Chapter 3
Dangers of Stimulant Addiction

Illegal stimulants are prevalent drugs of abuse. According to the 2001 National Household Survey on Drug Abuse, the number of people trying illegal stimulants for the first time tripled between 1991 and 2000. Worse, many of these people continued to use drugs. For example, the office of National Drug Control Policy says that in 2001 there were almost 2 million occasional cocaine users and an additional 1.7 million people who used the drug on a regular basis. Though all stimulants have the potential for misuse, nicotine, cocaine, and amphetamines are the most commonly abused and the most dangerous. Long-term usage of any of the three can seriously damage the heart, blood vessels, and lungs and lead to prolonged illness. These drugs are also the most addictive stimulants.

The ABCs of Addiction

Addiction is a condition in which a person compulsively uses a substance, or repeats a behavior, even though it has negative consequences. The term addiction comes from a Latin word that means "binding to something." This definition paints a vivid picture of the relationship some people develop with stimulants. The bond can be powerful and difficult to break.

An experienced twenty-eight-year-old drug user puts her own blunt spin on the word addict. She and some of her best friends have been addicted to stimulants. "Addicts … completely lack self-control," she says. "The drug controls them, they don't control the drug."³²

Why would people let themselves be "controlled" by a stimulant? No one expects to become an addict; addiction usually evolves along a path of increasing use. Paul Gahlinger, author of Illegal Drugs, explains: "Illegal drug use can be considered to fall into one of the following categories, where any level … may progress to the next: Experimental, Recreational, Circumstantial, and Compulsive."³³

The Addiction Theory

How does a person become addicted to stimulants? Dr. Alan Leshner, writing for the National Institute on Drug Abuse, explains his theory.

It is an all-too-common scenario: A person experiments with an addictive drug like cocaine. Perhaps he intends to try it just once, for "the experience" of it. It turns out, though, that he enjoys the drug's euphoric effect so much that in ensuing weeks and months he uses it again—and again. But in due time, he decides he really should quit. He knows that despite the incomparable short-term high he gets from using cocaine, the long-term consequences of its use are perilous. So he vows to stop using it. His brain, however, has a different agenda. It now demands cocaine. While his rational mind knows full well that he shouldn't use it again, his brain overrides such warnings. Unbeknown to him, repeated use of cocaine has brought about dramatic changes in both the structure and function of his brain. In fact, if he'd known the danger signs for which to be on the lookout, he would have realized that the euphoric effect derived from cocaine use is itself a sure sign that the drug is inducing a change in the brain—just as he would have known that as time passes, and the drug is used with increasing regularity, this change becomes more pronounced, and indelible, until finally his brain has become addicted to the drug.

And so, despite his heartfelt vow never again to use cocaine, he continues using it. Again and again. His drug use is now beyond his control. It is compulsive. He is addicted. While this turn of events is a shock to the drug user, it is no surprise at all to researchers who study the effects of addictive drugs. To them, it is a predictable outcome.

Escalating Use

A person may experiment with illegal stimulants for many reasons. He may want to know how a drug will make him feel or be urged by friends to try it. Rachel Tope had heard about drugs since middle school, and by the time she was a high school freshman, she estimated that 75 percent of her friends had experimented with them. Rachel says, "I was curious. It was what all my friends were doing."³⁴

Experimenting with strong stimulants can lead to the next phase, recreational use. According to Gahlinger, recreational users sometimes take drugs when they get together with friends. At this stage, illegal stimulant users see the drugs as a way to change their mood or to increase the enjoyment of a social situation.

For some people, part-time, recreational drug use can escalate to the more dangerous phase of circumstantial use. Nicole Hansen, Miss Teen Utah in 2001, was amazed when she realized that she had become a compulsive abuser within just a few months of first trying illegal stimulants. Nicole remembers, "I started popping [injecting under the skin] every other Saturday night. It was fun going to parties and meeting new people. Soon I was using every Thursday, Friday and Saturday."³⁵

Circumstantial users like Nicole find themselves turning to illegal stimulants more than they had originally planned. As a result, performance at school and work may decline, and their behavior may seem out of character to others. They try to hide their use, keeping the secret from family, employers, and friends at school. As Lyn, a former stimulant abuser, says, "All of a sudden, you have so many secrets to keep from others, so many lies to hide from your friends."³⁶ The ongoing deception often alienates users from people who were once close, resulting in feelings of aloneness and depression.

When a person can no longer resist the emotional and physical desire for stimulants, compulsive use or addiction has set in. At this point, the drug dictates every aspect of life. After taking drugs for so long and becoming so dependent on them, many addicts cannot function in any capacity without stimulants. Their lives can spiral out of control, leading to problems with their health, their family, their school and work, or the law.

The Cause of Withdrawal

No formula or timetable can predict if an abuser will become an addict, or how long it will take for addiction to develop. The degree to which stimulants cause addiction varies with the drug of choice and with the user. However, all addicts experience the same basic components of habitual use, no matter which stimulant they prefer.

When a person starts using stimulants, cells throughout the body respond to the drugs as they would to any other foreign material: They try to function normally by working around them. However, if the chemicals keep reappearing, cells eventually accept them as part of a new norm. Cells then adjust to the drugs by moderating their reactions to the stimulants. This causes tolerance, a reduced response when exposed to the drug.

Stimulant addicts develop two types of tolerance: physical and psychological. As physical tolerance builds, addicts find that they must use increasingly larger doses of the drug to feel high. When stimulants are not available, uncomfortable physical symptoms occur; this is known as physical withdrawal. In stimulant addiction, physical withdrawal includes a few days of flu-like symptoms.

Psychological Tolerance

Although physical withdrawal from stimulants is moderate in comparison to withdrawal from other drugs, stimulants' powerful interaction with the reward center of the brain causes severe psychological tolerance. Cells in the reward center realize that the flood of neurotransmitters and the strong surges of electrical impulses that occur with stimulant use are abnormal brain activities. The brain tries to protect itself from these overloads by slowing down the number and frequency of impulses. It cuts back on the number of nerve cell receptors that are available to pick up the impulses, assuring that only a portion of the impulses will be relayed.

This cutback strategy tones down sensory input in the short run, but it causes other problems. With fewer receptors functioning, addicts find that the small doses they used early in their drug experience no longer produce the mind-blowing highs that made the drug attractive in the first place. To compensate, they increase

their dosage. In the case of cocaine and amphetamines, users may triple their dosage in just a few weeks.

In the long run, tolerant cells become so habituated to the presence of the drug that they cannot operate normally without them. At that point, when the brain is deprived of stimulants, the reward center goes back to depending on normal levels of neurotransmitters for pleasure. Unfortunately, with fewer receptors in action, normal levels are too low to produce any feelings of happiness, satisfaction, or pleasure. As a result, the person feels tired, depressed, and discouraged, a condition called psychological or emotional withdrawal. As Kuhn, Swartzwelder, and Wilson explain, "Once the drug is gone, the few receptors left are not enough to do the job … so the cure has become the disease."³⁷

As a result of both physical and psychological tolerance, a user who stops taking stimulants experiences a tidal wave of bad feelings. Only two things can end these withdrawal symptoms: another dose of stimulants or time. Given enough time, the body will recover from most of the changes caused by earlier stimulant use. But it can be tough for a nicotine, cocaine, or amphetamine addict to give the body the time it needs to repair damage. Some who have experienced withdrawal in the past are anxious to avoid it again, so they continually use drugs to stay away from those bad feelings. At this stage, they are tangled in a vicious cycle that seems to have no end.

Who Uses Nicotine?

Of the three strongly addictive stimulants, nicotine is the most widely used. The 2001 National Household Survey on Drug Abuse identified about 66.5 million tobacco (and therefore nicotine) users in the United States. The majority are young adults between the ages of eighteen and twenty-five. However, the fastest growing segment of the tobacco-using population is the twelve- to seventeen-year-olds. The majority of nicotine users smoke—cigarettes, cigars, or pipes—while others chew tobacco.

Most of the 66.5 million individuals who smoke say that they would like to stop. Why don't they? They cannot easily quit because they are addicted, claim the authors of Drugs and Society. These experts explain that "the inevitability of cigarette addiction is undisputable. Studies have shown that 70% of current smokers want to quit but cannot."³⁸

When people who smoke or chew tobacco do stop, they experience many withdrawal symptoms. People trying to separate their lives from nicotine must endure cravings, irritability, restlessness, insomnia, aches, anxiety, and impaired judgment. These troublesome symptoms, which start just hours after the last tobacco use and can continue for months, are the primary reason most people go back to using nicotine.

Dangers of Nicotine

Most tobacco users are aware of the damage it can do to their health. Death is the most drastic result. According to the surgeon general, "Cigarette smoking is the single most preventable cause of premature death in the United States. Each year, more than 400,000 Americans die from cigarette smoking. In fact, one in every five deaths in the United States is smoking related."³⁹

The majority of these deaths are caused by cancer. Tobacco use is the primary cause of cancers of the lung, mouth, throat, pancreas, uterus, kidney, and bladder. It is also a major factor in a host of other debilitating conditions, such as emphysema, asthma, pneumonia, heart disease, high blood pressure, and stroke.

Impact on Nonsmokers

Sometimes, even those who do not smoke experience the negative consequences of nicotine use. Almost 20 percent of pregnant women ages fifteen to forty-four are smokers. Smoking during pregnancy has serious implications for the fetus. When a pregnant woman smokes, high levels of carbon monoxide (a poisonous gas) and nicotine enter her body, then cross the placenta to reach the fetus. There, these two dangerous chemicals may become fifteen times more concentrated in the fetal blood supply than they are in the mother's blood. These toxins interfere with the baby's ability to receive and use oxygen.

As a result, women who smoke have an increased risk of spontaneous abortion, or loss of the fetus. Babies born to smoking

mothers are more likely to have breathing conditions such as asthma than those born to nonsmokers. They also have an increased risk of premature delivery and low birth weight. Research has shown that the more a mother smokes, the greater the reductions in her child's birth weight. Women who stop smoking early in their pregnancy generally deliver babies with the same birth weights as babies of nonsmokers.

In addition to harming unborn babies, exposure to tobacco smoke is dangerous to children. Secondhand smoke comes from two sources: the end of a burning cigarette and the exhaled breath of a smoker. The American Lung Association reports that people who breathe secondhand smoke are exposed to four thousand chemicals, forty-three of which are known to cause cancer. Even though secondhand smoke is dangerous for people of all ages, small children are more vulnerable than adults, and therefore more likely to suffer long-term health problems.

Who Uses Coke and Meth?

Like smokers, cocaine and meth users are a large and diverse crowd whose numbers are growing. According to the National Household Survey on Drug Abuse, between 1994 and 2000, the last year for which statistics are available, first-time users of illegal stimulants increased from 219,000 to 697,000. In this time period, the number of new users in the age group from twelve to seventeen years was significantly larger than in the age group from eighteen to twenty-five years. Cocaine is the second most commonly used illegal drug in the United States, with meth close behind it. In 2000, the office of National Drug Control Policy reported that 445,000 people frequently used cocaine and 356,000 frequently used meth.

The Cost to Mind and Body

Use of illegal stimulants, especially long-term use, affects both the body and the mind. Because illegal stimulants decrease appetite, and since addicts spend much of their money on drugs rather than food, many users do not eat enough to support their daily caloric needs. Combined with lack of sleep, this causes excessive wear and tear to their bodies.

To make matters worse, prolonged use of these drugs can cause longer-lasting conditions. Many meth addicts look twice their age because of the physical trauma of repeated binges. Sky, a former addict, regrets the toll that bingeing took on her body:

During the last few months of my overpowering addiction I had lost about seven sizes…. I had translucent skin, bloody scabs and pick marks all over my body, my kidneys were failing, brittle hair and nails, paranoia, hallucinations, phobic and panic problems, weak muscles and a very low immune system to fighting off sickness. Actually, the … problems that I had … are too many to list.⁴⁰

Reporter Ken Olsen learned about what causes these problems from Dr. Thomas Martin, director of the University of Washington's Toxicology Service. Olsen relayed, "Meth addicts don't eat and don't sleep, sometimes for a month. All of their body's resources go to maintaining the high. There's no energy for normal tissue repair…. Gums break down. Teeth fall out. Major organs such as the kidneys disintegrate. Sores don't heal."⁴¹

Some users, especially those who repeatedly use stimulants, develop paranoid or hostile attitudes. One young man who has been on meth since 1996 often runs outside the house, where he lives with his mom, armed with knives and ready to fight. His mother explains that "he thinks people are after him."⁴² Even worse, this paranoia may persist long after the drugs are out of the body. Another man, clean for five years, still props heavy objects against doors when he enters a room because he is afraid that someone might be after him.

Such hostility and paranoia are not unusual in stimulant addicts, especially those on meth. Heavy users may hear and see things that are not really there. T.M., a meth addict in treatment, recalls the visions he had after a three-day binge: "I would see what looked like patches of smoke or mist. It seemed there was a person lurking in every shadow, the shadow people. I would hear voices and see things that weren't there. The voices were faint whispers plotting against me."⁴³

Under the Skin

Those who binge may also experience formication, the unpleasant feeling that insects are crawling under their skin. This eerie sensation causes bingers to pick at their skin, leaving bloody, open sores that usually need medical treatment. Among users, this problem is known as crank bugs, meth mites, or coke bugs. Fifteen-year-old Tina, who is now clean and living in Austin, Minnesota, saw the work of the "mites" firsthand:

There was this kid who had been up for like two or three weeks straight and he was picking at his nose because he thought there were bugs crawling around in there. He picked these big, bloody holes in his nostrils, and he finally took a scissors and cut into his nostrils on both sides.⁴⁴

Dr. Steven O'Mara, an emergency room physician at the Northwest Medical Center in Springdale, Arkansas, sees "bugs" and "mites" all too often. "We have lots of people who come in here who are literally scarred," O'Mara says. "They'll come in and they'll be scratching, picking 'bugs' off themselves…. They liter ally claw themselves."⁴⁵

Bugs, visions, paranoia, and weight loss are just some of the problems caused by the excessive use of coke or meth. The long-term complications to the body are more complex and dangerous, including such things as heart disease, stroke, and permanent damage to brain cells.

Over the Long Haul

One of the most serious complications of stimulant abuse is damage to the heart and blood vessels. Since stimulants rapidly accelerate the heart rate while simultaneously constricting blood vessels, making them work harder, they can weaken the cardiovascular system. Young adults rarely suffer from the same kinds of cardiovascular problems that cause heart attacks in older adults. Consequently, when a young person does experience heart damage, medical personnel always check to see if illegal stimulants are involved. Hospitals report that cocaine is cited most often in young heart damage.

Those who take illegal stimulants may also experience seizures as a result of damage to their brain and other parts of their nervous system. After three years of daily cocaine use, an anonymous addict gave this candid description of herself: "The cocaine was beginning to affect my central nervous system, where I would twitch…. I would have seizures and convulsions from doing too much."⁴⁶

Out of Touch with Reality

In 1938 the first case of amphetamine psychosis, permanent paranoia resulting from amphetamine use, was reported. The psychosis began as a vague feeling of suspiciousness. As it got worse, the amphetamine user began to believe that everything around him related to him in some way. Listening to a newscast, he thought that every bit of information, from reports of plane crashes to local football scores, had special relevance to him. Eventually, severe delusions developed, and the user became paranoid, believing that everyone was his enemy.

Besides causing convulsions, cocaine and meth use can result in permanent brain damage. In a recent study at Yale University, researchers found that a cocaine addict's response to stimulation is reduced, a symptom that may indicate permanent damage. Nashaat Boutros, the principal investigator of the study, says,

Contrary to what we expected, the results showed that cocaine-dependent individuals displayed increased resistance to brain stimulation. We expected them to be jumpy or more responsive because of the sensitizing effects of cocaine, but it took much stronger stimulation to get them to respond.⁴⁷

Special Problems for Meth Users

Some doctors have been surprised to see young patients displaying symptoms associated with diseases of aging, like Parkinson's and Alzheimer's. These patients were all meth users, and meth has been found to damage the brain in ways similar to those diseases, interfering with memory and learning. Jack Whittkopp, the program director for chemical dependency services at Austin Medical Center, says,

This drug [meth] ages the brain significantly, and we're only now starting to see studies that suggest the scale of the problems down the road. You see 19 year olds with depleted dopamine [neurotransmitter] levels that you generally associate with people who are 59. We could potentially be looking at a whole bunch of cases of early-onset Alzheimer's and Parkinson's and all sorts of other neurological complications. The horrible thing, of course, is that you're not supposed to experience this kind of neurological damage until you're aged.⁴⁸

Additional Damage

Many addicts also suffer from problems that are distinctive to their method of use. The techniques of injecting, smoking, and snorting create their own unique complications. For those who inject stimulants, the regular use of a hypodermic needle can damage blood vessels and therefore restrict the flow of blood. Blood flow can be further impeded by contaminants in the drugs that clog vessels, resulting in damage to tissues and organs that have been cut off from their normal blood supply. In addition, sharing needles carries a high risk of contracting blood-borne diseases such as HIV, hepatitis B, and hepatitis C.

Snorting and smoking are not benign, either. People who inhale cocaine or meth eventually damage the cells that make up the nasal lining, causing a constant runny nose. Extreme use can even erode or eat away portions of the septum, the structure that separates the nostrils. Smoking, meanwhile, leads to an increased incidence of breathing problems, a chronic cough, chest pain, and damage to lungs.

The Ultimate Price

A large dose of any illegal stimulant, whether taken purposely or accidentally, can send a user straight to the emergency room, or the morgue. A coke addict recalls how he accidentally overdosed on an unusually pure, and potent, batch of cocaine:

It is pure terror. Quite simply it feels like you are in the beginning stages of a heart attack and "the lights are about to go out" on your life at any moment. Your heart is beating so rapidly it becomes impossible to take your pulse. The fear shoots more adrenaline into your system, which just makes everything worse. I cannot think of a worse way to die.⁴⁹

A comprehensive study by the National Institute on Drug Abuse found that death from cocaine overdose occurs at a rate of about eight per one hundred thousand people who use the drug. According to one physician, "Sudden death is the most serious result of cocaine abuse. It can be due to a series of savage convulsions, paralysis of the breathing, or sudden heart failure."⁵⁰ The rate of overdose increases dramatically when cocaine is mixed with other drugs. Research from Austria indicates that the rate of non-fatal overdose is about seven times higher in people who combine cocaine with other drugs.

Injured Babies

Abusers and addicts are not the only victims of coke and meth; many others are hurt by the drug, too. Pregnant women taking illegal stimulants risk serious health problems, or even the death, of their unborn. The drugs can kill an unborn baby or cause a stroke, which triggers brain damage. During pregnancy, the use of illegal stimulants reduces the amount of nutrients and oxygen that reach the baby, so babies born to abusers are smaller and less healthy than those of women who do not use stimulants.

When Ken Olsen interviewed Lindy Haunschild, coordinator of the Parent-Child Assistance Program in Spokane, Washington,

he learned about babies who were born addicted to meth. Olsen found out that if women used meth while pregnant, their babies were born "with behavioral problems and tremors, and they scream from withdrawal 24 hours a day. Many grow up to be users themselves because [according to Haunschild] 'their systems are hard-wired to crave this drug.'"⁵¹

Olsen also talked to Angela, a meth addict in treatment. Her baby is due in a few months. He wrote,

Her child will have an operation almost immediately after it's born. Otherwise, the baby would die within a few days. An ultrasound shows the infant's heart is backward and has two holes. That's a condition nicknamed "worm heart." Officially it's called "transposition of the great vessels" and it's another signature of meth.

Olsen learned that during normal development, a child's heart will rotate into the correct position. However, "when the mom is a meth addict, the heart often remains reversed."⁵²

Meth hinders the development of other organs as well. Dr. Alex Stalcup, the medical director of New Leaf Treatment Center in Concord, California, explained to Olsen, "The brain, heart and kidneys form very early on—often before the mom knows she is pregnant—when the developing baby is the size of your thumb. If there's an insult to the organs, they don't develop properly. Meth is a very serious insult."⁵³

Children in Danger

Babies are not the only casualties of stimulant abuse. When a person is hooked on meth or cocaine, the entire family suffers, especially children. Teri Jones, a caseworker for child welfare, tells reporter Jon Bonné that half her cases are children whose methusing parents either did not notice or did not care that their children were sick or in danger. Jones's files

detail the drug's toll on kids born to a meth-using mother or those living around its manufacture: children with respiratory infections, unable to gain weight, absorb nutrients or have normal bowel movements…. An infant was found crawling among spilled acids … near Newport…. The boy had second-degree burns on his knees and palms.

But what may take a most lasting toll on the children is the severe, chronic neglect. Social workers say it is not uncommon to find 8-year-olds who've never been to school. Social workers often find older, "parentified" children who bathe, feed and care for younger siblings.⁵⁴

When a person becomes addicted to stimulants, the entire family suffers. If the chronic user loses a job, the family can be left without a home, a car, or food. Many addicts, in need of quick cash, turn to crime, a decision that can result in their arrest and imprisonment. In addition, child welfare agencies are often called in to take the children of stimulant abusers into protective custody.

Ladeeta Smith, a Brooklyn girl, knows all too well how a cocaine-using mother can impact a family. Ladeeta and her sisters had to move in with their grandmother after their mother was arrested for cocaine possession. While in prison, Ladeeta's mother learned that she had become infected with HIV. She died in jail at the age of thirty-nine, leaving three children to be raised by their grandmother.

In the End

In the final analysis, illegal stimulants fall short of most users' expectations. Whether one is seeking a way to lose weight, be more productive, or just have fun, the end result is often addiction and long-term health problems. Researchers are learning more each year about the long-term effects of stimulants, especially methamphetamine, and some of the most recent findings are alarming. Their insights into how strong stimulants act on the body have prompted others to reevaluate the traditional methods for treating and caring for stimulant addicts.