Club & Designer Drugs

Summary

• There is a high rate of depression and alcohol use.
• Bipolar disorder and marijuana use co-occur frequently.
• Schizophrenia and tobacco use is very common.

Co-occurring disorders (COD) means having at least one mental illness and one or more substance use disorder. The substance use can be any drug or drugs. The mental illness can be any mental disorder. There are many types of COD. Some, though, are more common than others.

Depression and alcohol use

Depression is a mental illness that is often ignored. Sometimes it is from some other health issue. Symptoms can be weight loss, lack of sleep and lack of energy.

A third of people with low spirits also have a substance or alcohol use disorder. Many people drink as a way of dealing with depression. While it may give short-term help, drinking makes things worse in the long run. It can even cause a person to feel even lower. Alcohol use often hinders a person’s mental health care. The person who is drinking is less likely to stick to her doctor’s plan. She may forget to take her pills and miss doctor visits.

Alcohol use has its own set of risk factors. Short-term can include bad judgment and motor skills as well as more risk taking. This can lead to alcohol-linked car crashes, injuries and death. Long-term issues can include liver and heart disease.

Bipolar disorder and marijuana use

A person with bipolar disorder has mood swings that get in the way of his normal life. These mood shifts can cause problems at home, at school, or at work. The low stages are much like states of depression. The difference is that people with bipolar disorder also have high stages called mania. Mania symptoms include high energy, rapid thoughts and speech, and reckless actions.

As with depression, there is a high rate of alcohol use among people who have bipolar disorder. Studies show an even higher rate of marijuana use among these same people. Marijuana is believed to be a trigger for those who are prone to the disease. It is not known if marijuana is a cause of the illness. It does appear to make the risk of getting such disorders higher.

Schizophrenia and tobacco use

Schizophrenia is a long-term mental illness that touches millions of adults. It upsets a person’s thinking, which can cause strange outward actions. People with the illness often hear voices. They may also see things that aren’t really there. These voices and visions are very real to the person. This can cause great fear within the person. It can also cause other people to be fearful of them and to stay away from them.

It is very common for people with schizophrenia to also use tobacco. Smokers with this illness have a greater dependence and a harder time quitting. When they do stop smoking, the withdrawal symptoms are worse than for those without the disease. The link between these disorders is thought to be the central nervous system. People with schizophrenia can have a hard time with memory and staying focused. Nicotine may make them feel better, but the long-term hazards of smoking greatly offsets any benefit.

Treating COD

No matter what type of COD you have, you should be treated for each issue separately. This is because one will affect the other. Treatment will most likely be talk therapy as well as taking meds. A 12-step program might be needed for substance use issues. Treatment may be long-term, but if you stick with it, you will get better.

Resources

Alcoholics Anonymous
www.aa.org

Depression and Bipolar Support Alliance
www.dbsalliance.org

Mental Health America
www.mentalhealthamerica.net

Narcotics Anonymous
www.na.org

National Alliance on Mental Illness
www.nami.org

National Institute of Mental Health
www.nimh.nih.gov

Substance Abuse and Mental Health Services Administration
www.samhsa.gov

By Kevin Rizzo

©2014-2019 Carelon Behavioral Health

Source: National Center for Biotechnology Information, www.ncbi.nlm.nih.gov/pmc/articles/PMC2215390/ www.ncbi.nlm.nih.gov/pmc/articles/PMC2811144/ and www.ncbi.nlm.nih.gov/pubmed/21288470; National Institute of Mental Health, www.nimh.nih.gov/health/publications/bipolar-disorder/complete-index.shtml; National Alliance on Mental Illness, www.nami.org; Mental Health America, www.nmha.org/conditions/co-occurring-disorders-and-depression

Reviewed by Sanjay Vaswani, M.D., C.M.Q., D.F.A.P.A., Regional Medical Director, Beacon Health Options

Summary

• Drug emergencies can be hard to identify.
• Medical emergencies from using club or designer drugs can happen quickly.
• People high on designer, club, or other drugs may act unpredictably.

If someone you know uses club or designer drugs, would you know the signs of a drug emergency? Drug emergencies can result from:

• Overdose—when too much of a drug is used
• Toxicity—when a drug causes a harmful reaction
• Interaction—when a drug mixes with another drug or alcohol, causing a toxic effect
• Withdrawal—when a person becomes sick after suddenly stopping a drug

Drug emergencies can be hard to identify because we expect people high on drugs to act oddly or not feel so well. Plus, emergency symptoms vary depending on the drug used. But if someone you know uses drugs, look out for signs and symptoms that emergency care may be needed.

Seek emergency care for these symptoms

• Racing heart or chest pain
• Agitation
• Out of touch with reality, hallucination, paranoia
• Extreme shaking or tremors
• Profuse sweating or very dry and hot skin
• High fever
• Seizure
• Problems breathing
• Drowsiness or passing out
• Vomiting
• Violent or aggressive behavior
• Suicidal thoughts

Tell emergency personnel what drug(s) was used (if you know it). This will help them know how to approach treatment.

If you’re not sure whether the problem is a true emergency, call the National Poison Control Center. Experts give free and confidential advice 24 hours a day, seven days a week. The number is: (800) 222-1222.

Don’t wait for symptoms to improve

If someone appears to be having a bad reaction to drugs, don’t wait to see if symptoms improve. Health problems that need medical care can start quickly and unexpectedly. People who have needed emergency medical care after using designer or club drugs have had these problems:

• High blood pressure
• Dehydration
• Dangerously high body temperature
• Breakdown of muscle tissue
• Heart attack or failure
• Kidney failure
• Liver damage
• Amnesia
• Coma
• Seizure
• Serotonin syndrome—a life-threatening drug reaction that causes the body to have too much of the brain chemical serotonin
• Death

Don’t take chances

Helping someone having a bad reaction to drugs is a noble act. But don’t take chances with your own safety. People high on designer, club, or other drugs may behave violently or unpredictably. Call 911 if a person is agitated or violent.

Resources

Emergency Care for You
www.emergencycareforyou.org

National Institute on Drug Abuse
www.drugabuse.gov

Substance Abuse Treatment Facility Locator
http://findtreatment.samhsa.gov

By Christine Martin

©2013-2019 Carelon Behavioral Health

Source: Drug Abuse First Aid. www.nlm.nih.gov/medlineplus/ency/article/000016.htm; interview with Richard F. Clark, MD, Professor of Clinical Medicine, University of California San Diego (UCSD) School of Medicine Department of Emergency Medicine, and Director, UCSD Division of Medical Toxicology, and Medical Director, San Diego Division, California Poison Control System; Spice. National Institute on Drug Abuse, www.drugabuse.gov/publications/drugfacts/Spice-synthetic-marijuana; Synthetic Cathinones. National Institute on Drug Abuse, http://www.drugabuse.gov/publications/drugfacts/synthetic-cathinones-bath-salts; Club Drugs. National Institute on Drug Abuse, www.drugabuse.gov/publications/drugfacts/club-drugs-ghb-ketamine-rohypnol; Hoffman RJ. MDMA intoxication. UpToDate.com; Hoffman RJ. Ketamine Poisoning. UpToDate.com; Arnold TC, Ryan ML. Acute amphetamine and synthetic cathinones (ﾓbath saltﾔ) intoxication. UpToDate.com

Reviewed by Enrique Olivares, MD, FAPA, Director of Addiction Services, Beacon Health Options

Summary

• Some people who know they have a drug problem still do not get needed help.
• People give these reasons for not seeking treatment: not ready to quit using, worry of job loss.

Acceptance that you have a problem with club or designer drugs is the first step toward living drug-free. Getting help is the second step. But some people who know they have a drug problem still do not get needed help. These people give many reasons for their inaction. If you think you have a problem with designer or club drugs, don’t let these reasons keep you from seeking help:

• “I don’t want to stop using.” Right now, you may not be ready to give up drugs. But, if you or others have concerns about your drug use, what’s the harm in talking to a counselor or therapist now? A counselor or therapist can offer an objective point of view, which will help inform your decision and readiness to seek help.
• “I’m worried that I will lose my job if I get treatment.” Federal laws protect people who are in treatment or who are recovering from drug problems from job loss and discrimination. In many workplaces, employees have the right to take up to 12 weeks of unpaid leave to get treatment or to take time off to attend counseling. But, these laws will not protect you if you continue to use illegal drugs.
• “I don’t want my family and friends to disapprove of me.” Shame, guilt, and other troubling feelings often keep people from seeking treatment. But treatment can help you and people who care about you understand that drug problems are disorders that affect the brain—and are not the result of personal weakness or bad choices. And, like other chronic disorders, drug problems can be treated. Treatment will also help you work through tough feelings that underlie drug use.
• “Quitting is a matter of willpower.” Science shows that repeated drug use alters the brain’s reward pathway and how it works, effectively “teaching” your brain to want drugs more and more. Science also shows that drug use changes parts of the brain involved in decision-making, judgment, behavior control, learning, and memory. These changes can impair your self-control and help explain, in part, why resisting the urge to use drugs is simply not a matter of willpower. One aspect of treatment is learning skills to avoid and resist the urge to use.
• “I don’t feel up to it.” Many people with drug problems have depression or other mental health problems and lack the mental or physical energy to seek treatment. If you cannot get yourself to treatment, ask someone to take you. Only then, will you begin to feel better.
• “I don’t have time.” In many cases, outpatient treatment programs can be as effective as live-in programs. Outpatient treatment is time intensive, however. Still, you may be able to work treatment into your usual routine, so you can keep up with your job and home life.
• “I don’t know where to go to get treatment.” Ask your doctor to help you find a program that suits your treatment needs. If you have an employee assistance program (EAP) through your work, you can get a confidential referral for drug counseling. The Behavioral Health Treatment Facility Locator also provides free substance abuse referrals to programs and facilities near you. Call 1-800-662-HELP (4357).
• “I cannot afford treatment.” Some treatment programs and facilities offer sliding scale fees or financial assistance. The Behavioral Health Treatment Facility Locator is a good resource. Your state substance abuse agency can also tell you about treatment facilities that provide treatment for people with limited means.

Resources

National Institute on Drug Abuse
www.drugabuse.gov

Substance Abuse Treatment Facility Locator
http://findtreatment.samhsa.gov

Ending Addiction for Good: The Groundbreaking, Holistic, Evidence-Based Way to Transform Your Life by Richard Taite and Constance Scharff, PhD. Wheatmark, 2012.

By Christine Martin

©2013-2019 Carelon Behavioral Health

Source: “Drugs, Brains, and Behaviorﾗthe Science of Addiction.” National Institute on Drug Abuse, www.drugabuse.gov/publications/science-addiction; “Principles of Drug Addiction Treatment: A Research Based Guide, 3rd edition.” National Institute on Drug Abuse, www.drugabuse.gov/publications/principles-drug-addiction-treatment; “Behavioral Health Treatment Facility Locator.” Substance Abuse & Mental Health Services Administration, http://findtreatment.samhsa.gov/; Jaffe A, Shaheed T. “Canﾒt get in: barriers to addiction treatment entry.” Psychology Today. March 20, 2012, www.psychologytoday.com/blog/all-about-addiction/201203/cant-get-in-barriers-addiction-treatment-entry; Substance Abuse and Mental Health Services Administration, Results from the 2011 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-44, HHS Publication No. (SMA) 12-4713. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2012; Substance Abuse Treatment and Family Therapy. Treatment Improvement Protocol (TIP) Series, No. 39. Center for Substance Abuse Treatment. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2004; Are you in recovery from alcohol or drug problems? Know your rights. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2004.

Reviewed by Enrique Olivares, MD, FAPA, Director of Addiction Services, Beacon Health Options

Summary

• Treatment should be client-centered.
• You may also need help with housing, child care, or finding a job.
   

Having a mental illness or a substance use disorder can be hard to deal with. Having both is even harder. Studies show that people with co-occurring disorders (COD) are less likely to comply with or respond to treatment. This puts them at a greater risk for relapse. They are also more likely to become violent, experience homelessness, or go to jail. The risk of getting AIDS and other illnesses is higher as well.

There is hope though. You can improve with proper treatment. This means being treated for both issues separately but at the same time. This is because the disorders not only co-exist, but they also co-affect each other. For instance, someone with depression may drink alcohol to try to feel better. A person who drinks may do so because he feels depressed. If only one issue is being addressed, the other issue can disrupt its treatment.

Before you can begin feeling better, you must first realize the need for treatment. You may not want to admit to your family or yourself that you have a mental illness. You may be afraid to tell your doctor or your boss about your substance use. You may be trying to hide one or both issues from your friends or co-workers. Maybe you simply are not sure if you have any serious issues or not.

Signs of mental illness

The symptoms of mental illness will vary depending on the disease. Often a person may not realize she is impaired. This is true whether it is the onset of a disease or a relapse. It is therefore good to have friends or family nearby looking out for you.

Some of the signs that could indicate a mental illness include:

• Extreme moodiness
• Depression
• Nervousness
• Paranoia
• Withdrawal
• Apathy
• High-risk taking
• High sensitivity
• Extreme irritation
• Inattention
• Trouble with eating or sleeping
• Sexual dysfunction

Signs of substance use disorder

Substance use disorder can have some of the same symptoms of mental illness. Some other signs that you may have a substance use disorder include:

• Getting drunk or high regularly
• Drinking or doing other drugs by yourself
• Driving while drunk or high
• Building up a tolerance to alcohol or other drugs
• Hiding or lying about drinking or taking other drugs
• Withdrawing from friends or hobbies to get drunk or high
• Going to work or school high or drunk
• Missing work or school because of drugs or alcohol
• Passing out or being hung over often

If you think your drinking or drug use may be an issue, get help right away. Do not try to carry the burden all by yourself. Seek out a trusted friend or loved one. Speak to a pastor or counselor. Then find a substance use treatment center and get involved in a 12-step program.

Client-centered treatment

To be successful, both disorders should be treated at the same time. Once you have reached out for help, you must stay involved in the treatment process. This means being active in the planning and decision making. Other people can give you advice but you should make your own choices. This will help empower you to better promote your own recovery.

Talk therapy will be a big part of your treatment. This may include one-on-one, group and family counseling. A 12-step program may be needed for help with substance use issues. Social skills and stress coping skills should be addressed. You may also need help with housing, child care or finding a job. Though you have the lead role, you will need the support of many others. Welcome the input from your doctor or health care worker, as well as family and friends. Realize that they all want what is best for you.

Be aware that recovery may take months or even years. Your progress may be slow at times and there could be setbacks. Do not lose hope. Instead, focus on short-term goals and ask for extra support. Distance yourself from negative influences and surround yourself with positive people. Believe that if you stay on course with your treatment, you can and will get better.

By Kevin Rizzo

©2014-2021 Carelon Behavioral Health

Source: Substance Abuse and Mental Health Services Administration; National Alliance on Mental Illness, www.nami.org; Mental Health America, www.mentalhealthamerica.net/conditions/co-occurring-disorder-and-youth

Summary

• Attend doctor appointments and support group meetings.
• Help her establish daily routines for eating, sleeping, and taking pills.
• Praise her successes and don’t dwell on her failures.

No one likes to see someone they care about go through hard times. A friend with a substance use disorder is hard to be around. A child with a mental illness is tough on the whole family. If you know someone with both issues, then you know it is even harder. As taxing as it may be, your support is a vital part of their recovery.

Identify the issues

The first step is to realize there is a co-occurring disorder (COD). Your friend or loved one may be in denial about her own situation. Her doctor or health care worker may not be aware of the other issue either. Therefore, the person is only getting treated for one issue. This is less than ideal since the two conditions affect each other. For instance, someone being treated for depression may drink alcohol to try to feel better. A person attending Alcoholics Anonymous meetings may continue drinking because she feels depressed. If only one issue is being addressed, the other issue can get in the way of its treatment. For treatment to work, it must be given for both disorders at the same time.

You may know your friend or loved one better than anyone. Therefore, you may be the first one to notice when he isn’t acting like himself. Watch out for sudden changes that may indicate mental illness or substance use or both.

Some of these changes may include:

• Extreme moodiness, touchiness or irritation
• High-risk drinking
• Violence
• Depression
• Apathy
• Inattention
• Nervousness
• Paranoia
• Withdrawal
• Eating, sleeping, or sexual troubles

Ways to promote recovery

When someone you care about has COD, you may feel helpless. This is a normal feeling, but it is far from the truth. Not only can you help, but your friend or loved one needs your help. Helping does not mean taking on the burden yourself. It does not mean you become the person’s enabler or watchdog either. A person with COD has to first be willing to get help. Recovery is hard work and no one can do the work for her. Your job is to show your support throughout the process. This means during both the good times and the bad times.

Sometimes, the best way to help someone with COD is just to be there for him. This allows your friend or loved one to open up about his struggles. You don’t need to have all the answers. You just need to give encouragement and support. Listen to him, and let him know he is not alone.

Here are other ways to help a friend or loved one recover:

• Go with her to doctor appointments.
• Attend support group meetings.
• Help her establish daily routines for eating, sleeping, and taking pills.
• Praise her successes and don’t dwell on her failures.
• Be patient with her.
• Encourage her by staying positive yourself.
• Invite her to partake in healthy activities.
• Stay informed about the disorders.
• Don’t ignore thoughts of suicide—call their doctor or 911.

Resources

Alcoholics Anonymous
www.aa.org

Narcotics Anonymous
www.na.org

National Alliance on Mental Illness
www.nami.org

National Institute of Mental Health
www.nimh.nih.gov

Substance Abuse and Mental Health Services Administration
www.samhsa.gov

By Kevin Rizzo

©2014-2019 Carelon Behavioral Health

Source: Substance Abuse and Mental Health Services Administration; National Institute of Mental Health, www.nimh.nih.gov/health/topics/schizophrenia/index.shtml

Reviewed by Sanjay Vaswani, M.D., C.M.Q., D.F.A.P.A., Regional Medical Director, Beacon Health Options

Summary

• Screening for both issues can be difficult
• Certain mental illnesses occur more commonly with substance use disorders
• Alcohol and nicotine are common drugs linked with COD

Checking for a mental illness is often fairly clear-cut. That is because a lot of research has been done to make this process better. The same can be said for substance use disorders. We now know a great deal more about this field than we ever did before.

It is harder to screen for more than one issue at the same time. One reason for this is a lack of dual training. A mental health service may not be able to spot a substance use disorder. A substance use treatment center may not be able to spot a mental illness. So just how does one know if he has a co-occurring disorder (COD)?

COD means having at least one mental illness and one or more substance use disorder. The substance use can be any drug or drugs. The mental illness can be any mental disorder, but some are more common with COD.

Depression and COD

Depression is a mental illness that is often ignored. Sometimes it is the result of another health matter. Symptoms can be weight loss, lack of sleep, and lack of energy. These signs are also common among other health issues. Studies show that a third of people with depression also have a substance use disorder.

Bipolar disorder and COD

Roughly 60 percent of people with bipolar disorder also have a substance use issue. It is thought that these two disorders affect the same chemicals in the brain. Studies suggest that people with this illness may try to medicate themselves through alcohol use. It is also believed that bipolar disorder may be a risk factor for substance use. Marijuana use can be very common with this disorder.

Schizophrenia and COD

Substance use disorder happens quite often with schizophrenia. Drinking and drug use can also mask some of its symptoms. This is true both during times of use as well as times of withdrawal. Marijuana use can even make the symptoms worse.

Obsessive-compulsive disorder and post-traumatic stress disorder also happen often with COD. Other disorders linked to mood, anxiety, sleep, eating, and personality can be common as well.

Substance use disorders and COD

Any drug can be the source of a substance use disorder. This can range from caffeine and nicotine to cocaine and heroin. When the drug use causes harm or makes normal living hard it is a disorder. Social, legal, and physical problems are often the result.

Alcohol and nicotine are among the most common drugs linked with COD. These types of addictions are very hard to break, but it can be done. Recovery requires a strong support group. Substance use must be treated apart from, but at the same time as, mental disorders.

Signs of substance use disorder

Substance use disorder has a broad range of symptoms based on the drug or drugs. Many of these are the same as those for a mental illness. Here is a list of some of the more common signs to look for:

• Moodiness
• Nervousness
• Touchiness
• Low spirits
• Numbness
• Forgetfulness
• High-risk taking
• Withdrawal

You may not realize that your drinking or substance use is an issue. You may be in denial about your need for help. Here are some other signs that you may have a substance use disorder:

• Getting drunk or high all the time
• Drinking or doing other drugs by yourself
• Driving while drunk or high
• Building up a tolerance to drinking or other drugs
• Hiding or lying about drinking or taking other drugs
• Withdrawing from friends or hobbies to get drunk or high
• Going to work or school high or drunk
• Missing work or school because of drugs or drinking
• Passing out or being hung over often

Get treatment

If you think you may have COD you should tell your doctor right away. You can then be evaluated to see if you need to be looked at further. If you do have COD, early care will help with your recovery. You should also notice feeling much better when you are being treated for both issues. With the right help and support, people can and do recover.

Resources

Alcoholics Anonymous
www.aa.org

Depression and Bipolar Support Alliance
www.dbsalliance.org

Mental Health America
www.mentalhealthamerica.net

Narcotics Anonymous
www.na.org

National Alliance on Mental Illness
www.nami.org

National Institute of Mental Health
www.nimh.nih.gov

Substance Abuse and Mental Health Services Administration
www.samhsa.gov

By Kevin Rizzo

©2014-2019 Carelon Behavioral Health

Source: Substance Abuse and Mental Health Services Administration; Mental Health America, www.nmha.org/conditions/co-occurring-disorders-and-depression and www.mentalhealthamerica.net/conditions/co-occurring-disorder-and-youth; National Alliance on Mental Illness, www.nami.org; National Institute of Mental Health, www.nimh.nih.gov/health/publications/bipolar-disorder/complete-index.shtml

Reviewed by Sanjay Vaswani, M.D., C.M.Q., D.F.A.P.A., Regional Medical Director, Beacon Health Options

Summary

Before forming an opinion about someone with substance use problems, consider these common myths.

“Those who overuse substances have a moral flaw.”

“People with alcohol and substance use disorders don’t want to quit—if they did, they would just stop using.”

“Locking up all the people who overuse substances will solve the problem.”

These and many other myths about drug use add to the problem. The stigma tied to drug use discourages treatment for addiction and limits chances for work, housing, and social relationships. Although drug use has a deep, harmful impact on society, it is not an insurmountable problem. Become part of the answer by helping to stop stigma.

Identifying the problem

Most American families have been touched in some way by a loved one with problems with drugs or drinking. According to the Substance Abuse and Mental Health Services Administration (SAMHSA) National Survey on Drug Use & Health, 24.6 million Americans aged 12 or older said they had used an illicit drug during the month before the survey.

Unfortunately, many people who have problems with drug use will come across stigma that hinders them from integrating back into society. Police, the legal system, ER staff, and even family members and friends can keep the stigma going, and stigma limits the attention and resources dedicated to solving problems linked to substance use. “Stigma is about discrimination,” says Ivette Torres, Director of Consumer Affairs for SAMHSA’s Center for Substance Abuse Treatment.

Separating myth from fact

Stigma comes from the myths about drug use. Before forming an opinion about someone with substance use problems, think over these common myths:

Myth: Those who overuse substances have a moral flaw—they could will themselves to stop using if they wanted to quit.

Fact: One common and false stereotype about people with substance use disorders is that they are all social misfits and outcasts. “Stigma can also get at the idea that the person is weak of character or untrustworthy,” explains Jim Beek, a SAMHSA information officer. In reality, “normal” people deal with drug use issues, which can touch whole families. Drug and alcohol dependence meet the standards for treatable, chronic health issues; dependence is not simply a matter of choice. “One of the biggest and most pervasive myths is that … a user can stop using alcohol or drugs by willing themselves to,” agrees Torres. “Society at large has to accept addiction treatment and begin to look at it as a public health issue.”

Myth: Addiction is not reversible: Once an addicted to a substance, it is always that way.

Fact: Many people don’t realize how helpful programs and services can be in treating substance use disorder. In fact, drug addiction treatment works as well as established medical treatments for other illnesses such as diabetes and asthma, the Physician Leadership on National Drug Policy has reported. Another study found that for each dollar invested in treatment, taxpayers saved $7 in future costs, according to the National Institute on Drug Abuse.

Unfortunately, the shame tied to being labeled or viewed negatively by others can keep people from seeking care. “Stigma is a factor,” Torres notes. “That’s why you see so many individuals speaking out, saying, ‘Recovery is possible. I am an example of that.’’’ And luckily, new choices, such as the prescription addiction treatment drug buprenorphine, can help stop the stigma linked to lining up outside a clinic.

Myth: Harsher criminal penalties for using drugs or increasing efforts to cut off the drug supply will solve the problem.

Fact: This common wisdom is at odds with research showing the effectiveness of treatment. And, keep in mind that there is no “silver bullet” when it comes to solving drug use problems. While a blend of things such as treatment, parental influence, and education programs can help, taken alone, “get tough” approaches don’t address the underlying social and family issues linked to drug use.

You can help

While views about people with drug problems and treatments have gotten better, we still have a long way to go toward skillfully addressing these issues. You can help by facing your own attitudes. If you know someone who may have a drug problem, treat him with concern, dignity, and respect. Rather than turning your back or getting angry, offer your support.

Resources

National Institute on Drug Abuse
www.drugabuse.gov

Physician Leadership on National Drug Policy
www.plndp.org

Substance Abuse and Mental Health Services Administration
www.samhsa.gov/

By Kristen Knight

©2022 Carelon Behavioral Health

Summary

• Drug treatment plans that work best have certain features.
• No single treatment approach is right for all people.
• Participation in a self-help recovery group should not take the place of formal treatment.

Every day, treatment and support help people like you overcome problems with club, designer, and other drugs. Some treatment programs work better than others. And no single approach is right for all people. This article provides basic facts about substance use disorder treatment. It also explains the role recovery groups play in helping people get long-term control over drug use.

What to look for in a program

Drug treatment programs that work best have these features:

• The approach is grounded in science. Treatment approaches specific to club or designer drug problems do not exist or are not well-defined. But, behavioral therapy, medicine, and in some cases, a blend of both are proven courses for helping people with a variety of addictions and are likely helpful for club and designer drugs as well.
• The program treats the whole person—not just drug use. The best programs offer services to meet all needs. This might include mental health care, such as for depression; family counseling; learning job skills and career counseling; parenting instruction; or supplying child care or transportation.
• The program can modify treatment as a person’s needs change. Recovery from a drug problem is a process that can have both successes and setbacks. The best programs monitor recovery and adjust care as needs change.
• The program is long enough. Most people need at least three months in formal treatment to stop drug use. But the best results come with much longer care. Once a person’s treatment goals are met, follow-up care for a year or longer can help the person stay clean.
• The program supports participation in self-help recovery groups. Self-help groups cannot take the place of professional treatment. But they do give an added layer of support, which can help a person stay clean.

Effective treatment programs can take place in a variety of settings. Residential programs are a good fit for people with severe drug problems or people who lack a strong support network and/or stable living or work situations. Outpatient programs are an option for people who have less severe drug problems, want to get treatment, and have supportive friends and family.

What to expect from treatment

When you enter treatment, a counselor will evaluate your problem to determine the type of care you need. Some club drugs, such as Rohypnol, may require detox under a doctor’s care as a first step. You will also work with your counselor to make a treatment plan. This plan will specify:

• Treatment goals
• Actions you will take to meet your goals
• A timeframe for meeting your goals
• Ways to measure your progress

From the start, behavioral therapy through one-on-one and possibly group counseling will play a vital role in your treatment. Counseling sessions will help you to:

• Build on your readiness to quit using
• Recognize emotions, people, places, and situations in which you are likely to use
• Develop ways to cope with cravings so you don’t relapse
• Identify and deal with painful emotions that underlie drug use
• Change negative ways of thinking and destructive patterns that contribute to drug use
• Build life skills, such as stress management, to help you handle hard times in the future
• Create a drug-free lifestyle

Your plan may also incorporate family counseling and other supportive services needed to fix broken relationships and prepare you for all aspects of life without drugs.

How support groups can help you stay clean

Participation in a self-help recovery group can also help you stay clean, but should not take the place of formal treatment. People in recovery can draw strength from others coping with similar issues, such job stress, family problems, and social situations, without using drugs. Some groups, such as Narcotics Anonymous, offer regular, private meetings, often at a school or place of worship. Others, such as SMART Recovery, sponsor online meetings and chat rooms to obtain recovery support.

Relapse is not treatment failure

A person in recovery may use drugs again. But relapse does not mean that treatment has failed. Like people with diabetes, heart disease, and other life-long disorders, people with drug problems can have setbacks in treatment. Your plan may need to be modified if relapse occurs. But sticking with treatment and support will, over time, make relapse less likely.

Resources

Substance Abuse and Mental Health Services Administration
www.samhsa.gov

Narcotics Anonymous
www.na.org

SMART Recovery
www.smartrecovery.org

Ending Addiction for Good: The Groundbreaking, Holistic, Evidence-Based Way to Transform Your Life by Richard Taite and Constance Scharff, PhD. Wheatmark, 2013.

By Christine Martin

©2013-2019 Carelon Behavioral Health

Source: “What Is Substance Abuse Treatment? A Booklet for Families.” Substance Abuse and Mental Health Services Administration, http://store.samhsa.gov/shin/content//SMA08-4126/SMA08-4126.pdf; “Principles of Drug

Summary

• Club and designer drugs can cause long-term health problems or death.
• Regular drug use can lead to work or school problems, money problems, family problems.

Some people mistakenly think that club drugs and designer drugs are harmless. Perhaps they have used them in the past without any problems. Or they believe that some drugs are natural, and therefore safe. This is not so. People who use any type of club or designer drug are taking a big risk each time they use. Consider how using these drugs can change people’s lives for the worse.

Using club or designer drugs threatens health

• Specific health risks depend on the drug used. People high on MDMA could dehydrate or overheat, which can lead to heart or kidney failure, and even death. Sedatives, such as GHB, can slow breathing and heart rate to dangerous levels. For some drugs, overdose happens quickly and can be fatal.
• Much is still unknown about designer drugs and how toxic they are or how long they stay in the body. As these drugs are more widely used, the risks are beginning to be revealed. For instance, people seen in the ER for bath salt-related emergencies have been treated for chest pain, dangerously high body temperature, and delirium. Some people high on bath salts become very violent. With synthetic marijuana, users have reported unexpected effects, like extreme anxiety, paranoia, and hallucinations. The Centers for Disease Control and Prevention reported that synthetic marijuana was found to harm and possibly cause long-lasting damage to the kidneys.
• Club and designer drugs may contain other, unknown substances that are also harmful. Drug-makers also commonly substitute substances found in similar drugs. So a buyer cannot be sure of a product’s content. People who use them also cannot count on a drug’s potency or predictability.
• Using club and designer drugs with other substances, such as alcohol, can make them more toxic and possibly fatal.
• People high on club drugs may be vulnerable to rape or other crimes. For instance, GHB, Rohypnol, and ketamine can impair a person’s ability to resist or fight off an assault. Some club drugs come in colorless, odorless, and nearly tasteless forms that are easily slipped into a person’s drink without her knowledge or consent.
• Using club or designer drugs can lead to risky sexual behaviors, such as having unprotected sex. Unprotected sex increases the risk of unplanned pregnancies and sexually transmitted diseases, including HIV.

Using club and designer drugs threatens lives and families

People who use club or designer drugs risk losing everything that is important to them. If a severe drug problem takes hold, a person will spend a lot of time trying to get drugs and getting high. All other aspects of life, including school or work, hobbies and interests, friendships, and family life, become less important. People who use club or designer drugs risk:

• Work problems and job loss
• Family problems and divorce
• Money problems and debt
• Losing custody of children
• Exposure to violence and crime
• Trouble with the law and going to jail

Using club and designer drugs may lead to addiction

Drugs can alter important brain structures and brain function. These long-lasting brain changes make it hard for people to stop using drugs even if they want to. People addicted to drugs continue to use despite any harms or problems their drug use has caused. Some club and designer drugs have a greater potential for addiction than others. And, the addictive potential of many new drugs is unknown.

Using club or designer drugs is risky and can cause long-lasting problems. The best way to avoid the dangers of these drugs is to never use them in the first place.

Resources

National Institute on Drug Abuse
www.drugabuse.gov

The Partnership at Drugfree.org
www.drugfree.org

By Christine Martin

©2013-2019 Carelon Behavioral Health

Source: Substance Abuse and Mental Health Services Administration, Office of Applied Studies. (March 30, 2007). The NSDUH Report: Sexually Transmitted Diseases and Substance Use. Rockville, MD; “Drugs, Brains, and Behaviorﾖthe Science of Addiction.” National Institute on Drug Abuse, www.drugabuse.gov/publications/science-addiction; Hoecker C. “Designer drugs of abuse.” UptoDate.com; Spice. National Institute on Drug Abuse, www.drugabuse.gov/publications/drugfacts/Spice-synthetic-marijuana; Synthetic Cathinones. National Institute on Drug Abuse, www.drugabuse.gov/publications/drugfacts/synthetic-cathinones-bath-salts; Tips for Parents: The Truth About Club Drugs. FBI, www.fbi.gov; Arnold TC, Ryan ML. Acute amphetamine and synthetic cathinone intoxication. UpToDate.com

Reviewed by Enrique Olivares, MD, FAPA, Director of Addiction Services, Beacon Health Options

Summary

• Club drugs include many types of drugs that are commonly used at all-night dance parties.
• Designer drugs are made by altering the chemical structure of existing illegal drugs in order to evade drug laws.

You may have heard people talk about “club drugs” and “designer drugs” and wondered what they are.

• Club drugs include many types of drugs that are commonly used at all-night dance parties called “raves.” But, they are also widely used at bars, parties, concerts, and other party venues.
• Designer drugs are drugs made by slightly altering the chemical structure of existing illegal drugs. They are also called synthetic drugs. These drugs are created to evade drug laws in the United States and other parts of the world. In 2011, a U.S. law was passed banning many of the harmful chemicals used to make popular designer drugs. Yet, new designer drugs are continually being created in an effort to keep ahead of the law.

This article provides an overview of the most widely used club and designer drugs. All club and designer drugs threaten the health and safety of the person who uses them. This article does not go into the specific dangers of each drug.

Club drugs

MDMA (methylenedioxymethamphetamine)
Street names: Ecstasy, E, X, XTC, Adam, Clarity, Lover’s Speed, Molly

What it is and how it is used: MDMA is a stimulant that comes in pill and powder forms that are swallowed. MDMA is both a club and designer drug; it is one of the most widely used designer drugs.

Why people use it: MDMA increases energy while making users feel relaxed, very friendly, and loving. It distorts time and perception. The effects last for several hours.

GHB (gamma-hydroxybutyrate)
Street names: Grievous Bodily Harm, G, Liquid Ecstasy, Georgia Home Boy

What it is and how it is used: GHB is a sedative that comes as a liquid that is swallowed.

Why people use it: GHB can make users feel joyful, relaxed and make them “see things.” The effects can last up to four hours. GHB is sometimes used to commit date rape. Because it is odorless and colorless, it can be easily slipped into a drink. The drugged person may be helpless and unable to fight back.

Rohypnol
Street names: Roofies, Rophies, Roche, Forget-me Pill

What it is and how it is used: Rohypnol is a sedative that comes as a white pill. It dissolves easily in liquid.

Why people use it: Rohypnol causes people to feel sleepy, calm, and relaxed. It is sometimes used to commit date rape. It can knock people out and cause amnesia, so a victim may not remember the rape.

Ketamine
Street names: Special K, K, Vitamin K, Cat Valium

What it is and how it is used: Ketamine is a drug used by veterinarians. It is usually swallowed, snorted, or injected.

Why people use it: Ketamine makes users feel like they are in a dream or far away. They might “see things” or have more energy. Some people are not able to move or communicate, which is why ketamine is sometimes used to commit date rape.

LSD
Street names: Acid, Boomers, Yellow Sunshines

What it is and how it is used: LSD is a potent hallucinogen that comes in pills or on paper that has been soaked in the drug.

Why people take it: LSD greatly distorts what a user sees, hears, and feels. The effects can last up to 12 hours.

Designer drugs

Synthetic cannabinoids (Spice, K2)
Street names: Spice, K2, herbal incense, herbal potpourri, fake weed; sold under brand names such as Spice Gold, Spice Diamond, Chill Out, Chill X, Yucatan Fire, Skunk, Moon Rocks

What it is and how it is used: Spice is an herbal mixture that is laced with manmade chemicals that mimic natural chemicals in marijuana. Spice is often sold as incense with the label, “Not for human consumption.” People usually smoke it in a pipe or joint.

Why people use it: People use it to feel happy and relaxed.  

Synthetic cathinones (bath salts)
Street names: Sold under brand names such as Ivory Wave, Bloom, Cloud Nine, Lunar Wave, Vanilla Sky, White Lightning, Scarface

What it is and how it is used: Bath salts are a manmade form of cathinone, a chemical found in the Khat plant. They typically come as a powder, which is snorted, injected, or smoked. They may be sold as bath salts, plant food, jewelry cleaner, or phone screen cleaner, with the warning label, “Not for human consumption.” Bath salts are not the same as Epsom salts, which are used for bathing.

Why people use it: Bath salts can cause intense pleasure and increased energy and sex drive.

Who uses club and designer drugs?

Overuse of club and designer drugs has long been a big problem among white teens and young adults. But these drugs are now seen among a broader range of ages and ethnicities. These drugs are inexpensive and easy to get. Some users mistakenly think that some drugs, such as Spice, are natural and therefore harmless. Standard drug tests cannot easily detect the chemicals used in some designer drugs, which is another reason for their appeal. Many club drug users are likely to use more than one drug, which compounds the danger.

Resources

National Institute on Drug Abuse
www.drugabuse.gov

The Partnership at Drugfree.org
www.drugfree.org

By Christine Martin

©2013-2019 Carelon Behavioral Health

Source: Hoecker C. ﾓDesigner drugs of abuse.ﾔ UptoDate.com; designerdrugtrends.org; U.S. Drug Enforcement Agency; Spice. National Institute on Drug Abuse, www.drugabuse.gov/publications/drugfacts/Spice-synthetic-marijuana; Synthetic Cathinones. National Institute on Drug Abuse, www.drugabuse.gov/publications/drugfacts/synthetic-cathinones-bath-salts; Club Drugs. National Institute on Drug Abuse, www.drugabuse.gov/publications/drugfacts/club-drugs-ghb-ketamine-rohypnol; Tips for Parents: The Truth About Club Drugs. FBI, www.fbi.gov/scams-safety/clubdrugs

Reviewed by Enrique Olivares, MD, FAPA, Director of Addiction Services, Beacon Health Options

Summary

• Designer drugs are widely used among teens. 
• Designer drugs appeal to teens for many reasons: Some mistakenly think they are safe and legal.

Parents can do a lot to prevent their teens from using designer or other drugs. This article answers questions parents might have about designer drugs, signs of drug use, and steps to prevent drug use.

What are designer drugs?

Designer drugs are drugs made by slightly altering the chemical structure of compounds banned by drug laws. They are also called synthetic drugs. Designer drugs include:

• Spice, K2, “herbal incense,” or “herbal potpourri” (synthetic cannabinoids/marijuana)
• Bath salts or “plant food” (synthetic cathinones)
• Ecstasy (MDMA)

Designer drugs are created to evade drug laws in the United States and other parts of the world. In 2012, a U.S. law was passed banning many of the harmful chemicals used to make Spice and bath salts. Yet, new compounds are continually being created in an effort to keep ahead of the law. And in some cases, drug laws have not curbed trends in a drug’s popularity or use, such as with Spice and Ecstasy.

Ecstasy is a designer drug that has been around for a long time. It is commonly distributed at raves, which are nighttime dance parties held in warehouses, dance clubs, and open fields. These events are often advertised as “safe” and “alcohol-free,” but they can be crowded and dangerous. 

Why are designer drugs so popular among teens?

Designer drugs appeal to teens for many reasons, including:

• New drugs are promoted on the Internet and social media as safe or legal ways to get high.
• Designer drugs are easy to get.
• Routine drug tests cannot detect most designer drugs.
• Teens may wrongly believe that drugs are safe or nonaddictive.

Are designer drugs more harmful to teens than other drugs?

We don’t know that much about designer drugs and their effects. Harmful effects are often not revealed until the drug becomes more widely used. Emergency rooms and poison control centers are often the first to report on the dangers. Moreover, we don’t know what long-term effects a designer drug might have on a teen’s developing brain and body.

We do know that teens can get sick or die from designer drugs. Mixing designer drugs with other drugs or alcohol can be especially toxic. We also know that teens under the influence of designer or other drugs can have impaired judgment, thinking, memory, and self-control, which might lead to:

• Sexual risk-taking
• Drugged driving
• Harming themselves or others

How can I tell if my teen is using designer drugs?

There’s no easy way to tell whether your teen is using a designer drug or something else. But any drug use is reason to take action. Some clues that your teen might be using drugs include:

• Unusual or bizarre behavior, such as being oddly elated, clumsy, goofy, hyper, or clenching teeth
• New circle of friends
• Problems with grades or school
• Mood changes
• Secretive behavior
• Makes lots of excuses
• Unkempt appearance
• Uses eye drops or chews gum or mints more than usual
• Dry mouth and unusual thirst
• Loss of interest in sports, clubs, or other activities

If your gut tells you that your teen may be using drugs, act now. Giving it time or making excuses are forms of enabling. Talk to your teen about your concerns or seek outside help if needed.

What can I do to prevent my teen from using designer drugs?

Get the facts about designer and other drugs teens are using. Talk to your teen about designer drugs and how they might be marketed as “safe” or “legal.” Make sure your teen knows that any drug use, even “experimental,” is not OK. Set clear limits, and hold your teen accountable if rules are broken. Get to know your teen’s friends and whereabouts. Encourage and praise your teen’s positive behaviors and choices. Work on your communication skills, so that you can positively and effectively work through conflict.

Resources

Get Smart About Drugs
www.getsmartaboutdrugs.com

Family Checkup: Positive Parenting Prevents Drug Abuse
www.drugabuse.gov/family-checkup

By Christine Martin

©2013-2019 Carelon Behavioral Health

Source: Johnston LD, OﾒMalley PM, Bachman JG, Schulenberg JE. (2013). Monitoring the Future National Results on Drug Use: 2012 Overview, Key Findings on Adolescent Drug Use. Ann Arbor: Institute for Social Research, The University of Michigan, www.monitoringthefuture.org//pubs/monographs/mtf-overview2012.pdf; World Drug Report 2013, www.unodc.org/wdr/; Hoecker C. “Designer drugs of abuse.” UptoDate.com. Designer Drug Trends. designerdrugtrends.org; What Parents Need to Know About Synthetic Marijuana and Bath Salts, www.nmslabs.com/services-forensic-K2-information; Family Checkup: Positive Parenting Prevents Drug Abuse, www.drugabuse.gov/family-checkup

Reviewed by Enrique Olivares, MD, FAPA, Director of Addiction Services, Beacon Health Options