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This Is Your Brain on Drugs

Read Time: 20 minutes

Readers of a certain age might remember the public service announcements from the late 1980s showing a frying egg with the tagline: “This is your brain on drugs.” Although these commercials were effective at delivering the message that drugs are harmful to the brain, the comparison is very simplistic, and some consider it no more than a “scare tactic”.1

For many people, addiction can be difficult to understand. After all, why do people risk so much, perhaps even their own lives, just to get high? Understanding how drugs affect the brain can help shed some light on this mystifying behavior.

Rather than “frying” all of the brain’s circuits at once, most drugs have very specific effects on the way the brain functions. This article is a brief survey of how various drugs affect the chemistry of the brain. This will help reveal why even though someone who is high on cocaine acts very differently than someone who is abusing heroin, both individuals may find it close to impossible to give up their drug habit, even if they desperately want to.
To understand how different drugs—with their diverse mechanisms of action and varied effects—can all lead to addiction in those who abuse them, it helps to know a little bit about how the brain works.

Neurotransmitters: the Messengers of the Brain

The brain is the most complex organ in the human body2 and has even been called “the most complex object in the known universe”.3 Around 100 billion individual nerve cells, or neurons, form a complex network that has over 100 trillion (100,000,000,000,000) connections, or synapses.
Information travels around this network 24 hours a day, allowing the brain to direct all the conscious and unconscious activities in the body. Everything from composing a symphony to deciding what to eat for dinner requires complex calculations carried out in the brain.

The brain uses chemicals called neurotransmitters to carry information from one neuron to another at junction points known as synapses. Neurotransmitter signaling is a crucial part of all the brain’s functions, and changes in neurotransmitter signaling can alter the way people think, feel, or perceive the world around them.

Important neurotransmitters in the human brain include:

  • Endorphins.
  • GABA.
  • Glutamate.
  • Norepinephrine.
  • Dopamine.
  • Serotonin.

Messages in the brain usually travel from the presynaptic neuron to the postsynaptic neuron. This occurs when the presynaptic neuron releases neurotransmitters into the synapse, which then attach to special proteins on the surface of the postsynaptic neuron called receptors.

Brain Synapse diagram Neurotransmitters and receptors fit together in specific combinations like a lock and key. Other specialized proteins, called transporters, move neurotransmitters from the synapse back inside the neuron to turn off signaling.

Medications and illicit drugs that affect the brain alter neurotransmitter signaling in several different ways:

  • Imitating neurotransmitters—Drugs like opiates and marijuana have chemical structures that are similar to natural neurotransmitters. Because they fit into the receptors, these drugs act like neurotransmitter “imposters”.
  • Causing neurotransmitter release—Drugs like methamphetamine cause neurons to release neurotransmitters into synapses when they would normally be inactive.
  • Preventing neurotransmitter signals from switching off—Certain drugs, like cocaine and many antidepressants block transporters so that neurotransmitters stay in the synapse and continue to activate receptors longer than normal.

All of the different ways drugs affect neurotransmitters have the effect of changing the information being processed by the brain. Drugs prescribed by a doctor, such as painkillers or antidepressants, can be used to “correct” imbalances in brain chemistry that may contribute to an individual experiencing physical or emotional distress. On the other hand, those who abuse drugs are altering the way their brains work in ways that may be temporarily pleasurable, but potentially dangerous in both the short- and long-term.

Drugs Hijack Communication in the Brain

The brain is a finely tuned machine, and individuals who abuse drugs upset its delicate balance. These outside chemicals can flood or supplant the brain’s natural circuitry, resulting in effects ranging from confusion to death. Several classes of drugs and the neurotransmitter systems they affect are described below.

Stimulants

Stimulant use between 2015 &2016

Stimulants are drugs that increase the activity of a few specific neurotransmitters in the brain. Prescription stimulant medications are mainly used to treat attention deficit hyperactivity disorder (ADHD) and narcolepsy. They function similarly to the illicitly abused stimulants like methamphetamine and cocaine, though, and all ultimately result in increased levels of the neurotransmitter dopamine in the brain. Stimulants are also sometimes referred to as “speed,” “uppers,” or “study drugs”. Well-known prescription stimulants include:

  • Methylphenidate (Ritalin).
  • Amphetamine + Dextroamphetamine (Adderall).
  • Lisdexamfetamine (Vyvanse).

Common illicitly abused stimulants include:
  • Methamphetamine (crystal meth).
  • Cocaine.

In the brain, dopamine is involved in several important behaviors including:
  • Arousal (the state of being awake or alert)—Boosting dopamine levels increases energy, wakefulness, and attention while decreasing dopamine causes fatigue and drowsiness.
  • Motor (movement) control—The death of dopamine-producing neurons in patients with Parkinson’s disease causes symptoms such as shaking, stiffness, and difficulty walking.
  • Reward and motivation—Activities that promote survival including eating food, having sex, socializing with friends, or hugging a puppy, all increase dopamine levels in the brain’s reward circuitry.

Dopamine is an important neurotransmitter for keeping people awake, focused, motivated, and coordinated. However, when someone abuses stimulants, the unnaturally elevated levels of dopamine in their brain can cause hyperactivity, insomnia, anxiety, increased risk taking, and euphoria.

Also, because these drugs unnaturally stimulate the brain’s reward and motivation circuitry, they are often abused in a “binge” pattern. In a binge, individuals will consume all of the available stimulants in one sitting, often neglecting eating or sleeping. Because the brain’s reward center is more strongly activated by stimulants than normal, healthy activities, the brain prioritizes drug use over almost any other behavior.

Opioids

Graphic of opioid use between 2013&2016Opioids are a group of natural and synthetic drugs that activate opioid receptors in the brain, spinal cord, and digestive tract. Opioid medications are also known as opiates or narcotics and are used as painkillers, cough suppressants, and anti-diarrhea medications. Well known opioids include:

  • Heroin.
  • Morphine.
  • Oxycodone (OxyContin).
  • Percocet.
  • Hydrocodone.

Normally, opioid receptors are activated by chemicals called endorphins. Endorphins are produced naturally in the brain and pituitary gland when the body is exposed to pain or other stressors such as an injury, childbirth, or intense exercise (runner’s high). In the brain, endorphin signaling has several roles, including:

  • Altering pain perception—Opioid signaling reduces pain sensations centrally – mitigating pain signaling within the brain without affecting the injury itself. This is different from many over-the-counter pain relievers such as aspirin or ibuprofen, which reduce swelling and inflammation at the site of the injury to achieve their analgesic effects.
  • Producing feelings of wellbeing—Endorphins cause more dopamine to be released in the reward and motivation circuits of the brain, which produces positive feelings. Opioid drugs mimic these endorphins but cause much more dopamine release in the reward pathways, creating a strong euphoric high.
  • Decreasing respiration—There are many opioid receptors in the areas of the brain stem that unconsciously control breathing. Endorphin signaling in these neurons helps to slow breathing in situations that might otherwise lead to hyperventilation – such as feeling pain or being under stress. Because opioids can activate these receptors more strongly than endorphins, individuals who overdose on these drugs could stop breathing and die.

The brain’s system of endorphins and opiate receptors is a survival tool that helps people in dangerous situations from being overcome by pain or fatigue. Medically, opioids are an important treatment for people who have severe pain that cannot be controlled with other medications.

Individuals who abuse illicit or prescription opioids do so because these drugs have unnaturally large effects on the opioid system, including the reward pathway. Because opioid use can initiate much higher dopamine release in the nucleus accumbens rather than endorphins, they produce a euphoric high that is difficult to achieve through natural means.
Brain reward pathways

By simply swallowing, snorting, or injecting these drugs, abusers can get all the feel-good effects of endorphins without having to break a bone or run a marathon. Also, because opioid users can control how much and how often they take the drug, they can get a more intense, longer-lasting high than is possible with natural endorphins.

Depressants

Depressent use comparison between 2015&2016

Many different types of legal and illegal drugs are classified as depressants. Dependent on the specific type of depressant medication, the prescription pharmaceuticals in this broad class may also be referred to as sedatives, tranquilizers, and hypnotics.

Substances classified as depressants include:

  • Phenobarbital (Luminal, goof balls).
  • Amobarbital (blue devils).
  • Secobarbital (Seconal, red devils).
  • Tuinal (Secobarbital + Amobarbital, rainbows)

Benzodiazepines—Also known as benzos, these drugs are used to treat anxiety and panic attacks, as well as to manage acute seizures in emergency situations. Examples include:

  • Diazepam (Valium).
  • Alprazolam (Xanax).
  • Lorazepam (Ativan).

Non-benzodiazepine sedatives—Often referred to as “z-drugs” because many of the drug names begin with the letter “z,” these medications are considered to be safer (milder effects and lower addictive potential) than benzodiazepines and are used to treat insomnia. Examples include:

  • Zolpidem (Ambien).
  • Eszopiclone (Lunesta).
  • Zaleplon (Sonata).

Although these different drugs are very different chemically, all of them ultimately increase the activity of a neurotransmitter known as gamma-aminobutyric acid (GABA). Alcohol, barbiturates, and benzodiazepines all bind at different sites on the surface of the GABA receptor to activate this type of inhibitory signaling.

Activated GABA receptors inhibit, or decrease, the firing of individual neurons, and GABA signaling is critical to maintaining a healthy level of brain activity. Insufficient levels of GABA can cause restlessness, insomnia, anxiety, and seizures due to abnormally high levels of neural overactivity.

Many people abuse sedatives because they reduce anxiety, help them to relax and, in some cases, to help them sleep. These drugs can also indirectly affect the reward pathway and cause a euphoric high, especially when taken in high doses.

However, excessive GABA signaling from depressant abuse can cause problems if brain activity is reduced too much. These negative side effects include:

  • Difficulty breathing
  • Slurred speech.
  • Memory loss.

In extreme cases, critical functions such as breathing might stop, causing death.

Cannabinoids

Marijuana use between to15&2016Cannabinoids are chemicals that bind with cannabinoid receptors in the brain. They are found naturally (in marijuana or cannabis), but may also be laboratory-made (synthetic cannabinoids, Spice/K2).

Although illegal in many parts of the country under federal law, cannabinoids are very popular recreational drugs that produce effects such as:

  • A euphoric high.
  • Distortion of perception.
  • Memory impairment.

Cannabinoid receptors were first discovered in the 1980s using tetrahydrocannabinol (THC) and other cannabinoids found in the marijuana plant. It took another decade of research before scientists discovered the natural brain chemical counterparts – called endocannabinoids – that naturally bind to these receptors. In 1992, researchers discovered the first endocannabinoid in the brains of pigs, which they called “anandamide” from the Sanskrit word for bliss.5

Endocannabinoid signaling is complex and slightly unusual because these are retrograde neurotransmitters. That means endocannabinoids are released by the postsynaptic neuron and their receptors are on the presynaptic neuron, so they send information in the reverse direction of most neurotransmitters.

Although scientists are still learning precisely what these chemicals do, they are involved in many brain processes including:6

  • Energy balance—Endocannabinoid signaling is important in brain pathways controlling hunger and energy metabolism in the body.
  • Sensory perception—Many brain cells in the areas of the cortex that process sight, sound, hearing, and touch have cannabinoid receptors.
  • Learning and memory—The hippocampus, an area involved in learning and forming short-term memories, is rich in cannabinoid receptors.
  • Coordination—Endocannabinoids are important for the function of the cerebellum and basal ganglia, areas of the brain involved in balance and motor control.

In the brain, endocannabinoids are created only in specific neurons where they are needed and only for the amount of time they are needed, which can be as short as a few minutes.7 In contrast, THC and other cannabinoid drugs are ingested in relatively large amounts and indiscriminately activate receptors all over the brain.

This is why natural endocannabinoids are essential for forming clear memories and maintaining a normal appetite, while cannabis abusers often find themselves craving junk food and forgetting mundane things like where they parked.

Why Do Drugs Feel Good?

Brain reward pathways

Dopamine levels increase in response to survival-related things like food. Drugs manipulate this function to cause increased dopamine signaling.

Most addictive drugs produce an intense euphoric high that abusers seek. This is because these drugs either directly or indirectly increase dopamine signaling in the limbic system, which includes a part of the brain that is involved with reward and motivation—the nucleus accumbens.

Behaviors that improve the chances of survival, like eating, having sex, and socializing with friends cause an increase in dopamine levels in this area. This increase in dopamine feels good and motivates people to repeat those actions.

Stimulants flood the whole brain with dopamine, including the nucleus accumbens, which causes intense pleasure in abusers and motivates them to repeat this behavior. Likewise, studies have shown that drugs that affect other neurotransmitter systems, such as alcohol,8 opioids,9 and cannabinoids,10 also cause dopamine levels to rise in regions of the brain involved in pleasure, especially the nucleus accumbens.

Experiments in animals have shown that drugs such as alcohol, amphetamine, cocaine, and morphine cause 2 to 10 times more dopamine to be released in the nucleus accumbens than natural rewards.11 This means that the motivation to use these drugs repeatedly is very strong, even if an individual knows that drug use is unhealthy and causes other problems such as losing a job or getting arrested. It also means that drug use takes priority over the desire for other healthy activities that originally provided a feeling of satisfaction or happiness.

Brain chemistry in the nucleus accumbens also shows the link between addictions to drugs and behavioral addictions. Research has shown, for example, that dopamine levels rise in the reward center when individuals with gambling addictions make bets, and that drugs that restore the normal neurotransmitter balance in the nucleus accumbens reduce both cocaine cravings in drug addicts and gambling urges in compulsive gamblers.12

How Drugs Change the Brain

Check out this awesome podcast all about how drugs work. What really happens when someone takes a drug? What’s going on in their brain to produce such wild effects? And what’s so weird about hallucinogens? Can your brain ever recover from the damage? Tune in to find out!

The brain and its networks have the ability to change and adapt, a property called plasticity. Plasticity is important for normal brain development and learning, as well as recovering from brain injuries and strokes. Plasticity is also the reason that long-term exposure to drugs produces abnormal changes in the brain.

The brain will attempt to correct network activity that is much higher or much lower than normal levels. If an individual is regularly flooding their brain with opioid or endocannabinoid signaling by abusing drugs, the brain makes attempts to counteract these changes and bring them back to natural levels. Like a thermostat in a house, which works to keep the temperature from getting too hot or cold, plasticity allows the brain to keep neurotransmitter signaling from getting far from normal levels.

This adaptation by the brain leads to 2 important consequences of drug abuse: tolerance and withdrawal.13

Tolerance

Individuals who abuse drugs often find that they need to take larger and larger doses of a drug over time to feel the same high. This is known as tolerance, and it is the result of the brain adapting to counteract the effects of abnormal neurotransmitter signaling caused by the drug.

One example of this is seen with long-term opioid abuse, which results in abnormally high opioid receptor signaling. The brain attempts to compensate for this imbalance by reducing the number of opioid receptors on the surface of neurons.14 Over time, this “pruning back” of receptors results in a reduced potential to experience the full spectrum of pain relief and euphoria that these drugs produce in a more “drug naïve” individual. Interestingly, circuits that control some of the more negative effects of opioids—including respiratory depression—do not develop tolerance as quickly. This phenomenon is known as asymmetric tolerance.15

An opioid abuser who develops asymmetric tolerance is at great risk for overdose. Why? When an individual has become tolerant to the effects on the reward pathways, it will take a lot to feel high. Meanwhile, the area of the brainstem that controls breathing has yet to develop an equal tolerance level, so there is a high risk of overdose and respiratory arrest.

Withdrawal

People who regularly abuse a drug may find that they feel sick or experience other negative symptoms when they stop using the drug suddenly. This phenomenon is referred to as a withdrawal syndrome. Many of the symptoms of withdrawal are caused by the same brain adaptations that lead to tolerance.

The brain of a person who abuses sedatives such as alcohol for months or years has an imbalance caused by too much GABA receptor activation. GABA signaling reduces overall neuron firing and slows down many networks in the brain. The brain tries to counteract this imbalance by decreasing the baseline amount of GABA being released as well as by increasing glutamate signaling to boost overall neuron activity.16 This adaptation works well as long as the person keeps using alcohol or sedatives. Logistically, this cannot occur indefinitely. Inevitably, the onset of withdrawal arrives at the point which the abuser stops taking these drugs for a certain amount of time. Without them, the brain will be over-stimulated – potentially resulting in anxiety, delirium, and even seizures. (This is the main reason that attempts to detox from alcohol and sedatives should take place under close medical supervision).

The Addiction Trap

Graphic of people suffering from substance use disorderThese drug-induced changes in the brain eventually lead to addiction. Individuals who have a drug addiction may have a variety of symptoms, but they all share the key feature of this condition, which is that they use their drug of choice compulsively despite experiencing serious negative consequences from their drug use such as being arrested, being fired from a job, or losing important relationships.

Avoidance of withdrawal symptoms can partially explain why it can be especially difficult for addicted individuals to stop taking drugs on their own.

However, it is adaptations in the nucleus accumbens and the motivation circuits of the brain that are thought to play the biggest part in the development of addiction. Every time an abuser gets high, they bombard the neurons in the reward pathway with unnaturally high levels of dopamine. Just as in other brain regions, these neurons adapt to counteract the repeated overstimulation.

Eventually, the brain adjusts to the intense rewards of drugs, and natural rewards such as food and friends no longer produce a pleasurable response in a drug abuser’s brain (a phenomenon referred to as “anhedonia”). The anticipation of obtaining and using drugs (wanting and craving) becomes the main source of excitement and produces a flow of dopamine that narrows that individual’s focus and excitement to drug use and little else.

This is why many people with addictions often feel life is pointless and empty. Individuals who have reached this stage may also stop feeling good at all when taking drugs; instead, they need the substance in order to feel “normal”.

Once this level of brain adaptation has been reached, taking drugs is no longer truly a choice. The addicted person will be driven to continue their habit as if it is necessary for survival, and drugs will seem more important than almost anything else. The effects of pleasure and motivation, powerful tools to help human survival, have been hijacked for a destructive and unhealthy purpose.

These physical changes in the brain support the idea that addiction is, in fact, a disease and not simply a moral failing. What is known today about the way drugs affect the brain also suggests why the 1980s “Just Say No” anti-drug campaign was not especially successful in preventing drug abuse.17

While using drugs may start out as a choice, physiologic changes in the brain caused by the drug use makes it difficult, if not impossible, for someone who is addicted to make rational decisions about their drug use. Also, individuals decide to first use drugs for many reasons; some want to get high, but others give in to social pressures or are prescribed opioid painkillers by their doctors and begin to misuse them.

By presenting addiction as an issue of morals or willpower, the “Just Say No” campaign did not offer practical tools for people who had already started down the path of drug dependency. It also created a stigma around addiction by sending the message that people could simply stop taking drugs if they wanted to. It is difficult to imagine that anyone really wants to ruin their lives with their drug use, and understanding how drugs affect the reward and motivation circuits of the brain shows us how an individual can lose the power to say “just say no”.

Instead of stigmatizing addiction, we can move forward by increasing the understanding of drug use on the brain and highlighting the ways that someone battling addiction can find recovery and sobriety in the long term.

Recovery

People who have received addiction treatment

Addiction does not have to be the end of the road for anyone. There are many drug detoxification and rehabilitation programs available all over the country to help people break out of the addiction trap.

Knowing how drugs affect the brain has provided healthcare professionals with tools that help break the hold of addiction. Benzodiazepines are used therapeutically to prevent life-threatening seizures in people who are addicted to alcohol, while medications like methadone and buprenorphine soothe intense withdrawal symptoms and block the high that comes from abusing opiates, serving as effective tools in recovery maintenance.

Although a happy, productive, drug-free life is possible for those who have become addicted to drugs, the brain adaptations caused by drug and alcohol abuse can be especially persistent.

Most symptoms of withdrawal last only a few days or weeks, but some effects including anxiety, fatigue, insomnia, and anhedonia (absence of pleasure) may last for months or even years. These symptoms are known as post-acute withdrawal syndrome (PAWS) and are thought to be caused by the slow process of the brain undoing drug-induced adaptations.

Some brain changes in the reward and motivation circuitry seem to be permanently affected by addiction.18 Though the vast majority of people recovering from addiction will soon be able to feel pleasure and enjoy life as much as ever, they may always be at risk for relapsing. It seems the brain never completely unlearns the rewarding aspects of drug abuse, so lifelong vigilance is important to prevent relapse.

References

  1. Alexander, E. (2000). Famous fried eggs: Students debate effectiveness, accuracy of well-known anti-drug commercial. CNNfyi.com.
  2. National Institute on Drug Abuse. (2007, July 2014). Drugs, Brains, and Behavior: The Science of Addiction. NIDA Notes.
  3. Kock, C., & Kuhl, P. (2013). Decoding ‘the Most Complex Object in the Universe’/Interviewer: I. Flatow. Science Friday, National Public Radio.
  4. Center for Behavioral Health Statistics and Quality. (2015). Behavioral health trends in the United States: Results from the 2014 National Survey on Drug Use and Health.
  5. Devane, W. A., Hanus, L., Breuer, A., Pertwee, R. G., Stevenson, L. A., Griffin, G., . . . Mechoulam, R. (1992). Isolation and structure of a brain constituent that binds to the cannabinoid receptor. Science, 258(5090), 1946-1949.
  6. Griffing, G. T., & Thai, A. (2015). Endocannabinoids.
  7. Cravatt, B. F., Demarest, K., Patricelli, M. P., Bracey, M. H., Giang, D. K., Martin, B. R., & Lichtman, A. H. (2001). Supersensitivity to anandamide and enhanced endogenous cannabinoid signaling in mice lacking fatty acid amide hydrolase. Proc Natl Acad Sci U S A, 98(16), 9371-9376.
  8. Boileau, I., Assaad, J. M., Pihl, R. O., Benkelfat, C., Leyton, M., Diksic, M., . . . Dagher, A. (2003). Alcohol promotes dopamine release in the human nucleus accumbens. Synapse, 49(4), 226-231.
  9. Gratton, A. (1996). In vivo analysis of the role of dopamine in stimulant and opiate self-administration. J Psychiatry Neurosci, 21(4), 264-279.
  10. Gilman, J. M., Kuster, J. K., Lee, S., Lee, M. J., Kim, B. W., Makris, N., . . . Breiter, H. C. (2014). Cannabis use is quantitatively associated with nucleus accumbens and amygdala abnormalities in young adult recreational users. J Neurosci, 34(16), 5529-5538.
  11. Di Chiara, G., & Imperato, A. (1988). Drugs abused by humans preferentially increase synaptic dopamine concentrations in the mesolimbic system of freely moving rats. Proc Natl Acad Sci U S A, 85(14), 5274-5278.
  12. Grant, J. E., Potenza, M. N., Weinstein, A., & Gorelick, D. A. (2010). Introduction to behavioral addictions. Am J Drug Alcohol Abuse, 36(5), 233-241.
  13. Koob, G. F., & Le Moal, M. (2001). Drug addiction, dysregulation of reward, and allostasis. Neuropsychopharmacology, 24(2), 97-129.
  14. DuPen, A., Shen, D., & Ersek, M. (2007). Mechanisms of opioid-induced tolerance and hyperalgesia. Pain Manag Nurs, 8(3), 113-121.
  15. Dumas, E. O., & Pollack, G. M. (2008). Opioid tolerance development: a pharmacokinetic/pharmacodynamic perspective. AAPS J, 10(4), 537-551.
  16. Mukherjee, S., Das, S. K., Vaidyanathan, K., & Vasudevan, D. M. (2008). Consequences of alcohol consumption on neurotransmitters -an overview. Curr Neurovasc Res, 5(4), 266-272.
  17. Scott O. Lilienfeld, & Arkowitz, H. (2014). Why “Just Say No” Doesn’t Work. Scientific American.
  18. Cornish, J. L., & Kalivas, P. W. (2000). Glutamate transmission in the nucleus accumbens mediates relapse in cocaine addiction. J Neurosci, 20(15), RC89.

Snorting Ambien

The sleep-aid Ambien (generic name: zolpidem) is a prescription medication used in the treatment of insomnia in adults 1. It works by slowing down brain activity to help users fall and stay asleep.

Zolpidem is similar in structure and effects to other sleep aids like Sonata and Lunesta 2. All of these fall under the class of drugs known as sedative-hypnotics and function as CNS depressants 3,4. These substances all work to slow down or depress the central nervous system (CNS) by disrupting the normal activity that takes place in the brain and the spinal cord 2. Examples of other sedative drugs include the barbiturates (e.g., phenobarbital) and benzodiazpeines (e.g., Valium). Some refer to Ambien and similar, non-benzodiazepine hypnotic medications as “z-drugs” because of the letter “z” common throughout their respective chemical names (e.g., zolpidem, zaleplon, eszopiclone).

Ambien and other sedatives produce their effects by interacting with a neurotransmitter in the brain called gamma-aminobutyric acid (GABA). In the brain, Ambien attaches to many of the same areas in the brain that benzodiazepines do. This binding increases the activity of GABA, which slows and limits brain activity 2. However, in most instances, Ambien rarely achieves the same intensity of effects that benzos produce. Instead, they elicit, on average 4:

  • A shorter duration of action.
  • Fewer lasting effects during the day.

Ambien is thought to have a lower risk of abuse and dependence compared to benzodiazepines; however, these drugs are not without abuse potential. In fact, there is the risk of people abusing Ambien and similar sleep aids—for example by taking excessive amounts and/or snorting them—with scary consequences. This risk increases in those with a history of substance use or mental health (co-occurring) disorders 4.


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Is Snorting Ambien Dangerous?

Someone looking to feel Ambien’s effects more rapidly or intensely may crush the pills and snort the powder. Whether the user is snorting the pills to get high, hallucinate, or just enhance the sleep-inducing effects 2,5, taking the drug this way constitutes substance abuse and is dangerous. It is never advisable to use any medication in ways other than prescribed 1. Whenever the route of administration is changed, the drug’s effects on the brain and body are changed, as well, and the risks to the user increase 5.

In the case of Ambien, the tablet should only be consumed orally because the medication inside is designed to be processed and released slowly into the body through the digestive system 12. Snorted substances take another route. It begins with the drug being absorbed into the blood stream from the mucus membranes in the nose 12. At this point, the drug can travel throughout the rest of the body and to the brain 6.

The user may experience a number of adverse reactions, dangerous levels of sedation, or even overdose.

The danger with this process is that snorting Ambien will increase the amount of medication released at one time 5. The user will experience an effect that is stronger and quicker acting than taking the substance orally 5,12. Crushing and snorting the medication can produce effects that overwhelm the body, and the user may experience a number of adverse reactions, dangerous levels of sedation, or even overdose. If you or someone you love is suffering from an inability to stop using Ambien, you can help today with one confidential call to 1-888-744-0069Who Answers?.


Side Effects

Ambien has many side effects that may present in those who take the medication as advised. However, for those who abuse the drug by snorting or injecting, these effects are likely to appear more frequently and intensely.  If you are snorting zolpidem, you may experience a multitude of amplified side effects that include 1,5:

  • Feeling sedated, drowsy, or tired.
  • Headaches.
  • Dizziness and lightheadedness.
  • Shakiness.
  • Memory problems.
  • Problems walking and maintaining balance.
  • Appetite changes.
  • Constipation or diarrhea.
  • Gas.
  • Strange or intense dreams.
  • Heartburn, pain, and discomfort in the stomach.
  • Pain or numbness throughout the body.

Dangerous side effects include 1:

  • Skin problems like rashes and hives.
  • Swelling of the face or throat.
  • Trouble breathing and swallowing/feeling that the throat is closing.
  • Shortness of breath.
  • Chest pain and pounding heartbeat.
  • Vomiting.
  • Problems with vision.

Other Effects of Ambien

symtoms of ambien

Abuse of Ambien can also trigger and/or exacerbate existing mental health symptoms and related behaviors, such as 5:

  • Depression with thoughts of self-injury or suicide.
  • Anxiety and restlessness.
  • Agitation.
  • Aggression.
  • Hallucinations.
  • Feeling odd or unlike oneself.
  • Increase in risky behaviors due to lowered fear and inhibitions.

One of the most unique and disconcerting effects of Ambien use is the emergence of “complex behaviors” while under the drug’s influence. Users may partake in activities while asleep and not remember doing so the next morning. Such complex – and potentially risky – behaviors can include 5,11:

  • Talking.
  • Walking.
  • Having sex.
  • Cooking.
  • Eating.
  • Shopping.
  • Driving.

In addition to Ambien’s side effects, snorting any substance on a continuing basis can lead to extensive damage to the nasal cavity, mouth, air passages and sinus network, including 7,8:

  • Death of tissue in the septum resulting in holes or tearing.
  • Decay of the soft palate.
  • Loss of sense of smell.
  • Pain in the ear and face.
  • Trouble swallowing.
  • Sinus congestion.
  • Runny nose.
  • Nosebleeds.
  • Swelling of the face.

Can Snorting Ambien Cause an Overdose?

Snorting Ambien or otherwise using at increased doses can intensify its CNS depressant actions, which can lead to an overdose. This risk of overdose builds when Ambien is combined with other sedating drugs such as 2:

Overdosing on Ambien is dangerous and, in extreme situations, potentially lethal. Ambien overdose is a growing concern—the National Institute on Drug Abuse estimates that there were approximately 28,000 visits to emergency rooms in 2008 alone that involved the adverse effects of Ambien use (a rate that more than doubled from 2004) 3.

The signs of overdose are 1,4:

  • Extreme sleepiness.
  • Dangerously slowed or stopped breathing.
  • Slurred speech.
  • Marked loss of coordination.
  • Loss of consciousness.
  • Blackout.

Nonfatal overdose symptoms often resolve within 6 hours after consumption. Some overdose patients can receive a medication to reverse effects of acute intoxication and overdose called flumazenil 4. This substance is primarily used to treat benzodiazepine overdose but has been shown to be effective in treating overdose from sleep aids like Ambien as well 4.


Signs That Someone is Addicted

man experiencing heavy sleepiness

Those abusing Ambien may display certain telltale behaviors commonly seen as part of the larger issue of addiction, or substance use disorder. A primary indicator of addiction is the persistent use of Ambien even when it causing or could be reasonably anticipated to lead to negative consequences 9. Other signs include 9:

  • Taking more and more of the substance over time.
  • Unsuccessfully trying to stop taking the drug.
  • Spending more time, effort, and money getting and using the drug.
  • Escalating conflicts with loved ones.
  • Experiencing more difficulty maintaining responsibilities at work, home, and school.
  • Worsening mental health or physical health symptoms.

Certain physical signs may indicate that someone you love is abusing Ambien by snorting it. These signs of abuse include:

  • Sniffing or wiping nose often.
  • Powder on face, hands, or clothes.
  • Tools like straws and mirrors that may be used when crushing and snorting Ambien.

Getting Help for Addiction

To end their addiction, people abusing Ambien may attempt to quit abruptly. This can be very challenging and problematic, though, as ending use can bring about withdrawal symptoms. The symptoms will present in a way similar to alcohol withdrawal and may include symptoms like 1,4:

  • Lightheadedness.
  • Cramps.
  • Shakiness.
  • Nausea and vomiting.
  • Increased sweating.
  • Tachycardia (raised heart rate).
  • Trouble sleeping despite being tired.
  • Increased crying.
  • Strong cravings for more Ambien.
  • Higher levels of anxiety and panic.
  • Hallucinations.
  • Seizures.

Withdrawal symptoms can peak after 5 days 4. This amount of time with strong cravings and uncomfortable symptoms can be difficult to endure and often precipitates a relapse. To break this cycle, professional treatment can be very helpful. A period of medically supervised detoxification can allow the individual to experience withdrawal in a safe, controlled environment while under medical care 4,10. Medical supervision is often of paramount importance for individuals with long-standing sedative abuse histories, given the number of significant risks associated with the acute sedative withdrawal syndrome.

Successfully traversing the withdrawal process is difficult, but it shouldn’t signal the end of recovery efforts. Some form of ongoing, professionally curated substance abuse treatment after detox can make all the difference in terms of maintaining recovery and avoiding relapse. Across settings like in-facility, outpatient, and longer-term residential treatment, the individual will participate in a variety of behavioral therapies to continue their drug-free lifestyle. Behavioral therapy options include 4:

  • MI (Motivational Interviewing) — Focuses on strengthening an individual’s motivation to end substance use and embrace recovery.
  • Behavioral modification and Cognitive-behavioral therapy — Works to identify stressors before building coping skills to limit the negative effects.
  • Relapse prevention — Gathers information related to triggers of use and ways to avoid them in the future to promote sustained abstinence.

If you are currently having issues related to your use of Ambien, now is the best time to seek treatment. Call 1-888-744-0069Who Answers? today to start the process and begin the path to recovery.


References:

  1. U.S. National Library of Medicine: MedlinePlus. (2015). Zolpidem.
  2. National Institute on Drug Abuse for Teens. (2016). Prescription Depressant Medications.
  3. National Institute on Drug Abuse. (2010). Prescription Drug Abuse.
  4. Weaver, M. F. (2015). Prescription Sedative Misuse and AbuseThe Yale Journal of Biology and Medicine88(3), 247–256.
  5. Connecticut Department of Consumer Protection. (n.d.). Zolpidem Tartrate.
  6. National Institute on Drug Abuse. (2007). The Neurobiology of Drug Addiction.
  7. Alexander, D., Alexander, K., & Valentino, J. (2012). Intranasal Hydrocodone-Acetaminophen Abuse Induced Necrosis of the Nasal Cavity and Pharynx. The Laryngoscope, 122(11), 2378–2381.
  8. National Institute on Drug Abuse. (2016). DrugFacts: Cocaine.
  9. National Institute on Drug Abuse. (2016). What to Do If Your Adult Friend or Loved One Has a Problem with Drugs.
  10. National Institute on Drug Abuse. (2012). Principles of Drug Addiction Treatment: A Research-Based Guide.
  11. Dolder C., Nelson M. Hypnosedative-Induced Complex Behaviours: Incidence, Mechanisms and Management. CNS Drugs. 2008;22(12),1021-36.
  12. National Institute of Health. (2010). The Brain: Understanding Neurobiology.

Treating Zolpidem Dependence

It can be difficult to figure out whether someone you care about is struggling with an addiction, and if so, how you can best help them. If your loved one has a prescription for zolpidem, it can be even more difficult to identify whether there’s a problem and how to help.

As a relatively commonly used sleeping medication, zolpidem (brand name: Ambien) is often seen as non-addictive and harmless. However, numerous case reports and reviews have identified that the drug can indeed lead to abuse, dependence, and severe withdrawal symptoms 2, 4-6, 8, 10-11.


Is Zolpidem Dangerous?

Worried someone you love is abusing zolpidem? Listen for street names such as “forget-me pill” “no-go pills,” “zombie pills,” and “A-minus.”

Zolpidem is a central nervous system (CNS) depressant, so the effects can be devastating if taken in higher doses or when combined with other CNS depressants such as alcohol, opioid painkillers, or muscle relaxers1. Many users have also experienced significant withdrawal symptoms upon discontinuing the medication, including anxiety, cravings, insomnia, and seizures 1, 8.

Even taking the drug as prescribed carries some risks. For example, zolpidem can lead to severe drowsiness, increasing the risk of accidents and bodily injury. This risk is great enough that in 2013 the FDA modified the label to recommend avoidance of activities that require a high degree of mental alertness, such as driving, even the day after taking the drug3.

People have also been known to engage in activities while under the influence of zolpidem that they have no recollection of the next day. These activities can range from mild (eating or having conversations) to risky or outright dangerous (having sex or driving) 1,12. According to The Drug Abuse Warning Network (DAWN), emergency room visits related to adverse reactions from zolpidem increased by almost 220% from 2005 to 2010 9.


What Are the Signs of Addiction?

The following signs and symptoms may indicate a problem with zolpidem addiction.

  • Showing changes in behavior such as increased depression or irritability, or conspicuously reacting to unusual experiences such as hallucinating.
  • Not remembering conversations they have had with you.
  • Misusing the medication (taking it in higher doses or for reasons other than what the original prescription was intended for).
  • Starting to take zolpidem a little earlier every night to experience the calming and sedative effects.
  • Experiencing symptoms of withdrawal when they do not take the drug or run out of it.
  • Trying to keep themselves awake after taking it so that they can experience the potential euphoric effects.
  • Visiting multiple doctors to try and get additional prescriptions.

Also, be aware that the risk of addiction to zolpidem is heightened in individuals who have a history of alcohol or drug abuse or dependence, or who have psychiatric diagnoses.


There is life after addiction. Get help now.

Helping Someone with an Addiction

When you have decided that your loved one may be dealing with an addiction to zolpidem, figuring out how you can best help them can feel daunting. However, there are some steps you can take to help both your loved one and yourself:

  1. Educate yourself and note any symptoms and behavior changes. Broadening your knowledge of zolpidem, as well as addiction in general, will allow you to approach your loved one with your concerns from a more understanding and informed position. Also noting behavior changes will help to better address someone in denial about their drug abuse. It is important to note however that any evidence of behavior changes or symptoms is solely to provide examples of your concerns in the interest of helping them, not to shame them.
  2. Prepare what you are going to say and how you are going to say it. When approaching a loved one about treatment, it is best to go in prepared so that you can clearly articulate your thoughts and feelings in a caring manner. This will increase the chances that your loved one will open to what you have to say. For example, try to stay calm and focus on their behaviors rather than making general statements about their character.
  3. Have a plan. Having a plan enables you to avoid unproductive, spontaneous confrontations that can deter your loved one from getting help. You may want to consider the options listed below. This can include taking your loved one to see a doctor or addiction specialist, planning an intervention, or utilizing the community reinforcement and family training (CRAFT) approach.
  4. Get Support for Yourself. The healthier you are, the better you will be able to support your loved one. You may want to consider pursuing your own personal individual counseling or joining a support or assistance group such as Nar-Anon, a 12-step group intended to support the friends and family of those struggling with an addiction.

Avenues for Approaching a Loved One

See a Doctor or Addiction Specialist. Taking your loved one to see a care provider who can assess their condition and influence them to get help can go a long way. For teens and young adults, The National Institute on Drug Abuse (NIDA) advises using incentives to get them to see a doctor since they may be more prone to listen to a professional than a family member 13.

Hold an intervention. An approach by intervention is a focused way of approaching your loved one and encouraging them to seek help. It involves gathering together a group of people in the addict’s life who share the same concerns and commitment to helping them recover. During the intervention, the concerned individuals take the opportunity to express to their loved one what they have observed, how it has impacted their own lives, and what they would like the addict to do for help, as well as the potential consequences of refusing to get help. Those seeking to hold an intervention often choose to employ the help of a professional who has experience in the field of addiction and can help make sure those involved confront the individual in the most effective manner.

Participate in Community Reinforcement and Family Training (CRAFT). CRAFT is an evidence-based approach that helps you figure out changes you can make to both motivate your loved one to seek treatment while addressing any personal issues you may be experiencing that are related to their addiction. This approach involves less confrontation than holding an intervention and instead harnesses the power of positive rewards and natural consequences to influence behavior change 7.


Addiction Treatment Options

Doctor and patient discussing treatment for Zolpidem addiction

There are several options an individual can take once they have committed to treatment. These include:

  • Detoxification. Due to the potential for significant withdrawal symptoms, many people look for medical and doctoral assistance for a safe and comfortable zolpidem detox. This is often the first step before treatment, and it can occur within an inpatient setting or before starting an outpatient program. It will begin with a taper to gradually remove the drug from the body. A benzodiazepine or selective serotonin reuptake inhibitor (SSRI) may be utilized to minimize discomfort 10.
  • Inpatient Treatment. Inpatient care provides not only a general environment supportive of recovery, but the structure can also help establish healthy sleeping behaviors and patterns. This can be especially important for people suffering from rebound insomnia after detox. Private rooms may be available to further minimize issues with sleep, depending on the center. During inpatient treatment, the individual will also be given a consistent and focused opportunity to deal with any issues that may have led them to abuse zolpidem, such as a co-occurring disorder like anxiety.
  • Outpatient Treatment. After successful detoxification and/or completion of an inpatient program, the recovering individual may consider beginning an outpatient treatment program that offers many benefits as inpatient programs, but in a non-residential setting and with more flexibility. This option is relatively less intensive but still generally entails participating in individual and group therapy to address both underlying issues as well as learn behaviors consistent with recovery such as good sleep hygiene.

There are a number of treatment options that can help you or your loved one leave zolpidem behind for good. For help finding the best treatment option, call 1-888-744-0069Who Answers?.


References:

  1. U.S. Food and Drug Administration. (2008). Ambien (Zolpidem Tartrate) Tablets. (2008)..
  2. Correas Lauffer, J., Braquehais Conesa, D., Barbudo Del Cura, E., & Ochoa Mangada, E. (2002). [Abuse, tolerance and dependence of zolpidem: three case reports]. Actas Espan?olas De Psiquiatri?a, 30(4), 259-262.
  3. U.S. Food and Drug Administration. (2013). FDA Drug Safety Communication: FDA approves new label changes and dosing for zolpidem products and a recommendation to avoid driving the day after using Ambien CR..
  4. Hajak, G., Muller, W., Wittchen, H., Pittrow, D., & Kirch, W. (2003). REVIEW Abuse and dependence potential for the non-benzodiazepine hypnotics zolpidem and zopiclone: a review of case reports and epidemiological data. Addiction, 98(10), 1371.
  5. Liappas, I., Malitas, P., Dimopoulos, N., Gitsa, O., Liappas, A., Nikolaou, C., & Christodoulou, G. (2002). A zolpidem and cocaine abuse case report. International Journal Of Psychiatry In Clinical Practice, 6(4), 217.
  6. Pourshams, M., & Malakouti, S. K. (2014). Zolpidem abuse and dependency in an elderly patient with major depressive disorder: a case report. Daru, 22(7), 1-3.
  7. Robert J. Meyers, Ph.D.  (2014). CRAFT.
  8. Sellami, R., Messedi, N., Feki, I., Baati, I., Zahaf, A., & Masmoudi, J. (2016). Zolpidem abuse: About a case. European Psychiatry, 33S372-S373.
  9. Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. (May 1, 2013).Emergency Department Visits for Adverse Reactions Involving the Insomnia Medication Zolpidem. Rockville, MD.
  10. Victorri-Vigneau, C., Dailly, E., Veyrac, G., & Jolliet, P. (2007). Evidence of zolpidem abuse and dependence: results of the French Centre for Evaluation and Information on Pharmacodependence (CEIP) network survey. British Journal Of Clinical Pharmacology, 64(2), 198-209.
  11. Victorri-Vigneau, C., Gérardin, M., Rousselet, M., Guerlais, M., Grall-Bronnec, M., & Jolliet, P. (2014). An Update on Zolpidem Abuse and Dependence. Journal Of Addictive Diseases, 33(1), 15.
  12. National Library of Medicine – PubMed Health. (2016). Zolpidem (Oral route)..
  13. National Institute on Drug Abuse. (2016). What to Do If Your Teen or Young Adult Has a Problem with Drugs..

Prescription Drug Abuse Problem

For some time now, the abuse of illicit substances such as marijuana, cocaine, methamphetamine and heroin has been a persistent national problem. In more recent years, however, our country has seen an alarming rise of prescription drug abuse – now sharing the dubious limelight with the old standby street drugs are otherwise controlled substances, such as those prescribed to relieve pain and anxiety.

Many of these drugs continue to be prescribed legitimately, yet continue to end up in the hands of those intent on abusing them. As would be expected, the resale value of some of these medications can be quite high. The price to society as a whole, however, is also taking its toll, as more and more people find themselves in the ER or hospitals for prescription drug overdoses or worse, deaths.


Video: Mind Your Meds



Credit: Partnership for Drug-Free Kids

Most Commonly Abused Prescription Drugs

The broad classes of drugs that are most prone to non-medical use or abuse are the ‘painkillers’ or opiate analgesics such as oxycodone (Oxycontin), the ‘sleeping pills’ or ssedative-hypnotics such as zolpidem (Ambien), ‘anti-anxiety medication’ or sedative-anxiolytics such as alprazolam (Xanax), and, lastly, stimulants such as dextroamphetamine (Adderall) and methylphenidate (Ritalin).

Numbers from SAMHSA’s 2013 National Survey on Drug Use and Health (NSDUH) included non-medical usage statistics for these prescription-type drug classes for American’s ages 12 and older. The survey defines ‘non-medical use’ as the use of the drugs for the effect or feeling that they produce, as opposed to for some medical indication. The survey reports an alarming 6.5 million nonmedical users of prescription-type drugs (2.5% of the entire population, ages 12 and up), with a majority of those (4.5 million – or 1.7% of Americans) having misused the aforementioned ‘painkillers’ (opiate analgesics).

Prescription drug abuse (and painkiller abuse, in particular) is a huge problem. Indeed, prescription opioid drugs are now the second-most used illicit substance (behind marijuana) if and when America’s youth make a first foray into drug experimentation.


Abused Prescription Drugs

Prescription Painkillers – Most prescribed pain medications have an opiate or opiate derived (from the opium poppy) component. Others might contain synthetic opioids that, to some degree, mimic the effects of the opiates. These medicines modify pain signaling, and are frequently prescribed for a variety of types of moderate to severe pain relief. Drugs in this class include:

Prescription Sleeping Pills – At one point in time, the barbiturate depressants were prescribed as sleep aids. Since then, barbiturates have been replaced by the benzodiazepines and, more recently, the non-benzodiazepine sleep aids have gained favor as the prescription of choice for insomnia. The benzodiazepines and non-benzodiazepine sleeping pills exert their effects by modulation of the GABA (gamma amino butyric acid) neurotransmitter system in the brain. Drugs prescribed for sleep include:

  • Ambien (Zolpidem)
  • Lunesta (Eszopiclone)

Prescription Anxiety Medication – As mentioned before, the GABA modifying effects of the benzodiazepine medications work well as prescription anti-anxiety medications. Because of their habit-forming propensity, many of these medications are now prescribed for temporary bouts of anxiety rather than as a nightly sleep aids. Some anti-anxiety medications include:

Prescription Stimulants – Amphetamines and amphetamine derivatives make up the prescription stimulant class. These types of medications, while once widely used for appetite control, are now prescribed for attention deficit hyperactivity disorder (ADHD), narcolepsy or other vigilance-related disorders. Common prescription stimulants include:


Abused Medications by Classification

While all of the prescription drugs mentioned here are beneficial to many as prescription medications, their pleasurable, calming and/or performance enhancing effects lead some to abuse them. When taken in larger doses or for longer periods than intended by prescription, many of them lead to the development of tolerance (needing more and more to get the same effect), as well as a marked withdrawal syndrome should they be stopped.

Both of these phenomena can lead to increasingly large doses of the drug being taken to overcome the tolerance, or to prevent the uncomfortable symptoms or potential medical complications of withdrawal. One should also keep in mind that the effects of these medications can be even more dangerous if taken simultaneously with alcohol.

The sedating, respiratory slowing effects of the opiate painkillers can lead to serious problems or death in overdose situations. Similarly, excessive doses of benzodiazepines can result in respiratory depression and slowed heart rate, especially when used with alcohol or other drugs. At the other end of the overdose spectrum, too many stimulant drugs can lead to dangerously elevated blood pressure, irregular heartbeat and seizure – a perilous mixture of symptoms that can result in death.

Physician supervision and appropriate use is critical for all prescription drugs to avoid abuse and misuse, especially for those with a history of substance abuse disorders. Whenever possible, medications which do not have an addiction potential should be considered as the first treatment option for those with a history of drug abuse.

The safety of the drug is based on taking the drug exactly as prescribed. Abusing prescription drugs is a sure way to disregard these safeguards, and is a recipe for disaster.


Video: Prescription Drug Abuse: A Public Health Epidemic



Credit: Robert Wood Johnson Foundation

Combating the Prescription Drug Abuse Problem

The National Institute on Drug Abuse (NIDA), along with several health organizations, has launched a national initiative to educate the public about the growing danger of prescription drug abuse and its associated problems. Their website contains a wealth of prescription drug abuse information. The non-medical use of prescription drugs and their potential for abuse and addiction are quite complex problems to address, as they involve not only patient misconduct in obtaining and abusing these drugs, but physician prescribing issues as well.

Risk assessment surveys such as the Prescription Drug Use Questionnaire have been developed and tested as tools to assist clinicians with the decisions that go into prescribing commonly abused medications. The hope is that with continued awareness of the problem, and with heightened scrutiny for both over-prescribing and patient misconduct, progress against the prescription drug abuse problem will be made.

If you or someone you know suffers from a prescription drug abuse problem, you can receive the help you need 24 hours a day and 7 days a week by calling our Drug Abuse Helpline at 1-888-744-0069Who Answers?. Our friendly staff can counsel you and help you find the perfect program or support group for your specific needs. All calls are toll-free and confidential.