Articles in the media show that use of crystal meth by young adult females has seen a steady increase in recent years.1 Also increasing is the number of young women facing depression. Meth provides an easy way to cope with these unwanted feelings as it provides a euphoric sensation and decreases inhibitions – but this long-term abuse often leads to dangerous behaviors like unwise sexual activity, random partners, and a stronger possibility of unprotected sex.
Methamphetamine causes the amount of the dopamine (a naturally occurring chemical affecting pleasure, attention, learning, and movement) in the brain to increase dramatically.
This quick and short-lasting boost to dopamine levels causes the user to seek more of the substance to further enhance the effects. But tolerance to these pleasurable sensations builds, and so too does the need for more of the drug, furthering use, and probable addiction.
Women and the Adverse Effects of Meth Use
Most people have heard about the common adverse effects caused by methamphetamine use: rotting teeth and gums, premature aging, loosening of inhibitions, exposure to STDs, and the like.
However, new studies are showing that there is another serious outcome of meth use, and it is particularly damaging to women at a greater rate than men.
In a study published by the RSNA, researchers found that “…women with stimulant dependence had a significantly lower gray matter volume (GMV) in the frontal lobe (orbitofrontal cortex, medial frontal gyrus, superior frontal gyrus), limbic regions (insula, amygdala, cingulate gyrus), temporal lobe (temporal pole, uncus, parahippocampal gyrus, hippocampus, occipitotemporal gyri, superior temporal gyrus, middle temporal gyrus), and inferior parietal lobule.”2
Simply put, this means that the study showed a marked reduction in gray matter volume (GMV) found in the brains of women who had used meth.
So…Just What is Gray Matter
Gray matter is part of the physical makeup of the brain and is really important to humans in two ways.
First, gray matter gives people their power to process information. Found in many areas of the brain, the three components of gray matter include “neurons, the cells that make connections and store information in our brain, glial cells that feed the neurons so they can work at their best, and capillaries, which provide cells with blood and oxygen.”3
Secondly, gray matter functions in what’s called “neuroplasticity” of the human brain, or the ability of one’s brain to change and adapt as a result of experience. With this capability, the brain will actually modify its own neural network in response to many events, including normal growth development (emotional development from a teenager to an adult), and sometimes to external input such as a traumatic physical injury to the head.
Why Does This Make a Difference to Females
Neuroplasticity acts to affect changes related to cognitive abilities, motor tasking, learning, memory, and more as children develop into adulthood.
In females, the activity of this neuroplasticity is complex and sex-specific. Changes happen in different areas of the brain than males, at different times, and in differing degrees.
For example, take changes that affect mood. Studies have shown that during puberty, females experience an increase in incidence of depression, caused by changes to the hypothalamic pituitary adrenal axis (HPA), which is a person’s central stress response system. “In females, there is an increased response of the HPA axis with advancing puberty, while in males, the response is decreased, possibly associated with increased testosterone levels. Schizophrenia is another disorder whose incidence rises markedly during adolescence and whose presentation shows significant sex differences.”4
Some researchers suspect that use of meth causes an actual shrinking of gray matter, which can lead to developmental issues and rocky recovery from later life stressors. Most agree that methamphetamine use causes permanent damage to the neural network, effectively interrupting messages transmitted by the brain’s neurons.
The female body is already loaded with its own complexities. Female teenagers who don’t use meth are already faced with complex and confusing physical and mental issues, especially those that relate to their emotional and sexual development. By introducing a chemical that works on the intricacies of the brain that control key developmental components, women who use meth place themselves at risk for developing serious physical and mental disadvantages that may last their lifetimes.
Live on American Addiction Centers
Once you’ve come to the conclusion that your teen needs help with a substance addiction, the type of treatment center to choose for their recovery can be daunting. There are several things that can play into your decision on which recovery center you select.
If your child has been diagnosed with a mental-health condition that is being affected by or affects their substance abuse, treatment facilities need to be carefully assessed with the help of your child’s physician. Not every recovery center may be able to provide exactly the right combination of care and attention that your teen may need.
Criminal Justice System Involvement
If your teenager has been ordered to seek treatment in lieu of incarceration, there are treatment facilities that have programs geared towards helping your teen resolve the issues that led them to substance abuse.
Type of Facility
There are two general types of recovery treatment centers to explore. Outpatient treatment centers allow the individual to remain at home while residential treatment facilities provide a long or short-term experience away from home.
Outpatient treatment is typically considered for people who have day-time obligations (i.e.: school or work) and have a large and solid social base that can help provide support. Outpatient recovery centers offer many of the same types of programs as residency-based centers, but the intensity of treatment is not always the same. Typically, low-intensity outpatient centers are modeled to provide drug education and group counseling, so one-on-one treatment should not be expected.
Short-term Residential Treatment
Originally founded to treat alcohol abuse and therefore based on a modified 12-step approach, short-term residential programs provide a short-term but intensive treatment option. In most cases, patients can expect to reside on location for a duration of three to six weeks. This hospital-based treatment phase works to help your teen to overcome the addiction and properly deal with any side effects while detoxing. Participation in therapy sessions, either individually or as part of a group, is a central component of the time spent at the facility while working to recover.
Long-term Residential Treatment
With planned stays ranging between 6 to 12 months, long-term recovery centers offer the most comprehensive care to their residents. Centers provide round-the-clock care, usually in a non-hospital setting often called a “therapeutic community” (TC). This type of treatment facility employs the use of everyone there (staff and other residents) to help the individual to overcome their social and psychological deficits.
Through highly-structured and sometimes confrontational treatment, residents are encouraged to be socially responsible and productive while developing their personal sense of accountability – all considered critical components of a successful recovery.
Therapy is also mandated here as well as it “examines damaging beliefs, self-concepts, and destructive patterns of behavior and adopt new, more harmonious and constructive ways to interact with others.” 1
Following stays in residential treatment programs, it is important for individuals to remain engaged in outpatient treatment programs and/or aftercare programs. These programs help to reduce the risk of relapse once a patient leaves the residential setting.
There are many other things that need to be considered when choosing a rehab center for your teen. Just some examples include the following:
According to the Federal Trade Commission (FTC), “no standard definitions exist for specific types of programs. The programs are not regulated by the federal government, and many are not subject to state licensing or monitoring as mental health or educational facilities, either.”2
They advise visiting potential rehab centers and asking lots of questions. To help you with knowing what to ask, they have put together an excellent document Residential Treatment Programs for Teens (accessible online – see footnote #2) that address things you should be asking of the treatment facility and its staff to help you make a decision on what type of recovery center would be best for your teen.
The life of a teenager careens between polar opposites: the most awesomely great day can be followed by the most painfully mortifying one. A proud moment carrying a sense of real achievement can be dissolved by gut-wrenching uncertainty. A teen’s outlook on life can be far from rosy; it can be thorny with the stabs of stress and anxiety. What’s a kid to do to ease the troubled mind? For many, drugs provide a dangerous panacea that can deepen troubles and ensnare the unwary. While healthy options exist, for many teens the availability of alcohol and/or drugs provides convenient solace.
Why Do Teens Start Abusing Drugs?
The National Survey of American Attitudes on Substance Abuse XVII: Teens, prepared by the Center on Addiction, reported the following:
“Nearly half of teens (46 percent) say they experience high stress (6 or higher on a scale of 1 to 10). Compared to teens who say their stress level is low (5 or less), teens who experience high stress are:
The report continues…
“The number one source of stress for teens is academic pressure, including pressure to do well in school and to get into college.”
Sadly, not everyone can get the “easy A”. Hard work followed by disappointing results can drive adults and teens to distraction. A teen’s perspective is so much more limited than a well-adjusted adult that disappointment can border on disaster.
Beyond academic pressures, a teen’s life includes many other anxiety triggers. Social stress, family discord, world events, traumatic events, significant life changes all play their part.2
I Just Want to Feel Better…
Triggered by stress and anxiety, our “fight or flight” response throws our physiology into overdrive. Beyond a simple sense of dread, our hearts beat faster, we breathe harder and faster, our circulatory system propels blood to the arms and legs, and we may feel cold, clammy and nauseous.
We don’t feel good.
Perhaps smoking a joint or taking a hit of something stronger will do the trick? Trick is the operative word here – the real “relaxation response” we crave is not the temporary and potentially addicting high driven by drug use.
According to the American Academy of Child and Adolescent Psychiatry,
“The same mechanism that turns on the stress response can turn it off… This “relaxation response” includes decreased heart and breathing rate and a sense of well-being. Teens that develop a “relaxation response” and other stress management skills feel less helpless and have more choices when responding to stress.”3
Teaching teens to deal with these frightening and anxiety-provoking feelings is critical for safe passage to young adulthood as, per the Center on Addiction, individuals who do not use alcohol, tobacco, or misuse drugs before age 21 are more likely never to do so in their lifetime.
Women in today’s society are under more pressure to be everything to everyone than ever before. Over time the media, entertainment industry and our own personal experiences have shaped what we recognize and define as a suburban housewife. The compounding stress on these women, plus the societal pressures they feel often leads them to look for a way to alleviate physical and emotional stress through medical means. In fact, since the 1800s women have been prescribed increasing amounts of anti-anxiety or antidepressant medication to combat the stresses they are dealing with in their everyday lives.
The middle of the 20th century saw a dramatic uptick in the drug-based treatment of women and their perceived anxiety. Often referred to tongue-in-cheek as “Mother’s Little Helper,” medications like Prozac, Librium, Valium, and Miltown were dispensed often too frivolously instead of working to get to the root of the problem.
The tranquilizer, Miltown (meprobamate in generic form), is an anxiety-relieving drug known for its marked effect, was made commercially available in 1954 and was once one of the most popular prescribed medications. By 1956, “doctors had written 36 million prescriptions for it. At the height of its popularity, one out of every three prescriptions called for this drug.”1
Women’s Lives Have Changed – So Have Their Drugs
Nowadays, women have different lifestyles than generations before them. They are often juggling many different tasks while trying to maintain their family unit and their sanity day after day.
With societal pressure and the common misconception that women are more emotional than their male counterparts, women are targeted constantly with medication that will enhance their mood and help them function to society’s definition of what is proper. Over the years, the idea of psychiatric help understood in Freudian terms, became a hugely popular concern. Everyone thought they should be better adjusted at work and be more mentally healthy.2
This mentality has caused increases in abuse of prescription mental health drugs in this community and a movement into drugs outside of the mental health category for women who feel that they need something else to help them get through their day.
The Power and Perils of Opioids
Currently, abuse of prescription painkillers by suburban housewives is greatly on the rise. According to the Centers for Disease Control and Prevention (CDC), suburban housewives in today’s society are turning to opioids on a regular basis to help them numb the pain they deal with day today. It typically starts innocently, surgery on a toothache, giving birth to a child, or a pinched nerve in the back. Doctors then prescribe opioid-based drugs that resemble opium in their physiological effects. Demerol, OxyContin, Percocet, Kadian, Actiq, and Vicodin are just some examples, typically designed to be taken on an “as-needed” basis and for a short duration. However, for some women, all it takes is one prescription, as their pain and anxiety fall away and the begin to feel normal again, the addiction begins.
For many, drug use invariably increases as tolerance to the opioid pain killer quickly builds up. For others, the injury requiring medication may last longer than first anticipated or become chronic. More of the drug is taken or it may be taken more frequently than prescribed. This leads the user to seek out even more of the drug to achieve a satisfactory effect. If they cannot get a prescription refilled, a crisis results. They may even start to look for other ways to alleviate pain, leading from use to misuse of stronger substances or medications used in conjunction with other substances such as alcohol, the once-familiar benzos from the past, or something even worse.
Per the CDC, “about 18 women die every day of a prescription painkiller overdose in the US, more than 6,600 deaths in 2010. Prescription painkiller overdoses are an under-recognized and growing problem for women. Although men are still more likely to die of prescription painkiller overdoses (more than 10,000 deaths in 2010), the gap between men and women is closing. Deaths from prescription painkiller overdose among women have risen more sharply than among men; since 1999 the percentage increase in deaths was more than 400% among women compared to 265% in men.”3
Notwithstanding a more demanding lifestyle with greater risks for pain, pain stemming from things as commonplace as dental procedures or childbirth sees physicians actively prescribing strong and potentially addictive drugs. When women can no longer acquire pain medications from their physicians, their need may lead them to find an alternative source on the street, not only for pain reduction but also for the euphoric feeling that comes with this type of drug.
Typically, this fix is found in heroin, a stronger and cheaper alternative to the pills they were once prescribed. A recent article in Marie Claire illustrates the story of one such woman, “Donna.”
Donna started on the road to addiction by borrowing some of her husband’s Percocet pills to help with an old back injury. At $25 per pill, Percocet was pretty expensive for them. She found that she could purchase heroin on the street for much less. According to Donna, she realized that “she and her husband could split the $10 bag and feel the same euphoria as with two $25 pills. That’s $50 or $10—what would you spend?”4
The stories of women like Donna are not uncommon. A simple pain, a need for an escape from the stress of everyday life, and a search for a feeling of normalcy have suburban housewives looking to increasingly harder substances to find that feeling of relief.
When people think about the bodily harm that results from drug abuse, they most often consider things like damage to the brain, lungs, heart or stomach. What is less known is the serious harm that drugs and substances cause to a person’s teeth and gums.
While almost any drug, legal or illegal, can affect a person’s system and cause harm to their teeth and gums the greatest damage comes from the use of common street drugs: methamphetamine (meth), heroin, marijuana and cocaine.
What Drug Use Does to the Teeth and Gums
Using of drugs frequently causes dry mouth – a serious lack of saliva production. Saliva is a key protector that wards off bacteria overpopulation. Without enough saliva, dry mouth irritates the soft tissue in the mouth and the gums. Once the gums are inflamed, they can recede from the tooth wall. This then allows bacteria to enter the gaps, resulting in infections and tooth decay. For people who abuse substances, poor oral hygiene is common due to multiple factors -an inability to afford proper oral care, a lack of concern for oral health, or a lack of nutritious foods. Stimulant drugs, such as ecstasy, meth, cocaine or heroin, cause the individual to clench or grind their teeth. This can result in jaw pain and the weakening of teeth -sometimes to the point that they end up breaking off. People who smoke in addition to using drugs are also at risk for infection and tooth decay since smoking negatively affects any part of the mouth.
Harm to Teeth Based on Specific Drugs
In addition to the general harm associated with substance abuse and poor oral health, each different street drug creates additional adverse health outcomes, resulting in rotten, discolored, broken, missing teeth and gum disease.
Methamphetamine is very acidic. Use can lead to upset stomach due to the drug’s acidity -causing reflux and vomiting. Excessive vomiting coats the teeth with acid, leading to further corrosion of the enamel and allowing more decay to set in. Additionally, meth sometimes makes people crave soda and sweets, another common element in tooth decay.
Use of heroin causes damage to the teeth that are nearly the same as those seen with meth use. Also, the drug’s pain-killing property can cause an individual to ignore symptoms of damaged teeth and gums, leading to further problems.
Smoking marijuana can cause mouth cancer. Additionally, some people develop a condition called “cannabinoid hyperemesis syndrome.” This condition leads to nausea and vomiting that can wear away the enamel of the teeth, leading to tooth decay.
When snorted, use of cocaine damages the tissue that separates the roof of the mouth from the nasal cavity. Over time, this can cause a hole to form, making it hard for the individual to eat or speak. Also, cocaine is acidic. If it is smoked (as with crack) or if the powder is placed in the mouth, the teeth are coated with the acid and their protective enamel breaks down. For some people, rubbing cocaine on the gums produces mouth sores.
Nyquil is a common cold and flu relief medication that is sold over-the-counter in either liquid or pill form. It is usually used to relieve coughing but it also produces a feeling of relaxation and drowsiness. Additionally, some people who have conditions with associated pain use Nyquil to help maintain a pain-free state of sleep.
Because Nyquil is thought to produce a deep and enduring state of sleep, people often ask: can you take Nyquil just to sleep? Or: can I use Nyquil as a sleep aid? To answer these questions, a few aspects of Nyquil need to be considered.
What Makes Using Nyquil for Sleep Work?
The main component of Nyquil is Doxylamine Succinate, an antihistamine that causes drowsiness by blocking histamine from attaching to receptors in the brain. Because doxylamine succinate doesn’t discriminate between which histamine receptors they block, they cross the blood-brain barrier and inhibit receptors that are involved with the regulation of sleep (just one of the important functions of histamines). The disruption of this particular function of histamines in the brain results in drowsiness. Nyquil also includes the ingredient dextromethorphan HBr, which is included in the medication to suppress coughing. However, as it metabolizes in the body, it becomes dextrorphan (DXO) and levorphanol. Levorphanol is a painkiller, reported to be five times more powerful than morphine. Listed as a dissociative drug by the National Institute on Drug Abuse, DXO is an NMDA receptor antagonist psychoactive that acts primarily as an antitussive (cough suppressant) but has dissociative hallucinogenic properties –like those found when using ketamine, DXM (dextromethorphan) and PCP (phencyclidine).
Taking Nyquil to Sleep
Even though Nyquil contains components that are specifically designed to induce sleep, relying on the medication for sleep is not advised. Use of Nyquil, as with any drug that is said to assist with either falling asleep or maintaining sleep throughout the night, may lead to several problems.
Nyquil Effects on Sleep
Using Nyquil as a sleep aid is known to make people drowsy and fall asleep. The duration of sleep can vary depending on the person. For some, taking Nyquil is good for sleeping between four to six hours while for others sleep lasts between seven to eight hours. For most people, sleep is calm and continuous; however, some people have reported experiencing disrupted sleep, often involving lucid and weird dreams, increased anxiety, breathing stoppage and trouble falling back to sleep. This can lead people to consume more of the drug in a shorter time period in order to get back to sleep.
Addicted to Nyquil for Sleep
According to Dr. Neal Barnard of the Physicians Committee for Responsible Medicine, “When used as directed, Nyquil does not present substantial risks, even with repeated use. It is better to stop using it for sleep-inducing purposes.” So, while using Nyquil as directed is thought to be safe, taking it in ways that are not recommended can be dangerous. As one becomes more accustomed to the positive effects brought on by drinking Nyquil, they may become psychologically addicted to using Nyquil. For these people, the thought of attempting to go to sleep without using Nyquil brings on anxiety. This anxiety then motivates them to use the product. However, people who have become addicted to Nyquil sometimes notice that, over time, the typical amount that they consume does not produce the same effect. Instead, it may take longer to fall asleep or they may not be sleeping as long. Taking larger doses or more frequent doses usually indicates that the body has developed a tolerance to the drug, and is likely to have formed a dependence and addiction. As with any drug, this situation should be treated as a serious condition. Withdrawal symptoms can occur, and the individual should seek assistance from medical and/or mental health providers in order to overcome the addiction.
Original blog post: TheRecoveryVillage.com
There’s a whole lot of truth in the adage “the eyes don’t lie.” So much so that, in law enforcement and medical communities that deal with substance misuse, the dilation level of an individual’s eyes is considered a key marker indicating that there has been consumption of an illicit drug and can often lend assistance in identification of the drug used.
Dilation of the pupil (mydriasis), or opening of the iris, is caused by the activation of two muscle groups in the eye: the iris sphincter and the iris dilator. The body’s parasympathetic nervous system (providing control of a person’s autonomic bodily processes when at rest) is what triggers the sphincter response. The sympathetic nervous system, which controls the body’s fight-or-flight response, triggers action of the dilator.
Certain drugs, most commonly psychotropic stimulants, have a large effect on both systems causing the pupils to respond by dilating. Drugs can affect the parasympathetic or sympathetic nervous systems individually or in combination and depends on the type of drug taken. This occurs when elements of the drugs affect neurotransmitters in the brain that work in part to control mydriasis – thus allowing the pupils of the user to dilate to differing degrees.
Drugs that Cause Dilated Pupils
There are many drugs that can work on the brain’s neurotransmitters and affect the dilation of pupils. These include SSRI antidepressants, amphetamines, MDMA, psilocybin, LSD, ecstasy, cocaine, and mescaline. In the case of these drugs, serotonin (a brain chemical affecting mood) agonizes the 5-HT2A receptors in the brain and kicks off the dilation. Adrenergic receptors, another neurotransmitter, is affected by other drugs (such as marijuana) when dopamine is released, again affecting the eyes so the pupils become dilated.
Simply put, drugs take affect on the muscles in the eye that control the amount of light being allowed in. Since many drugs affect perception in the brain, the reaction to light can be altered, allowing the pupils to react in atypical fashion as to what is expected. Because this alone is an imperfect way to check against sobriety, officials have also learned to take other factors into play, such as heavy sweating, dry mouth, excessive activity, and the like.
Dilated Pupils on Drugs – Seeing the Difference
In the event there is suspicion of substance misuse, there is a tool to help at least part of the determination. An official chart showing pupils on drugs is the “Drug Recognition Card,” used mostly by law enforcement and emergency medical teams. This card is based on standards set by the International Association of Chiefs of Police (IACP) and provides a means to readily assess likely substance use categories (depressants, stimulants, hallucinogens, phencyclidine, narcotics, inhalants, cannabis) based on pupil diameter.
The chart lists the drug categories in columns, and the physical conditions noticed (horizontal/vertical gaze, convergence, state of pupil dilation, light reaction rate, etc.) so a likely match can be obtained. It also features a scale of pupil dilation that, when held up to the user, provides a physical, visual gauge for referencing how much or little dilation there is. Other charts showing the effects of drugs on pupil dilation do exist though, while helpful, they are not always as reliable as the one provided by the IACP which can be readily purchased online for home use.
Written for Advanced Recovery Systems
One of the older classes of drugs, barbiturates are used for the treatment of insomnia, headaches, muscle cramping, and seizures as well as being a pre-operative sedative. Barbiturates are central nervous system depressants that affect the ability of the body’s nerves to communicate with one another. Some examples of barbiturates include Seconal, Donnatal, Nembutal, Fortabs, Fiorinal with Codeine, Ascomp, Butisol Sodium, Amytal Sodium, Belladonna, Esgic, and Fioricet. These drugs are available as injections, tablets, capsules, or oral liquids, depending on which is being used.
When used properly under a health care provider’s supervision, these barbiturates are considered to be highly effective for managing symptoms of anxiety and sleeplessness. However, as with any drug, there can be abuse - and this group is known for its addiction potential.
People who use barbiturates recreationally are typically looking for something that will help sedate them and possibly to even lower inhibitions. They describe having a feeling of tranquility and better overall well-being. These drugs initially induce a state-of-being similar to being drunk, but the condition can progress to one of total relaxation - sometimes to the point of losing one’s life. Individuals who abuse prescription opiates have been shown to seek out barbiturates if they are out of opiates or to give a dose of heroin more kick.
Effects of Barbiturates
Barbiturates’ effects are broad, as they act on the body both mentally and physically. This combination occurs because these drugs work on the central nervous system, slowing down both cognitive and motor processes. Effects of barbiturates use can include any of the following individually, but most often in conjunction with each other, as the central nervous system is the source of control for all functions of the human body.
At issue are the barbiturates’ side effects. Since barbiturates produce a sense of calm and drowsiness, someone experiencing any of the listed side effects post-use may have a lack of concern about them. They may not act on those concerns or seek assistance from somebody who can help. Additionally, the sedated user can sometimes become confused about how much of the drug they have consumed, or when the last time of use was. This can lead to an unintentional overdose with the possibility of lethal consequences. A final issue for those who misuse barbiturates is that, because the drugs affect the body’s normal ability to breathe, they are then at greater risk of developing pneumonia or bronchitis.
For some who have experienced long-term use of barbiturates, their tolerance to the drug is increased as the effectiveness seems to be reduced, leading them to self-increase their dosage. This often leads to “doctor shopping” where they seek out prescriptions from multiple health care providers to gain access to more quantities (or higher doses) of the drug.
Coming Off Barbiturates
Users usually notice the first signs of withdrawal within 24 hours of the last dose. Barbiturate withdrawal symptoms can include insomnia, anxiety, delirium, or tremors. Heavy users have even been known to have seizures when attempting to stop using barbiturates.
For a person who wishes to stop barbiturate misuse, medical supervision or detox in a managed detox facility is recommended, as this is not an easy thing to accomplish alone.
For those working to withdraw from alcohol misuse, the effects of withdrawing can be overpowering and unpleasant, often leading them to quit the process. In some cases, medications can be prescribed to help with those symptoms, however these drugs can be very strong on one’s body, can have side-effects of their own to be concerned with, and can sometimes lead to addiction themselves.
To help health care professionals objectify the severity of alcohol withdrawal symptoms when considering if medications are needed to ease or alleviate symptoms, a standardized tool called the Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) was created. Over time, this alcohol withdrawal scale has also been used for assessing patients in various situations other than those being considered for prescription drug administration to alleviate symptoms. These include assessment of those in general outpatient, emergency, surgical, or psychiatric care. Because patients sometimes under-report alcohol consumption, misuse can be overlooked by physicians. Potentially life-threatening consequences, such as delirium tremens or seizures, can be missed if alcohol withdrawal symptoms go unrecognized.
The CIWA-Ar Alcohol Withdrawal Scale
The CIWA-Ar scale consists of ten checkpoints (or conditions) for an attending health care provider to review towards an assessment of alcohol withdrawal. Each is evaluated separately, then an aggregated score is obtained to indicate the severity of alcohol withdrawal. It should be noted that any sign indicating a pattern, or the side-effects, of excessive alcohol consumption should raise a concern for the possibility of alcohol withdrawal being present.
The ten checkpoints of the scale are as follows. Some checkpoints give the provider instructions on what to say to the patient or what the patient should be asked to do. Once each is done, there are seven qualifiers for the health care provider to use for the assessment - some based on observation of the patient, while others are based on answers to questions they ask of the patient.
Upon completion of the assessment, the points are tallied, and the level of alcohol withdrawal is calculated. A score of less than or equal to eight shows that withdrawal is absent or minimal; nine through nineteen indicates mild to moderate alcohol withdrawal; twenty and above is considered severe alcohol withdrawal.
Once the severity has been calculated, the health care provider can further reference a part of the tool that provides information on drugs that can be used to manage alcohol withdrawal symptoms when needed.
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While it is commonly known that alcohol and drugs don’t mix, this is especially true for the class of psychoactive drugs. Psychoactive drugs are chemical substances that alter behavior, thought processes, and overall mood. These drugs carry the greatest risks when they are mixed with alcohol.
To best understand how the combination of alcohol and psychoactive drugs can alter a person’s mood, it is necessary to know more about the drugs and the effects that they have on the brain.
Interestingly, alcohol is classified as a depressive psychoactive drug itself, so combining it with any other psychoactive or depressant drugs can exacerbate the effects of both substances.
Psychoactive drugs fall into the following sub-categories: depressants, stimulants, opiates and opioids, and psychedelics.
Depressants depress activity in the central nervous system, leading to sedation and decreased physiological activity throughout the body. Alcohol, barbiturates, and benzodiazepines are drugs in this category. All of these can be legal substances, with alcohol being non-therapeutic while the others are considered to be therapeutic.
Stimulants work by stimulating the central nervous system, leading to an increase in physiological processes and motor function. Drugs in this category include drugs such as cocaine, amphetamine, caffeine, ecstasy, and nicotine. Cocaine, amphetamine, and ecstasy are all illegal, therapeutic drugs, while caffeine and nicotine are both legal, non-therapeutic drugs.
Opiates and Opioids
Opiates and opioids are pain-relieving drugs that act on opioid receptors in the central and peripheral nervous system, as well as the gastrointestinal tract, to produce effects like those of morphine. This group includes drugs such as heroin, Fentanyl, Vicodin, and Hydrocodone. All but heroin are legal when prescribed and each is considered to be a therapeutic drug.
Psychedelics are known for acting on the central nervous system to alter mood and perception. This category of drugs includes marijuana (THC), LSD, psilocybin (mushrooms), and phencyclidine (PCP). Each is considered to be illegal except for marijuana, which is legal as a medicinal and recreational drug in some states.
All of these substances can also be considered to be psychoactive drugs as they act on various parts of the brain to produce these effects. Psychoactive drugs typically activate dopamine receptors in the “reward pathway” of the brain.
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I'm April Bailey, a freelance writer and editor for hire who has been writing about various topics for many years. Most of my early print work was destroyed in a major house fire. Luckily, I was able to pull some copies from an old PC and have posted them here. Other items on this blog reflect my current articles and blog posts written for online publications and copied here so I never lose my work again!