3. Stimulants
Students studying long hours, athletes
who think their performance can improve
from drugs, and workers who want
to stay awake on the job often use
stimulants. Amphetamines and caffeine
are stimulants used primarily to
delay the onset of mental and physical
fatigue.
Stimulants enhance brain activity,
causing the following effects:
-
Increase
in alertness, attention, and energy
-
Elevated
blood pressure
-
Increased heart
rate and respiration
The drug compounds of stimulants are
often found in diet pills which,
if misused, can lead to anorexia nervosa.
Anorexia
nervosa is a pathological
loss of appetite thought to be psychological
in origin. Anorexia nervosa is manifested
in extreme dieting and excessive thinness.
Caffeine is also found in many beverages,
pain medications, and allergy and cold
remedies. From a strong stimulant such
as cocaine to nicotine in cigarettes
and caffeine in coffee and cola drinks,
stimulants are an intimate part of
our lives.
Some stimulants that may be prescribed
include:
-
Dexedrine® (dextroamphetamine)
-
Ritalin® (methylphenidate)
-
Adderall® (d-amphetamine
and amphetamine mixture)
Originally, stimulants were used in
treatment of asthma and other respiratory
problems, obesity, neurological disorders,
and many other illnesses. However,
they were prescribed less and less
as addiction and abuse emerged as dangers
of stimulants.
Currently, physicians prescribe stimulants
in treatment of only a few health conditions
such as narcolepsy, attention-deficit
hyperactivity disorder (ADHD), and
depression that has not responded to
other treatments. Stimulants also provide
suppression of appetite for short-term
treatment of obesity. Stimulants are
also sometimes used in treatment of
asthma.
Unusually high doses or excessive
use of stimulants over long periods
of time can lead to:
How Stimulants Work
Stimulants contain chemical structures
that are like the neurotransmitters
called monoamines, which are found
in the brain. Theses monoamines include
norepinephrine and dopamine. Stimulants
work by increasing the amount of
these neurotransmitters. The increased
neurotransmitters in turn lead to:
-
Increased
blood pressure and heart rate
-
Constricted
blood vessels
-
Increased blood
glucose
-
Expanded pathways
of the respiratory system
-
Released
dopamine producing euphoric feeling
Dangers of Stimulant Abuse
Although stimulant use is not characterized
by physical dependence and risky
withdrawal, stimulant abuse can be
dangerous. Sometimes users turn to
stimulants compulsively, similar
to an addiction. Taking high doses
of some stimulants over a short time
can lead to hostility and paranoia,
in addition to high body temperatures
and an irregular heartbeat. Stimulants
may present a risk of cardiovascular
failure or lethal seizures.
Using stimulants with Other Medications
Patients using stimulants should avoid
any other medicine unless their physician
prescribes it. This includes over-the-counter
cold medicines that contain decongestants,
as together they can cause blood
pressure to rise dangerously high
or lead to irregular heart rhythms.
Sometimes stimulants may be prescribed
to patients taking antidepressants,
and they actually enhance the effects.
Treatment for Addiction to Prescription
Stimulants
Behavioral therapies used for effectively
treating cocaine or methamphetamine
addiction are useful in treating prescription
stimulant addiction.
There are no medications that are
proven to treat stimulant addiction,
although antidepressants may play a
helpful role in managing the depression
that often sets in once stimulant use
is stopped.
Stimulant detoxification may be necessary
first, depending on the patient's situation.
This involves reducing the stimulant
and treating withdrawal symptoms.
Usually behavioral therapies are used
after detoxification. These may include
contingency management and cognitive-behavioral
intervention. Contingency management
provides rewards such as vouchers when
the patient passes routine drug tests
proving they have remained stimulant-free.
The vouchers provide rewards that promote
healthy living, such as gym memberships.
Cognitive behavioral intervention works
by modifying the patient's thinking,
expectations, and behaviors as they
learn how to cope better with stressors.
Recovery support groups often also
play an effective role combined with
behavioral therapy.
Antidepressants
Prescription antidepressants are used
to treat depression, a disease affecting
over 15 million Americans. Some of
the original drugs of this group
include:
-
Nardil®
-
Tofranil®
-
Elavil®
Although not technically an antidepressant,
lithium, which is used to treat manic
depression, is often included in this
group.
When abused, antidepressants can produce
adverse effects. The side effects of
prolonged, excessive use of antidepressants
are:
-
Excessive
urination
-
Excessive thirst
-
Diarrhea
-
Vomiting
-
Drowsiness
-
Dizziness
-
Muscle
weakness
Some newer antidepressants that show
great promise in treating depression
are:
-
Wellbutrin®
-
Prozac®
-
Zoloft®
The incidence of side effects with
these seems to be less than with the
previously used medications.
Prescription Drug Abuse is on the
Rise
It is estimated that 8-12% of Americans
suffer from substance abuse. And studies
indicate that abuse of prescription
drugs is rising.
In 1998, according to the 1999 National
Household Survey on Drug Abuse, around
1.6 million Americans began using prescription
pain relievers for non-medical use.
Prior to that, in the 1980s, first-time
users remained under 500,000 each year.
In the 1990s, (1990-98) the number
of people starting to abuse prescription
drugs rose dramatically, almost doubling
for pain reliever abuse:
-
Pain relievers – 181% increase
-
Tranquilizers – 132%
increase
-
Sedatives – 90%
increase
-
Stimulant – 165% increase
In 1999, around 2% of the population
aged 12 and older (approximately 4
million people) had abused prescription
drugs:
-
Pain
relievers - 2.6 million abusers
-
Sedatives
and tranquilizers - 1.3 million
abusers
-
Stimulants -
0.9 million abusers
Trends in prescription drug abuse
show that certain groups may be at
increased risk:
Health care providers such as physicians,
nurses, pharmacists, dentists, anesthesiologists,
and veterinarians are at risk of prescription
drug abuse because of the easy availability.
However, rates of abuse of substances
remain comparable to that of society
at large.
Prescription Drug Abuse and the Elderly
As people reach an advanced age, the
body cannot metabolize medications
as well as when younger. However,
data from the Veterans Affairs Hospital
System seems to indicate that older
people may often be prescribed doses
that are too high, lasting for longer
periods than younger patients. Physical
dependence becomes a danger for elderly
patients who use benzodiazepines
for longer than 4 months.
Prescription drug abuse is the most
common form of substance abuse for
patients of advanced age. In general,
the elderly are found to use prescription
medicine 3 times more than other people.
The elderly also are more likely to
take the drugs in ways not included
in the prescribing physician’s
directions.
It is thought that there may be a
relationship between abuse of prescription
medications and age-related diseases.
Increased number of falls that cause
hip and thigh fractures are often experienced
by elderly who take benzodiazepines.
It seems that benzodiazepines may also
damage cognitive abilities such as
memory. However, it appears that negative
effects on memory can sometimes be
reversed when the person stops taking
the drug.
Elderly persons who take benzodiazepines
are at increased risk for vehicle accidents,
as well.
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