Mens Health Blog. Medical Blog

At the turn of the century, the most common management technique for youngsters with ADHD was a sound thrashing when they misbehaved. Today, spanking has been replaced by an array of stimulant drugs. These drugs can often significantly curb the disruptive behaviors of ADHD and help patients lead a more normal life. However, stimulants are so widely prescribed in the United States today that some people wonder if they have become a method, like the spanking of yesteryear, that is indiscriminately and overly used.
Stimulants were first prescribed for symptoms of hyperactivity and distraction in youngsters following an outbreak of encephalitis in 1937. Doctors were amazed at the drugs’ paradoxical effectiveness on children who exhibited hyperactivity as a result of the viral infection, and stimulants have been used to curb all kinds of hyperactive behaviors ever since.
Researchers estimate that in 1970 about 150,000 children nationwide were taking prescribed stimulant medication. A decade later, that figure had escalated to between 270,000 and 541,000. By 1988, the number of school-age youngsters receiving stimulants was estimated at between 750,000 and 1.6 million, a figure that didn’t include the 25 percent of children in special education classes who received stimulants to improve academic performance. Today, the number of youngsters in the United States receiving various forms of stimulant medication is well over two million and climbing.
Benzedrine was the drug of choice in the 1940s and 1950s. Today it is methylphenidate (Ritalin), which is quite similar structurally to amphetamine. Doctors prefer Ritalin because it is fast-acting, clears the system well, and has a minimum of side-effects. Also effective are dextroamphetamine (Dexedrine) and pemoline (Cylert).
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Multiple substance abuse refers to simultaneous abuse of different mood-altering drugs, either one with another, or in combination with that all-time favorite, alcohol. Many who work in the alcoholism field have come to believe that addiction is addiction regardless of the substance being abused. For these people basic principles of treatment for drug abuse vary little from alcoholism treatment. Despite this view, the stereotype remains of drug abusers as different from alcoholics and more difficult to help. Thus, a tendency among some who work with alcoholics is to shy away from drug abusers or those who are cross-addicted to drugs as well as alcohol. Nevertheless, those working with alcoholics must become more knowledgeable and comfortable in working with clients who are also involved with other drugs. “Pure” alcohol abuse is less common than it used to be. A recent survey conducted by AA of its members revealed that 30% of those surveyed considered themselves addicted to drugs as well as alcohol. This was an increase of 7% from a similar survey 3 years earlier. Of AA members under 20 years of age, a whopping 76% said they were addicted to drugs as well, a 16% increase in just a 3-year period! Alcohol treatment units report that the number of clients being admitted who also abuse other drugs is increasing. Once again, the younger clients are more likely to use and abuse multiple substances.
Major substances of abuse
A complete listing of all the drugs of abuse and their effects is beyond the scope of this book. However, it is not necessary to be intimately familiar with every compound, if one is aware of the general classes into which psychoactive drugs or substances fall. Within each of the major classes there is similarity as to the drugs’ effects and the problems that may be encountered with use. The major classes of “abuse-able” drugs are as follows:
Depressants
examples: benzodiazepines (Librium, Valium, etc.); barbiturates, chloral hydrate, paraldehyde, meprobamate.
action: not completely understood, in general produce a reversible depression of the central nervous system, some more selectively than others.
desired effects: similar to alcohol; elation or excitement secondary to depression of inhibitions and judgment or reduction of anxiety.
common problems: tolerance; physical dependence; respiratory depression with overdose.
withdrawal syndromes: physical symptoms similar to alcohol withdrawal, including seizures; psychological withdrawal.
Stimulants
examples: amphetamines, cocaine, methylphenidate (Ritalin), action: stimulation probably due to increased levels of
norepinepherine and/or dopamine in-central nervous system, desired effects: increased alertness; feeling of well-being; euphoria;
increased energy; decreased appetite; rapid onset of mood change
with cocaine.
common problems: tolerance; anxiety; confusion; irritability; psychosis; with cocaine-delusions, some data indicating physical dependence.
withdrawal syndromes: depression (possibly suicidal); loss of ability to enjoy ordinary pleasures.
Opiates
examples: heroin, morphine, methadone, opium, codeine, Demerol, Percodan.
action: affect central nervous system, probably by mimicking or blocking normally occuring opiate-like substances in the brain, thereby causing mood changes and mental clouding.
desired effects: “the rush” (feeling of intense pleasure immediately following injection); state of mental and physical relaxation with decreased mental awareness and reduction of drives.
common problems: production of tolerance and both physical and psychological dependence; death by overdose or as result of injection.
withdrawal syndromes: psychological (drug craving); physical symptoms (chills and sweats, abdominal pain, diarrhea, gooseflesh, tears).
Hallucinogens
examples: LSD, mescaline, psilocybin, DMT.
action: alteration of normal functioning of central and peripheral nervous systems, central nervous system excitement.
desired effects: modification of perception of all sensory input (hallucinations, distortions); temporary modification of thought processes; claims of “special insights.”
common problems: acute anxiety and panic reactions; depression; flashbacks (post-LSD).
withdrawal syndromes: generally believed not to occur.
Cannabinoids
examples: marijuana, hashish, THC.
action: acts on the brain as a foreign substance.
desired effects: euphoria; detachment; modification of level of consciousness; relaxation; reported sexual arousal; altered perceptions.
common problems: psychomotor impairment; impairment in memory, comprehension, thinking, learning, and general intellectual function; respiratory problems with prolonged use; reproductive system problems with prolonged use; paranoia and psychosis in large doses; possible long-term psychological impairment with chronic use.
withdrawal syndromes: psychological dependence suggested; no physical withdrawal demonstrated.
Phencyclidine
examples: Phencyclidine (PCP).
action: nonspecific central nervous system depressant; anesthetic; psychedelic (multiple proposed actions on various neurotransmitters in central nervous system).
desired effects: visual illusions and distorted perceptions; depersonalization; distortion of body image; hallucinations; feelings of strength, power, and invulnerability; claims of “special insights.”
common problems: feelings of severe anxiety, doom, or impending death; bizarre behavior; outbursts of hostility and excitement.
withdrawal syndromes: potential for both psychological and physical withdrawal reported, but not well documented.
Inhalants
examples: aerosol sprays, paint, model cement, adhesives, gasoline, amyl nitrite, butyl nitrite, nitrous oxide, benzydrex inhalors, asthma inhilators
action: central nervous system depression, generally secondary to access through respiratory system.
desired effects: immediate effects—euphoria, excitement (also often inexpensive and legal).
common problems: impulsive and destructive behavior; slurred speech; ataxia; impaired judgment; development of tolerance; “Sudden Sniffing Death”; possible long-term central nervous system damage and damage to multiple physical systems.
withdrawal syndromes: psychological documented; physical, not clinically established.
In respect to the drugs of abuse, there are clearly trends as to what is and is not popular, or “in,” at any particular time. For example, the interest in psychedelics has waned. Cocaine use has become very widespread. Also apparently true is that drugs, though often touted as being nonaddictive when they are becoming popular, generally turn out not to be as universally benign as thought. Current terminology refers to “recreational” drug use, which by analogy is the counterpart of “social drinking.” Controlled studies of the effects of “recreational” drug use are for the most part nonexistent. The problems that can accompany “casual use” are the same as for “casual use” of alcohol, for example, auto accidents from driving in an impaired state. Or there is the possibility that casual use may not remain casual. Any use of illicit substances invites a host of other difficulties.
For the counselor, the importance of distinguishing between legal and illegal substances is less a matter of pharmacology than it is “quality assurance.” Inevitably, illicit drugs are pharmacologically of unknown strength and purity. And a safe, reliably available supply can never be assured. Also, the illicit drug use can invite social and legal problems. For example, while the price of cocaine may be coming down, it remains a very expensive drug. Therefore, large sums of money are spent for even “recreational” use. Heavy users may find themselves borrowing money, going into debt, or stealing. Or they begin to sell to others to cover the costs of their own coke use. Cocaine has thus been called the “Amway drug.”
The observation has been made that for illicit drug users, because the substance is not legally available, some of the behaviors common in the later stages of alcoholism are present virtually from the beginning of the drug use. Early on with the drug use there is a need for the secretiveness, concern about supply, and feelings of guilt and apprehension.
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Pollen is everywhere, and it flourishes where most people live. There are exceptions, such as at the polar caps and at very high altitudes, but these are sufficiently inaccessible to most of us to be, essentially, irrelevant.
The following are general guidelines that can reduce both your exposure to the ubiquitous pollens and the symptoms that result from that exposure:
1. Staying inside with closed doors and windows is the best way to reduce your exposure to pollens during your particular pollen season(s).
2. Window fans and attic fans are infamous for drawing pollens into homes. Any type of fan can stir up mite particles, mold spores, animal danders, and pollens already within your home. In general, if you are allergic to a variety of inhaled indoor and outdoor allergens, it is best not to use fans in your home.
3. Putting the car air conditioner on “re-circulate” while driving will help reduce pollen exposure.
4. Obviously, outdoor activities and yard work during your pollen season(s) can worsen your symptoms. If you are grass-or tree-pollen allergic, try to have someone else tend your yard during the weed, grass, and tree pollen seasons.
5. Don’t hang clothes or bedding outside to dry, as they become pollen catchers.
6. A good filter on your central air/heat system or a standalone filtering unit in your bedroom can be very helpful. Remember, though, filters filter. Since these filter systems work effectively only as long as they are kept clean, wash them weekly during your allergy season(s).
7. It is best if you are not the one to hose down, blow, or sweep the yellow pollen off of your driveway, porch or patio.
8. Get out of town – way out of town – during your season(s). If possible, plan your vacation and go to an area not filled with the pollen(s) to which you are allergic. If only we could escape for an entire season!
Getting away during a pollen season does work for some people, especially people who are very reactive to only a single pollen such as ragweed. They can go where the counts are generally very low, places like Florida, the big island of Hawaii, Alaska, eastern Canada, the Virgin Islands, or even Bermuda. If you live in south central Texas and happen to be very reactive only to mountain cedar pollen, you can go almost anywhere else and get relief during your season.
Unfortunately, most people with chronic allergic rhinitis are reactive to many different allergens: pollens, dusts, mites, and molds. So, even though they might vacation away from ragweed, they are likely to discover that their vacation paradise has grass or tree pollens, or mites and mold spores in abundance – that they have even worse allergies on vacation than they do at home.
Before you rush off someplace, be sure you’re not going from the frying pan into the fire. Talk to your allergist.
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