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How Drugs Affect the Body

The drugs discussed in this chapter have complex and variable effects, many of which can be traced to changes
in brain chemistry. However, the same drug may affect different people differently or the same person in
different ways under different circumstances. Beyond a fairly predictable general change in brain chemistry, the
effects of a drug may vary depending on drug factors, individual factors, and social factors.

Changes in Brain Chemistry

Psychoactive drugs produce most of their key effects by acting on brain chemistry in a characteristic fashion.
Before any changes in brain chemistry can occur, however, molecules of the drug have to be carried to the brain
through the bloodstream via a particular route of administration. A drug that is taken by mouth has to dissolve in
the stomach, be absorbed into the bloodstream through the lining of the small intestine, and then pass through
the liver, heart, and lungs before returning to the heart to be carried via arteries to the brain. A drug that is
already dissolved and is injected directly into the bloodstream will reach the brain in much less time, and drugs
that are inhaled and absorbed by the lungs travel to the brain even more rapidly. The faster a drug reaches the
brain, the more likely the user is to become addicted.

Once a psychoactive drug reaches the brain, it acts on one or more neurotransmitters, either increasing or
decreasing the neurotransmitters' concentration and actions. Cocaine, for example, affects dopamine, a
neurotransmitter thought to play a key role in the process of reinforcementthe brain's way of telling itself
That's good; do the same thing again. When a neurotransmitter is released by one neuron, it travels across a
gap, called a synapse, to signal another neuron. The signaling is controlled in part by removing the
neurotransmitter molecules from the synapse by a process called resorption. Some drugs, such as cocaine, inhibit
the resorption of dopamine, thereby extending or intensifying their action (see Figure 14.2). The euphoria
produced by cocaine is thought to be a result of its effect on dopamine. Heroin, nicotine, alcohol, and
amphetamines also affect dopamine levels.

Click here for a description of Figure 14.2 Effect of Cocaine on Brain Chemistry.

FIGURE 14.2
FIGURE 14.2 Effect of Cocaine on Brain ChemistryUnder normal circumstances, the amount of dopamine at a
synapse is controlled in part by the reuptake of dopamine by the transmitting neuron. Cocaine blocks the
removal of dopamine from a synapse; the resulting buildup of dopamine causes continuous stimulation of the
receiving neurons.

The duration of a drug's effect depends on many factors and may range from 5 minutes (crack cocaine) to 12 or
more hours (LSD). As drugs circulate through the body, they are metabolized by the liver and eventually
excreted by the kidneys in urine. Small amounts may also be eliminated in other ways, including in sweat, in
breast milk, and via the lungs.

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Factors That Influence a Drug's Effect

When different drugs or dosages produce different effects, the differences are usually caused by one or more of
five different drug factors:

1. The pharmacological properties of a drug are its overall effects on a person's body chemistry, behaviour,
and psychology. The pharmacological properties also include the amount of a drug required to exert
various effects, the time course of these effects, and other characteristics, such as a drug's chemical
composition.

2. The dose-response function is the relationship between the amount of drug taken and the type and
intensity of the resulting effect. Many psychological effects of drugs reach a plateau in the dose-response
function, and increasing the dose does not increase the effect any further. With LSD, for example, the
maximum changes in perception occur at a certain dose, and no further changes in perception take place if
higher doses are taken. However, all drugs have more than one effect, and the dose-response functions
usually are different for different effects. This means that increasing the dose of any drug may begin to
result in additional effects, which are likely to be increasingly unpleasant or dangerous at high doses.

3. The time-action function is the relationship between the time elapsed since a drug was taken and the
intensity of its effect. The effects of a drug are greatest when concentrations of the drug in body tissues are
changing fastest, especially if they are increasing.

4. The person's drug use history may influence the effects of a drug. A given amount of alcohol, for example,
will generally affect a habitual drinker less than an occasional drinker. Tolerance to some drugs, such as
LSD, builds rapidly. To experience the same effect, a user has to abstain from the drug for a time before
that dosage will again exert its original effects.

5. The method of use (or route of administration) has a direct effect on how strong a response a drug
produces. Methods of use include ingestion, inhalation, injection, and absorption through the skin or tissue
linings. Drugs are usually injected in one of three ways: intravenously (IV, or mainlining), intramuscularly
(IM), or subcutaneously (SC, or skin popping).

Physical Factors

Certain physical and psychological characteristics also help determine how a person will respond to a drug.
Body mass is one variable. The effects of a certain dose of a drug on a 50-kilogram person will be twice as great
as on a 100-kilogram person. Other variables include general health and genetic factors. For example, some
people have an inherited ability to rapidly metabolize a cough suppressant called dextromethorphan, which also
has psychoactive properties. These people must take a higher-than-normal dose to get a given cough-suppressant
effect.

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The method of use (or route of administration) is one variable in the overall effect of a drug on the body.
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If a person's biochemical state is already altered by another drug, this too can make a difference. Some drugs
intensify the effects of other drugs, as is the case with alcohol and sedatives. Some drugs block the effects of
other drugs, such as when a tranquilizer is used to relieve anxiety caused by cocaine. Interactions between drugs,
including many prescription and over-the-counter (OTC) medications, can be unpredictable and dangerous.

One physical condition that requires special precautions is pregnancy. It can be risky for a woman to use any
drugs at all during pregnancy, including alcohol and common OTC preparations like cough medicine. The risks
are greatest during the first trimester, when the fetus's body is rapidly forming and even small biochemical
alterations in the mother can have a devastating effect on fetal development (see Chapter 12). Even later, the
fetus is more susceptible than the mother to the adverse effects of any drugs she takes. The fetus may even
become physically dependent on a drug being taken by the mother and suffer withdrawal symptoms after birth.

Psychological Factors

Sometimes a person's response to a drug is strongly influenced by the individual's expectations about how he or
she will react (the psychological set). With large doses, the drug's chemical properties seem to have the strongest
effect on the individual's response. But with small doses, psychological (and social) factors are often more
important. When people strongly believe that a given drug will affect them a certain way, they are likely to
experience those effects regardless of the drug's pharmacological properties. In one study, regular users of
marijuana reported a moderate level of intoxication ( high) after using a cigarette that smelled and tasted like
marijuana but contained no THC, the active ingredient in marijuana. This is an example of the placebo effect
when a person receives an inert substance yet responds as if it were an active drug. In other studies, participants
who smoked low doses of real marijuana that they believed to be a placebo experienced no effects from the drug.
Clearly, the person's expectations had a greater effect than the drug itself.

QUESTIONS FOR CRITICAL THINKING AND REFLECTION

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Has an over-the-counter medication (such as a decongestant) ever made you feel strange, drowsy, or even high?
Did you expect to react to the medication that way? Do such reactions influence the way you use OTC drugs?

Social Factors

The setting is the physical and social environment surrounding the drug use. If a person uses marijuana at home
with trusted friends and pleasant music, the effects are likely to be different from the effects if the same dose is
taken in an austere experimental laboratory with an impassive research technician. Similarly, the dose of alcohol
that produces mild euphoria and stimulation at a noisy, active cocktail party might induce sleepiness and slight
depression when taken at home while alone.

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THINKING ABOUT THE ENVIRONMENT

A number of addiction researchers have focused on interpersonal and intrapersonal characteristics associated
with an individual's drug use. Recently, however, there has been increasing interest in environmental factors that
may influence substance abuse. For example, the proximity of commercial outlets selling alcohol has been
suggested as an important determinant of heavy alcohol use.

Spatial and spatially-related features of the environmentsuch as land use, urban sprawl, quality of housing,
neighbourhood characteristics, and density of particular commercial outletsare emerging topics in addiction
research. The term built environment has been used to refer to attributes of an area or neighbourhood (such as
parks, schools, buildings, roads, and sidewalks) that individuals use and encounter regularly, which may be
associated with substance use.

For more information on the environment and health, see Chapter 21.

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