Benzodiazepines – Pronounced: ben-zo-dye-az-e-peens

What are benzodiazepines used for?

Benzodiazepines are a group of medicines usually used to relieve the symptoms people may have with anxiety (feeling tense, fearful or on edge) and insomnia (not being able to sleep or waking up earlier than usual). Medicines are often used to treat more than one condition, so if you are not sure why you have been prescribed a benzodiazepine, you should discuss this with your doctor. Benzodiazepines are also used to manage other problems such as epilepsy, symptoms of alcohol withdrawal, panic disorder and manic episodes. Your medicine may also have a trade or brand name. This is the name that the manufacturer gives to the medicine, for example Ativan® is a brand name for lorazepam, Rivotril® is a brand name for clonazepam and Xanax® is a brand name for alprazolam. Other examples of benzodiazepines are diazepam and oxazepam.

What are the benefits of taking a benzodiazepine?

People with anxiety may feel uneasy because they may worry or may be fearful. There are different types of anxiety disorders and these may be mild or severe. People with anxiety disorders may feel nervous and tense. These feelings may be experienced as physical symptoms such as sweating, irregular or unusually fast heartbeat, butterflies or cramps in the stomach and tremor (feeling shaky). There are a number of anxiety disorders, for example panic disorder when people sometimes feel panicky or frightened and may try to change their life to avoid situations that make them feel like this. Another example of an anxiety disorder is generalised anxiety disorder where people may experience symptoms most of the time. These symptoms may include sleep problems, worry, difficulty in concentrating and feeling constantly on edge.

The amount of sleep people need is different. Some people may manage on as little as four to five hours while others may require up to ten hours per night. People with insomnia may wake up in the middle of the night or have difficulty falling asleep. They may not feel refreshed after a sleep or may wake up very early in the morning. Insomnia means not being able to sleep properly and difficulty staying asleep. There can be many different reasons for this. Benzodiazepines are used to relieve the symptoms of anxiety and insomnia.

How quickly do benzodiazepines work?

Benzodiazepines usually take between 15 and 45 minutes until they have their full effect. Some symptoms may start to improve before others. Not everybody benefits from benzodiazepines, but most people do. If you do not feel any benefit or improvement in your symptoms, you should discuss this with your doctor or healthcare worker.

What are the usual doses of benzodiazepines and how should I take them?

Refer to the manufacturer’s patient information leaflet for the benzodiazepine that you have been given. Do not change the dose of your benzodiazepine without checking with your doctor, as it can affect your response to the medication or may be harmful.

What should I do if I miss a dose?

You will get the most out of your medication when taken correctly. If you miss, or forget a dose at your usual time, but remember within an hour or two then take it straight away. If it is longer than this just leave out the missed dose and take the next dose at the usual time. Never take extra medication at the next dose.

For how long should I take benzodiazepines?

Your doctor will discuss with you the length of treatment, which will vary depending on the type of illness you have. Benzodiazepines are usually taken for a few weeks or less. Your doctor should regularly review your medication to make sure that you do not take medicines for longer than needed. If you take benzodiazepines for longer than you need to, you may become dependent on the medicine or the medicine may not be as effective as it was (you become tolerant as the body gets used to the medicine). If you stop taking or reduce the dose of a benzodiazepine suddenly you may get unpleasant symptoms called ‘withdrawal’ and these can range from mild to severe. Check with your doctor for advice about this.

What are the side effects of benzodiazepines?

As with all medicines there is a risk of unwanted effects (side effects). Some can occur soon after starting treatment so you may experience these before you feel better. Most are temporary and should go away after a few days or weeks. Not everyone will get side effects and people experience them to different degrees. If you feel that you have side effects that are causing you discomfort, discuss this with your doctor, pharmacist, nurse or healthcare worker. The table on the following page lists some of the main recognised side effects of benzodiazepines.

What about alcohol and ‘street’ drugs?

Both alcohol and benzodiazepines can affect the brain so it is not recommended that you drink alcohol while taking benzodiazepines. Drinking alcohol can cause drowsiness and in combination with benzodiazepines can cause severe drowsiness. Once you are used to the medication and know the effects of taking alcohol you may be able to drink alcohol occasionally and in small amounts. It is good to be cautious because alcohol affects people in different ways, especially when taking medication.

Do not stop taking your medication because you feel like drinking alcohol. If you drink alcohol, drink only small amounts. Never drink alcohol and drive while taking medication.

‘Street’ drugs (for example, cannabis, ecstasy, speed, heroin and cocaine) can also often affect your treatment. People taking cannabis and heroin with benzodiazepines may become very drowsy and this can be harmful. There is very little information on taking benzodiazepines with other ‘street’ drugs and so the effect and safety of doing this is unknown. It is best if you do not take ‘street’ drugs whilst taking benzodiazepines. You may need to get advice and support to help you do this.

What about other medicines?

If you take any other medicines or herbal remedies including any that have been newly prescribed or bought, it is important to check with your doctor or pharmacist that they are safe with benzodiazepines.

When I should be cautious?

It is usually safe to take benzodiazepines as prescribed by your doctor, but they are not suitable for everyone. If any of the following situations apply to you, you should tell your doctor immediately:

1 If you are allergic to benzodiazepines (if you have had one before and developed a rash, itching, a swollen mouth or throat);

2 If you have epilepsy (or have had a fit in the past), suffer from depression, kidney or liver disease;

3 If you have sleep apnoea (long intervals between breaths when sleeping);

4 If you have breathing difficulties (eg wheezing or asthma);

5 If you suffer from myasthenia gravis;

6 If you are pregnant, or are planning to become pregnant; or

7 If you are breastfeeding.

Please refer to the manufacturer’s patient information leaflet that comes with your medicine for more information and the full list of side effects and precautions. If you have any questions or concerns about your medicines, or if you are worried about anything you think might be a side effect, ask your doctor, pharmacist or nurse.

This leaflet gives you some information about this medicine. It does not replace the expertise or judgement of a doctor, pharmacist or other healthcare professional. It is not a manufacturer’s patient information leaflet and is not to be taken as a substitute for, or an endorsement of, the manufacturer’s information or advice in respect of any medicine referred to in this leaflet. You might find more information in other leaflets or books, or on the internet but remember, the internet is not always accurate.

Whilst every care has been taken in the compilation of this leaflet, CNWL is not responsible for any loss or damage howsoever caused as a result of any inaccuracy or error contained in this leaflet, including (for the avoidance of doubt) in relation to breach of contract, misrepresentation or negligence whether of CNWL or any other person; but nothing in this leaflet shall exclude or restrict liability for death or personal injury resulting from negligence.

The information given in this leaflet is current as at the publication date.

This leaflet has been written by Central and North West London Mental Health NHS Trust Pharmacy Department, 30 Eastbourne Terrace, London W2 6LA www.cnwl.org – Publication Date: May 2007

Source: http://beh.zedcore.com

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What are tricyclic antidepressants (TCAs) used for?

Tricyclic antidepressants (TCAs) are a group of medicines usually used to help treat people with depression. Medicines are often used to treat more than one condition, so if you are not sure why you have been prescribed a TCA, you should discuss this with your doctor. Types of TCAs are amitryptyline, clomipramine, dosulepin (dothiepin), imipramine, lofepramine, nortriptyline and trimipramine. Your medicine may also have a trade or brand name. This is the name that the manufacturer gives to the medicine, for example Anafranil® is a brand name for clomipramine.

What are the benefits of taking TCAs?

People with depression may feel fed up, unhappy and miserable most of the time, and this usually interferes with their everyday life. This feeling of depression is worse than short periods of unhappiness that people can experience from time to time. Restlessness, agitation and tiredness are common, as well as difficulty in sleeping and loss of appetite. People with depression may also feel hopeless and inadequate, and find it difficult to enjoy life. They may also have thoughts of harming themselves or committing suicide.

TCAs can help to treat these symptoms in people who are unwell, and may also help to keep people well in the longer term. They may also help people to cope better so that they can enjoy life and be able to deal with any problems they may have.

How quickly do TCAs work?

TCAs work over a period of weeks. Some symptoms may start to improve before others, but it may take up to four weeks until they have their full effect. Not everybody benefits from TCAs, but most people do. If you do not feel any benefit after four to six weeks, you should discuss this with you doctor or healthcare worker. Occasionally, thoughts of suicide or self-harm may increase in the first few weeks of treatment until your medicine has taken its full effect. If this happens to you tell your doctor immediately or go to the nearest hospital.

What are the usual doses of TCAs and how should I take them?

Refer to the manufacturer’s patient information leaflet for the TCA that you have been given. TCAs are usually started at low doses that are gradually increased, depending on how you respond to the treatment. The usual doses of some TCAs are given below, but do not change your dose of medication without checking with your doctor, as doing so may affect your response to the medication or be harmful.

• The usual dose of amitriptyline is between 150milligrams (mg) and 200mg daily.

• The usual dose of clomipramine is between 10mg and 150mg daily. The maximum dose is 250mg daily.

• The usual dose of imipramine is between 150mg and 200mg daily. The maximum dose is 300mg daily.

• The usual dose of lofepramine is between 140mg and 210mg daily usually given in two doses.

• The usual dose of nortriptyline is between 75mg and 100mg daily. The maximum dose is 150mg daily.

• The usual dose of trimipramine is between 150mg and 300mg daily.

What should I do if I miss a dose?

You will get the most out of your medication when taken correctly and regularly. If you miss, or forget to take a dose at your usual time, but remember within an hour or two then take it straight away. If it is longer than this just leave out the missed dose. Take the next dose at the usual time. If you miss a few doses you may experience ‘discontinuation’ symptoms (see below). Never take extra medication at the next dose. If you find it difficult to remember taking medication speak to your pharmacist or healthcare worker.

For how long should I take TCAs?

Your doctor will discuss with you the length of treatment, which will vary depending on the type of illness you have. It may be for a few months or longer. TCAs are usually taken for at least six months after you start to feel better. Taking medication regularly may prevent you from becoming unwell again. Your doctor should regularly review your medication to make sure that you do not take medicines for longer than needed. If you stop taking TCAs suddenly you may get unpleasant symptoms called ‘discontinuation’ or ‘withdrawal’. These are usually mild and disappear by themselves, but occasionally can cause problems. TCAs are not addictive.

What are the side effects of TCAs?

As with all medicines there is a risk of unwanted effects (side effects). Some can occur soon after starting treatment so you may experience these before you feel better. Most are temporary and should go away after a few days or weeks. Not everyone will get side effects and many people experience them to different degrees. If you feel that you have side effects that are causing you discomfort, discuss this with your doctor, pharmacist, nurse or healthcare worker. The table on the following page lists some of the main recognised side effects of TCAs but the chance of experiencing each of these side effects will depend on the individual TCA that you have been prescribed.

What about alcohol or ‘street’ drugs?

Both alcohol and TCAs can affect the brain so it is not recommended that you drink alcohol while taking TCAs. Drinking alcohol can cause drowsiness and in combination with TCAs can cause severe drowsiness. Once you are used to taking medication, and know the effects of taking alcohol you may be able to drink occasionally and in small amounts. It is good to be cautious because alcohol affects people in different ways, especially when taking medication.

Do not stop taking your medication because you feel like drinking alcohol. If you drink alcohol, drink only small amounts. Never drink alcohol and drive while taking medication.

‘Street’ drugs (for example, cannabis, ecstasy, speed, heroin and cocaine) may affect your antidepressant treatment. Taking amphetamines, ecstasy and cocaine whilst taking TCAs may increase their toxicity and can cause an abnormal heart rhythm, which potentially can be very serious. Taking cannabis whilst on TCAs can cause tachycardia (a rapid heart beat). There is very little information on taking TCAs with other ‘street’ drugs and so the effect and safety of doing this is unknown. It is best if you do not take any ‘street’ drugs whilst taking TCAs. You may need to get advice and support to help you do this.

What about other medicines?

If you take any other medicines or herbal remedies including any that have been newly prescribed or bought, it is important to check with your doctor or pharmacist that they are safe with TCAs.

When I should be cautious?

It is usually safe to take TCAs regularly, as prescribed by your doctor, but they are not suitable for everyone. If any of the following situations apply to you, you should tell your doctor immediately:

1 If you are allergic to TCAs (if you have taken one before and developed a rash, itching, swollen mouth or throat);

2 If you are taking or have recently been taking medicines called monoamine oxidase inhibitors (MAOIs), used to treat depression;

3 If you have previously had thoughts about harming yourself or committing suicide;

4 If you have diabetes, epilepsy (or have had a fit in the past), suffer from kidney, thyroid or liver disease or heart problems;

5 If you have an eye condition known as glaucoma;

6 If you have phaeochromocytoma (a tumour of the adrenal gland);

7 If you have difficulty passing urine or have an enlarged prostate;

8 If you have episodes of mania (overactive behaviour or thoughts);

9 If you are having electro-convulsive therapy (ECT);

10 If you are an older person and have a history of falls;

11 If you are pregnant, or are planning to become pregnant; or

12 If you are breastfeeding.

Please refer to the manufacturer’s patient information leaflet that comes with your medicine for more information and the full list of side effects and precautions. If you have any questions or concerns about your medicines, or if you are worried about anything you think might be a side effect, ask your doctor, pharmacist or nurse.

This leaflet gives you some information about this medicine. It does not replace the expertise or judgement of a doctor, pharmacist or other healthcare professional. It is not a manufacturer’s patient information leaflet and is not to be taken as a substitute for, or an endorsement of, the manufacturer’s information or advice in respect of any medicine referred to in this leaflet. You might find more information in other leaflets or books, or on the internet but remember, the internet is not always accurate.

Whilst every care has been taken in the compilation of this leaflet, CNWL is not responsible for any loss or damage howsoever caused as a result of any inaccuracy or error contained in this leaflet, including (for the avoidance of doubt) in relation to breach of contract, misrepresentation or negligence whether of CNWL or any other person; but nothing in this leaflet shall exclude or restrict liability for death or personal injury resulting from negligence.

The information given in this leaflet is current as at the publication date.

This leaflet has been written by Central and North West London Mental Health NHS Trust Pharmacy Department, 30 Eastbourne Terrace, London W2 6LA www.cnwl.org - Publication Date: May 2007

Source: http://beh.zedcore.com

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What is IDARS?
“IDARS” is an acronym for the International Drug Abuse Research Society. The purposes of IDARS are scientific, educational and charitable. The Society seeks to promote excellence in: 1) advancing the understanding of drug abuse, substance abuse, and addiction, 2) bringing together scientists of varying backgrounds and disciplines within the field of drug abuse research, 3) integrating drug abuse research directed at all levels of biological organization to improve prevention and treatment efforts, 4) promoting education in the addiction sciences, 5) informing the general public about the results and implications of current research in the addiction sciences.

Who are the members of IDARS?
Members of IDARS are research scientists and clinicians from around the world. The current president of IDARS is Dr. Michael J. Kuhar, Professor of Pharmacology, at the Yerkes National Primate Center of Emory University, in Atlanta, GA. The Executive Officer is Dr. Syed F. Ali, Head, Neurochemistry Laboratory, Division of Neurotoxicology, at the National Toxicological Research Center, Food and Drug Administration, in Jefferson, AR.

IDARS has 3 categories of membership.
Regular Members: Any credentialed research scientist or health professional working in the field of substance abuse may be considered for Regular Membership. Annual dues are $50.
Student and Post-Doctoral Fellow Members: Any post-baccalaureate student matriculated in an advanced degree program, or anyone participating in a post-doctoral training program, in a field related to drug abuse research, may be considered for this category of membership. Annual dues are $20.
Emeritus Members: Upon retirement, any member of IDARS may apply for Emeritus status. In some cases, distinguished scientists will be nominated for Emeritus membership. There are no annual dues for Emeritus members.

The current IDARS Board of Directors:
Peter Dodd, Brisbane, Australia
Francesco Fornai, Pisa, Italy
Carlos Jimenez-Rivera, San Juan, Puerto Rico
Timothy Maher, Boston, MA, USA
Deborah Mash, Miami, FL, USA
Jerrold Meyer, Amherst, MA, USA
Sakire Pogun, Izmir, Turkey
Marcus Rattray, London, UK
Susan Schenk, Wellington, NZ
George Uhl, Baltimore, MD, USA

When does IDARS meet?
IDARS will have annual meetings, where members and non-members alike can share their most recent research data. IDARS plans to hold its first meeting in Spring 2006 in Washington, DC. This year, many members of IDARS will attend a scientific conference entitled, “Cellular and Molecular Mechanisms of Drugs of Abuse and Neurotoxicity: Cocaine, GHB and Substituted Amphetamines”, which will take place from August 16-19, in Venice, Italy. The Venice conference is an official Pre-Satellite meeting of the 20th Biennial meeting of the International Society for Neurochemistry (ISN), held jointly with the European Society for Neurochemistry (ESN).

Worldwide Stimulant Abuse – An Emerging Health Crisis
“Stimulant” drugs produce a spectrum of effects that includes increased energy, cardiovascular stimulation, heightened mood and decreased need for sleep. After high doses or long periods of use, stimulants can produce a range of medical complications including heart attacks, strokes, psychotic episodes and seizures. From a molecular perspective, most stimulants interact with monoamine transporter proteins found on nerve cells. Stimulant drugs can be divided into two classes based on their transporter-mediated mechanisms of action: monoamine transporter blockers (i.e., cocaine) and substrate-type monoamine releasers (i.e., amphetamines) [reviewed in Baumann and Rothman, 2003]. It is noteworthy that many stimulants are useful medications with long histories of safety and efficacy, whereas others are highly addictive substances associated with considerable morbidity and mortality. Illicit stimulants are some of most commonly abused drugs worldwide – during the year 2000, it is estimated that 34.3 million people used amphetamines, 14.1 million used cocaine, and 7.7 million used the amphetamine analog, 3,4,-methylenedioxymethamphetamine (MDMA) [UNODC, 2003]. Such evidence supports the emergence of stimulant abuse as global health crisis.

“Super Coke” In Colombia – It’s the Real Thing!
The abuse of cocaine continues to be a problem in the US and other nations around the world. Colombia remains the number one producer of marketable cocaine hydrochloride and provides more than 80% of global supply. Figure 1 shows the explosive growth in Colombian cocaine production in the past few years. Cocaine alkaloid is extracted from the coca plant, Erythroxylaceae coca, which is cultivated throughout the Andean region (see Figure 2). Recently, anti-drug operatives in Colombia have identified genetically-modified (GM) coca plants that produce yields of cocaine much greater than normal. The “super coke” plants grow to heights of 7-9 ft whereas typical coca plants grow to heights of 3-4 ft. Furthermore, the GM plants are resistant to herbicides and produce up to 5-times more cocaine alkaloid than normal plants. The discovery of transgenic coca plants adds a troubling new dimension to the spread of cocaine abuse.

Few treatments options are available for cocaine-dependent patients, and the development of medications to combat cocaine addiction is a major challenge for biomedical research. IDARS scientists have discovered novel approaches for treating cocaine dependence. Christian Heidbreder and colleagues at Glaxo-Smith-Kline have identified and tested the selective dopamine D3 receptor antagonist, SB277011A as a potential treatment for cocaine dependence [reviewed in Heidbreder and Hagan, 2005]. In animal models, SB277011A blocks the ability of cocaine and stress to induce reinstatement of cocaine-seeking behavior [Xi et al., 2004]. Moreover, SB277011A appears to reduce drug-seeking behavior in general, suggesting that D3 antagonists could have anti-addictive efficacy in the treatment of nicotine, opioid and stimulant dependence.

“Ya-Ba” Da-Ba Doom in Thailand
Similar to the cocaine crisis, the abuse of methamphetamine is increasing in the US and abroad. One of worst epidemics of methamphetamine abuse is occurring in Thailand, where 70% of drug addicts, or 2.5 million people, are dependent upon methamphetamine. Most users ingest a tablet formulation of methamphetamine known as “Ya-Ba”, meaning “crazy medicine”. Figure 3 depicts the typical appearance of Ya-Ba tablets. Nearly all Ya-Ba confiscated in Thailand is produced in the neighboring country of Burma, by the drug-trafficking insurgent group, the United Wa State Army (USWA). USWA and other such groups pose a significant threat to the national security of countries in South East Asia and elsewhere. It is estimated that Burmese methamphetamine production exceeds 800 million tablets per year. Figure 4 shows Thai police prepared to destroy large quantities of confiscated Ya-Ba tablets.

The long-term effects of methamphetamine abuse in humans are not well studied, but in rodents, methamphetamine causes depletions of dopamine and serotonin in the brain. Methamphetamine-induced loss of monoamines could underlie depression and suicidal ideation that often accompany drug withdrawal. Members of IDARS have shown that methamphetamine can cause neurotoxic effects. Francesco Fornai and colleagues at the University of Pisa, in Italy, demonstrated that mice treated with methamphetamine display abnormal dopamine cells in the brain [Fornai et al., 2004a]. The affected cells have intracellular inclusions which resemble those found in Parkinson’s disease and other neurodegenerative disorders. Methamphetamine produces similar inclusions in cultured PC12 cells. While the clinical relevance of these data is uncertain, they suggest that methamphetamine abuse could predispose individuals to neurodegenerative disorders [Fornai et al., 2004b].

Ecstasy in the UK and Beyond: It’s Nothing to Rave About!
The “rave” scene continues to be major source of drug abuse in the UK, throughout Europe, and in the US. In particular, the substituted amphetamine MDMA (Ecstasy, or E) is commonly abused at all night dance parties, or raves. Users often take multiple doses of MDMA at once (i.e., “stacking”) or take supplemental doses of the drug repeatedly during the party (i.e., “bumping”). Figure 5 shows some examples of MDMA tablets. US statistics show that medical complications associated with MDMA use have risen exponentially – MDMA-related emergency room visits increased from 253 in 1994 to 4026 in 2002. Young people continue to experiment with MDMA despite the risk of adverse effects including depression, cognitive disturbances and memory problems. Figure 6 depicts a popular DVD program, “Generation E”, that describes the rave culture and criticizes attempts by the US government to criminalize rave-related activities.

The long-term consequences of MDMA abuse in humans are not well understood, and there is disagreement concerning the reinforcing properties of MDMA in animals and humans. IDARS scientists are exploring the potential addictive properties of MDMA. Susan Schenk and colleagues at University of Wellington, in New Zealand, have developed a novel paradigm where rats learn to self-administer MDMA [Schenk et al., 2003]. Their work shows that MDMA is a positive reinforcer in rats, and prior experience with cocaine engenders more rapid acquisition of MDMA intake. Dopamine appears to be involved in the addictive properties of MDMA, since D1 dopamine receptor antagonists reduce self-administration of the drug [Daniela et al., 2004]. These findings may have implications for the development of treatments for MDMA addiction.

New “Legal Highs” in New Zealand
A number of non-amphetamine designer drugs have appeared on internet websites where they are marketed as “legal Ecstasy”. In particular, the substituted piperazine analogs 1-benzylpiperazine (BZP, or ‘A2’) and 1-(m-trifluoromethylphenyl)piperazine (TFMPP, or ‘Molly’) are increasingly trafficked in the US, Europe, and elsewhere. BZP produces amphetamine-like stimulant effects in humans, suggesting the potential for abuse. Figure 7 shows BZP tablets confiscated by US authorities. The US DEA has moved swiftly to place BZP in Schedule 1 of the Controlled Substances Act, making possession of this substance a criminal offense. In other places, however, BZP is legally available. A significant level of BZP abuse is occurring in New Zealand, where BZP is widely sold over the internet and at “party pill” shops. Figure 8 depicts the Rave.Net.NZ website, a popular site for sharing information about the rave scene in New Zealand.

The pharmacology of BZP, and other substituted piperazines, is not well characterized, but available data suggest that BZP has stimulant properties. Members of IDARS are examining the neurobiological effects of BZP in animal models. Michael Baumann and colleagues at the NIDA IRP have shown BZP interacts with monoamine transporters to release dopamine and serotonin from brain tissue in vitro [Baumann et al., 2005]. Microdialysis studies in rats show that BZP causes elevations in extracellular monoamines that are similar to the effects of methamphetamine. Likewise, self-administration studies in monkeys demonstrate that BZP is a powerful reinforcer with significant abuse liability [Fantegrossi et al., 2005]. The long-term effects of BZP are unexplored and warrant further investigation.

Michael H. Baumann, Ph.D., Staff Scientist, IRP, NIDA, NIH, Baltimore, MD, USA
Chairman, Membership Committee, International Drug Abuse Research Society (IDARS)

References
Baumann MH, Clark RD, Budzynski AG, et al. (2005) Neuropsychopharmacology 30: 550-560.
Daniela E, Brennan K, Gittings D, et al. (2004) Pharmacol Biochem Behav 77: 745-750.
Fantegrossi WE, Winger G, Woods JH, et al. (2005) Drug Alcohol Depend 77: 161-168.
Fornai F, Lenzi P, Gesi M (2004a) J Neurochem 88: 114-123.
Fornai F, Lenzi P, Gesi M (2004b) Ann N Y Acad Sci 1025: 162-170.
Heidbreder CA, Hagan JJ (2005) Curr Opin Pharmacol 5:107-118.
Rothman RB, Baumann MH (2003) Eur J Pharmacol 479: 23-40.
Schenk S, Gittings D, Johnstone M, et al. (2003) Psychopharmacology 169: 21-27.
UNODC (2003) Global Illicit Drug Trends, New York, NY, United Nations Office on Drugs and Crime.
Xi Z, Gilbert J, Campos AC, et al. Psychopharmacology 176: 57-65.

The IDARS reception held at the NIDA International Forum is generously supported by the following sponsors:

Bio-Rad Laboratories
C.A.R.E., Inc., Addiction Treatment Center
G & G Holistic Addiction Treatment, Inc.
Geller and Geller, P.A., Attorneys at Law
Luis and Stavroula Mendez
Novoneuron, Inc., Miami, FL.
Ocean Drive Magazine
Tango Technology

Source: www.idars.org/docs/IDARS-Final.doc

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Factors associated with increased risk for any type of illicit drug use include at least one or more of the following:
Poor parent-child relations. Studies show that living in a stressful home environment with relatively little parental support and monitoring places adolescents at greater risk for drug use.
Family environments that model drug use. Adolescents are more likely to use drugs if someone in their home uses drugs. For example, parents who use drugs may practice poor parenting which may increase the risk of drug abuse for adolescents. Also, parental or sibling drug use sets a model of acceptable inappropriate behavior for teens, makes it seem like a normal part of life, and may encourage its acceptance by youth.
Peer drug use. During adolescence, peers become a major influence because of the increased time spent with them outside of the home. Some teens feel pressured to fit in and do what their friends are doing. Consequently, teens that have friends who use drugs are more likely to use drugs themselves.
High risk communities. Living in communities where drug use is widespread not only makes drug accessibility easier, but also normalizes the act of using drugs.
Low self-esteem. Adolescents who do not have positive views of themselves, or who lack support and encouragement from others are more likely to use drugs.
Poor school achievement. Teens who have negative attitudes toward school and low expectations of academic success are at increased risk of drug use. Also, teens who use drugs typically exhibit declines in grades, and inconsistent attendance at school.
What Are the Consequences?

The effects of drug use vary by type of drug and frequency of use, however, some consequences may include the following:
Mental and physical health problems. Teens who use drugs are at greater risk for developing a number of health problems including attention deficit disorder, anxiety disorders, phobias, and depression.
Increased likelihood of drug use later in life. Early drug use has been linked to positive attitudes toward drug use. Consequently, teens who begin drug use early are at risk for continued drug habits into and through adulthood.
Involvement in other illegal activities. Drug use has been linked to higher tolerance of deviant behavior among adolescents. This results in increased criminal activity for drug users compared to non-drug using peers.
Increased likelihood of death. Drug use increases the odds of death from accidental or intentional drug overdoses as well as engagement in other unsafe behaviors (e.g., driving under the influence).
What Can Parents Do?

Communication is key in dealing with any type of risk taking behavior during the teen years. The hectic pace of work and school can sometimes estrange family members, especially parents and teens. But make the effort to keep in touch with your teen. Find out what’s going on in his or her life. The best way to find out if your teen is using drugs is to just ask. During adolescence, parents may feel that their influence over their teen’s life is waning, but in fact, you have more power than anyone to prevent your child from using drugs. Here are some things that you can do to encourage your child to “Just Say No.”
Stay connected with your teen. Keeping up to date with your teen’s interests and friends is an important step in creating a warm, communicative, and open environment. If your teen feels that you are available and easy to talk to, then he or she will be more likely to share concerns that might lead to risk taking behavior.
Begin an ongoing conversation with your teen (vs. giving a one time speech). Make it clear that drug use is not an acceptable behavior in your family and be sure to talk about the reasons why. Talk about the consequences of drug use. Help your teen visualize two futures, one that includes drug use and one that remains drug free. Where do these paths lead? Discuss your teen’s life goals and how drug use can hinder them from reaching them.
Empower your teen. Teens tend to want to rebel against their parents’ standards or advice. Rather than dictate what your child should or should not do, remind him or her that they have the power of choice and that you trust that they can and will make good decisions.
Teens sometimes abuse substances as a way of alleviating stress. Some experiences in life (e.g., not making the basketball team, breaking up with a girlfriend or boyfriend) are both stressful and painful. Drugs are often sought as a means of temporarily easing pain or stress. Talk to your teen about any stressful events that are going on in his or her life and ways they can effectively handle them.
Know your teen’s friends. You can influence your teen’s choice of peers by talking with them about the qualities that make a good friend.
Encourage your teen’s self-esteem by praising their efforts and achievements. Help them to master the things that they are good at. Show them you care through your involvement in their lives/activities.
Take advantage of teachable moments. These include talking about scenes in movies or news headlines that deal with drug associated topics. Explain your position on these topics and ask your teen how they feel about what they are viewing.
Encourage healthy activities that promote the use of your teen’s interests and talents. Most teens are curious and are eager to try something new and challenging. High school is the peak time for both beginning substance use and beginning lifetime habits that include using illegal substances. Your parental example, support, and monitoring has a great influence on your teen’s behavior. Talk early and often about the consequences of and alternatives to using illicit drugs.
References and Resources
Anthony, J. C., & Petronis, K. R. (1995). Early onset drug use and risk of later drug problems. Drug and Alcohol Dependence, 40 (1), 9-15.
Blum, R. W., & Rinehart, P. M. (1997) Reducing the risk: Connections that make a difference in the lives of youth. Minneapolis, MN: Division of General Pediatrics and Adolescent Health.
Brook, J. S., Brook, D. W., De La Rosa, M., Whiteman, M., Johnson, E., & Montoya, I. (2001). Adolescent illegal drug use: The impact of personality, family and environmental factors. Journal of Behavioral Medicine, 24 (2), 183-203.
Gullotta, T. P., Adams, G. R., & Montemayor, R. (1994). Substance misuse in adolescence. Thousand Oaks, CA: Sage Publications.
Johnston, L. D., O’Malley, P. M., & Bachman, J. G. (2001). Monitoring the future: National results on adolescent drug use. Bethesda, MD: The National Institute on Drug Abuse.
Kipke, M. (1999). Risks and opportunities: Synthesis of studies on adolescence. Washington, DC: National Academy Press.
Kurtzman, T. L., Otsuka, K. N., & Wahl, R. A. (2001). Inhalant abuse by adolescents. Journal of Adolescent Health, 28, 170-180.
Partnership for a Drug Free America: www.drugfreeamerica.org.
The National Crime Prevention Council: www.ncpc.org.
The United States Drug Enforcement Administration: www.usdoj.gov/dea.

FLM-FS-15-02
Urvia McDowell, M.S.,
Ted G. Futris, Ph.D.,
CFLE, Extension State Family Life Specialist and Assistant Professor,
Department of Human Development and Family Science, The Ohio State University
Source: http://ohioline.osu.edu/flm02/FS15.html

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