substance abuse

Opioids

Heroin, morphine, hydromorphone; injected/smoked/inhaled/swallowed; high misuse risk.

Opioids – Intended Effects

Rush of euphoria; pain relief.

Opioids – Intoxication

Slurred speech, impaired memory, pupillary changes, ↓ respirations, ↓ LOC, impaired judgment; naloxone reverses toxicity.

Opioids – Withdrawal

Sweating, rhinorrhea, gooseflesh, tremors, irritability → weakness, diarrhea, fever, insomnia, dilated pupils, N/V, muscle pain/spasms; not life-threatening.

Alcohol – Intended Effects

Relaxation, ↓ social anxiety, stress reduction.

Alcohol – Intoxication

Slurred speech, nystagmus, memory issues, ↓ judgment/motor skills/LOC, respiratory arrest; chronic use → CV damage, liver disease, GI bleeding, pancreatitis.

Alcohol – Withdrawal

Abdominal cramps, vomiting, tremors, insomnia, ↑ HR/BP/RR/temp, hallucinations, seizures; delirium tremens 2–3 days → severe HTN, arrhythmias, delirium → fatal.

Sedatives – Intended Effects

Decreased anxiety; sedation.

Sedatives – Intoxication

Drowsiness, agitation, slurred speech, uncoordinated movement, nystagmus, disorientation, N/V; respiratory depression → fatal; flumazenil reverses benzos.

Sedatives – Withdrawal

Anxiety, insomnia, diaphoresis, HTN, psychosis, tremors, N/V, hallucinations, agitation, seizures.

Cannabis Marijuana/hashish;

smoked or ingested.

Cannabis – Intended Effects

Euphoria, sedation, hallucinations, ↓ N/V, chronic pain relief.

Cannabis – Intoxication

Respiratory issues, cannabis use disorder, paranoia/hallucinations (high doses), ↑ appetite, dry mouth, tachycardia; impaired motor skills 8–12 hrs; synthetic cannabinoids toxic.

Cannabis – Withdrawal

Irritability, aggression, anxiety, insomnia, ↓ appetite, restlessness, depression, abd pain, tremors, fever, headache.

Cocaine

Injected, smoked, or snorted.

Cocaine – Intended Effects

Euphoria, pleasure, ↑ energy.

Cocaine – Intoxication

Dizziness, irritability, tremor, blurred vision; severe → hallucinations, seizures, extreme fever, tachycardia, HTN, chest pain → cardiovascular collapse/death.

Cocaine – Withdrawal

Depression fatigue, cravings, hypersomnia/insomnia, vivid dreams, psychomotor changes; possible suicidal ideation.

Amphetamines/Methamphetamines

Taken orally, IV, or smoked.

Amphetamines – Intended Effects

↑ energy, euphoria.

Amphetamines – Intoxication

Impaired judgment, agitation, hypervigilance, irritability, tachycardia, HTN → death risk.

Amphetamines – Withdrawal

Craving, depression, fatigue, sleep disturbances; not life-threatening.

Inhalants

Amyl nitrate, nitrous oxide, solvents; sniffed/huffed/bagged.

Inhalants – Intended Effects

Euphoria.

Inhalants – Intoxication

Behavioral changes, dizziness, nystagmus, uncoordinated gait, slurred speech, drowsiness, hyporeflexia, muscle weakness, double vision, stupor/coma, respiratory depression → death.

Inhalants – Withdrawal

None.

Hallucinogens

LSD, mescaline, PCP; ingested, injected, or smoked.

Hallucinogens – Intended Effects

Altered perception; heightened awareness.

Hallucinogens – Intoxication

Anxiety, depression, paranoia, poor judgment, social impairment, dilated pupils, tachycardia, diaphoresis, palpitations, tremors, panic.

Hallucinogens – Withdrawal

Hallucinogen persisting perception disorder; flashbacks for years.

Caffeine

Cola, coffee, tea, chocolate, energy drinks.

Caffeine – Intended Effects

↑ alertness; ↓ fatigue.

Caffeine – Intoxication

250 mg → tachycardia, arrhythmias, flushed face, twitching, restlessness, diuresis, GI upset, anxiety, insomnia.

Caffeine – Withdrawal

Headache, N/V, muscle pain, irritability, drowsiness, poor focus.

Nicotine

Cigarettes, cigars, smokeless tobacco.

Nicotine – Intended Effects

Relaxation; ↓ anxiety.

Nicotine – Intoxication

Highly toxic in children/pesticide exposure; long-term → CV disease, stroke, emphysema, lung cancer; smokeless tobacco → oral lesions/cancer.

Nicotine – Withdrawal

Irritability, cravings, anxiety, insomnia, ↑ appetite, anger, poor concentration, depressed mood.

Diazepam

(Benzo) Used for alcohol withdrawal to prevent seizures, reduce agitation, and ease withdrawal symptoms.

Lorazepam

(Benzo) Used for alcohol withdrawal; controls tremors, agitation, and seizures; safer for liver impairment.

Carbamazepine

(Anticonvulsant) Used for alcohol withdrawal to reduce seizure risk and decrease withdrawal severity.

Clonidine

(Alpha-2 agonist) Used in alcohol or opioid withdrawal to reduce autonomic symptoms (BP, HR, sweating); does NOT prevent seizures.

Chlordiazepoxide

(Benzo) Long-acting benzo for alcohol withdrawal; prevents seizures and delirium tremens.

Phenobarbital

(Barbiturate) Used for severe alcohol withdrawal when benzos are ineffective; prevents seizures.

Naltrexone

(Opioid antagonist) Used for alcohol withdrawal recovery to reduce cravings and block reward from drinking.

Disulfiram

(Antidipsotropic/aldehyde dehydrogenase inhibitor) Used for alcohol abstinence; causes severe reaction if alcohol is consumed.

Naltrexone

(Opioid antagonist) Used for alcohol abstinence; reduces cravings and pleasurable effects of alcohol.

Acamprosate

(GABA/glutamate modulator) Used for alcohol abstinence; decreases anxiety, restlessness, and cravings.

Methadone

(Opioid agonist) Used for opioid withdrawal; replaces opioid, prevents withdrawal, reduces cravings.

Clonidine

(Alpha-2 agonist) Used for opioid withdrawal; reduces autonomic symptoms (N/V, diarrhea, sweating); does NOT reduce cravings.

Buprenorphine

(Partial opioid agonist) Used for opioid withdrawal; prevents withdrawal symptoms and reduces cravings.

Naltrexone

(Opioid antagonist) Used for opioid dependence; prevents relapse by blocking opioid effects.

Levo-alpha-acetylmethadol (LAAM)

(Long-acting opioid agonist) Used for opioid withdrawal; prevents withdrawal and cravings with long duration.

Bupropion

(Atypical antidepressant) Used for nicotine withdrawal; reduces cravings and withdrawal symptoms.

Nicotine replacement therapy

(Nicotine agonist) Nicotine gum/patch provides controlled nicotine to reduce cravings and withdrawal.

Varenicline

(Partial nicotinic receptor agonist) Used for nicotine withdrawal; reduces cravings and decreases reward from smoking.

Varenicline

(Partial nicotinic receptor agonist) Used for nicotine abstinence; continues blocking nicotine’s rewarding effects.

Rimonabant

(CB1 receptor antagonist) Used for nicotine abstinence; reduces cravings (rarely used due to psychiatric risks).