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INTRODUCTION

Experimenting with alcohol or tobacco for the first time is common among adolescents. By the time they are seniors, almost 70% of high school students will have tried alcohol, 50% will have used an illegal drug, nearly 40% will have smoked a cigarette, and more than 20% will have misused a prescription drug for a nonmedical purpose. Ongoing substance use, however, is a nonnormative risk behavior with the potential to compromise adolescent development and lead to a substance use disorder (SUD).

The American Psychiatric Association has outlined criteria to assess the severity of SUDs. The most recent version, DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition), has moved from the previous terms “substance abuse” and “substance dependency” to mild, moderate, and severe SUD. There are 11 features described in DSM-5. Patients with mild SUD have two or three features, whereas those with moderate have four or five features without loss of control or compulsive features. Patients with severe SUD have more than six features, including loss of control or compulsive features.

Common physiologic effects and symptoms of intoxication (which can occur at any stage of substance use) and withdrawal (a symptom of dependency) for the major classes of substances are shown in Tables 5–1 and 5–2.

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Table 5–1. Physiologic effects of commonly abused mood-altering substances by organ/system.
Eyes/pupils
Mydriasis Amphetamines, MDMA, or other stimulants; cocaine; glutethimide; jimson weed; LSD. Withdrawal from alcohol and opioids
Miosis Alcohol, barbiturates, benzodiazepines, opioids, PCP
Nystagmus Alcohol, barbiturates, benzodiazepines, inhalants, PCP
Conjunctival injection LSD, marijuana
Lacrimation Inhalants, LSD. Opioid withdrawal
Cardiovascular
Tachycardia Stimulants, including amphetamines, MDMA, cocaine; LSD; marijuana; PCP. Alcohol, barbiturate, benzodiazepine withdrawal
Hypertension

Stimulants, including amphetamines, MDMA, cocaine; LSD; marijuana; PCP. Alcohol, barbiturate, benzodiazepine withdrawal

Amphetamines, MDMA, or other stimulants; cocaine; LSD; marijuana; PCP. Withdrawal from alcohol, barbiturates, benzodiazepines

Hypotension Barbiturates, opioids. Orthostatic: marijuana. Withdrawal from depressants
Arrhythmia Amphetamines, MDMA, or other stimulants; cocaine; inhalants; opioids; PCP
Respiratory
Depression Opioids, antidepressants, GHB
Pulmonary edema Opioids, stimulants
Core body temperature
Elevated Amphetamines, MDMA, or other stimulants; cocaine; PCP. Withdrawal from alcohol, barbiturate, benzodiazepine, opioid withdrawal
Decreased Alcohol, barbiturates, benzodiazepines, opioids, GHB
Peripheral nervous system response
Hyperreflexia Amphetamines, MDMA, or other stimulants; cocaine; LSD; marijuana; methaqualone; PCP. Withdrawal from alcohol, barbiturates, benzodiazepines
Hyporeflexia Alcohol, barbiturates, benzodiazepines, inhalants, opioids
Tremor Amphetamines or other stimulants, cocaine, LSD. Alcohol, barbiturate, benzodiazepine, opioid withdrawal
Ataxia Alcohol, amphetamines, MDMA, or other stimulants; barbiturates; benzodiazepines; inhalants; LSD; PCP; GHB
Central nervous system response
Hyperalertness Amphetamines, MDMA, or other stimulants; cocaine
Sedation, somnolence Alcohol, barbiturates, benzodiazepines, inhalants, marijuana, opioids, GHB
Seizures Alcohol; amphetamines, MDMA, or other stimulants; cocaine; inhalants; methaqualone; opioids (particularly meperidine, propoxyphene). Alcohol, barbiturate, benzodiazepine, opioid withdrawal
Hallucinations Amphetamines, MDMA, or other stimulants; cocaine; inhalants; LSD; marijuana; PCP. Alcohol, barbiturate, benzodiazepine, opioid withdrawal
Gastrointestinal
Nausea, vomiting Alcohol, amphetamines or other stimulants, cocaine, inhalants, LSD, opioids, peyote, GHB. Withdrawal ...

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