Stages of Change and Psychoactive Substances Overview

Vocabulary flashcards covering the Transtheoretical Model's stages of change, psychoactive substance classifications, routes of administration kinetics, pharmacological interactions, and current epidemiological trends.

Precontemplation

The first stage of change in which an individual is not yet considering change, denies having a problem, exhibits defensiveness or resistance, avoids feedback, and sees no connection between behavior and consequences.

Contemplation

The second stage of change characterized by awareness that a problem may exist, ambivalence, gathering information, weighing pros and cons, and uncertainty about one's ability to change.

Preparation

The third stage of change where an individual intends to take action soon, makes a concrete plan, gathers information, takes small initial steps, and displays increased hope and confidence.

Action

The fourth stage of change in which an individual actively implements their plan, alters behaviors, participates in treatment, builds new habits, and works to overcome barriers.

Maintenance

The fifth stage of change involving sustaining behavioral changes over time, employing healthy coping skills, strengthening support networks, working to prevent relapse, and building a fulfilling life.

Relapse (Stages of Change)

A return to problematic behavior that is viewed clinically not as a failure, but as feedback and an opportunity to learn, adjust strategies, and resume progress toward recovery.

Stimulants

A major drug class that accelerates central nervous system activity, elevates dopamine and norepinephrine, and increases alertness, energy, heart rate, and blood pressure.

Depressants

A major drug class that slows central nervous system activity to calm the body and quiet the mind, carrying high risks of respiratory depression, memory impairment, and fatal overdose.

Psychedelics

A major drug class that alters perception, mood, and cognitive thought processes without necessarily causing sedation or stimulation.

Contingency Management

The behavioral treatment approach possessing the strongest clinical evidence for treating stimulant use disorders, for which there are no FDA-approved medications.

Alcohol and Benzodiazepine Withdrawal

A critical depressant withdrawal condition that carries severe medical risks, including potentially fatal withdrawal seizures, requiring medical detoxification.

Hallucinogen Persisting Perception Disorder (HPPD)

A clinical complication of hallucinogen/psychedelic use characterized by the continuous or recurrent presence of sensory and visual disturbances (flashbacks).

Ketamine

A dissociative psychedelic substance possessing both approved medical applications and potential for recreational misuse.

Smoking (Route of Administration)

A rapid route of drug administration taking $7\text{ to }10\text{ seconds}$ to cross the blood-brain barrier and affect the CNS, associated with high addiction liability and elevated overdose risk due to rapid delivery and high peak levels.

Injection (Route of Administration)

A route of administration delivering the entire substance dose directly into the bloodstream with $100\%$ bioavailability within $15\text{ to }30\text{ seconds}$, conferring high addiction and overdose potential.

Snorting (Route of Administration)

An insufflation route where drugs are absorbed via the nasal mucosa within $2\text{ to }5\text{ minutes}$, producing lower peak blood concentrations than smoking or injection with moderate addiction and overdose risk.

Oral Administration

A slower ingestion route taking $30\text{ to }90\text{ minutes}$ to reach the central nervous system, characterized by lower peak drug levels and comparatively lower addiction and overdose risk.

Transdermal Administration

A delivery route using a patch that provides slow, steady absorption across several hours to $24+\text{ hours}$, resulting in the lowest peak levels and lowest addiction and overdose potential.

Synergism

A drug interaction occurring when the combined pharmacologic effect of two or more substances is greater than the mathematical sum of their individual effects.

Drug Potentiation

An interaction where the presence of one drug intensifies the potency or prolongs the duration of action of another drug.

Cytochrome P450 System

The liver enzyme system responsible for metabolizing most drugs; competition for shared enzymes within this system delays drug breakdown and prolongs full potency in the body.

CYP3A4 Inhibitors

Substances (including chronic alcohol use, grapefruit juice, certain antibiotics, antifungals, and antidepressants) that inhibit liver enzymes, raising circulating blood levels of co-administered drugs and increasing overdose risk.

Enzyme Induction

A hepatic process stimulated by agents such as smoking (which induces CYP1A2), carbamazepine, rifampin, and St. John's Wort that speeds drug clearance, lowering circulating drug levels and risking withdrawal or treatment failure.

Speedball

The concurrent use of a stimulant (cocaine or methamphetamine) and a depressant (heroin), wherein the stimulant masks depressant sedation; once the shorter-acting stimulant wears off, the unopposed depressant can precipitate fatal overdose.

Opioid and Benzodiazepine Co-Use

The combined use of two central nervous system depressants which, according to NIDA, is associated with a $10\text{-fold}$ increase in the risk of overdose death.

Youth Cannabis Disorder (Johns Hopkins Study)

A condition identified in a 2026 Johns Hopkins study linked to a $52\%$ increased risk of schizophrenia, $21\%$ increased risk of anxiety, and $30\%$ increased risk of recurrent major depression later in life, an association that reverses in adults age $18+$.

Polysubstance Use

The concurrent consumption of multiple psychoactive substances, recognized as the most common drug use pattern currently encountered in addiction treatment settings.

Fentanyl Contamination

The widespread adulteration of illicit drug supplies—including counterfeit pills, cocaine, methamphetamine, benzodiazepines, and cannabis—with potent synthetic opioids, often without the user's awareness.