Alcohol & Substance Addictions



Alcohol consumption can damage the brain and most body organs, including the heart, liver, and pancreas. It also increases the risk of some cancers, weakens the immune system, puts fetal development at risk, and causes deadly vehicle accidents. Areas of the brain that are especially vulnerable to alcohol-related damage are the cerebral cortex (largely responsible for our higher brain functions, including problem-solving and decision-making), the hippocampus (important for memory and learning), and the cerebellum (important for movement coordination).

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Cocaine is a short-acting stimulant that can lead users to “binge”—take the drug many times in a single session. Cocaine use can lead to severe medical consequences related to the heart and the respiratory, nervous, and digestive systems. Cocaine users can also experience severe paranoia, in which they lose touch with reality. The powdered form of cocaine is either inhaled through the nose (snorted), where it is absorbed through the nasal tissue or dissolved in water and injected into the bloodstream.

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Opioids are usually prescribed for pain relief. Commonly prescribed opioids include hydrocodone (e.g., Vicodin), oxycodone (e.g., OxyContin), morphine, fentanyl, and codeine. In the United States and Canada, more people now die from opioid painkiller overdoses than from heroin and cocaine combined. Codeine is an opioid that can produce relaxation and euphoria when consumed in sufficient quantities.

Opioids are medications that relieve pain. They reduce the intensity of pain signals reaching the brain and affect those brain areas controlling emotion, which diminishes the effects of a painful stimulus. Medications that fall within this class include hydrocodone (Vicodin), oxycodone (OxyContin, Percocet), morphine (Kadian, Avinza), codeine, and related drugs. Hydrocodone products are the most commonly prescribed for a variety of painful conditions, including dental and injury-related pain. Morphine is often used before and after surgical procedures to alleviate severe pain. Codeine, on the other hand, is often prescribed for mild pain. In addition to their pain-relieving properties, some of these drugs—codeine and diphenoxylate (Lomotil) for example—can be used to relieve coughs and severe diarrhea.

  • constant concern about having another panic attack or the consequences of a panic attack (e.g., having a heart attack), and/or
  • significant behaviour changes related to the attacks (e.g., avoiding exercise or places for fear of having a panic attack).

A panic attack is a sudden feeling of intense fear or discomfort that peaks within minutes. It includes stressful physical and cognitive symptoms as well as behavioural signs.” People struggling with panic disorder may use substances to cope, which can lead to addiction. The team at CHRC is experienced at treating clients with panic disorder and who abuse substances.

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Marijuana (cannabis) is the most commonly used illicit substance. This drug impairs short-term memory and learning, the ability to focus, and coordination. It also increases heart rate, can harm the lungs and may increase the risk of psychosis in vulnerable people. Research suggests that when regular marijuana use begins in the teen years, addiction is more likely: 1 in 6 users, compared to 1 in 9 among adults. In addition, recent research suggests that heavy cannabis use that starts in the teen years is associated with declines in IQ scores in adulthood.

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Since their introduction in the 1960s, tranquilizer drugs categorized as benzodiazepines, which include diazepam (Valium®) and alprazolam (Xanax®), have been widely prescribed to treat anxiety and insomnia, alcohol withdrawal, and other conditions. Although they are highly effective for their intended uses, these medications must be prescribed with caution because they can be addictive in a way similar to that of opioids, cannabinoids and the club drug gamma-hydroxybutyrate (GHB).

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Fentanyl is a powerful synthetic opiate analgesic similar to but more potent than morphine. It is a Schedule II prescription drug, typically used to treat patients with severe pain, or to manage pain after surgery. It is also sometimes used to treat people with chronic pain who are physically tolerant of opiates. In its prescription form, fentanyl is known as Actiq®, Duragesic® and Sublimaze®. Street names for the drug include Apache, China girl, China white, dance fever, friend, goodfella, jackpot, murder 8, TNT, as well as Tango and Cash.

Like heroin, morphine and other opioid drugs, fentanyl works by binding to the body’s opiate receptors, highly concentrated in areas of the brain that control pain and emotions. When opiate drugs bind to these receptors, they can drive up dopamine levels in the brain’s reward areas, producing a state of euphoria and relaxation. Medications called opiate receptor antagonists act by blocking the effects of opiate drugs. Naloxone® is one such antagonist. Overdoses of fentanyl should be treated immediately with an opiate antagonist.

When prescribed by a physician, fentanyl is often administered via injection, transdermal patch, or in lozenge form. However, the type of fentanyl associated with recent overdoses was produced in clandestine laboratories and mixed with (or substituted for) heroin in a powder form. Mixing fentanyl with street-sold heroin or cocaine markedly amplifies their potency and potential dangers. Effects include euphoria, drowsiness/respiratory depression and arrest, nausea, confusion, constipation, sedation, unconsciousness, coma, tolerance and addiction

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Amphetamines, including methamphetamine, are powerful stimulants that can produce feelings of euphoria and alertness. Methamphetamine is a white, odourless, bitter-tasting crystalline powder that easily dissolves in water or alcohol and is taken orally, intra-nasally (snorting the powder), by needle injection, or by smoking. Methamphetamine’s effects are particularly long lasting and harmful to the brain. Amphetamines can cause high body temperature and can lead to serious heart problems and seizures. Regular methamphetamine use significantly changes how the brain functions. Non-invasive human brain imaging studies have shown alterations in the activity of the dopamine system that are associated with reduced motor skills and impaired verbal learning, which may account for many of the emotional and cognitive problems observed in regular methamphetamine users.


Heroin is a powerful opioid drug that produces euphoria and feelings of relaxation. It slows respiration and can increase the risk of serious infectious diseases, especially when taken intravenously. Regular heroin use changes the functioning of the brain, causing tolerance and dependence. Other opioid drugs include morphine, OxyContin®, Vicodin® and Percodan®, which have legitimate medical uses; however, using them in ways other than prescribed (or using them without a prescription) can result in the same harmful consequences as heroin use.


Ketamine, Rohypnol® and GHB have come to be known as “date rape” drugs because they can cause someone to lose their memory of an assault. Rohypnol® and GHB can easily be added to beverages and ingested unknowingly. Any of these drugs can also cause someone to lose consciousness. Ketamine and GHB are predominantly central nervous system depressants, whereas Rohypnol® is a benzodiazepine.


The effects of hallucinogens—perception-altering drugs—are highly variable and unreliable, producing different effects in different people at different times. This is mainly due to differences in the amounts and chemistries of active compounds within the drugs. Because of their unpredictable nature, the use of hallucinogens can be particularly dangerous. Examples of hallucinogens include the following:

MDMA (Ecstasy, “Molly”)

The drug 3,4-methylenedioxymethamphetamine produces both stimulant and mind-altering effects. It can increase body temperature, heart rate, blood pressure and heart-wall stress. Ecstasy may also be toxic to nerve cells. It is taken orally, usually as a capsule or tablet. Its effects last approximately 3 to 6 hours, although it is not uncommon for users to take a second dose of the drug as the effects of the first dose begin to fade. Ecstasy is commonly taken in combination with alcohol and other drugs.

Molly—slang for “molecular”—refers to the pure crystalline powder form of ecstasy. Users may seek out Molly to avoid the adulterants or substitutes known to be commonly found in ecstasy, but those who purchase what they think is pure ecstasy may actually be exposing themselves to the same risks, since Molly often contains toxic additives. In fact, Molly is often nothing more than repackaged ecstasy.


Is one of the most potent hallucinogenic drugs. Its effects are unpredictable, and users may see vivid colors and images, hear sounds and feel sensations that seem real but do not exist. Users also may have traumatic experiences and emotions that can last for many hours. Some short-term effects can include increased body temperature, heart rate and blood pressure; sweating; loss of appetite; sleeplessness; dry mouth, and tremors.


Phencyclidine was developed in the 1950s as an intravenous anesthetic. Its legitimate use has since been discontinued due to serious adverse effects.


“magic” or “psychedelic” mushrooms is obtained from certain types of mushrooms that are found in tropical and subtropical regions of South America, Mexico and the United States. These mushrooms typically contain less than 0.5 percent psilocybin plus trace amounts of psilocin, another hallucinogenic substance.


Hydromorphone is an opioid pain medication (Dilaudid®, Exalgo®, Palladone®). The extended-release form of this medicine is used to relieve moderate to severe pain in opioid-tolerant patients who require around-the-clock pain relief for a long period of time. This medicine should not be used to treat pain that you only have once in a while or “as needed.” Hydromorphone belongs to the group of medicines called narcotic analgesics (pain medicines). It acts on the central nervous system to relieve pain and can slow or stop your breathing if taken in larger doses than prescribed. When a narcotic medicine is used for a long time, it may become habit-forming, causing mental or physical dependence and may lead to withdrawal side effects if treatment is stopped suddenly. However, severe withdrawal side effects can usually be prevented by gradually reducing the dose over a period of time before treatment is stopped completely.


Inhalants are volatile substances found in many household products (such as oven cleaners, gasoline, spray paints and other aerosols) that induce mind-altering effects. Inhalants are extremely toxic and can damage the heart, kidneys, lungs and brain. Even a healthy person can suffer heart failure and death within minutes of a single session of the prolonged sniffing of an inhalant. People tend to abuse different inhalant products at different ages. New younger users (ages 12-15) most commonly abuse glue, shoe polish, spray paints, gasoline and lighter fluid. First-time older users (ages 16-17) most commonly abuse nitrous oxide, or “whippets.” Adults most commonly abuse a class of inhalants known as nitrites (such as amyl nitrites, or “poppers”).


Ketamine, Rohypnol® and GHB have come to be known as “date rape” drugs because they can cause someone to lose their memory of an assault. Rohypnol® and GHB can easily be added to beverages and ingested unknowingly. Any of these drugs can also cause someone to lose consciousness. Ketamine and GHB are predominantly central nervous system depressants, whereas Rohypnol® is a benzodiazepine.


Methylphenidate (Ritalin®, Concerta®, Focalin® and Metadate®) and amphetamines (Adderall®, Dexedrine®) are stimulants commonly prescribed for attention-deficit hyperactivity disorder (ADHD). Prescription stimulants have a calming and “focusing” effect on individuals with ADHD. They are prescribed to patients for daily use, and come in the form of tablets or capsules of varying dosages. Because prescription stimulants suppress appetite, increase wakefulness and increase focus and attention, they are frequently abused for purposes of weight loss or performance enhancement. Because they may produce euphoria, these drugs are also frequently abused for recreational purposes

When taken in doses and via routes other than those prescribed, prescription stimulants can increase brain dopamine in a rapid and highly amplified manner (similar to other drugs of abuse such as methamphetamine), thereby disrupting normal communication between brain cells and producing euphoria and, as a result, increasing the risk of addiction. They can lead to malnutrition and its consequences. Repeated abuse of stimulants can lead to feelings of hostility and paranoia. At high doses, they can lead to serious cardiovascular complications, including stroke.

If stimulants are abused chronically, withdrawal symptoms—including fatigue, depression, and disturbed sleep patterns—can result when a person stops taking them. Additional complications from abusing stimulants can arise when pills are crushed and injected: insoluble fillers in the tablets can block small blood vessels.


Anabolic steroids refer to synthetic variants of the male sex hormone testosterone. The proper term for these compounds is anabolic-androgenic steroids (AAS—“anabolic” referring to muscle building and “androgenic” referring to increased male sexual characteristics.) Steroids can be prescribed for certain medical conditions, however, they are often abused to increase muscle mass and to improve athletic performance or physical appearance. Anabolic steroids are usually either taken orally or injected into the muscles, although some are applied to the skin as a cream or gel. Doses taken by abusers may be 10 to 100 times higher than doses prescribed to treat medical conditions.

Anabolic steroids work very differently from other addictive drugs, and they do not have the same acute effects on the brain. However, long-term steroid use can affect some of the same brain pathways and chemicals—including dopamine, serotonin and opioid systems—that are affected by other drugs. They thereby may have a significant impact on mood and behaviour.

Other serious consequences of steroid abuse can include heart disease, liver problems, stroke, infectious diseases, depression and suicide. Less serious side effects include severe acne and changes in sex characteristics, like shrinking of the testicles in men and growth of facial hair in women.


Nicotine is an addictive stimulant found in cigarettes and other forms of tobacco. Tobacco smoke increases a user’s risk of cancer, emphysema, bronchial disorders and cardiovascular disease. Smoking rates have decreased in the United States and Canada in recent years, yet the mortality rate associated with tobacco addiction is still staggering, with more than 480,000 premature deaths in the United States each year—about 1 in every 5 deaths.1 Tobacco use killed approximately 100 million people during the 20th century and if current smoking trends continue, the cumulative death toll for this century is projected to reach 1 billion.2 Tobacco smoke contains over 4,000 chemicals, more than 70 of which cause cancer. Smoking tobacco is the main risk factor for 4 of the leading causes of death in Canada (cancer, heart disease, stroke and lung disease). About 37,000 people die each year in Canada as a result of smoking tobacco.

  1. Centers for Disease Control and Prevention. Smoking and Tobacco Use: Fast Facts
  2. WHO Report on the Global Tobacco Epidemic, 2008: The MPOWER package. Geneva, World Health Organization, 2008


Methadone is a long-acting synthetic opioid agonist medication that can prevent withdrawal symptoms and reduce craving in opioid-addicted individuals without causing the “high” associated with the drug addiction and can also block the effects of illicit opioids. It is most commonly used to treat addiction to opioid drugs such as heroin, oxycodone (OxyContin®) and hydromorphone (Dilaudid®). Methadone is sometimes prescribed as a pain reliever for people who have severe chronic pain or pain associated with terminal illness. It has a long history of use in the treatment of opioid dependence in adults and is taken orally. It is available only from certified pharmacies.

Most people experience some side-effects from methadone treatment. Possible side-effects include sweating, constipation and weight gain. Methadone can slow or stop your breathing, especially when you start using this medicine or whenever your dose is changed. Never use this medicine in larger amounts unless prescribed by your doctor.

Methadone maintenance is a treatment and should not be considered a “cure.” Through treatment, people who are addicted to opioids receive the medical and social support they need to stabilize and improve their lives. Daily treatment with methadone may continue indefinitely, however if the desire is toward ending treatment, it is advised to do this gradually. Your doctor will taper the methadone dose over the course of weeks or months, easing the process of withdrawal. If methadone is stopped abruptly, symptoms such as stomach cramps, diarrhea and muscle and bone ache will occur. These symptoms begin within one to three days after the last dose, peak at three to five days and then gradually subside. The amount of time you experience methadone withdrawal symptoms varies, lasting up to a few weeks or longer.

Bath salts

The term “bath salts” refers to an emerging family of drugs containing one or more synthetic chemicals related to cathinone, an amphetamine-like stimulant found naturally in the khat plant. Reports of severe intoxication and dangerous health effects associated with the use of bath salts have made these drugs a serious and growing public health and safety issue. Some users experience paranoia, agitation, hallucinatory delirium, and psychotic and violent behaviour. Deaths have also been reported.

These synthetic cathinone products—marketed as “bath salts” to evade detection by authorities—should not be confused with products such as Epsom salts for bathing. Bath salts typically take the form of a white or brown crystalline powder and are sold in small plastic or foil packages labeled “not for human consumption.”

Concurrent Mental Health Disorders



Panic Disorder

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