Download Center for Development of Human Services

The Effects of Parental Alcohol and Drug Abuse on Children
Child Welfare Worker Handbook
Stephen Webster, Pharm.D. Candidate
University at Buffalo School of Pharmacy and Pharmaceutical Sciences
William A. Prescott Jr., Pharm.D.,
Clinical Assistant Professor
University at Buffalo School of Pharmacy and Pharmaceutical Sciences
James Brustman, CDHS Child Welfare Trainer
Phyllis Harris, CDHS UB Partnership Coordinator
William Rea, CDHS Child Welfare Trainer
David Peters, CDHS Senior Child Welfare Trainer
Funding for this research project was provided by NYS Office of Children and Family Services, Contract year
2005: Project 1044698, Award: 34851; Contract year 2006: Project 1052594, Award 38452, through the Center
for Development of Human Services, College Relations Group, Research Foundation of SUNY, Buffalo State
College.
© 2005-2006 CDHS/Research Foundation of SUNY/BSC College Relations Group
Table of Contents
Page(s)
Section
1
Introduction
2
Explanation of Terms
3-4
Frequently Asked Questions (FAQs)
5
Signs and Symptoms of Drug Intoxication and
Withdrawal
6-10
Commonly Abused Substances Quick Reference Chart
11
Alcohol
12
Cannabinoids
13
Cocaine / Crack
14
Dissociative Drugs
15
Ecstasy/MDMA
16
Hallucinogens
17
Heroin
18
Methamphetamine / Amphetamine
19-20
Prescription Analgesics / Opioids
21-22
Prescription Depressants
23
Family-related Consequences of Parental Substance Abuse
24
Website Resource Table
25-26
References
© 2005-2006 CDHS/Research Foundation of SUNY/BSC College Relations Group
Introduction
Overview: Child welfare workers are faced with decisions regarding the current safety of and
future risk to children. When parents are actively involved in the use of drugs and/or alcohol,
their behavior may cause the children to be in immediate danger of serious harm. Such
behavior may result in interventions that include removal of children from their home. In order
to strengthen decision making so that children are not being removed when they can remain at
home and that they are not being left in situations that leave them in danger of serious harm,
workers need to understand the behavioral and psychological aspects of drug/alcohol abuse.
When children have been placed in out of home care, caseworkers are required to pursue
diligent efforts to reunite the family. Under the Adoption and Safe Families Act (ASFA), child
welfare caseworkers are required to file for termination of parental rights if the children have
been in foster care for 15 of the past 22 months. As a result, caseworkers are making decisions
regarding family reunification fairly early in the treatment process, often after only 12 months
of foster care. If the risk to the children is high, parental rights may be terminated. However,
where risk can be reduced to acceptable levels, children may be returned home. In order to
better assess the risk presented by parents with alcohol and/or other drug abuse or addiction,
caseworkers can benefit from knowledge of the behavioral and physical changes that occur
during the treatment period.
Purpose: This handbook is designed for use by CDHS child welfare workers with the goal to
improve the quality and efficiency of child welfare interventions.
1
Explanation of Terms
Drug Abuse: The use of a drug that results in cognitive, physical, or emotional impairment and adverse
consequences.
Drug Addiction: Means that a drug user/abuser is unable to reduce the dose, discontinue using, or is unable to
remain abstinent from using a drug because the brain has become chemically dependent on the drug.
Psychological Drug Dependence: Refers to compulsive drug-using behavior in which a person uses a drug for
that’s drug’s effect, not necessarily due to a physical dependence, often in the face of known health risks.
Physical Drug Dependence: The physiological adaptation of the body to a drug when that drug is used for an
extended period of time, such that when use is abruptly discontinued, certain withdrawal symptoms appear.
Tolerance: The body's need for increasing amounts of a drug to attain the desired effect and avoid withdrawal.
Withdrawal: Symptoms that occur after the use of specific addictive drugs are reduced or discontinued. The
duration and type of withdrawal symptoms vary with the type of drug.
Relapse: The abuse of drugs and/or alcohol or the return of drug abusing behavior after a period of abstinence
or recovery planning.
Potentiation: Occurs when the combined action of two or more drugs is greater than the sum of the effects of
each drug taken alone.
Abused Child: A child less than eighteen years of age whose parent/caregiver inflicts or allows to be inflicted
upon such a child physical or emotional injury by other than accidental means, or creates or allows to be created
a substantial risk of physical or emotional injury to such a child by other than accidental means.
(see NYS law section 412)
Child Neglect: Failure to provide for a child’s basic needs. Neglect can be physical, educational, or emotional.
Neglect includes withholding of medically indicated treatment.
Child Maltreatment: An act or the failure to act on the part of a parent/caregiver that results in either death,
serious physical or emotional harm, sexual abuse or exploitation, or an imminent risk of serious harm to a child.
© 2005-2006 CDHS/Research Foundation of SUNY/BSC College Relations Group
Frequently Asked Questions
Why do individuals use mood-altering substances?
People start using illicit substances for a variety of reasons including but not limited to, depression, stress,
boredom, peer pressure, traumatic life experiences, and curiosity. These individuals may continue to use moodaltering substances as a result of addiction and physical dependence.
How quickly can someone become addicted to a drug?
If and how quickly someone may become addicted to a drug depends on many factors including a person’s
genetic make-up, the type of drug used, the dose of drug used, and the frequency of drug usage.
Why do some individuals become dependent/addicted and others not?
The likelihood that an individual user will advance to addiction is difficult to predict. Some people may
experiment with drugs and then stop, while others may continue to use. The genetic predisposition to
alcoholism has been well established, while genetic involvement with respect to addiction to other drugs has
been less well-defined.
Why does recovery from substance dependency/addiction vary from individual to individual?
The ability of an individual to recover from addiction is difficult to predict. While certain persons may remain
abstinent for life after a single treatment episode, others may experience a lifelong cycle of relapse and
treatment. The type of drug addiction may play a role as certain drug addictions may be more difficult to
overcome than others, namely drugs that lead to physical dependence as well as a psychological addiction.
Can individuals addicted to drugs quit without medical treatment?
A small proportion of persons addicted to drugs may be able to quit without medical treatment. However, those
addicted to drugs suffer from a compulsive drug craving and usage, and most often cannot quit by themselves.
Thus, treatment is generally necessary to end this compulsive behavior.
Are substance dependent parents more likely to abuse/neglect their children?
Research has demonstrated that compared with children in non-substance abusing households, children of
substance abusing parents are more likely to experience neglect or physical, sexual, or emotional abuse. A
parent’s inability to function in a parental role may be due to a disproportionate amount of time and money
spent acquiring and using drugs.
What dangers are posed to children residing near drugs of abuse?
The presence of drugs and drug paraphernalia (syringes, razors, etc.) in the household pose a significant risk to
children. Most illicit and prescription drugs are toxic when orally ingested, especially by a small child. The
effect on a small child could be fatal. Needles, syringes, and razor blades are types of drug paraphernalia that
pose another danger to children. Households involved in drug production place children at risk as well, as the
preparation of many drugs requires the use of highly volatile chemicals.
Are there effective treatments for all types of drug addiction?
All types of drug addiction can be effectively treated with behavioral-based therapies. Treatment will vary for
each person depending on the type of drug(s) being used, and multiple courses of treatment may be needed to
achieve success. Medications may assist in the recovery from physical dependence to certain.
© 2005-2006 CDHS/Research Foundation of SUNY/BSC College Relations Group
How can the risk of relapse be lessened?
Cognitive-behavioral therapy based on the theory that learning processes play a critical role in the development
of maladaptive behavioral patterns, is used to prevent relapse. The use of this therapy helps individuals to learn
to identify and correct problematic behaviors. Relapse prevention encompasses several cognitive-behavioral
strategies that facilitate abstinence as well as provide help for people who experience relapse. Prescription
medications may also be useful to help prevent relapse.
How does a family history of substance abuse affect children?
Substance abuse by any member places a burden on the household. A family history of substance abuse places
future generations at greater risk to develop substance abuse problems themselves.
Is it possible to be an effective parent while abusing drugs?
This question may be unanswerable. The central issue is that addiction to alcohol and other drugs can be a
chronic relapsing disorder. Recovery can be a long term process. At the same time, children have an
immediate need for a safe and stable home in which to live. Balancing these factors, as parents make sincere
efforts to provide safe and loving homes for their children, represents a key challenge for the child welfare field
and for judges making critical custody decisions.
© 2005-2006 CDHS/Research Foundation of SUNY/BSC College Relations Group
Signs and Symptoms of Drug Intoxication and Withdrawal
Note: These are only possible signs and symptoms of drug use. All signs and symptoms listed may have a variety of other causes.
Mood
Calm
Excited
Thought
Thought
Not Psychotic
Psychotic
Not Psychotic
Psychotic
Pupils
Pupils
Pupils
Pupils
Constricted
Constricted
Dilated
Dilated
1
2
3
4
Key: 1 = Opiate (Heroin) or Sedative (Benzodiazepine, Barbiturate) Intoxication
2 = Stimulant (Cocaine, Methamphetamine) Withdrawal
3 = Opiate (Heroin) or Sedative (Benzodiazepine, Barbiturate) Withdrawal
4 = Stimulant (Cocaine, Methamphetamine, Ecstasy), Hallucinogen (LSD), Dissociative (Ketamine, PCP) Intoxication
*
These are possible signs and symptoms of drug use, but all signs and symptoms listed may have a variety of other causes.
5
Commonly Abused Substances Quick Reference Chart
This reference can be used by CDHS trainers and child welfare workers when quick access to basic information
on commonly abused substances is needed.
Key: Bolded = Most common intoxicating effects
Italicized = Parenting implications
Cannabinoids
Abused
Substance
Street Names
Administered
Intoxication
Effects
Health Consequences
Hashish
boom, chronic,
gangster, hash,
hash oil, hemp
smoked
swallowed
euphoria; slowed
thinking and
reaction time;
confusion;
impaired balance
and coordination
Marijuana
blunt, dope,
ganja, grass,
herb, joint,
mary jane, pot,
reefer, weed
smoked
swallowed
cough, frequent
respiratory infections;
impaired memory and
learning; increased heart
rate; anxiety; panic
attacks; tolerance;
addiction
Hallucinogens
Abused
Substance
LSD
(lysergic acid
diethylamide)
Mescaline
Psilocybin
Street Names
Administered
acid, blotter,
boomers, cubes,
microdot, yellow
sunshines
buttons, cactus,
mesc, peyote
magic
mushroom,
shrooms
swallowed
absorbed through
mouth tissues
Intoxication
Effects
altered states of
perception and
feeling; nausea
swallowed
smoked
swallowed
6
Health
Consequences
flashbacks; paranoia
Also for LSD and
Mescaline:
increased heart rate,
blood pressure;
sleeplessness;
numbness; weakness;
tremors; persistent
mental disorders
Depressants
Abused Substance
Street Names
Administered
Intoxication
Effects
Health
Consequences
Barbiturates
barbs, reds,
red birds,
phennies,
tooies,
yellows,
yellow
jackets
candy,
downers,
sleeping
pills, tranks
injected
swallowed
sedation;
drowsiness;
dizziness;
reduced
anxiety; feeling
of well-being;
lowered
inhibitions;
slowed pulse
and breathing;
lowered blood
pressure; poor
concentration
fatigue;
confusion;
impaired
coordination,
memory,
judgment;
addiction;
respiratory
depression and
arrest, death
(Amytal,
Nembutal,
Seconal,
Phenobarb)
Benzodiazepines
(Ativanlorazepam,
Halciontemazepam,
Libriumchlordiazepoxide,
Valiumdiazepam,
Xanaxalprazolam)
Flunitrazepam
(Rohypnol)
GHB
(gammahydroxybutyrate)
forget-me
pill,
Mexican
Valium,
R2, Roche,
roofies,
roofinol,
rope,
rophies
G, Georgia
home boy,
grievous
bodily
harm,
liquid
ecstasy
injected
swallowed
swallowed
snorted
Also for
Barbiturates:
depression;
unusual
excitement; fever;
irritability; poor
judgment; slurred
speech; lifethreatening
withdrawal
Also for
Flunitrazepam:
visual and
gastrointestinal
disturbances;
urinary retention;
memory loss for
the time under the
drug's effects
swallowed
Also for GHB:
nausea/vomiting;
headache; loss of
consciousness;
loss of reflexes;
seizures; coma;
death
7
Opioids and Morphine Derivatives
Abused
Substance
Street
Names
Administered Intoxication
Effects
Health
Consequences
Codeine
Captain Cody,
schoolboy;
doors & fours,
loads,
pancakes and
syrup
Apache,
China girl,
China white,
dance fever,
friend,
goodfella,
jackpot,
murder 8,
TNT, Tango
and Cash
brown sugar,
dope, H,
horse, junk, ,
skunk, smack,
white horse
M, Miss
Emma,
monkey,
white stuff
injected
swallowed
nausea;
constipation;
confusion;
sedation;
respiratory
depression and
arrest; tolerance;
addiction;
unconsciousness;
coma; death
big O, black
stuff, gum
Hillbilly
heroin,
Kickers, Blue,
Oxy, O.C.,
Killer, Percs,
Percodoms
swallowed
smoked
injected
swallowed
snorted
(Robitussin AC, Tylenol w/
Codeine (#3
and #4)
Fentanyl
(Actiq,
Duragesic,
Sublimaze)
Heroin
Morphine
(Kadian, MS
Contin,
Roxanol)
Opium
Oxycodone
(Endocet,
Oxycontin,
Percocet,
Roxicet,
Roxicodone)
Hydrocodone
bitartrate
buccal
injected
smoked
snorted
transdermal
pain relief;
euphoria;
drowsiness
Also for
Codeine: less
analgesia;
sedation; and
respiratory
depression than
morphine
Also for
Heroin:
staggering gait
injected
smoked
snorted
injected
swallowed
smoked
Vike, Watson- swallowed
387
(Lorcet,
Norco, Lortab,
Vicodin)
8
Stimulants
Abused
Substance
Street
Names
Administered Intoxication Health
Effects
Consequences
Amphetamine
bennies,
black
beauties,
crosses,
hearts, LA
turnaround,
speed, truck
drivers,uppers
blow, bump,
C, candy,
Charlie, coke,
flake, rock,
snow, toot
Adam,
clarity, Eve,
lover's speed,
peace, STP,
X, XTC
chalk, crank,
crystal, fire,
glass, go fast,
ice, meth,
speed
JIF, MPH, Rball, Skippy,
the smart
drug, vitamin
R
injected
swallowed
smoked
snorted
(Biphetamine,
Dexedrine,
Adderall)
Cocaine/Crack
MDMA/Ectasy
(methylenedioxymethamphetamine)
Methamphetamine
(Desoxyn)
Methylphenidate
(Ritalin, Metadate)
Increased
heart rate;
blood
pressure;
metabolism;
feelings of
exhilaration,
energy;
increased
mental
alertness
irregular heart
beat; weight loss,
heart failure,
nervousness,
insomnia;
tolerance;
addiction
injected
swallowed
smoked
snorted
Also for
Cocaine:
increased
temperature
injected
swallowed
snorted
Also for
MDMA: mild
hallucinogenic
effects;
increased
tactile
sensitivity;
empathic
feelings
Also for
Cocaine: chest
pain; respiratory
failure; nausea;
strokes; seizures;
panic attacks
Also for
Amphetamine:
tremor; loss of
coordination;
Also for
panic; paranoia;
Amphetamine: impulsive
rapid
behavior;
breathing;
aggressiveness;
tremor
psychosis
injected
smoked
snorted
swallowed
Also for
Methamph:
aggression;
violence;
psychotic
behavior
9
Also for
MDMA:
impaired
memory and
learning,
cardiac, renal
and liver toxicity
Also for
Methamph:
memory loss;
cardiac and
neurological
damage;
impaired
memory and
learning
Dissociative Anesthetics
Abused
Substance
Street
Names
Administered Intoxication
Effects
Health
Consequences
Ketamine
cat Valiums,
K, Special K,
vitamin K
angel dust,
boat, hog,
love boat,
peace pill
injected
snorted
smoked
injected
swallowed
smoked
snorted
memory loss;
numbness;
nausea/vomiting
(Ketalar SV)
PCP and
analogs
(phencyclidine)
increased heart
rate and blood
pressure;
impaired motor
function
Also for
Ketamine:
delirium;
depression;
respiratory
depression and
arrest
Also for PCP:
Loss of appetite;
depression
Also for PCP:
possible
decrease in
blood pressure
and heart rate;
panic;
aggression;
violence
Inhalants
Abused
Substance
Street
Names
Administered Intoxication
Effects
Health
Consequences
Solvents
(paint thinners,
gasoline,
glues),
Gases
(butane,
propane,
aerosol
propellants,
nitrous oxide),
nitrites
(isoamyl,
isobutyl,
cyclohexyl)
laughing gas,
poppers,
snappers,
whippets
stimulation;
inhaled
through nose or loss of
inhibition;
mouth
headache;
nausea or
vomiting;
slurred speech;
loss of motor
coordination;
wheezing
unconsciousness;
cramps; weight
loss; muscle
weakness;
depression;
memory
impairment;
damage to
cardiovascular
and nervous
systems; sudden
death
10
Alcohol
Physiological Effects
Drowsiness
Slowed respiration
Slowed cognition
Decreased heart rate
Signs and Symptoms of Intoxication
Decreased blood pressure
Feeling of well-being
Decreased coordination
Decreased body temperature
Severe drowsiness
Confusion
Emotional blunting
Memory impairment
Slurred speech
Increased irritability
Severe respiratory depression
Aggression
Hypotension
Poor coordination
Decreased heart rate
Decreased body temperature
Complications of Abuse/Addiction
The most serious complication of alcohol abuse is addiction and physical dependence. Alcohol addiction can dominate a person’s life,
such that all aspects of everyday living become increasingly affected.
After many years of heavy alcohol abuse, the liver becomes damaged and full of scar tissue. Subsequently, a person may develop
liver cirrhosis, kidney damage, immune system impairment, gastric ulceration and cancer, heart disease, and high blood pressure.
When alcohol is abruptly discontinued in patients with a long history of abuse, severe withdrawal symptoms result. Alcohol
withdrawal is a serious medical condition, and can be life-threatening without medical supervision.
The combination of alcohol and other drugs can be extremely dangerous as alcohol may intensify the effects of other drugs.
Alcohol impairment can lead to a variety of mishaps that endanger the lives of the user/abuser and innocent bystanders. Within the
United States, alcohol is a major cause of traffic accidents and on-the-job injuries.
Withdrawal
Onset: A person with a long history of regular alcohol intake who abruptly discontinues or drastically reduces alcohol consumption
may experience withdrawal symptoms within 12 hours of their final drink. Major withdrawal symptoms peak between 24 and 72
hours after the last drink and last between 5 and 7 days.
Symptoms:
Alcohol craving
Paranoid delusions
Tremors
Pupil dilation
Agitation
Anxiety
Disorientation
Headache
Nausea
Vomiting
Diarrhea
Elevated blood pressure
Elevated body temperature
Elevated pulse
Increased respiration
Auditory hallucinations
Visual hallucinations
Seizures
Delirium tremens (DT’s)
Increased light sensitivity
Increased audio sensitivity
Severity: Alcohol withdrawal is one of the few withdrawal syndromes that has the potential to be life-threatening. Approximately
25% of people experiencing alcohol withdrawal will have seizures. Approximately 10% of people will experience hallucinations.
Delirium tremens, the most serious alcohol withdrawal syndrome, occurs in 5% of cases. It is characterized by hyperagitation,
disorientation, tremor, persistent hallucinations, and marked increases in heart and respiratory rates and blood pressure. Roughly 5%
of those experiencing Delirium tremens die from complications.
11
Cannabinoids
Includes:
Marijuana, Hashish
Physiological Effects:
Euphoric feeling
Increased anxiety
Altered sensation
Increased hunger
Signs and Symptoms of Intoxication
Increased heart rate
Drowsiness
Loss of time perception
Eye redness
Altered sensation
Intense hunger
Hallucinations
Poor judgment
Rapid heart beat
Euphoric feeling
Loss of time perception
Eye redness
Poor coordination
Poor reaction time
Anxiety/Confusion
Short-term memory impairment
Complications of Abuse/Addiction
Long-term cannabis use may lead to addiction in some people, and is usually limited to individuals who use the drug very frequently
over prolong periods of time. The use of cannabis becomes compulsory and often interferes with daily life. Long-time Cannabis
users report craving and withdrawal symptoms including irritability, difficulty sleeping, anxiety, and aggression. Ongoing research is
being conducted to determine if cannabis causes physical dependence.
The most serious effect of long-term cannabis use is the resulting cognitive symptoms; depression, anxiety, and personality
disturbances. Users may become withdrawn from relationships, and may lack motivation to perform school or job related activities.
Heavy cannabis use impairs the ability to form memories, recall events, and shift focus, sometimes making learning very difficult.
This impairment can last days to weeks following use.
The long-term physiological consequences of inhaling cannabis specifically include increased risk of lung infections, chronic cough,
bronchitis, emphysema, and lung cancer.
Another danger of cannabis use is that product bought on the street is often mixed with other dangerous substances, often times
without the knowledge of the buyer. These additives include but are not limited to codeine, cocaine, PCP, and formaldehyde. The
risks are those which are associated with these substances and may be found in their respective sections of this text.
There has been much discussion about cannabis being considered a “gateway drug”, meaning that after experimenting with cannabis, a
person is more likely to try “harder” drugs like cocaine or heroin. While it is true that frequent users of more intense illicit drugs also
have cannabis in their system, the correlation is open for interpretation. It is worth noting that approximately 50% of arrestees have
used cannabis within the past year.
Withdrawal
Long-term cannabis users can experience mild to moderate withdrawal symptoms when they abruptly stop using the drug. The
withdrawal symptoms include irritability, increased aggression, difficulty sleeping, decreased appetite, drug craving, and anxiety.
Peak severity of symptoms occurs approximately one week following the last use of the drug.
12
Cocaine/Crack
Physiological Effects
Signs and Symptoms of Intoxication
Increased blood pressure Increased heart rate
Dilated pupils
Increased alertness
Decreased appetite
Increased energy
Increased body temperature
Intense euphoria
Muscle twitches
Tremors
Increased energy
Increased irritability
Erratic and violent behavior
Paranoia
Increased alertness
Heavy sweating
Complications of Abuse/Addiction
As a result of the tolerance that develops to its euphoric effect, cocaine is often abused in a “binge and crash” pattern. While tolerance
to the euphoric effect occurs, repeated abusers actually become more sensitive to cocaine’s anesthetic and convulsant effects. For this
reason, abusers who frequently increase their doses to intensify and prolong their high, put themselves at tremendous risk for longterm detrimental effects and sudden death. The frequent use of high-dose cocaine ultimately leads to a state of heightened irritability,
restlessness and paranoia, which may result in a full-blown paranoid psychosis. Other long-term psychological effects of cocaine use
include addiction, mood disturbances, auditory hallucinations, and personality changes.
Long-term physiological effects of cocaine abuse include heart attacks, ventricular fibrillation, chest pain, respiratory failure, strokes,
seizures, abdominal pain, weight loss, loss of the sense of smell, and nosebleeds.
Taken in combination, cocaine and alcohol are converted by the body to cocaethylene, a more toxic substance which has a longer
duration of action. Cocaine and alcohol is the most common two-drug combination that results in drug-related death.
Additional complications of using cocaine intravenously include severe allergic reactions, and acquisition blood-born pathogens such
as HIV and hepatitis B hepatitis C through the sharing of contaminated drug paraphernalia and risky sexual behavior during drug use.
Withdrawal
Onset: The peak severity of cocaine-related withdrawal symptoms occur 1 to 3 days after the last administered dose. Mild
withdrawal symptoms may continue for approximately 2 weeks.
Symptoms:
Severe depression
Drug craving
Excessive eating
Paranoid delusions
Slowed motor response
Hypersomnia
Social withdrawal/Emotional blunting
Suicidal thoughts and behavior
Severity: Cocaine-withdrawal syndrome is similar to severe depression. The withdrawal symptoms are not life-threatening, but may
require hospitalization due to precipitating psychiatric disturbances.
13
Dissociative Drugs
Includes:
Phencyclidine (PCP), Ketamine, Dextromethorphan
Physiological Effects
Rapid breathing
Increased heart rate
Dizziness
Blurred vision
Signs and Symptoms of Intoxication
Increased blood pressure
Muscle contractions
Decreased sense of pain
Increased body temperature
Uncoordinated movements
Sensory detachment
Panic
Feelings of vulnerability
Hyperthermia
Disorientation
Euphoria
Hallucinations
Aggression
Feeling of increased strength
Dizziness
Suicidal thoughts
Complications of Abuse/Addiction
Long-term use of dissociative drugs can lead to addiction, in which a user’s priorities are shifted so that obtaining the drug becomes a
main goal of everyday life. Withdrawal symptoms precipitate if the drug use is abruptly discontinued.
Long-term abuse of dissociative drugs is associated with memory loss, numbness, and depression which can persist for up to a year
after drug use stops.
Withdrawal
Onset: The peak severity of dissociative drug-related withdrawal can occur days to weeks following the last administered dose.
Withdrawal symptoms can persist for months.
Symptoms:
Hyperactivity
Hyperreflexia
Agitation
Depression
Delusions
Memory loss
Increased pain threshold
Violent behavior
Increased blood pressure
Increased heart rate
Visual hallucinations
Auditory hallucinations
Severity: While dissociative drug-related withdrawal is not considered life-threatening, medical attention may be necessary because
of precipitating psychiatric disturbances.
14
Ecstasy/MDMA
Physiological Effects
Mental stimulation
Nausea
Sweating
Blurred vision
Increased energy
Signs and Symptoms of Intoxication
Decreased anxiety
Chills
Muscle cramping
Increased body temperature
Increased heart rate
Sense of well-being
Hypersexuality
Heavy sweating
Intense thirst
Decreased anxiety
Empathy towards others
Altered time perception
Enhanced sensory perception
Complications of Abuse/Addiction
Within hours of taking the drug, MDMA significantly reduces mental ability. These changes, particularly those affecting memory,
can last for up to a week and sometimes longer. MDMA impairs information processing, which is why performing skilled activities
such as driving an automobile under the influence of this drug is very dangerous.
Within days of taking MDMA, a person experiences negative behavioral effects because the brain has been significantly depleted of
the chemical serotonin. These negative behavioral effects include depression, anxiety, and agitation. Regular users of MDMA report
feeling a variety of emotions, sleep disturbances, memory loss, impulsiveness, aggression, lack of interest in sex, and decreased
appetite.
Long-term psychological effects of heavy MDMA use can result in increased incidences of confusion, depression, selective
impairment of working memory and attention processes, changes in cognition and motor function, and possibly addiction. Long-term
physiological effects of MDMA use include weight loss, and heart, kidney, and liver toxicity.
Recent studies have concluded that MDMA may be addictive for some people. Roughly 50% of MDMA users surveyed reportedly
met the criteria for dependence, as evidenced by withdrawal effects, tolerance, and continued use despite knowledge of physical or
psychological harm.
Withdrawal
Withdrawal from MDMA is controversial. It is nearly impossible to discern between symptoms related to withdrawal and those
attributed to neurologic damage caused by prolonged MDMA use. Chronic, heavy users of MDMA who abruptly discontinue use are
likely to have depressive symptoms similar to amphetamine and cocaine withdrawal.
15
Hallucinogens
Includes:
D-Lysergic Acid (LSD), Mescaline, Psilocybin
Physiological Effects
Dizziness
Dry mouth
Sweating
Nausea
Altered emotions
Pupil dilation
Signs and Symptoms of Intoxication
Loss of appetite
Increased blood pressure
Increased heart rate
Tremors
Altered senses
Increased body temperature
Emotional instability
Increased blood pressure
Euphoria
Sweating
Nausea
Anxiety
Pupil dilation
Increased heart rate
Violent outbursts
Hallucinations
Altered sensory perception
Dizziness
Tremors
Increased body temperature
Complications of Abuse/Addiction
Hallucinogen use is generally not considered to be habit forming. However, rapid tolerance does develop with repeated use of LSD,
necessitating dose increases to attain desired effects. LSD use also produces tolerance to mescaline and psilocybin as they each work
through similar mechanisms. The tolerance is of short duration and dissipates following several days of abstinence.
There are two serious long-term psychological effects of hallucinogen use that may occur after a single use. First, a person may
develop drug-related psychosis characterized by frequent mood swings and visual disturbances, an effect which can potentially persist
for years. Second, a user may develop hallucinogen persisting perception disorder (HPPD), better known as “flashbacks”, in which
the user experiences spontaneous recurrent episodes of sensory distortion similar to that which was originally caused by the
hallucinogen. The visual disturbances usually consist of halos or tails attached to moving objects.
Withdrawal
There is no withdrawal syndrome associated with hallucinogens.
16
Heroin
Physiological Effects
Signs and Symptoms of Intoxication
Pain relief
Decreased cardiac function
Intense euphoria
Spontaneous abortion
Decreased respiration
Alternating wakeful and drowsy states
Intense euphoric state
Pupil Constriction
Impaired mental function
Heavy-feeling extremities
Staggering gait
Dry mouth
Warm flushing of the skin
Nausea
Vomiting
Severe Itching
Alternating wakeful and drowsy states
Complications of Abuse/Addiction
The most ominous long-term effect of heroin use is addiction. Heroin produces profound degrees of tolerance and physical
dependence. Once addicted, the behavioral habits of a person become extremely altered, and their primary purpose in life becomes
seeking and using heroin, to the detriment of their personal health, family, and occupation. With physical dependence, the body
adapts to the presence of the drug, with the precipitation of withdrawal symptoms seen if the drug is abruptly removed.
The long-term physiological effects of heroin use include collapsed veins, bacterial infections of blood vessels and cardiac tissue, liver
and kidney disease, lung complications including pneumonia and tuberculosis, arthritis, and constipation.
Although purity levels are rapidly increasing, most street heroin is “cut” with other substances such as sugar, starch, quinine, and even
poisons like strychnine. Often times, heroin abusers do not know the purity of heroin they are using, increasing their risk for overdose
as well as complications from unknown additives.
Heroin abusers often share and reuse syringes and injection paraphernalia, and are therefore at increased risk of contracting bloodborn pathogens such as HIV and Hepatitis B and C. Injection drugs users represent 70-80% of all new Hepatitis C infections
worldwide.
Heroin abuse during pregnancy can lead to many adverse consequences to a fetus, including low birth weight and spontaneous
abortion.
Withdrawal
Onset: For chronic abusers, withdrawal symptoms may occur within a couple hours after the last administered dose. Major
withdrawal symptoms peak between 48 and 72 hours after the last dose and subside after 7 to 10 days.
Symptoms:
Drug craving
Nausea
Restlessness
Diarrhea
Cold flashes
Pupil dilation
Vomiting
Bone and muscle pain
Malaise
Insomnia
Severity: Heroin withdrawal resembles a severe case of influenza and is not considered life-threatening. Withdrawal symptoms
associated with Heroin are considered to be the most severe of all opioid-related substances.
17
Methamphetamine/Amphetamine
Physiological Effects
Increased attention
Increased blood pressure
Increased heart rate
Increased breathing rate
Increased body temperature
Signs and Symptoms of Intoxication
Decreased fatigue
Decreased appetite
Dry mouth
Dilated pupils
Increased energy
Heavy sweating
Chills
Hyper-sexuality
Heavy breathing
Intense irritability
Euphoria
Increased self-esteem and confidence
Paranoia
Complications of Abuse/Addiction
Methamphetamine, like many other stimulants, is used in a “binge and crash” pattern. Tolerance develops within minutes of
administration, leading to a decrease in pleasurable effects before a significant decrease in blood drug concentration occurs. As a
result, abusers may attempt to maintain the high by binging on the drug, leading to an increased risk of overdose. Overdose elevates
body temperatures to dangerous levels which can result in convulsions and death.
Long-term methamphetamine abuse results in many physiologic effects, including addiction psychosis, irreversible heart damage,
stroke, and weight loss. Chronic abusers exhibit symptoms that include violent behavior, anxiety, confusion, and insomnia. Heavy
users also show progressive social and occupational deterioration.
Chronic methamphetamine use has been associated with psychosis, most resembling paranoid schizophrenia. Visual and auditory
hallucinations, intense paranoia, mood disturbances, repetitive motor activity, and out-of-control rages that can be coupled with
extremely violent behavior are all symptoms of methamphetamine addiction psychosis.
Additional complications of using methamphetamine intravenously include the acquisition of blood-born pathogens such as HIV
and/or hepatitis B and C through the sharing of contaminated drug paraphernalia and risky sexual behavior during drug use.
Withdrawal
Onset: For chronic abusers, withdrawal symptoms may occur within hours of the last administered dose. Major withdrawal
symptoms peak between 48 and 72 hours after the last dose and subside after 5 to 7 days.
Symptoms:
Severe depression
Emotional blunting
Excessive eating
Paranoid delusions
Drug craving
Slowed motor response
Hypersomnia
Social withdrawal
Suicidal thoughts and behavior
Severity: Methamphetamine-withdrawal syndrome is similar to severe depression. The withdrawal symptoms are not lifethreatening, but may require hospitalization due to precipitating psychiatric disturbances. The severity of methamphetamine
withdrawal symptoms are relatively equivalent to those of cocaine-withdrawal syndrome.
18
Prescription Analgesics / Opioids
Includes (( ) = brand names, [ ] = main indication):
Opiates:
Semi-synthetic Opioids:
Synthetic Opioids:
Codeine (Robitussin A-C, Tylenol #3 & #4) [suppress cough, pain]
Morphine (Avinza, Kadian, MS Contin, Roxinol) [pain]
Hydrocodone (Lorcet, Lortab, Norco, Vicodin, Vicoprofen) [pain]
Hydromorphone (Dilaudid) [pain]
Oxycodone (Endocet, Oxycontin, Percocet, Roxicet) [pain]
Buprenorphine (Subutex) [pain]
Buprenorphine/Naloxone (Suboxone)[narcotic addiction treatment]
Diphenoxylate (Lomotil) [diarrhea]
Fentanyl (Actiq, Duragesic) [pain]
LAAM [narcotic addiction treatment]
Loperamide (Imodium) [diarrhea]
Meperidine (Demerol) [pain]
Methadone (Methadose) [narcotic addiction treatment, pain]
Pentazocine/Naloxone (Talwin Nx) [pain]
Propoxyphene (Darvocet, Darvon) [pain]
Tramadol (Ultram, Ultracet) [pain]
Physiological Effects
Pain relief
Pupil Constriction
Vomiting
Euphoric feeling
Confusion
Signs and Symptoms of Intoxication
Drowsiness
Flushing
Nausea
Decreased body temperature
Decreased respiration
Decreased respiration
Hypothermia
Drowsiness
Vomiting
Confusion
Pupil constriction
Euphoria
Warm flushing of the skin
Dry mouth
Itching
Complications of Abuse/Addiction
When taken as directed and used over a short period of time, opioids rarely cause long-term problems. However, when opioids are
legitimately used for long periods of time or illegally abused, complications are common. The most severe complication of long-term
opioid use is physical dependence and addiction. The physical dependence leads to withdrawal symptoms if the drug is abruptly
discontinued. Consequently, patients in a clinical setting are tapered off of opiates or given medications to decrease their withdrawal
symptoms.
Addiction leads to a compulsive psychological urge to use the offending drug. Overtime, a person’s behavior changes, more time and
energy is placed of obtaining the drug, and the addiction will ultimately dominate the person’s life, to the detriment of their health,
family, and occupation.
Tolerance is another complication of long-term opioid use. With long-term use, the dose must be increased to obtain the same pain
relief, euphoria, and sedation. Increasing doses of opioids can lead to severe constipation and progress to bowel obstruction.
The long-term physiological effects of opioid use include confusion, constipation, and immune system impairment.
Use of opioids with alcohol and/or other depressant drugs can have serious implications; rapid respiratory failure, coma, and death.
Withdrawal
Onset: For chronic abusers, withdrawal symptoms may occur within a day of the last administered dose. . Major withdrawal
symptoms peak 48 to 96 hours after the last dose and may persist for more than 14 days.
19
Symptoms:
Drug craving
Nausea
Restlessness
Diarrhea
Cold flashes
Pupil dilation
Vomiting
Bone and muscle pain
Malaise
Insomnia
Severity: Opioid withdrawal resembles a severe case of influenza and is not considered life-threatening. Withdrawal symptoms
related to prescription opioids are longer lasting but are considered to be less severe compared with those related to heroin withdrawal.
20
Prescription Depressants
Includes (( ) = brand name):
Barbiturates
Short/Intermediate-acting
Amobarbital (Amyta)
Butalbital (Fiorinal)
Pentobarbital (Nembutal)
Secobarbital (Seconal)
Long-acting
Mephobarbital (Mebaral)
Phenobarbital (Luminal)
Benzodiazepines
Short-acting
Alprazolam (Xanax)
Lorazepam (Ativan)
Oxazepam (Serax)
Temazepam (Restoril)
Triazolam (Halcion)
Long-acting
Chlordiazepoxide (Librium)
Clonazepam (Klonopin)
Clorazepate (Tranxene)
Diazepam (Valium)
Flurazapam (Dalmane)
Physiological Effects
Slowed respiration
Decreased heart rate
Drowsiness
Pupil constriction
Non-Benzodiazepine Sleep Aids
Eszopiclone (Lunesta)
Zaleplon (Sonata)
Zolpidem (Ambien)
Signs and Symptoms of Intoxication
Decreased blood pressure
Feeling of well-being
Slowed muscle response
Dizziness
Severe drowsiness
Confusion
Emotional blunting
Memory impairment
Slurred speech
Fever
Severe respiratory depression
Aggression
Hypotension
Poor coordination
Decreased heart rate
Increased irritability
Complications of Abuse/Addiction
Depressants can be effectively used short-term to relieve a variety of symptoms. However, long-term use of depressants causes a
multitude of complications, the most serious of which is addiction and physical dependence. When physical dependence develops, the
abrupt discontinuation of a drug precipitates withdrawal symptoms. While withdrawal from benzodiazepines and new sleep aids can
be symptomatically problematic, withdrawal from barbiturates can be fatal.
Tolerance is the second most important consequence of long-term depressant use. All depressants result in tolerance, some more
rapidly than others. As tolerance develops to barbiturates, the margin of safety between the effective dose and the lethal dose becomes
very narrow. Benzodiazepines rarely retain efficacy after continual use over four to six months, and therapy is often continued solely
to suppress withdrawal symptoms.
Depressants are rarely the sole drug of abuse. Benzodiazepines are used to enhance the euphoric effects of opioids like methadone, to
alleviate withdrawal symptoms of alcohol dependence, or to counteract abstinence syndromes between heroin “fixes”. Thus,
benzodiazepine abuse is very common in those who abuse alcohol and opioids. The mixing of depressants and alcohol is very
dangerous. The cocktail of barbiturates and alcohol is particularly dangerous, and may lead to rapid respiratory collapse, coma, and
possibly death.
Withdrawal
Onset: Long-term benzodiazepine or barbiturate use is associated with acute withdrawal symptoms that precipitate within 24 hours
following the last administered dose. For short-acting depressants, major withdrawal symptoms peak 2 to 4 days following the last
administered dose and last for approximately 7 days. For long-acting depressants, major withdrawal symptoms peak 4 to 7 days
following the last dose and last for approximately 2 weeks.
Symptoms:
Depression
Paranoid delusions
Elevated blood pressure
Elevated body temperature
21
Tremors
Pupil dilation
Agitation
Anxiety
Disorientation
Headache
Nausea
Sleep disturbances
Convulsions
Elevated pulse
Increased respiration
Auditory hallucinations
Visual hallucinations
Seizures
Delirium tremens
Muscular weakness
Increased light sensitivity
Increased audio sensitivity
Severity: Depressant-withdrawal syndrome resembles stimulant intoxication. Barbiturate withdrawal is more severe than
benzodiazepine withdrawal, but both are potentially life-threatening. Seizures, hallucinations, and delirium tremens are possible
serious symptoms of both barbiturate and benzodiazepine withdrawal.
22
Family-related Consequences of Parental Substance Abuse
Parental substance abuse may lead to a variety of detrimental outcomes including poor parental and family functioning. It
may also have a wide range of effects on children including an increased incidence of attention deficit hyperactivity disorder (ADHD),
oppositional defiant disorder (ODD), and other conduct disorders. The following list details possible family-related consequences of
parental substance abuse and in no way is an all-inclusive list.
Parental Effect
Effect on the Family
Effect on the Child






















Alcohol Abuse
Decreased parental monitoring
Poor problem-solving ability
Increased incidence of aggression
Less emotional sensitivity
Lower positive engagement with the child
Antisocial behavior including child
avoidance
Poor intellectual stimulation of the child
Negative parent/child relationship
Poor family functioning
Increased levels of conflict
Poor communication
Increased incidence of domestic violence
Unpredictable home life
Poor organization, including cleaning,
timeliness, planning
Increased incidence of physical, sexual,
and verbal abuse
Increased risk of neglect
Increased risk to develop alcoholism
Increased incidence of disruptive
behavior problems
Increased incidence of low self-esteem,
depression, aggression, and anxiety
Increased risk of developing psychiatric
disorders
Increased incidence of impaired cognitive
and verbal skills
Poor school performance



Illicit Drug Abuse
Increased parental stress
Poor and inconsistent family management
Increased incidence of aggression
Increased incidence of child neglect
versus child abuse
Ineffective socialization and discipline
Negative parent/child relationship
Increased incidence of child abandonment






Poor family functioning
Increased levels of conflict
Poor communication
Increased incidence of domestic violence
Unpredictable home life
Poor organization

Increased incidence of physical, sexual,
and verbal abuse
Increased risk of neglect
Increased risk of early drug and alcohol
abuse
Increased incidence of emotional
disorders including chemical dependence,
eating disorders, depression, anxiety,
aggression, suicidal behavior, phobias,
low self-esteem
Increased incidence of disruptive
behavior disorders
Increased incidence of physical problems
including asthma, hypertension,
headaches, and allergies
Increased incidence of learning
disabilities



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

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


23
Website Resource Table
Organization Name
National Institute on
Drug Abuse
Website Address
http://www.nida.nih.gov/
National Institute on
Drug Abuse
http://www.clubdrugs.gov/
National Institute on
Drug Abuse
http://www.marijuana-info.org/
National Institute on
Drug Abuse
http://inhalants.drugabuse.gov/
Office of National Drug
Control Policy
http://www.whitehousedrugpolicy.
gov/index.html
National Institute on
Alcohol Abuse and
Alcoholism
National Association for
Children of Alcoholics
http://www.niaaa.nih.gov/
U.S. Department of
Health and Social
Services
http://www.health.org/
U.S. Drug Enforcement
Administration
http://www.usdoj.gov/dea/
http://www.nacoa.net/
24
Description
This website provides general information on all illicit
drugs, including a brief description of how the drug is
abused, street names, effects, statistics, and treatment
options. The website provides links that cater to different
groups including parents and teachers, researchers and
health professionals, even young adults and students. The
website covers important topics like drug use trends,
medical consequences of drug abuse, and also the linkage of
stress and drug abuse.
This website is a branch off of the NIDA website and
provides specific information on Ecstasy, GHB, Rohypnol,
Ketamine, Methamphetamine, and LSD; the “Club Drugs”.
The information provided includes statistics and trends,
effects, updated research reports.
This website is a branch off of the NIDA website and
provides specific information on Marijuana. The
information provided includes statistics and trends, effects,
updated research reports, and facts for parents.
This website is a branch off of the NIDA website and
provides specific information on inhalant abuse. The
information provided includes statistics and trends, effects,
updated research reports, and press releases.
This website provides a variety of information on all types
of illicit drugs; including background, effects, prevalence
estimates, availability, treatment, legislation, enforcement,
and consequences of use. The website also provides links to
state and local resources that give a regional perspective on
drug use and abuse. This website has the ability to focus on
a specific city and view local trends of abuse, city initiatives,
federal funding, drug trafficking and seizure statistics,
emergency department episodes and deaths associated with
each illicit drug. The website also provides a link to an
overview of Drug Endangered Children (DEC) programs.
This website provides a variety of information on alcohol
abuse and alcoholism; including frequently asked questions,
news releases, and links to research databases.
The website provides research information, information for
healthcare professionals, and press releases pertaining to
children of alcoholics. The website also provides many
links, including those to government agencies and family
support websites.
The website provides a vast amount of information catering
to variety of groups. There is information for families,
youth, schools, work place, community, researchers, and
healthcare professionals. This website also has multimedia
resources including a library of informative web casts.
The website provides information on all types of illicit drugs
and even prescription drugs; including background, effects,
street names, and availability. The website also has a vast
amount of legal information on consequences of drug abuse.
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