Drug Addiction: Specialists and Information

Opioids include

• morphine,
• heroin, and
• morphine derivatives,

which are used as strong painkillers (e.g., Tramal®). However, addiction generally does not develop in the context of pain management.

Opiates lead to severe psychological and physical dependence, which can develop very quickly, especially with heroin: as few as two or three injections can lead to drug addiction.

Addicts usually inject the drugs into their veins. Less commonly, they smoke or snort the substances. Injection carries the risk of infection with hepatitis or HIV viruses when the same needle is used by multiple drug users. There is also a risk of poisoning, which can be fatal.

Symptoms of Opioid Use

Heroin induces a state of euphoria within about 15 minutes, accompanied by

• a strong sense of euphoria,
• a sense of detachment, and
• heightened self-confidence.

This is usually followed by a calming effect accompanied by apathy or, occasionally, irritability. Eventually, this leads to lethargy and impaired thinking. Overdoses (so-called “golden shots”) can lead to death through slowed breathing and loss of consciousness.

Mental and Physical Symptoms of Opioid Withdrawal

Both the psychological and physical symptoms are very pronounced during withdrawal (opiate withdrawal). This is why opiates lead to dependence much more quickly than other addictive substances.

Withdrawal symptoms begin as early as four hours after the last dose and intensify hour by hour. They peak after about one to two days and can last for one to two weeks.

• Psychologically, opiate withdrawal is accompanied by intense “craving” (a strong desire for the substance), depression, sleep disturbances, anxiety, and restlessness.
• Physically, withdrawal symptoms include nausea, vomiting, diarrhea, tremors, sweating, goosebumps, muscle pain and cramps, dilated pupils, tearing, high blood pressure, rapid heart rate, and fever.

Physical withdrawal symptoms usually last for one week after complete and abrupt cessation of use. Psychological symptoms (dysphoria, cravings) can persist for many weeks.

Treatment for Opioid Addiction

The goal of treatment is complete abstinence from the substance of dependence. This is often difficult because most patients are also dependent on other drugs or alcohol. As a rule, only long-term withdrawal treatments lasting up to six months are effective for opiate withdrawal. Long-term success rates are below 50 percent.

Detoxification for opiate-dependent individuals can take place in a specialized hospital, either with or without medication support. If abstinence is not achievable for various reasons, substitution therapy with opiates such as methadone can be administered.

The main goals of substitution therapy are

• the decriminalization of the addict by reducing drug-related crime,
• distancing the individual from the drug scene,
• improving mental and physical health (including reducing the risk of HIV infection), and
• reintegration into the workforce.

Ideally, once the patient has stabilized, the goal is to achieve complete abstinence through a gradual reduction in dosage.

Cannabis (hashish, marijuana; main active ingredient tetrahydrocannabinol, or THC) is usually smoked (“getting high”) or eaten. In 1994, approximately 17 percent of men and approximately 9 percent of women smoked cannabis, of whom about one-fifth did so almost daily, and two-thirds at most once a year.

When smoked, a state of intoxication sets in within a minute, accompanied by

• euphoria,
• detachment,
• altered perception of space and time, and
• heightened visual and auditory perceptions

.

The peak of the high is reached after 20 to 30 minutes and lasts about two to three hours. The effects of the high vary greatly from person to person and also depend heavily on

• one’s current mood,
• expectations, and
• personality type

.

Cannabis leads to psychological dependence, but probably not to physical dependence. With regular use, a condition known as amotivational syndrome may develop. This results in concentration and memory problems, as well as a lack of drive and direction. These effects are believed to encourage continued drug use and a transition to “hard drugs” (gateway drug!).

Cocaine and amphetamines such as “speed,” “ice,” or “ecstasy” lead to strong psychological, but not physical, dependence. They induce a pleasant emotional state (“rush”), which is characterized by

• a heightened state of alertness,
• euphoria and a sense of well-being,
• suppression of hunger and fatigue,
• increased performance and drive,
• desensitization to stimuli, and
• an intensification of sexual experience

. This “rush” usually lasts only a few minutes.

It is now known that these substances have very harmful effects on nerve cells, especially when taken regularly. In isolated cases, deaths have occurred following the use of ecstasy.

The hallucinogens LSD, mescaline, and psilocybin initially cause vegetative symptoms such as

• dizziness,
• rapid heartbeat, and
• nausea

as well as inner restlessness during the high. In addition, psychedelic effects set in within minutes. These consist of pseudo-hallucinations, primarily visual in nature, involving

• scenic experiences,
• hallucinations of color and shape,
• illusory misperceptions, and
• an intensification of perceptual content.

A “trip” lasts about six to eight hours and can lead to severe depression in its final phase (“coming down”), which is why people often take another dose to “come down.” At the peak of the high, especially among inexperienced users, a “bad trip” can occur, characterized by

• panic-induced paranoid anxiety,
• intensely experienced depersonalization, and
• extreme perceptual disturbances

, which can trigger suicidal behavior or aggression toward others.