INTRODUCTION

A psychoactive drug or psychotropic substance is a chemical substance that acts primarily

upon the central nervous system where it alters brain function, resulting in temporary
changes in perception, mood, consciousness and behavior. These drugs may be used
recreationally to purposefully alter one's consciousness (such as coffee, alcohol or
cannabis), as entheogens for spiritual purposes (such as the mescaline-containing peyote
cactus or psilocybin-containing mushrooms), and also as medication (such as the use of
narcotics in controlling pain, stimulants to treat narcolepsy and attention disorders, as well
as anti-depressants and anti-psychotics for treating neurological and psychiatric illnesses).
Many of these substances (especially the stimulants and depressants) can be habitforming, causing chemical dependency and may lead to substance abuse.
The role of psychoactive drugs, also called psychotherapeutic agents or psychotropic drugs,
in the treatment of mental illness is dependent on the disorder for which they are
prescribed. In cases where mental illness is considered biological in nature, such as with a
diagnosis ofbipolar disorder or schizophrenia, pharmaceutical therapy with
psychotherapeutic drugs is recommended as a primary method of treatment. In other
cases, such as in personality disorder or dissociative disorder, psychoactive medications
are usually considered a secondary, companion treatment (or adjunct) to a type
of psychotherapy, such as cognitive-behavioral therapy. In these situations, medication is
used to provide temporary symptom relief while the patient works on the issues leading to
his illness with a therapist or other mental healthprofessional.
Psychoactive drugs can be classified into seven major categories. These include:
Antianxiety agents. Drugs used to treat anxiety disorders and symptoms. These include
benzodiazepines such as alprazolam (Xanax), lorazepam (Ativan), diazepam (Valium), and
chlordiazepoxide (Librium), and other medications including buspirone (Bu Spar) and
paroxetine (Paxil).
Antidepressants. Prescribed to treat major depressive disorder, dysthymic disorder, and
bipolar disorder. Popular antidepressants include venlafaxine (Effexor), nefazodone
(Serzone), bupropion (Wellbutrin), MAOI inhibitors such as phenelzine (Nardil) and
tranylcypromine (Parnate); selective serotonin reuptake inhibitors (SSRIs) such as
fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft); tricyclic antidepressants

such as amitriptyline (Elavil), doxepin hydrochloride (Sinequan), desipramine

(Norpramin), and perphenazine/amitriptyline combinations (Etrafon).
Antimanic agents. This category includes medications used to treat mania associated
with bipolar disorder (or manic-depressive disorder) such as divalproex sodium
(Depakote) and lithium carbonate (Lithium, Eskalith, Lithobid, Tegrator).
Antipanic agents. Prescribed to treat the panic symptoms that are a defining feature of
many anxiety disorders. Medications include clonazepam (Klonopin), paroxetine (Paxil),
alprazolam (Xanax), and sertraline (Zoloft).
Antipsychotic agents. Also known as neuroleptic agents, these medications are used to
manage psychosis related to schizophrenia, delusional disorder, and brief psychotic
disorder. They include clozapine (Clozaril), haloperidol (Haldol), loxapine (Loxitane),
molindone (Moban), thiothixene (Navane), risperidone (Risperdal), and olanzapine
(Zyprexa); also includes phenothiazines such as prochlorperazine (Compazine),
trifluoperazine hydrochloride (Stelazine), and chlorpromazine (Thorazine).
Obsessive-compulsive disorder medications. Drugs used to treat OCD include
fluvoxamine (Luvox), paroxetine (Paxil), fluoxetine (Prozac), and sertraline (Zoloft).
Psychostimulants. Also known as central nervous system stimulants, these medications
are used to treat attention deficit disorders (ADD and ADHD) and narcolepsy. They
include methylphenidate hydrochloride (Methylin, Ritalin) and methaamphetamines
(Desoxyn, Dexedrine, and Dextro Stat).

DRUG ABUSE and DRUG ADDICTION

Drug abuse is a disorder that is characterized by a destructive pattern of using a substance that
leads to significant problems or distress.
Drug addiction is a disease that is characterized by a estrucive pattern of drug abuse that leads
to significant problems involving tolerance to or withdrawal from the substance, as well as
other problems use of the substance can cause for th sufferer.
Drug abuse and addiction are unfortunately quite common, affecting 7% and more than 2% of
people at some point in their lives respectively.
While the physical and psychological fffects of drug abuse and addiction then to vary based on
the particular substance involved, the general effects of abuse or addiction to any drug can be
devastating.
Similar to other chronic, relapsing diseases, such as diabetes, asthma, or heart disease, drug
addiction can be managed successfully. And as with other chronic diseases, it is not uncommon
for a person to relapse and begin abusing drugs again. Relapse, however, does not signal
treatment failurerather, it indicates that treatment should be reinstated or adjusted or that
an alternative treatment is needed to help the individual regain control and recover.
As a person continues to abuse drugs, the brain adapts to the overwhelming surges in
dopamine by producing less dopamine or by reducing the number of dopamine receptors in
the reward circuit. The result is a lessening of dopamines impact on the reward circuit, which
reduces the abusers ability to enjoy not only the drugs but also other events in life that
previously brought pleasure. This decrease compels the addicted person to keep abusing drugs
in an attempt to bring the dopamine function back to normal, but now larger amounts of the
drug are required to achieve the same dopamine highan effect known as tolerance.
Long-term abuse causes changes in other brain chemical systems and circuits as well.
Glutamate is a neurotransmitter that influences the reward circuit and the ability to learn.
When the optimal concentration of glutamate is altered by drug abuse, the brain attempts to
compensate, which can impair cognitive function. Brain imaging studies of drug-addicted
individuals show changes in areas of the brain that are critical to judgment, decision making,
learning and memory, and behavior control. Together, these changes can drive an abuser to
seek out and take drugs compulsively despite adverse, even devastating consequencesthat is
the nature of addiction.

Classifications of Psychoactive Drugs

Psychoactive drugs are chemical substances that affect the brain functioning, causing changes in
behavior, mood and consciousness. While these drugs can be used therapeutically to treat both
physical and psychological disorders, they are also used recreationally to alter mood, perceptions
and consciousness. The way drugs are grouped together will vary depending upon who is doing
the categorisation and the purpose for which it is intended. The laws surrounding drug use
serve two purposes. On the one hand they are intended to directly restrict access to particular
substances. Restrictions on the sale of alcohol and penalties for the sale and possession of illicit
drugs are designed to reduce the availability of, and therefore prevent consumption of,
substances which may have detrimental effects. From a psychological perspective they also
contribute to social norms surrounding those substances. The fact that a substance is illegal
will discourage some individuals from using it, even if they could actually obtain it. Of course,
other individuals might be attracted to that substance for the same reason.
In addition to the classification scheme embodied in the law, such drugs can also be
categorised based on their effects. Here too, the number of categories identified will vary.
Categorisation may be on the basis of drugs' broad effects on behaviour, their chemical
structure or the brain neurotransmitter systems they primarily affect. Different approaches will
give rise to slightly different classification schemes. Drugs which have similar chemical
structures may have different behavioural effects, while drugs which have similar effects may
have very different chemical structures. I am going to describe the main classes of
psychoactive drugs that are used for non-medical purposes below. By now I hope you realise
that this division is somewhat arbitrary. Any of the psychopharmacology texts on the module
reading list would tell you more about the topics discussed. The textbooks by Parrot et al.
(2004) or Mckim (2003) are particularly recommended. The next section of the course will say
more about the ways in which drugs are able to affect behaviour and how drug's effects may
be influenced by the route by which they are administered.
Here are the classifications of psychoactive drugs:

Stimulants
Depressants
Opiates
Hallucinogens
Cannabis

 Stimulants
Stimulants are a class of psychoactive drug that increase activity in thebrain. These drugs
can temporarily elevate alertness, mood, and awareness. While some stimulant drugs are
legal and widely used, all can be addicting. Stimulants share many commonalities, but each
has unique properties and mechanisms of action. These drugs are sometimes called as
uppers.
The most commonly used street drugs that fall into this category are cocaine and
amphetamines.
Prescription stimulants come in tablets or capsules. When abused, they are swallowed,
injected in liquid form or crushed and snorted.
SHORT-TERM EFFECTS
The short-term effects of stimulants include exhaustion, apathy and depressionthe
down that follows the up. It is this immediate and lasting exhaustion that quickly leads
the stimulant user to want the drug again. Soon he is not trying to get high, he is only
trying to get wellto feel any energy at all.
LONG-TERM EFFECTS
Stimulants can be addictive. Repeated high doses of some stimulants over a short period
can lead to feelings of hostility or paranoia. Such doses may also result in dangerously high
body temperatures and an irregular heartbeat.

Drugs that are classed as stimulants include:

Caffeine

Nicotine

Cocaine

Amphetamines

Prescription drugs

 Caffeine
Caffeine is naturally produced by several
plants, including coffee beans, guarana,
yerba mat, cacao beans, and tea. For the
plants, caffeine acts as a natural pesticide.
caffeine is also an addictive stimulant. In
humans, it stimulates the central nervous
system, heart rate, and respiration, has
psychotropic (mood altering) properties, and acts as a mild diuretic.
A normal dose of caffeine is generally considered to be 100 mg, which is roughly the
amount found in a cup of coffee. However, more than half of all American adults consume
more than 300 mg of caffeine every day, which makes it America's most popular drug.
Caffeine is generally consumed in coffee, cola, chocolate, and tea, although it is also
available over-the-counter as a stimulant.
Caffeine is believed to work by blocking adenosine receptors in the brain and other organs.
This reduces the ability of adenosine to bind to the receptors, which would slow down
cellular activity. The stimulated nerve cells release the hormone epinephrine (adrenaline),
which increases heart rate, blood pressure, and blood flow to muscles, decreases blood flow
to the skin and organs, and causes the liver to release glucose. Caffeine also increases levels
of the neurotransmitter dopamine.
Caffeine is quickly and completely removed from the brain. Its effects are short-lived and it
tends not to negatively affect concentration or higher brain functions. However, continued
exposure to caffeine leads to developing a tolerance to it. Tolerance causes the body to
become sensitized to to adenosine, so withdrawal causes blood pressure to drop, which can
result in a headache and other symptoms. Too much caffeine can result in caffeine
intoxication, which is characterized by nervousness, excitement, increased urination,
insomnia, flushed face, cold hands/feet, intestinal complaints, and sometimes
hallucinations. Some people experience the symptoms of caffeine intoxication after
ingesting as little as 250 mg per day. The lethal ingested dose, for an adult person, is
estimated to be 13-19 grams. While generally considered safe for people, caffeine can be
very toxic to household pets, such as dogs, horses, or parrots. Caffeine intake has been
demonstrated to reduce the risk of type II diabetes mellitus. In addition to use as a

stimulant and flavoring agent, caffeine is included in many over-the-counter headache

remedies.

Nicotine
Nicotine is a chemical compound that is present in tobacco. When tobacco is smoked,
nicotine is absorbed through the wall lining of the
small air sacs in the lungs. When sniffed or chewed,
it is absorbed through the mucous membranes of
the nose or mouth. Nicotine can also be absorbed
through the skin. Regardless of how nicotine is
absorbed, it enters the bloodstream where it
circulates throughout the body and travels to
the brain where it crosses the blood-brain barrier.
Once in the brain, it binds to and activates receptors called the cholinergic receptors.
Effects
These cholinergic receptors are present in the brain as well as in other areas such as the
muscles, heart, adrenal glands and other vital organs. Normally, these receptors are
activated by the neurotransmitter acetylcholine which is produced at nerve endings in the
brain and in the nerves of the peripheral nervous system.
The actions of acetylcholine help to maintain healthy respiration, heart function, muscle
movement and cognitive functions such as memory.
Since nicotine has a similar structure to acetylcholine, it can activate the cholinergic
receptors. However, unlike acetylcholine, nicotine enters the brain and disrupts its normal
functioning. Regular smoking leads to a change in the number of cholinergic receptors and
to changes in their sensitivity to nicotine. This can lead to the development of nicotine
tolerance.
Once this happens, the affected person needs to use nicotine regularly to maintain normal
brain function. If the level of nicotine falls, the smoker may experience unpleasant
withdrawal symptoms that lead to them "topping up" their nicotine levels by smoking
again. Because of its highly addictive properties, smoking is considered by the American
Heart Association to be one of the hardest addictions to break.

 Coccaine

Cocaine is an illegal psychoactive drug made from the leaves of the coca tree.
During the late 1800s, psychoanalystSigmund Freud advocated the use of cocaine as a
therapeutic treatment for psychological disorders, but later realized the addictive
properties of the drug. During the early 1900s, cocaine was legal in the U.S. and could be
found in many over-the-counter medications.
Cocaine is rapidly absorbed from any administration point, including being snorted,
inhaled, injected, or taken orally. The drug reaches the brain quickly and is then
distributed to other tissues throughout the body. Cocaine is rapidly metabolized by
enzymes in the liver and plasma in approximately 30 to 60 minutes, but can be detected in
urine tests for up to 12 hours after administration.

 Amphetamines

Amphetamines, sometimes referred to as "uppers," are a group of psychoactive

drugs that affect the central nervous system and autonomic nervous system. Some
of the effects of using these drugs include tremors, vasoconstriction, restlessness,
tachycardia, insomnia, agitation, and loss of appetite.
Amphetamines were once widely used in obesity and weight loss treatments, but
their addictive properties have caused them to be rarely used today. Today,
methamphetamine, also known as meth, is one of the most commonly used illegal
amphetamines. Meth is extremely addictive and destroys tissues in the brain, which
can lead to brain damage.

Prescribed Stimulants

Prescription stimulants are used to treat some physical and psychological disorders,
including attention-deficit hyperactivity disorder (ADHD) and narcolepsy. Common
names of prescription stimulants include Ritalin, Adderall, and Dexedrine.
Prescription stimulants work by enhancing the effects of dopamine and

norepinephrine, and can lead to increased blood pressure, respiratory function and
euphoria.
Depressants

Depressants are drugs that inhibit the function of thecentral nervous system
(CNS) and are among the most widely used drugs in the world. These drugs operate
by affecting neuronsin the CNS, which leads to symptoms such as drowsiness,
relaxation, decreased inhibition, anesthesia, sleep, coma, and even death. All
depressants also have the potential to be addictive.
While CNS depressants all share an ability to reduce activity in the central nervous
system and lower levels of awareness in the brain, there are important differences
among substances within this drug class. Some are safer than others, while others
have more potential for use for medicinal purposes.

Depressants are generally used to induce sleep or relaxation. While depressants

are typically associated with sleep or relaxation, they act upon the body by
"depressing" or inhibiting the central nervous system's normal activity. Since
some parts of the brain function to control outward behavior, the use of
depressants may lead to an inhibition of that control. Thus, behavior not
occurring under normal circumstances might occur with depressant use. A
stereotypical example of this concept is an individual, after consuming too much
of the depressant alcohol at a party, loses his ability to control his behavior, and
decides to dance with a lampshade on his head. Some typical physiological
responses occurring with depressant use include reduced tension, anxiety relief,
slurred speech, staggered gait, and relaxed muscles. Excessive use may lead to
slowed, shallow breathing; clammy skin; weak, rapid pulse; coma and death.
Alcohol is one of the better-known, legal depressants readily available today.
Drugs that are classed as depressants include:

Ethyl alcohol

Barbiturates

Benzodiazepines

 Ethyl Alcohol

Alcohol, also known as ethyl alcohol, is the second most widely used
psychoactive drugs in the world (caffeine is number one). While alcohol is a
legal drug, it also has a high potential for abuse. One survey conducted by the
Substance Abuse and Mental Health Services Administration found that
nearly 70 million over the age of 12 reported participating in binge drinking or
heavy drinking (2002). Alcohol use and abuse also has high social costs.
According to the American Psychiatric Association, approximately 50 percent
of all assaults, homicides, and highway deaths involve alcohol (2000).

 Barbiturates
Barbiturates are a class of drugs derived from
barbituric acid that act as depressants to
the central nervous system. These drugs are
frequently used for medical reasons as sedatives
or anesthetics.

Effects of Barbiturates
The pharmacological actions of barbiturates include depressing nerve activity in the
cardiac, smooth and skeletal muscles. These drugs also affect the CNS in several
different ways and can produce effects ranging from mild sedation to a coma
depending upon the dosage. Low doses of barbiturates can lower anxiety levels and
relieve tension, while higher doses can decrease the heart rate and blood pressure.

Barbiturates do have some severe drawbacks, including:

Potentially dangerous interactions with other drugs.

Lack of safety and selectivity.

A tendency to create dependence, tolerance, abuse and withdrawal.

Examples of Barbiturates

Allobarbital

Amobarbital

Barbital

Pentobarbital

Phenobarbital

Secobarbital

Benzodiazepines
Benzodiazepines are a class of psychoactive drugs that act as central
nervous system depressants. Because death from from benzodiazepine
overdose is rare, these are the CNS depressants most prescribed and
have largely replacedbarbiturates for use as hypnotics, anesthetics and
sedatives.

Effects of Benzodiazepines
Benzodiazepines have been used for a wide variety of purposes, including in the
treatment of back pain, anxiety and insomnia. The drugs work by selectively
affecting neurons that have receptors for the neurotransmitter gamma
aminobutyric acid (GABA). When benzodiazepines are introduced, the inhibiting
effects of GABA are magnified. As a result, people taking these drugs experience
altered mood, relaxed muscles and drowsiness.

In some instances, benzodiazepines can

have what are known as paradoxical
effects. Unusual symptoms such as
nervousness, anxiety, sweating, tension,
restlessness and nightmares can occur.

Examples of Benzodiazepines

Alprazolam (Xanax)

Clonazepam (Klonopin)

Deazepam (Valium)

Lorazepam (Ativan)

Triazolam (Halcion)