Stimulant intoxication As in other situations, behavioral and psychological changes occur in stimulant intoxication. Auditory hallucinations or paranoid ideations may be prominent (APA, 2013). Signs and symptoms of intoxication develop during or shortly after use, including: ● Tachycardia or bradycardia. ● Pupillary dilation. ● Elevated or lowered blood pressure. ● Perspiration or chills. ● Nausea or vomiting. ● Evidence of weight loss. ● Psychomotor agitation or retardation. ● Muscular weakness, respiratory depression, chest pain, or cardiac arrhythmias. ● Confusion, seizures, dyskinesias, dystonias, or coma. Stimulant intoxication is not a criterion for substance use disorder (APA, 2013). A specific antidote does not exist;
therefore, activated charcoal is warranted in this situation. Otherwise, supportive treatment is prescribed in the case of an overdose. Stimulant withdrawal The essential feature of stimulant withdrawal is characterized by the development of dysphoria along with: ● Fatigue.
● Vivid or unpleasant dreams. ● Insomnia or hypersomnia. ● Increased appetite. ● Psychomotor retardation or agitation.
Bradycardia is often present and can be a measure of withdrawal (APA, 2013). Additionally, anhedonia and drug craving can also be present. Withdrawal lasts up to 1-3 weeks. Pharmacotherapeutics utilized in withdrawal include trazodone, benzodiazepines, and neuroleptics as part of a comprehensive treatment plan (Preda, 2018). ● Ketamine is a dissociative anesthetic for animals and humans. Unfortunately, much of it is obtained illegally from veterinary offices. This is also used as a date rape drug (NIDA, 2019). ● Dextromethorphan (DXM) is an over-the-counter cold and cough medicine. ● Salvia is a plant common to southern Mexico and Central and South America. This drug is ingested by chewing fresh leaves and drinking the extracted juice. Dissociative hallucinogens interfere with glutamate, which regulates pain perception, environmental response, emotion, and learning and memory (NIDA, 2019). Dissociative drugs can cause numbness, disorientation, loss of coordination, hallucinations, and increased blood pressure, heart rate, and body temperature; long-term effects cause speech problems, memory loss, weight loss, anxiety, and depression or suicidal thoughts (NIDA, 2019). PCP can be addictive. Individuals demonstrating a problematic pattern of substance use which leads to significant impairment as manifested by two or more of the following over a 12-month period meet the criteria for a hallucinogen use disorder (PCP): ● PCP is taken in larger amounts than intended. ● There is a persistent desire or unsuccessful efforts to cut down or control PCP. ● A great deal of time is spent in activities to obtain PCP. ● Craving is an urge to use PCP. ● Recurrent PCP use results in a failure to fulfill work or home obligations. ● PCP use is continued despite persistent or recurrent interpersonal problems. ● Important social, occupational, or recreational activities are given up or reduced due to stimulant use. ● Recurrent PCP use occurs in situations when physically hazardous. ● PCP use is continued despite the knowledge of having physical or psychological problems that may have been caused or exacerbated by PCP. ● Tolerance develops: ○ A need for increased amounts of PCP to achieve intoxication. ○ Diminished effect with continued use of the same amount of the stimulant. ● Withdrawal occurs: ○ Characteristic withdrawal syndrome for PCP. ○ PCP taken to relieve or avoid the withdrawal. (APA, 2013)
HALLUCINOGEN RELATED DISORDERS
A long history of using hallucinogenic plants exists among humans for ceremonial and religious purposes. It is difficult to define psychoactive drugs that are so diverse in chemical structures. Hallucinogens are a group of drugs that alter an individual’s awareness of surroundings, emotions, and thoughts. Despite their name, hallucinogens do not consistently cause hallucinations (Forrest, 2020). These are divided into two categories, including classic hallucinogens and dissociative drugs. Classic hallucinogens Common classic hallucinogens include the following: ● D-lysergic acid diethylamide (LSD) is one of the most potent mind-altering chemicals. Theis clear or white odorless substance is derived from a fungus that grows on rye or grains (NIDA, 2019). ● Psilocybin originates from mushrooms in tropical and subtropical regions of South America, Mexico, and the United States (NIDA, 2019). ● Peyote (mescaline) is a small, spineless cactus with mescaline as its main ingredient (NIDA, 2019). ● DMT (N,N-dimethyltryptamine) is a powerful chemical found in plants in the Amazon. Ayahuasca is a tea from these plants, called hoasca , aya , and yagé (NIDA, 2019). ● 251-NBOMe is a synthetic hallucinogen similar to LSD and MDMA but much more potent. Classic hallucinogens temporarily disrupt communication through the brain and spinal cord (NIDA, 2019). Additionally, some interfere with serotonin, which regulates mood, sensory perception, sleep, hunger, body temperature, sexual behavior, and intestinal muscle control (NIDA, 2019). These hallucinogens cause individuals to see images, hear sounds, and feel sensations that seem real, which generally begin within 20-90 minutes and can last from 15 minutes to 12 hours. These are commonly referred to as a trip by the individual. The short-term effects can range from tachycardia and nausea to seeing intense colors and changes in the sense of time (NIDA, 2019). Other short-term effects of hallucinogens include increased blood pressure, tachypnea, hyperthermia, loss of appetite, dry mouth, spiritual experiences, relaxation, uncoordinated movements, excessive sweating, panic, paranoia, psychosis, and bizarre behaviors (NIDA, 2019). Long-term effects include persistent psychosis and hallucinogen persistent perception disorder, which are also evident in individuals with mental illness (NIDA, 2019). Dissociative hallucinogens Common dissociative drugs include the following: ● PCP (phencyclidine) was developed as a general anesthetic but is no longer used because of serious side effects. Now it is found in a variety of forms.
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