Mens Health Blog. Medical Blog

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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Every morning when we wake up and open our eyes we see the sun shining through the window. The light/dark cycle appears to be very important in the resetting of our circadian rhythm. When we open our eyes in the morning, the light stimulates the light-sensitive part of our eyes, the retina. The retinae from both eyes convey the light message along the optic nerves to a central point called the optic chiasma, which is in the middle of the brain stem adjacent to the hypothalamus. Half of this light message crosses the optic chiasma and is relayed to the rear part of the cerebral cortex. Scientists now believe that part of the light message is also relayed to a group of nerve cells in the hypothalamus adjacent to the optic chiasma. This area is called the suprachiasmatic nucleus (SCN) in the hypothalamus and is the site of master control of the circadian rhythm. In animals destruction of the SCN abolishes the circadian rhythm.

It is thought that the SCN possesses an endogenous oscillating mechanism which in free running conditions in man is 25 hours. The SCN is the master oscillator, and it is believed that there are other suboscillators which control hormone rhythm, body temperature rhythm, etc. Hence in cases of jet lag or shift work, the phase maps of the different suboscillators are thrown out of phase with each other. By resetting the master oscillator, the SCN, the circadian rhythm, and the suboscillators are put back into place.

Chronobiologists have recently studied the SCN in detail, both in animals and in man. They have found that if a strong light message is received in the SCN at an hour different to normal sunrise, the SCN is reset into a new circadian rhythm after a few days. Chronobiologists call the light signal the Zeitgeber, synchronizer, or time giver, and the resetting process the entrainment.

The Zeitgeber for crabs that are flown from one coast to the other in the USA is the light/dark cycle of the new location. The Zeitgeber for Dr Charles Czeisler to entrain his jet lag patient to a new circadian rhythm is artificial bright light Dr Thomas Wehr of the National Institute of Mental Health in the USA has been using light treatment and sleep deprivation to treat certain kinds of depressive illness. It is believed that, by adjusting the master oscillator, its suboscillator that modulates mood and depression will also be adjusted and lead to recovery from the depressive illness.

At present, in Australia and New Zealand, a great deal of research is being conducted on the chemistry of the biological clock. Melatonin, a chemical secreted from the pineal gland situated at the base of the brain, has been shown to be closely related to the circadian rhythm. During the night, the SCN relays impulses to the pineal gland and melatonin is secreted into the blood. In the day, sunlight has an inhibitory effect on the SCN, and this stops the pineal gland from releasing melatonin. The concentration of melatonin in the blood hence becomes a good marker of the circadian rhythm.

Melatonin comes from the word melanin, which means skin pigment. In some lower animals, skin colour changes according to the amount of sunlight. At night, there is more melatonin and this contracts the melanophores of the skin, making the skin pale in colour, whereas in the day, with plenty of sunlight, the skin becomes darker. This skin colour change is controlled by the light/dark – , of the circadian rhythm through melatonin.

However, in man, the exact role of melatonin is stillunknown. It has been suggested that there is a melatonin stimulates the SCN to secrete even more melatonin and a rise in melatonin concentration speeds up the resetting of the biological clock. A group of volunteers were asked to travel from New Zealand to London and back, and were given melatonin capsules to take for a few nights on arrival at their new destination. It appears that this increase in the concentration of melatonin at night speeded up the resetting of their biological clock to the new local time. They felt more alert in the day and their sleep pattern was reset much sooner than if they had not taken melatonin capsules. A new company, called Circadian Technologies, has recently been set up in Melbourne. It plans to produce melatonin capsules on a commercial scale. Of course, this has yet to be approved by the Food and Drug Administration in the USA. Perhaps, one day, overseas travellers will regularly be taking melatonin capsules to minimise their jet lag. Or there may be coin-operated bright light machines available at all major airports to entrain the travellers’ biological clock to the new local time.

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Ideas can be accepted into the mind by two distinct mechanisms. We can scrutinize an idea that is offered to us, and examine it logically and critically. If we find it a good idea we accept it by this intellectual process of evaluation. On the other hand, many ideas are accepted into the mind quite uncritically and without any intellectual evaluation. We see this most commonly in children and in adults who are very relaxed, fatigued, or alcoholic. In this process the acceptance of the idea depends much more on our feeling toward the person who offers the idea than on the merits of the idea itself. The process by which ideas are accepted uncritically in this way is technically known as suggestion. It is important to remember that the uncritical acceptance of ideas in this fashion does not result from the evaluing mechanism working in less degree, but results from the activity of suggestion, which is quite a different mechanism of the mind. However, if the alert critical faculties of the intellect come into play, they always put a stop to suggestion, and the idea is subjected to the intellectual process of evaluation.

If we consider this matter from the biological point of view, we see that the critical method of accepting ideas is a recent evolutionary development, whereas the uncritical method based on our feeling for the other person is a biologically primitive process which has been practically superseded by this more recent development of our ability to evaluate things critically.

The important fact from our point of view is that this primitive process of suggestion functions very much more effectively when we have regressed a little toward a more primitive mode of mental functioning. This of course is exactly what we do in the regression of our mental exercises. So while we are regressed like this, we can use the process of suggestion to influence the working of our mind in a way that would be quite impossible if we were in our normal alert waking state.

In the matter of anxiety and general nervous tension our mind is quite impervious to the logical reasoned approach of the intellect, but on the other hand it is quite amenable to the process of suggestion when in this relaxed and regressed condition. In our exercises we ourselves present the ideas to our mind, so in this case the process is known as autosuggestion.

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