As substances of abuse, depressants produce
INTOXICATIONwith initial euphoria and subsequent
diminished cognitive function. Those who abuse
depressants often do so to dull the effects of coming
down from other drugs such as METHAMPHETAMINE
and COCAINE. The most commonly abused depres-
sants are ALCOHOLand benzodiazepines, notably
alprazolam and diazepam. Other commonly abused
depressants include the illicit drugs FLUNITRAZEPAM
and GAMMA HYDROXYBUTYRIC ACID(GHB).
See also ALCOHOLISM; ILLICIT DRUG USE; PRESCRIP-
TION DRUG ABUSE; STIMULANTS.
designer drugs Illicit drugs created by altering
the molecular structure of existing drugs, usually
drugs that are legal but restricted. The designer
drug is typically similar to the derivative drug in
its actions and effects, though both are often
enhanced or intensified in some way. Because
“street chemists” (commonly called cookers) man-
ufacture designer drugs in casual settings, these
drugs are often of inconsistent potency and purity.
There are often dozens of variations on a particu-
lar formula, each somewhat different molecularly
but all touted as the same drug.
Most designer drugs are CLUB DRUGSproduced
solely for the purpose of creating an intoxicating
or hallucinogenic experience, though some
designer drugs are substances people take to
improve physical or athletic performance. The risk
for OVERDOSE, either from a single unexpectedly
potent dose or through combining drugs, is very
high. Designer drugs have no therapeutic use.
See also AMPHETAMINES; BLOOD DOPING; HALLU-
CINOGEN; METHAMPHETAMINE; PERFORMANCE-ENHANC-
ING SUBSTANCES; SUBSTANCE ABUSE PREVENTION.
detoxification The process of eliminating from
the body a substance to which a person is
addicted. Detoxification causes physiologic
changes that restore to normal the way the body
functions, reversing the changes that occurred as
DEPENDENCEand ADDICTIONdeveloped. This process
of restoration can cause symptoms such as ABDOM-
INAL PAIN, JOINTand MUSCLE PAIN, NAUSEA, VOMITING,
“shakes” (tremors), and sometimes seizures.
Controlled detoxification, also called medically
supervised withdrawal, is the first stage of treat-
ment for DRUGaddiction (including ALCOHOLaddic-
tion). Many people undergoing treatment for
addiction receive medications to mitigate with-
drawal symptoms. Detoxification may take as long
as 14 days, though the most severe symptoms
occur within the first 3 to 5 days for most addic-
tions. Successful recovery from addiction requires
further, and often ongoing, treatment that may
include PSYCHOTHERAPY, BEHAVIOR MODIFICATION THER-
APY, COGNITIVE THERAPY, and intensive family and
peer support.
See also ALCOHOLIC HALLUCINOSIS; ALCOHOLISM;
INTOXICATION; SOBRIETY; WITHDRAWAL SYNDROME.dextromethorphan A COUGH suppressant, also
called an antitussive, that is a common ingredient
in numerous OVER-THE-COUNTER(OTC) DRUGS. These
products are the most common sources for abuse,
though other sources include illicit dextromethor-
phan powder or capsules that contain dex-
tromethorphan powder. Though not a narcotic,
dextromethorphan binds with certain opiate
receptors in the BRAIN and SPINAL CORD(CENTRAL
NERVOUS SYSTEM) and has an opioid effect in sup-
pressing the cough REFLEX. Dextromethorphan has
low risk for DEPENDENCEor ADDICTION.
At the recommended DOSAGEin cough and cold
relief products dextromethorphan effectively
relieves cough without significant side effects.
When taken in amounts that exceed the recom-
mended dosage dextromethorphan causes NAUSEA,
disorientation, HALLUCINATION, and dissociation
(perceptions of separating from the physical
body). In very high doses, dextromethorphan
causes confusion, slurred speech, disturbed vision,
tachycardia (rapid HEART RATE), and peripheral
PARESTHESIA(tingling and numbness of the fingers
and toes). Seizures or fatal ARRHYTHMIA(irregular
HEARTbeat) may also occur with very high doses.
Chronic dextromethorphan abuse may result in
PSYCHOSISand permanent neurologic damage to
the brain.
Other ingredients in multisymptom products
that contain dextromethorphan, such as aceta-
minophen (an analgesic and antipyretic) and
guaifenesin (an expectorant), may cause other
undesired side effects. Chronic acetaminophen use
or acetaminophen OVERDOSEhas high risk for per-
manent LIVERdamage, LIVER FAILURE, kidney dam-
age, and RENAL FAILURE.332 Substance Abuse