Altering Consciousness with Drugs
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Altering Consciousness with Drugs
Two middle-aged couples having dinner at a fancy restaurant were talking about taxes, politics, and drugs. They agreed that they would never use any drugs that could affect their minds. Halfway through the meal, they asked the waitress to bring them another bottle of wine. Later they had several cups of coffee with their chocolate pie. After dinner, they went for a walk and smoked a few cigarettes.
Are illicit drugs the only substances that can affect consciousness, perception, mood, and behavior?
Many people use the term drug to refer to illegal, possibly addicting substances, as opposed to the medicines taken to cure illnesses. Actually, the term refers to both legal and illegal substances; a drug is any chemical that modifies physiological functioning. Psychoactive substances, which include many illegal or illicit drugs, are chemicals that can alter consciousness, perception, mood, and behavior.
The two couples just described claimed that they would never use any drugs that could affect their minds. Yet within a few hours, they used three legal psychoactive substances: alcohol (in wine), caffeine (in coffee and chocolate pie), and nicotine (in cigarettes). When they said they would never use drugs, they meant illegal or mind-altering drugs; they were assuming that the substances they were using would not affect their minds. But as we will see shortly, they were mistaken. The most common psychoactive substances are listed in Table 5-2. They are divided into four categories on the basis of their effects: depressants, stimulants, opioids, and hallucinogens.
The National Household Survey on Drug Abuse estimates that 12 million individuals in the United States used an illicit drug in the month prior to the survey. Marijuana, the most commonly used illicit drug, was used by 77 percent of the sample. The 1.3 million cocaine users represented a significant drop from the peak of 5.3 million in 1985 (U.S. Department of Health and Human Services, 1994). Approximately $50 billion was spent on illicit drugs in 1993; the largest share of the money was spent on cocaine (Rhodes et al., 1995).
The effects of most psychoactive substances can be explained by the changes they cause in the action of neurotransmitters (see Chapter 3), especially in the brain. Thus most psychoactive substances can have wide-ranging effects.
The regular and excessive use of drugs can lead to a pattern of maladaptive behavior known as a substance use disorder that includes substance abuse and substance dependence. Substance abuse occurs when use of a substance leads to maladaptive behaviors. The substance use may disrupt family and social relationships, interfere with work, and create physical hazards for the abuser.
People who display substance dependence, a more serious disorder that is popularly called addiction, develop a physical dependence on the substance in addition to a pattern of abuse. Physical dependence is evident in the phenomenon of tolerance, which occurs when a person needs increasing doses of a substance to achieve the effect formerly obtained from a smaller dose. Withdrawal may then occur if the person stops taking the substance or reduces the amount taken. The symptoms of withdrawal range from irritability to a craving for the substance that can begin within hours of taking the last dose.
In the remainder of this section, we take a closer look at each of the major categories of psychoactive substances.
Depressants
Alcohol and barbiturates are both depressants that reduce the functioning of the central nervous system. Alcohol is one of the most widely used psychoactive substances in the United States and throughout the world. Barbiturates are less common but are still readily available.
Alcohol.
Along with nicotine and caffeine, alcohol might be called an unrecognized drug. We are so accustomed to consuming alcohol that "to drink" often means to drink alcoholic beverages unless otherwise specified. The following are some significant facts about alcohol use in the United States:
Alcohol contributes to 100,000 deaths each year; about 40 percent of all traffic fatalities are alcohol-related.
- The economic cost of alcohol use was estimated to be $150 billion in 1995.
- A survey of college students found that 50 percent of men and 39 percent of women engaged in binge drinking, which is defined as drinking five or more drinks in a row for men or four or more for women during the two weeks prior to the survey. Binge drinking was associated with health and other problems such as personal injuries and damaging property.
- In 1993, fully 87 percent of high school seniors admitted using alcohol at least once. (Dufour, 1995; Johnston, O’Malley, & Bachman, 1994; McGinnis & Foege, 1993; National Institute on Alcohol Abuse and Alcoholism, 1994; Wechsler et al., 1994).
The use of alcohol is associated with a range of medical and mental health problems. Heavy use of alcohol is linked to several forms of cancer, antisocial personality disorder (see Chapter 14), bulimia (Chapter 9), and heart damage (National Institute on Alcohol Abuse and Alcoholism, 1991). Alcohol is the primary contributor to cirrhosis, a disease of the liver that is the eleventh leading cause of death in the United States (Dufour, 1995). Thus it is important to identify and treat alcohol abuse or dependence as early as possible. The questionnaire in Table 5-4 is designed to help people determine whether they have a problem with alcohol.
Effects of Alcohol.
The alcohol in beer, distilled liquor, and wine is ethyl alcohol, or ethanol. This colorless liquid contains a relatively high number of calories but virtually no vitamins or other nutrients. Drinking alcoholic beverages adds calories to your diet at the same time that it slows your rate of fat metabolism. The fat that is not broken down is deposited on your hips, thighs, and stomach (Suter, Schutz, & Jequier, 1992).
Alcohol content varies with the beverage: Beer is 3 to 6 percent alcohol, wine 8 to 20 percent, distilled beverages 40 to 50 percent. Typical servings of these beverages contain similar amounts of alcohol, so the effects of alcohol do not depend so much on what you drink as on how much you drink.
Your body can break down alcohol before it affects you if you consume it slowly, but few people consume it slowly enough. The amount of alcohol in the blood depends in part on how long it takes the stomach to empty its contents into the small intestine, where most of the alcohol enters the bloodstream. If you slow the stomach’s emptying time, you slow (but do not stop) the release of alcohol into the blood. One reason to eat food while drinking alcoholic beverages is that the presence of food in your stomach slows the emptying process.
Blood alcohol concentration (BAC) is the percentage of alcohol in the blood; a BAC of 0.05 percent is 5 parts of alcohol per 1,000 parts of blood. Almost all states use a BAC of 0.10 as the legal definition of intoxication, although some states have lowered it to 0.08. As you can see in Figure 5-9, your BAC depends primarily on your weight and the number of drinks you have consumed. A person who weighs 120 pounds will have a much higher BAC than one who weighs 240 pounds if they consume the same number of drinks. Women may metabolize alcohol less efficiently than men; as a result, women will have a slightly higher BAC over a shorter time period (U.S. Department of Health and Human Services, 1993). With a BAC of about 0.32, you could endure surgery without awareness; BAC levels of 0.40 and higher can paralyze the part of the brain that controls breathing (the medulla) and cause death (Julien, 1995).
Alcohol affects virtually all organs of the body, especially the brain (Charness, 1990). Did you ever wonder why some of your friends act stupid at parties after having consumed alcohol? Alcohol depresses brain areas that inhibit behavior, thereby allowing the person to engage in behaviors that might not otherwise occur. Even at low levels, alcohol quickly affects vision, reaction time, muscle coordination, and judgment.
One reason that people drink alcohol is the
expectation of positive effects:
They believe alcohol helps them feel better, overcome a gloomy mood, or fall asleep more
easily (Stacy, Widaman, & Marlatt, 1990). In low doses, alcohol does reduce anxiety in
nervous or shy individuals, but in higher doses, it interferes with sexual performance
(Crowe & George, 1989). Shakespeare summarized the effects of alcohol on sexual
arousal in these words from Macbeth (Act 2, Scene 1): "It provokes the desire but
takes away the performance." Remember that alcohol also impairs judgment, so people
who drink too much may find themselves engaging in unwanted sexual activity.
People who have been drinking alcoholic beverages may end up in a sexual or driving situation that seems to contradict their usual attitudes and intentions. Why? The answer appears to be that the altered state of consciousness brought on by alcohol decreases our capacity to attend to the information presented. In one study, sober and intoxicated college students expressed equally negative attitudes when they were asked general questions about drinking and driving. However, when asked more specific questions, such as "Would you drink and drive only a short distance?" intoxicated students were less likely to say no (MacDonald, Zanna, & Fong, 1995). Thus intoxicated individuals may attend only to the most salient cues at the moment, such as the desire to get home as quickly as possible. This alcohol myopia (Steele & Josephs, 1990) may account for a number of instances in which intoxicated drinkers engage in behaviors that contradict attitudes they express while sober.
A number of studies suggest that alcohol and aggression are related. For example, 54 percent of all murderers were drinking just before they committed their crimes. Recent laboratory research has clarified our understanding of the association between alcohol and aggression. At low BAC levels, our expectations seem to play a significant role in the effects of alcohol; however, at higher levels, the biological effect of alcohol on the central nervous system, especially the brain, is the prime determinant of its effect. Violence is more likely to occur at higher BAC levels (Chermack & Taylor, 1995). The specific mechanism that accounts for increased aggression following high doses of alcohol is not known. Alcohol has a wide range of effects that may play a role. For example, high doses of alcohol reduce fear which may diminish the concern about potential harm resulting from aggressive actions.
One serious consequence of long-term heavy consumption of alcohol is a form of withdrawal called delirium tremens (DTs). The symptoms include severe anxiety, a fast pulse, and even death. Vivid hallucinations, especially of small, quickly moving insects or animals, also occur and can heighten the person’s anxiety. The hallucinations may be due to REM rebound, because alcohol suppresses REM; when alcohol is withdrawn, a great deal of REM returns.
Another long-term consequence of alcohol use is Korsakoff’s syndrome, a severe brain impairment characterized by the inability to remember recent events or to learn new information. Extensive use of alcohol damages brain areas that are important to memory, such as the hippocampus (Berman, 1990).
Factors that Influence Alcohol Use.
Drinking patterns vary among different populations within our society. For example, men drink more than women and experience more adverse consequences of drinking (U.S. Department of Health and Human Services, 1993). According to an annual survey of drug use by high school seniors, 3.6 percent of boys but only 1.4 percent of girls use alcohol on a daily basis. Thirty-five percent of high school senior boys drank five or more drinks in a row in the two weeks prior to the survey versus 21 percent of the girls (Johnston, O’Malley, & Bachman, 1994).
In the United States, the one-year prevalence of alcohol abuse and dependence (commonly called alcoholism) is approximately 7 percent of individuals over age 18, a total of about 13 million people. The rates of alcohol abuse and dependence vary according to a variety of factors, especially the individual’s sex (Grant et al., 1994). The rates of alcohol abuse and dependence are higher for men than for women. Age is also a factor: The 1-year prevalence of problem drinking is much higher among individuals aged 18-29 than at other ages (Grant et al., 1994).
Both physiological and social factors play important roles in alcohol consumption. About half of East Asians have a deficiency in the enzyme that breaks down alcohol in the body. As a result, they may experience flushing when they consume as little as one drink. This reaction involves a reddening of the face and neck that may be accompanied by headaches, nausea, and other symptoms. Therefore, East Asians are often thought to be unlikely to become problem drinkers. Asian Americans in the United States report lower levels of alcohol drinking than Caucasians, which may be due to this reaction (Akutsu et al., 1989). However, surveys of drinking among males in Korea and Japan find that alcohol abuse and dependence is at least as high as in the United States (Helzer et al., 1990; Yamamoto & Lin, 1995). In contrast, Chinese people in Taiwan drink significantly less than Koreans and Japanese do, and they are less likely to develop alcohol abuse and dependence. Korean and Japanese men often feel social pressures to drink, even though their capacity to handle alcohol is limited. In contrast, Chinese culture advocates moderation in the use of alcohol (Yamamoto & Lin, 1995).
Barbiturates.
Barbiturates, such as Nembutal and Seconal, are commonly called "downers" because they depress the functioning of the central nervous system. Depending on the dosage, their effects range from mild sedation to coma (Julien, 1995). At very high doses, barbiturates can lead to serious withdrawal symptoms, including life-threatening convulsions.
Because most barbiturates cause drowsiness, they were formerly used to treat insomnia. However, this use has declined dramatically as physicians recognized that barbiturates do not induce a natural sleep; rather, they suppress REM and Stage 4 sleep. Moreover, it is easy to take a lethal overdose of barbiturates. An individual with a sleep problem might seek a prescription for a barbiturate and then either knowingly or unknowingly also consume some alcohol. The two drugs can combine to reduce the activity of the central nervous system, sometimes leading to death. In fact, many of the effects of barbiturates are indistinguishable from those of alcohol.
Stimulants
Stimulants are drugs that speed up the activity of the central nervous system. Among the most common stimulants are amphetamines, also known as "uppers" or "speed," which stimulate the release of dopamine and norepinephrine. In low to moderate doses, they make us more alert, elevate mood, reduce appetite and the need for sleep, and induce euphoria. Larger doses of amphetamines can make us irritable and anxious or bring on a serious reaction that is indistinguishable from paranoid schizophrenia (see Chapter 14).
Amphetamines
Amphetamines were formerly used in weight-loss programs because they increase metabolism, but they are rarely used for that purpose today because their rapid tolerance can lead to serious physical and psychological effects (Morgan, 1988). Among the few appropriate medical uses of amphetamines are the treatment of narcolepsy and attention deficit hyperactivity disorder (ADHD) in children. Children with this disorder display high levels of activity and are inattentive and impulsive. Although amphetamines would appear to be the last drug to give to a child with ADHD, they have a paradoxical effect on such children: The drug calms them down. However, when amphetamines are administered continually over time, the drug’s calming effect tends to diminish.
Caffeine
Although it is not generally considered a drug and certainly does not require a prescription, caffeine is a widely available and frequently used stimulant. Caffeine is found in a variety of foods and drinks, including coffee, tea, chocolate, soft drinks, and some nonprescription drugs. Heavy and continuous use of food products that contain caffeine is responsible for many cases of insomnia. The effects of caffeine are not as severe as those of other stimulants because large amounts of caffeine would be necessary to cause similar symptoms.
Cocaine
Another stimulant, cocaine, is extracted from the leaves of the South American coca plant. For centuries, inhabitants of the Andes Mountains have chewed coca leaves to counteract fatigue. Popular views of cocaine have changed dramatically over the years. In the 1800s, cocaine was hailed as a wonder drug and used as an ingredient in cold remedies. Sigmund Freud heralded it as a cure for depression and fatigue. Until 1903 it was an ingredient in Coca-Cola. During the 1960s and 1970s, cocaine use increased and was often associated with glamorous industries and lifestyles, such as show business, professional sports, and high finance (Morgan, 1988). The high cost of cocaine made it more accessible to economically prosperous people.
Cocaine can be eaten, injected into the veins, smoked, or inhaled through the nose. When it is injected, its potency is increased greatly, making this practice very dangerous and potentially lethal. Crack is a purified form of cocaine that is very potent when smoked. The term crack derives from the crackling sound heard when the drug is mixed with chemicals and heated (Langton, 1991).
Cocaine gets to the brain very quickly, where it acts to increase the release and block the reuptake of dopamine and norepinephrine. A rapid and powerful high is followed by a dramatic low that creates a craving for more of the drug. Laboratory animals have been observed to self-administer cocaine until they died. Ronald Siegel (1989) observed monkeys that would press a bar more than 12,000 times to obtain a single dose of cocaine. Cocaine also increases heart rate and blood pressure, raises mental awareness, and reduces fatigue. These effects are similar to those of amphetamines, although they do not last as long.
About 11 percent of Americans above the age of 12 have used cocaine at least once (U.S. Department of Health and Human Services, 1994), although the number of users has declined since the 1980s. Although the availability of cocaine has not changed significantly, perceptions of cocaine’s risk and disapproval of its use have increased (Bachman, Johnston, & O’Malley, 1990).
Nicotine
Also included in the category of stimulants is nicotine, a potent substance that activates the brain, heart, and nervous system. Next to caffeine, nicotine is the most widely used stimulant in our society. Found in tobacco products, it increases blood pressure and heart rate, and it stimulates the body’s fight-or -flight response. There are at least 1,200 toxic chemicals in tobacco smoke, many of which cause cancer. Cigarette smoke contains tar; a number of gases, including carbon monoxide; and, of course, nicotine. The surgeon general of the United States (U.S. Department of Health and Human Services, 1988a) cited cigarette smoking as the largest single preventable cause of premature death in the United States. Nevertheless, millions of Americans continue to smoke. Concern has also been aroused by the harmful effects of "passive smoking"—the effects of smoking on people in the smoker’s vicinity. We discuss the health problems associated with smoking in more detail in Chapter 9.
The opioids are a group of naturally occurring and synthetic drugs (see the discussion of opioid peptides in Chapter 2). Opium is derived from the unripe seedpod of the poppy plant; it may have been used as early as the Stone Age. Today the primary medical uses of opioids are pain relief (analgesia), relief of coughing, and treatment of diarrhea. Two of the drugs derived from opium are morphine and codeine (Julien, 1995); of the two, morphine is the more powerful painkiller. Also included in the opioid category is heroin, a synthetic compound that is produced from morphine. People who use opioids initially experience a sleepy, pleasant euphoria and relief from anxiety and stress. However, continued use leads to tolerance that makes it impossible to feel any pleasurable effects (Morgan, 1988).
The opioids are highly addictive and potentially dangerous. Depending on the dosage, the method of administration, and the user’s tolerance level, their effects can range from mild sedation and relaxation to paralysis and death. Opioids are also associated with very powerful withdrawal effects. Withdrawal from opioids produces agitated dysphoria, a condition whose symptoms include pain throughout the body, as well as sweating and stomach upset that may be mistaken for flu symptoms.
Hallucinogens
Hallucinogens are drugs that can change a person’s perception, thinking, emotions, and self-awareness. They have been used for thousands of years in magical, mystical, and religious ceremonies. This class of drugs, sometimes called psychedelic drugs, includes compounds that are natural in origin as well as a growing number of drugs produced in laboratories. Hallucinogens can produce hallucinations, time and space distortions, and symptoms similar to those found in severe psychological disorders.
Lysergic acid diethylamide (LSD)
Lysergic acid diethylamide (LSD) is a colorless, odorless, and tasteless drug that is derived from the ergot fungus that grows on rye. Usually taken by mouth, LSD is rapidly absorbed by the body, although a small amount finds its way to the cortex. The effects of LSD depend on the amount taken; the user’s personality, mood, and expectations; and the surroundings in which the drug is used. Physical effects include dilated pupils, elevated body temperature, and increases in heart rate and blood pressure. Sensations and feelings, however, are much more dramatic than the physical signs. A user may feel several emotions at once or swing rapidly from one emotion to another. Larger doses can produce delusions and hallucinations such as changing colors and shapes. Another reaction to the use of LSD, the flashback, is most likely to occur in people who are chronic users of hallucinogens. Without having taken the drug again, the individual suddenly experiences a recurrence of aspects of an earlier drug experience, complete with feelings of paranoia and perceptual distortions. Flashbacks may be induced by circumstances similar to those surrounding the original experience with the drug (National Institute on Drug Abuse, 1992).
Phencyclidine piperidine (PCP)
Phencyclidine piperidine (PCP) can have depressant, stimulant, hallucinogenic, or analgesic effects, depending on the dosage. PCP can be taken orally, smoked, or inhaled through the nose ("snorted"). It is frequently mixed with other illicit drugs, and for this reason it is difficult to obtain accurate reports of the extent of PCP use.
The varied effects of PCP include euphoria, very unpleasant feelings, distorted sensations, hallucinations, and even a tendency to commit violent acts. A particularly dangerous effect of PCP is a type of dissociation in which sensory inputs are so distorted that the user experiences no pain. In this condition a user might incur serious physical injury without realizing it.
Consider the case of 17-year-old Martin, who smoked one PCP cigarette. As he walked down the street, Martin broke store windows with karate kicks. When the police arrived he flashed a butcher knife and attacked them. It took six officers to put him in handcuffs. In the hospital emergency room, he sang, "I’m strong to the finish, I’m Popeye the sailorman!" (Siegel, 1989, pp. 218-219).
Marijuana
An estimated 70 million Americans aged 12 and older have used marijuana at some time in their lives (U.S. Department of Health and Human Services, 1994). Marijuana consists of the dried leaves and flowers of the Cannabis sativa (hemp) plant; it can be smoked, eaten, or drunk. Hashish, or "hash," is a more potent form of marijuana made by pressing resin from the leaves or flowers of the cannabis plant.
Of the more than 400 compounds found in marijuana (Grinspoon & Bakalar, 1993), one is an important psychoactive ingredient—delta-9-tetrahydrocannabinol (THC). This compound is rapidly absorbed into blood and tissue throughout the body, including the brain. It stimulates nerve receptors in the cortex and hippocampus, which suggests that the body produces its own version of the substance (Matsuda et al., 1990). The by-products of THC can be detected for days or weeks following even brief use of marijuana.
The subjective experience of the marijuana high is influenced by the person’s expectations about how he or she will feel, the amount of the drug taken, and its potency. Small to moderate doses of THC usually lead to feelings of well -being and euphoria; large doses can cause paranoia, hallucinations, and dizziness (Fackelmann, 1993). The most common physical effects of THC are an increase in heart rate and a reddening of the eyes; however, attention, short -term memory, and coordination can be impaired (Block, Farinpour, & Braverman, 1992; Block & Ghoneim, 1993; Grinspoon & Bakalar, 1993; Leavitt, 1995).
At one time marijuana was portrayed as a "killer weed" that drove people to insanity and violence. Nevertheless, it became widely used during the 1960s and 1970s. Since 1979 its use has declined, largely because of growing disapproval and concern about perceived risks (Bachman et al., 1988). However, marijuana use may be on the rise, especially among individuals aged 12 to 17 (Chalsma & Boyum, 1994).
Marijuana appears to have few serious medical effects (Grinspoon & Bakalar, 1993). For example, reports that marijuana suppresses the immune system are contradictory (Hollister, 1988). Some of these studies are flawed by use of very high concentrations of marijuana to produce suppression of the immune system. There is one well-confirmed physical effect of marijuana: harm to the pulmonary system. Marijuana contains more tar and carbon monoxide than tobacco smoke, and marijuana smokers inhale more deeply than tobacco smokers. However, most marijuana smokers do not smoke as much marijuana as tobacco smokers smoke tobacco (Grinspoon & Bakalar, 1993).
Recent reports about the effects of marijuana have been more balanced than the claims of earlier years. In fact, some researchers have noted that THC may have medical benefits such as reducing side effects of chemotherapy and treating glaucoma (Grinspoon & Bakalar, 1993).
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