A word about alcohol and stimulant use…

Alcohol is one of the most commonly abused drugs. A central nervous system (CNS) depressant, ethyl alcohol (ethanol) is the result of fermentation. Because it is a ‘natural’ substance, people may be inclined to see alcohol as relatively benign (insofar as drugs go), thereby underestimating the negative consequences of both immediate and chronic, long-term use. Many users employ alcohol as a means to reduce anxiety and enhance sociability, and alcohol’s initial inhibitory effect on brain communication can induce relaxation, easy amusement, and risk-taking behavior. Although alcohol can be initially stimulating, with increasing consumption comes intoxication and its attendant deterioration of reflexes and coordination, nausea, and vomiting. Risk of coma and lethal cardiovascular and respiratory depression accompany blood alcohol levels of .3 mg/dL and above. Alcohol’s primary byproduct via liver metabolism is acetaldehyde, a carcinogen. Alcohol interferes with sleep cycles and sexual libido and functioning, and long-term immoderate consumption can lead to fatty liver disease and cirrhosis, alcoholic hepatitis, and alcoholic pancreatitis. Individuals who consume alcohol specifically for its inhibitory and intoxicating effects may choose to consume more alcohol per hour than their body can metabolize (given their gender, stature, and body weight), may be prone to binge drinking, and may choose to consume alcohol without eating in order to maximize absorption (Lewis, 2014).

CNS stimulants provide very different effects to their users, ranging from increased feelings of well-being to euphoria, along with enhanced energy levels and mental focus. These desirable effects may also be accompanied by dangerous increases in heart rate and respiration, elevated blood pressure, anorexia, and insomnia. These side effects are magnified in overdose, and are likely to be accompanied by extreme agitation, hallucinations, hyperthermia, and cardiac arrhythmia, carrying the potential for stroke and myocardial infarction. As stimulants are metabolized, the desired effects wane, with the result that users experience their antithesis: Depressed mood, irritability, apathy, and malaise. This inevitable cycle can drive chronic users to increase their dosage or dosing frequency. Licit psychostimulants prescribed for the treatment of Attention Deficit Hyperactivity Disorder (ADHD) (e.g. Adderall, Ritalin) carry not insubstantial risk of abuse and dependence, are prone to misuse among adolescents and adults under health care providers’ supervision, and are increasingly diverted, primarily to adults who seek the cognitive enhancing effects of these stimulants, their utility as an appetite suppressant, and for recreational purposes to potentiate or modify the effects of one or more other substances, notably alcohol (Kaye, Dark, & Torok, 2014; Lewis, 2014).

The combination of alcohol with psychostimulants severely compromises higher order thinking, significantly impairs psychomotor function, and exacerbates the risk of myocardial infarction. Further, combined use has been shown to promote greater alcohol consumption, as psychostimulants buffer the effects of intoxication and thereby blunt awareness of how much alcohol is being consumed. Users seeking to augment licit psychostimulant effects — by bypassing first-pass metabolism — may elect to pulverize the tablets and snort them, or dissolve and inject them (Altobaiti & Sari, 2016). The combination of licit (and illicit) psychostimulants with alcohol is gaining in popularity, particularly among educated and employed young adults, whose use of licit psychostimulants in order to boost their work and school performance finds new value as a recreational activity among a new generation of upwardly mobile ‘ravers’ (Jenkinson, Jolley, & Dietze, 2014).

The most casual recreational use of a substance with legitimate medical use can, of course, evolve into dependence, and CNS stimulants carry significant risk. Substance abuse, regardless of the substance or substances in question, wreaks havoc on individuals and those closest to them. Copello, Templeton, and Powell (2010) discuss what they term, the ‘ripple effect’ of substance abuse and dependence — the cascade of negative consequences that addiction imposes upon non-addicted family members who quite often serve as a primary social resource and who fulfill a caregiving — and possibly caretaking — role. Family members’ emotional, physical, social, and economic contribution to caring for an addicted relative comes at high cost to themselves. Sleep deprivation, depression and anxiety, harassment and shunning, loss of work hours or employment, postponement of career and educational goals, homelessness, becoming the victim of crime, and general self-neglect are just a few of these associated costs.

It is important, therefore, to consider substance abuse and dependence for its impacts on the individual and beyond, and judge the implications of public, governmental, and legal/judicial policies and mental health and substance abuse treatment access in light of current substance use trends and their societal costs. Polysubstance use is increasingly common as individuals chase the hope of achieving emotional, cognitive, and physical effects reminiscent of their first experiences with a drug or drug combination. No individual suffers alone, and the burden borne by families and communities is sufficient argument in favor of a comprehensive response, one involving education, treatment, and recovery support, including addressing systemic factors that encourage drug abuse and impede recovery. Alcohol is ubiquitous in our culture and is readily abused. (And Prohibition was not successful.) Some of alcohol’s most striking effects are immediate. Licit CNS stimulants are a great advantage to individuals managing ADHD, and so should remain available, despite the fact they are increasingly the subject of drug diversion. In combination with alcohol, CNS stimulants can be deadly. Rather than select one or the other of these drugs as worthy of greater concern, perhaps the best investment lies in education.

References

Althobaiti, Y. S., & Sari, Y. (2016). Alcohol interactions with psychostimulants: An overview of animal and human studies. Journal of Addiction Research & Therapy, 7(3), 281. http://doi.org/10.4172/2155-6105.1000281

Copello, A., Templeton, L., & Powell, J. (2010). The impact of addiction on the family: Estimates of prevalence and costs. Drugs: Education, Prevention & Policy, 1763-74. doi:10.3109/09687637.2010.514798

Jenkinson, R., Jolley, D., & Dietze, P. (2014). ‘Weekend on the town’: Discrete sessions of drug use for a sample of young psychostimulant users. Drug and Alcohol Review, 33(4), 428-435. doi:10.1111/dar.12168

Kaye, S., Darke, S., & Torok, M. (2014). Diversion and misuse of pharmaceutical stimulants among illicit drug users. Addiction Research & Theory, 22(2), 109-116. doi:10.3109/16066359.2013.779677

Lewis, T. F. (2014). Substance abuse and addiction treatment: Practical application of counseling theory. Upper Saddle River, NJ: Pearson.

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