Rehabilitation (rehab) is the stage of treatment that offers the opportunity to develop positive motivation for recovery; stabilize health status through longer-term withdrawal symptoms, using medications if needed; learn skills for stopping drug and alcohol use and avoiding relapse; gain positive incentives to encourage participation in both treatment and follow-up programs in rehab and earn new ways of dealing with family and friends. Rehabilitation centers may be residential, outpatient, therapeutic communities, long- or short-term, or support groups. Detoxification from many drugs can be accomplished fairly quickly, and with the help of medication, but the psychological dependence is so strong that longer treatment is needed for lasting recovery.
All programs—residential and outpatient—have group and individual counseling. Many now offer medications for addiction and psychiatric problems and help patients become aware of “Post Acute Withdrawal Syndrome” (PAWS) that may disturb patients during the first year or so of recovery. The programs are designed to provide structure in their curriculum, trained and supervised therapists and counselors, individualized treatment planning, and monitoring for any
alcohol and drug use during
rehab treatment. Treatment programs arrange for continuing and follow-up care after discharge (many state agencies require rehabilitation programs to do this). The more thorough programs offer social services to help gain better employment, deal with pending legal problems, improve parenting and marital relationships, and even obtain drug-free housing.
Virtually all current research shows that a combination of treatments, with pharmaceutical support as necessary and professional counseling plus follow-up connection with support groups, works the best and for the longest time. Remember how the disease is described as “mental, physical, and spiritual”? These all things are dealed at
alcohol and drug rehab. The treatments have to cover all those aspects: physical detox alone, medication alone, psychotherapy alone, or spiritual energy gained from religious experiences or support- group fellowships alone aren’t as effective as the interaction of all those ingredients.
Stimulants take many forms. Dexedrine and methamphetamine, also known as crystal, crank, and speed, increase alertness and physical activity and so are called uppers. Heart and breathing rates and blood pressure go up, as does a sense of energy. Pupils dilate and appetite decreases. They have nicknames such as ups, copilots, and bumble bees. Taken orally, injected, snorted, or smoked, stimulants are also often in the form of pills, sometimes prescribed (see Prescription Drugs section below). Uppers can cause sweating, dry mouth, blurred vision, insomnia, loss of appetite, and dizziness. Users can feel restless, anxious, and have a false sense of power. Uppers also cause increased blood pressure and convulsions, and over a longer term they can cause overaggressive behavior, depression, and paranoia.
Methamphetamine is the most commonly abused amphetamine, in part because it is so easy to manufacture that its off-the-shelf ingredients have now been restricted. Called, among other nicknames, speed, white cross, or glass, it is taken orally, injected, snorted, or smoked. Meth has effects similar to any other amphetamine, but usually more intense. The addiction can be more powerful too. Delusions include “formication,” the feeling that the skin is crawling with bugs.
Cocaine and crack are stimulants that are extremely addictive and produce intense euphoria. A powerfully addictive stimulant, cocaine directly affects the brain, causing quick highs and triggering intense cravings. Since the high these drugs produce is short-lived, users typically use repeatedly. They are often taken to “level off” the effects of downers, and to allow drinkers to consume increased quantities for long periods. One of the oldest known drugs, pure cocaine is extracted from the leaves of the coca plant, the Erythroxylon bush, which grows primarily in Peru and Bolivia. It is powdered and usually mixed with other substances.
Coca leaves have been ingested for thousands of years, and the pure chemical—cocaine hydrochloride—has been an abused substance for more than a century. The hydrochloride salt, or powdered form of cocaine, can be taken intranasally, or through the nose (“snorted”), or when dissolved in water can be injected. On the street it may be diluted with such substances as cornstarch, talcum powder, sugar, or with such active drugs as the anesthetic procaine or stimulants like amphetamines.
Short-term effects include increased heart rate, blood pressure, and metabolism; feelings of exhilaration, energy, increased mental alertness, and increased temperature. Once used widely as medication, it is still used as specialized anesthetic and high-altitude remedy in mountainous countries. Its abuse or continued use produces insomnia, hyperactivity, anxiousness, agitation, and malnutrition. Overdoses can be lethal, often from heart attacks.
Freebase refers to a compound that has not been neutralized by an acid to make the hydrochloride salt.
Crack is the street name given to the freebase form of cocaine that has been processed into a smokable substance. The term crack refers to the crackling sound heard when the mixture is smoked. Because crack is smoked, the user experiences an immediate high. This fact and the relatively low cost of the drug made it popular, but addiction is extremely powerful and triggers almost constant use, so long-term costs are high and withdrawal difficult. Smoking crack cocaine can produce a particularly aggressive paranoid behavior in users. In addition, it carries the same risks as any kind of smoking.
The duration of cocaine’s immediate “upper” effects is short, and the faster the absorption, the more intense the high. Snorting it may create a 30-minute high; smoking, a five- or 10-minute one. Long-term effects include rapid or irregular heartbeat, reduced appetite, weight loss, heart failure, chest pain, respiratory failure, nausea, abdominal pain, stroke, seizure, headache, and malnutrition. Because it can severely inhibit the brain’s production of dopamine, long-term cocaine use can cause serious depression.
Marijuana, or cannabis, has been used as a psychoactive substance since prehistoric times, whether smoked, eaten, or used as tea. It is considered a “quasi-psychedelic” because it is not strictly a hallucinogen but provides hallucinatory effects to some users. Because of those cases, it has often been made part of spiritual practices. The main active chemical is delta-9-tetrahydrocannabinol, abbreviated THC, which triggers brain cells to release the chemical dopamine. Marijuana is the dried leaves and flower tops of the cannabis hemp plant, grown throughout the world. “Pot” is a common nickname for marijuana. In fact, there are hundreds of slang terms for marijuana, including ganja, weed, grass, herb, Mary Jane, gangster, and sinsemilla. Hashish is a stronger version of marijuana, made from concentrated resins of the cannabis plant and smoked as cigarettes or in pipes called bongs. While widely used, it is an illegal controlled substance in most parts of the world.
Marijuana makes people feel high because of its effect on dopamine levels, but the drug is characterized more as a hallucinogen because it can create varieties of hallucinations. Marijuana’s effects on the user depend on its strength, related to the amount of THC it contains. The THC content of marijuana has been increasing since the 1970s, so what was once considered a mild substance now has more potentially ill effects. Short-term effects include euphoria, slowed thinking and reaction time, confusion, and impaired balance and coordination. Longer-term effects can include memory and learning problems, distorted perception, and difficulty thinking. Cannabis can cause physical dependence and withdrawal symptoms.
Probably the oldest psychoactive substance around, with evidence of use for at least 10,000 years, starting in the Stone Age, alcohol is also available in the widest variety of forms. A chemical called ethanol is the basis of alcoholic substances, which is made through simple processes of fermenting or distilling sugar-based products.
Strength and flavors depend on the process and the products used. Fermentation, or the chemical breakdown of agricultural products like grains, fruits, and vegetables, produces wine and beer. Distillation—the purification by evaporation and condensation—of those products makes hard liquor. Beer, wine, liquor, coolers, and malt liquor are all forms of alcohol. Even some nonalcoholic products actually contain small percentages of alcohol, such as ice cream. Ethanol is also present in a wide variety of products, including mouthwash, toothpaste, cough syrup, prescription drugs, and many foods.
Taken orally, alcohol is characterized as a depressant, although it may seem to have stimulant or “upper” qualities. Users feel high because the inhibitions and judgment sections of the brain are depressed. Alcohol also seems to stimulate blood flow, causing flushing, because it relaxes the passages of the circulatory system. After an initial high, users often experience depression.
Other short-term effects include dizziness, slurred speech, disturbed sleep, impaired motor skills, nausea, and sometimes violence. High doses can lead to respiratory depression and death. Blackouts frequently occur during drinking episodes—a kind of amnesia during which drinkers may act normal but not be conscious of their behavior. Hangovers—sick feelings following drinking episodes—are common. Over the long term, alcohol ingestion can lead to learning impairments and addiction (alcoholism).
Drugs are categorized according to the effects they have: stimulants, depressants, narcotics, and hallucinogens. Stimulants speed up the activities of the brain, producing feelings of well being and alertness. Depressants slow down activities of the brain, producing a sedating effect. Narcotics alleviate pain and affect the brain’s pleasure-control center, causing feelings of well-being. Hallucinogens cause hallucinations, or distortions in the perception of reality, and produce a sense of detachment from reality. Different as their specific effects are, all substances of abuse share one characteristic in common, in addition to their addictive nature: Almost any drug taken for one effect will end up having the opposite. “It’s like backlash—you use cocaine [a stimulant] to get high and then you get depressed,” as one addict puts it. And as addictive substances, each of those drugs requires increasing amounts to achieve the same result.
