Alcohol and Drug Abuse

Alcohol Related
Alcohol is the oldest and most widely used drug in the
world. Nearly half of all Americans over the age of 12 are
consumers of alcohol. Most people don’t have a problem
with alcoholism but there are an estimated 10 to 15 million
alcoholics or problem drinkers in the United States, with
more than 100,000 deaths each year attributed to alcohol.
What most people don’t realize is that among the nation’s
alcoholics and problem drinkers are as many as 4.5 million
adolescents
 Friend or Foe ?
– High levels of alcohol consumption can lead to
physical illness and psychological and social distress.
–
– Small, regular amounts of alcohol also seem to have a
positive effect on the heart and circulation.
–
– But too much alcohol is often a recipe for disaster.
• The increasing use of alcohol, along with other drugs of
abuse, is a serious public health problem across all age
ranges, but especially so in the young.
Signs and symptoms of Alcholism
• alcohol use and intoxication: • alcohol withdrawal, experienced
• Smell of alcohol on breath by alcoholics and problem
• drinkers:
Irritability
• • Tremors
Euphoria
• • Agitation
Loss of physical coordination
• • Anxiety and panic attacks
Inappropriate or violent behavior
• • Paranoia and delusions
Loss of balance
• • Hallucinations (usually visual)
Unsteady gait
• • Nausea and vomiting
Slurred and/or incoherent speech
• Increased body temperature
• Loss of consciousness
• Elevated blood pressure and heart
• Slowed thinking
rate
• Depression
• Convulsions
• Impaired short-term memory
• Seizures
• Blackouts
 Alcoholism
• Alcoholism or alcohol dependence is a medical term with a
deliberately more precise Meaning than the problems that can occur,
sometimes as one-offs, through an uncharacteristic binge. In alcohol
dependence a number of features come together in the behavior of the
person affected.
– Drinking begins to take priority over other activities.
– It becomes a compulsion.
– Tolerance develops, it takes more alcohol to produce drunkenness.
– Withdrawal symptoms such as anxiety and tremor develop after a
– short period without a drink, and are reduced by taking more
alcohol.
• Often alcohol dependence remains undetected for years
 Signs of Alcoholism
• As alcohol levels increase with more drinking, there is poor control of
muscles, poor coordination, double vision, flushing of the face,
bloodshot eyes, and vomiting.
• Behavior varies greatly. It is hard to predict what an intoxicated
person will do next. He/she may cry bitterly, show unexplained
happiness, change moods rapidly, or just pass out.
• NOTE: “Passing out” or “falling asleep” can be a warning sign that
the person is actually in a dangerous alcohol coma.

• Get immediate help if you suspect alcoholic coma.

 Effects of Alcoholism
• Excessive and inappropriate alcohol consumption at work leads to
accidents, absenteeism and lost revenue .
• 25% people who die in road accidents have blood alcohol levels
greater .08 (current legal limit)
• Aggressive and criminal behavior and the consumption of alcohol are
linked.
• Alcoholics and heavy drinkers are especially susceptible to the
development of other diseases.
• Alcoholics and problem drinkers also undoubtedly contribute to the
deterioration of the mental health of other members of their families
through verbal, physical, and sexual abuse.
 Serious Intoxication
• Serious intoxication results when a large amount of an alcoholic
beverage is taken over a relatively short period of time (or for a longer
period of time, when alcohol intake exceeds alcohol excretion).
Memory is commonly lost for the events while intoxicated. Symptoms
are drowsiness that can progress rapidly to coma; slow snoring
breathing; blueness of the face, lips, and fingernail beds; involuntary
passage of urine or feces; dilated pupils; and rapid weak pulse. A
suspected alcoholic stupor or coma represents a medical emergency .
 Alcohol Withdrawal
• Alcohol withdrawal occurs when a physiologically dependent person
abruptly stops using alcohol. Physiologic dependence can develop
after prolonged and heavy drinking.

• Alcohol withdrawal can be a life-threatening emergency. Symptoms

include increased sweating and pulse (greater than 100/min), hand
tremor, insomnia, nausea or vomiting, hallucinations or illusions,
agitation, anxiety, and grand mal seizures.
 Dependency
• A short list of questions that can indicate if alcohol dependence is a
possibility. Two or more positive answers to these questions suggests
dependence. Have you ever:

– Thought you should Cut down on your drinking?

– Felt A annoyed by others criticizing your drinking?
– Felt bad or Guilty about your drinking?
– Had a drink first thing in the morning to steady your nerves or get
rid of a hangover ?
 Alcohol Related Problems
• Excess alcohol can lead to health problems
including but not limited to: Depression,
Liver cirrhosis, Heart failure, Damage to
the brain and nervous system.
• Along the way there is often damage to
relationships, finances and jobs and
problems with the law.
Sudden Death May Occur
When the individual has ingested so much alcohol that the brain
center which controls breathing and heart action is fatally
depressed.
When other depressant drugs (such as “sleeping pills”) are taken
along with alcohol, magnifying the depressant effects.
During an accident (one-half of all fatal traffic accidents involve
the use of alcohol); or
As a result of suicide or murder (many self-inflicted deaths as well
as homicides involve the use of alcohol.)
 Binge Drinking
• Binge drinking is defined as drinking five
or more standard alcohol drinks for males,
and four or more for females within a two-
hour interval. In the United States, up to
45% of college students report binge
drinking or heavy drinking episodes at least
once a week.
 Binge Drinking
• If you are 25 years or younger and you
drink to excess even once a week, your
brain may exhibit some deficits as a result
of your binge drinking. Your ability to pay
attention and use your visual working
memory could be compromised, according
to researchers.
 Binge Drinking
• Heavy Drinking Pattern Affects Brain
• Binge Drinkers, But Not Alcoholics
• Problems With Working Memory
• Alterations In the Brain
MIX Ecstasy and Alcohol
 20 Questions
• Do you lose time from work due to
drinking?
• Is drinking making your home life unhappy?
• Do you drink because you are shy with other
people?
• Is drinking affecting your reputation?
• Have you ever felt remorse after drinking?
• Have you had financial difficulties as a result
of drinking?
• Do you turn to inferior companions and
environments when drinking?
• Does your drinking make you careless of
your family's welfare?
• Has your ambition decreased since drinking?
• Do you crave a drink at a definite time daily?
• Do you want a drink the next morning?
• Does drinking cause you to have difficulty in
sleeping?
• Has your efficiency decreased since
drinking?
• Is drinking jeopardizing your job or
business?
• Do you drink to escape from worries or
trouble?
• Do you drink alone?
• Have you ever had a loss of memory as a
result of drinking?
• Has you physician ever treated you for
drinking?
• Do you drink to build up your self-
confidence?
• Have you ever been to a hospital or
institution on account of drinking?
 20 Questions Results
• According to the Office of Health Care Programs,
Johns Hopkins University Hospital, developers of
this screening quiz, if you answered 3 of these
questions with a Yes it is a definite sign that your
drinking patterns are harmful and possibly
considered alcohol dependent or alcoholic. You
may want to seek an evaluation by a healthcare
professional.
Drug Abuse
 Drug abuse
• Has a wide range of definitions related to taking a psychoactive drug
or performance enhancing drug for a non-therapeutic or non-medical
effect . Some of the most commonly abused drugs include alcohol,
amphetamines, barbiturates, cocaine, methaqualone, opium, and minor
tranquilizers.

• Use of these drugs may possibly lead to physical, social, and

psychological harm, as well as criminal charges.
 Drugs and the Work Place

• A country with only 'five' percent (5%)

of the entire world's population buys
and consumes sixty percent (60%) of
the entire world's supply of illicit
drugs.
Lowers productivity / causes accidents
and injuries.
• Problems related to alcohol and drug abuse cost American
businesses roughly $81 billion in lost productivity in just
one year
• Studies have shown that substance-abusing employees
function at about 67% of their capacity
• Up to 40 percent of industrial fatalities and 47 percent of
industrial injuries can be linked to alcohol use and
alcoholism.
• Employees who use drugs are 3.6 times more likely to be
involved in a workplace accident and 5 times more likely
to file a workers’ compensation claim.
Increases Absenteeism, Turnover and
Employer’s medical costs.
• An estimated 500 million workdays are lost annually due
to alcoholism.
• Employees who use drugs are 2.2 times more likely to
request early dismissal or time off, 2.5 times more likely to
have absences of eight days or more, and 3 times more
likely to be late for work.
• Illicit drug users are more than twice as likely than those
who do not use drugs to have changed employers three or
more times in the past year.
• Employees who use drugs cost their employers about twice
as much in medical claims as do non-drug-using
employees.
 What can your organization do to
decrease the impact of substance abuse
• Implement a drug-free workplace program
• In a drug-free workplace, all employees adhere to a
program of policies and activities designed to provide a
safe Workplace.
• The policies and activities discourage alcohol and drug
abuse and encourage treatment, recovery and the return to
work of those employees who have abuse problems.
• Even if your organization is not required to have a drug-
free workplace program, your organization can still
benefit.
 Drug-free workplace program
may include:
• a written policy
• employee education
• supervisor training
• access to assistance
• drug testing
 A good drug-free workplace
program can lead to
• Decreases in: • Increases in:
• absenteeism • productivity
• accidents • profits
• downtime • customer satisfaction
• turnover • health status
• workers’ compensation • employee morale
costs
• employee discipline
problems
 What are the Signs of Abuse?
• Substance abusers in the workplace can be difficult to identify. But
there are some clues that signal possible drug and alcohol problems.

• Here’s what to look for:

• Frequent, prolonged, and often unexplained absences
• Involvement in accidents both on and off the job
• Erratic work patterns and reduced productivity
• Indifference to personal hygiene
• Overreaction to real or imagined criticism
• Such overt physical signs as exhaustion or hyperactivity, dilated
pupils, slurred speech, or an unsteady walk
• Marijuana users may have bloodshot or glassy eyes and a persistent
cough.
 Signs of Abuse
Cocaine Users Alcohol abusers
• Display increased • Find it hard to conceal
energy and enthusiasm morning-after
early in their drug hangovers.
involvement. • Their productivity
• Later they may be declines, and they may
subject to extreme mood show signs of physical
swings and can become deterioration.
paranoid or delusional.
 How Can it Be Prevented?
• A written policy
• Employee drug education
• Training (Managers, Front-line supervisors,
Human Resource)
• Identifying and dealing with substance
abusers
• Employee Assistance Program
 What Can Employees Do?
• Don’t be an "enabler."
• Don’t "look the other way."
• Don’t intervene on your own
• Don’t worry about jeopardizing a substance
abuser’s job.
 Types of Drugs
• Drugs can be categorized in many ways, hard or soft, uppers or
downers, addictive or non-addictive, most harmful or least harmful,
legal or illegal. However, we think a useful way of categorizing drugs
is by dividing them into three categories based on the effect they
achieve:

• STIMULANTS

• DEPRESSANTS

• HALLUCINOGENS
 STIMULANTS
• Increase the activity of the central nervous
system, some examples include, but are not
limited to Amphetamines, Steroids, Cocaine
& Crack, Caffeine, Ecstasy and Tobacco.
 DEPRESSANTS

• Reduce the activity of the central nervous

system, some examples include but are not
limited to Alcohol, Barbiturates, Heroin and
Solvents.
 HALLUCINOGENS
• Alter perceptions of reality and may result
in hallucinations some examples include but
are not limited to LSD, Cannabis and Magic
Mushrooms.
ECSTASY
 ECSTASY
• COMMON & BRAND NAMES
– Ecstasy; E; X; XTC; Rolls; Beans; Adam

• CHEMICAL NAME
– 3,4-methylenedioxymethamphetamine

• DESCRIPTION
– MDMA is one of the most popular recreational psycho actives,
most commonly sold in the form of "ecstasy" tablets. It is
known for its empathogenic, euphoric, and stimulant effects,
and has also been used in psychotherapy.
 PMA and MDMA
• Taken in tabs although inhalation and injection
have been infrequently reported.
• Effects generally appear within 15-30 minutes
(MDMA) or almost 60 minutes (PMA).
• The usual dose ranges from 100 to 150 mg.
Toxicity may be seen at doses as little as 175 mg
 MDMA/PMA how It Looks

• Powder
• Pressed pills
“Euros”
• Capsules (may not be full)
• Wide range of logos
• Wide variety of colors & shapes
• Nicknames reflect logos & colors
• Designed to look “innocent” & thus
“harmless.”
 MDMA/PMA Packaging
• Because of their small size, MDMA pills may be
easily hidden. They may simply be mixed in with
other candies, such as Skittles, M&Ms, etc. Pez
containers are common too.
 Long Term effects

• More prolonged “burn

out” or “crash
periods” up to a week
later
• Dental Damage
• Depression for weeks
• Renal failure
 Ecstasy Effects
•extreme mood lift
•increased willingness to communicate
•increase in energy (stimulation)
•ego softening
 Ecstasy Effects
•appetite loss
•visual distortion
•rapid, involuntary eye jiggling
•mild visual hallucinations
 Ecstasy Effects

•mild to extreme jaw clenching (trisma), tongue and

cheek chewing, and teeth grinding (trisma)
•Hangover the next day, lasting days to weeks
•possible strong urge to repeat the experience,
though not physically addictive
•possible psychological crisis requiring
hospitalization (psychotic episodes, severe panic
attacks, etc) (rare
ECSTASY
LSD
 LSD
• COMMON & BRAND NAMES
– Acid; L; Tabs; Blotter; Doses; Trips
• EFFECTS CLASSIFICATION
– Psychedelic
• CHEMICAL NAME
– d-lysergic acid diethylamide
• DESCRIPTION
– LSD is the best known and most researched
psychedelic. It is the standard against which all other
psychedelics are compared. It is active at extremely low
doses and is most commonly available on blotter or in
liquid form.
 LSD Effects
•increase in energy (stimulation)
•increase in associative & creative thinking
•mood lift
•increased awareness & appreciation of music
 LSD Effects
•general change in consciousness (as with
most psychoactive)
•pupil dilation
•difficulty focusing
•quickly changing emotions
 LSD Effects
•over-awareness & over-sensitization to
music and noise
•paranoia, fear, and panic
•unwanted and overwhelming feelings
•unwanted life-changing spiritual experiences
Marijuana
 Marijuana
• Cannabis has been around for centuries and the plant has been used to
make rope, thread, clothes and even smoked for its psychoactive
properties and medicinal purposes. The drug has been widely used in
America for more than 40 years. It is estimated that close to 5 million
Americans regularly use marijuana.
• Marijuana is obtained from the dried leaves and flowers of the hemp
plant. The potency of marijuana depends on the method of
preparation.
• Although marijuana is usually smoked, it can also be eaten or mixed in
beverages like tea, coffee and in very rare cases, it is also injected.
• THC is the primary psychoactive component of marijuana. The
intoxicating effects of marijuana usually last 2-3 hours.
 Cannabis (Marijuana)
• COMMON NAMES
– Marijuana; Marihuana; Pot; Weed; Grass; Mary Jane; ...
• EFFECTS CLASSIFICATION
– Intoxicant; Stimulant; Psychedelic; Depressant
• DESCRIPTION
– Cannabis, a fast-growing bushy annual with dense
sticky flowers, produces the psychoactive THC. It is the
most widely used illegal psychoactive and has a long
history of medicinal, recreational, and industrial use.
The fibrous stalks of the plant are used to produce
clothing and rope.
Some of the Hazards of Using Marijuana?

• Some of the common discomforts found

when using marijuana include dry mouth,
swollen eyelids, bloodshot eyes, loss of
coordination and an accelerated heart rate.
 Hazards of Marijuana Use
• Short Term • Long Term

• Anxiety and paranoia • Respiratory problems

• Impaired memory • Poor short-term recall

• Difficulty in thinking • Inability to shift attention

normally
• Learning difficulties
• Inability to understand complex
• Lack of attention and focus information

• Poor driving skills • An increased risk of developing

lung, head and neck cancers
 Marijuana Short Term Effects
•mood lift
•relaxation, stress reduction
•creative, philosophical or deep thinking :
ideas flow more easily
•increased appreciation of music. More aware
of, deeper connection to music.
 Signs of Marijuana Use
• Dilated (large) pupils • Sleepy appearance

• Cigarette rolling papers • Reduced motivation

• Seeds that have been cleaned • Pipes, bongs, homemade

from marijuana smoking devices (you may see
sticky residue from burned
• Smell on clothing, in room, or marijuana)
in car
• Anxiety
• Bloodshot eyes
• Difficulty thinking
 Signs of Marijuana Use
• Distorted sensory perceptions
• Dry mouth
• Euphoria (temporary feelings of
elation, energy and limitless
power)
• Feeling sluggish
• Impaired judgment
• Impaired short-term memory
• Inappropriate laughter
• Increased heart rate
• Increased appetite, craving
sweets

• Grandiosity (acting in a • Reduced coordination

pompous or boastful manner)
 Signs of Marijuana Use
• Temporary feelings of reduced
anxiety or stress
• Sadness/depressed mood
Sensation that time is passing
slowly
• Social withdrawal and isolation
• Discolored fingers
• Sleepiness
• Generally it can be
difficult to recognize
the signs of marijuana
addiction if you don't
see the individual after
smoking when they are
still experiencing the
effects of the drug.
Marijuana
Marijuana
Marijuana
Marijuana Buds and Blount
Marijuana Blount
Marijuana Pipe
Marijuana Pipe
Cocaine Crack Cocaine
 Cocaine (Crack Cocaine)
• COMMON & BRAND NAMES
– Coke; Crack; Blow; Snow; Nose
Candy
• EFFECTS CLASSIFICATION
– Euphoric Stimulant
• CHEMICAL NAME
– benzoylmethyl ecognine
• DESCRIPTION
– Cocaine is a common stimulant derived from the
Erythroxylum coca plant. It is best known for its
massive popularity in powdered and freebase (crack)
forms.
 Cocaine (Crack Cocaine)
• PSYCHOLOGICAL EFFECTS :
– Varies with dose and the tolerance of the user. Increases alertness,
wakefulness, elevates the mood, mild to high degree of euphoria,
increases athletic performance, decreases fatigue, clearer thinking,
increases concentration, increases energy, increased irritability, insomnia,
restlessness. With high doses may exhibit a pattern of psychosis with
confused and disorganized behavior, irritability, fear, paranoia,
hallucinations, may become extremely antisocial and aggressive
• WITHDRAWAL SYMPTOMS:
– Although cocaine does not cause dangerous physical addiction,
discontinuing regular use can lead to a wide varieties of (very) unpleasant
withdrawal and craving symptoms, including: intense cravings for more
cocaine, hunger, irritability, apathy, depression, paranoia, suicidal
ideation, loss of sex drive and more.
 Cocaine Addiction
• Cocaine is a powerfully addictive central nervous system
(CNS) stimulant. It has extremely potent effects, and
individuals who take cocaine can develop an addiction to
cocaine after using the drug for a very short period of time.
Cocaine is a crystalline, granular, or powder substance,
having a saline, slightly bitter taste that numbs the tongue
and lips. It heightens alertness, inhibits appetite and the
need for sleep, and provides intense feelings of pleasure.
Some users find that the drug helps them to perform
simple physical and intellectual tasks more quickly, while
others can experience the opposite effect. It is prepared
from the leaf of the Erythroxylon coca bush, which grows
primarily in Peru and Bolivia.
 Cocaine Addiction
• The effects of cocaine are immediate, extremely pleasurable, and brief.
Cocaine produces intense but short-lived euphoria and can make users
feel more energetic. Like caffeine, cocaine produces wakefulness and
reduces hunger. Psychological effects include feelings of well-being
and a grandiose sense of power and ability mixed with anxiety and
restlessness. As the drug wears off, these temporary sensations of
mastery are replaced by an intense depression, and the drug abuser
will then "crash", becoming lethargic and typically sleeping for several
days.
• When cocaine use is stopped or when a binge ends, depression (crash)
follows almost immediately. This is accompanied by a strong craving
for more cocaine, fatigue, pleasurelessness, anxiety, irritability,
sleepiness, and sometimes agitation or paranoia.
 Signs of Cocaine Addiction
• Red, bloodshot eyes
• Runny nose or
frequent sniffing
• Weight loss
• Increased
susceptibility to illness
• Increased blood
pressure
• Constricted blood
vessels
• Dilated pupils
• Increased heart rate
• Increased temperature
• Nosebleeds
• Altered motor
activities (tremors,
hyperactivity)
• Perspiration or chills
• Nausea or vomiting
 Common emotional signs of cocaine
addiction
• Change in eating or sleeping • Erratic behavior
patterns • Isolation
• Change in groups of friends • Strained relationships
• Change in school grades or • Missed work
behavior • Increased time away from family
• Withdrawn, depressed, tired, or • Stealing/Lying/Financial problems
careless about personal appearance
• Thoughts of suicide
• Loss of interest in school, family,
or activities • Paranoia
• Frequently in need of money • Auditory hallucinations
• Unusual energy followed by • Talking rapidly
excessive sleeping
• Depression
• Irritability
 Common signs of cocaine addiction
withdrawal

• depressed mood
• fatigue
• generalized malaise
• vivid and unpleasant dreams
• agitation and restless behavior
• slowing of activity
• increased appetite
• intense cravings for cocaine
Cocaine Powder
Cocaine for Injecting
Cocaine for Snorting
 Signs of Crack Addiction
• The signs of crack addiction are very similar to cocaine
addiction. However, there are many differences between
how the drugs are used and the duration and types of
effects experienced by the user. Crack, sometimes called
"Rock", is a purified form of cocaine that is smoked by
inhaling the vapors of cocaine that are given off as the
drug is heated. Crack is cocaine has been distilled form its
familiar powder form of cocaine hydrochloride. Cocaine
powder is put into a mixture with baking soda, heated,
hardened and then broken into pieces. Crack is often more
pure than sniffable cocaine (85%-90% pure). It is sold as
light brown or beige pellets. Drug dealers distribute ready
to smoke freebase cocaine packaged in small vials.
 Crack Cocaine Addiction
• Crack is typically smoked in pipes constructed of glass bowls
fitted with one or more fine mesh screens that support the drug.
The user heats the side of the bowl (usually with a lighter), and
the heat causes the cocaine base to vaporize. The user inhales
the cocaine-laden fumes through the pipe. Alternatively, crack
cocaine can be sprinkled in cigarettes and smoked. Usually the
crack is ground up and sprinkled into a marijuana joint and
smoked. These cocaine laced joints are referred to as primos.
The vapors of the freebase are absorbed through the lungs into
the bloodstream and transported to the brain within 10-15
seconds. One inhalation will produce a degree of intoxication
usually lasting 10-15 minutes. The drug is said to take its name
from the crackling noise it makes when it is smoked.
 Crack Cocaine Addiction
• Crack is a purified form cocaine. Two or three doses can cause addiction.
Because this smokable form of cocaine delivers 10 times the impact of
"snorting" the powder, casual use can cause death from heart or respiratory
failure. Crack smokers also run an increased risk of addiction and paranoid
psychosis. The high from smoking crack lasts between 5 to 7 minutes and is
followed by severe depression, feelings of worthlessness, and a craving for
more of the drug. In a brief period of time, crack begins to control the user.
This is the pattern of behavior that leads to addiction and dependence. The
compulsion to continue to use crack has led to the "binges" that are often
described by users. During a binge, Crack is smoked continuously until
money and/or drug supplies are gone, or the user experiences physical
collapse. The need for crack supersedes every other need, leading to crime
and violence to acquire it.
 Signs of Crack Addiction
• Crack addicts have many tell tale signs of their addiction.
A few physical signs of crack addiction include dilated
pupils, sweating, weight loss, irregular heartbeat, frequent
upper respiratory infections, fits of coughing, coughing up
black mucous, muscle tremors, severe headaches and a
decline in personal appearance. Additionally, a few
emotional signs of crack addiction include dramatic mood
changes, and insomnia followed by exhaustion, loss of
interest in friends, loss of interest in food, sex, or other
pleasures, hearing voices and hallucinations.
Crack Cocaine
Vial Crack Cocaine
Methamphetamine
 Methamphetamine
• COMMON & BRAND NAMES
– Meth; Speed; Crystal; Glass; Crank;
Tweak; Yaba
• CHEMICAL NAME
– d-N-methylamphetamine
• DESCRIPTION
– Methamphetamine is a strong physical and mental
stimulant available widely in both prescription and
street forms. It is relatively easy to synthesize which has
contributed to its widespread use.
 Methamphetamine High
• A methamphetamine-induced "high" artificially
boosts self-confidence, many users are overcome
by a so-called "superman syndrome." In this state,
methamphetamine abusers ignore their physical
limitations and try to do things which they are
normally incapable of performing. Meth is highly
addictive because people often continue using the
drug to avoid an inevitable crash that comes when
the drugs' positive effects begin to wear off. Even
first-time users experience many of meth's
negative effects.
 Methamphetamine

• As a powerful stimulant, methamphetamine, even in small

doses, can increase wakefulness and physical activity and
decrease appetite. A brief, intense sensation, or rush, is
reported by those who smoke or inject methamphetamine.
Oral ingestion or snorting produces a long-lasting high
instead of a rush, which reportedly can continue for as
long as half a day. Both the rush and the high are believed
to result from the release of very high levels of the
neurotransmitter dopamine into areas of the brain that
regulate feelings of pleasure. Short-term effects of
methamphetamine:
 Methamphetamine Effects
• Hyperactivity
• Irritability
• Visual hallucinations
• Auditory hallucinations
(hearing "voices")
• Suicidal tendencies
• Aggression
• Suspiciousness, severe paranoia
• Shortness of breath
• Increased blood pressure
• Cardiac arrhythmia
• Stroke
• Sweating
• Nausea, vomiting, diarrhea
• Long periods of sleep
("crashing" for 24-48 hours or
more)
• Prolonged sluggishness, severe
depression
• Weight loss, malnutrition,
anorexia
• Itching (illusion that bugs are
crawling on the skin)
• Welts on the skin
• Involuntary body movements
• Paranoid delusions
 Physiological effects of methamphetamine
use include:

• abnormally high blood pressure

• rapid and irregular heart rate and rhythm
• seizures
• damage to blood vessels in the brain (stroke)
• accumulation of excess fluid in lungs, brain tissue and skull
• continuous/excessive dilation of the pupils
• impaired regulation of heat loss
• hyperpyrexia (body temperatures higher than 104°)
• internal bleeding; damage to other organs caused by disruption of
blood flow
• and breakdown of muscle tissue leading to kidney failure
 Methamphetamine Short Term
• increased attention
• decreased fatigue
• increased activity
• decreased appetite
• euphoria and rush
• increased respiration
• hyperthermia
 Long-term effects of
methamphetamine use
• Long-term methamphetamine abuse results in many damaging effects,
including addiction. Addiction is a chronic, relapsing condition,
characterized by compulsive drug-seeking and drug use which is
accompanied by functional and molecular changes in the brain. In
addition to being addicted to methamphetamine, chronic
methamphetamine abusers exhibit symptoms that can include violent
behavior, anxiety, confusion, and insomnia. They also can display a
number of psychotic features, including paranoia, auditory
hallucinations, mood disturbances, and delusions (for example, the
sensation of insects creeping on the skin, called "formication"). The
paranoia can result in homicidal as well as suicidal thoughts.
 Long-term effects of
methamphetamine use
• dependence
• addiction psychosis
• paranoia
• hallucinations
• mood disturbances
• repetitive motor activity
• stroke
• weight loss
 Meth Chronic Use
• With chronic use, tolerance for methamphetamine
can develop. In an effort to intensify the desired
effects, users may take higher doses of the drug,
take it more frequently, or change their method of
drug intake. In some cases, abusers forego food
and sleep while indulging in a form of binging
known as a "run," injecting as much as a gram of
the drug every 2 to 3 hours over several days until
the user runs out of the drug or is too disorganized
to continue
 Methamphetamine Addiction
• Methamphetamine is a highly addictive
drug. Recovery and rehabilitation from
methamphetamine addiction may require a
treatment program ranging from certified
addiction counseling to treatment at a
residential alcohol and drug rehab center,
depending on the extent of the addiction
and a number of other factors
 Making Crank/Meth Made Easy
• Nazi Method • Red, White and Blue
• Iodine Method
• Red Phosphorus • Iodine
• Lithium • Red Phosphorus
• Anhydrous Ammonia • Ether
• Hydrochloric Acid
• Sodium Hydroxide
• Methanol
GHB
 GHB
• GHB may be made in
homes by using recipes
with common ingredients.
• "Liquid Ecstasy,"
"Georgia Home Boy,"
"Grievous Bodily Harm,
• “Liquid ecstasy," do not
confuse w/ MDMA
• GBL, GBH, One 4 B
 Recognizing GHB
AKA: GHB, G, Jib, Scoop, Liquid
E, Liquid X, Woman’s Viagra,
Grievous Bodily Harm, Easy Lay,
Gamma 10, Salty Water, GH
Buddy, Aminos, Blue Nitro, Blue
Thunder, Thunder Nectar,
Renewtrient, Revivarant, Remforce,
Firewater, Invigorate, Xyrem
(research product), sodium oxybate,
Fantasy & One4B (NZ)
 So Many Names….
• Tranquili G, Midnight Blue, Verve, Rejoov,
Somax, SomatoPro, Flower Power, Puritech,
Alcover, G-riffick, Eclipse, GHGold, Soap, Vita
G, Dormir, Enliven, FX, Serenity, Inner G, Zen,
White Magic Cleaner, Weight Belt Cleaner, Ink
Jet Cartridge Cleaner, Plant Food, Fingernail
Polish Remover, Paint Stripper.
There are more than 80 known names for GHB and
its equally deadly analogs.
 GHB How are they used?

• GHB can be produced in clear liquid, or a white

powder, tablet, and capsule forms, and it is often
used in combination with alcohol, making it even
more dangerous
• It is often carried in an eye dropper, or in
water/Gatorade bottles and passed around.
• Typically measured out in capfuls.
• Occasionally blue food coloring is used to identify
it at some raves.
• It is occasionally used as a body building aid
Other GHB Products
 Efforts to Avoid Detection
• GHB & its analogs are
NOT protected by the
Dietary Supplement &
Heath Education Act of
1994.
• Unapproved for human
use.
• “Misbranded” drugs.
• May be listed as “weight
belt cleaner” or other
solvent use or plant growth
formula—trying to avoid
detection
 GHB- No longer Just for Rapists

• Recreational Use
• Muscle Gain
• Those under
mandatory drug
testing
• Elderly
What To Expect
 Typical GHB Containers
Typical bottles for hiding GHB-- film
canisters, hair spray, liquid candy
bottles, food coloring, breathe mint
containers (may be liquid LSD or
G), vanilla bottles, Gatorade, pump
hand lotion bottles.
Recognizing Containers

ANY container
that will hold a
liquid.

GHB addicts have hidden it in

engine compartments, attics, etc.
 GHB analogs - What does it do
• At lower doses, GHB has sedative effects,
but, as the dose increases, GHB effects may
result in sleep ,eventual coma, respiratory
arrest, or death.
• It is these effects that make it both a prime
drug at Raves, and for Date Rape
 GHB toxicity- mild
• Lethargy, easily aroused with repeated
stimulation
• Drowsiness, somnolence, dizziness,
euphoria
• Confusion (dazed and confused)
• Amnesia, Susceptible to suggestion
 GHB Toxicity- Severe

• Frequent Vomiting,
• Respiratory depression or arrest
• Seizures
• Sudden onset of coma . Patients often demonstrate
extreme SUDDEN combativeness and agitation despite
such profound CNS and respiratory depression
• Death (usually secondary to respiratory failure or
aspiration)
 GHB

• ALCOHOL IS THE
MOST COMMON
DRUG CO
CONSUMED IN
GHB RELATED
DEATHS
 GHB Treatment
• Primary Supportive
• Beware of positional Asphyxia, but soft
restraints are a good idea
• Due to the risk of sudden airway failure,
aspiration, and respiratory collapse, these
patients need aggressive airway monitoring
by ALS providers
 GHB Treatment
• Protect your self
• VOMIT
• Be cautious using respiratory depressants
• Making the decision to tube/not tube is tough,
these patients do frequently vomit.
• ETT placement is uncommon, but post ETT
sedation/paralysis and restraint should be
mandatory in the field
 Difficulty in Prosecution

• Sort Duration
• Amnesia clouds recall
• Often pro-sexual
appearing behavior
• Lack of :
– Credible witness
– Evidence
 GHB analogs- What does this
mean to me?
• GHB analogs are unpredictable in clinical
course, other than duration.
• GHB analogs cause a rapid change in
mental and respiratory status that makes it
difficult to plan treatment and care
• GHB’s presentation often mimics ETOH
abuse and is often co-imbibed.
 Those who have Died
• More than 16,000 adverse reaction to GHB are
documented. More than 72 deaths have been deemed GHB
related by the DEA (230 more are known), perhaps just a
tip of the iceberg since routine testing does not detect it.
Deaths include a college student who took it as a "safe"
sleep aid and died in his sleep. A 15 year- old in
California's high desert who gulped GHB at a RAVE died.
A 32 year-old male in Atlanta died from GHB only. A
body builder in Ohio died, with only alcohol and GHB use.
A 15 year-old female in Michigan died from GHB/GBL
use. Death is even more likely when alcohol or other drugs
are added
 Field Testing

This is what
GHB/GBL
does to a
Styrofoam cup!
Raves
 The Rave Culture
• Generally speaking, “Rave” applies not just
to the parties but to an entire subculture
• Not just “Night time” Parties at clubs
• Can extend into multi-day events (Burning
Man)
• Hallmarked by techno/new age music and
Psychedelic visual displays.
 Rave Culture
• Tend to be “Sponsored” (A.K.A. “Promoters”), limits
liability on both sides
• Sometimes marketed as “Drug Free Teen Dance
Parties”
• If not at a formal club, they tend to be located in
remote locations to limit outside interference.
• Often will have a DJ instead of a band. Some DJ’s are
celebrities, called the “A-List”, traveling a “Circuit”
• Remember, the overall event doesn't have
to be a rave to have a strong Raver
presence
Rave Culture
 Possible Rave Indicators

• Light Sticks
• Water/Gatorade Bottles for sale
• H2O shut off in bathroom
• Crash Rooms/Candles/Etc.
• Have Dance Breaks/cool down periods
 Possible Rave Indicators
• Glow sticks of all sizes
• Special mouth guards
– Protect from swallowing mini glow sticks
– Also less visible than the pacifiers
 Possible Rave Indicators
• The sensation of breathing is intensified by the
menthol (eucalyptus) in vapor rub products. This
will be slathered on their upper lips or in face
masks. Or inhalers will be used.
• Remember, many report things like “being burned
by a cigarette feels good.” It’s all about sensation
 It’s About Sensation
• Many carry personal vibrators. Notice the “x” & “e”
& butterfly beads. Butterfly is a common emblem
for Ecstasy.
• Every touch feels good.
• They may rub each other with things like Tiger Balm
or with hair brushes or gloves with the “gripper dots”
to intensify touch.
 Rave Paraphernalia

• MDMA causes
“bruxism”—teeth
grinding & involuntary
jaw locking; damages
teeth.
• Pacifiers, lollipops,
mouthguards & other
things to suck help
reduce this.
• Hidden compartments
Common Medical concerns
• Severe Dehydration
and Hyperthermia
• Poly-Pharm
involvement
• Date Rape
• Multiple Patients
(approach with a plan)
• Volatile Crowds
Heroin
Heroin

• Also Known as
• Black Tar
• China White
• Speed Ball
• Homicide, Buick,
super Buick, twilight
sleep
 Methods of use:
• Shooting:
• Skin Popping:
• Muscle Popping:
• Chasing the dragon:
Smoking
• Freebasing
 Signs and Systems of an
Opiate Overdose
• Pin Point Pupils • Dirty Needles
• Hypotension (“Diabetics”)
• N/V • Cotton balls, Cig
• Respiratory/CNS Filters
depression
• Spoons w/ residue or
• Aspiration and Hypoxia
similar improvised
• Hallucinations
device
• Other s/s? Think poly-
pharm involvement
 Long Term problems
• HIV, HEP-A/B/C,
• BLOOD POISONING (Septicemia) “Cotton
Fever”
• ENDOCARDITIS
• TETANUS
• NECROTIZING FASCIITIS (Flesh-Eating
Disease) Associated w/ black tar
• WOUND BOTULISM
• TRACKING AND BRUISING
• CONSTIPATION, BOWEL OBSTRUCTION
 Some things that have been done with a
Heroin OD by Junkies

• Injected someone with salt water or Milk This

is an old junky myth sometimes still used.
• Injected someone who overdosed on heroin
with cocaine or speed, or vice versa. Another old
myth.
• Narcan Used PTA of EMS- Narcan is becoming
more and more common among junkies for
“emergencies” (some trials are being done in
Seattle and Europe)
• Put ice on their genitals (down their pants) .
• Placed in a cold shower
 Signs of Drug Abuse
• There's no easy way to figure out if someone, especially a
teenager, is using drugs or alcohol. As you'll see, many of the
signs and symptoms of substance abuse are also, at times,
typical adolescent behavior. There are other causes for some of
these behaviors.
• But do not use this as an excuse to ignore the warning signs of
drug abuse. If some of these signs, (not all in the same
category), are present for a period of time, you should talk to the
person you suspect of using illicit drugs. Remember don't be
afraid to come right out and ask. Before you ask, Decide in
advance, how you'll respond to a "yes" answer.
 Personality:
• Becomes disrespectful—is verbally and physically abusive
• Is angry a lot, acts paranoid or confused, or suffers from
extreme mood swings
• Seems depressed and less out-going than usual
• Is secretive and lies about what he is doing and where he is
going
• Is stealing or “losing” possessions he used to value
• Seems to have a lot of money, or is always asking for
money
• Withdraws from the family and family activities
 Physical Appearance:
• Not taking care of hygiene and grooming
• Not sleeping or sleeping too much
• Loss of appetite
• Weight loss or weight gain
• Too hyperactive or too little energy
 Social Activity/School Performance:

• Drops old friends and activities

• Is skipping school
• Loses interest in school work and is getting low grades
• Sleeping in class
• Loses concentration and is having trouble remembering things.
• Not Doing Homework
• Defiant of authority
• Poor attitude toward sports or other extracurricular activities
• Reduced memory and attention span
• Not informing you of teacher meetings, open houses, etc
 Should You Snoop ?
• It's a controversial topic. if you suspect a
family member, especially your child is
drinking or using drugs, snooping can help
keep your children safe. If they’ve got
something to hide, you need to know about
it. You’re talking about their health and
well-being.
 General Affects on the Public
• Violent Crimes (Murder, Robberies)
• Ingress in Burglaries (Mainly Residential,
Home Invasions)
• Thief’s in General
• Any Thing for Quick Easy Cash
 Examples
• Person steals Check Book during burglary
or from purse, Buys Large amount of meat
at grocery store with stolen checks, trades
meat for drugs.
• Steals anything of value trades for drugs
• Street drug deal goes bad, buyer / seller gets
shot.
 Drug Abuse
• It is not uncommon for Law Enforcement to
recover stolen property from a Drug House
during the execution of a search warrant.
Signs of Alcohol and Drug Addictions
• There are many signs that an individual
may have a drug or alcohol addiction. The
drug addiction signs listed below are cues to
look for when evaluating this matter. Be
aware that possessing several of these signs
does not always imply that there is a drug
addiction present, but if one is suspected be
supportive of the individual in their road to
drug addiction recovery.
 Signs / Indicators of Addication
• Increase or decrease in appetite;
changes in eating habits,
unexplained weight loss or gain.
• Smell of substance on breath, body
or clothes.
• Extreme hyperactivity; excessive
talkativeness.
• Needle marks or bruises on lower
arm, legs or bottom of feet.
• Change in overall attitude /
personality with no other
identifiable cause.
• Changes in friends: new hang-outs,
avoidance of old crowd, new
friends are drug users.
• Change in activities; loss of interest
in things that were important
before.
• Drop in school or work
performance; skips or is late to
school or work.
• Changes in habits at home; loss of
interest in family and family
activities.
• Difficulty in paying attention;
forgetfulness.
• Lack of motivation, energy, self-
esteem, discipline. Bored, "I don't
care" attitude.
• Defensiveness, temper tantrums,
resentful behavior (everything's a
hassle
 Signs / Indicators of Addication
• Unexplained moodiness,
irritability, or nervousness.
• Violent temper or bizarre
behavior.
• Unexplained silliness or
giddiness.
• Paranoia -- suspiciousness.
• Excessive need for privacy;
keeps door locked or closed,
won't let people in.
• Secretive or suspicious
behavior.
• Car accidents, fender benders,
household accidents.
• Chronic dishonesty; trouble
with police.
• Unexplained need for money;
can't explain where money
goes; stealing.
• Unusual effort to cover arms,
legs.
• Change in personal grooming
habits.
• Possession of drug
paraphernalia.
 The Results of
Alcohol and Drug Abuse