Pleasure
People use alcohol because they enjoy the way it makes them feel, report doctors at the American Academy of Family Physicians (AAFP). The brain is wired to seek out enjoyable feelings and to repeat the process that made those reactions possible. Alcoholism is a disease that affects the brain, creating a craving for a repetition of the good sensations. Doctors at the AAFP say that the brain chemistry actually changes to seek out those pleasurable activities, causing the consciousness to lose control over the behavior that will provide them. Alcoholism, or an addiction to alcohol, results when the need for those repeated pleasurable sensations becomes stronger than the need for security. Consequences such as loss of relationships, jobs and freedom cannot overcome the brain's desires to seek more pleasure.

Physical Changes 
Doctors report that, over time, the balance of gamma-aminobutyric acid (GABA) and glutamate become altered. GABA inhibits impulsive behavior and glutamate causes the nervous system to become excited. Dopamine levels are also increased by alcohol, which cause the pleasure-seeking behaviors. Genetic markers also can contribute to alcoholism, as the disease tends to run in families. Those with a genetic tendency toward alcoholism are more likely to become addicted once they start drinking. Drinking also can block certain stress hormones, which add to the likelihood of addiction for those who use alcohol to combat stress. 

Psychological Boost 
Many people use alcohol to be socially accepted into various groups. Doctors report that people with low self-esteem often use alcohol to boost their confidence and fit in with their peers, which can lead to extended use and addiction. People with other mental disorders in addition to social phobias often turn to alcohol to self-medicate. Patients with depression, bipolar disorder and obsessive compulsive disorder commonly become addicted to alcohol after using the drug to decrease the intensity of their symptoms.

Excess
Addiction to alcohol is a process that evolves over time, often years. Drinking to excess for an extended period of time increases the likelihood of developing a dependence on the drug. Mayo Clinic doctors report that for men, 15 drinks or more a week can lead to a physical dependence, while women drinking 12 or more drinks per week are at risk for becoming alcoholics. Time frames vary between individuals and can be affected by heredity, the age when the drinking first began, environmental factors, such as drinking in the home, and other emotional and mental disorders. 

RISK FACTORS FOR ADDICTION: 
People of any age, sex or economic status can become addicted to a drug. However, certain factors can affect the likelihood of your developing an addiction: 

Family history of addiction. Drug addiction is more common in some families and likely involves the effects of many genes. If you have a blood relative, such as a parent or sibling, with alcohol or drug problems, you're at greater risk of developing a drug addiction.Being male. Men are twice as likely to have problems with drugs.Having another psychological problem. If you have a psychological problem, such as depression, attention-deficit/hyperactivity disorder or post-traumatic stress disorder, you're more likely to become dependent on drugs.Peer pressure. Particularly for young people, peer pressure is a strong factor in starting to use and abuse drugs.Lack of family involvement. A lack of attachment with your parents may increase the risk of addiction, as can a lack of parental supervision.Anxiety, depression and loneliness. Using drugs can become a way of coping with these painful psychological feelings.Taking a highly addictive drug. Some drugs, such as heroin and cocaine, cause addiction faster than do others.

Diagnostic Criteria for Alcohol Abuse and Dependence 
Diagnosis is the process of identifying and labeling specific conditions such as alcohol abuse or dependence (1). Diagnostic criteria for alcohol abuse and dependence reflect the consensus of researchers as to precisely which patterns of behavior or physiological characteristics constitute symptoms of these conditions (1).

Diagnostic criteria allow clinicians to plan treatment and monitor treatment progress; make communication possible between clinicians and researchers; enable public health planners to ensure the availability of treatment facilities; help health care insurers to decide whether treatment will be reimbursed; and allow patients access to medical insurance coverage (1-3). 

Diagnostic criteria for alcohol abuse and dependence have evolved over time. As new data become available, researchers revise the criteria to improve their reliability, validity, and precision (4,5). This Alcohol Alert traces the evolution of diagnostic criteria for alcohol abuse and dependence through the current standards of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) (6). For comparison, the criteria found in the World Health Organization's International Classification of Diseases, Tenth Revision (ICD-10) also are reviewed briefly, although these are not often used in the United States (7). 

Evolution of Diagnostic Criteria 
Early Criteria 
At least 39 diagnostic systems had been identified before 1940 (2). In 1941 Jlinek first published what is considered a groundbreaking theory of subtypes of what was, until 1980, termed alcoholism (2,8). Jellinek associated these subtypes with different degrees of physical, psychological, social, and occupational impairment (2,9). 

Formulations of diagnostic criteria continued with the American Psychiatric Association's publication of the Diagnostic and Statistical Manual of Mental Disorders, First Edition (DSM-I), and Second Edition (DSM-II) (10,11). Alcoholism was categorized in both editions as a subset of personality disorders, homosexuality, and neuroses (2,12). 

In response to perceived deficiencies in DSM-I and DSM-II, the Feighner criteria were developed in the 1970's to establish a research base for the diagnostic criteria of alcoholism (5,13). These criteria were the first to be based on research rather than on subjective judgment and clinical experience alone (5). Though designed for use in clinical practice, they were primarily developed to stimulate continued research for the development of even more useful diagnostic criteria (5). Several years later, Edwards and Gross focused solely on alcohol dependence (8). They considered essential elements of dependence to be a narrowing of the drinking repertoire, drink-seeking behavior, tolerance, withdrawal, drinking to relieve or avoid withdrawal symptoms, subjective awareness of the compulsion to drink, and a return to drinking after a period of abstinence (8) 

The DSM Criteria 
Researchers and clinicians in the United States usually rely on the DSM diagnostic criteria. The evolution of diagnostic criteria for behavioral disorders involving alcohol reached a turning point in 1980 with the publication of the Diagnostic and Statistical Manual of Mental Disorders, Third Edition (14). In DSM-III, for the first time, the term "alcoholism" was dropped in favor of two distinct categories labeled "alcohol abuse" and "alcohol dependence" (1,2,12,15). In a further break from the past, DSM-III included alcohol abuse and dependence in the category "substance use disorders" rather than as subsets of personality disorders (1,2,12). 

The DSM was revised again in 1987 (DSM-III-R) (16). In DSM-III-R, the category of dependence was expanded to include some criteria that in DSM-III were considered symptoms of abuse. For example, the DSM-III-R described dependence as including both physiological symptoms, such as tolerance and withdrawal, and behavioral symptoms, such as impaired control over drinking (17). In DSM-III-R, abuse became a residual category for diagnosing those who never met the criteria for dependence, but who drank despite alcohol-related physical, social, psychological, or occupational problems, or who drank in dangerous situations, such as in conjunction with driving (17). According to Babor, this conceptualization allowed the clinician to classify meaningful aspects of a patient's behavior even when that behavior was not clearly associated with dependence (18). 

The DSM was revised again in 1994 and was published as the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) (6). The section on substance-related disorders was revised in a coordinated effort involving a working group of researchers and clinicians as well as a multitude of advisers representing the fields of psychiatry, psychology, and the addictions (2). The latest edition of the DSM represents the culmination of their years of reviewing the literature; analyzing data sets, such as those collected during the Epidemiologic Catchment Area Study; conducting field trials of two potential versions of DSM-IV; communicating the results of these processes; and reaching consensus on the criteria to be included in the new edition (2,19). 

DSM-IV, like its predecessors, includes nonoverlapping criteria for dependence and abuse. However, in a departure from earlier editions, DSM-IV provides for the subtyping of dependence based on the presence or absence of tolerance and withdrawal (6). The criteria for abuse in DSM-IV were expanded to include drinking despite recurrent social, interpersonal, and legal problems as a result of alcohol use (2,4). In addition, DSM-IV highlights the fact that symptoms of certain disorders, such as anxiety or depression, may be related to an individual's use of alcohol or other drugs (2). 

The ICD Criteria While the American psychiatric community was formulating its editions of diagnostic criteria for mental disorders, the World Health Organization was developing diagnostic criteria for the purpose of compiling statistics on all causes of death and illness, including those related to alcohol abuse or dependence, worldwide (1,4,20). These criteria are published as the International Classification of Diseases (ICD). The first ICD classification of substance-related problems, published in 1967 in ICD-8 (21), classified what was then called alcoholism with personality disorders and neuroses, as had DSM-I and DSM-II. In ICD-8, alcoholism was a separate category that included episodic excessive drinking, habitual excessive drinking, and alcohol addiction that was characterized by the compulsion to drink and by withdrawal symptoms when drinking was stopped (1). 

Although ICD-9 (22,23) included separate criteria for alcohol abuse and dependence, this revision defined them similarly in terms of signs and symptoms (1). According to Babor, an important assumption in ICD-9 was that alcohol use in the absence of dependence "merits a separate category by virtue of its detrimental effects on health" (1, p. 87).

The category of alcohol dependence was central to the current revision, ICD-10 (1,2,7). Alcohol dependence is defined in this classification in a way that is similar to the DSM. The diagnosis focuses on an interrelated cluster of psychological symptoms, such as craving; physiological signs, such as tolerance and withdrawal; and behavioral indicators, such as the use of alcohol to relieve withdrawal discomfort (1). However, in a departure from the DSM, rather than include the category "alcohol abuse," ICD-10 includes the concept of "harmful use." This category was created so that health problems related to alcohol and other drug use would not be underreported (1). Harmful use implies alcohol use that causes either physical or mental damage in the absence of dependence (1). 

Moving Toward Agreement Between Diagnostic Criteria 
The DSM diagnostic criteria for psychiatric disorders are the criteria primarily used in the United States. The ICD is an international diagnostic and classification system for all causes of death and disability, including psychiatric disorders (4). Earlier editions of these two major diagnostic criteria dealing with alcohol abuse and dependence were criticized for being too dissimilar (2). Therefore, the DSM-IV and the ICD-10 were revised in a coordinated effort among researchers worldwide to develop criteria that were as consistent with one another as possible (1,2). 

Although some differences between the two major diagnostic criteria still exist, they have been revised by consensus as to how alcohol abuse and dependence are best characterized for clinical purposes (18). Clinicians, international health agencies, and researchers are now better able to categorize people with alcohol dependence, abuse, and harmful use to plan treatment, collect statistical data, and communicate research results (18). 

The research community has long found standardized diagnostic criteria useful. Such criteria provide agreement as to the constellation of symptoms that indicate the alcohol dependence syndrome and allow researchers all over the world to communicate clearly as to what kinds of disorders are being studied. 

Standardized diagnostic criteria are equally important and useful to clinicians. In the alcohol field, there have been many different ways by which clinical staff might arrive at a diagnosis--sometimes differing among staff within the same program. Although the use of standard diagnostic criteria may seem somewhat burdensome, it provides many benefits: more efficient assessment and placement, more consistency in diagnoses between and within programs, enhanced ability to measure the effectiveness of a program, and provision of services to people who most need them. As we move more and more into a managed health care arena, third-party payors are requiring more standardized reporting of illnesses; they want to know what conditions they are paying for and that these conditions are the same from program to program. The standardized diagnostic criteria presented in this Alert are based on the newest research, have been developed based on field trials and extensive reviews of the literature, and are continually revised to reflect new findings. Although clinical judgment will always play a role in diagnosing any illness, alcohol treatment programs that use standardized diagnostic criteria will be in the best position to select appropriate treatment and to justify their selection to third-party payors

Teenage drug abuse is a growing problem. Here are some commitments you can make to help your addicted teen. These suggestions are intended to help families who are working with a therapist. The therapist can point out which commitments will be most helpful to your family.

• I’m willing to sit down and listen to my child. Really listen. I’m willing to do this often. I’ll ask my teen what I am doing that gets on his/her nerves. I’ll listen and take notes.
• I’m willing to give up nagging, lecturing, guilt-tripping, yelling, judging, and moralizing.
• I’m willing to “let the cat out of the bag.” I know that it takes a village to raise a child. Therefore, I’m willing to set aside my pride, abandon secrecy (except where it would be harmful to do so), sit down with my family and extended family to explain the nature of the problem, ask for help, brainstorm solutions, and really listen to suggestions from family.
• I’m willing to spend time with my teen every week. Lots of time. I’m willing to attend family activities that may or may not be especially fun for me. I'm willing to spend time, even though I have a lot of work to do. I’m willing to enforce time together with my teen, even if he/she doesn’t want to spend time together.
• I’m willing to set and enforce strict boundaries about drug/alcohol usage around my family. If my teen’s friend smokes, drinks, or uses drugs, that teen will not be allowed to come to our home. I realize I can’t control what happens outside the home. If I have using friends or family members, they won’t be allowed in the home if they are drunk, stoned, or high. We will not visit them when they are drunk, stoned, or high. No exceptions.
• I’m willing to educate myself about becoming a drug-free family. I’m willing to read website articles, research areas where I know I’m weak, talk to other parents about the problem, humble myself so that I can listen for help, and ask for resource materials if I can’t find any. I’m willing to attend therapy or classes so that I can learn.
• I’m willing to improve my parenting skills so that I’m an appropriate parent—not a drill sergeant, not a helicopter, not a marshmallow, and not a friend. I need to be firm, fair, and friendly. If necessary, I’ll sign up for a community class on parenting. I’ll read books on the subject, watch videos, research the internet, and listen to audiobooks. I realize that a strong, healthy relationship with my teen is absolutely vital.
• I’m willing to look at my own addictions. If I smoke, drink alcohol in excess, or use drugs (even excessive reliance on prescription medications), I’ll get the help I need so that I can quit. If I have other addictions, such as being a workaholic, churchaholic, rageaholic, foodaholic, or even chocaholic, I’ll get myself into treatment so that I can stop. I want to set a good example for my teen. Addiction runs in families. Ultimately, there are no secrets in a family. Sooner or later everyone knows anyway. Better to be honest if I want my teen to be honest.
• I’ll look at my codependency. I realize that everyone in the family plays a role in the problem. Therefore, I have a role in this also. I’ll seek to find out what my role has been, and how I can change it. Perhaps I’ve been an enabler. I will take the problem seriously and work very hard to quit enabling. I’ll seek help from others, perhaps attend Al Anon, and ask how I can stop enabling.
• I’ll look for community resources to address our family needs. If I’m a single parent, I’ll find a substitute parent of the opposite sex, a role model, to spend time with my teen.

Do's and Don'ts of Intervention 
Do
Act from true concern or love for the addict. Explain that the addiction stems from an illness. Avoid hatred, hostility, condemnation, lecturing or moralizing. You are there to help him. Tell him about the methods of treatment available for his disease. Allow the addict to feel the full weight of the consequences of his drinking behavior. Offer limited choices for the addict to consider, such as:
1. get help and retain your work position and role in the family or. . .
2. do nothing and possibly lose your job and possibly live alone. 
Prepare to act upon the addict’s decision to seek help. Admission arrangements at a treatment facility should have been made (even provisions made for transportation, childcare, and pet care). Remove the excuses for not acting now. Prepare to act upon the addict’s decision not to seek help. The Intervention must not be perceived by the addict as a "cry wolf" exercise that will blow over in a few hours. Give him hope that recovery is possible. Hundreds of thousands of addicts have already done so. 

Don't
Don't grow emotional and hostile about your own hurts. You may document your hurts, but maintain your focus upon the factual effects of the addict’s behavior. 
Don't digress into possible reasons why the alcoholic drinks/addict uses, or why he drinks or uses so often. To seek such explanation is a futile exercise. It is enough to establish and have the addict accept the fact that his addiction has become a problem in his life. 
Don't accept further hollow promises from the addict, no matter how sincere or tearful (haven't you been along this road before?). The addict’s commitment must be to accepting immediate treatment for his disease. 

The Key 
The key is to document, not judge. The events given should show only that there is cause for genuine and deep concern.

• Classification of Drug Addictive Substances: 
  Children get easily impressed and influenced as they are nave, less experienced and cocooned by us. Hence they easily fall prey to the external pressures and create problem hampering their physical and mental activity. We routinely find changes in their attitudes in the form of lying, stealing etc. Usually we neglect and bypass the issue imagining it to be irrelevant and a one off case. This careless and negligent attitude of ours can cost us heavily in the long run.
  
  Some medicines like valium, laxatives and codeine prescribed for their curative effect were later on found to be harmful to human health on prolonged use. Hence any drug helpful to us for a certain condition should not be over used without the consultation of physician. Certain substances when taken in limit are not considered as addictives. Some herbal medicine contain stimulant and excessive use is hazardous to health.
  
  The common legal drug substances available over the counter include
  • Medical prescriptions like analgesics, steroid, tranquilizers, barbiturates etc.
  • Caffeine in coffee and nicotine of smoking item like cigars and cigarettes etc.
  • Inhalant like nail polish and gasoline etc.
  • Alcoholic beverages.
  
  Many other substances are categorized by the legal system and Food and Drug Administration, FDA, as injurious to human health. The up dating of the bad effects of substances should be conducted. This can be achieved by experiment and census taken from the intake of drug and their effect on the general population.
  
  The deadlier and illegal drug substances which are stolen into the market and are used by drug abusers include- Morphine, ketamine and opiates usually land up in the hands of medical professionals as they are freely used by them. The misuse of drug for the purpose of abuse in clinics and hospitals is illegal and should be brought to the notice of authorities.
  
  The most commonly used drug in U.S.A is marijuana. Along with it the drugs cocaine, heroin and hashish are taken by the drug abusers. 
  
  Hallucinogenic drugs like LSD and PCP, designer drug like MDMA, party drugs like GHB are easily available in pubs and parties.
  
  According to their sphere of action the drugs are classified as follows
  • Narcotics/ Analgesic opiates, heroin, morphine etc.
  • Psychomotor stimulant Amphetamine, cocaine, nicotine, methylxanthine etc.
  • Hallucinogen LSD, mescaline, phencyclidine etc
  • Central depressant Barbiturate, alcohol etc.
  • Anxiolytic Benzodiazepines and other sedatives.
  
  Thus we come across a wide range of substances which can produce addiction to such an extent that the return from their abuse is quite a difficult task. Try to keep away from drugs which have severe side effects so as to become life threatening.

• Narcotic Analgesics In Greek prefix ‘Narco’ means to ‘deaden’ or ‘benumb’. Analgesics means pain killer or pain relieving. The term Narcotic medically refers to opium and opium derivatives or synthetic substitutes that produce opium–like effects. 
  Drugs belonging to this category can be studied under three broad categories Narcotic of natural origin 
  Opium comes from Poppy plant, Botanical called ‘Papaver Somniferum’. 
  Opium is collected from unripe fruit of the Poppy plant. Opium is dark greyish or brownish tar like substance. 
  Opium is smoked, Chewed and absorbed through the mucuous membrane of the mouth. It is also boiled with water and drunk. 
  Morphine
  Morphine is principal alkaloid that is extracted from opium about 10 to 15 % of opium contains morphine. It is one of the most effective drugs for relief of pain.
  
  Routes of administration 
  Injected – Subcutaneously, Intra muscularly or intravenously. Most morphine addict use intravenous route. 
  
  Codeine
  Codeine is another alkaloid found in opium, 1 to 2 %.
  Codeine is used in cough– suppressant drugs and anti diarrhoeal preparations. 
  
  Route of administration 
  Injected – subcutaneously or intramuscularly.
  Oral – medical preparation of codeine are made in combination with other chemicals and are available in the form of tablets and syrups. 
  Codeine is very rarely abused as its analgesic effects are mild and severe side effects (Eg. Convulsions) are often experienced. 
  
  Semi synthetic narcotics 
  Heroine/ Brown Sugar
  Heroine(Di–acetyl morphine) is a semi synthetic derivative of drug morphine.
  Brown sugar is adulterated form of heroine.
  Brown Sugar is ‘smoked’ of ‘chased’.
  Synthetic Narcotics
  Synthetic narcotics are produced only in laboratory. These drugs imitate the effects of opiates but are not prepared from opium. Pethidine and methadone are most widely available synthetic drugs.
  Routes of administration 
  Oral – Meperidine (Pethidine) can be administered orally in the form of tablets.
  Injected– Subcutaneously, intramuscularly or intravenously.
  Pethidine addicts almost always inject the drug intravenously.
  Methadone is effective when administered orally, so Methadone is usually taken in the form of tablets. Short term effects of narcotic analgesics
  When injected, the effects are immediate and pronounced. The main effects include: 
  Short lived state of euphoria during which feelings of hunger and pain are not felt.
  Mental clouding – impairment of intellectual processes.
  Drowsiness, apathy, decreased physical activity.
  Reduced heart rate and blood pressure.
  Constipation.
  Constriction of pupils.
  A few adverse reaction may also appear.
  Nausea, vomiting.
  Dysphoria (A feeling of unpleasantness).
  Increase sensitivity to pain after the initial effects wears off.
  Itchy skin.

• How Do Stimulants Produce Euphoria? 
  Stimulants change the way the brain works by changing the way nerve cells communicate. Nerve cells, called neurons, send messages to each other by releasing chemicals called neurotransmitters. Neurotransmitters work by attaching to key sites on neurons called receptors. 
  
  There are many neurotransmitters, but dopamine is the main one that makes people feel good when they do something they enjoy, like eating a piece of chocolate cake or riding a roller coaster. Stimulants cause a buildup of dopamine in the brain, which can make people who abuse stimulants feel intense pleasure and increased energy. They can also make people feel anxious and paranoid. And with repeated use, stimulants can disrupt the functioning of the brain’s dopamine system, dampening users’ ability to feel any pleasure at all. People may try to compensate by taking more and more of the drug to experience the same pleasure. 
  
  What Are the Short-Term Effects? 
  In the short term, stimulants can produce feelings of tremendous joy, increased wakefulness, and decreased appetite. People who abuse them can become more talkative, energetic, or anxious and irritable. Other short-term effects of stimulants can include increased body temperature, heart rate, and blood pressure; dilated pupils; nausea; blurred vision; muscle spasms; and confusion. 
  
  Stimulants can also cause the body’s blood vessels to narrow, constricting the flow of blood, which forces the heart to work harder to pump blood through the body. The heart may work so hard that it temporarily loses its natural rhythm. This is called fibrillation and can be very dangerous because it stops the flow of blood through the body. 
  
  What Are the Long-Term Effects? 
  As with many other drugs of abuse, repeated stimulant abuse can cause addiction. That means that someone repeatedly seeks out and uses the drug despite its harmful effects. Repeated drug use changes the brain in ways that contribute to the drug craving and continued drug seeking and use that characterizes addiction. Other effects of long-term stimulant abuse can include paranoia, aggressiveness, extreme anorexia, thinking problems, visual and auditory hallucinations, delusions, and severe dental problems. 
  
  Repeated use of cocaine can lead to tolerance of its euphoric effects, causing the person to take greater amounts or to use the drug more frequently (e.g., binge use) to get the same effects. Such use can lead to bizarre, erratic behavior. Some people who abuse cocaine experience panic attacks or episodes of full-blown paranoid psychosis, in which the individual loses touch with reality and hears sounds that aren’t there (auditory hallucinations). Different ways of using cocaine can produce different adverse effects. For example, regularly snorting cocaine can lead to hoarseness, loss of the sense of smell, nosebleeds, and a chronically runny nose. Cocaine taken orally can cause reduced blood flow, leading to bowel problems. 
  
  Repeated use of methamphetamine can cause violent behavior, mood disturbances, and psychosis, which can include paranoia, auditory hallucinations, and delusions (e.g., the sensation of insects creeping on the skin, called “formication”). The paranoia can result in homicidal and suicidal thoughts. Methamphetamine can increase a person’s sex drive and is linked to risky sexual behaviors and the transmission of infectious diseases, such as HIV. However, research also indicates that long-term methamphetamine use may be associated with decreased sexual function, at least in men. 
  
  Can These Drugs Be Lethal? 
  Yes, in rare instances, sudden death can occur on the first use of cocaine or unexpectedly thereafter. And, like most drugs, stimulants can be lethal when taken in large doses or mixed with other substances. Stimulant overdoses can lead to heart problems, strokes, hyperthermia (elevated body temperature), and convulsions, which if not treated immediately can result in death. Abuse of both cocaine and alcohol compounds the danger, increasing the risk of overdose. 
  
  What Are the Differences Between Cocaine and Methamphetamine? 
  They act in different ways to increase dopamine in the brain. Cocaine works by blocking the dopamine transporter; that is, it doesn’t allow dopamine to be recycled back into the neuron after it has done its work. Methamphetamine interferes with this recycling process as well, but it also causes too much dopamine to be released. Another difference is that cocaine disappears from the brain quickly, while methamphetamine has a much longer duration of action. The long presence in the brain ultimately makes methamphetamine very harmful to brain cells. 
  
  If a Pregnant Woman Uses Stimulants, Will the Baby Be Hurt? 
  In the United States, 16.2 percent of pregnant teens age 15 to 17 used an illicit drug in 2009-2010. Scientists have found that exposure to cocaine during fetal development may lead to subtle but significant deficits later in life, including problems with attention and information processing—abilities that are important for success in school. Research is also underway on the effects of methamphetamine use during pregnancy. So far, the data suggest that it may affect fetal growth and contribute to poor quality of movement in infants.
  
  Research in this area is particularly difficult to interpret because it is often hard to single out a drug’s specific effects among the multiple factors that can all interact to affect maternal, fetal, and child outcomes. These factors include exposure to all drugs of abuse, including nicotine and alcohol; extent of prenatal care; possible neglect or abuse of the child; exposure to violence in the environment; socioeconomic conditions; maternal nutrition; other health conditions; and exposure to sexually transmitted diseases. 
  
  What Treatments Are Available for Stimulant Abuse? 
  Several behavioral therapies are effective in treating addiction to stimulants. These approaches are designed to help the person think differently, change their expectations and behaviors, and increase their skills in coping with various stresses in life. One form that is showing positive results in people addicted to either cocaine or methamphetamine is called contingency management, or motivational incentives (MI). These programs reward patients who refrain from using drugs by offering vouchers or other small rewards. MI may be particularly useful for helping patients to initially stop taking the drug and for helping them to stay in treatment.

• Depressants are psychoactive drugs which temporarily diminish the normal function of the brain and central nervous system. These drugs include opiates and opioids, barbiturates, benzodiazepines, tranquilizers and alcohol. Due to their effects, these drugs can be referred to as "downers".
  
  Types of Depressants 
  Alcohol 
  Alcohol is the most frequently used depressant. Types of alcohol include beer, wine, and liquor. Alcohol is a psychoactive drug that reduces attention and slows reaction speed. Alcohol intoxication affects the brain, causing slurred speech, clumsiness, and delayed reflexes. Other physiological effects include altered perception of space and time, reduced psychomotor skills, disrupting equilibrium. The immediate effects of a large amount of alcohol include spurred speech, disturbed sleep, nausea, and vomiting. Even at low doses, alcohol significantly impairs judgment and coordination. For Immediate Assistance with DepressantsCall 866.879.5424 
  
  Barbiturates 
  Barbiturates are a group of drugs known as sedative-hypnotics, creating sleep-inducing and anxiety-decreasing effects. Barbiturates produce effects from mild sedation to total anesthesia. Barbiturates can be injected into veins or muscles, but usually taken in pill form. They are sedatives used to treat insomnia, anxiety, and seizures. Barbiturates produce similar effects during intoxication. Symptoms of barbiturate intoxication include respiratory depression, lowered blood pressure, fatigue, fever, unusual excitement, irritability, dizziness, poor concentration, sedation, confusion, impaired coordination, impaired judgment, addiction, and respiratory arrest which may lead to death. Users report that a barbiturate high gives feelings of relaxed contentment and euphoria. The main risk of abuse is respiratory depression. Other effects of barbiturate intoxication include drowsiness, lateral and vertical nystagmus, slurred speech and ataxia, decreased anxiety and loss of inhibitions. 
  
  Benzodiazepines 
  Benzodiazepine, commonly referred to as "benzo", are most commonly used to treat insomnia and anxiety. The five most common benzos are Xanax, Ativan, Klonopin, Valium, and Restoril. Benzodiazepines are used to produce sedation, induce sleep, relieve anxiety and muscle spasms, and to prevent seizures. In general, they act as hypnotics in high doses, anxiolytics in moderate doses, and sedatives in low doses. 
  
  Opiates and Opoids 
  Opiates are found in opium. The major active opiates found in opium are morphine, codeine, thebaine, and papaverine. Semi-synthetic opioid such as heroin, oxycodone, and hydrocodone are derived from these substances as well. Opiates can be injected, snorted, or smoked. The short-term effect of opiate abuse consists of a surge of euphoria coupled with a warm flushing of the skin, dry mouth, and heavy extremities. Following initial euphoria, users alternate between a wakeful and drowsy state. Mental functioning becomes clouded due to the depression of the central nervous system. 
  
  Tranquilizers 
  Tranquilizers are used to treat anxiety or problems with sleep. They have a calming effect by depressing the nervous system in a way similar to alcohol. They are the most commonly prescribed psychiatric medications. They produce a relaxing and anxiety-reducing effect. Minor tranquilizers have direct depressant effects on brain areas that regulate wakefulness and alertness. They enhance the action of receptors that stimulate the nervous system. Major tranquilizers primarily affect specific receptors in the brain that reduce psychotic thoughts, perceptions and agitation. 
  
  Side Effects 
  General side effects may include:
  • Anxioysis
  • Analgesia
  • Sedation
  • Somnolence
  • Cognitive/Memory Impairment
  • Dissociation
  • Muscle relaxation
  • Lowered blood pressure/heart rate
  • Respiratory depression
  • Anesthesia
  • Anticonvulsant effects
  • Feelings of euphoria
  Health Effects 
  Most CNS depressants act on the brain by affecting the neurotransmitter gammaaminobutyric acid (GABA). Neurotransmitters are brain chemicals that enable communication between brain cells. GABA works by decreasing brain activity. So, due to depressants ability to increase GABA activity, a drowsy or calming effect is produced.
  
  With continued use of depressants, the body will develop a tolerance for the drugs, requiring larger doses to achieve the initial effects. When use is reduced or stopped, withdrawal will occur due to the reuse of brain activity, potentially leading to seizures and other harmful consequences.

• Hallucinogenic compounds found in some plants and mushrooms (or their extracts) have been used—mostly during religious rituals—for centuries. Almost all hallucinogens contain nitrogen and are classified as alkaloids. Many hallucinogens have chemical structures similar to those of natural neurotransmitters (e.g., acetylcholine-, serotonin-, or catecholamine-like). While the exact mechanisms by which hallucinogens exert their effects remain unclear, research suggests that these drugs work, at least partially, by temporarily interfering with neurotransmitter action or by binding to their receptor sites. This DrugFacts will discuss four common types of hallucinogens: 
  
  LSD (d-lysergic acid diethylamide) is one of the most potent mood-changing chemicals. It was discovered in 1938 and is manufactured from lysergic acid, which is found in ergot, a fungus that grows on rye and other grains. Peyote is a small, spineless cactus in which the principal active ingredient is mescaline. This plant has been used by natives in northern Mexico and the southwestern United States as a part of religious ceremonies. Mescaline can also be produced through chemical synthesis.
  
  Psilocybin (4-phosphoryloxy-N,N-dimethyltryptamine) is obtained from certain types of mushrooms that are indigenous to tropical and subtropical regions of South America, Mexico, and the United States. These mushrooms typically contain less than 0.5 percent psilocybin plus trace amounts of psilocin, another hallucinogenic substance.
  
  PCP (phencyclidine) was developed in the 1950s as an intravenous anesthetic. Its use has since been discontinued due to serious adverse effects.
  
  How Are Hallucinogens Abused? 
  The very same characteristics that led to the incorporation of hallucinogens into ritualistic or spiritual traditions have also led to their propagation as drugs of abuse. Importantly, and unlike most other drugs, the effects of hallucinogens are highly variable and unreliable, producing different effects in different people at different times. This is mainly due to the significant variations in amount and composition of active compounds, particularly in the hallucinogens derived from plants and mushrooms. Because of their unpredictable nature, the use of hallucinogens can be particularly dangerous.
  
  LSD is sold in tablets, capsules, and, occasionally, liquid form; thus, it is usually taken orally. LSD is often added to absorbent paper, which is then divided into decorated pieces, each equivalent to one dose. The experiences, often referred to as “trips,” are long; typically, they end after about 12 hours.
  
  Peyote: 
  The top of the peyote cactus, also referred to as the crown, consists of disc-shaped buttons that are cut from the roots and dried. These buttons are generally chewed or soaked in water to produce an intoxicating liquid. The hallucinogenic dose of mescaline is about 0.3 to 0.5 grams, and its effects last about 12 hours. Because the extract is so bitter, some individuals prefer to prepare a tea by boiling the cacti for several hours.
  
  Psilocybin:
  Mushrooms containing psilocybin are available fresh or dried and are typically taken orally. Psilocybin (4-phosphoryloxy-N,N-dimethyltryptamine) and its biologically active form, psilocin (4-hydroxy-N,N-dimethyltryptamine), cannot be inactivated by cooking or freezing preparations. Thus, they may also be brewed as a tea or added to other foods to mask their bitter flavor. The effects of psilocybin, which appear within 20 minutes of ingestion, last approximately 6 hours. PCP is a white crystalline powder that is readily soluble in water or alcohol. It has a distinctive bitter chemical taste. PCP can be mixed easily with dyes and is often sold on the illicit drug market in a variety of tablet, capsule, and colored powder forms that are normally snorted, smoked, or orally ingested. For smoking, PCP is often applied to a leafy material such as mint, parsley, oregano, or marijuana. Depending upon how much and by what route PCP is taken, its effects can last approximately 4–6 hours. How Do Hallucinogens Affect the Brain?
  
  LSD, peyote, psilocybin, and PCP are drugs that cause hallucinations, which are profound distortions in a person’s perception of reality. Under the influence of hallucinogens, people see images, hear sounds, and feel sensations that seem real but are not. Some hallucinogens also produce rapid, intense emotional swings. LSD, peyote, and psilocybin cause their effects by initially disrupting the interaction of nerve cells and the neurotransmitter serotonin.1 Distributed throughout the brain and spinal cord, the serotonin system is involved in the control of behavioral, perceptual, and regulatory systems, including mood, hunger, body temperature, sexual behavior, muscle control, and sensory perception. On the other hand, PCP acts mainly through a type of glutamate receptor in the brain that is important for the perception of pain, responses to the environment, and learning and memory. 
  
  There have been no properly controlled research studies on the specific effects of these drugs on the human brain, but smaller studies and several case reports have been published documenting some of the effects associated with the use of hallucinogens. 
  
  LSD: Sensations and feelings change much more dramatically than the physical signs in people under the influence of LSD. The user may feel several different emotions at once or swing rapidly from one emotion to another. If taken in large enough doses, the drug produces delusions and visual hallucinations. The user’s sense of time and self is altered. Experiences may seem to “cross over” different senses, giving the user the feeling of hearing colors and seeing sounds. These changes can be frightening and can cause panic. Some LSD users experience severe, terrifying thoughts and feelings of despair, fear of losing control, or fear of insanity and death while using LSD. 
  
  LSD users can also experience flashbacks, or recurrences of certain aspects of the drug experience. Flashbacks occur suddenly, often without warning, and may do so within a few days or more than a year after LSD use. In some individuals, the flashbacks can persist and cause significant distress or impairment in social or occupational functioning, a condition known as hallucinogen-induced persisting perceptual disorder (HPPD).
  
  Most users of LSD voluntarily decrease or stop its use over time. LSD is not considered an addictive drug since it does not produce compulsive drug-seeking behavior. However, LSD does produce tolerance, so some users who take the drug repeatedly must take progressively higher doses to achieve the state of intoxication that they had previously achieved. This is an extremely dangerous practice, given the unpredictability of the drug. In addition, cross-tolerance between LSD and other hallucinogens has been reported.
  
  Peyote: 
  The long-term residual psychological and cognitive effects of mescaline, peyote’s principal active ingredient, remain poorly understood. A recent study found no evidence of psychological or cognitive deficits among Native Americans that use peyote regularly in a religious setting.2 It should be mentioned, however, that these findings may not generalize to those who repeatedly abuse the drug for recreational purposes. Peyote abusers may also experience flashbacks.
  
  Psilocybin: The active compounds in psilocybin-containing “magic” mushrooms have LSD-like properties and produce alterations of autonomic function, motor reflexes, behavior, and perception.3 The psychological consequences of psilocybin use include hallucinations, an altered perception of time, and an inability to discern fantasy from reality. Panic reactions and psychosis also may occur, particularly if a user ingests a large dose. Long-term effects such as flashbacks, risk of psychiatric illness, impaired memory, and tolerance have been described in case reports.
  
  PCP: 
  The use of PCP as an approved anesthetic in humans was discontinued in 1965 because patients often became agitated, delusional, and irrational while recovering from its anesthetic effects. PCP is a “dissociative drug,” meaning that it distorts perceptions of sight and sound and produces feelings of detachment (dissociation) from the environment and self. First introduced as a street drug in the 1960s, PCP quickly gained a reputation as a drug that could cause bad reactions and was not worth the risk. However, some abusers continue to use PCP due to the feelings of strength, power, and invulnerability as well as a numbing effect on the mind that PCP can induce. Among the adverse psychological effects reported are— Symptoms that mimic schizophrenia, such as delusions, hallucinations, paranoia, disordered thinking, and a sensation of distance from one’s environment.
  
  Mood disturbances: 
  Approximately 50 percent of individuals brought to emergency rooms because of PCP-induced problems—related to use within the past 48 hours—report significant elevations in anxiety symptoms.4
  
  People who have abused PCP for long periods of time have reported memory loss, difficulties with speech and thinking, depression, and weight loss. These symptoms can persist up to one year after stopping PCP abuse.
  
  Addiction: 
  PCP is addictive—its repeated abuse can lead to craving and compulsive PCP-seeking behavior, despite severe adverse consequences. What Other Adverse Effects Do Hallucinogens Have on Health? Unpleasant adverse effects as a result of the use of hallucinogens are not uncommon. These may be due to the large number of psychoactive ingredients in any single source of hallucinogen.3 
  
  LSD: 
  The effects of LSD depend largely on the amount taken. LSD causes dilated pupils; can raise body temperature and increase heart rate and blood pressure; and can cause profuse sweating, loss of appetite, sleeplessness, dry mouth, and tremors.
  
  Peyote: 
  Its effects can be similar to those of LSD, including increased body temperature and heart rate, uncoordinated movements (ataxia), profound sweating, and flushing. The active ingredient mescaline has also been associated, in at least one report, to fetal abnormalities.5
  
  Psilocybin:
  It can produce muscle relaxation or weakness, ataxia, excessive pupil dilation, nausea, vomiting, and drowsiness. Individuals who abuse psilocybin mushrooms also risk poisoning if one of many existing varieties of poisonous mushrooms is incorrectly identified as a psilocybin mushroom.
  
  PCP: 
  At low-to-moderate doses, physiological effects of PCP include a slight increase in breathing rate and a pronounced rise in blood pressure and pulse rate. Breathing becomes shallow; flushing and profuse sweating, generalized numbness of the extremities, and loss of muscular coordination may occur.
  
  At high doses, blood pressure, pulse rate, and respiration drop. This may be accompanied by nausea, vomiting, blurred vision, flicking up and down of the eyes, drooling, loss of balance, and dizziness. PCP abusers are often brought to emergency rooms because of overdose or because of the drug’s severe untoward psychological effects. While intoxicated, PCP abusers may become violent or suicidal and are therefore dangerous to themselves and others. High doses of PCP can also cause seizures, coma, and death (though death more often results from accidental injury or suicide during PCP intoxication). Because PCP can also have sedative effects, interactions with other central nervous system depressants, such as alcohol and benzodiazepines, can also lead to coma.
  
  What Treatment Options Exist?
  Treatment for alkaloid hallucinogen (such as psilocybin) intoxication—which is mostly symptomatic—is often sought as a result of bad “trips,” during which a patient may, for example, hurt him- or herself.6 Treatment is usually supportive: provision of a quiet room with little sensory stimulation. Occasionally, benzodiazepines are used to control extreme agitation or seizures. 
  
  There is very little published data on treatment outcomes for PCP intoxication. Doctors should consider that acute adverse reactions may be the result of drug synergy with alcohol.7 Current research efforts to manage a life-threatening PCP overdose are focused on a passive immunization approach through the development of anti-PCP antibodies.8 There are no specific treatments for PCP abuse and addiction, but inpatient and/or behavioral treatments can be helpful for patients with a variety of addictions, including that to PCP. 
  
  How Widespread Is the Abuse of Hallucinogens?
  According to the National Survey on Drug Use and Health (NSDUH)*, there were approximately 1.1 million persons aged 12 or older in 2007 who reported using hallucinogens for the first time within the past 12 months.

• Marijuana is the most commonly abused illicit drug in the United States. It is a dry, shredded green and brown mix of flowers, stems, seeds, and leaves derived from the hemp plant Cannabis sativa. The main active chemical in marijuana is delta-9-tetrahydrocannabinol, or THC for short.
  
  How is Marijuana Abused? 
  Marijuana is usually smoked as a cigarette (joint) or in a pipe. It is also smoked in blunts, which are cigars that have been emptied of tobacco and refilled with a mixture of marijuana and tobacco. This mode of delivery combines marijuana's active ingredients with nicotine and other harmful chemicals. Marijuana can also be mixed in food or brewed as a tea. As a more concentrated, resinous form, it is called hashish; and as a sticky black liquid, hash oil. Marijuana smoke has a pungent and distinctive, usually sweet-and-sour odor.
  
  How Does Marijuana Affect the Brain?
  Scientists have learned a great deal about how THC acts in the brain to produce its many effects. When someone smokes marijuana, THC rapidly passes from the lungs into the bloodstream, which carries the chemical to the brain and other organs throughout the body.
  
  THC acts upon specific sites in the brain, called cannabinoid receptors, kicking off a series of cellular reactions that ultimately lead to the "high" that users experience when they smoke marijuana. Some brain areas have many cannabinoid receptors; others have few or none. The highest density of cannabinoid receptors are found in parts of the brain that influence pleasure, memory, thinking, concentrating, sensory and time perception, and coordinated movement.1
  
  Not surprisingly, marijuana intoxication can cause distorted perceptions, impaired coordination, difficulty with thinking and problem solving, and problems with learning and memory. Research has shown that, in chronic users, marijuana's adverse impact on learning and memory can last for days or weeks after the acute effects of the drug wear off.2 As a result, someone who smokes marijuana every day may be functioning at a suboptimal intellectual level all of the time.
  
  Research into the effects of long-term cannabis use on the structure of the brain has yielded inconsistent results. It may be that the effects are too subtle for reliable detection by current techniques. A similar challenge arises in studies of the effects of chronic marijuana use on brain function. Brain imaging studies in chronic users tend to show some consistent alterations, but their connection to impaired cognitive functioning is far from clear. This uncertainty may stem from confounding factors such as other drug use, residual drug effects, or withdrawal symptoms in long-term chronic users.
  
  Addictive Potential
  Long-term marijuana abuse can lead to addiction; that is, compulsive drug seeking and abuse despite the known harmful effects upon functioning in the context of family, school, work, and recreational activities. Estimates from research suggest that about 9 percent of users become addicted to marijuana; this number increases among those who start young (to about 17 percent) and among daily users (25-50 percent).
  
  Long-term marijuana abusers trying to quit report withdrawal symptoms including: irritability, sleeplessness, decreased appetite, anxiety, and drug craving, all of which can make it difficult to remain abstinent. These symptoms begin within about 1 day following abstinence, peak at 2-3 days, and subside within 1 or 2 weeks following drug cessation.3
  
  Marijuana and Mental Health A number of studies have shown an association between chronic marijuana use and increased rates of anxiety, depression, and schizophrenia. Some of these studies have shown age at first use to be an important risk factor, where early use is a marker of increased vulnerability to later problems. However, at this time, it is not clear whether marijuana use causes mental problems, exacerbates them, or reflects an attempt to self-medicate symptoms already in existence.
  
  Chronic marijuana use, especially in a very young person, may also be a marker of risk for mental illnesses - including addiction - stemming from genetic or environmental vulnerabilities, such as early exposure to stress or violence. Currently, the strongest evidence links marijuana use and schizophrenia and/or related disorders.4 High doses of marijuana can produce an acute psychotic reaction; in addition, use of the drug may trigger the onset or relapse of schizophrenia in vulnerable individuals.
  
  What Other Adverse Effect Does Marijuana Have on Health? 
  Effects on the Heart Marijuana increases heart rate by 20-100 percent shortly after smoking; this effect can last up to 3 hours. In one study, it was estimated that marijuana users have a 4.8-fold increase in the risk of heart attack in the first hour after smoking the drug.5 This may be due to increased heart rate as well as the effects of marijuana on heart rhythms, causing palpitations and arrhythmias. This risk may be greater in aging populations or in those with cardiac vulnerabilities.
  
  Effects on the Lungs 
  Numerous studies have shown marijuana smoke to contain carcinogens and to be an irritant to the lungs. In fact, marijuana smoke contains 50-70 percent more carcinogenic hydrocarbons than tobacco smoke. Marijuana users usually inhale more deeply and hold their breath longer than tobacco smokers do, which further increase the lungs' exposure to carcinogenic smoke. Marijuana smokers show dysregulated growth of epithelial cells in their lung tissue, which could lead to cancer;6 however, a recent case-controlled study found no positive associations between marijuana use and lung, upper respiratory, or upper digestive tract cancers.7 Thus, the link between marijuana smoking and these cancers remains unsubstantiated at this time.
  
  Nonetheless, marijuana smokers can have many of the same respiratory problems as tobacco smokers, such as daily cough and phlegm production, more frequent acute chest illness, and a heightened risk of lung infections. A study of 450 individuals found that people who smoke marijuana frequently but do not smoke tobacco have more health problems and miss more days of work than nonsmokers.8 Many of the extra sick days among the marijuana smokers in the study were for respiratory illnesses.
  
  Effects on Daily Life 
  Research clearly demonstrates that marijuana has the potential to cause problems in daily life or make a person's existing problems worse. In one study, heavy marijuana abusers reported that the drug impaired several important measures of life achievement, including physical and mental health, cognitive abilities, social life, and career status.9 Several studies associate workers' marijuana smoking with increased absences, tardiness, accidents, workers' compensation claims, and job turnover.
  
  What Treatment Options Exist? 
  Behavioral interventions, including cognitive-behavioral therapy and motivational incentives (i.e., providing vouchers for goods or services to patients who remain abstinent) have shown efficacy in treating marijuana dependence. Although no medications are currently available, recent discoveries about the workings of the cannabinoid system offer promise for the development of medications to ease withdrawal, block the intoxicating effects of marijuana, and prevent relapse.
  
  The latest treatment data indicate that in 2008 marijuana accounted for 17 percent of admissions (322,000) to treatment facilities in the United States, second only to opiates among illicit substances. Marijuana admissions were primarily male (74 percent), White (49 percent), and young (30 percent were in the 12-17 age range). Those in treatment for primary marijuana abuse had begun use at an early age: 56 percent by age 14.**
  
  Is Marijuana Medicine? 
  The potential medicinal properties of marijuana have been the subject of substantive research and heated debate. Scientists have confirmed that the cannabis plant contains active ingredients with therapeutic potential for relieving pain, controlling nausea, stimulating appetite, and decreasing ocular pressure. Cannabinoid-based medications include synthetic compounds, such as dronabinol (Marinol®) and nabilone (Cesamet®), which are FDA approved, and a new, chemically pure mixture of plant-derived THC and cannabidiol called Sativex®, formulated as a mouth spray and approved in Canada and parts of Europe for the relief of cancer-associated pain and spasticity and neuropathic pain in multiple sclerosis.
  Scientists continue to investigate the medicinal properties of THC and other cannabinoids to better evaluate and harness their ability to help patients suffering from a broad range of conditions, while avoiding the adverse effects of smoked marijuana.

• The harmful effects of smoking extend far beyond the smoker. Exposure to secondhand smoke can cause serious diseases and death. Each year, an estimated 126 million Americans are regularly exposed to secondhand smoke and almost 50 thousand nonsmokers die from diseases caused by secondhand smoke exposure.4
  
  How Does Tobacco Affect the Brain? 
  Cigarettes and other forms of tobacco—including cigars, pipe tobacco, snuff, and chewing tobacco—contain the addictive drug nicotine. Nicotine is readily absorbed into the bloodstream when a tobacco product is chewed, inhaled, or smoked. A typical smoker will take 10 puffs on a cigarette over a period of 5 minutes that the cigarette is lit. Thus, a person who smokes about 1 1/2 packs (30 cigarettes) daily gets 300 “hits” of nicotine each day.
  
  Upon entering the bloodstream, nicotine immediately stimulates the adrenal glands to release the hormone epinephrine (adrenaline). Epinephrine stimulates the central nervous system and increases blood pressure, respiration, and heart rate. Glucose is released into the blood while nicotine suppresses insulin output from the pancreas, which means that smokers have chronically elevated blood sugar levels. 
  
  Like cocaine, heroin, and marijuana, nicotine increases levels of the neurotransmitter dopamine, which affects the brain pathways that control reward and pleasure. For many tobacco users, long-term brain changes induced by continued nicotine exposure result in addiction—a condition of compulsive drug seeking and use, even in the face of negative consequences. Studies suggest that additional compounds in tobacco smoke, such as acetaldehyde, may enhance nicotine’s effects on the brain.5 A number of studies indicate that adolescents are especially vulnerable to these effects and may be more likely than adults to develop an addiction to tobacco.
  
  When an addicted user tries to quit, he or she experiences withdrawal symptoms including irritability, attention difficulties, sleep disturbances, increased appetite, and powerful cravings for tobacco. Treatments can help smokers manage these symptoms and improve the likelihood of successfully quitting.
  
  What Other Adverse Effects Does Tobacco Have on Health? 
  Cigarette smoking accounts for about one-third of all cancers, including 90 percent of lung cancer cases. Smokeless tobacco (such as chewing tobacco and snuff) also increases the risk of cancer, especially oral cancers. In addition to cancer, smoking causes lung diseases such as chronic bronchitis and emphysema, and increases the risk of heart disease, including stroke, heart attack, vascular disease, and aneurysm. Smoking has also been linked to leukemia, cataracts, and pneumonia.1,2 On average, adults who smoke die 14 years earlier than nonsmokers.2
  
  Although nicotine is addictive and can be toxic if ingested in high doses, it does not cause cancer—other chemicals are responsible for most of the severe health consequences of tobacco use. Tobacco smoke is a complex mixture of chemicals such as carbon monoxide, tar, formaldehyde, cyanide, and ammonia—many of which are known carcinogens. Carbon monoxide increases the chance of cardiovascular diseases. Tar exposes the user to an increased risk of lung cancer, emphysema, and bronchial disorders. 
  
  Pregnant women who smoke cigarettes run an increased risk of miscarriage, stillborn or premature infants, or infants with low birthweight.2 Maternal smoking may also be associated with learning and behavioral problems in children. Smoking more than one pack of cigarettes per day during pregnancy nearly doubles the risk that the affected child will become addicted to tobacco if that child starts smoking.6
  
  While we often think of medical consequences that result from direct use of tobacco products, passive or secondary smoke also increases the risk for many diseases. Secondhand smoke, also known as environmental tobacco smoke, consists of exhaled smoke and smoke given off by the burning end of tobacco products. Nonsmokers exposed to secondhand smoke at home or work increase their risk of developing heart disease by 25 to 30 percent7 and lung cancer by 20 to 30 percent.2 In addition, secondhand smoke causes respiratory problems, such as coughing, overproduction of phlegm, and reduced lung function and respiratory infections, including pneumonia and bronchitis, in both adults and children. In fact, each year about 150,000 – 300,000 children younger than 18 months old experience respiratory tract infections caused by secondhand smoke.4 Children exposed to secondhand smoking are at an increased risk for sudden infant death syndrome, ear problems, and severe asthma. Furthermore, children who grow up with parents who smoke are more likely to become smokers, thus placing themselves (and their future families) at risk for the same health problems as their parents when they become adults. 
  
  Although quitting can be difficult, the health benefits of smoking cessation are immediate and substantial—including reduced risk for cancers, heart disease, and stroke. A 35-year-old man who quits smoking will, on average, increase his life expectancy by 5 years.8
  
  Are There Effective Treatments for Tobacco Addiction? 
  Tobacco addiction is a chronic disease that often requires multiple attempts to quit. Although some smokers are able to quit without help, many others need assistance. Generally, rates of relapse for smoking cessation are highest in the first few weeks and months and diminish considerably after about 3 months. Both behavioral interventions (counseling) and medication can help smokers quit; but the combination of medication with counseling is more effective than either alone.
  
  Behavioral Treatments 
  Behavioral treatments employ a variety of methods to assist smokers in quitting, ranging from self-help materials to individual counseling. These interventions teach individuals to recognize high-risk situations and develop coping strategies to deal with them.
  
  Nicotine Replacement Treatments 
  Nicotine replacement therapies (NRTs), such as nicotine gum and the nicotine patch, were the first pharmacological treatments approved by the Food and Drug Administration (FDA) for use in smoking cessation therapy. NRTs deliver a controlled dose of nicotine to a smoker in order to relieve withdrawal symptoms during the smoking cessation process. They are most successful when used in combination with behavioral treatments. Current FDA-approved NRT products include nicotine chewing gum, the nicotine transdermal patch, nasal sprays, inhalers, and lozenges.
  
  Other Medications 
  Bupropion and varenicline are two FDA-approved non-nicotine medications that effectively increase rates of long-term abstinence from smoking. Bupropion, a medication that goes by the trade name Zyban, was approved by the FDA in 1997 for use in smoking cessation. Varenicline tartrate (trade name: Chantix) targets nicotine receptors in the brain, easing withdrawal symptoms and blocking the effects of nicotine if people resume smoking.
  
  Current Treatment Research 
  Scientists are currently pursuing many other avenues of research to develop new smoking cessation therapies. One promising intervention is a vaccine called NicVax that works by targeting nicotine in the bloodstream, blocking its access to the brain and thereby preventing its reinforcing effects. Preliminary trials of this vaccine have yielded promising results, with vaccinated smokers achieving higher quit rates and longer term abstinence compared to smokers given placebo. NicVax is now being evaluated in Phase III clinical trials; successful completion will bring NicVax closer to final approval by the FDA. 
  
  How Widespread Is Tobacco Use? Monitoring the Future Survey* Current smoking rates among 8th- and 12th-grade students reached an all-time low in 2009. According to the Monitoring the Future survey, 6.5 percent of 8th-graders and 20.1 percent of 12th-graders reported they had used cigarettes in the past month. Current smoking also decreased among 10th-graders, to about 13 percent in 2009. Although unacceptably high numbers of youth continue to smoke, these numbers represent a significant decrease from peak smoking rates (21 percent in 8th-graders, 30 percent in 10th-graders and 36 percent in 12th-graders) that were reached in the late 1990s. 
  
  The decrease in smoking rates among young Americans corresponds to several years in which increased proportions of teens said they believed there was a “great” health risk associated with cigarette smoking and expressed disapproval of smoking one or more packs of cigarettes per day. Students’ personal disapproval of smoking has risen for some years; for example, the percentage of 12th-graders reporting disapproval of smoking one or more packs of cigarettes per day increased from 68.8 percent in 1998 to 81.8 percent in 2009. During the same period, the percentage of 8th-graders who said it was “very easy” or “fairly easy” to obtain cigarettes declined from 73.6 percent in 1998 to 55.3 percent in 2009.
  
  Current use of smokeless tobacco remained steady among 8th-graders and 12th-graders in 2009 (3.7 percent and 8.4 percent, respectively); however, current smokeless tobacco use among 10th-grade students increased significantly from 5.0 percent in 2008 to 6.5 percent in 2009.

• WHAT IS INHALANT ABUSE 
  Inhalant abuse refers to the deliberate inhalation or sniffing of common products found in homes and communities with the purpose of "getting high." Inhalants are easily accessible, legal, everyday products. When used as intended, these products have a useful purpose in our lives and enhance the quality of life, but when intentionally misused, they can be deadly. Inhalant Abuse is a lesser recognized form of substance abuse, but it is no less dangerous. Inhalants are addictive and are considered to be "gateway" drugs because children often progress from inhalants to illegal drug and alcohol abuse. The National Institute on Drug Abuse reports that one in five American teens have used Inhalants to get high. 
  
  Huffing, Sniffing, Dusting and Bagging 
  Inhalation is referred to as huffing, sniffing, dusting or bagging and generally occurs through the nose or mouth. Huffing is when a chemically soaked rag is held to the face or stuffed in the mouth and the substance is inhaled. Sniffing can be done directly from containers, plastic bags, clothing or rags saturated with a substance or from the product directly. With Bagging, substances are sprayed or deposited into a plastic or paper bag and the vapors are inhaled. This method can result in suffocation because a bag is placed over the individual's head, cutting off the supply of oxygen. 
  
  Other methods used include placing inhalants on sleeves, collars, or other items of clothing that are sniffed over a period of time. Fumes are discharged into soda cans and inhaled from the can or balloons are filled with nitrous oxide and the vapors are inhaled. Heating volatile substances and inhaling the vapors emitted is another form of inhalation. All of these methods are potentially harmful or deadly. Experts estimate that there are several hundred deaths each year from Inhalant Abuse, although under-reporting is still a problem. 
  
  What Products Can be Abused? 
  There are more than a 1,400 products which are potentially dangerous when inhaled, such as typewriter correction fluid, air conditioning coolant, gasoline, propane, felt tip markers, spray paint, air freshener, butane, cooking spray, paint, and glue. Most are common products that can be found in the home, garage, office, school or as close as the local laptop store. The best advice for consumers is to read the labels before using a product to ensure the proper method is observed. It is also recommended that parents discuss the product labels with their children at age-appropriate times. The following list represents categories of products that are commonly abused.

• There are many options for treatment for alcohol use disorders. They depend in part on the severity of the patient’s drinking. 
  Treatment options include: 
  Behavioral therapy, which may include individual sessions with a health professional and support groups 
  
  Medications 
  Guidelines encourage primary care doctors to do “brief intervention” to help patients who are alcohol abusers (but who may not yet be alcohol dependent) reduce or stop their drinking. In these interventions, your doctor may give you an action plan for working on your drinking, ask you to keep a daily diary of how much alcohol you consume, and recommend for you target goals for your drinking. If your doctor thinks that you have reached the stage of alcoholism, he or she may recommend anti-craving or aversion medication and also refer you to other health care professionals for substance abuse services.
  
  Overall Treatment Goals 
  The ideal goal of long-term treatment for alcohol dependence is total abstinence. Patients who secure total abstinence have better survival rates, mental health, and marriages, and they are more responsible parents and employees than those who continue to drink or relapse. To achieve this, the patient aims to avoid high-risk situations and replace the addictive patterns with satisfying, time-filling behaviors.
  
  Because abstinence is so difficult to attain, however, many professionals choose to treat alcoholism as a chronic disease. In other words, patients should expect and accept relapse but should aim for as long a remission period as possible. Even merely reducing alcohol intake can lower the risk for alcohol-related medical problems.
  
  Alcoholics Anonymous (AA) and other alcoholism treatment groups express concern about treatment approaches that do not aim for strict abstinence. Many people with alcoholism are eager for any excuse to start drinking again. There is also no way to determine which people can stop after one drink and which ones cannot. 
  
  Evidence strongly suggests that seeking total abstinence and avoiding high-risk situations are the optimal goals for people with alcoholism. A strong social network and family support is also important. Families and friends need to be educated on how to assist, and not enable, the drinker. Support groups such as Al-Anon can be very helpful in providing advice and guidance. 
  
  Inpatient Versus Outpatient Treatment 
  Inpatient Treatment . Inpatient care is usually reserved for patients whose alcoholism places them in danger. Inpatient treatment may be performed in a general or psychiatric hospital or in a center dedicated to treatment of alcohol and other substance abuse. Factors that indicate a need for this type of treatment include: 
  
  Coexisting medical or psychiatric disorder 
  Delirium tremens (a neurological condition associated with withdrawal that involves uncontrollable trembling, sweating, anxiety, and hallucinations or other symptoms of psychosis) Potential harm to self or others Failure to respond to conservative treatments Disruptive home environment 
  
  A typical inpatient regimen may include the following stages: 
  A physical and psychiatric work-up for any physical or mental disorders Detoxification -- this phase involves initiating abstinence, managing withdrawal symptoms and complications, and ensuring that the patient remains in treatment On-going treatment with medications in some cases Psychotherapy, usually cognitive behavioral therapy An introduction to AA Some -- but not all -- studies have reported better success rates with inpatient treatment of patients with alcoholism. However, newer studies strongly suggest that alcoholism can be effectively treated in outpatient settings. 
  
  Outpatient Treatment. 
  People with mild-to-moderate withdrawal symptoms are usually treated as outpatients. Treatments are similar to those in inpatient situations and include: Psychotherapy or counseling Medications that target brain chemicals involved in addiction Social support groups such as AA Cognitive therapies Involvement of family and other significant people in patient's life The current approach to outpatient treatment uses “medical management” -- a disease management approach that is used for chronic illnesses such as diabetes. With medical management, patients receive regular 20-minute sessions with a health care provider. The provider monitors the patient’s medical condition, medication, and alcohol consumption. 
  
  After-Care and Work Therapy. After-care uses services to help maintain sobriety. For example, in some cities, sober-living houses provide residences for people who are trying to stay sober. They do not offer formal treatment services, but the people living there offer each other support and maintain an abstinent environment. 
  
  Factors That Predict Success or Failure after Treatment 
  About 25% of people are continuously abstinent following treatment, and another 10% use alcohol moderately and without problems. Relapse is common and intensive and prolonged treatment is important for successful recovery, whether the patient is treated within or outside a treatment center.
  
  Treating People Who Have Both Alcoholism and Health Problems 
  Severe alcoholism is often complicated by the presence of serious medical illnesses. People with alcoholism should try at least to maintain a healthy diet and take vitamin supplements. Such deficiencies are a major cause of health problems in people with alcoholism. Women are particularly at risk.
  
  Treating People Who Have Both Alcoholism and Mental Illness Treatment for patients with both alcoholism and mental illness is particularly difficult. The greater the psychiatric distress a person is experiencing, the more the person is tempted to drink, particularly in negative situations. 
  
  There has been some concern that self-help programs such as AA are not effective for patients with dual diagnoses of mental illness and alcoholism because they focus on addiction, not psychiatric problems. Studies, however, have reported that they can also help many of these patients. (AA may not be as helpful for people with schizophrenia and schizoaffective disorder.) 
  
  Antidepressants or anti-anxiety medication may help people contending with depression or anxiety disorders. However, in general, these types of medications should be prescribed with caution as they may interact with alcohol. In particular, patients who are currently drinking should never take monoamine oxidase inhibitor (MAOIs) antidepressants as alcohol can trigger a dangerous spike in blood pressure. People with alcoholism and more severe problems such as schizophrenia or severe bipolar disorder may require other types of medications.

• Principles of Effective Treatment 1.Addiction is a complex but treatable disease that affects brain function and behavior. Drugs of abuse alter the brain's structure and function, resulting in changes that persist long after drug use has ceased. This may explain why drug abusers are at risk for relapse even after long periods of abstinence and despite the potentially devastating consequences.
  
  2.No single treatment is appropriate for everyone. Matching treatment settings, interventions, and services to an individual's particular problems and needs is critical to his or her ultimate success in returning to productive functioning in the family, workplace, and society.
  
  3.Treatment needs to be readily available. Because drug-addicted individuals may be uncertain about entering treatment, taking advantage of available services the moment people are ready for treatment is critical. Potential patients can be lost if treatment is not immediately available or readily accessible. As with other chronic diseases, the earlier treatment is offered in the disease process, the greater the likelihood of positive outcomes.
  
  4.Effective treatment attends to multiple needs of the individual, not just his or her drug abuse. To be effective, treatment must address the individual's drug abuse and any associated medical, psychological, social, vocational, and legal problems. It is also important that treatment be appropriate to the individual's age, gender, ethnicity, and culture.
  
  5.Remaining in treatment for an adequate period of time is critical. The appropriate duration for an individual depends on the type and degree of his or her problems and needs. Research indicates that most addicted individuals need at least 3 months in treatment to significantly reduce or stop their drug use and that the best outcomes occur with longer durations of treatment. Recovery from drug addiction is a longterm process and frequently requires multiple episodes of treatment. As with other chronic illnesses, relapses to drug abuse can occur and should signal a need for treatment to be reinstated or adjusted. Because individuals often leave treatment prematurely, programs should include strategies to engage and keep patients in treatment.
  
  6.Counseling—individual and/or group—and other behavioral therapies are the most commonly used forms of drug abuse treatment. Behavioral therapies vary in their focus and may involve addressing a patient's motivation to change, providing incentives for abstinence, building skills to resist drug use, replacing drug-using activities with constructive and rewarding activities, improving problem solving skills, and facilitating better interpersonal relationships. Also, participation in group therapy and other peer support programs during and following treatment can help maintain abstinence.
  
  7.Medications are an important element of treatment for many patients, especially when combined with counseling and other behavioral therapies. For example, methadone and buprenorphine are effective in helping individuals addicted to heroin or other opioids stabilize their lives and reduce their illicit drug use. Naltrexone is also an effective medication for some opioid-addicted individuals and some patients with alcohol dependence. Other medications for alcohol dependence include acamprosate, disulfiram, and topiramate. For persons addicted to nicotine, a nicotine replacement product (such as patches, gum, or lozenges) or an oral medication (such as bupropion or varenicline) can be an effective component of treatment when part of a comprehensive behavioral treatment program.
  
  8.An individual's treatment and services plan must be assessed continually and modified as necessary to ensure that it meets his or her changing needs. A patient may require varying combinations of services and treatment components during the course of treatment and recovery. In addition to counseling or psychotherapy, a patient may require medication, medical services, family therapy, parenting instruction, vocational rehabilitation, and/or social and legal services. For many patients, a continuing care approach provides the best results, with the treatment intensity varying according to a person's changing needs.
  
  9.Many drug-addicted individuals also have other mental disorders. Because drug abuse and addiction—both of which are mental disorders—often co-occur with other mental illnesses, patients presenting with one condition should be assessed for the other(s). And when these problems co-occur, treatment should address both (or all), including the use of medications as appropriate.
  
  10.Medically assisted detoxification is only the first stage of addiction treatment and by itself does little to change long-term drug abuse. Although medically assisted detoxification can safely manage the acute physical symptoms of withdrawal and, for some, can pave the way for effective long-term addiction treatment, detoxification alone is rarely sufficient to help addicted individuals achieve long-term abstinence. Thus, patients should be encouraged to continue drug treatment following detoxification. Motivational enhancement and incentive strategies, begun at initial patient intake, can improve treatment engagement.
  
  11.Treatment does not need to be voluntary to be effective. Sanctions or enticements from family, employment settings, and/or the criminal justice system can significantly increase treatment entry, retention rates, and the ultimate success of drug treatment interventions.
  
  12.Drug use during treatment must be monitored continuously, as lapses during treatment do occur. Knowing their drug use is being monitored can be a powerful incentive for patients and can help them withstand urges to use drugs. Monitoring also provides an early indication of a return to drug use, signaling a possible need to adjust an individual's treatment plan to better meet his or her needs.
  
  13.Treatment programs should assess patients for the presence of HIV/ AIDS, hepatitis B and C, tuberculosis, and other infectious diseases as well as provide targeted risk-reduction counseling to help patients modify or change behaviors that place them at risk of contracting or spreading infectious diseases. Typically, drug abuse treatment addresses some of the drug-related behaviors that put people at risk of infectious diseases. Targeted counseling specifically focused on reducing infectious disease risk can help patients further reduce or avoid substance-related and other high-risk behaviors. Counseling can also help those who are already infected to manage their illness. Moreover, engaging in substance abuse treatment can facilitate adherence to other medical treatments. Patients may be reluctant to accept screening for HIV (and other infectious diseases); therefore, it is incumbent upon treatment providers to encourage and support HIV screening and inform patients that highly active anti-retroviral therapy (HAART) has proven effective in combating HIV, including among drug-abusing populations.

• Drug addiction is a complex illness characterized by intense and, at times, uncontrollable drug craving, along with compulsive drug seeking and use that persist even in the face of devastating consequences. While the path to drug addiction begins with the voluntary act of taking drugs, over time a person's ability to choose not to do so becomes compromised, and seeking and consuming the drug becomes compulsive. This behavior results largely from the effects of prolonged drug exposure on brain functioning. Addiction is a brain disease that affects multiple brain circuits, including those involved in reward and motivation, learning and memory, and inhibitory control over behavior.
  
  Because drug abuse and addiction have so many dimensions and disrupt so many aspects of an individual's life, treatment is not simple. Effective treatment programs typically incorporate many components, each directed to a particular aspect of the illness and its consequences. Addiction treatment must help the individual stop using drugs, maintain a drug-free lifestyle, and achieve productive functioning in the family, at work, and in society. Because addiction is typically a chronic disease, people cannot simply stop using drugs for a few days and be cured. Most patients require long-term or repeated episodes of care to achieve the ultimate goal of sustained abstinence and recovery of their lives.
  
  Too often, addiction goes untreated: According to SAMHSA's National Survey on Drug Use and Health (NSDUH), 23.2 million persons (9.4 percent of the U.S. population) aged 12 or older needed treatment for an illicit drug or alcohol use problem in 2007. Of these individuals, 2.4 million (10.4 percent of those who needed treatment) received treatment at a specialty facility (i.e., hospital, drug or alcohol rehabilitation or mental health center). Thus, 20.8 million persons (8.4 percent of the population aged 12 or older) needed treatment for an illicit drug or alcohol use problem but did not receive it. These estimates are similar to those in previous years.1
  
  Principles of Effective Treatment 
  Scientific research since the mid–1970s shows that treatment can help patients addicted to drugs stop using, avoid relapse, and successfully recover their lives. Based on this research, key principles have emerged that should form the basis of any effective treatment programs:
  
  Addiction is a complex but treatable disease that affects brain function and behavior. No single treatment is appropriate for everyone. Treatment needs to be readily available.
  
  Effective treatment attends to multiple needs of the individual, not just his or her drug abuse. Remaining in treatment for an adequate period of time is critical. Counseling—individual and/or group—and other behavioral therapies are the most commonly used forms of drug abuse treatment. Medications are an important element of treatment for many patients, especially when combined with counseling and other behavioral therapies.
  
  An individual's treatment and services plan must be assessed continually and modified as necessary to ensure that it meets his or her changing needs. Many drug–addicted individuals also have other mental disorders. Medically assisted detoxification is only the first stage of addiction treatment and by itself does little to change long–term drug abuse.
  
  Treatment does not need to be voluntary to be effective. 
  Drug use during treatment must be monitored continuously, as lapses during treatment do occur. Treatment programs should assess patients for the presence of HIV/AIDS, hepatitis B and C, tuberculosis, and other infectious diseases as well as provide targeted risk–reduction counseling to help patients modify or change behaviors that place them at risk of contracting or spreading infectious diseases.
  
  Effective Treatment Approaches 
  Medication and behavioral therapy, especially when combined, are important elements of an overall therapeutic process that often begins with detoxification, followed by treatment and relapse prevention. Easing withdrawal symptoms can be important in the initiation of treatment; preventing relapse is necessary for maintaining its effects. And sometimes, as with other chronic conditions, episodes of relapse may require a return to prior treatment components. A continuum of care that includes a customized treatment regimen—addressing all aspects of an individual's life, including medical and mental health services—and follow–up options (e.g., community – or family-based recovery support systems) can be crucial to a person's success in achieving and maintaining a drug–free lifestyle. 
  
  Medications
  Medications can be used to help with different aspects of the treatment process. 
  
  Withdrawal 
  Medications offer help in suppressing withdrawal symptoms during detoxification. However, medically assisted detoxification is not in itself "treatment"—it is only the first step in the treatment process. Patients who go through medically assisted withdrawal but do not receive any further treatment show drug abuse patterns similar to those who were never treated. 
  
  Treatment 
  Medications can be used to help reestablish normal brain function and to prevent relapse and diminish cravings. Currently, we have medications for opioids (heroin, morphine), tobacco (nicotine), and alcohol addiction and are developing others for treating stimulant (cocaine, methamphetamine) and cannabis (marijuana) addiction. Most people with severe addiction problems, however, are polydrug users (users of more than one drug) and will require treatment for all of the substances that they abuse. 
  
  Opioids: 
  Methadone, buprenorphine and, for some individuals, naltrexone are effective medications for the treatment of opiate addiction. Acting on the same targets in the brain as heroin and morphine, methadone and buprenorphine suppress withdrawal symptoms and relieve cravings. Naltrexone works by blocking the effects of heroin or other opioids at their receptor sites and should only be used in patients who have already been detoxified. Because of compliance issues, naltrexone is not as widely used as the other medications. All medications help patients disengage from drug seeking and related criminal behavior and become more receptive to behavioral treatments.
  
  Tobacco: 
  A variety of formulations of nicotine replacement therapies now exist—including the patch, spray, gum, and lozenges—that are available over the counter. In addition, two prescription medications have been FDA–approved for tobacco addiction: bupropion and varenicline. They have different mechanisms of action in the brain, but both help prevent relapse in people trying to quit. Each of the above medications is recommended for use in combination with behavioral treatments, including group and individual therapies, as well as telephone quitlines.
  
  Alcohol: 
  Three medications have been FDA–approved for treating alcohol dependence: naltrexone, acamprosate, and disulfiram. A fourth, topiramate, is showing encouraging results in clinical trials. Naltrexone blocks opioid receptors that are involved in the rewarding effects of drinking and in the craving for alcohol. It reduces relapse to heavy drinking and is highly effective in some but not all patients—this is likely related to genetic differences. Acamprosate is thought to reduce symptoms of protracted withdrawal, such as insomnia, anxiety, restlessness, and dysphoria (an unpleasant or uncomfortable emotional state, such as depression, anxiety, or irritability). It may be more effective in patients with severe dependence. Disulfiram interferes with the degradation of alcohol, resulting in the accumulation of acetaldehyde, which, in turn, produces a very unpleasant reaction that includes flushing, nausea, and palpitations if the patient drinks alcohol. Compliance can be a problem, but among patients who are highly motivated, disulfiram can be very effective.
  
  Behavioral Treatments 
  Behavioral treatments help patients engage in the treatment process, modify their attitudes and behaviors related to drug abuse, and increase healthy life skills. These treatments can also enhance the effectiveness of medications and help people stay in treatment longer. Treatment for drug abuse and addiction can be delivered in many different settings using a variety of behavioral approaches.
  
  Outpatient behavioral treatment encompasses a wide variety of programs for patients who visit a clinic at regular intervals. Most of the programs involve individual or group drug counseling. Some programs also offer other forms of behavioral treatment such as— 
  
  Cognitive–behavioral therapy, which seeks to help patients recognize, avoid, and cope with the situations in which they are most likely to abuse drugs.
  
  Multidimensional family therapy, which was developed for adolescents with drug abuse problems—as well as their families—addresses a range of influences on their drug abuse patterns and is designed to improve overall family functioning. Motivational interviewing, which capitalizes on the readiness of individuals to change their behavior and enter treatment. Motivational incentives (contingency management), which uses positive reinforcement to encourage abstinence from drugs.

• Ways to Stay Sober 
  Making the decision to quit drinking alcohol or drugs and to begin living a sober life can be challenging. Someone who depends on alcohol continues to drink in the face of serious family, health or legal problems, according to the National Institute on Alcohol Abuse and Alcoholism (NIAAA). Some alcohol abusers have to hit what Alcoholics Anonymous (AA) refers to as "bottom," before they are able to give up the bottle. Attending AA meetings or similar support groups, taking an honest look at your behaviors while using, building a support network and possibly taking medications may all help you stay sober. 
  
  Support Groups 
  AA was launched in the 1930s and has since grown into an international non-profit organization that provides support for people who are trying to live sober lives. The only requirement for AA membership is a desire to stop drinking. AA is a 12-step program that emphasizes turning your drinking problems over to a higher power. During meetings, you can share your experiences and concerns and hear other problem drinkers share their experiences. AA meetings provide a source of strength and hope for attendees. 
  
  A sponsor is similar to a mentor or tutor who may offer supportive guidance in your quest to stay sober. He has also struggled with sobriety and can relate to what you are going through. A sponsor can help you work the steps of AA and is usually a phone call away if you need to talk about an urge to drink or use drugs.
  
  Self-Assessment 
  Taking an honest self-evaluation of your behavior while you were drinking or taking drugs is a critical part of staying sober, according to the 12 steps of AA. Openly sharing information about your past conduct with another person, such as your sponsor or a member of the clergy, is intended to help clear your conscience and pave the way for a fresh start. 
  Supportive Friends 
  When you make the decision to quit drinking or using drugs, it may be unwise to socialize in bars or other settings where you may run into former drinking buddies. Spending time with a friend who is sober or one who is happy to refrain from drinking in your company can be helpful as you work to stay sober. 
  
  Medications
  Certain oral medications may help maintain sobriety in different ways, according to the NIAAA. Disulfiram makes you feel sick if you drink alcohol; naltrexone decreases craving for alcohol while acamprosate appears to diminish symptoms, like anxiety and insomnia, that may develop when you been abstinent for a period of time.