Comprehensive Guide to Drugs, Alcohol, and Addiction: Routes, Effects, and Treatment

Routes of Administration

Methods by which drugs enter the body, including ingestion, inhalation, intranasal, and injection.

Ingestion

The most common route of administration where substances are absorbed through the stomach and intestines into the bloodstream.

Inhalation

The second most common route of administration where substances are absorbed through the lungs into the bloodstream within seconds.

Intranasal (Snorting)

A route of administration where drugs are absorbed via nasal blood vessels.

Injection

A route of administration that includes intravenous (IV), intramuscular (IM), and subcutaneous (SC) methods.

Intravenous (IV)

The most common injection route for heroin and meth, known for being the fastest and most dangerous.

Pharmacokinetics

The study of how drugs move through the body, including absorption, distribution, metabolism, and elimination.

Blood-Brain Barrier

A selective barrier that drugs must cross to have psychoactive effects.

Half-life

The time required for the concentration of a drug to reduce by 50%.

Alcohol Dehydrogenase (ADH)

An enzyme that converts alcohol into acetaldehyde, which is toxic.

Aldehyde Dehydrogenase (ALDH)

An enzyme that converts acetaldehyde into acetate, which is then further broken down into water and carbon dioxide.

Blood Alcohol Content (BAC)

A measure of the amount of alcohol in a person's bloodstream, expressed as a percentage.

Standard Drink

A drink that typically results in a BAC of approximately 0.02-0.05, averaging around 0.03.

Metabolization Rate

The rate at which alcohol is metabolized, approximately 0.015 BAC per hour.

Legal Limit (U.S.)

The legal BAC limit for driving in the U.S., set at 0.08.

Subjective vs. Objective Intoxication

The phenomenon where individuals feel less impaired than they actually are, posing dangers for driving.

Agonists

Substances that mimic neurotransmitters, such as opiates that activate endorphin receptors.

Antagonists

Substances that block neurotransmitters, reducing their activation.

Reuptake Inhibitors

Drugs that prevent the reabsorption of neurotransmitters, such as SSRIs.

Tolerance

A decreased response to a drug following repeated use.

Distribution

The process by which drugs circulate through the body after being absorbed.

Elimination

The process of metabolizing drugs in the liver and excreting them via kidneys, lungs, sweat, or breast milk.

Alcohol

Activates GABA and Endorphin; suppresses NMDA Glutamate and Acetylcholine.

Barbiturates

Activates GABA; suppresses NMDA Glutamate.

Benzodiazepines

Activates GABA.

Stimulants

Activates Dopamine, Norepinephrine, and Serotonin.

Caffeine

Activates Dopamine and Acetylcholine; suppresses Adenosine.

Nicotine

Activates Acetylcholine.

Opioids

Activates Endorphin.

Marijuana

Activates Cannabinoid; suppresses Glutamate.

Psychedelics

Activates Serotonin and Dopamine; suppresses Acetylcholine.

Peak

Desired intoxicating effects.

Valley

Rebound (often opposite effects).

Stimulants Effects

Peak: euphoria, alertness, suppressed hunger; Valley: depression, fatigue, paranoia.

Sedatives Effects

Peak: calm, mild euphoria, lowered inhibitions; Valley: agitation, anxiety, insomnia, nausea.

Opiates Effects

Peak: euphoria, pain relief, drowsiness; Valley: flu-like withdrawal symptoms.

Psychedelics Effects

Peak: hallucinations, sensory distortions; Valley: minimal withdrawal; possible flashbacks.

Cannabis Effects

Peak: dream-like, sensory distortion; Valley: irritability, restlessness, insomnia.

Impaired Driving Statistics

31% of all U.S. traffic deaths involve alcohol; 121 million self-reported alcohol-impaired drives yearly.

Cross-tolerance

Tolerance to one drug → tolerance to similar drugs (e.g., Alcohol ↔ Benzodiazepines).

Combining sedatives

Leads to multiplicative effect (2+2=6).

Dependence Potential - Very High

Examples: Amphetamines, Cocaine, Nicotine, Heroin.

Dependence Potential - High

Examples: Caffeine, PCP.

Dependence Potential - Moderate

Examples: Alcohol, Marijuana, Benzodiazepines.

Dependence Potential - Low

Examples: Psychedelics, Steroids.

Dependence Potential - Very Low

Examples: Antidepressants, Antipsychotics.

Korsakoff's Syndrome

Caused by Vitamin B1 (thiamine) deficiency; symptoms include memory loss, confabulation, hallucinations.

Fetal Alcohol Syndrome (FAS)

Results from alcohol crossing the placenta; leads to growth & mental retardation, facial & limb deformities, behavioral problems.

Addiction

A behavior done regularly, habitually, or compulsively, partially out of conscious control.

Substance Use Disorder (DSM-V)

Combines abuse and dependence into one diagnosis with severity levels: Mild: 2-3 symptoms, Moderate: 4-5 symptoms, Severe: 6+ symptoms.

DSM Evolution

DSM-I & II: Grouped addiction under personality disorders. DSM-III & IV: Split into abuse vs. dependence. DSM-V (2013): Unified under SUD; based on 11 behavioral and physiological symptoms.

Risky Drinking (NIAAA)

Men: >4 drinks/day or >14 per week; Women: >3 drinks/day or >7 per week.

Binge Drinking

5+ drinks (men) or 4+ drinks (women) on one occasion.

Heavy Alcohol Use

Binge drinking for ≥5 days in the past month.

Variations in Use

Age: Highest among young adults; Gender: Men > women (except prescription sedatives); Race: White and Native American groups show higher rates; lower among Black, Hispanic, and Asian populations.

Biological & Genetic Models

Genetics: 35-70% of variance in vulnerability; twin studies show both genetic and environmental roles.

Environmental Influence

Stronger during adolescence; genetic factors increase in adulthood.

Positive Reinforcement

Drugs activate dopamine and reward systems.

Impulsivity

Preference for immediate reward; predicts later substance use.

Developmental

Substance use usually begins in adolescence; Early initiation (before age 15) → 4x higher risk of lifetime dependence.

Cognitive/Learning Factors

Expectancy Theory: Beliefs about effects of use predict initiation and persistence.

Self-Awareness Model

Alcohol lowers self-awareness → reduces anxiety/self-criticism.

Alcohol Myopia

"Tunnel vision" on immediate cues → extreme behaviors.

Behavioral/Social Learning

Learn from observing peers, family, and media; Perceived norms shape behavior; changing perceived norms reduces use.

Individual Differences

Externalizing: Impulsivity, conduct disorder, ADHD → early onset SUD; Internalizing: Anxiety/depression → self-medication with substances.

Sociocultural Factors

Family use, peer groups, stress, maltreatment, and low parental monitoring increase risk.

Gene × Environment interaction

Genetic vulnerability expressed more under environmental stress.

Alcohol metabolism

ADH → Acetaldehyde (toxic) → ALDH → Acetate → CO₂ + H₂O

Gender Differences in BAC

Women have higher BAC due to: 1. More body fat, less water 2. Less stomach ADH 3. Less active liver ADH

Stimulants - Peak Effects

Euphoria, energy, alertness

Stimulants - Valley Effects

Anxiety, fatigue, depression

Sedatives - Peak Effects

Relaxation, calmness

Sedatives - Valley Effects

Agitation, insomnia

Opiates - Peak Effects

Pain relief, euphoria

Opiates - Valley Effects

Flu-like withdrawal

Psychedelics - Peak Effects

Hallucinations, sensory distortion

Psychedelics - Valley Effects

Few physical withdrawal effects

Cannabis - Peak Effects

Relaxation, time distortion

Cannabis - Valley Effects

Irritability, insomnia

Potentiation

Combining drugs amplifies effects; alcohol + benzos can be lethal.

Dependence Potential

Highest in stimulants, nicotine, opioids.

Toxicity

Brain, liver, lungs, heart damage; combined drinking + smoking → cancer risk.

Wernicke-Korsakoff's Syndrome

Memory loss, confabulation (thiamine deficiency).

Fetal Alcohol Syndrome

Growth retardation, facial defects, ADHD.

Opioid Epidemic

Deadliest drug crisis in U.S. history.

OxyContin

Marketed as less addictive; Purdue concealed abuse data.

Fentanyl

Synthetic opioid, 2mg can be lethal; often mixed with heroin.

Carfentanil

Even stronger, used as elephant tranquilizer.

Naloxone (Narcan)

Antagonist; reverses respiratory depression, may require multiple doses for fentanyl.

College Drinking Patterns

79% drank in past year; 68% in past month.