We treat all types of drug addiction. We don’t blame, judge, or debate people on how they became addicted. We treat these conditions as disorders and help people restart their lives.
The US has an epidemic of illicit and prescription drug addiction. A greater numbers of people using recreational drugs, too. The recreational and illicit drug addictions we treat are:

Marijuana/Hashish/THC

Marijuana use can lead to the development of problem use, known as a marijuana use disorder, which takes the form of addiction in severe cases. Recent data suggest that 30 percent of those who use marijuana may have some degree of marijuana use disorder. People who begin using marijuana before the age of 18 are four to seven times more likely to develop a marijuana use disorder than adults.

Marijuana use disorders are often associated with dependence—in which a person feels withdrawal symptoms when not taking the drug. People who use marijuana frequently often report irritability, mood and sleep difficulties, decreased appetite, cravings, restlessness, and/or various forms of physical discomfort that peak within the first week after quitting and last up to 2 weeks. Marijuana dependence occurs when the brain adapts to large amounts of the drug by reducing production of and sensitivity to its own endocannabinoid neurotransmitters.

Marijuana use disorder becomes addiction when the person cannot stop using the drug even though it interferes with many aspects of his or her life. Estimates of the number of people addicted to marijuana are controversial, in part because epidemiological studies of substance use often use dependence as a proxy for addiction even though it is possible to be dependent without being addicted. Those studies suggest that 9 percent of people who use marijuana will become dependent on it, rising to about 17 percent in those who start using in their teens.

In 2015, about 4.0 million people in the United States used or were dependent on marijuana; 138,000 voluntarily sought treatment for their marijuana use.

Rising Potency

Marijuana potency, as detected in confiscated samples, has steadily increased over the past few decades. In the early 1990s, the average THC content in confiscated marijuana samples was roughly 3.7 percent. In 2014, it was 6.1 percent. Also, newly popular methods of smoking or eating THC-rich hash oil extracted from the marijuana plant (a practice called dabbing) may deliver very high levels of THC to the person. The average marijuana extract contains more than 50 percent THC, with some samples exceeding 80 percent. These trends raise concerns that the consequences of marijuana use could be worse than in the past, particularly among those who are new to marijuana use or in young people, whose brains are still developing.

Researchers do not yet know the full extent of the consequences when the body and brain (especially the developing brain) are exposed to high concentrations of THC or whether the recent increases in emergency department visits by people testing positive for marijuana are related to rising potency. The extent to which people adjust for increased potency by using less or by smoking it differently is also unknown. Recent studies suggest that experienced people may adjust the amount they smoke and how much they inhale based on the believed strength of the marijuana they are using, but they are not able to fully compensate for variations in potency.

Ecstasy/MDMA, GHB, Ketamine

Club drugs are substances commonly used at nightclubs, music festivals, raves, and dance parties to enhance social intimacy and sensory stimulation. The most widely used club drugs are 3,4-methylenedioxymetham-phetamine (MDMA), also known as ecstasy; gamma-hydroxybutyrate (GHB); flunitrazepam (Rohypnol); and ketamine (Ketalar). These drugs are popular because of their low cost and convenient distribution as small pills, powders, or liquids. Club drugs usually are taken orally and may be taken in combination with each other, with alcohol, or with other drugs. Club drugs often are adulterated or misrepresented. Any club drug overdose should therefore be suspected as polydrug use with the actual substance and dose unknown. Persons who have adverse reactions to these club drugs are likely to consult a family physician. Toxicologic screening generally is not available for club drugs. The primary management is supportive care, with symptomatic control of excess central nervous system stimulation or depression. There are no specific antidotes except for flunitrazepam, a benzodiazepine that responds to flumazenil. Special care must be taken for immediate control of hyperthermia, hypertension, rhabdomyolysis, and serotonin syndrome. Severe drug reactions can occur even with a small dose and may require critical care. Club drug overdose usually resolves with full recovery within seven hours. Education of the patient and family is essential.

Although alcohol remains the primary “social lubricant,” it has been joined by many newer psychoactive drugs that are used to intensify social ex-eriences. Because of the prevalence of these drugs at dance parties, raves, and nightclubs, they often are referred to as “club drugs.” The most prominent club drugs are MDMA (3,4-methylenedioxymethamphetamine), also known as ecstasy; gamma-hydroxybutyrate (GHB); flunitrazepam (Rohypnol); and ketamine (Ketalar).

Club drugs are favored over other recreational drugs, such as marijuana, lysergic acid diethylamide (LSD), methamphetamine, and opiates, because they are believed to enhance social interaction. They often are described as “entactogens,” giving a sense of physical closeness, empathy, and euphoria. MDMA is structurally similar to amphetamine and mescaline, which is a hallucinogen. However, it is not as stimulating or addictive as amphetamine, and is considered much less likely to cause psychosis than LSD and other potent hallucinogens.2 GHB and Rohypnol are powerful sedative/hypnotic agents. Ketamine is a dissociative anesthetic that produces a dreamy tranquility and disinhibition in small doses. Unlike opiates, these sedatives encourage sociability and seldom cause nausea.

Hallucinogens (LSD, DMT, STP, PCP, etc.)

Research suggests that hallucinogens work at least partially by temporarily disrupting communication between brain chemical systems throughout the brain and spinal cord. Some hallucinogens interfere with the action of the brain chemical serotonin, which regulates:

  • mood
  • sensory perception
  • sleep
  • hunger
  • body temperature
  • sexual behavior
  • muscle control

Other hallucinogens interfere with the action of the brain chemical glutamate, which regulates:

  • pain perception
  • responses to the environment
  • emotion
  • learning and memory
Short-Term Effects

The effects of hallucinogens can begin within 20 to 90 minutes and can last as long as 6 to 12 hours. Salvia’s effects are more short-lived, appearing in less than 1 minute and lasting less than 30 minutes. Hallucinogen users refer to the experiences brought on by these drugs as “trips,” calling the unpleasant experiences “bad trips.”

Along with hallucinations, other short-term general effects include:

  • increased heart rate
  • nausea
  • intensified feelings and sensory experiences
  • changes in sense of time (for example, time passing by slowly)

Specific short-term effects of some hallucinogens include:

  • increased blood pressure, breathing rate, or body temperature
  • loss of appetite
  • dry mouth
  • sleep problems
  • mixed senses (such as “seeing” sounds or “hearing” colors)
  • spiritual experiences
  • feelings of relaxation or detachment from self/environment
  • uncoordinated movements
  • excessive sweating
  • panic
  • paranoia—extreme and unreasonable distrust of others
  • psychosis—disordered thinking detached from reality
Long-Term Effects

Little is known about the long-term effects of hallucinogens. Researchers do know that ketamine users may develop symptoms that include ulcers in the bladder, kidney problems, and poor memory. Repeated use of PCP can result in long-term effects that may continue for a year or more after use stops, such as:

  • speech problems
  • memory loss
  • weight loss
  • anxiety
  • depression and suicidal thoughts
Though rare, long-term effects of some hallucinogens include the following:
  • Persistent psychosis—a series of continuing mental problems, including:
    • visual disturbances
    • disorganized thinking
    • paranoia
    • mood changes
  • Flashbacks—recurrences of certain drug experiences. They often happen without warning and may occur within a few days or more than a year after drug use. In some users, flashbacks can persist and affect daily functioning, a condition known as hallucinogen persisting perceptual disorder (HPPD). These people continue to have hallucinations and other visual disturbances, such as seeing trails attached to moving objects.
  • Symptoms that are sometimes mistaken for other disorders, such as stroke or a brain tumor
What are other risks of hallucinogens?

Other risks or health effects of many hallucinogens remain unclear and need more research. Known risks include the following:

  • Some psilocybin users risk poisoning and possibly death from using a poisonous mushroom by mistake.
  • High doses of PCP can cause seizures, coma, and death, though death more often results from accidental injury or suicide during PCP intoxication. Interactions between PCP and depressants such as alcohol and benzodiazepines (prescribed to relieve anxiety or promote sleep—alprazolam [Xanax®], for instance) can also lead to coma.
  • Some bizarre behaviors resulting from hallucinogens that users display in public places may prompt public health or law enforcement personnel intervention.
  • While hallucinogens’ effects on the developing fetus are unknown, researchers do know that mescaline in peyote may affect the fetus of a pregnant woman using the drug.
Are hallucinogens addictive?

Evidence indicates that certain hallucinogens can be addictive or that people can develop a tolerance to them. Use of some hallucinogens also produces tolerance to other similar drugs.

For example, LSD is not considered an addictive drug because it doesn’t cause uncontrollable drug-seeking behavior. However, LSD does produce tolerance, so some users who take the drug repeatedly must take higher doses to achieve the same effect. This is an extremely dangerous practice, given the unpredictability of the drug. In addition, LSD produces tolerance to other hallucinogens, including psilocybin.

On the other hand, PCP is a hallucinogen that can be addictive. People who stop repeated use of PCP experience drug cravings, headaches, and sweating as common withdrawal symptoms.

Scientists need more research into the tolerance or addiction potential of hallucinogens.

How can people get treatment for addiction to hallucinogens?

There are no government-approved medications to treat addiction to hallucinogens. While inpatient and/or behavioral treatments can be helpful for patients with a variety of addictions, scientists need more research to find out if behavioral therapies are effective for addiction to hallucinogens.

Cocaine/Crack

Crack causes a short-lived, intense high that is immediately followed by the opposite—intense depression, edginess and a craving for more of the drug. People who use it often don’t eat or sleep properly. They can experience greatly increased heart rate, muscle spasms and convulsions. The drug can make people feel paranoid, angry, hostile and anxious—even when they aren’t high.

Regardless of how much of the drug is used or how frequently, crack cocaine increases the risk that the user will experience a heart attack, stroke, seizure or respiratory (breathing) failure, any of which can result in sudden death.

Smoking crack further presents a series of health risks. Crack is often mixed with other substances that create toxic fumes when burned. As crack smoke does not remain potent for long, crack pipes are generally very short. This often causes cracked and blistered lips, known as “crack lip,” from users having a very hot pipe pressed against their lips.

What are the long-term effects of crack cocaine?

In addition to the usual risks associated with cocaine use, crack users may experience severe respiratory problems, including coughing, shortness of breath, lung damage and bleeding.

Long-term effects from use of crack cocaine include severe damage to the heart, liver and kidneys. Users are more likely to have infectious diseases.

Continued daily use causes sleep deprivation and loss of appetite, resulting in malnutrition. Smoking crack cocaine also can cause aggressive and paranoid behavior.

As crack cocaine interferes with the way the brain processes chemicals, one needs more and more of the drug just to feel “normal.” Those who become addicted to crack cocaine (as with most other drugs) lose interest in other areas of life.

Coming down from the drug causes severe depression, which becomes deeper and deeper after each use. This can get so severe that a person will do almost anything to get the drug—even commit murder. And if he or she can’t get crack cocaine, the depression can get so intense it can drive the addict to suicide.
PHYSICAL & MENTAL EFFECTS

Because it is smoked, the effects of crack cocaine are more immediate and more intense than that of powdered cocaine.

  • Loss of appetite
  • Increased heart rate, blood pressure, body temperature
  • Contracted blood vessels
  • Increased rate of breathing
  • Dilated pupils
  • Disturbed sleep patterns
  • Nausea
  • Hyperstimulation
  • Bizarre, erratic, sometimes violent behavior
  • Hallucinations, hyperexcitability, irritability
  • Tactile hallucination that creates the illusion of bugs burrowing under the skin
  • Intense euphoria
  • Anxiety and paranoia
  • Depression
  • Intense drug craving
  • Panic and psychosis
  • Convulsions, seizures and sudden death from high doses (even one time)
LONG-TERM EFFECTS
  • Permanent damage to blood vessels of ear and brain, high blood pressure, leading to heart attacks, strokes and death
  • Liver, kidney and lung damage
  • Severe chest pains
  • Respiratory failure
  • Infectious diseases and abscesses if injected
  • Malnutrition, weight loss
  • Severe tooth decay
  • Auditory and tactile hallucinations
  • Sexual problems, reproductive damage and infertility (for both men and women)
  • Disorientation, apathy, confused exhaustion
  • Irritability and mood disturbances
  • Increased frequency of risky behavior
  • Delirium or psychosis
  • Severe depression
  • Tolerance and addiction (even after just one use)

Methamphetamines/Amphetamines

Long-term methamphetamine abuse has many negative consequences, including addiction. Addiction is a chronic, relapsing disease, characterized by compulsive drug seeking and use and accompanied by functional and molecular changes in the brain.

As is the case with many drugs, tolerance to methamphetamine’s pleasurable effects develops when it is taken repeatedly. Abusers often need to take higher doses of the drug, take it more frequently, or change how they take it in an effort to get the desired effect. Chronic methamphetamine abusers may develop difficulty feeling any pleasure other than that provided by the drug, fueling further abuse. Withdrawal from methamphetamine occurs when a chronic abuser stops taking the drug; symptoms of withdrawal include depression, anxiety, fatigue, and an intense craving for the drug.

In addition to being addicted to methamphetamine, chronic abusers may exhibit symptoms that can include significant anxiety, confusion, insomnia, mood disturbances, and violent behavior. They also may display a number of psychotic features, including paranoia, visual and auditory hallucinations, and delusions (for example, the sensation of insects creeping under the skin). Psychotic symptoms can sometimes last for months or years after a person has quit abusing methamphetamine, and stress has been shown to precipitate spontaneous recurrence of methamphetamine psychosis in formerly psychotic methamphetamine abusers.

These and other problems reflect significant changes in the brain caused by abuse of methamphetamine. Neuroimaging studies have demonstrated alterations in the activity of the dopamine system that are associated with reduced motor speed and impaired verbal learning. Studies in chronic methamphetamine abusers have also revealed severe structural and functional changes in areas of the brain associated with emotion and memory, which may account for many of the emotional and cognitive problems observed in chronic methamphetamine abusers.

Opioids (Heroin/Pain Killers/Medication)

The abuse of and addiction to opioids such as heroin, morphine, and prescription pain relievers is a serious global problem that affects the health, social, and economic welfare of all societies.  It is estimated that between 26.4 million and 36 million people abuse opioids worldwide,[1] with an estimated 2.1 million people in the United States suffering from substance use disorders related to prescription opioid pain relievers in 2012 and an estimated 467,000 addicted to heroin.[2]   The consequences of this abuse have been devastating and are on the rise.  For example, the number of unintentional overdose deaths from prescription pain relievers has soared in the United States, more than quadrupling since 1999.  There is also growing evidence to suggest a relationship between increased non-medical use of opioid analgesics and heroin abuse in the United States.[3]  

To address the complex problem of prescription opioid and heroin abuse in this country, we must recognize and consider the special character of this phenomenon, for we are asked not only to confront the negative and growing impact of opioid abuse on health and mortality, but also to preserve the fundamental role played by prescription opioid pain relievers in healing and reducing human suffering. That is, scientific insight must strike the right balance between providing maximum relief from suffering while minimizing associated risks and adverse effects.

The recent trend of a switch from prescription opioids to heroin seen in some communities in our country alerts us to the complex issues surrounding opioid addiction and the intrinsic difficulties in addressing it through any single measure such as enhanced diversion control (Fig.3). Of particular concern has been the  rise in new populations of heroin users, particularly young people.

The emergence of chemical tolerance toward prescribed opioids, perhaps combined in a smaller number of cases with an increasing difficulty in obtaining these medications illegally[28], may in some instances explain the transition to abuse of heroin, which is cheaper and in some communities easier to obtain than prescription opioids.