PSYCHOLOGICAL EFFECTS OF DRUGS

The psychological setting or frame of mind is important in the effect of many drugs, particularly with psychotropics.

Psychological effects are also important for other medications and treatments and often result in cures or symptomatic relief when no drugs has actually been given.

There are several psychological aspects of drug use, including the placebo effect, set and setting, which are discussed below.

Placebo Effect

If a person thinks that he or she is taking a certain drug that is supposed to have a certain effect, and it does (whether or not it contains any active ingredients designed to produce the desired results), this is the placebo effect.

This effect can happen with any substance; it is important in medicine and probably has resulted in many "cures" of a variety of ailments.

An example of the placebo effect is chicken soup taking away the symptoms of a cold, or hot lemon tea eliminating a headache.

Set

Psychological or mental set is the frame of mind a person is in when he or she takes a drug. It is also considered to be an unconscious expectation and is a factor in the placebo effect. If a person does not think that a certain medication will work, it often does not.

Setting

The actual physical, social and cultural environment in which a person finds him/herself when a substance is consumed can determine how that person reacts to a drug.

As an example, a glass of wine in a fine crystal wine glass, sipped in a candlelit restaurant with music playing in the background will have a different effect than the same wine drank from a paper cup in a classroom.

TERMINOLOGY OF DRUG ACTION

TOLERANCE

Tolerance to a drug develops when the response to the same dose of the drug decreases with repeated use. As an example, if you are an occasional drinker, you may become intoxicated after drinking three beers.

However, after drinking every night for a week, you may find that it takes five beers to get that same feeling. This would indicate a developing tolerance to alcohol.

The rate at which an individual develops tolerance to a drug depends upon that individual's heredity, the dose of the drug, the size of the person, and the frequency of drug administration.

Tolerance usually occurs with depressants, which include alcohol, opiates, synthetic narcotics, barbiturates, some minor tranquilizers, and volatile substances such as ether and glue.

Tolerance to amphetamines when used in large doses has also been found.

Withdrawal Symptoms

When one has become physically dependent upon a drug and abruptly abstains from the substance, a psychological and/or physiological reaction occurs. The reaction is the opposite of the effect of the drug.

In withdrawal from a depressant drug, restlessness, irritability, nausea, tremors, inability to sleep, and sometimes, in the case of alcohol and barbiturates, convulsions that may lead to death may occur.

addiction (Physical Dependence)

Addiction has often been considered to be physical dependence upon a drug. This generally occurs with depressant drugs, which include alcohol, barbiturates, tranquilizers, and opiates.

Increased tolerance to the substance and withdrawal symptoms upon cessation of use are usually present. However, according to L.J. Hatterer, "we now extend addiction to relate to almost any substance, activity or interaction, as well as to drugs".

The individual has an overpowering need for the substance, object, or activity that produces a psychological and/or physiological high. The desire or need is repetitive, impulsive, and compulsive in nature. If the person ceases the activity or abstains from the substance, withdrawal symptoms usually occur.

Habituation (Psychological Dependence)

Habituation was at one point considered to be psychological dependency upon a substance or activity.

However, with the expanded definition of addiction to include the addictive behaviors or the addictive process, which can apply to any activity, interaction or object, this term is not used as frequently as it was in the past.

Psychological withdrawal symptoms, including irritability, depression, and sleep disturbances often accompany habituation.

Stimulants

Stimulants are a group of drugs that tend to stimulate the central nervous system. Habituation to these drugs can occur.

Depressants

Depressants are a group of drugs that depress the central nervous system. Tolerance and physical dependency are common with them. More information about depressants is given in later chapters.

Cross Tolerance and Cross Dependence

Cross tolerance refers to the fact that if a person has developed a tolerance to a drug in a certain classification, such as the depressants, that person is more likely to develop tolerance with another drug in that classification.

As an example, people who are dependent upon alcohol show an increased tolerance to barbiturates, synthetic and natural opiate narcotics, and anesthetics. This, of course, means that the person must have a higher dose of the new drug for it to be effective. In cross dependence, the withdrawal symptoms from one drug in a classification can be relieved by another.

As an example, many alcoholics are given barbiturates and tranquilizers to prevent withdrawal symptoms. However, the person may soon develop a dependency on the other drug as well.

Potentiation

Potentiation occurs when two drugs are taken together and one of them intensifies the action of the other. This could be expressed by a +b= B.

As an example, Phenergan(R), an antihistamine, when given with a painkilling narcotic such as Demerol(R) intensifies its effect, there by cutting down on the amount of the narcotic needed.

Synergism

Synergism is similar to potentiation. If two drugs are taken together that are similar in action, such as barbiturates and alcohol, which are both depressants, an effect exaggerated out of proportion to that of each drug taken separately at the given dose may occur.

This could be expressed by 1+1= 5. An example might be a person taking a dose of alcohol and a dose of a barbiturate. Normally, taken alone, neither substance would cause serious harm, but if taken together, the combination could cause coma or death.

Additive Effect

Additive effect is the term used when two or more drugs are taken at the same time and the action of one plus the action of the other results in an action as if just one drug had been given. This could be represented by 1+1= 2. An example would be a barbiturate and a tranquilizer given together before surgery to relax the patient.

Antagonism

Antagonism is action in which two drugs given together will have an opposite effect on the body. This could be expressed by 1+1=0. An example might be the use of a tranquilizer to stop the action of LSD. Some stimulants will counteract the effects of depressants and thus are used to treat overdoses of barbiturates and narcotics.

Hypersensitivity

One of the biggest problems with many drugs, especially antibiotics, is an allergic or hypersensitive reaction. An allergic reaction can range from hives, itching, and nausea to a shock in which the person can die.

The allergic reaction occurs after the first time the person has been exposed to the drug, not the first time the drug is taken. It should be noted that a person can use a drug for years without any adverse reaction and then become hypersensitive to it. This sometimes occurs to individuals handling drugs, such as nurses, pharmacists, and veterinarians.

Idiosyncrasy

When a person exhibits an abnormal or peculiar response to a drug, it is called an idiosyncratic response to that drug. An example would be a person who becomes nervous or excited after being administered a sleeping medication such as a barbiturate.

Side Effects

Most substances have side effects that may or may not be harmful to the individual. A side effect is an effect of the drug other than the one for which it was administered. The main effect and side effects of a drug sometimes depend upon the purpose of its administration.

As an example, antihistamines are often given to dry and reduce swollen nasal passages caused by allergies.

However, antihistamines can also cause sleepiness, which would be the side effect. The main effect of sleepiness is used by manufacturers of over-the-counter sleep aids to produce drowsiness and promote sleep.

In this case, a side effect of the medication would be the drying of the nasal passages. Some side effects can cause serious problems, such as abnormal production of red blood cells called aplastic anemia, or stomach bleeding from the consumption of too much aspirin.

These more serious side effects are called untoward actions.

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Adapted from Engs, R.C. Alcohol and Other Drugs: Self Responsibility