Substance use, also known as drug use, is a patterned use of a substance (drug) in

which, “the user consumes the substance in amounts or with methods which
are harmful to themselves or others”
Substance usage is often linked to altered judgment, perception, attention, &
physical control, unrelated to medical effects.
Misuse of drugs leads to tolerance, dependence, addiction, & withdrawal symptoms.
Commonly abused psychoactive substances impacting CNS function are,
alcohol, nicotine, tranquilizers, amphetamines, heroin, Ecstasy, & marijuana.

Substance Related Disorders:

Cluster of cognitive, behavioral, & physiological symptoms indicating that individual
continues using substance despite sig. substance-related problems.
Divided into 2 groups:
Substance use disorders & Substance-induced disorders.
Following conditions may be classified as substance-induced, intoxication, withdrawal,
& other substance/medication-induced mental disorders

Alcohol Related Disorders

Definition:
“drinking that causes detrimental health & social consequences for drinker, the
people around the drinker and society at large, as well as the patterns of
drinking that are associated with increased risk of adverse health outcomes”.

falls under the category of Depressants, which primarily decrease central

nervous system activity.

causes both acute & chronic changes in almost all neurochemical systems.

5 types of Alcohol Related Disorders (as per DSM V)

Alcohol Use Disorder
Alcohol Intoxication
Alcohol Withdrawal
Other Alcohol-induced Disorders
Unspecified Alcohol-Related Disorder
Effects of Alcohol:

Biological Effects of Alcohol:

Activation of brain's pleasure areas, releasing endogenous opioids at lower levels.
Depression of brain functioning at higher levels, inhibiting excitatory NT glutamate,
impairing learning, judgment, self-control.
Induction of warmth, expansiveness, & well-being, screening out unpleasant realities,
boosting self-esteem.
Decline in motor coordination & dulled perception of discomforts.

Physiological Effects of Alcohol:

Liver overwork & potential irreversible damage due, especially with excessive intake.
High cal. content without nutritional value, impairing nutrient utilization, leading
to potential malnutrition.
Increased gastrointestinal symptoms such as stomach pains in alcohol abusers.
Withdrawal symptoms like hand tremors, nausea, vomiting, anxiety, hallucinations,
agitation, insomnia, and potentially withdrawal delirium.

Psychosocial Effects of Alcohol:

Chronic fatigue, oversensitivity, & depression in heavy drinkers.
Initial perception of alcohol as coping mechanism for life stressors, enhancing
feelings of adequacy.
Coarse & inappropriate behavior, neglect of responsibilities, personal appearance,
family---->irritability & avoidance of discussing problem.
Counterproductive consequences: legal, conduct problems, strained relationships,
financial, employment, & educational repercussions, organ changes, persistent
insomnia, hopelessness, anxiety, anger, resentment, & intense fears.

Alcohol Use Disorder

Defined by cluster of bhvral & physical symptoms, which can include withdrawal,
tolerance, & craving.
withdrawal from ! can be unpleasant & intense, individuals may continue to
consume ! despite adverse consequences, often to avoid or to relieve withdrawal
symptoms
Once pattern of repetitive & intense use develops, individuals with ! use disorder
may devote substantial periods of time to obtaining & consuming ! beverages.

Diagnostic Criteria

A problematic pattern of ! use leading to clinically sig. impairment or distress, as

manifested by at least 2 of the following, occurring within a 12-month period:
! is often taken in larger amounts or over a longer period than was intended.
There is persistent desire or unsuccessful efforts to cut down or control ! use.
 A great deal of time is spent in activities necessary to obtain !, use !, or
recover from its effects.
Craving, or a strong desire or urge to use !.
Recurrent ! use resulting in a failure to fulfill major role obligations at
work, school, or home.
Continued ! use despite having persistent or recurrent social or interpersonal
problems caused or exacerbated by the effects of !.
Imp. social, occupational, or recreational activities are given up or reduced because
of ! use
Recurrent ! use in situations in which it is physically hazardous.
! use is continued despite knowledge of having persistent or recurrent physical
or psychological problem that is likely to have been caused or exacerbated by !.
Tolerance, as defined by either or both of the following:
A need for markedly increased amounts of ! to achieve intoxication or
desired effect.
A markedly diminished effect with continued use of the same amount of !.
Withdrawal, as manifested by either of the following:
The characteristic withdrawal syndrome for !
! (or a closely related substance such as benzodiazepine) is taken to relieve
or avoid withdrawal symptoms.

Specifiers
Early remission: no AUD criteria met for at least 3 but less than 12 months.
Sustained remission: no AUD criteria met during 12 months or longer since they last
did.
Controlled environment: if individual's access to alcohol is restricted.
Severity: Mild (2-3 symptoms); Moderate (4-5 symptoms); Severe (6 or more
symptoms).
Case Study

Mark, 45-year-old divorced man, examined in a hospital E.R because he had been confused &
unable to care for himself last 3 days. His brother, reported that patient has consumed
large quantities of 5 ! & fourth of a " daily for more than 5 years post his divorce 5
years prior. M often experienced blackouts from drinking & missed days of work. As a result,
Mark has lost several jobs in the past 5 years. 3 days earlier he ran out of # & ! and
resorted to panhandling on streets for # to buy $. Mark had been poorly nourished,
having 1 meal per day at best & was evidently relying on ! as his prime source of
nourishment. Mark alternates b/w apprehension & chatty, superficial warmth. He is pretty
keyed up & talks constantly in a rambling & unfocused manner. His recognition of physician
varies, sometimes believing doctor to be his other brother who lives in another state. He has
a gross hand tremor at rest & is disoriented to time. He believes he's in a parking lot
rather than a hospital. Efforts at memory & calculation testing fail because Mark's
attention shifts so rapidly.
Onset & Course

1st episode of ! intoxication is likely to occur during mid-teens.

age at onset of an AUD meeting 2 or more criteria peaks in late teens or early to
mid-20s.
large majority of individuals who develop !-related disorders do so by their late
30s

Variable course characterized by periods of remission & relapse.

Epidimiology

12-month prevalence of AUD is estimated to be 4.6% among 12-17 year-olds &

8.5% among adults age 18 years and older"
12-month prevalence of AUDs in # in the year 2010 was 2.6%.

Environment: Cultural attitudes, alcohol availability, stress, & peer influence impact
! issues.
Genetics: contribute 40-60% to AUD risk, with specific markers indicating varying
susceptibility.
Behavioral Impact: High impulsivity often leads to an earlier & more severe onset
of AUD

Males have higher rates of drinking & related disorders.

Females can reach higher blood alcohol levels per drink than males.
Heavy drinking in females may lead to increased vulnerability to certain alcohol-
related physical consequences, like liver disease.

Differential Diagnosis
Non pathological use of !: Heavy ! use causing distress or impaired functioning is
the key feature.
Sedative, Hypnotic, or Anxiolytic Use Disorder: course may differ, particularly
concerning medical issues.
Conduct Disorder & Antisocial Personality Disorder: AUD commonly coexists with other
substance use disorders in individuals with pre-existing conduct disorder or
antisocial personality disorder.

Comorbidity
majority of individuals with antisocial personality & pre-existing conduct disorder.
may suppress immune mechanisms & predispose individuals to infections & increase
the risk for cancers.
Other comorbid disorders are mood & anxiety disorders.
Alcohol Intoxicaton

Diagnostic Criteria

Recent ingestion of alcohol.

Clinically sig. problematic behavioral or psychological changes (inappropriate sexual

or aggressive behavior, mood lability, impaired judgment) that developed during, or
shortly after, ! ingestion.

One (or more) of following signs or symptoms developing during, or shortly after,
! use:
Slurred speech.
Incoordination.
Unsteady gait.
Nystagmus.
Impairment in attention or memory.
Stupor or coma.

The signs or symptoms are not attributable to another medical condition & are not
better explained by another mental disorder, including intoxication with another
substance.

Alcohol Withdrawal

Diagnostic Criteria

Cessation of (or reduction in) ! use that has been heavy & prolonged.

2 (or more) of following, developing within several hours to a few days after the
cessation of (or reduction in) ! use described in Criterion A:
Autonomic hyperactivity
Increased hand tremor.
Insomnia.
Nausea or vomiting.
Transient visual, tactile, or auditory hallucinations or illusions.
Psychomotor agitation.
Anxiety.
Generalized tonic-clonic seizures.

The signs or symptoms in Criterion B cause clinically sig. distress or impairment in

social, occupational, or other important areas of functioning.
Same as earlier D

Specifier:
With perceptual disturbances: when hallucinations occur with intact reality testing,
or auditory, visual, or tactile illusions occur in absence of a delirium.

Other Alcohol Induced Disorders

!-induced disorders in DSM-5 mirror independent m. disorders but arise temporarily
after severe ! intoxication or withdrawal.
Diagnosed distinctly when symptoms reach a severity necessitating separate clinical
attention.
Included !-induced disorders cover psychotic, bipolar, depressive, anxiety, sleep,
sexual dysfunction, & neurocognitive disorders.

ETIOLOGY
Biological & Genetic Factors
Neurochemical Changes & Tolerance: Continued exposure leads to neuroadaptation,
causing tolerance & requiring increased substance intake for same effect. This can
lead to dependence.
MCLP & Genetic Influences: Genetic & epigenetic alterations in reward-related
brain circuits, like MCLP, play role in AUD development. ! triggers dopamine release
in this area, reinforcing its use.
Genetic Vulnerability: Heredity sig. influences sensitivity to !'s addictive properties.
Individuals with ! bio. parents have higher risk of AUD. Genetic predispositions
might exhibit different physiological responses, like greater stress reduction post-
alcohol ingestion.
Ethnic Differences: Certain ethnicities experience abnormal reactions to !, impacting
their susceptibility to AUD.
Family & Adoption Studies: These studies distinguish b/w familial & non-familial
, highlighting genetic link in some cases. Children with biological parents,
particularly fathers, are more prone to addiction.
Subtypes of Addiction: Research suggests the existence of subtypes (group A and
group B) within addiction, akin to type I & type II , with implications for
understanding its development.

Psychological
Learning Theories:
Modeling: Individuals imitate bhvr, especially from same-gender parents, contributing
to habits like ! consumption.
O.C: ! alleviates -ve emotions, leading people to use it as a coping mechanism.
 !

B.C: Environmental cues in places where alcohol is consumed trigger similar effects,
reinforcing alcohol consumption habits.

Psychodynamic Factors:
Defense Mechanism: Psychodynamic theories attribute AUD to defense against anxious
impulses or oral regression, recently linking substance use to coping with reality.
Self-Medication & Cycles of Addiction Motivation: Individuals turn to ! to control
panic or emotional turmoil, seeking control, relief, & attachment needs through
substance use.

Psychological Vulnerability:
Schizophrenia often coexists with ! or drug abuse. Antisocial personality disorder
correlates with ! misuse & increased aggression. Depressive disorders show potential
gender-specific associations with ! abuse.

Stress, Tension Reduction, & Reinforcement:

Tension Reduction & AUD: Tension reduction through ! use can lead to AUD,
regardless of specific life stressors.
Association with Trauma & PTSD: ! consumption correlates strongly with -ve
affectivity. Trauma history, especially among certain demographics like American
Indian adolescents, increases vulnerability to substance abuse.

Social

Inadequacies in Parental Guidance:

Parenting Influences: Both !-specific & non-!-specific factors influence
development of ! abuse in children.
Non-!-Specific Factors: Inadequate parenting patterns fostering aggression raise
risk of ! linked to antisocial personality disorder. Other non-!-specific family
influences contribute to alcoholism emerging after the onset of depression.

Anticipations of Achieving Social Success:

Adolescents' beliefs that ! use enhances popularity & acceptance influence
drinking bhvr . Older college students tend to show reduced expectations regarding
! benefits compared to newer students.

Family Relationship Factors:

Studies highlight 6 crucial family relationship factors predisposing individuals to
substance use issues, including parental , marital discord, inadequate maternal
supervision, & lack of family cohesion.
 DRUG ABUSE & DEPENDENCE

Psychoactive drugs most commonly associated with abuse & dependence in society
appear to be most common during adolescence & young adulthood
behaviour patterns vary markedly depending on type, amount, & duration of drug
use; on physiological & psychological makeup of individual; &, in some instances, on
social setting in which drug experience occurs.

OPIATES: MORPHINE & HEROIN

Opium is a mixture of about 18 chemical substances known as alkaloids.

History:
1805: Bitter alkaloid discovered, constituting 10-15% composition, identified as
potent sedative & pain reliever,named "morphine" after god of sleep, Morpheus.
Concerns arose over morphine's addictive potential, prompting research into its
molecule's distinct components
Morphine treatment with acetic anhydride led to creation of heroin, a faster, more
intense, & equally, if not more, addictive analgesic.
Heroin's heightened dangers led to its discontinuation from medical use.

Mode of Consumption:
Commonly introduced into body by smoking, snorting, eating, "skin popping," or
"mainlining,"
Skin popping is injecting liquefied drug just beneath skin, while mainlining is
injecting drug directly into bloodstream

Effects:

Immediate effects of include an intense euphoria lasting around 60 seconds, akin

to a sexual orgasm, alongside potential vomiting & nausea.
Following it, addicts experience a high, characterized by lethargy, withdrawal,
reduced bodily needs & dominant feelings of relaxation & euphoria, lasting 4-6
hours. Leads to a subsequent -ve state, prompting desire for more of drug.
Prolonged use leads to drug craving, typically established within 30 days of
continual use, resulting in physical illness when not taken.
Tolerance builds up over time, necessitating larger drug doses to achieve desired
effects.
Withdrawal symptoms emerge around 8 hours after the last dose.
Withdrawal from heroin varies in danger & pain, with some managing withdrawal
independently. For others, withdrawal can be agonizing
Symptoms may worsen over time, including chills, flushing, excessive sweating,
vomiting, diarrhea, abdominal cramps, back & limb pains, severe headache, tremors,
insomnia, and potential hallucinations, or manic activity.
Severe dehydration and weight loss occur due to refusal of ! & ", compounded
by vomiting, sweating, & diarrhea. Cardiovascular collapse may result in death.
Administering morphine temporarily relieves addict's distress & restores
homeostasis.
Withdrawal symptoms usually subside within 7-8 days, during which one gradually
resumes normal eating & regains lost weight.
Post-withdrawal, reduced drug tolerance poses a risk of overdose when taking the
previous high dosage.

Opiate addiction often leads to a life revolving around drug acquisition & use,
resulting in socially maladaptive behavior such as lying & stealing to sustain it.
Addicts resort to theft & sometimes prostitution to finance their addiction.
Addiction undermines ethical & moral restraints & disrupts immune system, leading
to ill health & increased susceptibility to various ailments due to inadequate diet &
lifestyle factors.
Unsterile equipment usage can cause liver damage (hepatitis) & transmission of
diseases like AIDS; fatal overdoses can occur due to impure or excessively potent
drugs.
Pregnant women addicted to heroin risk dire consequences for their unborn children,
including premature births & heroin addiction in infants, making them vulnerable
to diseases.
Opiate addiction gradually deteriorates well-being, not solely due to drug's effects
but also from sacrifices in money, diet, social position, & self-respect in pursuit of
daily dosage
Opioid abuse significantly increases risk of other mental health issues, substance
abuse, & a history of trauma.

SEDATIVES: BARBITURATES

Once widely used by physicians to calm patients & induce sleep.

Act as depressants to slow down action of CNS & sig reduce performance on
cognitive tasks.
Legit medical uses, they are extremely dangerous drugs commonly associated with
both physiological & psychological dependence & lethal overdoses.
Effects:
Barbiturates, known as "downers," induce feeling of relaxation, alleviating tension
shortly after consumption. (varies based on type & quantity taken.)
Higher doses can induce immediate sleep, while excessive amounts can be fatal due
to respiratory center paralysis in brain.
Effects include impaired decision-making, slowed speech, mood swings, sluggishness,
& diminished problem-solving abilities.
Excessive use leads to increased tolerance & physiological as well as psychological
dependence.
Barbiturate abuse can result in brain damage & deterioration of personality.
Unlike opiates, tolerance build-up for barbiturates doesn't prevent fatal overdose,
making accidental or intentional overdoses easily achievable by users.

Stimulants:
They stimulate the action of the CNS (speed it up).

COCAINE

Cocaine is a plant product discovered in ancient times & used ever since
"Crack" is street name applied to cocaine that has been processed from cocaine HCL
to a free base for smoking.

Mode of Consumption:
Cocaine may be ingested by sniffing, swallowing, or injecting.

Effects:

Short-term effects:
Cocaine primarily functions by obstructing presynaptic dopamine transporter,
amplifying dopamine levels in the synapse and stimulating the receiving cells.

Long-term effects:
Both acute & chronic tolerance often develop with prolonged cocaine use.
Cog. impairment linked to cocaine abuse becomes a sig. concern regarding its long-
term impact.
Psychological, employment, familial, & legal issues are more prevalent among cocaine
& crack users compared to non-users.
Financial requirement to sustain habits contributes to many life problems faced by
cocaine abusers.
Pregnant women using cocaine expose babies to health & psychological risks. Infants
born to crack-using mothers face potential maltreatment & heightened risk of
losing their mothers during infancy.
AMPHETAMINES

History:
1927-1930s: Benzedrine, or amphetamine sulphate, was the earliest amphetamine
synthesized & made available in drugstores by early 1930s as a nasal inhalant
for relieving congestion.
Late 1930s: Intro. of 2 newer amphetamines - Dexedrine & Methedrine ("speed").
Methedrine, more potent stimulant was recognized as more dangerous & capable of
causing lethal outcomes.
Initially hailed as "wonder pills," these were believed to enhance alertness, sustain
wakefulness, & temporarily elevate functional capabilities beyond normal levels.

Uses:
Medical Purposes: used medically for appetite suppression, narcolepsy, ADHD, mild
depression, fatigue relief, & sustaining alertness.
Illicit Use: Despite their medical applications, amphetamines are widely abused &
commonly obtained from illegal sources globally.

Effects:
Resource Drain: They don't provide extra energy but push users toward exhausting
their resources, leading to hazardous fatigue.
Addictive & Tolerance: Psychologically & physically addictive, they lead to rapid
tolerance buildup, causing users to consume lethal amounts.
Physical Symptoms: Excessive consumption results in heightened bp, enlarged pupils,
rapid speech, sweating, tremors, excitability, appetite loss, confusion, & sleeplessness.
Injected in large quantities, Methedrine can be fatal.
Chronic Abuse Effects: Long-term abuse can lead to brain damage & psychological
issues like "A psychosis," resembling paranoid schizophrenia. Violence-related incidents
are associated with amphetamine abuse.
Withdrawal & Dependence: Withdrawal is usually safe, but dependence might affect
treatment. Abrupt withdrawal can cause cramping, nausea, diarrhoea, & even
convulsions.
Depression & Long-term Effects: Abrupt abstinence leads to weariness & depression. D
peaks in 48-72 hours & diminishes gradually but may persist for weeks or months.
Brain damage might result in concentration, learning, & memory impairments,
leading to social, economic, & personality deterioration

CAFFEINE & NICOTINE

In DSM-5, addictions to caffeine and nicotine, though not as extreme, can lead to
sig physical & mental health issues in society due to various reasons:
Ease of Abuse: These are highly addictive & easily accessible, often encountered
early in life.
Widespread Availability: They are readily available, making it challenging to resist
societal pressures for their use.
Addictive Nature: Both exhibit addictive properties, leading to a regular craving for
consumption.
Difficulty in Quitting: Their addictive traits & integration into social contexts make
it hard to cease usage.
Withdrawal Challenges: Dealing with withdrawal symptoms while attempting to quit
often causes frustration due to intensity of symptoms.

Caffeine
Caffeine, commonly found in various foods & drinks, is
widely consumed & socially promoted in contemporary
society.
Excessive intake of caffeine can lead to intoxication, causing
symptoms like restlessness, nervousness, excitement, insomnia,
muscle twitching, & gastrointestinal complaints.
Withdrawal from caffeine typically results in mild symptoms, with headaches being
primary complaint.
DSM-5 outlines caffeine disorder, triggered by ingestion of caffeine-containing
substances like coffee, tea, cola, & chocolate.
Individual thresholds for caffeine intoxication vary, with diff. amounts affecting
different individuals.

Nicotine
Nicotine, active ingredient in tobacco, is a poisonous alkaloid present in cigarettes,
chewing tobacco, & cigars, & also used as an insecticide.
Nicotine dependence usually begins in adolescence, continuing into adulthood as a
challenging & health-threatening habit.
Nicotine use is prevalent among individuals with anxiety disorders, possibly due to
its observed antianxiety effects.
DSM-5 identifies "tobacco withdrawal disorder" resulting from reduced or ceased
nicotine intake after developing physical dependence.
Withdrawal symptoms include craving, irritability, anxiety, concentration difficulties,
restlessness, decreased heart rate, increased appetite or weight gain, decreased
metabolic rate, headaches, insomnia, tremors, increased coughing, & impaired
performance on attention-requiring tasks.
These typically persist for several days-weeks based on intensity of nicotine habit.
Some experience lingering cravings for months after quitting, but like other
addictions, withdrawal symptoms gradually diminish over time as drug intake stops.

HALLUCINOGENS
Drugs that are believed to induce hallucinations, distorting sensory perceptions to
make individuals see or hear things in altered and unconventional ways.
These substances, often termed psychedelics, include LSD or "acid," mescaline,
psilocybin, Ecstasy, and marijuana.
Let Him Cook
LSD

most potent of hallucinogens, odourless, colourless, &

tasteless drug LSD (lysergic acid diethylamide).
chemically synthesized substance 1st discovered
by Swiss chemist Albert Hofmann in 1938.

Mode of Consumption:
Most often sold & consumed via tiny sheets of blotter paper containing few
micrograms of drug, which is ingested by letting paper dissolve on tongue.

Effects:

Short-term effects:
Typically, after ingesting LSD, person experiences around 8 hours of altered sensory
perception, mood swings, & sensations of detachment & depersonalization.
LSD experience can be intense & may induce traumatic feelings due to distorted
perceptions of objects, sounds, colors, & intrusive thoughts.

Long-term effects:
Rare phenomenon that might occur post-LSD use is "flashback," an involuntary
recurrence of perceptual distortions or hallucinations weeks or months later.
Flashbacks are infrequent among those who've used LSD occasionally, & extended
effects on visual function, including reduced sensitivity to light in dark env., have
been observed up to 2 years after LSD use.

ECSTASY

Ecstasy, or MDMA (3,4-methylenedioxymethamphetamine), is both a hallucinogen & a

stimulant that is popular as a party drug among young adults.
It has been used increasingly among college students & young adults as a party
enhancement or "rave" drug at dances.

History:
MDMA, originally patented by Merck in 1914, was initially intended for sale as a
diet pill. However, due to its side effects, company chose not to market it.
Subsequently, during 1970s & 1980s, it underwent further evaluation & testing.
Researchers explored its potential as medication for treatments targeting various
conditions including PTSD, phobias, psychosomatic disorders, depression, & suicidal
tendencies.
Effects:

Instant or Temporary Effects:

Typically, around 20 mins. after consumption, Ecstasy users feel a "rush" followed by
sensations of calmness, energy, & well-being.
The effects can last for several hours, during which users often report heightened
sensory experiences, mild hallucinations, & increased energy levels.
It's generally considered less addictive than cocaine.
Common adverse effects include nausea, sweating, teeth clenching, muscle cramps,
blurred vision, & hallucinations.

Long-term Effects & Consequences:

Recreational use of Ecstasy has been linked to impulsivity & poor judgment.
Users are often associated with concurrent use of marijuana, binge drinking, smoking,
& engaging in multiple sexual partners.
While some use it to stay awake in social, it's also connected to -ve psychological &
health outcomes, including death.
Reported cases include panic disorder & prolonged psychosis after 1-use instances.
Memory impairment, obstructive sleep apnea, & severe organic brain problems have
been documented.
Long-term users have shown moderate memory loss compared to controls, as per a
study by Schilt et al. in 2010.

MARIJUANA

Marijuana comes from leaves & flowering tops of hemp plant,

Cannabis sativa, which grows in mild climates throughout the
world.

Mode of Consumption:
Marijuana is primarily made of dried green leaves & is commonly smoked in
cigarettes or pipes. In some cultures, it's brewed into a tea-like drink.
Hashish, a stronger form of cannabis, is derived from the plant's resin & made into
a gummy powder, primarily smoked.
While marijuana can be classified as mild hallucinogen, there are notable variations
in nature, intensity, & duration of its effects compared to potent hallucinogenic
drugs like LSD or mescaline.

Effects:

Short-term Effects
Inhaled marijuana creates a mild state of euphoria, enhancing feelings of well-
being, perception, & relaxation.
Alters internal clock, distorting one's sense of time.
Affects short-term memory, leading to instances of forgetfulness.
Reported enhancement of pleasurable experiences, including sexual intercourse.
Effects appear rapidly, within seconds to mins, but typically last 2-3 hours.
Can be used to relieve pain or nausea.
Physiological effects include increased heart rate, slowed reaction time, smaller
pupil size, bloodshot & itchy eyes, dry mouth, & increased appetite.
Induces memory dysfunction & slows information processing.

Long-term effects
Prolonged, heavy use can lead to lethargy, passivity, & reduced life success.
Long-term effects are still being studied, but heavy marijuana use is associated with
several adverse side effects.
Higher dosages can induce extreme euphoria, hilarity, overtalkativeness, anxiety,
depression, delusions, hallucinations, & psychotic-like experiences.
Daily use is linked to occurrence of psychotic symptoms.
Some report withdrawal-like symptoms such as nervousness, tension, sleep problems, &
changes in appetite when abstaining from marijuana.
Marijuana has been distributed for pain/nausea relief in medical conditions like
cancer, AIDS, glaucoma, multiple sclerosis, migraines, & epilepsy. Proponents suggest its
value in these treatments may align with other forms of drug treatment without
adversely affecting outcomes.