Poppers are recreational drugs made out of aliphatic nitrites, dissolved in chemical solvents with psychotropic properties. Poppers come as small bottles or glass ampoules filled with liquid chemicals called Alkyl Nitrites. There are three different types of poppers: amyl nitrate, butyl nitrate and isobutyl nitrite. All of these are directly sniffed from the bottle and have a strong acrid smell.

Amyl nitrate was discovered in 1844 by the French chemist Antoine Jérôme Balard. In 1867, the Scottish physician Lauder Brunton used amyl nitrate as a treatment of Coronary artery spasm, before being replaced by nitroglycerin. It first came out as a recreational drug during the 1970s in sex shops and nightlife settings. Opening one of these small bottles makes a small click sound which is often described as “pop”, hence their name.

In some European countries, amyl nitrate and butyl nitrate are prohibited and classified as narcotics since the 1990s; but many countries such as the United Kingdom tolerate it: poppers can often be found in sex shops, clubs and gay bars. The possession of poppers is not illegal but supply could be an offence under the Medicines Act.

How does it make you feel?

Their effect is short, and does not exceed a few minutes. They give headrush (Vertigo), they cause disinhibition, euphoria and laughter. Some people sniff poppers during sex to enhance the experience: poppers are deemed to increase the duration of erection, amplifying sexual pleasure, and delaying ejaculation.

Organic nitrates cause a direct vasodilator effect. Vasodilation is the relaxation of the smooth muscles surrounding the arteries. It causes the dilatation of blood vessels; it decreases blood pressure, which is compensated by an increase of the heart rate. The digestive system and intestine are relaxed. Cerebral blood flow is also increased, which can explain the euphoric effect of poppers.

Risks for young people

Today, more young people – and sometimes teenagers – have an easy access to poppers. They always want to experience new things, boost the effects of music and lights on the dance floor, and/or enhance their sexual experiences: they are seeking for the euphoric effects of poppers.

As mentioned earlier, Poppers use is primarily recreational. It does not expose at any risk of long-term cognitive deficits, or mood disorders. The risk is of addiction is low, as stopping poppers does not expose to any particular difficulty: there is no physical dependence or withdrawal syndrome for poppers users. However, taking poppers repeatedly can lead to severe complications that many people (including adults) are unaware. Moreover, the legal status of this drug in many countries, plus the lack of awareness campaigning for educating the young public increases the risks.

Short-term side effects

First of all, you should be aware that snorting poppers can cause nose irritation; the appearance of yellowish crusts on your face; intraocular pressure, ocular hypertension and glaucoma (which can lead to blindness); headaches, nausea and vomiting. People suffering from occasional asthma attacks should avoid poppers, as nitrates can lead to further chronic bronchitis. For those suffering from heart disease, there is a higher risk of heart attack by hypotension, due to vasodilation mentioned earlier.

Second, when taken with other PDE inhibitor drugs (such as Viagra, Levitra, and Cialis) with the purpose to improve your sexual performance, you can suffer from intense vasodilatation. Indeed, using poppers repeatedly can alter your hemoglobin: your body is no longer able to transport oxygen in your vessels which causes a gray coloring of your skin (i.e. cyanosis with methemoglobinemia). Anyone suffering from cyanosis needs an oxygen treatment that can only be performed at the A&E (i.e. the emergency department), by methylene blue injection. In this case, further emergency actions will be carried out on the patient: blood pressure, pulse, respiration, etc. If the patient shows signs of prolonged malaise, Laboratory tests will be carried out such as: arterial blood sampling, complete blood cell count, or liver function tests.

Finally, users should always bear in mind that swallowing poppers is toxic and can be life-threatening.

Excessive game playing, whether it is by computer, video, console, or on-line can have serious consequences on people’s lives: adult pathological gamers can be excluded from work (or reduce their chance to find a job), family and friends; whereas children having similar disorder can be struggling at school, being isolated from friends and their family, or abandoning sports and leisure activities that are recommended for their personal development.

Pathological video-gaming is certainly the most common addictive disorder that children can develop: many families offer consoles to their children. These are more and more affordable and their popularity continues to increase over time, as fast as high technology evolves. But parents should be able to spot signs of pathological video-game use: a child in his/her room, hanging on his/her console, staring at the screen, impervious to any comments or requests as his/her attention is held by the video-game. Many children play online, which means that children’s attention may also be held by other young people experiencing the same virtual world than him/her.

A recent study made in Singapore shows that 83% of pupils at primary and secondary school played occasionally (the average is 19 hours per week), and nearly 10% were considered as pathological gamers with an average of 31 hours per week. Two years later, further investigations were made on the same baseline research sample, they showed that these young people haven’t had solved their addiction problem, whilst 1% of those who were considered as “occasional players” in first place, became pathological gamers too.

Consequences of excessive game playing

A child struggling at school or not taking part in family life, who refuses to get up in the morning or to take part in outdoor leisure activities, is a child who is having a problem. Many doctors link these symptoms with Attention deficit hyperactivity disorder (ADHD), which is “a group of behavioural symptoms that include inattentiveness, hyperactivity and impulsiveness”, according to the NHS (i.e. the National Health Service in the UK). Many young people spotted as excessive internet users or pathological gamers were diagnosed as having ADHD; but at the moment, there is no serious research proving that excessive game playing aggravates attention deficit or whether an ADHD child tends to spend more time on video games.

The best thing to do is to repeat the top tips for parents: Children are using more technology – and at a younger and younger age – than ever before. Keep an eye on your children; make sure that your children do not stay awake after 10 p.m. during weekdays; make sure they do their homework before pressing “start” on their Xbox; set reasonable game time with healthy limits for your children while they are young, and make sure that they think about study first before video-game when they grow up. Try not to make the video-game playing activity a factor of tension between you and your child: a normal – and reasonable – video-game playing can also teach success, encourage to perseverance, and teach your children how to control their abilities… Many arguments that teenagers can exploit to convince their parents that investing in the last PlayStation is a right thing to do. Finally, contrary to popular belief, playing video games at night – reasonably – does not always keep young people from falling asleep.

Amphetamine is a powerful central nervous system stimulant that includes psychological and physical addiction: amphetamine addicts become mentally dependent and have an increased tolerance for this substance.

Tolerance: physiological state where the patient’s body gets accustomed to a substance due to chronic administration. As his/her body can cope with more substance, he/she feels the need to increase the dose to reach the desired effects.

It is a considered as a narcotic since the 1960s. The desired effects are usually euphoria, excitement and a sense of deep well-being. Although, there is a wide range of side-effects including serious – but rare – heart disease and other complications that can cause death.
Amphetamine was discovered in 1887 by the Romanian chemist Lazar Edeleanu, who was doing his research on adrenalin. Further research on this molecule was conducted in 1927 by the American chemist and pharmacologist Gordon A. Alles, who reported the physiological properties of amphetamine as a synthetic substance having similitudes with ephedrine. From 1930, amphetamine was used as a medicine for its bronchodilating, stimulating and anorectic (i.e. appetite suppressant) properties. During World War II, historians report that all the belligerent powers used the stimulating effects of amphetamine for military purposes: to enable the soldiers to use their full potential and keep fighting at night if needed. From 1955 til the mid-1960s, amphetamine was considered as safe enough to be sold over-the-counter (i.e. without prescription), but the medical community spotted a massive amphetamine misuse among students and athletes seeking for enhancing their performances at their exams or during competitions: amphetamine soon became a performance enhancing drug.

Amphetamine chronic addictive use has fallen sharply since it was classified as a narcotic; although, some doctors kept prescribing this drug for treating children suffering from Attention Deficit Hyperactivity Disorder (AHDA), adults suffering from obesity or those trying to quit smoking. Amphetamine use for medical purposes created many controversies as the public opinion began to be informed about the serious side-effects caused by this drug and other derivatives: fenfluramine and dexfenfluramine used for treating obesity until the mid-1990s, Benfluorex used in certain case of obesity until the 2000s and methylphenidate derivatives used for treating AHDA (as mentioned above) and Bupropion (amfebutamone) used for quitting smoking.

Amphetamines comes as white powder, crystals (known as ice) or in tablet form. Those using amphetamine as a recreational drug usually ingest it orally; they can also snort it, smoke it and inject it intravenously. The illegal use of amphetamine and its market have long been supplied by prescription drug diversion or illicit production.

A recreational drug

Since it has been discovered in the 19th Century, amphetamine has been synthesized and several derivatives have been found (e.g. ecstasy and methamphetamine) to be used as recreational drug. But there is also a natural form of amphetamine-like stimulant called Khat that can be found in the countries bordering the Southern part of the Red Sea.

• Ecstasy: MDMA (3.4-methylenedioxy-methamphetamine), popularly known as ecstasy or “Molly”, is a synthetic, psychoactive drug that is widely used in the nightlife setting. It comes as tablets containing 1 to 200 mg of MDMA and other psychoactive substances. Recreational ecstasy use involving a low dose of MDMA (from 1 to 200 mg) is toxic to central serotonergic nerve terminals and a high dose of MDMA includes hallucinations. Ecstasy use rarely leads to chronic dependence.

• Methamphetamine: Also called “speed” “ice” or “crystal meth” is a highly addictive and very potent central nervous stimulant. It is derived from amphetamine and recent reports show that methamphetamine has incredibly risen over the last years among young people. Reports say that “speed” has become a more popular drug than cocaine.

• Khat (Catha edulis), is a plant growing in the mountainous area of the countries bordering the Southern part of the Red Sea (i.e. Ethiopia, Eritrea, Djibouti, Somalia and Yemen). When freshly harvested, these green leaves containing cathinone, are chewed as they are amphetamine-like stimulant, causing excitement, loss of appetite and euphoria. Khat has raised many concerns in the international community as many people living in these countries suffer from psychological dependence. Khat leaves are chewed immediately as it loses its stimulant properties soon after it has been picked from the branches. It is not as dangerous as synthesized amphetamines and it cause fewer complications, but it remains a major obstacle for the difficult socio-economic development of these countries.

The immediate effects of amphetamine use

Amphetamine causes physical and psychological effects on the drug user. These effects can last for up to six hours. Usually, taking amphetamine increases your heart rate and blood pressure, causing irregular heartbeat, palpitations or chest pain. It can also increase your breathing rate, making you sweat, dilates your pupils, dries your mouth and it can cause loss of coordination.

The psychological effects of amphetamine occur within one hour after ingestion. This psychoactive drug makes you feel like euphoric, excited and gives a deep sense of wellbeing. It can also increase your confidence, motivation and it increases your talkativeness; some users feel a sense of power and superiority over others (which can explain why students misused and overestimated this drug because they felt like amphetamine increased their intellectual capacity or their abilities to concentrate. Although, researchers specialized in chemistry, pharmacology or other sciences never confirmed that amphetamine has such properties). Once the stimulating effects of amphetamine begin to wear off, the drug user begins to come down and experiences other effects for about eight hours: tremors, dizziness and headaches. The amphetamine user experiences radical mood swings from restlessness, irritability, tension and violence to depression, lethargy and total exhaustion.

Chronic amphetamine use leads to physical dependence that includes malnutrition and rapid weight loss due to reduced appetite; acne; cracked teeth and other dental problems from clenching the jaw; etc. Psychological dependence can cause insomnia; panic, confusion and paranoia; depression, anxiety and tension; violence.

What treatment?

Amphetamine must be prescribed under strict medical supervision. It is essential to review the prescription regularly to make sure that the patient receives the right dosage, and avoid the possible side-effects of amphetamine. Anyone suffering from the physical or psychological dependence to amphetamines should ask for help and start a therapy that can be conducted either according to the cognitive behavioural method or with neurobiology of addiction. In any case, the first step of addiction recovery is to reckon that you have an addiction problem, ask for help and follow your doctor’s instructions.

In case of overdose, the patient should be taken to hospital as soon as possible. From there, several procedures can be carried out, such as gastrointestinal decontamination which aims to minimize the absorption of the substance. Urinary acidification can also accelerate the elimination of amphetamines.

Hydration is essential to prevent the development of a malignant fever and other complications. The only thing they can do to treat hyperthermia is to cool the patient’s body with ice or with dantrolene sodium injection. As mentioned earlier, a high dose of amphetamine can cause important mood swings, including restlessness, irritability, and sometimes violent behaviours. These psychiatric symptoms often describes as “crises” can be very serious, including hypertension and seizures, and it can be stopped with antipsychotic medications.

LSD, or lysergic acid diethylamide, is a substance extracted from ergot of rye, produced by a fungus that grows parasitically on rye and some other wild grasses. LSD was synthesized for the very first time in 1938 by the Swiss scientists Albert Hofmann and Arthur Scholl. It takes its name from the German abbreviation Lyserg Säure Diethylamid.

LSD is one of the most powerful hallucinogenic drugs known. It was declared as a narcotic in the United States in 1971. This drug is widely associated with the hippie subculture, a youth movement that took its roots in the US during the 1960s and then developed all over the world. Nowadays, LSD is used as a recreational drug in nightlife settings, where it is also called under different slang names: acid, blotter, cheer, dots, drop, flash, rainbows, or Lucy. The most common form of LSD is a small square shaped tablet, but it can also be found in liquid or powder. Therefore, it is usually ingested orally or rarely intravenously. As many other drugs, LSD is metabolized in the liver, the user can feel its first effects after 20-60 minutes and it lasts for 6 and up to 8 hours.

How does it feel?

Popularized in 1967 by The Beatles’ song “Lucy in the sky with diamonds”, LSD is considered as an illegal drug that can be harmful for its users and others around them. There is no particular mental or physical dependence to LSD known at the moment. Its popularity mainly lies on its relative non-toxic and non-addictive properties and the guarantee for its users to live a psychedelic experience; such as John Lennon and The Beatles certainly did during the 1960s, according to the lyrics of their song:

Picture yourself in a boat on a river
With tangerine trees and marmalade skies
Somebody calls you, you answer quite slowly
A girl with kaleidoscope eyes

Cellophane flowers of yellow and green
Towering over your head
Look for the girl with the sun in her eyes
And she’s gone

Lucy in the sky with diamonds (3)

Follow her down to a bridge by a fountain
Where rocking horse people eat marshmallow pies
Everyone smiles as you drift past the flowers
That grow so incredibly high

Newspaper taxis appear on the shore
Waiting to take you away
Climb in the back with your head in the clouds
And you’re gone.

                            Lucy in the sky with diamonds, The Beatles (1967)

Low dose LSD has minor effects on perception, thoughts and mood; but a higher dose (more than 100 micrograms) has more overwhelming effects on its user: as described in the lyrics the song, Lucy causes visual hallucinations, distorted perceptions, and it includes mydriasis (i.e. dilated pupils and unreactive to light), sweating and increased heart rate, shaking or exaggerated shivering.

The trip on LSD, also known as “experience”, mainly consists of psychedelic visions. The LSD user feels like his/her body can interact with the distorted time-space he/she is experiencing. This strange feeling can be more or less intense and different settings can be created by each person experiencing LSD. Some users reported a feeling of “seeing the music”, “hearing colours” or “tasting words” (i.e. synesthesia phenomenon). Depending on the user, this strange experience can go from peace and oneness to pure horror and anxiety, to the extent that some user can lose their ability to evaluate danger and display harmful behaviours to themselves and others around them. During this unpleasant experience or “bad trip”, many harmful or dangerous situations may occur; and this is probably the biggest danger of LSD use. Therefore, many users usually prefer to experience LSD in group and in an environment where they feel relatively safe (e.g. in their homes). Finally, a trip on LSD can be a traumatic experience for some people who keep having “flashbacks”, which mean that the user re-experiences episodes of his/her LSD trip, long after the drug has been ingested (i.e. sometimes months later!). This rare phenomenon is reported as a manifestation of post-traumatic stress disorder.

The best way to protect a LSD user experiencing a “bad trip”, showing important signs of anxiety or a dangerous form of disorientation (e.g. feeling like able to fly) is to call the emergencies. This person might need to be prescribed anti-anxiety medications or sedatives..

Are there any long-term effects of LSD?

There is no specific medical test to detect LSD use. As mentioned earlier, confusion and hallucinations disappear after 8 hours and there no physical dependence known at the moment. Although, some researchers have reported psychological dependence which means that the user feels the need to re-experience LSD to explore further “altered states of consciousness”, like the members of the hippie community often said. Many of those who joined the hippie subculture during the 1960s, used drugs repeatedly in their quest for altered state of mind. We can suppose that it took an exaggerated importance in their lives and isolated them from the rest of the society. Besides, many utopian communities created during the hippie movement have quickly imploded; which could explain that long-term social isolation caused by drugs use encourages people to stop using drugs and leaving this social group.

In rare cases, people taking LSD repeatedly can suffer from chronic psychoses. However, it is very rare that LSD is used on a daily basis. Many users explain that they take LSD occasionally in nightlife settings, combined with other substances such as alcohol, cocaine, ecstasy, etc. But those who seek for the ultimate adrenalin-pumping blast fest put themselves and the others around them in danger.

Heroin is a drug made from morphine, which is extracted from the opium poppy. It was synthesized for the first time in the late 19th Century, manufactured from 1898 by the Bayer Pharmaceutical Company of Germany and marketed until 1920 to treat morphine addiction, asthma, diarrhoea and insomnia. Today, despite of its illegality, heroin is widely used as a recreational drug; but heroin is a powerful opiate and a psychoactive substance which is highly addictive.

Heroin is a semi-synthetic alkaloid called diacetylmorphine hydrochloride which can be found in two main forms:

• Popularized by the Rolling Stones in 1971, “Brown Sugar” or the brown heroin base is composed of 30% to 50% of heroin, strychnine, quinine and aspirin; it takes its colour from caffeine. Brown sugar must be mixed with an acidic liquid (e.g. lemon juice or vinegar) before use.
• The “white” refined heroin consists of a white powder, very thin and pure. This freebase form of heroin has a lower boiling point which enables its users to smoke it.

The expression “chasing the dragon” comes from Asia, where people smoke opium or heroin (i.e. they heat the substance before breathing in its smoke with a straw). Of course, heroin can also be snorted, injected intravenously; and it can also be mixed with cocaine (i.e. the so-called “speedball”). In all its forms, production, trade and heroin use are prohibited and punishable under international law.

The effects of heroin use

The immediate effect of heroin use is also known as the “rush”. Illustrated in the highly realistic (and surrealistic) British comedy drama Trainspotting (1996), the “rush” is a surge of intense pleasurable feeling reached by the heroin user, which often compares this feeling with sexual orgasm, relaxation, calming and euphoria. Heroin narrows the pupil in the eye (i.e. they go like pinheads) and make inexperienced users being constipated, having nausea or vomiting, forgetful, or drowsy.

The immediate and most serious risk is overdose, which includes risks of respiratory depression, severe low blood pressure and sudden cardiac arrest. Overdose can result in coma which may lead to death. It can happen with inexperienced heroin users or with regular users, when they change their addiction habits or when they relapse. The risk of overdose is increased if alcohol is associated with heroin. The other heroin-related risk is the short-term physical and psychological dependence: the compulsive and out-of-control heroin use is process that can start a few days after regular use.

Urine drug tests can detect heroin from 24 to 48 hours after the last dose for an occasional user, and for up to 72 hours after the last injection for a heavy drug addict. In any case, it stays in the bloodstream for up to 6 hours. Urine and blood drug tests are primarily used in A&E (i.e. the emergency department) when a patient is admitted in severe coma or acute psychiatric disorders; or in a department of psychiatry and addiction, when detoxification is indicated for patients who wish to become drug-free. During their stay in the hospital, further tests are carried out, such as Hepatitis C, Hepatitis B or HIV, as heroin users may have been contaminated by blood transfer, through the sharing of drug taking equipment with other drug users.

Treatment of heroin addiction

In case of severe overdose, there is an antidote called Naloxone that can reverse heroin overdoses and lead to a very quick recovery. This medication can only be prescribed at the hospital under very close medical supervision.

Besides, the best treatment for heroin addiction is withdrawal. Those who want to become drug-free have to go through this very painful experience that includes cravings. These extreme physical and mental symptoms are well illustrated in Trainspotting (i.e. the British film mentioned earlier), when the main character Renton describes how he feels when him and his family decide to quit heroin:

INT. RENTON’S BEDROOM – DAY

Renton lies on the bed.

RENTON: I don’t feel the sickness yet, but it’s in the post, that’s for sure. I’m in the junky limbo at the moment, too ill to sleep, too tired to stay awake, but the sickness is on its way. Sweat, chills, nausea, pain and craving. Need like nothing else I have ever known will soon take hold of me. It’s on the way.

The door opens. Renton’s Mother walks in with a bowl ofsoup and a piece of bread. Father watches from the doorway.

MOTHER: We’ll help you, son. You’ll stay with us until you get better. We’ll beat this together.

RENTON: Maybe I could go back to the clinic.

MOTHER: No. No clinics, no methadone. That made you worse, you said so yourself. You lied to us, son, your own mother and father.

RENTON: At least get us some Tempazepam.

MOTHER: No, you’re worse coming off that than you are with heroin. Nothing at all.

FATHER: It’s a clean break this time.

MOTHER: You’re staying where we can keep an eye on you.

RENTON: I do appreciate what you’re trying to do, I really do, but I need just one score, to ease myself off it. Just one. Just one.

“Cold turkey” and “warm turkey” detox

As mentioned in this example, clinics, residential addiction treatment centres and detox units at the hospital can offer the patient to stay between 7 and 15 days in a suitable environment: away from drugs and other drug abusers (also known as the “cold-turkey” heroin detox). During this time of isolation, the drug addict is usually supported by carers or nurses. After a few days, he/she is usually offered to meet other patients, in order to foster their ability to overcome their addiction and convince them that remaining drug-free is the right thing to do. The second important step on his/her road to recovery is to stay clean. Most of the patients decide to get help from a psychiatrist whose mission is to accompany and prevent him/her from a possible relapse. This is usually the most difficult part: proving to yourself, your friends and family that you are clean. Drug addicts and their families can also find support from their general practitioner (GP), therapists and twelve-step groups (e.g. Narcotic Anonymous N.A. and Nar-Anon Family groups).

In other cases, neurobiology of addiction may be preferred (also known as “warm-Turkey”). This includes the prescription of alternative drugs such as methadone (as mentioned by Renton’s mum) or high-dose intravenous buprenorphine. The reason why Renton’s mum refuses to send her son back to the clinic to let him have methadone is because methadone is derived from opiates. This drug, which is often used to treat opiate addiction, belongs to the same family as heroin. Therefore, even if it helps the patient to cope with the physical withdrawal syndrome and psychotic effects of heroin, his/her body is still dependent on opiates. Being on drugs of substitution should be seen as a transitional phase on the road to recovery, but such dependence can last for years. This is the reason why some patients and their families (like Renton’s) choose the more radical option to quit heroin: “cold turkey” detox.

Cannabis is originally coming from equatorial regions and it has been used since the Ancient History for hemp fibre, oil and seed. Nowadays, a variant of the herb cannabis, commonly known as marijuana, is rarely used for medical purposes and widely used as a recreational drug. According to a recent Drug report published by the United Nations Office for Drugs and Crimes, marijuana is the most-used illicit drug in the world.

Distinction between hemp and marijuana

Among the various cannabis species, we must distinguish hemp and marijuana. On one hand, the first variety of cannabis is legally produced and regulated by the State. Hemp is used for many purposes and in different industries: food, paper, manufactured fibre, plastics, building material, etc. In fact, hemp fiber has been used for thousands of years in the textile industry, paper and rope, because of its resistance. Hemp seeds have been used for feeding domesticated livestock. On the other hand, marijuana is consumed for its psychoactive and physiological effects caused by Tetra-Hydro-Cannabinol (THC), which can be found in the flowering part of the plant. This part of the plant contains between 0.1% and 25% of THC, which can be inhaled or ingested. After harvest time, the cannabis plant is dried and its THC level is increased by turning it either into hash resin (10-30% of THC) or hash oil (from 60% and up to 80% of THC).

In many countries, marijuana is consumed illegally for its relaxing properties. It is also used for medical purposes (i.e. its orexigenic effect which stimulates appetite for malnourished patients): marijuana is usually prescribed to patients suffering from cancer or AIDS. Regular marijuana use results in a moderate psychological dependence and low physical dependence.

How does it feel to be “high” on marijuana?

It depends on each user. Casual marijuana use causes signs of acute marijuana intoxication. This begins either with a feeling of great elation and euphoria or sedation. Dizziness, shallow breathing, reed eyes and dilated pupils, dry mouth, increased appetite and slowed reaction time are the most common effects described on a “high” person.

What people often describe as “being high” is actually a few hours of serious disturbances and mental disorders. These effects are not permanent and reversible: short-term forgetfulness (which may persist for several days), disorientation, lack of coordination and sedation; which make the marijuana user dangerous to him/herself and others (e.g. walking, driving vehicles, etc.). Marijuana intoxication disrupts sensory perception, especially vision, and causes various psychological disorders which change from time to time: euphoria, sorrow, anxiety (or panic attack), distorted sense of time, random thinking, paranoia and irritability. Finally, some very rare cases show that marijuana users can have hallucinations.

What treatment?

The effects of marijuana intoxication are usually eased up a few hours after inhalation or ingestion. However, a psychological treatment can be appropriate in case of excessive use. If the patient suffers from his/her dependence and if he/she is willing to start a therapy, he/she can ask for help from a psychologist, a substance abuse counsellor, a therapist or join a twelve-step group such as Marijuana Anonymous (M.A.). Individual or group therapy can help the patient to find out the origin of his/her dependence and overcome his/her addiction problem. Psychotherapy can allow the patient to address this and get out of isolation, which affects many drug users. However, therapy can be emotionally harmful and represent a challenge to the patient. This is probably to price to pay: the road to recovery is made of risks and sufferings, but it usually the only way to make a real change in the addict’s life.

Consequences of marijuana addiction

When Marijuana is used occasionally, as a recreational drug between friends, smoking weed can be seen as a normal socializing activity. The recreational aspect of marijuana fades away once the user is not seeking for the euphoric effect of marijuana; but he/she uses cannabis whenever he/she feels stressed or “wants to escape” his/her problems. Marijuana used on a daily basis (i.e. seen as a way to deal with anxiety, including isolation and loneliness) is an alienating process that is difficult to get out once the marijuana user has reached this stage. Isolation and apathy are the common reactions of those who suffer from dependence and it has greater consequences on their personal and professional lives.

As mentioned above, using a large quantity of marijuana can lead to hallucinations. In any case, smoking weed will increase your heart rate for up to 3 hours. The worst case scenarios are when:

• The marijuana user has motor coordination disorders.
• Marijuana can cause complications for people suffering from serious mental illness, especially among decompensated schizophrenic patients. We must emphasize the rarity of violent episodes experienced by schizophrenic marijuana users, but we must also remember that marijuana use can cause relapse of people who suffered from severe mood disorders.

In fact, the risks are more likely to happen among under-18s, who usually have difficulties to cope with the psychoactive effects of marijuana and find it difficult to manage their emotions. Otherwise, apart from the risks associated with nausea and vomiting, it does not present clinical severity and its psychoactive and physiological effects regress within 24 hours. The toxicity of cannabis is low on the body and there is no fatal overdose possible.

Irritability and insomnia can occur to heavy cannabis users trying to quit. Withdrawal symptoms disappear within a few days and can be relieved with a light treatment with antihistamines, used for their sedative properties. If the heavy smoker does not quit, he/she risks important bronchitis and cancer. Indeed, recent report claims that inhaling cannabis fumes is about ten times more carcinogenic than tobacco.

Long-term effects on the brain

Experts warn that chronic marijuana use has long-term effects on the brain, including risk of deterioration of IQ. Therefore, THC would not have mere immediate and reversible effects on the marijuana user, but it could also have underlying effects on the brain, which are irreversible, detectable only in the longer term. This side-effect of chronic marijuana use can particularly affect under-18s, whose brains are still maturing; which means that risk of deterioration of IQ mainly depends on age of first use and duration of use.

Forgetfulness, which is one of the immediate effects that we mentioned earlier, corroborates this theory: THC has short-term AND long-term effects on the brain. Daily marijuana users have a 20% decrease of dopamine transporter, which is a molecule that modulates the transmission of information between neurons. When THC is inhaled or ingested, it reaches rapidly the bloodstream and goes up to the brain neurotransmitter system. Yet, THC mechanism of action and its biochemical interaction on the brain are not all known, and many researchers have always claimed that THC is quickly stored in the liver and excreted in the urine; but neurobiology advances as treatment and prevention of marijuana abuse evolves.

There is a wide range of games of chance where people can wager their money in the hope to win: casino games, bingo, fruit machines, lottery, scratch cards, card games, board games; horse racing and other sports, raffles, internet gambling, trading speculation, etc. There are hundreds of ways to blow your money or anything of value with these games, which outcome strongly depends on luck.

What is problem gambling?

As any other addictive disorder, gambling becomes a problem when it has greater consequences on different aspects of your life. You cannot focus on your daily activities anymore: you feel the urge to gamble and excitement whilst you are performing this specific activity. The patient often confuses his/her excessive gambling activity with a mere hobby, and tends to increase the frequency of this leisure activity. However, the mechanisms involved are the same as those of in other types of addiction (e.g. alcohol, nicotine, food, etc.). Gambling addiction is a mental and health condition which includes serious side effects such as isolation and bankrupt.

In sum, a gambling addict is a person who has to play the game regularly instead of doing his/her daily activities or interests. This urge to play never stops until he/she wins. The gambling addict remains optimistic about his/her chances to win, despite of repeated experiences of failure. While he/she is playing, a gambling addict takes risks and he/she is overwhelmed with conflicting feelings which are both pleasurable and painful: thrill, excitement and tension.

Pathological and compulsive gambling

A Pathological gambler is defined as someone performing such activities in an inappropriate, repetitive and persistent way. According to the DSM-IV Codes, a pathological gambler is characterized by at least five of these statements:

• Thinking obsessively about gambling;
• The urge to gamble and bet more money in order to intensify the feeling of excitement;
• Helplessness and/or unsuccessful attempts to control or stop the gambling activity;
• Restlessness or irritability when attempting to stop the gambling activity;
• Gambling to escape conflicts and problems. Then, the pathological gambler feels helpless, guilty, anxious and depressed;
• After money loss, the pathological gambler gambles again in order to recover his/her money losses (i.e. to redo);
• Lying to his family, friends or therapist, to conceal the extent of his gambling habits;
• Borrowing money in order to finance the gambling activity;
• Committing a crime in order to finance the gambling activity: theft, fraud or embezzlement;
• Put your studies, career or your family at risk because of gambling.

Compulsive gambling is slightly different from pathological gambling and it can be defined as a process: the gambling activity keeps growing inexorably. It is a permanent and irreversible condition. The only treatment is total abstinence. The process experienced by the typical compulsive gambler can be defined as following:

• An initial successful experience, which is often an important jackpot, suggests that the gambler will earn greater gains in the future by gambling more money and more often. This is of course an illusion;
• The more the “winner” gambles, the less he/she earns money;
• The urge to gamble becomes stronger and reaches a compulsive aspect;
• The gambler loses the sense of moderation and bets money without restrictions;
• Soon, the compulsive gambler reaches a pathological cycle with significant psychological problems: confusions, misconceptions, beliefs in impossible situations, and of course the inability to stop gambling;
• Finally, the apex of the process followed by the typical compulsive gambler is dependence. He/she is isolated. Despite of his/her attempts to stop gambling, the compulsive gambler keeps blowing his/her money.

Risks and consequences

Anyone has an easy access to gambling: widely accepted in our communities as a leisure activity, most people are not aware of the risks associated with gambling or the first signs of problem gambling mentioned above. It is clear that most of the gambling addicts do not even realize that they have a problem.

However, it is important to note that the large majority of gamblers do not suffer from any addictive disorder. They consider gambling as an entertainment, a good way to spend time with friends, with the possibility to have a delightful surprise and a good new for their personal finance. Of course some forms of gambling are more at risk than others. For example, fruit machines can be more addictive due to their combination between frequent small gains and the opportunity to earn the jackpot.

The consequences of problem gambling can be severe: money loss, separation or divorce, and health, etc. Twelve-step groups specialized in gambling problems could make an exhaustive survey of side-effects of this very specific addictive disorder; but the typical consequences are bankrupt, job loss, health problems such as depression and anxiety or development of other addictions (e.g. drug and alcohol abuse), participation in crimes, or suicide attempts.

The consequences on families

Pathological gambling destroys families as much as it destroys individuals. Living with a pathological gambler is both heartbreaking and exhausting. Indeed, this condition can worsen and give a real exhaustion with serious consequences for their health.

In these families children are not being spared, as many of them feel neglected, abandoned, which can cause angry reactions. There can be consequences on their behaviour and results at school; but behavioral disorders can also cause depression and suicide attempts. Moreover, these children are more likely to have drug and alcohol problem, to misbehave or to commit minor crimes in order to get their parent’s attention. These Children need help to understand that they are not responsible for their parents’ problems.

The pathological gamblers’ partner can also be seriously affected: the gambler may blow his family’s savings to finance his/her gambling activities, and he/she can put his/her family at risk by accumulating debts, going bankrupt, or causing crimes such as theft, fraud and embezzlement to reimburse his/her debts. This kind of problem can be hidden for a long time and have very serious consequences his/her family’s financial situation. Broken families cannot be healed with the promise to recover the losses caused by the gambling activities; especially when the gambler expects to get his/her money from further gambling. Separation and divorce rates are much higher in such family than in the rest of the population.

Discovered by Albert Niemann in 1859, Cocaine is an alkaloid, chemically extracted from the coca leaf, a plant that comes from the western South America.

Initially used for its local anaesthetic properties, today cocaine is consumed by millions of people in the form of a white powder that is inhaled, injected or smoked in the form of crack. Crack cocaine is also known as “the most addictive form of cocaine” (Todd Wilk Estroff, 2001). In all its forms, production, trade and cocaine use are prohibited and punishable under international law.

The main effect of cocaine is a stimulant. Cocaine addiction is psychological and physical. Cocaine blocks the regulation of dopaminergic neurons (reuptake inhibition). It increases their action on emotions, behaviour and motivation by producing dopamine build-up between neurons.

What are the short-term effects of cocaine use?

After absorption of its powder form through nasal or intravenous routes, cocaine is metabolized by the liver and the first effects appear after three minutes and they last for up to an hour. The cocaine rush corresponds to the first effect felt by the user: it consists of an intense stimulation with sensation of deep well-being, followed by excitation with euphoria. Cocaine use includes dilated pupils, sweating and increased heart rate (tachycardia) and blood pressure; including possible urinary and faecal retention.

Crack cocaine (the crystalline and purer form) is smoked but not damaged at all by the heat after inhaling smoke. It goes directly into the bloodstream and up to the brain. Contrary to the powder form, crack cocaine does not need to be transformed by any organ to be active. This drug is highly addictive and its first effects come quicker as they appear after 10 seconds, they are more intense and they only last about 10 minutes. The crack cocaine rush is followed by another phase that corresponds to a near-overdose, combining hallucinations and anxiety with risks of violence.

Cocaine is rapidly absorbed, metabolized and excreted in urine, which enables the user to have another shot within thirty hours. Overdose is extremely dangerous and the user can suffer from serious medical complications. In this case, an emergency medical check-up must be carried out in search of cardiac or neurological complications. After the intoxication, the effects are mainly psychological and the cocaine addict can start a psychiatric treatment, and be possibly prescribed a psychotropic treatment.

Withdrawal symptoms

The withdrawal symptoms of cocaine can be described in four main phases:

• Craving is characterized by depression and anxiety. Soon, the drug addict tries to find more cocaine by any means. The first phase can be extremely painful. This is the reason why most of cocaine users cannot help with taking a small quantity of cocaine repeatedly for a short period of time.
• The second phase is called cocaine binge. In about two hours after the last shot, the drug addict feels despair and hopelessness that goes along with depression. It is associated with apathy, intense physical fatigue and it can last from ten hours to five days.
• After one or up to six weeks, the drug addict is affected by a severe mood disorder. The patient can be described as emotionally instable, his/her mood swings can alternate between excitement and manic depressive episodes.
• The final phase is called “extinction”. The patient can remain passive or apathetic for months or years, which slows the process of rehabilitation and social insertion.

What treatment for cocaine addicts?

In case of serious intoxication, medications must be given to the patient in the first place at the emergency department, then by a doctor specialised in addiction treatment. If the patient is unconscious or comatose when he/she arrives at the emergency department, he/she would be placed in an Intensive Care Unit, where the patient’s breathing and brain activity will be checked, and his/her respiration and circulation will be maintained. Heart disease can be treated with beta-blockers, seizures with benzodiazepines, and possible persecutory delusional disorder can be treated with neuroleptics.

The long-term complications are not negligible either: they are primarily psychiatric. Depending on the seriousness of his/her addictive disorder, the patient would be admitted in Addiction Treatment Unit at the hospital, where cognitive-behavioural therapy including support from a psychiatrist can be prescribed; whereas other cases can be treated with neurobiological treatment (i.e. including medications).

Long-term social consequences of cocaine use

Considering the millions of cocaine users and risks of major medical complications, cocaine is a hard drug that is increasingly used in our communities, by a larger number of under 18 users who lack of awareness regarding its related risks. Long-term mental and social consequences of cocaine use cannot be controlled by the patient. As mentioned earlier, the cocaine withdrawal effects can include months or years of apathy, mood disorders and depression. The price of cocaine use is unfairly paid by too many young people excluded from work, rejected by their friends and families, and progressively isolated in deviant social groups where cocaine use is trivialized.

What is it?

Sex addiction is a process in which the patient develops a pathological sexual behaviour. The concept of sex addiction appeared in the late 1970s, when it was discovered that the mechanisms involved were the same as those found in other types of addiction: alcohol, gambling, food, etc.

Sex addiction often affects people who are married and have a family. The patient tends to develop a parallel sex life / identity, different from his/her “normal” life. Sometimes, it includes a reality distortion which is a wrong perception of others: not based on actual experience with another person, but on a projected fantasy personality attributed to that person. Contrary to other addictions such as alcohol abuse, there are no statistics or official data reporting the number of people suffering from sex addiction. Sex addicts are unknown: they hide it as much as they can as they generally live in shame. Although, as many other addiction treatment, the first step of the road to recovery is to accept, to talk openly about the problem and its consequences. Asking for help is often a difficult step to undertake – especially when you have to admit that you have a problem with your sex life – while being a decisive one. Indeed, sex addiction must be treated as any other disease involving behavioural disorder symptoms.

Sex addiction is often crossed with others behavioural disorders. It affects both men and women who are usually characterized by an excessive use of the internet to view pornography, to chat with others or to invent a sexual identity. The sensation of anonymity, security, impunity facilitates excitement and obsessive-compulsive behaviour.

How does it happen?

A sex addict progressively develops a pathological sexual behaviour that causes suffering. As mentioned above, sex addiction includes a reality distortion. These biased judgements and opinions towards the others is affected by our central or core belief system.

A belief system is a set of beliefs which guide and govern a person’s attitude. Usually, it is directed towards a system such as a religion, philosophy, or ideology. Attitudes and beliefs in these systems are closely associated with one another and retained in memory.

To some extent, our belief system is our internal scale which allows us to interpret reality through our values, opinions, judgments. The belief system enables us to make decisions, solve problems, set priorities, to interpret the actions of others, to give meaning to the way we live, etc. So it is not surprising that the behaviour of a sex addict seems absurd for someone who has a different belief system.

Usually, the treatment focuses on their belief system:

• Raise awareness and open up new perspective on the patient’s weaknesses of his/her belief system;
• Set a strategy to avoid new crises and prevent a possible relapse.

Their belief system is based on denial. The addict may rationalize his behavior so he/she is convinced that he/she controls the situation: they often consider that their excessive sexual drive is part of their personality, it does not hurt anyone, it helps them to relax, or sometimes they reject the responsibility on their partner.

If the sex addict is caught red-handed, he/she can really appear sincere in his/her intention to change, but if he/she does not start a therapy, his/her good will is often affected by the reality of his/her addiction. The addict is very critical towards his family and friends that he/she indirectly judges responsible for his/her behaviour. This state of mind includes blame and paranoia. It is not easy to reckon that you have a problem with your sex life, and it all explains why the addict folds into a world of his/her own, which is not accessible to the others.

There are four stages of sex addiction:

• Obsession. The sex addict’s thoughts are focused on the satisfaction of his/her sexual needs. He/she spends most of his/her time to plan and perform sexual activities. These influence the sex addict’s life at professional and social level. All the people’s behaviour surrounding him/her is reinterpreted and imbued with eroticism;
• Ritualization. The sex addict develops routine behaviour in the form of ritualized acts leading to sexual behaviour. Rituals strengthen and maintain the excitement;
• Compulsive sexual behaviour is the uncontrollable repetition of addictive sexual behaviour;
• Despair results in a feeling of powerlessness regarding to his/her addictive sexual behaviour.

Surprisingly enough, it is when the sex addict starts a new cycle of sex addiction that he/she alleviates the suffering caused by stage #4. It means that sexual addiction is self-sustaining: whenever the sex addict decides to take strong resolutions (when in stage #4) in order to stop his/her addictive sexual behaviour, any relapse causes of feeling of helplessness and despair. The sex addict feels like a weak and untrustworthy person who maintains shame and social withdrawal.

What sexual addictions?

There are different ways to develop pathological sexual behaviour. Sex addicts can perform their sexual activities:

• On their own. Nobody is involved in their sexual activities, they prefer to use their own imagination to create fantasies, use the internet to view pornography or object and device that is primarily used to facilitate human sexual pleasure.
• With another person. Some other sex addicts feel the need to charm constantly or have sexual intercourses with unknown persons, without worrying about risks. Some others prefer to meet prostitutes-only, which means that the sex addict wants to control everything (choice of the partner and choice of sexual activities). The transaction can also increase their excitement; whereas
  some other sex addicts get excited by selling their sexual activities in pornographic photos or videos, or offering their sexual favors in exchange for gifts or drugs. Finally, they can also be violent and harmful for themselves and their partner(s): they can put themselves in dangerous situations, impose their dangerous – and sometimes illegal – behaviour to their partners. If not treated in time, this extreme pathological sexual behaviour can lead to sexual abuse and/or pedophilia.
• In public space. Here, the risk of being discovered is involved in their excitation. It can be voyeurism, exhibitionism or intrusive sex. The sex addict feels the need to do it in public space and it often occurs in a crowded area in which the addict can easily escape.

What treatment for sex addicts?

As mentioned above, treatment is possible for sex addicts. However, its effectiveness depends on a variety of factors: In many cases, sex addicts start a treatment as part of a legal decision rather than seeking it on their own. Denial, shame, humiliation and/or the fear of legal consequences prevent many sex addicts from therapy. Psychotherapy is one of the primary forms of treatment for sex addiction. Group therapy, medication, and other treatment methods may also be included in the treatment.

Contrary to popular belief, very often treatment does not involve one but two persons: the addict and the co-addict (i.e. his/her partner). Indeed, by his/her involvement in these sexual activities, the co-addict is part of the addicts’ pathological sexual behaviour. Just like the Twelve-step programme, the first step of treatment for the sex addict and the co-addict is to admit that they are powerless over sex and that their lives have become unmanageable. Part the therapist’s job is to understand his/her patient’s belief system. Then, the addict and the co-addict must stop thinking that their excessive sexual drive is due to a combination of factors in their lives (our society, their families and friends, etc.); but our personal beliefs are stronger than our deeds. This positive approach helps addict(s) to have a better self-esteem and another vision on love and sexual activities. It is essential for them to accept help from others and not remain caught in their cycles of addiction. For some people, religion or spirituality – that can be found in Twelve-step groups – can help to reconsider themselves as human beings, with strengths and weaknesses.

Finally, the sex addict must be able to ask for forgiveness from those who suffered from his/her pathological sexual behaviour; except, of course, if what the addict did was too serious (e.g. sexual abuse and/or pedophilia). All through his/her treatment, the sex addict and his/her psychiatrist explore other ways to deal with anxiousness, sorrow and others feelings triggering crises. Having a better control on his/her own life and considering sex in a more reasonable way is the pathway to recovery.

Alcohol consumption is a cultural phenomenon but also a major public health and social issue that tear apart the fabric of our communities. According to the British Office for National Statistics, “In 2013 there were 8,416 alcohol-related deaths registered in the UK [and] 66% of [these] alcohol-related deaths were among males”.

Considered as a normal socializing practice, drinking alcohol often means having a good time with your friends and relatives. For some people, alcohol is seen as the unavoidable ingredient of a meal, which means that alcohol consumption has become a food habit. For others, alcohol is an anxiolytic or an antidepressant. These people feel the need to drink alcohol whenever they feel anxious. This is the reason why researchers quickly spotted alcohol abuse as an addiction: having a glass wine whenever you feel stressed, reflects an inadequate management of emotions that can be extremely difficult to solve without help.

So, is alcohol a lifestyle or a drug? Everyone can step the line of alcohol use disorder and no one is untouchable. The figures above show that alcoholism is the second leading cause of avoidable death in the UK. Today, millions of people are suffering from this chronic and progressive disease that affects them with further medical, psychological and social issues. These exorbitant figures tell us about the importance of alcohol-related death in our communities. But, why do we become an alcoholic? What does a person, at some point in his/her life, finds himself or herself caught in the vicious and deadly circle of alcohol abuse? Those whose job consists of helping people to recover from addictions, who are coping with alcoholics every day: doctor, nurses, therapists working in rehab centres may have the answer (if there is one). Finding the right answer seems very complex: we know that the cause of alcoholism must be the aggregate of different factors (people’s medical, psychological and social conditions). Are some people socially predisposed or is there any genetic predisposition to become alcoholic? Or both? A sociologist is not a doctor specialized in genetics, nor a psychiatrist is a sociologist; which may explain why we can find so many different explanations or reasons of alcoholism.

Anyway, each individual finds his/her own explanation for being an alcoholic (if they are aware and they reckon that they have a drinking problem!) and there is no unique profile to define an alcoholic subject; but a diversity of psychological profiles of those defined as “alcoholics”. In most cases, we observed that a person suffering from alcoholism does not really know or understand what led him/her to alcohol abuse. They link it with their habits, depression, or the fact that they got used to drink with their social circle. For some researchers, understanding the actual reason of their alcoholic behaviour is an important step the recovery process: every patient would have a very specific use of alcohol, related to their psychic structure.

“The concept of psychic structure refers to enduring aspects of the personality and to means-end functions that do not have to be created de novo each time one is faced with a similar situation. A psychic structure is a functional organization that generates a range of meaningful contents.” (Schwartz F., 1981)

Besides, some researchers agree that alcohol is external to the mental preparation of the alcoholic subject: he/she feels the need to use a third party, an external object (i.e. alcohol) to resolve any internal conflict. Here, the act of drinking appears as a solution to his/her problem; but wouldn’t it be a mere misinterpretation of his/her internal conflicts? Hence the needs for the alcoholic subject to get help, in order to explore and learn how to interpret his/her internal conflicts. Still according to this theory, the alcoholic subject feels the need to be always surrounded by people: he/she cannot deal with himself/herself on his/her own. This is why alcoholics tend to stick with their close friends, relatives or even their therapist. Some people say that they seem like addicted to the presence of their partners, husband or wife and children (if any). This leads to a certain emotional immaturity of the alcoholic subject, which can be explained by the fact that those individuals who turn to substance abuse will often do so because they feel unable to deal with their feelings – Hence the need of their relatives when they experience cravings along their road to recovery.

In sum, we go back to the social dimension of alcoholism: it may be influenced by the alcoholic’s social environment. Soon, that person starts to show symptoms of dependence and his/her alcoholism has also greater influence on his/her social life. And once the alcoholic subject reckons that he/she has a drinking problem and starts a therapy, the social dimension keeps coming back as a boomerang as the alcoholic subject is emotionally immature and sometimes he/she desperately needs his/her social circle until his/her full recovery.