Alcohol and other Drugs

Understanding the consequences, avoiding the pitfalls.

Almost as long as human beings have been in existence, tobacco, alcohol, marijuana, cocaine, and other drugs have been used to celebrate, to relax, to perform religious ceremonies, and to escape the problems of a demanding world. Legal and illegal substances are readily available. The control of their use and abuse is left to the individual, who alone can determine the boundaries of personal tolerance. The tremendous potency of some of these drugs, given our highly technological and dangerous world, can be lethal. The automobile is involved in about 25,000 alcohol-related deaths annually.

Although the use of such drugs as heroin, cocaine, speed, PCP, LSD, and marijuana is highly publicized, the two most widely used drugs are alcohol and nicotine. In the long run, they have the greatest potential for causing death and disability among young people.

If you have not already been offered these substances, you probably will be in the future. It's best to make some decisions in advance about how you will handle these situations. There is a great deal of peer pressure to do something just because "everyone else is doing it." It's important that you realize not everyone else is doing it. You have a right to make up your own mind about the way you treat your body.

Alcohol and other drug abuse tends to sneak up. No one tries a substance with the expectation of abusing it. Taking a puff of marijuana or having a few drinks at a party doesn't seem like a big deal. The big deal comes when you find yourself drinking or smoking every day, missing classes because of a hangover, or needing money because it all went for cocaine.

What are the different stages of druge use?

Any drug-caffeine, alcohol, tobacco, marijuana, cocaine-can be used intensively and compulsively. Continued use will take you progressively through the stages listed below. If you inject or smoke a drug like cocaine, you may advance rapidly through the first three stages. In general, there are five stages, or patterns, of drug use.

1. Experimental. This is short-term, non-repetitive use fewer than five times. The person is motivated by curiosity or by peer pressure. It is a low-risk activity usually resulting in no long-term problems.

2. Social or recreational. The drug is used in group or social situations and is sometimes instigated by peer pressure. The risk varies greatly with the frequency and type of drug. This use pattern may involve some risk, but if it is done in a way that is appropriate to the setting and situation and does not interfere with the health and safety of yourself and others, it may be responsible use.

3. Situational. The drug is used in specific situations or for certain events. The individual is motivated by the desire to feel the drug's effects-for example, drinking champagne on New Year's Eve. This can escalate to overuse or more frequent use.

4. Intensive. There is frequent use of a drug, primarily to cope, reduce stress, or obtain pleasure-for example, smoking marijuana to relax or to sleep. This pattern can lead to changes in relationships, behavior, and daily functioning.

5. Compulsive. There is regular and compulsive drug use that pervades the user's life. With cessation of use (usually when the supply is depleted), the user frequently enters a prolonged depression, during which alcohol and other drugs are often ingested.

Both intensive and compulsive use patterns indicate abuse, or chemical dependence. The drug is interfering with normal functioning and with the development of self-esteem and healthy coping mechanisms. A person with these use patterns is chemically dependent. The student who is using drugs in stage 4 or stage 5 needs to stop this destructive behavior pattern.

This section gives you information about how all drugs affect your body and mind, as well as the danger signals to look for when you suspect you have lost control of their use.

Is alcohol really a big problem for young people?

Alcohol is by far the most common drug used on campus; 85 to 95 percent of all college students drink. Alcohol is, for those over 21, a legal drug. It is available almost everywhere, it is widely socially accepted, and its use is encouraged in many social situations. Alcohol is heavily promoted by the media-it is hard to pass a day without hearing or seeing some message related to the pleasures of alcohol.

For many people, alcohol is part of the rites of passage in human life - christenings, birthdays, a new year or a new job. It is part of the socializing at many college parties. But there is a heavy price. Alcohol is the largest drug problem on campus. Its abuse is closely correlated with missed classes, hangovers, injuries, auto and motorcycle accidents, violence, unwanted pregnancies, and sexually transmitted diseases.

Learning about alcohol and making choices about its use can be a key ingredient in your success in college.

How does alcohol affect the body?

Alcohol is rapidly absorbed into the bloodstream through the stomach and the duodenum, the first part of the small intestine. Alcohol molecules are so small, they need not be digested before they can be absorbed. This means that alcohol can reach the brain in less than a minute after consumption.

Once in the bloodstream, alcohol continues to circulate through the system until it is metabolized by alcohol dehydrogenase, an enzyme in the liver. About 10 percent of the ingested alcohol is eliminated in the urine and by the lungs, but the remainder must be processed by the liver.

The amount that is excreted by the lungs is used by the police in their breathalyzer test to determine blood alcohol level. It is a fairly accurate reflection of the concentration of alcohol in the bloodstream.

The liver can metabolize only a limited amount of alcohol per hour. In most people, that is ½ ounce an hour-about the amount of alcohol in a 12-ounce beer, a 4-ounce glass of wine, or one mixed drink (1½ ounces of liquor). Additional alcohol remains in the bloodstream until the liver can generate enough enzyme to metabolize it.

While it is circulating in the bloodstream, alcohol mainly affects the brain. Alcohol is a narcotic, not a stimulant. It depresses the central nervous system. Many people erroneously think it is a stimulant because it makes them feel outgoing and relaxed and removes normal inhibitions.

When alcohol reaches the brain, it affects the frontal lobe first, the part of the brain that controls reasoning and judgment. There it sedates the inhibitory nerves, possibly resulting in your making decisions you would not have made without one or two drinks under your belt.

You may have decided to have only "one or two" drinks but after you've had them, the alcohol affects your judgment, and you may lose your inhibition to drink more. Many a hangover has resulted from this spoiled strategy.

With continued alcohol consumption, the speech and vision centers are affected next, resulting in slurred speech and blurred vision. By listening for a speech change, you can usually figure out if a person is being affected by alcohol. Later, the brain cells that control muscular coordination are sedated, resulting in loss of coordination and in slowed reactions.

Finally, the conscious brain is overwhelmed and the individual loses consciousness. Drinking alcohol can be fatal if too much is consumed too fast. The victim may pass out while the alcohol continues to be absorbed into the system. If the alcohol reaches the deepest centers of the brain, it can paralyze the areas that control breathing and heartbeat. This explains the occasional death during drinking contests.

Alcohol causes permanent brain damage in heavy drinkers. With long-term exposure to alcohol, brain cells die and are unable to regenerate. The early effects are a weakening of mental capacities; perception, coordination, motor function, and memory are impaired.

Not only the brain is affected by alcohol. The liver, the organ that metabolizes alcohol, is the principal site of damage. Alcohol, when introduced into the liver, causes a shift in metabolic pathways, resulting in a buildup of fatty acids. Fat can accumulate in the liver after one night of heavy drinking. This infiltration of fat deposits-the condition is known as fatty liver-is the first stage of liver disease found in drinkers. The process interferes with nutrients and oxygen flowing to the liver cells.

The condition can be detected by a simple blood test measuring enzymes of the liver.

This stage of liver disease is reversible, and the liver will recover if alcohol is no longer consumed. Almost everyone who drinks, even occasionally, gets fatty liver and stresses the body to recover and heal this damage.

However, if heavy alcohol consumption is continued, the liver cells die and are replaced by scar tissue. Cirrhosis, an irreversible and potentially fatal complication, may then develop. Cirrhosis of the liver is one of the main causes of death in alcoholism.

Processing the alcohol becomes a priority for the liver and limits its ability to carry on the normal functions of managing dietary glucose and fat and synthesizing certain proteins. One of the proteins the liver synthesizes is important to the functioning of the immune system. When you are drinking heavily, therefore, you are less able to resist and overcome diseases.

Alcohol affects the stomach by causing it to secrete excess acid. In the short run this causes acute gastritis. During extended periods of alcohol consumption, the increased acidity can become a chronic condition, making the stomach susceptible to inflammation, bleeding, and ulcers.

The heart is also affected by alcohol consumption. Acute intoxication depresses heart muscle contraction and thus the heart's ability to pump blood. This decreases the effectiveness of each heartbeat, and the heart has to work harder to pump the same amount of blood. Chronic intoxication can lead to cardiomyopathy, a weakening of the heart muscle that can result in heart failure.

Alcohol is also a diuretic, causing increased urination and contributing to dehydration. It dilates blood vessels, particularly those in the skin, making some people appear to blush and giving others a false sense of warmth. Alcohol contains calories in the form of carbohydrates, but very few other nutrients; these are "empty" calories. Other effects of too much alcohol are impotence and disruption of the menstrual cycle.

Of great concern is that a woman who drinks heavily during pregnancy can subject her baby to physical and mental retardation. Fetal alcohol syndrome, which comprises numerous birth defects, can result if a woman drinks too much even once during a critical stage of pregnancy. The FDA has concluded that as few as two drinks a day may carry an increased risk for the fetus. Pregnant women who drink have a higher risk of spontaneous abortion, premature births, and low weight babies. A woman should not drink at all when she is trying to become pregnant and during the first 12 weeks of pregnancy.

Is it possible to drink socially without getting drunk or risking serious health problems?

Yes. Many people find that having a drink or two helps them relax. If you want to drink but don't want to experience the unpleasant effects of overconsumption, moderate your drinking. Drink slowly. Depending on body size, it can take 1 to 2 hours to metabolize one drink. Remember, a 12-ounce beer, 4 ounces of wine, and 1 1/2 ounces of hard liquor all contain about ½ ounce of alcohol, approximately the amount your body can process in an hour.

Decide on a limit. (Inability to stick to your limit may be a sign that you are not able to control your drinking.) Alternate your alcoholic drink with a nonalcoholic drink to reduce the effects of dehydration and quench your thirst. If you are mixing your own, dilute your drink with plenty of ice and mixer, preferably water. Carbonated drinks speed alcohol absorption.

Don't drink on an empty stomach. High-fat and high-protein foods slow the absorption of the alcohol and give the liver more time to process it.

How many drinks can I have without getting drunk?

This varies from individual to individual and often depends on the person's size. There are three considerations: body size, amount of alcohol consumed, and time. And remember that food in the stomach delays the absorption of alcohol. The legal definition of intoxication in most states is blood alcohol level of 0.1 percent or less.

Will coffee sober up a drunk?

This supposedly tried-and-true remedy doesn't work because it has no effect on the blood level of alcohol that causes intoxication. It may, however, wake up a drunk, causing more problems than if he or she had just gone to sleep.

What's the best cure for a hangover?

The best cure for a hangover is time, fluids, aspirin, rest, and solid food. The common symptoms of a hangover are nausea, gastritis, anxiety or depression, dry mouth, headache, and fatigue. Many of these symptoms can be the result of the alcohol's dehydrating effects. Alternating an alcoholic drink with a nonalcoholic drink can minimize hangovers and reduce the amount of liquor you drink. Drinking two or three glasses of water before you go to sleep and immediately on awakening can lessen dehydration, headache, and dizziness. Some experts believe that additional B vitamins may also help.

Don't make the mistake of having another drink the morning after to help cure your hangover. This can be the start of a vicious cycle in which you are drinking daily and starting in the morning.

How do you identify an alcoholic?

An alcoholic is an individual who is dependent on, or is addicted to, alcohol; the excessive drinking can be habitual or episodic. Alcoholism is a serious illness and can result in severe physical or mental disability and even death. Alcoholism is not uncommon among teenagers. Many high school and college students suffer from alcohol abuse, which may lead to dependence.

Drinking is a serious problem on many campuses, particularly at fraternity parties. It can be responsible for missed classes, hangovers, incomplete assignments, failed tests, lost friends, and confrontations with the law stemming from rowdy behavior, drunk driving, or traffic accidents.

To determine if you are an alcoholic, or at risk for becoming one, ask yourself the following four questions:

1. Have you ever felt you should cut down on your drinking?

2. Have people annoyed you by telling you to cut down on your drinking?

3. Have you ever felt bad or guilty about your drinking?

4. Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover?

This questionnaire, used by Alcoholics Anonymous and other substance abuse programs, is known as the CAGE questionnaire: Cut down, Annoyed, Guilty, Eye opener. If you answer yes to two or more of these questions, you have the potential for developing an alcohol problem and should seek counseling. A yes answer to all four of these questions is virtually a diagnosis of alcoholism.

Doesn't It take years before you get into trouble with alcohol?

It can take years of abuse to develop some of the serious health consequences of alcoholism, such as cirrhosis of the liver, but the secondary effects-being involved in accidents, missing classes, and losing friendships-are immediate. An abusive pattern of drinking can develop quite rapidly.

How can I tell if I have an alcohol problem?

There are a number of signs that indicate you or one of your friends is having an alcohol problem. Getting drunk on a regular basis is obviously one of them. Drinking only on Saturday nights may seem okay, but getting drunk every Saturday night is another matter. This can soon include Friday nights, and often results in daily drinking.

Drinking to the point of experiencing a blackout, or not remembering what you did under the influence of alcohol, is another sign of trouble. Also, some people susceptible to alcohol problems experience mood swings or personality changes when they start drinking, expressing anger and irritation more readily when they are intoxicated.

Trouble with the law or missing classes or work because of alcohol consumption means you need help if you can't stop drinking on your own. Very often a friend or a family member will approach you to suggest that you reduce your drinking. If this happens, you can be sure you have stepped over the bounds of good sense and need to reevaluate your alcohol consumption. Drinking does not solve problems, which are best confronted honestly and forthrightly when you are sober. Drinking may just compound a problem-with grades, relationships, or money.

Any of these behaviors indicates an alcohol problem is developing or is in full swing. If you or a friend of yours is experiencing these types of behaviors, it is important to stop drinking. If there is a family history of substance abuse, the appearance of just one of these signs is even more serious.

What should I do if someone I know seems to be drinking too much?

Wait until your friend is sober before you express your concern. Stay calm and unemotional and be honest when you talk about the drinking. Before anything can be done, an alcoholic must recognize that there is a problem. When confronting someone, you may expect denial, anger, and even rejection. You may lose a friend, perhaps temporarily or even permanently, but you may "plant a seed" that will help your friend recognize his or her problem. Emotional appeals, threats to punish, and preaching, even when the individual is sober, can be counterproductive by increasing guilt and the compulsion to drink.

Don't cover up by supplying notes for missed classes or by calling in sick on behalf of the person. This can make it easier for your friend to continue to drink and not face up to the destructive behavior. Helping someone continue substance abuse is called "enabling" behavior. It is a sign that you may be a codependent, that you depend on your relationship with the abuser for a concept of self-identity.

If you are regularly rescuing someone from alcohol or substance abuse, or if your closest friend or a family member is a substance abuser, you may need professional help to deal with what has become your own problem. Go to the student health service, the college counseling center, Alcoholics Anonymous, Al-Anon, or Alateen for help. Interventionists have been trained by these professionals to help in confronting an alcoholic or chronically dependent person. Above all, don't accept responsibility or guilt for another's behavior.

What are the consequences of heavy drinking?

Long-term alcohol abuse has a number of irreversible health effects. Cells are destroyed in nearly every organ of the body. Most of the damage is in the brain and the liver, but serious diseases can also develop in the heart and the stomach.

Regular drinking promotes a tolerance to alcohol, allowing the individual to drink more and appear less inebriated. The appearance is deceptive. Despite clear speech, the physical damage to the brain and the liver continues, coordination is still severely affected, withdrawal effects are increased, and the cycle of dependence and addiction has started.

Another clear danger from heavy drinking and the resultant alcoholism is the automobile accident. Nearly 50 percent of all fatal traffic accidents are caused by drunk drivers. These accidents are now the most frequent cause of death in the 1 5-to-24 age group. There are more fatalities per licensed driver at 18 than at any other age.

What are the DTs?

Delirium tremens, which is also known as the DTs, is a particularly severe delirium associated with alcohol and other drug withdrawal. It is characterized by uncontrollable tremors, hallucinations, acute anxiety, delusions, incoherence, and other physical and neurological symptoms. To an alcoholic, it is a very good reason to keep drinking. If an alcoholic attempts to go through withdrawal without medical supervision, the condition can result in death.

I've heard that an alcoholic can never drink again. Is this true?

You are referring to the alcoholic who has a relapse after withdrawing from alcohol and who becomes addicted all over again. Many alcoholics find this to be the case if they do drink again after drying out. Alcoholism is a disease from which a person will spend a lifetime recovering. Like cancer, alcoholism may go into remission, but it can recur. The foundation of recovery is to stay sober, one day at a time. It can be very difficult, if not impossible, for an alcoholic to resume even social drinking. This is the reason you should never push alcohol on someone at a party and the reason nonalcoholic beverages should always be available for guests.

My father is an alcoholic. We've tried for years to get him to seek help, but he won't. Is there a place I can go for help?

Get in touch with Al-Anon, a self-help program for the families of alcoholics, and Alateen, a group that helps adolescents deal with family drinking problems. Also, for insight into your problem, read some of the books on adult children of alcoholics listed in For Further Reading. As the adult child of an alcoholic (ACA), you are not alone. Many students are in a similar situation. It is important to recognize and accept the fact that parental abuse of alcohol has affected you and may continue to influence your life.

How does smoking cigarettes affect the body?

When you inhale tobacco smoke, you are inhaling organic compounds that are harmful to your body. Of the more than two thousand different compounds identified in tobacco smoke, the three most dangerous are tar, nicotine, and carbon monoxide. Tar; a thick, sticky residue of hydrocarbons, coats the lungs. Nicotine, a toxic alkaloid, is the addictive ingredient in tobacco; it is absorbed into the bloodstream from the lungs and affects the central nervous system. Carbon monoxide enters the bloodstream, where it reduces the ability of the red blood cells to carry oxygen to body tissues.

Many other gases and particulates released in cigarette smoke are both irritants and carcinogens. Among them are ammonia, acetaldehyde, acetone, benzene, toluene, phenol, cresol, naphthalenes, benzopyrene, and nitrosamine. (Most of these compounds are also found in marijuana smoke.) Smoke from cigarettes coats the mouth, throat, and lungs with these carcinogenic substances. When they are absorbed into the bloodstream, they are excreted in the urine. They have been associated with cancer of the mouth, throat, esophagus, lung, and bladder.

Tobacco smoke also destroys the cilia, the threadlike processes of the sweeper cells that remove bacteria and particulates from the lungs. Smokers are therefore more susceptible to bronchial infections and colds. Smoker's cough is the result of increased mucous production and the inability of the disabled ciliated cells to clear the mucus as they normally would.

Nicotine, the addictive ingredient that makes it so difficult to stop smoking, is a powerful central nervous system stimulant that increases the heart rate and raises the blood pressure. It is quickly absorbed through the lungs and goes into the bloodstream.

If the nicotine level in the bloodstream drops below a certain level, withdrawal symptoms take effect. The smoker starts to feel edgy and irritable. These symptoms are relieved when the smoker lights another cigarette.

Cigarette smokers have twice the rate of coronary heart disease that nonsmokers have, and heavy smokers have nearly four times the rate. Heavy smokers are two to three times more likely to die of heart disease than are nonsmokers. Women over the age of 35 who smoke and use oral contraceptives are 10 times more likely to die prematurely of a heart attack or a stroke. This combination is particularly dangerous. Some experts advise women of any age who smoke to use another form of birth control or to stop smoking.

What is passive smoking, and can it harm me?

Passive smoking occurs when air polluted by a smoker is inhaled by a nonsmoker. This often happens at campus parties, where the air may contain up to 40 times the particulates of the United States Environmental Protection Agency (EPA) air quality standards. A nonsmoker in a very smoky room may inhale enough smoke in 1 hour to raise the blood levels of nicotine and carbon monoxide to the levels they would be if a cigarette had actually been smoked.

Sidestream smoke, the smoke that escapes into the air between puffs, is actually more dangerous than smoke that is inhaled directly from puffing. When a smoker puffs on a cigarette, the combustion temperature is raised, causing "cleaner" smoke. When the cigarette is not being puffed on, the smoke contains twice the amount of nicotine and tar, 5 times the amount of carbon monoxide, and 50 times the amount of ammonia and all the other cancer-causing chemicals.

Recent studies have shown that the life expectancy of nonsmokers living with smokers is shortened by 4 years. The nonsmokers also show reduced lung capacity and increased lung cancer rates. Passive smoking is definitely a health risk.

What is the best way to quit smoking?

Smokers involved in intervention programs are more likely to be successful at quitting than are those who try to go it on their own. Personal determination to quit seems to be a primary factor for success. Joining an intervention program and quitting cold turkey is more successful than slowly reducing the number of cigarettes you smoke.

Many smokers are unprepared to deal with the effects of withdrawal. Although giving up smoking is a very difficult task, the rewards are great. Almost immediately, your body begins to repair the damage from years of even heavy smoking. Quitting smoking at any age can be beneficial to your health and your pocketbook. After you have not smoked for 5 years, the risks of developing heart disease and lung cancer are reduced by half. After 10 years, the risks are nearly equal to those of someone who has never smoked.

If you are unable to stop smoking on your own, seek help from an organization such as the American Lung Association and the American Cancer Society, or see your physician for a referral to a program.

I've tried, but I've never been able to quit smoking. Is there anything I can do to reduce my risks?

You are not alone. Nine out of 10 smokers wish they could quit, but only about 1 in 4 of those who try to quit is successful. If you are unable to quit no matter how hard you try, there are several ways you can reduce your health risks.

Switch to a low-tar brand and try to decrease the number of cigarettes you smoke. Take fewer puffs on the cigarette and smoke only half of each cigarette before discarding it. When you are not taking a puff, put the cigarette down. Try not to inhale smoke into your lungs.

If you switch to a pipe or a cigar to reduce your intake, be very careful not to inhale. Cigar and pipe smoke contains more harmful chemicals than cigarette smoke does. The only benefit is if you do not inhale. Otherwise you may be doing yourself more harm than good. Cigar and pipe smoking has been associated with cancer of the mouth.

Is smoking really addictive?

Very much so. Despite what many smokers say about being able to quit anytime, doing so is difficult because nicotine is a powerfully addictive drug. Denial is a common aspect of any addiction, whether it is alcohol, tobacco, cocaine, or heroin. Before addicts can get the help they need to quit their habit, they need first to admit they are addicted.

Is chewing tobacco safer than smoking it?

No. It may be more dangerous. Cancers of the lip, mouth, and throat have been known to develop in a remarkably short time (2 to 5 years) in people who chew tobacco.

I've been smoking pot for years, and it doesn't seem to have affected me. Why should I worry?

The final report is not yet in. Scientific study of the long-term effects of marijuana and all other drugs is still in its infancy. Serious medical problems may not be recognized until years after exposure.

Some experts believe that the occasional (less than once a week) smoking of marijuana will not have any long-term medical effects for an adult. Serious effects are seen with chronic abuse (more than one or two times a week), and these effects are more damaging to young people.

Smoking marijuana affects the learning centers of the brain and can disrupt the memory processes. There is evidence that this effect can carry over into the unintoxicated state, particularly in a chronic user who begins in adolescence. It is definitely not a good idea to smoke pot when you are studying, attending class, or planning to take a test.

Acute marijuana intoxication reduces motivation. Chronic marijuana use has been associated with what is called the amotivational syndrome. The student who exhibits the syndrome is apathetic, unconcerned, and uninterested in the normal activities of what should be a challenging and exciting time in life. You might call the person a burnout. It is not an uncommon reaction in the student who smokes marijuana heavily.

Research has shown that heavy use of marijuana does cause a number of physical changes in the body. Heavy use is considered to be one to five marijuana cigarettes, or joints, smoked four or more days a week.

Marijuana smoke and tobacco smoke are closely related chemically. It took many years for the health effects of tobacco to be documented, and it looks as though there will be a similar delay for conclusive evidence on marijuana's effects, particularly given its illegal status.

Some of the carcinogens in tobacco smoke are also in marijuana smoke, at levels 50 to 100 percent greater. Studies in which the tars of marijuana and tobacco were painted on the skins of mice for 74 weeks, found that tumors developed in both groups, with a slightly larger number in the tobacco group.

While tobacco contains no THC (tetrahydrocannabinol), marijuana contains no nicotine. You may think that because marijuana smokers smoke less than tobacco smokers do, they would be at lower risk. However, because of the method of smoking-deep inhalations of marijuana smoke are held in the lungs for extended periods-smoking one joint is comparable to smoking four or five tobacco cigarettes. In the short run, smoking marijuana decreases lung capacity and can cause a chronic sore throat, a cough, and sinus problems.

Even though marijuana does not contain nicotine, some marijuana users seem to develop a powerful psychological addiction, or habituation. There are minor withdrawal symptoms; heavy marijuana users become irritable or nervous when they run out of the drug. This doesn't happen to everyone and seems more consistent with the incidence of alcoholism in a small percentage of those who drink, as opposed to the percentage of tobacco smokers who become addicted (close to 100 percent).

If it takes 20 to 30 years of cigarette smoking to develop lung cancer and heart disease, it could take a similar time for the overall health effects of marijuana to become apparent. Remember also that when you smoke marijuana, you may be inhaling pesticides or a herbicide like paraquat that may have been sprayed on the marijuana.

What is THC?

The active ingredient in marijuana is THC, or tetrahydrocannabinol. When smoked, THC enters the bloodstream through the lungs and circulates throughout the body. It is a psychoactive drug, and most users experience a dreamy state of consciousness in which time, colors, and spatial perceptions are slightly distorted. It has a particularly strong effect on the heart and can increase the heart rate 50 percent or more. Other physical reactions are a dry mouth and throat, red eyes and eyelids, and increased appetite. Primarily processed by the liver, THC is fat-soluble and accumulates in the fat cells of the body. A chronic user who is being drug-tested for a job or a sport should be aware that it can be detected in the urine for about 20 days following the last use.

There is a wide variation in potency, but the marijuana of today can have 10 to 20 times the strength of marijuana grown in the 1960s. Most marijuana then contained 0.1 to 0.5 percent of THC. Samples of marijuana in the 1980s have shown THC levels as high as 14 percent. This increase in potency has probably led to the recently reported increase in side effects.

Is it possible to overdose on marijuana?

It would be difficult to overdose on marijuana by smoking it, but if you eat too much of it as an ingredient in cookies or brownies, there is a possibility of overdose. When you eat marijuana, you won't feel the effects for about 45 minutes. It takes about 2 hours before the blood levels of THC peak; they then decline over the next 8 to 12 hours.

Don't make the mistake of eating a handful of brownies and then eating another handful 30 minutes later because you "don't feel anything." You may end up taking a much longer trip than you bargained on. Remember that it takes about 2 hours for THC blood levels to peak.

The use of the very potent marijuana currently available sometimes causes a panic attack. This effect, more common in inexperienced users, can occur with weak marijuana as well. A panic attack produces extreme anxiety, paranoia, fear of death, and sensations of distorted body image. Usually these psychological effects pass in half an hour to 45 minutes, leaving the user convinced that marijuana is not a mild drug.

Sometimes when I drink a few beers and then smoke a joint, it seems to sober me up. Does it?

No, you only feel more sober-like the drunk who drinks a cup of coffee to sober up and simply becomes a wide-awake drunk. Marijuana and alcohol, however, have a cumulative effect. One unit of alcohol plus one unit of marijuana equals two units of intoxication, so that, unlike the drunk drinking coffee, you are increasing your level of intoxication.

Smoking marijuana has a considerable effect on motor control and time-speed-distance perception. It does not improve, but actually worsens, driving ability and coordination. Tests have shown that coordination and depth perception can be affected for as long as 24 hours after the marijuana high has worn off.

Marijuana actually potentiates, or makes the effect stronger, of such drugs as speed, cocaine, barbiturates, and psychedelics. In other words, the sum is greater than the parts if you start mixing your drugs.

Can smoking pot make you sterile?

No, smoking marijuana does not make you sterile. Some research has shown that it can decrease the production of testosterone, the male sex hormone, and lower the sperm count. It may disrupt the menstrual cycle in women. Marijuana has also been associated (rarely) with breast enlargement in men (not in women) because of the lowered testosterone.

Although marijuana is not implicated in sterility, testosterone levels may be crucial to a developing fetus. Tiny amounts of testosterone produced by the developing embryo have substantial impact on its growth. Your smoking marijuana may disturb this testosterone production and contribute to physical and mental retardation in the fetus. There is considerable evidence that smoking marijuana during pregnancy can increase the rate of miscarriage and stillbirth.

Are there any medical considerations or problems that prohibit smoking pot?

A woman who is pregnant, or is trying to become pregnant, should not smoke marijuana. A heart or lung condition, such as asthma or bronchitis, can be made worse by smoking pot because it decreases lung capacity. Smoking marijuana is harmful for diabetics and for people who suffer from epilepsy or other seizure disorders; marijuana can interfere with the action of the drugs used to control these conditions.

What can you tell me about cocaine?

Cocaine is an alkaloid obtained from the leaves of the coca shrub grown in South America. It is a stimulant that usually comes in the form of a white, crystalline powder. It is inhaled through the nose, injected with a needle, or smoked. It is currently among the most popular, most available, and most dangerous of the illegal drugs.

When sniffed, it is quickly absorbed through the mucous membranes lining the nasal passages, giving the user a rush in a matter of moments. The rush is a sudden sensation of extreme well-being accompanied by a perception of strength and mental alertness.

Within 20 or 30 minutes, the effect starts to dissipate, leaving the user depressed and jittery. The "solution" is to recapture the euphoria by using more cocaine. The difficulty arises when the supply runs out.

Cocaine became very popular in the 1970s as a so-called recreational drug. It was not considered addicting and was thought to be a "mild" stimulant with few physical side effects. Medically, this is no longer considered true. Only in the 1980s has its true toxicity and addictive potential been recognized. Research has shown that cocaine is at least as addictive as heroin and perhaps more so. Although sniffing the drug has a powerful effect that is psychologically addictive, it is not so physically addicting as freebasing (smoking) or injecting it.

Cocaine can permanently damage the heart muscle and can cause heart attacks in people with healthy hearts. Think of the recently published accounts of young athletes in peak physical condition who died from cocaine use. It does not necessarily require massive doses of the drug for heart attacks and death to occur.

Many people believe that you can hurt yourself only by injecting or freebasing, not by sniffing. This is not necessarily true. Regardless of how it is taken, cocaine affects the electrical stimulation that controls the heartbeat and probably causes more deaths by heart attack and disordered heart rhythms than we realize.

How does cocaine affect the body?

Cocaine is a stimulant and a vasoconstrictor, meaning it causes blood vessels to constrict, or to narrow. When cocaine is sniffed, it takes 5 to 10 minutes to circulate in the body. As it enters, cocaine constricts the blood vessels in the nose, leading to dryness and bleeding. There is also the possibility of perforations in the nasal septum and of sinus infections.

Once in the body, cocaine causes a rapid, possibly irregular heartbeat, increased blood pressure, and constricted blood vessels, especially in the heart. Conflict develops in the heart muscle. The brain is telling it to pump faster, but the blood vessels feeding the heart muscle are constricted, providing it with less oxygen to do the work.

In the brain, cocaine causes the release of certain chemicals called neurotransmitters, which give the high. However, the uptake or replacement of these chemical messengers is blocked. With extended use the chemicals become depleted, resulting in depressed brain function and general fatigue as well as emotional depression, paranoia, delusions, hallucinations, and thoughts of suicide.

The stimulation lasts as long as you keep taking the drug, but it soon takes more of the drug to get the same effect. This can result in extreme mental and physical overstimulation, which is followed by exhaustion. Other drugs are often used to moderate or prolong the effects of cocaine. Heroin is occasionally injected together with cocaine, a practice called speedballing, which resulted in the death of John Belushi. Alcohol or downers are sometimes used to moderate cocaine's overstimulating effects. This polydrug usage can have dangerous additive effects.

What about using cocaine occasionally?

The patterns of cocaine use have shown that cocaine is highly addictive. In animal studies, monkeys preferred cocaine over any other substance and died of starvation because they chose a cocaine-delivering lever over a food-delivering lever.

The use of cocaine may begin as a form of recreation or as an experiment. When its use has become intensive or compulsive, a true problem exists. Compulsive use-in which the user is spending much time and money seeking, using, or recovering from drugs-leaves the user unable to function in other areas of life. (See page 310 for the five stages of drug use.)

What does it mean if cocaine is "cut?

Cocaine and many other illegal drugs are often cut, or adulterated with other substances, so that the dealer can make more money or have more cocaine for personal use. Most cocaine bought in small quantities contains only 10 to 20 percent of the drug. The balance is made up of some type of filler, as each dealer takes out a portion and replaces it with an inexpensive substance, or cut.

A student who may be spending almost $600 for less than a month's supply of cocaine may buy larger quantities and sell grams to friends. By cutting the product, the user has funds to support what has become compulsive use.

Many cuts used in the illegal drug trade are innocuous and not nearly so damaging as the drug itself. However, some of them, such as strychnine and household cleansers, are extremely dangerous. Other drugs such as amphetamines may serve as the cocaine cut because they are cheaper and can induce similar feelings in the user. It can be very difficult to tell what an illegal drug is cut with.

Why is injecting drugs so dangerous?

When a drug is injected, it goes directly into the bloodstream. Within seconds it is directly affecting major organs such as the brain and the heart. Excessive amounts of the drug or impurities cannot be limited by the body's natural defenses or filtering systems, such as the stomach, liver, or kidneys.

By their very nature, illegal drugs vary widely in potency and purity. Someone who is used to injecting a substance that is 10 to 20 percent cocaine can easily overdose by injecting the same amount of a substance that is 90 percent cocaine.

In addition to the dangers of overdose and of poisoning from a contaminated drug, injecting a drug seems to contribute substantially to its addictive potential. An individual who injects heroin, cocaine, or speed is likely to become addicted to the drug more quickly than is someone who sniffs it or takes a pill.

Using a needle also creates a hygiene problem. It is very difficult to keep a syringe sterile. Many drug abusers share needles when they are doing drugs. A dirty needle can easily transfer viruses, such as those causing hepatitis, and AIDS, from one user to another. It is estimated that over 70 percent of the intravenous (IV) drug abusers in New York City have become infected with the AIDS virus through the sharing of needles.

If you are involved in IV drug abuse, you should use extreme caution and never share needles or use someone else's "works," "kit," or "fit." The risk of transmitting the AIDS virus is simply too great; IV drug abuse is not necessarily fatal, but AIDS always is. Clean your needle by running household bleach through it twice, and then repeat the procedure using clean water. And seek help to quit this destructive activity.

What is crack cocaine?

Most cocaine is actually cocaine hydrochloride, a salt. The hydrochloride and any impurities are chemically removed, and the cocaine base is left. Called freebase, crack, or rock cocaine, it vaporizes easily when it is smoked.

Smoking, or freebasing, cocaine gives the user a rush similar to that produced by injection. The feeling similarly wears off quickly, in a matter of minutes, and the craving for more cocaine is much stronger than when it is sniffed. Freebasing is very addictive.

What are hallucinogens?

Hallucinogens are drugs that include hallucinations, or abnormal psychic effects-sensations or perceptions not based on reality. The most common hallucinogen is LSD (lysergic acid diethylamide), or acid. It characterizes the class of powerful psychedelic drugs. Minute doses can send an individual on a "trip" that may last 8 to 12 or more hours. The LSD user can expect intense hallucinations and other psychological responses ranging from ecstatic joy to abject terror.

Hallucinations can include time and space distortion, swirling colors, and distorted shape patterns. While under the influence of LSD, the user is strongly influenced by the external environment; an experienced user will therefore select the time and place for the trip carefuHy. Serious psychological difficulties induced by a bad trip can persist for weeks. Sometimes the effects of a drug may be felt after its use has been discontinued. These are called flashbacks and can be a disconcerting side effect of psychedelic use, particularly of LSD.

Usually, both the pleasant perceptions and the unpleasant effects decrease when the drug wears off after 12 to 16 hours. Long-term problems are rare and are usually triggered only when an underlying mental disorder is already present. A psychosis is likely to last longer than several weeks and is more common to PCP, which is discussed below.

There are other hallucinogens such as mescaline (from peyote) and psilocybin (from Psilocybe mushrooms), which have effects similar to those of LSD but are not usually so powerful. Peyote cactus has been used for centuries by American Indians in their religious ceremonies. It is usually in the form of mescal buttons, the dried tops of the cactus. The white fur on them is poisonous and must be removed before they are eaten. Nausea and vomiting are common side effects of ingesting peyote and psilocybin.

Psychedelic mushrooms require the utmost caution. There are many different mushroom species and many can cause kidney and liver damage, and even death. Even a mushroom you have eaten before and consider safe may cause a severe reaction if taken in a larger amount or under stressful conditions. Sometimes nonpsychedelic mushrooms are soaked in LSD and then sold.

Most "mescaline" sold on the street is not mescaline. Over 95 percent of the street drug samples turned into the Los Angeles Street Drug Identification Program contained no mescaline but were LSD, PCP, or a combination of both.

A friend started using something called Ecstasy. What is it?

Ecstasy, or MDMA (3,4-methylenedioxymethamphetamine), is one of the so-called designer drugs. These drugs are slightly different in chemical composition from their counterparts like LSD and mescaline. Ectasy has been considered illegal since 1985; other designer drugs are listed as illegal as soon as they are recognized by the Drug Enforcement Agency. These drugs, prepared by underground chemists, are extremely dangerous. Although their chemical composition may be only slightly different, their effects on the human body can be drastic.

There is no way for underground chemists to know what kind of drugs they have created or to know what the effects might be on human beings. Designer drugs may have been the cause of sudden death in some users 24 to 48 hours after ingestion. They have also been linked to the permanent onset in young people of symptoms resembling those in Parkinson's disease, an incurable, degenerative disease of the nervous system that causes uncontrollable tremors. It is usually a disease of middle or old age.

Some of the names that underground designer drugs go by are MDA, Ecstasy, and MDMA. Studies have recently documented that MDMA causes serious brain damage, even in low doses.

Several types of synthetic heroin have been created, so potent that 1 gram is sufficient to make about 50,000 doses. Sometimes called "China white" or "synthetic heroin," these drugs have been responsible for over 90 overdose deaths in California alone. It is possible that many other deaths have been caused by designer drugs, but that the extremely low tissue levels of these substances have not been detected by regular toxicological methods.

What is angel dust?

Angel dust is the common name for the psychedelic drug PCP (phencyclidine), a central nervous system depressant. Also called jet fuel, sherms, superweed, or any of many other street names, it can be smoked, snorted, swallowed, injected, or even put in eyedrops. It can be packaged as a powder, tablet, leaf mixture, or rock crystal.

Low doses (less than 5 milligrams) can induce disorganized thought processes, hallucinations, amnesia, agitated or combative behavior, and schizophrenic reactions. Higher doses can induce a catatonic, or unresponsive, state, heart arrhythmias, convulsions, seizures, coma, and death.

The users of PCP often suffer burnout when they use the drug on a regular basis. Usually, the paranoia and other psychoses subside in several weeks of abstinence, but anyone who uses PCP is headed for trouble. It can be difficult to administer safe doses of a drug whose strength wildly fluctuates.

When cornered or restrained, a PCP user can exhibit superhuman strength, and a confrontation with the police can have disastrous results. PCP is sometimes used to adulterate marijuana to give it an extra kick.

What is "speed"?

Speed is the street term for amphetamine, a powerful central nervous system stimulant in the class of drugs known as uppers. Amphetamines usually come in pill form and are often used by college students when they are cramming for finals and completing term papers. This is not a good idea. Speed can impair your judgment, and what you do under its influence may be severely lacking when scrutinized soberly.

Speed can make you feel exhilarated, alert, and talkative, but there is always a price to pay when the drug wears off. Tolerance and psychological dependence can build. You may soon be unable to function unless you are using speed, and physical addiction can occur after heavy and prolonged use.

Coming down off speed can leave you depressed, anxious, jittery, and nervous. And those are the mild symptoms. Psychotic reactions under the influence are not uncommon. Speed can affect your heart, causing arrhythmias, and an overdose can result in circulatory collapse, cerebral hemorrhage, coma, and death.

Speed is sometimes injected intravenously, a more dangerous practice than taking it orally. You may rapidly become addicted. Also, the likelihood of overdose or injury from a contaminated drug is much higher with an injection. An IV drug abuser can get sick from using an unsterile needle. Such diseases as hepatitis and AIDS are commonly shared right along with the needles.

What are "reds"?

Reds are barbiturates - given the common name because one of the more popular brands, Seconal, comes in a red capsule. Known as downers, barbiturates depress the central nervous system. Low doses have a mild sedative effect, higher doses have a hypnotic effect, and very large doses can result in coma and death. The drugs in this class have a legitimate use as sedatives and sleeping aids, but they have a high rate of abuse. Nonbarbiturate central nervous system depressants commonly abused are Valium, Librium, and Quaaludes.

Usually these drugs are taken in pill form, but they are sometimes injected. All of these drugs are addictive and regular users suffer withdrawal symptoms when they try to stop the drug.

Quaaludes have an undeserved reputation for increasing sexual arousal. Like other depressants, including alcohol, they act by releasing inhibitions. They are more likely to result in sleepiness.

Combining alcohol and sedatives or tranquilizers produces a potentially lethal effect. When they are taken together, the effects of both are intensified. Taking a couple of downers and drinking alcohol is a common mistake that can severely distort judgment and result in an overdose.

As with many addictive drugs, a tolerance can build in which the body adapts by lessening response to the drug. This can be very dangerous because even though the user then needs more of the drug to achieve the same effect, the lethal dose remains the same. In other words, the more you need to satisfy your addiction, the closer you are to ingesting the amount that can kill you.

What about painkillers like Percodan and codeine?

These drugs are also abused on campus. Usually they come in pill form, but sometimes codeine is in a combination drug product-a prescription cough syrup, for example. These painkillers usually have a mild sedative effect, but they can be extremely dangerous when taken in conjunction with alcohol. They are also addictive, and overdose of these substances can lead to respiratory failure.

What is heroin?

Heroin is a highly addictive narcotic derived from the opium poppy, which is also the source of opium, morphine, and codeine. Heroin acquired its name when it was introduced in the late 1800s as the cure-all for a multitude of illnesses-a "heroine" to those who benefited from its pain-relieving qualities.

Heroin is usually injected but is more often being smoked or sniffed. It induces a dreamlike, carefree euphoria that neutralizes most physical endeavors, including sexual activity. Its addictive qualities make it extremely dangerous.

Most heroin in the United States is only about 5 percent pure; the rest is made up of adulterants, or cut. Usually heroin is cut with sugar, talcum powder, Epsom salts, or quinine, all of which are harmful when injected directly into the bloodstream. Particles of these materials can become lodged in the heart, brain, and lung.

Most heroin overdoses are caused by a product that is 10 to 15 times more powerful than the user is used to, although it may still be only 50 percent heroin. Other overdoses occur when

a toxic substance such as strychnine contaminates the cut.

Is it safe to sniff glue?

No, not at all. Sniffing glue can cause permanent brain, liver, and kidney damage as well as bronchitis, heart arrythmias, seizure, coma, and death. These effects can result from even the first experience. In short, this is a senseless, high-risk activity. The risk applies also to sniffing other chemicals such as gasoline and deodorant sprays.

Glue is sometimes sniffed by putting the substance in a plastic bag and breathing the fumes. Inhaling the fumes can lead to euphoria, loss of muscle control, slurred speech, impaired judgment, and unconsciousness, and sometimes to asphyxiation because the plastic bag has cut off the oxygen supply.

How can I tell if an illegal drug I buy is safe?

You can't. By their very nature, illegal drugs are not subject to quality control. Many of these drugs are adulterated, or cut, with substances that may not be what you intended to ingest. You should use extreme caution in taking any illegal drugs that you are not sure of.

Some cities have street drug identification programs that will identify the contents of a sample you give them anonymously. It is very wise to submit a sample of a substance you have a question about before you take it.

What is an addict?

Classically, the term is applied to a person who has developed compulsive use of and an increasing tolerance for a substance. He or she is likely to suffer the symptoms of withdrawal if the use of that substance is curtailed. Addiction is sometimes referred to as "chemical dependence." The withdrawal symptoms vary with the specific drug and include restlessness, tremors, fever, vomiting, diarrhea, involuntary muscle spasms, and terrifying hallucinations.

Some drugs are addictive not only because of the pleasurable sensations they provoke but because of the unpleasant effects of withdrawal. Tobacco, alcohol, heroin, cocaine, speed, and barbiturates can all bring on serious physiological changes when their use is discontinued.

More recently the definition of addiction has been expanded to include psychological dependence, which can be more difficult than physical dependence to treat. Psychological addiction often continues after the physical addiction has been dealt with, leaving the former addict highly susceptible to resuming use of the drug after its withdrawal. Psychological dependence (or addiction) refers to the desire, or craving, for the sensation the drug produces. It occurs only after someone has tried the drug and found that its effect is pleasurable. This dependence can remain for years after the person has become drug-free and can lead to craving and susceptibility to relapse.

Exactly when occasional use of a drug turns into abuse and, perhaps, addiction is difficult to determine. You have probably become addicted if you depend on a drink, a smoke, a snort, or a fix to feel as if you are functioning normally. When an addiction is interfering with your academic performance, your job, or your personal life, you have a very serious problem.

If I try a drug once, will I become addicted to it?

Not if that is the last time you use it. The addiction-inducing qualities of a drug vary widely, not only from drug to drug but from person to person. The addictive qualities of a drug can also depend on the method of ingestion. For example, smoking or injecting cocaine is drastically more addicting than sniffing it.

Tolerance, the body's decreased response to a drug, which results in the person's need to increase the drug dose in order to get the original effect, varies by drug and by user. Different people have different tolerances for differing substances.

Abuse and addiction are more likely among students who take drugs to escape their problems or as a means of handling them. You may think that smoking a joint before taking a test helps lessen tension, but there is no way it will improve performance. Taking drugs won't solve problems. It can compound them or create new ones.

If I am not going to become addicted the first time I use a substance, why shouldn't I try it once?

In the use of illegal drugs like heroin, cocaine, PCP, speed, crack, reds, and even alcohol if you are underage, it may not be the danger of addiction that is your immediate problem. You could end up in jail, get sick from a tainted drug, or even die from an overdose or a bad reaction to any drug, including alcohol.

Experimentation is part of life. Most people have tried alcohol and continue to use alcohol to some degree. Many people have tried smoking cigarettes, even if they couldn't stand the taste. Research has shown that over 50 percent of college freshmen have tried marijuana and that 25 percent have used cocaine. It is not usually the first-time use that creates problems. Rather, it is the repeated use, coupled with the illegality of some drugs and their interaction with driving, that puts you at risk or can lead to dependence and its serious physical and emotional consequences.

How do I know if I am abusing drugs or if I am chemically dependent?

If you answer yes to any of the following questions, you possibly have a drug or drinking problem and should seriously attempt to reduce or eliminate use. If you are unable to do so, go to your student health service or to another recognized agency for help.

  1. Are your friends, family, teachers, or employers concerned about your drug or alcohol use?
  2. Do you use drugs or alcohol to handle stress or escape from problems?
  3. Do you use drugs or alcohol daily?
  4. Do you believe you can't go to class, go to a party, go on a date, or relax without using drugs or alcohol?
  5. Do you think you are more fun when you use drugs or alcohol?
  6. Have you ever been in trouble with the law or your parents because of your drug use or drinking?
  7. Do you lie about your drinking or drug use?
  8. Do you do things under the influence that you would not normally do?
  9. Do you neglect your studies, friends, or responsibilities because you d rather use drugs or alcohol?

A friend is using marijuana daily, has a cough, and is missing classes. How can I help?

A friend who can't or won't control a drug problem that is interfering with his or her life is clearly a drug abuser. There are several factors to consider when discussing a friend's drug abuse:

How could this happen to someone?

There are as many reasons as there are people with problems. Some people are prone to drug abuse. They may have a family history of alcohol or other drug abuse, and some research is pointing toward a hereditary predisposition to these problems. There is an increased risk of becoming an alcoholic if one or both parents have the problem. Approximately half of all alcoholics have an alcoholic parent.

In a social environment filled with change, many young adults have increasing difficulty establishing a self-identity and a sense of self-worth. They may have low self-esteem, low tolerance for stress, poor impulse control, and may be susceptible to peer pressure. Alcohol or other drugs may be an attempt to find identity.

Drug use may mask, or be a self-treatment for, other problems like depression, anxiety, or stress. Psychologists have identified an addictive personality that is more prone to develop a chemical dependence.

Although there are many reasons for drug abuse, there seems to be an underlying theme of a drug's taking control of someone's life. Drugs are powerfully addictive, whether the dependence is psychological or physical. Their power over someone's life is especially strong when other stabilizing factors like family, social mores, and a strong self-identity are lacking.

It isn't your fault that your friend has developed a drug problem, but by using a nonjudgmental approach, you may be able to be of help.

How can I get help?

Get in touch with your student health service counseling center. Almost all campuses have counselors trained to help students with drug problems. Getting help involves learning the consequences of, and the problems that result from, drug use, as well as addressing the underlying problems. Your counselor will be nonjudgmental and will guide you in techniques to handle the problems that your friend may be suppressing by drug abuse. Your situation will be handled with the utmost confidentiality, and you will not be turned in to the police for trying to help a friend.

What else should I know about drug abuse?

Too many accidents that result in death and injury to young people are the result of mixing drugs (including alcohol) and the automobile. This combination could very well be your greatest health risk. If you consume alcohol or use illegal drugs, do it under conditions that are safe and do not necessitate your driving, or being driven by someone, under the influence.

Getting involved with more addicting drugs like heroin and cocaine or with IV drug abuse is simply foolish and self-destructive. If this happens to you, the first step to recovery is to admit you have a problem. The second step is to seek professional help.

Don't be afraid to talk with your physician about a drug abuse problem, and ask for a professional referral to a drug treatment program if necessary. The supervisors of these programs are trained to maintain confidences and to preserve your privacy. You will not be turned over to the police.

How can I reduce my chances of developing an alcohol or other drug problem?

Preventing problems with alcohol or other drug use involves developing your own responsible drug-use guidelines, particularly if you are at high risk for problems of abuse. In situations that may lead to trouble, use some of the following techniques to help you make choices that avoid or prevent problems.

  1. Develop your own standards of self-worth and self-esteem. Establish self-generated goals and work toward their accomplishment. These are major tasks of young adulthood, but very few campuses offer curriculums addressing these concerns. If you have problems in any of these areas, you can benefit from short-term counseling available through student counseling services.
  2. If you come from a family with any addicted members, seek help from a support group like Al-Anon or Alateen.
  3. Know the laws in your state and the consequences of breaking them. Are you willing to accept these consequences if you act illegally?
  4. Learn to use in moderation and keep track of your consumption. Set limits on the amount of alcohol or other drugs you can handle and the setting in which you will use them. Determining a safe, responsible dosage is crucial in learning to make responsible choices and in avoiding problems. Mix alcohol with food and nonalcoholic beverages.
  5. Avoid alcohol or other drug use if you are taking other medications. Alcohol mixed with even mild over-the-counter medications, such as the antihistamines in cold preparations, can intensify the sedative effects of both. Alcohol also impairs the effectiveness of antibiotics and may cause a severe reaction when combined with Flagyl (metronidazole).
  6. Avoid using these substances if you aren't feeling well. Alcohol and other drugs depress the immune system and make it more difficult for you to recover.
  7. Develop a strategy to avoid driving under the influence. Choose a sober, designated driver for your group, or choose an alternative means of transportation. Stop drinking 1 or 2 hours before the time to leave and follow the drinking guidelines to be sure your blood alcohol concentration is well below 0.05. Consider ahead of time what you will do if a driver is intoxicated-take the keys, call for another ride home, stay over with a friend, or drive home yourself if you are sober.
  8. Develop alternatives. See below for suggestions on alternatives to use some or all of the time.

What about alternatives to drugs? Isn't there something else?

First, you should be aware of all drugs you are using and the reasons you have for using them. You may want to make a list of the drugs you have used or considered using and the benefits

you get from them. Then list three or four alternatives you might find acceptable. For example:

Substance/Use Benefits Risks Alternatives
Caffeine, 6 cups a day Wake upJittery feelingsShower in the a.m.
Stay alert Difficulty sleeping Exercise
Like taste Upset stomach Drink decaf

In addition to listing alternatives, be honest with yourself about the risks to your health and the illegality of some drugs. Alternatives include another activity that gives you the same benefits-such as dancing, laughing, sports, nature walks, friends, movies, trips, or even roller coaster rides.

If you use drugs to relax, you will find that stress management techniques (see chapter 8) have longer-lasting results and no side effects. If you use drugs for self-discovery or insight, meditation, yoga, biofeedback, and relaxation training are alternative techniques.

These alternatives offer a more positive approach, not only because they are legal and self-regulated but because they actively involve you. They are learning exercises that teach you self-control, self-discipline, and self-transcendence. They have no side effects, and their positive benefits last well past their time of use.