritability and short-temper
- Anxiety
- Depression
- Extreme mood swings similar to bipolar disorder
- Suicidal ideation
- Sensory misperception
- Auditory and visual hallucinations and realistic nightmares
- Psychosis that is similar to schizophrenia
- Drug cravings
- Excessive hunger
- Extreme fatigue – sleeping for more than 24 hours at a time
- Lack of coordination, slow speech, dizziness
- Rapid or irregular heartbeat
- Poor blood circulation to the extremities
- Hypersensitivity to light and sound
- Sudden death, heart attack, or stroke in those with heart problems
Cannabis
Cannabis Use Disorder (CUD) refers to the dependency on marijuana or cannabis to achieve a sense of well-being, disregarding the potential mental and physical harm it can cause. The primary psychoactive component of marijuana, THC, possesses mind-altering properties and can lead to adverse health effects, including permanent IQ loss (if initiated at a young age), significant impairment in driving and athletic performance, damage to fetal growth and brain development during pregnancy, diminished motivation impacting relationships, academic achievements, and work performance, as well as potential risks of depression, psychotic and suicidal thoughts, and anxiety.
Marijuana can be consumed through smoking, vaporization, incorporation into food, or infusion in drinks and other liquids. Smoking THC resins in the form of hash oil, wax, budder, or shatter can result in dangerously high levels of THC. Vaping THC has been associated with numerous cases of severe lung diseases and even fatalities. The effects of cannabis are typically felt within minutes when smoked and can last for two to six hours, depending on the dosage.
Prevalence-wise, approximately 50% of the United States population has used marijuana, and this number continues to rise. About 9 to 30% of marijuana users develop cannabis dependence. The largest group of marijuana users falls within the 18 to 25 age range, with nearly 4% of 18-year-olds engaging in daily THC vaping.
While certain countries and states in the United States have legalized the recreational use of marijuana, its medical use, which requires approval from a physician, has been legalized in an increasing number of countries.
Symptoms
Symptoms of Cannabis Dependence or Abuse:
Marijuana has multiple mental and physical effects.
- Mental effects– include euphoria, disinhibition, impaired judgment, altered states of mind, altered sense of time, mood changes, difficulty thinking or concentrating, tiredness, relaxation, confusion, anxiety, paranoia, and defective short-term memory. Hallucinations, delusions, and psychosis can be experienced with higher doses.
- Physical effects– include a faster heart rate, decreased blood pressure, difficulty breathing, dizziness, nausea, dry mouth, red eyes, poor coordination, distorted perception, awkward or impaired body movements, sedation, and an increase in appetite.
Cocaine
Cocaine dependence is a type of physical and psychological addiction that develops as a result of regular cocaine use, with individuals progressively consuming larger quantities in the belief that it will enhance their functioning. Withdrawal symptoms include deficits in emotional and motivational states, along with intense cravings. People experiencing cocaine dependence may also develop tolerance, necessitating higher doses of the drug to achieve the desired effect or “high.”
Cocaine is an extremely addictive and potent stimulant that affects the brain’s reward pathways. It exerts its influence by increasing the levels of neurotransmitters like dopamine and serotonin, which contribute to feelings of pleasure and well-being.
Cocaine dependence gives rise to various psychiatric and legal problems, resulting in changes in personality and an obsession with obtaining an adequate supply of cocaine, often at the expense of job performance, academic pursuits, and interpersonal relationships.
Cocaine is commonly used by snorting, smoking, rubbing on the gums, or injecting directly into a vein. Its effects typically manifest within seconds to minutes of use and last anywhere from 5 to 30 minutes. Street names for cocaine include blow, crack, coke, snow, and rock. Illicit versions of the drug may be mixed with substances like talcum powder, flour, or cornstarch to create the appearance of a larger quantity.
Symptoms:
Effects of Cocaine use
Mental and behavioral effects (long and short term) may include:
- Euphoria – an intense feeling of happiness
- Mental alertness or slowness
- Agitation, restlessness, extreme anxiety
- Aggression – behavior can become violent and unpredictable
- Confusion
- High amounts of energy and increased talkativeness
- Mood swings, irritability
- Panic attacks
- Emotional, intellectual, and mental impairments
- Profound changes in personality
Physical effects may include:
- Increased body temperature and sweating
- Irregular or rapid heart rate, heart attack
- High blood pressure from constricted blood vessels leading to a stroke
- Dilated / Large pupils
- Weight loss – emaciated and malnourished appearance
- Emaciated and malnourished appearance
- Insatiable hunger
- Generalized aches and pains
- Persistent runny nose
- Nausea
- Insomnia / hypersomnia
- Vertigo, tremors and twitches, or seizure
- Hypersensitivity to touch, sight, and sound
Ketamine
What is ketamine?
Ketamine is used by medical practitioners and veterinarians as an anaesthetic. It’s sometimes used illegally by people to get high.
Ketamine is a dissociative drug, which means it acts on different chemicals in the brain to produce visual and auditory distortion, and a detachment from reality.
When it’s sold illegally, ketamine usually comes as a white or off-white powder. It can also be made into pills, or dissolved in a liquid.
Clinical trials and studies are assessing ketamine as a treatment for depression. Early indications show good results.
Other names
Special K, K, ket, kitkat, super k or horse trank.
Other types of dissociatives
- Methoxetamine
- Nitrous oxide
How is it used?
Ketamine can be swallowed, snorted or injected. It’s also sometimes smoked with cannabis or tobacco. The effects of ketamine may be experienced within one minute if injected, 5–15 minutes if snorted, and up to 30 minutes if swallowed. Its effects can last for around an hour, however an individual’s coordination or senses may be affected for up to 24 hours after initial use.4
Effects of ketamine
There is no safe level of drug use. Use of any drug always carries some risk. It’s important to be careful when taking any type of drug.
Ketamine affects everyone differently, based on:
- size, weight and health
- whether the person is used to taking it
- whether other drugs are taken around the same time
- the amount taken
- the strength of the drug (varies from batch to batch)
The following effects may be experienced:
- feeling happy and relaxed
- feeling detached from your body (‘falling into a k-hole’)
- visual and auditory hallucinations
- confusion and clumsiness
- increased heart rate and blood pressure
- slurred speech and blurred vision
- anxiety, panic and violence
- vomiting
Opioid
Opioid use disorder refers to a condition where individuals become dependent on opioids, leading to significant distress and impairment. Many individuals initially start using opioids for pain management but gradually increase their dosage to achieve the same level of pain relief, eventually becoming reliant on high and destructive doses within a short period of 1 to 8 weeks. Misuse of opioids can quickly result in physical and mental disability, as well as death, depending on the potency of the opioid involved.
Opioids primarily target pain receptors in the central and peripheral nervous systems, as well as the gastrointestinal tract. These receptors play a role in both the mind-altering and physical effects of opioids.
Opioids are commonly prescribed for pain relief and may also be used to treat diarrhea or suppress coughing. However, they are frequently misused for their euphoric effects. Opioids can be taken orally, injected, or snorted. Examples of opioids include fentanyl, oxycodone, and hydrocodone. Common side effects of opioids include itchiness, sedation, nausea, respiratory depression, constipation, and a profound sense of happiness.
Prevalence
According to the Centers for Disease Control and Prevention (CDC), there were approximately 47,000 deaths related to prescription or opioid overdose in the United States in 2018. This number was 194% higher than deaths resulting from heroin use and 213% higher than deaths caused by prescription painkillers. The opioid crisis was declared a nationwide public health emergency in late 2017.
Around 4% of individuals develop long-term opioid use following trauma, surgery-related pain, or cancer treatment. Onset of opioid use disorder often occurs during young adulthood, and males are affected more frequently than females.
Preventive measures in the United States to address the opioid crisis include monitoring prescriptions through insurance claims, pharmacy records, and licensed healthcare practices, as well as educating healthcare providers, patients, and the general public about the risks associated with the misuse of prescribed opioids.
OUD is a problematic pattern of opioid use leading to distress, with at least two of the following occurring within a 12-month period:
- Taking higher doses to get the desired effect
- Wanting to quit or to control amount used / frequency of use but never succeeding
- Spending a lot of time each day to get, use, or recover from using the opioid
- Strongly craving opioids
- Difficulty fulfilling responsibilities at work, school, or home
- Continuing to use opioids in spite of the social and relational consequences
- Giving up previously enjoyed activities in order to spend more time using opioids
- Putting others in danger by performing life-endangering activities while high — driving, operating heavy machinery, etc.
- Continuing to use opioids despite the obvious physical or mental problems caused by using them
- Tolerance – need for increased amounts to get the same “high”
- Experiencing withdrawal – opioid withdrawal syndrome
- Taking opioids or a similar substance to lessen or avoid withdrawal symptoms
Opioid withdrawal syndrome is characterized by:
- Nausea, vomiting
- Muscle aches, chills, cramps
- Diarrhea
- Trouble sleeping, yawning, restlessness
- Runny nose
- Dilated pupils
- Agitation, irritability, low mood, anxiety, goosebumps
- Severe cravings
Psychedelics
What are psychedelics?
Psychedelics (also known as hallucinogens) are a class of psychoactive substances that produce changes in perception, mood and cognitive processes.1
Psychedelics affect all the senses, altering a person’s thinking, sense of time and emotions. They can also cause a person to hallucinate—seeing or hearing things that do not exist or are distorted.1
Commonly used psychedelics
- 2C-B
- Ayahuasca
- DMT
- LSD
- Mescaline
- NBOMes
- Psilocybin (magic mushrooms)
- Salvia
Explore psychedelics on the Drug Wheel
View the Drug Wheel
What do psychedelics look like?
There are many different kinds of psychedelics. Some occur naturally, in trees, vines, seeds, fungi and leaves. Others are made in laboratories.2 They come in many forms including tablets, blotter paper, dried mushrooms, powders and crystalline powders.
Types of psychedelics
- LSD (Lysergic acid diethylamide) is made from a substance found in ergot, which is a fungus that infects rye.3
- Psilocybin is a naturally occurring substance found in mushrooms and is found in many parts of the world.4
- Mescaline is derived from the Mexican peyote and San Pedro cactus and produces similar effects to LSD.5
- DMT (Diemethyltryptamine) is structurally similar to psilocin, an alkaloid found in psilocybin mushrooms. It can be synthesised in the laboratory but is also a naturally occurring component of several plants.4
- 2C-B (4-Bromo-2,5-dimethoxyphenethylamine) is a psychedelic drug first synthesised in 1974. 2C-B is considered both a psychedelic and a mild entactogenic. ‘Entactogen’ means ‘touching within’ and is a term used by psychiatrists to classify MDMA and related drugs.6
- Peyote (Lophophora williamsii) is the most well-known and potent psychedelic cactus, although the smallest and slowest growing. Instead of growing upward to form a column, it grows as ‘buttons’ low to the ground. It has been used by Native Americans for over 5000 years.5
- 25[-x]-NBOMe (N-methoxybenzyl) is the name for a series of drugs that have psychedelics effects. Reports indicate that there are a number of different versions of NBOMe available – all with differing effects.7
How are they used?
- Psychedelics have been used since ancient times by various cultures throughout the world for their mystical and spiritual associations. LSD, magic mushrooms, Mescaline and DMT are usually swallowed, smoked or inhaled. Mushrooms are usually eaten fresh, cooked or brewed into a ‘tea’.
- Occasionally, they may be mixed with tobacco or cannabis and smoked. Mescaline is usually swallowed. Peyote buttons may be ground into a powder and smoked with cannabis or tobacco. The buttons can also be chewed or soaked in water to produce a liquid.
- Most forms of NBOMe are inactive if swallowed, and the most common methods of taking them are under the tongue, held in the cheek or snorted.
- Generally, people who use psychedelics don’t take them on a regular basis, but on occasions that may be weeks or months apart.
Effects of psychedelics
There is no safe level of drug use. Use of any drug always carries some risk. It’s important to be careful when taking any type of drug.
Psychedelics affect everyone differently, based on:
- size, weight and health
- whether the person is used to taking it
- whether other drugs are taken around the same time
- the amount taken
- the strength of the drug (varies from batch to batch)
- environment (where the drug is taken).
The effects of psychedelics can last several hours and vary a lot, depending on the type of psychedelic used.
- Feelings of euphoria
- Sense of relaxation and wellbeing
- seeing and hearing things that aren’t there
- confusion and trouble concentrating
- dizziness
- blurred vision
- clumsiness
- fast or irregular heart beat
- breathing quickly
- vomiting
- sweating and chills
- numbness.6,7
Impact of mood and environment
Set: a person’s state of mind, previous encounters with psychedelic drugs, and expectations of what’s going to happen. For example, feelings of stress or anxiety before using psychedelic drugs may result in an unpleasant experience (bad trip).9
Setting: the environment in which someone consumes psychedelic drugs – whether it’s known and familiar, who they’re with, if they’re indoors or outdoors, the type of music and light. For example, using psychedelics in a calm, quiet and relaxed environment can lead to, or contribute to, a pleasant experience but being in a noisy, crowded place may result in a negative experience.9
Being in a good state of mind, with trusted friends and a safe environment before taking psychedelics reduces the risk of having a bad trip.
Drugs that affect a person’s mental state (psychoactive drugs) can also have varied effects depending on a person’s mood (often called the ‘set’) or the environment they are in (the ‘setting’).
Bad trips
Sometimes you can experience a ‘bad trip’, which is frightening and disturbing hallucinations. This can lead to panic and unpredictable behaviour, like running across a road or attempting suicide.
If you take a large amount or have a strong batch, you are likely to experience negative effects of psychedelics.3,9
Flashbacks
The most common long-term effect of psychedelic use is the ‘flashback’. Flashbacks are a re-experience of the drug and can occur days, weeks, months and even years later.
Flashbacks can be triggered by the use of other drugs or by stress, fatigue or physical exercise. The flashback experience can range from being pleasant to causing severe feelings of anxiety. They are usually visual and last for a minute or two.3,9
Mixing psychedelics with other drugs
The effects of mixing psychedelics with other drugs, including alcohol, prescription medications and over-the-counter medicines, are often unpredictable.
Mixing psychedelics with stimulant drugs increases the stimulant effect and can further increase heart rate and place the body under extreme stress. Stimulants can also increase anxiety which can lead to a negative experience.10
Mixing psychedelics with benzodiazepines can increase anxiety, sadness and rapid heart rate.11