Addiction Treatment Blog

Poppers make you feel really heady when you’re dancing but you have to keep sniffing it every few minutes because it doesn’t last long. Sometimes it makes you feel a bit dizzy.

Comment from user, 1996.

Poppers

History

Three alkyl nitrites are commonly abused: amyl nitrite, butyl nitrite and isobutyl nitrite. Amyl nitrite was used from 1867 until the earlier part of this century as a treatment for angina attacks. It was supplied in small glass ‘capsules’ (or vitrellae) which were broken open during an attack of angina and the contents inhaled. The nitrites are essentially vasodilators, being converted to the endogenous mediator nitric oxide in vivo.

The popping sound made when vitrellae were broken has given rise to the most popular street name for nitrites: ‘poppers‘. The name has persisted despite the fact that this particular preparation has not been available at street level for many years. Amyl nitrite is currently a ‘pharmacy’ medicine and so supplies in any form are limited. The Medicines Control Agency has proposed that it should be rendered a prescription only drug. This proposal would not apply to other alkyl nitrites. Butyl and isobutyl nitrites are used far more frequently than amyl nitrite at street level because until recently the sale of these nitrites was not tought to have been covered by the Medicines Act. As a consequence, they could be sold freely anywhere without prescription, usually under the guise of ‘room odourisers’ to avoid claiming medicinal or intoxicating properties. However, a test case was recently brought by the Royal Pharmaceutical Society in which it was ruled that the sale of butyl and isobutyl nitrites to the public was illegal in the UK because they were medicinal products. It remains to be seen whether this decision can or will be enforced. Abuse, possession or supply of nitrites does not contravene the Misuse of Drugs Act in the UK but in the USA amyl, butyl and isobutyl nitrites are illegal substances. This has led to the limited, and legal, abuse of propyl nitrites in some states. Read more…

And the Lord God took the man, and put him into the Garden of Eden to dress it and to kept it.

The Bible, Genesis 2: v.15.

Deliberate self-intoxication with plant material is an ancient human practice. Mescaline-containing plants have been used by the people of Central America for at least 10,000 years and nicotine abuse has been identified from Sudanese remains of 5000 BC. Cannabis was known to the Chinese in 4000 BC as well as to the ancient Egyptians. Tobacco, tea, coffee and cannabis are the most conspicuous psychotropic plant materials that are still widely used. These have been the subject of earlier articles in this blog.

Many street drugs have strong links with the plant kingdom. Cannabis and cocaine are clearly derived directly from plants (Cannabis sativa and Erythroxylum coca respectively). Opioids are all ultimately analogues of the morphine found in the opium poppy, Papaver somniferum. LSD is a modified form of the inactive lysergic acid found in the rye-fungus or ergot (Claviceps purpurea), although there are many other LSD-like compounds found in nature which are psychoactive. Several examples of amphetamine-like substances have also been isolated from plants.

Some of the plants that are abused throughout the world today are considered below. Their similarities with more well known drugs of abuse highlighted. Read more…

If we heard it said of Orientals that they habitually
drank a liquor which went to their heads, deprived
them of reason and made them vomit, we should
say: ‘How very barbarous!’

Jean de la Bruyere (1645-96), ‘Les Caracteres’.

In 1994, the UK spent nearly £12 billion on alcohol.

History of Alcohol

Alcohol has been available to man for several thousand years. Ethyl alcohol, or ethanol, is produced by the action of yeasts on sugars found in fruit and other plant material. Compared with most other substances of abuse it has a very simple chemical structure. One tends to assume that it was one of the first intoxicants used by man because it is so easy to make. However most of the fruits grown today have been selected for their high sugar content and so the manufacture of fruit wines is a relatively simple process. This was no so in prehistoric times, when sugar-rich plants and sugars themselves were rare. Therefore other plant-derived psychotropic substances that could simply be eaten without preparation probably pre-date alcohol. The first cultures to produce alcohol are thought to have been based in the eastern Mediterranean and Mesopotamia. During the 4th millennium BC they probably fermented dates. The warm climate and the high sugar content of the dates were ideal for the purpose. As the process spread, a whole range of naturally occurring substances were used to produce alcoholic drinks.

The discovery of distillation enabled early civilisations to make more concentrated alcoholic drinks. This process was probably discovered independently by several ancient societies. Concentrating the active constituent in this way enabled the alcohol to act as a preservative and beverages could be stored for longer. In Britain, the strength of alcohol-containing drinks was traditionally measured in terms of ‘percentage proof‘; 100 percent proof was equal to 57.1 per cent ethanol by volume. However, it is now the standard practice to state alcohol content in terms of percentage by volume and to refer to the content of individual drinks in terms of ‘units’. Read more…

A custom loathsome to the Eye, hateful to the Nose,
harmful to the Braine, dangerous to the Lungs, and in
the black, stinking fume thereof, nearest resembling the
horrible Stygian smoke of the pit that is bottomless.

King James I, ‘Counterblaste to Tobacco’, 1604.

When asked to ban smoking in France, Napoleon was candid: 'This vice brings in one hundred million francs in taxes every year. I will certainly forbid it at once - as soon as you can name a virtue that brings in as much revenue.'

History

Tobacco is the dried leaf of Nicotiana tabacum, one of a number of Nicotiana species all of which contain similar alkaloids and which can be smoked. These plants are members of the Solanaceae or potato family and are indigenous to Americas. When Colombus landed there in 1492 he observed the natives smoking rolls of dried Nicotiana leaves which were known as ‘tobacos’. The plant and related species were widely known to the North American Indians and the Aztecs. The popularity of tobacco smoking spread rapidly in the Europe of the 16th century. Sir Walter Raleigh was a famous advocate of pipe smoking in Elizabethan England, a practice that found less favour under the Stuart King, James I. Jean Nicot is reputed to have introduced tobacco to France in 1560, his name being commemorated in the genus Nicotiana and the principle alkaloid, nicotine (which was isolated in 1828).

Nicotine is found in small quantities in several other solanaceous plants (e.g. aubergine, tomatoes) but the amounts are generally too small to have pharmacologically significant effects after human ingestion. However, there are a large number of compounds in Nicotiana leaves other than nicotine, and tobacco smoke contains over 3000 chemicals. Read more…

While the bubbling and loud hissing urn
Throws up a steamy column, and the cups,
That cheer but do not inebriate, wait on each,
So let us welcome peaceful evening in.

William Cowper (1731-1800), ‘The Task’.

History

Caffeine addiction is one of the most common addiction types.

Caffeine is an important constituent of several plants that are cultivated for widespread consumption in the West. The most popular of these are listed in the table below, together with their caffeine content. The tea plant is native to Southeast Asia. It has been consumed in China as a hot infusion for many centuries. The Chinese character for tea is pronounced ‘tay‘ or ‘cha‘ depending upon the dialect. Tea was introduced into Europe in the early 1600s and in Britain was originally termed ‘tay’; the modern pronounciation ‘tea‘ originated in the 18th century.

The coffee plant is native to Ethiopia and local legend relates that the first human use was by a holy man who prepared an infusion of the seeds in water so that he might stay awake at night to pray. The plant was first cultivated by man in the vicinity of Mocha in Yemen, the plants having been originally taken from Kefa in Ethiopia. Until the end of the 17th century, this region supplied most of the world’s coffee. From the mid-17th century onwards, coffeehouses in London became important centres for political, literary and business dealings. Coffee and tea consumption and cultivation spread rapidly once Europeans acquired a taste for them. European nations, especially the British and Dutch, subsequently encouraged their colonies to grow the plants.

Chocolate is a relatively minor source of caffeine. It is prepared from the seeds of the cacao tree (Theobroma cacao) which is native to South America. A drink prepared from the seeds by the Aztecs was ‘chocalatl’ (bitter), and was described as the food of the gods. Read more…

A hundred doses of happiness are not enough: send to the drug store for another bottle – and, when that is finished, for another…

Aldous Huxley (1894-1964), ‘Brave New World Revisited’.

Some people may be addicted to over-the-counter drugs.

Over-the-counter (OTC) medicines are defined as those which are available without prescription from a pharmacy. As is the case with prescription only medicines, it is important to distinguish between medicine abuse and unnecessary use. For example, many members of the public take vitamin and analgesic preparations indiscriminately. These are examples of unnecessary use of OTC medicines. Many products are also taken for inappropriate medical conditions of where there is little evidence of therapeutic benefit. Examples include vitamin C for colds and a large number of ‘alternative medicine’ products. In the context of this article, abuse implies use of a preparation for a non-medical purpose in order to achieve psychoactive effects (e.g. euphoria) or altered body-image (e.g. weight loss).

Reasons for OTC Abuse

Sometimes the abuse potential of an OTC product is discovered by chance while a patient is taking the preparation for a legitimate reason. Increasingly, however, people may experiment with OTC substances to try to find an effect to their liking. Rumours among the drug culture may alert abusers to a cheap, ready source of an alternative to street drugs. Sometimes, OTCs are used to ‘top-up’ or augment the effects of an illicit substance and occasionally they are used in an attempt to lessen or stave off withdrawal symptoms or for self ‘detoxification‘.

Certain abusers of OTC medicines are mentally ill and consume these products because of obsessive/compulsive disorder or other psychiatric condition. Read more…

The medicine increases the disease.

Virgil (70-19BC), ‘The Aeneid’.

Prescription Drugs

This chapter highlights the important areas of abuse of prescription drugs. Opioids, cocaine, dexamphetamine, anabolic steroids and many of their derivatives are prescription medicines in the UK but these have been the subject of earlier chapters. Similarly, some ‘smart drugs‘ and certain preparations used in association with anabolic steroids are also prescription drugs and are discussed elsewhere in the blog.

Anaesthetics

Many gaseous anaesthetics have been subject to abuse but in practice these all have a low abuse potential because although they may produce pleasurable effects they are not easily available and are inconvenient to use, even for healthcare professionals with access to them. The exception is ketamine abuse which is well-described problem at street level.

Nitrous oxide

Nitrous oxide gas is not a prescription medicine in the UK but is included in this chapter for ease of reference. It is used therapeutically to induce anaesthesia and also as an analgesic. In this setting it is usually mixed with oxygen and is available commercially as Entonox in characteristic blue and white cylinders. Abuse is most likely to involve healthcare personnel who use nitrous oxide in the workplace, e.g. dentists, anaesthetists and theatre staff. However, the gas is also the propellant used in many canisters of pressurised whipped cream. The experienced abuser is able to release the gas into containers, allowing subsequent gas inhalation with minimum cream contamination. Inhalation is usually via a plastic bag, balloon or similar device. Healthcare staff may, of course, use anaesthetic administration equipment. In 1979, a US survey of 524 medical and dental students showed that 16 per cent of those questioned had abused nitrous oxide on at least one occasion. Read more…

Man is a gaming animal. He must always be trying to get the better in something or other.

Charles Lamb (1775-1834), ‘Essays of Elia’.

Performance Enhancing Drugs

A huge range of drugs have been used to enhance athletic and gymnastic performance, to increase strength, assist in training, boost stamina or promote a muscular physique. Stimulant drugs such as amphetamines, cocaine, over-the-counter sympathomimetics and caffeine have been used widely to enhance performance in endurance sports and to increase stamina during training but these are the subject of other chapters in this blog. Similarly, cannabis has been used to promote calmness and relaxation for events where this is desirable. The remaining substances discussed below range from simple chemical elements to complex naturally occurring proteins. Many of the preparations used are nutritional supplements and a detailed discussion of these is beyond the scope of this blog. However, some individual nutrients are highlighted.

Anabolic Steroids

Anabolic steroids are the classic performance enhancing drugs; associated with Soviet Block athletes in the Cold War, cheating at the Olympics and a range of unpleasant side effects. So much so that the generic term ’steroid’, which incorporates a wide range of drugs used therapeutically from vitamin D to oral contraceptives, has become synonymous with anabolic steroid in the minds of many members of the public.

Abuse of anabolic steroids has become increasingly prevalent in the West during the past decade. In the USA, both the possession and supply of these drugs were declared illegal in 1990. In the UK, the situation is more complex. It is not illegal to import anabolic steroids from outside the UK as long as these are for personal use. Consequently, possession of anabolic steroids in the form of a medicinal product is also not illegal. However, possession of anabolic steroids in the form of raw materials (i.e. unformulated) was made a criminal act under new legislation in September 1996. An offence is also committed if anabolic steroids are supplied in any form to another private individual within the UK without prescription. Read more…

I never thought I would ever become an addict; I thought I was too level-headed and had a strong mind, one that would never lose control. But I was wrong, and if fate hadn’t intervened, I would have gone on to become an alcohol addict, a class of people I despised and pitied equally. I’ve always looked at addicts with disdain – how can they not control themselves, I would ask myself? Is it that hard to say no?

I found out the answers to these questions the hard way – yes, it is the hardest thing in the world to say No, because your body and mind are clamoring for it. When my husband left me for another woman, I was devastated. I could not sleep or function normally. And this is when I discovered that alcohol could induce slumber and give me the peace I needed. I did realize later that sleep so induced was but a small lull in a major storm, one that did not give my body the rest and rejuvenation it needed.

I would tell myself that I could stop at any time, but I hit the bottle every night, and sometimes, when I had no work on weekends and holidays, during the day as well. I woke up one day to hear the phone ringing; the shrill noise hurt my ears and I found myself lying in an unbelievable mess. The call was from my friend, someone I knew since first grade but who I had not met in a few years. She was in town and wanted to visit. The sour smell that pervaded the house spurred me to action – I did not want her to see how low I had sunk.

That was the day I cleaned up my act and became sober again – I left town with my friend for a few days because I needed to regroup and find myself again. And I did, although it took some time. The point I’m trying to make is that addiction is stealthy – it creeps up on us when we least expect it, and if we give it a toehold in our lives, it soon takes us over entirely. We lose our identities and become synonymous with the bottle, the need to drink overrides every other sane thought, and we slowly start to degenerate into scum. Read more…