abuse may be swallowed, inhaled, snorted (or by nose
drops), injected, or even absorbed through the skin,
rectum, or vagina. When abused, therapeutic drugs
become a source of poison to the body. Drug abuse
can lead to serious illness, dependency, and death.
Death is usually because of acute intoxication or
Drugs of abuse can be classified in many different
ways. This chapter will classify drugs of abuse based
on the symptoms they produce: CNS depression, CNS
stimulation, and hallucinations. The CNS depressants
include narcotics, ethanol, barbiturates, non-
barbiturate sedative-hypnotics (including benzo-
diazepines). The CNS stimulants include caffeine,
nicotine, amphetamines, and cocaine.
hallucinogens include LSD, PCP, and marijuana.
Table 5-6 lists many of the most frequently abused
drugs with their recognizable trade names, some
commonly used street names, and observable
symptoms of abuse.
The following sections contain specific
information about commonly abused drugs, as
classified in table 5-6, including availability and
methods of administration.
Unfortunately, narcotic abuse is common,
although it is rare among military personnel. This
group of drugs includes the most effective and widely
used pain killers in existence.
Prolonged use of
narcotic drugs, even under medical supervision,
inevitably leads to physical and psychological
dependence. The more commonly known drugs within
this group are opium, morphine, heroin, codeine, and
methadone (a synthetic narcotic). In addition, Darvon 7
and Talwin7 are included in this group because of their
narcotic-like action. Next to cocaine (discussed later),
heroin is the most popular narcotic drug because of its
intense euphoria and long-lasting effect. It is far more
potent than morphine but has no legitimate use in the
United States. Heroin appears as a white, gray, or tan
fluffy powder. The most common method of using
heroin is by injection directly into the vein, although it
can be sniffed. Codeine, although milder than heroin
and morphine, is sometimes abused as an ingredient in
cough syrup preparations. Symptoms of narcotic drug
abuse include slow, shallow breathing; possible
unconsciousness; constriction (narrowing) of the
pupils of the eyes to pinpoint size; drowsiness;
confusion; and slurred speech.
The narcotic user, suddenly withdrawn from
drugs, may appear as a wildly disturbed person who is
agitated, restless, and possibly hallucinating. Initial
symptoms start within 2 to 48 hours and peak at about
72 hours. Although these signs and symptoms are not
life-threatening, most users will state that they feel so
bad they wish they were dead. The signs and symptoms
of withdrawal immediately stop upon re-administering
a narcotic and withdrawing the drug by tapering the
dose over several days.
Alcohol is the most widely abused drug today.
Alcohol intoxication is so common that it often fails to
receive the attention and respect it deserves. Although
there are many other chemicals that are in the chemical
grouping of alcohols, the type consumed by people
as a beverage (in wines, beers, and distilled liquors) is
known as ethyl alcohol, ethanol, grain alcohol, or just
alcohol. It is a colorless, flammable, intoxicating
liquid, classed as a drug because it depresses the
central nervous system, affecting physical and mental
Alcohol affects the body of the abuser in stages.
Initially, there is a feeling of relaxation and well-being,
followed by confusion with a gradual disruption of
coordination, resulting in inability to accurately and
efficiently perform normal activities and skills.
Continued alcohol consumption leads to a stuporous
state of inebriation that results in vomiting, an inability
to walk or stand, and impaired consciousness (sleep or
stupor). Excessive consumption can cause loss of
consciousness, coma, and evenin extreme cases
death from alcohol poisoning.
The potential for physical and psychological
addiction is very high when alcohol is abused. The
severely intoxicated individual must be closely
monitored to avoid inhalation of vomit (aspiration) and
adverse behavioral acts to the patient or others.
Withdrawal from alcohol is considered to be
life-threatening and should be appropriately treated in
a healthcare facility. Individuals withdrawing from
alcohol are at a greater risk of serious complications or
death than those withdrawing from narcotics. The
effects of alcohol withdrawal include severe agitation,
anxiety, confusion, restlessness, sleep disturbances,
sweating, profound depression, delirium tremens
(DTs, a particular type of confusion and shaking),
hallucinations, and seizures.