9.7: Substances and Substance Abuse

Drug use and the possibility of abuse and addiction primarily manifest as physical problems. However, the effects of these substances are not only physical, but also have long lasting consequences on cognitive development as well as effect social emotional development in a variety of ways. In the next section we’ll learn about what drugs are, the different kinds of drugs, and what the effects are of each.

Drug Experimentation

Figure \(\PageIndex{1}\): Social norms and peers influence adolescents’ drug use.[2]

What Are Drugs?

A psychoactive drug is a chemical that changes our states of consciousness, and particularly our perceptions and moods. These drugs are commonly found in everyday foods and beverages, including chocolate, coffee, and soft drinks, as well as in alcohol and in over-the-counter drugs, such as aspirin, Tylenol, and cold and cough medication. Psychoactive drugs are also frequently prescribed as sleeping pills, tranquilizers, and antianxiety medications, and they may be taken, illegally, for recreational purposes. The four primary classes of psychoactive drugs are stimulants, depressants, opioids, and hallucinogens.

Stimulants

A stimulant is a psychoactive drug that operates by blocking the reuptake of dopamine, norepinephrine, and serotonin in the synapses of the central nervous system (CNS). Because more of these neurotransmitters remain active in the brain, the result is an increase in the activity of the sympathetic division of the autonomic nervous system (ANS). Effects of stimulants include increased heart and breathing rates, pupil dilation, and increases in blood sugar accompanied by decreases in appetite. For these reasons, stimulants are frequently used to help people stay awake and to control weight.

Used in moderation, some stimulants may increase alertness, but used in an irresponsible fashion they can quickly create dependency. A major problem is the “crash” that results when the drug loses its effectiveness and the activity of the neurotransmitters returns to normal. The withdrawal from stimulants can create profound depression and lead to an intense desire to repeat the high.

Table \(\PageIndex{1}\): Stimulants

Drug	Dangers and Side Effects	Psychological Dependence	Physical Dependence	Addiction Potential
Caffeine	May create dependence	Low	Low	Low
Nicotine	Has major negative health effects if smoked or chewed	High	High	High
Cocaine	Decreased appetite, headache	Low	Low	Moderate
Amphetamines	Possible dependence, accompanied by severe “crash” with depression as drug effects wear off, particularly if smoked or injected	Moderate	Low	Moderate to High

A Closer Look at the Danger of Adolescence Use of Nicotine

Nicotine is a psychoactive drug found in the nightshade family of plants, where it acts as a natural pesticide. Nicotine is the main cause for the dependence-forming properties of tobacco use, and tobacco use is a major health threat. Nicotine creates both psychological and physical addiction and it is one of the hardest addictions to break. Nicotine content in cigarettes has slowly increased over the years, making quitting smoking more and more difficult. Nicotine is also found in smokeless (chewing) tobacco and electronic cigarettes (vaping).

Figure \(\PageIndex{2}\): Electronic devices - large, medium, rechargeable and disposable - are now common ways to consume nicotine.[3]

Nicotine exposure can harm adolescent brain development by changing the way synapses form, which continues into the early to mid-20s. Using nicotine in adolescence may also increase risk for future addictions to other drugs. E-cigarette aerosol and cigarettes contain chemicals that are harmful to the lungs and chewing tobacco.

In many cases, people are able to get past the physical dependence, allowing them to quit using nicotine containing products at least temporarily. In the long run, however, the psychological enjoyment of smoking may lead to relapse.[4]

Depressants

In contrast to stimulants, which work to increase neural activity, a depressant slows down consciousness. A depressant is a psychoactive drug that reduces the activity of the CNS. Depressants are widely used as prescription medicines to relieve pain, to lower heart rate and respiration, and as anticonvulsants. The outcome of depressant use (similar to the effects of sleep) is a reduction in the transmission of impulses from the lower brain to the cortex (Csaky & Barnes, 1984).

Table \(\PageIndex{2}\): Depressants

Drug	Dangers and Side Effects	Psychological Dependence	Physical Dependence	Addiction Potential
Alcohol	Impaired judgment, loss of coordination, dizziness, nausea, and eventually a loss of consciousness	Moderate	Moderate	Moderate
Barbiturates and benzo-diazepines	Sluggishness, slowed speech, drowsiness, in severe cases, coma or death	Moderate	Moderate	Moderate
Toxic inhalants	Brain damage and death	High	High	High

A Closer Look at the Danger of Adolescent Alcohol Use

Alcohol is the most commonly used of the depressants and is a colorless liquid, produced by the fermentation of sugar or starch that is the intoxicating agent in fermented drinks. Alcohol is the oldest and most widely used drug of abuse in the world. In low to moderate doses, alcohol first acts to remove social inhibitions by slowing activity in the sympathetic nervous system. In higher doses, alcohol acts on the cerebellum to interfere with coordination and balance, producing the staggering gait of drunkenness. At high blood levels, further CNS depression leads to dizziness, nausea, and eventually a loss of consciousness. High enough blood levels such as those produced by “guzzling” large amounts of hard liquor at parties can be fatal. Alcohol is not a “safe” drug by any means.[5]

Short-Term Health Risks

Excessive alcohol use has immediate effects that increase the risk of many harmful health conditions. These are most often the result of binge drinking (drinking 4-5 drinks during a single occasion) and include the following:

• Injuries, such as motor vehicle crashes (1 in 5 teen drivers involved in fatal crashes had some alcohol in their system in 2010), falls, drownings, and burns.
• Violence, including homicide, suicide, sexual assault, and intimate partner violence.
• Alcohol poisoning, a medical emergency that results from high blood alcohol levels.
• Risky sexual behaviors, including unprotected sex or sex with multiple partners. These behaviors can result in unintended pregnancy or sexually transmitted diseases, including HIV.
• Miscarriage and stillbirth or fetal alcohol spectrum disorders (FASDs) among pregnant women.

Long-Term Health Risks

Over time, excessive alcohol use can lead to the development of chronic diseases and other serious problems including:

• High blood pressure, heart disease, stroke, liver disease, and digestive problems.
• Cancer of the breast, mouth, throat, esophagus, liver, and colon.
• Learning and memory problems, including dementia and poor school performance.
• Mental health problems, including depression and anxiety.
• Social problems, including lost productivity, family problems, and unemployment.
• Alcohol dependence, or alcoholism.[6]

Figure \(\PageIndex{3}\): Adolescent alcohol use poses many health risks.[7]

Opioids

Opioids are chemicals that increase activity in opioid receptor neurons in the brain and in the digestive system, producing euphoria, analgesia, slower breathing, and constipation. Their chemical makeup is similar to the endorphins, the neurotransmitters that serve as the body’s “natural pain reducers.” Natural opioids are derived from the opium poppy, which is widespread in Eurasia, but they can also be created synthetically.

Table \(\PageIndex{3}\): Opioids

Drug	Dangers and Side Effects	Psychological Dependence	Physical Dependence	Addiction Potential
Opium	Side effects include nausea, vomiting, tolerance, and addiction.	Moderate	Moderate	Moderate
Morphine	Restlessness, irritability, headache and body aches, tremors, nausea, vomiting, and severe abdominal pain	High	Moderate	Moderate
Heroin	All side effects of morphine but about twice as addictive as morphine	High	Moderate	High

Hallucinogens

The drugs that produce the most extreme alteration of consciousness are the hallucinogens, psychoactive drugs that alter sensation and perception and that may create hallucinations. The hallucinogens are frequently known as “psychedelics.” Drugs in this class include lysergic acid diethylamide (LSD, or “Acid”), mescaline, and phencyclidine (PCP), as well as a number of natural plants including cannabis (marijuana), peyote, and psilocybin. The hallucinogens may produce striking changes in perception through one or more of the senses. The precise effects a user experiences are a function not only of the drug itself but also of the user’s preexisting mental state and expectations of the drug experience. In large part, the user tends to get out of the experience what he or she brings to it. The hallucinations that may be experienced when taking these drugs are strikingly different from everyday experience and frequently are more similar to dreams than to everyday consciousness.

Table \(\PageIndex{4}\): Hallucinogens

Drug	Dangers and Side Effects	Psychological Dependence	Physical Dependence	Addiction Potential
Marijuana	Mild intoxication; enhanced perception	Low	Low	Low
LSD, mescaline, PCP, and peyote	Hallucinations; enhanced perception	Low	Low	Low

A Closer Look at the Danger of Adolescent Marijuana Use

Marijuana (cannabis) is the most widely used hallucinogen. Until it was banned in the United States under the Marijuana Tax Act of 1938, it was widely used for medical purposes. While medical and recreational marijuana is now legal in several American states, it is still banned under federal law, putting those states in conflict with the federal government. Marijuana also acts as a stimulant, producing giggling, laughing, and mild intoxication. It acts to enhance perception of sights, sounds, and smells, and may produce a sensation of time slowing down, and is much less likely to lead to antisocial acts than that other popular intoxicant, alcohol.

Using marijuana—can have harmful and long-lasting effects on an adolescent’s health and well-being.[8]

Marijuana and the teen brain

Unlike adults, the teen brain is actively developing and often will not be fully developed until the mid 20s. Marijuana use during this period may harm the developing teen brain.

• Negative effects include:
• Difficulty thinking and problem solving.
• Problems with memory and learning.
• Impaired coordination.
• Difficulty maintaining attention.

Figure \(\PageIndex{4}\): Marijuana is a commonly used hallucinogen and is often smoked by teens, but can also be eaten.[9]

Negative effects on school and social life

Marijuana use in adolescence or early adulthood can have a serious impact on an adolescent’s life.

• Decline in school performance. Students who smoke marijuana may get lower grades and may be more likely to drop out of high school than their peers who do not use.
• Increased risk of mental health issues. Marijuana use has been linked to a range of mental health problems in teens such as depression or anxiety. Psychosis has also been seen in teens at higher risk like those with a family history.
• Impaired driving. Driving while impaired by any substance, including marijuana, is dangerous. Marijuana negatively affects a number of skills required for safe driving, such as reaction time, coordination, and concentration.
• Potential for addiction. Research shows that about 1 in 6 teens who repeatedly use marijuana can become addicted, which means that they may make unsuccessful efforts to quit using marijuana or may give up important activities with friends and family in favor of using marijuana.

Psychoactive drug effects

In some cases, the effects of psychoactive drugs mimic other naturally occurring states of consciousness. For instance, sleeping pills are prescribed to create drowsiness, and benzodiazepines are prescribed to create a state of relaxation. In other cases psychoactive drugs are taken for recreational purposes with the goal of creating states of consciousness that are pleasurable or that help us escape our normal consciousness.

The use of psychoactive drugs, and especially those that are used illegally, has the potential to create very negative side effects. This does not mean that all drugs are dangerous, but rather that all drugs can be dangerous, particularly if they are used regularly over long periods of time. Psychoactive drugs create negative effects not so much through their initial use but through the continued use, accompanied by increasing doses, that ultimately may lead to drug abuse.

Substance Abuse

Many drugs create tolerance: an increase in the dose required to produce the same effect, which makes it necessary for the user to increase the dosage or the number of times per day that the drug is taken. As the use of the drug increases, the user may develop a dependence, defined as a need to use a drug or other substance regularly. Dependence can be psychological, in which the drug is desired and has become part of the everyday life of the user, but no serious physical effects result if the drug is not obtained; or physical, in which serious physical and mental effects appear when the drug is withdrawn. Cigarette smokers who try to quit, for example, experience physical withdrawal symptoms, such as becoming tired and irritable, as well as extreme psychological cravings to enjoy a cigarette in particular situations, such as after a meal or when they are with friends. Users may wish to stop using the drug, but when they reduce their dosage they experience withdrawal—negative experiences that accompany reducing or stopping drug use, including physical pain and other symptoms. When the user powerfully craves the drug and is driven to seek it out, over and over again, no matter what the physical, social, financial, and legal cost, we say that he or she has developed an addiction to the drug.

It is a common belief that addiction is an overwhelming, irresistibly powerful force, and that withdrawal from drugs is always an unbearably painful experience. But the reality is more complicated and in many cases less extreme. For one, even drugs that we do not generally think of as being addictive, such as caffeine, nicotine, and alcohol, can be very difficult to quit using, at least for some people. On the other hand, drugs that are normally associated with addiction, including amphetamines, cocaine, and heroin, do not immediately create addiction in their users. Even for a highly addictive drug like cocaine, only about 15% of users become addicted (Robinson & Berridge, 2003; Wagner & Anthony, 2002). Furthermore, the rate of addiction is lower for those who are taking drugs for medical reasons than for those who are using drugs recreationally. Patients who have become physically dependent on morphine administered during the course of medical treatment for a painful injury or disease are able to be rapidly weaned off the drug afterward, without becoming addicts.[10]

People have used, and often abused, psychoactive drugs for thousands of years. Perhaps this should not be surprising, because many people find using drugs to be enjoyable. Even when we know the potential costs of using drugs, we may engage in them anyway because the pleasures of using the drugs are occurring right now, whereas the potential costs are abstract and occur in the future.[11]

Attributions:

Child Growth and Development by Jennifer Paris, Antoinette Ricardo, and Dawn Rymond, 2019, is licensed under CC BY 4.0

[1] Beginning Psychology - Altering Consciousness With Psychoactive Drugs by Charles Stangor is licensed under CC BY-NC-SA 3.0

[2] Image by Find Rehab Centers is licensed under CC BY 2.0

[3] Image by the CDC is in the public domain

[4] Altering Consciousness With Psychoactive Drugs by The Open University of Hong Kong is licensed under CC BY-NC-SA 4.0

About Electronic Cigarettes (E-Cigarettes) by the CDC is in the public domain

Quick Facts on the Risks of E-cigarettes for Kids, Teens, and Young Adults by the CDC is in the public domain

[5] Altering Consciousness With Psychoactive Drugs by The Open University of Hong Kong is licensed under CC BY-NC-SA 4.0

[6] Teen Drinking and Driving by the CDC is in the public domain

Fact Sheets - Alcohol Use and Your Health by the CDC is in the public domain

[7] Image by Scott Air Force Base is in the public domain

[8] Altering Consciousness With Psychoactive Drugs by The Open University of Hong Kong is licensed under CC BY-NC-SA 4.0

What You Need to Know About Marijuana Use in Teens by the CDC is in the public domain

[9] Image by Cannabis Culture is licensed under CC BY 2.0

[10] Altering Consciousness With Psychoactive Drugs by The Open University of Hong Kong is licensed under CC BY-NC-SA 4.0

[11] Beginning Psychology - Altering Consciousness With Psychoactive Drugs by Charles Stangor is licensed under CC BY-NC-SA 3.0