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Cannabis and Amphetamines
3. Obtain evidence of medical/ psychiatric illness
■ existing medical care
■ current medications
4. Identify psychosocial factors
■ social and family supports
■ living arrangements and accommodation
■ employment/finances
■ relationships, dependents
■ legal issues
299
Withdrawal
The ‘typical’ pattern of ‘Using and Stopping’ varies across individuals and with
previous withdrawal experiences. Most withdrawal signs and symptoms dissipate
over the course of two weeks to a month, however, withdrawal may be protracted,
lasting a few months or more.
During the crash phase (days 1–4 post cessation of use) common complaints may
include:
■ fatigue and exhaustion
■ hunger
■ emotional liability (irritable, agitated,
■ depressed)
■ overwhelming desire to sleep, or sleeping difficulties
■ cravings
During the crash phase, advise careers to ensure that adequate food and fluids are
provided and encouraged.
During the next week, typical complaints include:
■ strong cravings or urges to use
■ disrupted sleeping patterns and sleeping difficulties
■ mood swings
■ headaches, and generalized aches and pains
■ increased appetite
■ irritability, possibly paranoia or misinterpretation of surroundings
During the following weeks, most signs and symptoms tend to subside, with mood
swings, sleeping problems and cravings causing patients the most difficulty. After
300
1–3 months, sleeping patterns, health and interest in other activities should return
to normal.
Illustrated Handbook of Drugs & Alcohol Related Health Issues
Non-pharmacological Management of Withdrawal
Psychosocial management is crucial in providing support for people withdrawing
from alcohol or other drugs. Supportive care is crucial to reducing the incidence
and severity of somatic complaints, for example:
■ organizing a safe environment
■ organizing supports
■ non-pharmacological means of coping with cravings
■ tips to improve sleep
■ relaxation techniques
■ coping with mood swings, strange thoughts and aches and pains
■ eating properly
■ concentrating only on the immediate future
■ identifying high risk situations
■ obtaining counseling
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Cannabis and Amphetamines
Abstinence from all psychoactive drugs is the preferred treatment goal, as other drugs
may trigger reinstatement or reduce ability to cope with cravings. There is no evidence
to suggest that either inpatient withdrawal management or tapered withdrawal with
amphetamines or other drugs is any more effective in achieving long-term cessation of
the use of amphetamines.
301
Inpatient Withdrawal Management
Inpatient treatment may, however, be appropriate in the following circumstances:
■ evidence of polydrug dependence
■ where severe withdrawal is anticipated
■ for medical complications requiring close observation or treatment
■ psychiatric complications (e.g. psychotic, suicidal)
■ absence of social supports
■ previous failed outpatient treatment
■ for specific therapies e.g. introducing cue exposure
Where inpatient treatment is necessary, programs should be tailored to the specific
needs of the patient, focusing on management of emotional liability (mood change)
and cravings. Patients should ideally remain in inpatient care until the main withdrawal
symptoms subside, however, days 3–5 following cessation of use are often risky,
and for many, may result in early self-discharge. Encourage usual sleeping patterns,
dietary and self-care habits, and provide distractions from drug using activities.
Because of the protracted nature of amphetamine withdrawal, encourage involvement
in outpatient programs for additional support and relapse prevention.
Pharmacotherapies for Managing Withdrawal and Relapse
Evidence is inconclusive regarding the efficacy of pharmacotherapies in managing
amphetamine withdrawal or relapse, however trials with dexamphetamine show
promise as a replacement therapy. Medications that may assist in reducing the
severity of withdrawal symptoms include:
■ Somatic symptoms: mild analgesics (such as paracetamol)
■ Anxiety and insomnia: a short low dose course of benzodiazepines may
reduce irritability and promote sleep (e.g. diazepam, p.r.n. for a week or
less)
■ Gastrointestinal complaints such as diarrhoea, cramps, nausea and vomiting:
loperamide, hyoscine butylbromide, metoclopramide (Victoria Police, 2001).
(Whilst these symptoms are normally associated with heroin withdrawal
they may not necessarily be unusual in a person tolerant to amphetamines,
who is a polydrug user with a recent history of poor self-care.)
■ Cravings and dysphoria: desipramine, bromocryptine, amantadine
302
Illustrated Handbook of Drugs & Alcohol Related Health Issues
Intervention Strategies Post-withdrawal
There are a number of strategies health workers can use to intervene with problematic
amphetamine use. These should be individualized. There are few randomized
controlled trials of counseling and much of the outcome literature is based on
cocaine users. A review of the evidence recommended:
■ cognitive-behavioral therapy/relapse prevention (particularly for heavy users)
■ cue exposure therapy
■ multi-faceted behavioral treatment involving family support, addressing
the antecedents and consequences of use, employment counseling and
recreation
The principles for intervening with amphetamine users are similar to those
employed with other drugs. Engaging clients, planning withdrawal management,
skill development (goal setting, relapse prevention etc.) within the context of the
client’s readiness to change are important.
Harm Reduction Measures
For people likely to experiment with amphetamines
Discuss advantages and disadvantages of oral versus other forms of amphetamine
administration. Discuss hazards of injection, without exaggerating risks of occasional
oral use of low doses of amphetamines, and discourage injecting.
For current amphetamine users
Advise:
■ against daily use
■ against injection, or to use other forms of administration
■ If injecting, encourage use of new injecting equipment, and awareness of
locations of services that provide new needles and equipment. Stress that
all injecting paraphernalia and the using environment must be sterile to
avoid local infection risks and transmission of blood borne viruses
■ Practicing safe sexual behaviour
For people using large amounts of amphetamines on single occasions,
or over short periods of time
Encourage awareness of:
■ techniques for moderating use and minimizing potential harms, such as
• planning use earlier in the weekend to allow for recovery
• use routes of administration other than injecting
Cannabis and Amphetamines
o avoid high doses in any one episode
o avoid using for extended periods, and before important events, or before
work or study
o avoid using with other drugs whilst using speed, including alcohol
o general health care, such as getting enough sleep, drinking plenty of water
and eating before, during and after using
Symptoms of heavy use, such as:
• preoccupation with obtaining and using speed
• increased tolerance
• continued use despite evidence of problems associated with use
• emergence or exacerbation of social, physical or mental problems
• transition to other methods of administration (e.g. IV use)
• polydrug use to exacerbate the effect of amphetamine or to modify
withdrawal symptoms
■ The false sense of psychomotor competence’ that amphetamines may
produce, and especially when used in combination with alcohol (e.g.
Avoid driving when using amphetamines)
■ Strategies to reduce harmful side effects, e.g. to obtain the drug from the
same, or reliable sources; to use smaller amounts per occasion;
303
REFERENCES
1. https://ncpic.org.au/static/pdfs/resources/fast-facts-on-cannabis.pdf
2. http://www.health.gov.au/internet/main/publishing.nsf/content/E5203E6D5C
BAA696CA257BF0001E02ED/$File/aodgp.pdf
3. http://www.defence.gov.au/health/dmh/mh_fact_sheets/cannabis_web%20
version%202015.pdf
4. https://erowid.org/plants/cannabis/cannabis_cultivation17_ultimate.pdf
5. https://www.unodc.org/documents/drug-prevention-and-treatment/cannabis_
review.pdf
6. http://www.wisegeek.com/what-is-a-medical-marijuana-license.htm
7. http://www.wisegeekhealth.com/what-are-the-medical-uses-of-thc.htm
8. https://www.marijuanatimes.org/the-pharmacology-of-marijuana/
9. http://www.wisegeekhealth.com/what-is-the-cardiovascular-system.htm
10. http://www.dhhs.tas.gov.au/mentalhealth/alcohol_and_drug/services/
psychosocial_intervention
CHAPTER 5
DRUGS RELATED
HEALTH ISSUES
306
Illustrated Handbook of Drugs & Alcohol Related Health Issues
INTRODUCTION
Mental health means different things to
different people. You may think of control,
happiness, contentment, order – but
good mental health is usually a sign of
a positive way of life. Mental ill health is
the opposite of this – it causes problems
and creates barriers to being happy. Your
frame of mind may vary between the
two as mental health can change. It can
be affected by external influences, and
one of these is drugs. Drugs that are
psychoactive, such as cannabis, alcohol,
ecstasy and heroin, have the ability to
affect your mood. They can arouse certain
emotions or dampen down others. This
may be why you use them. The changes in
your mood or behaviour caused by drugs
are the result of changes to your brain.
This is also the part of you that controls
your mental health. Drugs interfere with
the chemicals in your brain. This affects
the messages those chemicals are trying
to send. You need to weigh up both the
short-term and long-term effects that drugs
can have on your mental health.
The short-term effects may well be
something you enjoy – but probably only
if they happen like you expect them to.
You may also have unwanted short-term
drug-induced side effects, such as acting
or feeling strange. These are short-term
because they pass as the drug leaves
your system.
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Drugs can have a longer-lasting impact on your mental health too, and you need to
think seriously about your own strengths and vulnerabilities. Consider whether you use
drugs to make bad feelings go away and whether you are in control of your use. Even
if you start using drugs with a clear mind they may still affect your mental health.
Drugs can simply expose bad feelings you never knew you had. Unwanted effects
may stay with you because you have a pre-existing mental health condition you
were not aware of. Or you may get the dose very wrong and permanently disrupt
a chemical balance in your brain.
Drugs Related Health Issues
The negative physical and mental effects of the use of alcohol and other drugs are
well documented. Use of these drugs may cause: blackouts, poisoning, overdose
and death; physical and psychological dependence; damage to vital organs such
as the brain, heart, and liver; inability to learn and remember information; and
psychological problems including depression, psychosis, and severe anxiety.
Impaired judgment and coordination resulting from the use of alcohol and other
drugs are associated with acquaintance assault and rape; hazing; falls, drowning
and other injuries; contracting sexually-transmitted infections including AIDS; and
unwanted or unplanned sexual experiences and pregnancy.
The substance abuse of family members and friends may also be of concern to
individuals. Patterns of risk-taking behavior and dependency not only interfere in the
lives of the abusers, but can also have a negative impact on the affected students’
academic work, emotional wellbeing and adjustment to college life.
Alcohol abuse is a progressive disorder in which physical dependency can develop.
Even low doses of alcohol impair brain function, judgment, alertness, coordination
and reflexes. Very high doses cause suppression of respiration and death. Chronic
alcohol abuse can produce dementia, sexual impotence, cirrhosis of the liver,
and heart disease; and sudden withdrawal can produce severe anxiety, tremors,
hallucinations, and life-threatening convulsions.
307
Some of the negative consequences that drinking alcohol can have, both as a result
of your drinking and others’ drinking:
■ hangovers
■ academic problems--missed classes, getting behind in school work
■ arguing with friends
■ engaging in unwanted and/or unprotected sexual activity
■ Weight gain-the “Freshman 15” is not all due to campus dining!
■ getting injured / assaulted / sexually assaulted
■ damaging property or having your property damaged
■ requiring treatment for alcohol poisoning
■ trouble on campus or with police
■ being insulted or humiliated
■ having your study or sleep interrupted
■ developing tolerance, dependence or addiction
■ death from alcohol poisoning or alcohol-related injury
308
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Illustrated Handbook of Drugs & Alcohol Related Health Issues
Neuroscience research shows that alcohol impairs the formation of new memories
and learning, especially in the developing brain--and as college-aged students,
your brains are still developing. Alcohol use can cause both short term and longterm problems for those who choose to use it. Alcohol is a central nervous system
depressant whose effects depend on how much you drink. These effects may range
from loss of inhibition with only one drink to making someone “stumbling drunk
“ to acute alcohol poisoning with loss of consciousness and difficulty breathing.
Acute alcohol poisoning usually occurs in situations of rapid alcohol intake such
as shots, funneling, keg stands and drinking games. Even after someone passes out
their BAC (blood alcohol concentration) can continue to rise from the alcohol still
in their stomach. Medical attention is critical to prevent serious injury or death.
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