Created by CK-12 Foundation/Adapted by Christine Miller

Art in a Cup

Who knew that a cup of coffee could also be a work of art? A talented barista can make coffee look as good as it tastes. If you are a coffee drinker, you probably know that coffee can also affect your mental state. It can make you more alert, and it may improve your concentration. That’s because the caffeine in coffee is a psychoactive drug. In fact, caffeine is the most widely consumed psychoactive substance in the world. In North America, for example, 90 per cent of adults consume caffeine daily.

Psychoactive drugs are substances that change the function of the brain and result in alterations of mood, thinking, perception, and/or behavior. Psychoactive drugs may be used for many purposes, including therapeutic, ritual, or recreational purposes. Besides caffeine, other examples of psychoactive drugs include cocaine, LSD, alcohol, tobacco, codeine, and morphine. Psychoactive drugs may be legal prescription medications (codeine and morphine), legal nonprescription drugs (alcohol and tobacco), or illegal drugs (cocaine and LSD).

Cannabis (or marijuana) is also a psychoactive drug that while illegal in many countries is legal for use in Canada by individuals over the age of 19 years. Legal prescription medications (such as opioids) are also used illegally by increasingly large numbers of people. Some legal drugs, such as alcohol and nicotine, are readily available almost everywhere, as illustrated by the images below.

Figure 8.8.2 These psychoactive drugs are legal and accessible almost anywhere.  

Psychoactive drugs are divided into different classes based on their pharmacological effects. Several classes are listed below, along with examples of commonly used drugs in each class.

• Stimulants are drugs that stimulate the brain and increase alertness and wakefulness. Examples of stimulants include caffeine, nicotine, cocaine, and amphetamines (such as Adderall).
• Depressants are drugs that calm the brain, reduce anxious feelings, and induce sleepiness. Examples of depressants include ethanol (in alcoholic beverages) and opioids, such as codeine and heroin.
• Anxiolytics are drugs that have a tranquilizing effect and inhibit anxiety. Examples of anxiolytic drugs include benzodiazepines (such as diazepam/Valium), barbiturates (such as phenobarbital), opioids, and antidepressant drugs (such as sertraline/Zoloft).
• Euphoriants are drugs that bring about a state of euphoria, or intense feelings of well-being and happiness. Examples of euphoriants include the so-called “club drug” MDMA (ecstasy), amphetamines, ethanol, and opioids (such as morphine).
• Hallucinogens are drugs that can cause hallucinations and other perceptual anomalies. They also cause subjective changes in thoughts, emotions, and consciousness. Examples of hallucinogens include LSD, mescaline, nitrous oxide, and psilocybin.
• Empathogens are drugs that produce feelings of empathy, or sympathy with other people. Examples of empathogens include amphetamines and MDMA.

Many psychoactive drugs have multiple effects, so they may be placed in more than one class. One example is MDMA, pictured below, which may act both as a euphoriant and as an empathogen. In some people, MDMA may also have stimulant or hallucinogenic effects. As of 2016, MDMA had no accepted medical uses, but it was undergoing testing for use in the treatment of post-traumatic stress disorder and certain other types of anxiety disorders.

Psychoactive drugs generally produce their effects by affecting brain chemistry, which in turn may cause changes in a person’s mood, thinking, perception, and behavior. Each drug tends to have a specific action on one or more neurotransmitters or neurotransmitter receptors in the brain. Generally, they act as either agonists or antagonists.

• Agonists are drugs that increase the activity of particular neurotransmitters. They might act by promoting the synthesis of the neurotransmitters, reducing their reuptake from synapses, or mimicking their action by binding to receptors for the neurotransmitters.
• Antagonists are drugs that decrease the activity of particular neurotransmitters. They might act by interfering with the synthesis of the neurotransmitters or by blocking their receptors so the neurotransmitters cannot bind to them.

Consider the example of the neurotransmitter GABA. This is one of the most common neurotransmitters in the brain, and it normally has an inhibitory effect on cells. GABA agonists — which increase its activity — include ethanol, barbiturates, and benzodiazepines, among other psychoactive drugs. All of these drugs work by promoting the activity of GABA receptors in the brain.

You may have been prescribed psychoactive drugs by your doctor. For example, your doctor may have prescribed you an opioid drug, such as codeine for pain (most likely in the form of Tylenol with added codeine). Chances are you also use nonprescription psychoactive drugs (like caffeine) for mental alertness. These are just two of the many possible uses of psychoactive drugs.

Medical Uses

General anesthesia is one use of psychoactive drugs in medicine. With general anesthesia, pain is blocked and unconsciousness is induced. General anesthetics are most often used during surgical procedures and may be administered in gaseous form, as in Figure 8.8.4. General anesthetics include the drugs halothane and ketamine. Other psychoactive drugs are used to manage pain without affecting consciousness. They may be prescribed either for acute pain in cases of trauma (such as broken bones) or for chronic pain caused by arthritis, cancer, or fibromyalgia. Most often, the drugs used for pain control are opioids, such as morphine and codeine.

Many psychiatric disorders are also managed with psychoactive drugs. Antidepressants like sertraline, for example, are used to treat depression, anxiety, and eating disorders. Anxiety disorders may also be treated with anxiolytics, such as buspirone and diazepam. Stimulants (such as amphetamines) are used to treat attention deficit disorder. Antipsychotics (such as clozapine and risperidone) — as well as mood stabilizers, such as lithium — are used to treat schizophrenia and bipolar disorder.

Ritual Uses

Certain psychoactive drugs, particularly hallucinogens, have been used for ritual purposes since prehistoric times. For example, Native Americans have used the mescaline-containing peyote cactus (pictured in Figure 8.8.5) for religious ceremonies for as long as 5,700 years. In prehistoric Europe, the mushroom Amanita muscaria, which contains a hallucinogenic drug called muscimol, was used for similar purposes. Various other psychoactive drugs — including jimsonweed, psilocybin mushrooms, and cannabis — have also been used for millennia, by various peoples, for ritual purposes.

The recreational use of psychoactive drugs generally has the purpose of altering one’s consciousness and creating a feeling of euphoria commonly called a “high.” Some of the drugs used most commonly for recreational purposes are cannabis, ethanol (alcohol), opioids, and stimulants (such as nicotine). Hallucinogens are also used recreationally, primarily for the alterations they cause in thinking and perception.

Some investigators have suggested that the urge to alter one’s state of consciousness is a universal human drive, similar to the drive to satiate thirst, hunger, or sexual desire. They think that this instinct is even present in children, who may attain an altered state by repetitive motions, such as spinning or swinging. Some nonhuman animals also exhibit a drive to experience altered states. They may consume fermented berries or fruit and become intoxicated. The way cats respond to catnip (see Figure 8.8.6) is another example.

Addiction, Dependence, and Rehabilitation

Psychoactive substances often bring about subjective changes that the user may find pleasant (euphoria) or advantageous (increased alertness). These changes are rewarding and positively reinforcing, so they have the potential for misuse, addiction, and dependence. Addiction refers to the compulsive use of a drug, despite negative consequences that such use may entail. Sustained use of an addictive drug may produce dependence on the drug. Dependence may be physical and/or psychological. It occurs when cessation of drug use produces withdrawal symptoms. Physical dependence produces physical withdrawal symptoms, which may include tremors, pain, seizures, or insomnia. Psychological dependence produces psychological withdrawal symptoms, such as anxiety, depression, paranoia, or hallucinations.

Rehabilitation for drug dependence and addiction typically involves psychotherapy, which may include both individual and group therapy. Organizations such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) may also be helpful for people trying to recover from addiction. These groups are self-described as international mutual aid fellowships, and their primary purpose is to help addicts achieve and maintain sobriety. In some cases, rehabilitation is aided by the temporary use of psychoactive substances that reduce cravings and withdrawal symptoms without creating addiction themselves. The drug methadone, for example, is commonly used to treat heroin addiction.

In North America, a lot of media attention is currently given to a rising tide of opioid addiction and overdose deaths. Opioids are drugs derived from the opium poppy or synthetic versions of such drugs. They include the illegal drug heroin, as well as prescription painkillers such as codeine, morphine, hydrocodone, oxycodone, and fentanyl. In 2016, fentanyl received wide media attention when it was announced that an accidental fentanyl overdose was responsible for the death of music icon Prince. Fentanyl is an extremely strong and dangerous drug, said to be 50 to 100 times stronger than morphine, making risk of overdose death from fentanyl very high.

The dramatic increase in opioid addiction and overdose deaths has been called an opioid epidemic. It is considered to be the worst drug crisis in Canadian history. Consider the following facts:

• In 2016, there were almost 2,500 opioid-related deaths in Canada — almost 7 per day.
• The number of prescriptions written for opioids quadrupled between 1999 and 2010.  If you have been prescribed codeine, fentanyl, morphine, oxycodone, hydromorphone or medical heroin, then you have been prescribed an opiate.
• There are many long-term health effects of using opioids, which include:
  • Increased tolerance to the drug.
  • Liver damage.
  • Substance use disorder or addiction.

Doctors, public health professionals, and politicians have all called for new policies, funding, programs, and laws to address the opioid epidemic. Changes that have already been made include a shift from criminalizing to medicalizing the problem, more treatment programs, and more widespread distribution and use of the opioid-overdose antidote naloxone (Narcan). Opioids can slow or stop a person’s breathing, which is what usually causes overdose deaths. Naloxone helps the person wake up and keeps them breathing until emergency medical treatment can be provided.

What, if anything, will work to stop the opioid epidemic in Canada and the United States? Keep watching the news to find out.

Attributions

Figure 8.8.1

Cappucino Art by drew-coffman-tZKwLRO904E [photo] by Drew Coffman on Unsplash is used under the Unsplash License (https://unsplash.com/license).

Figure 8.8.2

• 3804, Saint-Laurent, Montreal – Cannabis Culture shop by Exile on Ontario St (Montreal, Canada) on Wikimedia Commons is used under a CC BY SA 2.0 (https://creativecommons.org/licenses/by-sa/2.0/deed.en) license.
• Drive Through Cigarette Store by Cosmo Spacely on Flickr is used under CC BY-NC-SA 2.0 (https://creativecommons.org/licenses/by-nc-sa/2.0/) license.
• Franklin-Nicollet Liquors by Max Sparber on Flickr is used under a CC BY 2.0 (https://creativecommons.org/licenses/by/2.0/deed.en) license.

Figure 8.8.3

Ecstasy_monogram by Drug Enforcement Administration on Wikimedia Commons is in the public domain (https://en.wikipedia.org/wiki/Public_domain).

Figure 8.8.4

US Navy 030513-N-1577S-001 Lt. Cmdr. Joe Casey, Ship’s Anesthetist, trains on anesthetic procedures with Hospital Corpsman 3rd Class Eric Wichman aboard USS Nimitz (CVN 68) by U.S. Navy photo by Photographer’s Mate Airman Timothy F. Sosais on Wikimedia Commons is in the public domain (https://en.wikipedia.org/wiki/Public_domain).

Figure 8.8.5

Peyote Lophophora_williamsii_pm by Peter A. Mansfeld on Wikimedia Commons is used under a CC BY 3.0 (https://creativecommons.org/licenses/by/3.0/deed.en) license.

Figure 8.8.6

Alcoholics Anonymous World Services, Inc. (n.d.). Regional correspondent U.S. and Canada [website]. https://www.aa.org/pages/en_US/regional-correspondent-us-and-canada

Belzak, L., & Halverson, J. (2018). The opioid crisis in Canada: a national perspective. La crise des opioïdes au Canada : une perspective nationale. Health promotion and chronic disease prevention in Canada : research, policy and practice, 38(6), 224–233. https://doi.org/10.24095/hpcdp.38.6.02

British Columbia Regional Service Committee of Narcotics Anonymous. (n.d.). Welcome to the B.C. region of N.A. [website]. https://www.bcrna.ca/

Centers for Disease Control and Prevention (CDC). (2011 November 4). Vital signs: overdoses of prescription opioid pain relievers—United States, 1999–2008. Morbidity and Mortality Weekly Report (MMWR),60(43):1487-1492. https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6043a4.htm

TED-Ed. (2017, June 29). How do drugs affect the brain? – Sara Garofalo. YouTube. https://www.youtube.com/watch?v=8qK0hxuXOC8&feature=youtu.be

TED-Ed. (2017, July 17). How does caffeine keep us awake? – Hanan Qasim. YouTube. https://www.youtube.com/watch?v=foLf5Bi9qXs&feature=youtu.be

TED-Ed. (2019, December 2). Is marijuana bad for your brain? – Anees Bahji. YouTube. https://www.youtube.com/watch?v=Nlcr1jd_Tok&feature=youtu.be