Substance Use Disorders 413
take the drug, again and again—which in turn leads to tolerance. Tolerance makes
the same dose of heroin fall short: Instead of causing euphoria, it often causes ir-
ritability. Extraordinarily unpleasant withdrawal symptoms can arise within a few
hours of the last dose, peak within 72 hours, and take up to a week to subside;
symptoms include bouts of chills and hot fl ashes, diarrhea, and extreme restlessness
(NIDA, 2007c). Debbie describes her fi rst experience with heroin:
[It’s] as if you’re drifting off into a deep, deep, deep, deep sleep.... You’ve got no
feeling in a way. It feels like you’re dead, you’re [sic] body’s dead in some ways but
it’s still warm... .You feel like you’re in this little bubble and nobody can burst it
but at the same time, you don’t realise [sic] how much danger you’re in.
(Substancemisuse.net, 2007)Debbie goes to describe heroin withdrawal, after 2 years of daily use:
You’re like a wild animal. You feel like you’re climbing the ceiling. You’re pulling your
hair out.... You hit yourself, you know, to try and bring yourself out of it, to get that
pain away.... you have stomach cramps, you feel sick. You don’t know whether to
put your arse on the toilet or your face down it. You can never get comfortable...... my skin was getting turned inside out and there were things crawling underneath
it.... It felt like my head was going to blow up.... I didn’t know what to do. I was hav-
ing hot and cold [fl ashes]. I didn’t know whether to get dressed and go out looking but
there was nothing anywhere.... You get very nasty and violent coz I did and I’m not a
very violent person... that day I really did go for it and, you know, “Without that [heroin]
I can’t live,” that’s what got into my head “Without that [heroin] I can’t live.”
(Substancemisuse.net, 2007)
Debbie’s experience with heroin withdrawal apparently involved many of the classic
symptoms including chills and hot fl ashes, and restlessness.
Progression to Injection
Most people with substance abuse and dependence didn’t begin by using a “hard”
drug but progressed to such a drug over time; similarly, people who inject heroin
(“shoot up”) didn’t necessarily start their heroin use that way. People rarely, if ever,
plan to become addicted—rather, they just slip into this pathological state. Surveys
of people who have used heroin fi nd that the typical user starts out snorting heroin
(as Lennon did), progresses to injecting heroin under the skin but not into blood
vessels (termed skin popping), and then ends up injecting into blood vessels (termed
mainlining). Injecting heroin causes a more intense experience: a “rush,” a feeling
of immediate intensity. Some users who inhale heroin do so because they mistakenly
believe that this method of use is less likely to lead to tolerance and withdrawal
(NIDA, 2005a). Most users proceed from occasional use to daily use, and their pri-
mary motivation in life becomes obtaining enough money to procure the next dose,
or “fi x.” Because users become tolerant to the drug, they must increase the amount
they use in order to get an effect. But their habit becomes a tightrope walk: Too
great an amount is fatal.
Heroin abuse and dependence is associated with a variety of medical problems,such as pneumonia and liver disease. In addition, heroin often has various other
substances added to it; these substances can clog blood vessels leading to vital
organs. Moreover, abusers who inject the drug are at risk to develop AIDS and
hepatitis as well as collapsed veins (NIDA 2007c).
Hallucinogens
In 1964, the Beatles began their search for the meaning of life through transcenden-
tal meditation, Hinduism, and “mind-altering” drugs such as lysergic acid diethyl-
amide (LSD, also known as acid). George Harrison recounted that he had heard that
hippies in the Haight-Ashbury district of San Francisco, California, were “dropping
acid” in a similar search for meaning. Harrison fl ew there but was disgusted to fi nd
that the hippies generally weren’t using LSD to seek enlightenment, but simply as an-
other way to get high. Harrison was so disillusioned that he stopped using LSD in his
search for meaning. Unlike other types of drugs we’ve discussed so far, hallucinogens