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The Psychopathological Effects and Repercussions of the Consumption of Psychotropic Substances

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Introduction


The consumption of substances and drug addiction present themselves as global issues. Recent investigations by the World Health Organisation indicate that 275 million people, 5.6% of the global population aged between 15 and 64, have used drugs at least once in the course of a year. Approximately 31 million people who consume substances suffer from substance dependency disorders and other associated psychopathologies, with around 450,000 people dying in 2015 due to substance consumption, with the deaths attributed mainly to overdose (predominantly from opioids) and infectious diseases such as hepatitis and HIV, acquired through poor intravenous drug use practices.


Substance consumption varies across countries, as well as according to socioeconomic levels and recreational contexts. Today, two main scenarios are considered to illustrate the initiation of substance use among young people: on the one hand, drugs are used in recreational settings to enhance excitement and intensify the experience, and on the other hand, individuals living in extremely disadvantaged conditions use substances to cope with their difficulties. The substances used in these two scenarios are quite different. In more affluent socioeconomic situations, usage is reported in university settings and at festivities (raves, festivals, clubs), where the most commonly used drugs are predominantly alcohol, cannabis, ecstasy (MDMA), cocaine, ketamine, and LSD. Among young people living on the streets and/or experiencing extreme socioeconomic and psychological difficulties (such as experiences of sexual, physical, or psychological abuse), the most commonly used drugs are alcohol, cannabis, residual compounds of other drugs (such as crack and oxi), and inhalants, which include substances like petrol, paint, correction fluid, and glue.


There is also another type of substance consumption, independent of social class, with spiritual and self-exploration purposes. In these cases, entheogens, psychedelic substances traditionally used in indigenous rituals to assist people in processes of transcendence (whether with the divine, a higher force, or the cosmos itself) and to reach more expansive levels of consciousness, are utilised. Some of these substances include Ayahuasca tea (active ingredient – DMT), argyreia and morning glory (active ingredient – LSA), peyote (active ingredient – mescaline), and hallucinogenic mushrooms, among others.


The factors that lead a young person to prolong their substance use in harmful ways are numerous, requiring a systemic and inter-relational approach between these factors. There are individual factors (such as behaviour, mental health, neurological development, genetic inheritance, and coping mechanisms for dealing with difficulties), proximal context factors (parental and family functioning, school/work environment, and social circle influences), and broader contextual factors (physical and socioeconomic environment). Generally, it is the critical combination of risk factors (childhood and/or current trauma and adversity, such as abuse and neglect, mental health problems, poverty, substance use by close social circles, easy access to substances, isolation, a negative school climate, and sensation-seeking) that are present, and protective factors that are absent (involvement and monitoring by caregivers, normal health and neurological development, problem-solving and emotional regulation skills, physical safety and social inclusion, neighbourhood safety, and a positive school environment) at a particular stage of an individual’s life that makes them susceptible to substance use.

Vulnerable and harmful substance use by young people can have multiple effects: the development of psychopathologies, physical health problems, unemployment, dysfunctional social relationships, criminality, and lower life expectancy. There are also reports of substance use among adults over 40, largely due to the continuation of substance use that began in youth.


It is worth noting that with the growth of the entertainment industry, as well as the psychotropic substances market, the experiences and meanings associated with substance use have diversified. Some consumers, due to the negative balance between protective factors and risk factors, become vulnerable and problematic users. However, contemporary trends in psychoactive substance use among young people tend to consider a profile of non-problematic and non-recurring users with recreational purposes, who are not seen as marginalised (Balsa, Vital, Urbano & Pascoeiro, 2007; Duff, 2005; Gourley, 2004; Measham, 2004; Parker, Williams & Aldridge, 2002; Pilkington, 2007), as well as occasional use of entheogens for ritualistic purposes. Nevertheless, the majority of users are unaware of the true psychopathological effects of these substances, and here we will outline the most well-known psychological effects and consequences of different substance use.


There is a comorbidity between psychotropic substance dependency and individuals suffering from mental illnesses, in comparison to those without any mental disorders. Several hypotheses have been proposed to explain such co-occurrences:


  1. Similar neurobiological basis: For example, sensation seekers—individuals who have a strong need to experience intense sensations—tend to have relatively lower production of dopamine and adrenaline and therefore seek to compensate through substance use.


  2. Self-medication: Substance use may alleviate some of the symptoms of mental illness or reduce the side effects of medication.


  3. Substance-induced mental illness: Substance use may trigger mental illnesses and/or cause biological changes that share common elements with mental disorders.


Among psychoactive substances, there are different categories, which can be divided into:


  • Central Nervous System depressants (e.g., alcohol, sedatives/hypnotics, volatile solvents),


  • Stimulants (e.g., nicotine, amphetamines, cocaine, ecstasy),


  • Opioids (e.g., morphine, heroin),


  • Hallucinogens (e.g., LSD, cannabis, DMT).


Each of these categories of substances interacts differently with the brain and body, influencing the development of mental health disorders in various ways.


Effects and Consequences


Although the effects and consequences of substance use are not universal, as they depend on numerous factors (such as mental health, the individual's personality, the quality of the product consumed, the potency of the product, the emotional state during consumption, the environment in which consumption occurs, and the presence or absence of psychopathology both personally and within the family), significant trends within the population are presented here.


Alcohol


In Portugal, the prevalence of alcohol consumption is 86.4% of the population. In 2017, 44.7% of men and 18.1% of women reported binge drinking (sporadic consumption characterised by high intake in a short period) with drunkenness. The prevalence of alcohol abuse and dependence is 3.5% of the population, with 6.2% among men and 1% among women. The figures are also alarming regarding early consumption; in 2017, 30.6% of 13-year-olds had already consumed some form of alcoholic drink, and 3.4% had engaged in binge drinking in the previous month. In 2016, Security Forces recorded that 41% of those reported for domestic violence indicated alcohol-related problems. In a 2014 national survey on addictive behaviours in prisons, 28% of young people aged 16 and over who had committed crimes stated they were under the influence of alcohol.


Effects


The main effects are social disinhibition and euphoria (beneficial when consumption is moderate), associated with reduced motor skills (balance, coordination, reflexes), impulse control, and increased heart and respiratory rates. Heavy consumption can lead to alcohol poisoning and death due to the shutdown of all physiological systems and the maximum reduction in central nervous system activity.


Consequences


Prolonged consumption leads to brain changes, accompanied by cognitive disturbances such as difficulties in impulse control, decision-making, and problem-solving, as well as a reduction in brain volume. Depression and anxiety are also associated.


In men, alcohol abuse is linked to deficits in impulse control, aggression, and jealousy delusions, often present in crimes of passion and domestic violence. In women, alcohol abuse is more associated with anxiety and depression.


withdrawal can include tremors, seizures, sweating, weakness, psychomotor agitation, anxiety, headaches, nausea, insomnia, transient visual hallucinations, and delirium tremens.



Tobacco


In Portugal, the prevalence of tobacco consumption is 48.8% of the population.


Effects


Nicotine can act as a stimulant when smokers experience fatigue and low activity levels, as well as a tranquiliser when they feel overactive or anxious.


Consequences


In the long term, there are significant changes, culminating in dependence. Withdrawal is characterised by irritability, hostility, anxiety, dysphoria, apathy, decreased heart rate, and increased appetite. The long-term effects of smoking are well-known, such as lung cancer, throat and tongue cancer, as well as damage to the circulatory system, bronchitis, and emphysema.



Cannabis


In 2016, the World Health Organisation recorded 192 million cannabis users worldwide. In Portugal, cannabis is the most commonly used illicit drug, with a prevalence of approximately 11% of the population, with higher rates among young people (aged 15-34). The onset of consumption is increasingly earlier, with estimates suggesting that 13.8 million young people aged 15-16 used cannabis in 2017. This requires serious attention, as early use disrupts and hinders the biological processes of growth and development of neural structures, significantly increasing the risk of neurological and psychiatric disorders.


Effects


Its effects include relaxation, accelerated thinking and attention, insights and increased creativity, increased appetite, conjunctival hyperaemia (red eyes), dry mouth, confusion, spatial disorientation and altered sense of time, psychotic symptoms (hallucinations, paranoia), anxiety symptoms (including panic attacks), sensory alterations, reduced motor coordination and reaction time, and mood swings.


Consequences


Since 2017, recreational cannabis use has been legalised and regulated in various countries. However, it is too early to assess long-term mental health consequences, although there is evidence that regulated and moderate use can help with issues like anxiety, depression, insomnia, libido, and other needs depending on the type of strain used.


Some visible consequences of cannabis use (especially when illegal) include increased hospitalisation due to acute intoxication, with users in crisis experiencing anxiety, panic attacks, and nausea. However, greater control over product quality and dosage is possible with legalised cannabis trade, requiring a product with a maximum of 9% tetrahydrocannabinol (THC) and a minimum of 3% cannabidiol (CBD), which are the plant's psychotropic (causing psychological effects) and antipsychotic (calming and reducing hallucinations, paranoia, etc.) properties, respectively. Illegal cannabis sales involve product adulteration, with a substantial increase in THC concentration and mixing with other substances, leaving consumers unaware of what they are ingesting. In Portugal, in 2017, the potency of cannabis seized in hashish form was 14% THC, contributing to the onset of psychopathologies with psychotic symptoms (Ferdinand, van der Ende, Bongers, Selten, Huizink & Verhulst, 2005), particularly schizophrenia. There are also reports of mood disorders, such as panic attacks, depression, and amotivational syndrome, characterised by a lack of motivation, energy, and apathy. Additionally, prolonged cannabis exposure can cause lasting cognitive impairment, damaging learning and memory processes.


Withdrawal is rare and brief, with symptoms of irritability, anxiety, and insomnia lasting around two weeks on average.



Opioids and Opiates/Opium, Morphine, and Heroin


In 2016, the World Health Organisation recorded 34 million opioid users and 19 million opiate users. In Portugal, the prevalence of heroin consumption is 0.5% of the population.


Effects


The consumption of opioids/opiates induces a state of lightness and euphoria that can last for hours, also reported as enhancing memory efficiency, rapid thinking, and producing significant "insights." As central nervous system depressants, they relieve feelings of distress and pain. They can also cause nausea and drowsiness. Abuse may lead to coma and death.


Consequences


These substances are highly addictive, and tolerance develops quickly, requiring increasingly higher doses. In the long term, there are reductions in the body’s pleasure and reward responses, learning impairments, and increasing intolerance to stress. As highly neurotoxic substances, they cause significant irreversible damage to the nervous system, reducing basic functions such as reaction time to stimuli. Respiratory and digestive system damage is also frequent, often leading to hypoxia (lack of oxygen) in different parts of the body. Their use is beneficial only in cases of severe pain, such as with morphine.


Withdrawal symptoms include tearing, runny nose, yawning, sweating, restlessness, anxiety, insomnia, chills, cramps, and intense muscle pain.



Cocaine


In 2016, the World Health Organisation recorded 18 million cocaine users. In Portugal, the prevalence of cocaine use is 0.4% of the population.


Effects


Its effects include a strong sense of euphoria and agitation, along with heightened alertness, confidence, increased concentration, and reduced need for sleep. Clinical complications include tachycardia, vasoconstriction (narrowing of blood vessels), hypertension, and sudden heart attacks. Over time, euphoria is replaced by fatigue, sadness, and/or apathy.


Consequences

Cocaine is highly addictive, and prolonged use can lead to motor function impairments, aggression, paranoia, learning difficulties, problem-solving challenges, memory problems, mood swings, and hallucinations. Cocaine use can also induce the development of psychotic disorders and mood disorders (bipolar disorder, depression, and anxiety).


Withdrawal is marked by severe depressive episodes, extreme sleepiness, and muscle spasms.



Amphetamines – Methamphetamine (MA) and Ecstasy (MDMA)


In 2016, the World Health Organisation recorded 34 million amphetamine and prescribed stimulant users. In Portugal, the prevalence of amphetamine use is 1.1% of the population, with ecstasy (MDMA) mostly consumed by young people (aged 15-34).


General Effects of Amphetamines


Their effects can last between 2 to 8 hours and are characterised by euphoria, heightened interest in stimuli and enhanced senses, increased energy, strength, and psychomotor agitation, as well as an increase in heart rate, blood pressure, and alertness. They can also produce adverse effects such as insomnia, aggression, anorexia (severe weight loss below normal levels), irritability, teeth grinding, impulsivity, panic attacks, hallucinations, hyperthermia (overheating), dehydration, tachycardia, paranoia, seizures, and strokes. However, despite the risks, supervised use has been found effective in treating patients with post-traumatic stress disorder (Fontes, E. V. B., et al., 2022).


Consequences


Tolerance develops quickly, and withdrawal is characterised by fatigue, depression, anxiety, and intense cravings. Prolonged use leads to brain degeneration (often irreversible), sleep disturbances, mood disorders (anxiety, panic disorder, depression), loss of appetite, reduced reward and pleasure responses, metabolic changes, and motor and learning deficiencies. Amphetamine use can also induce psychotic symptoms, primarily paranoia. Psychotic features include stereotyped and bizarre movements, repetitive and purposeless activities, repetitive word use, monologues in social settings, social isolation with inadequate responses to stimuli, sexual disturbances such as inability to ejaculate, and hallucinations of different types (auditory, visual, tactile, olfactory). Studies also suggest that methamphetamine (MA) and MDMA use increases the risk of developing Parkinson’s disease.


Differences Between Methamphetamines (MA) and Ecstasy (MDMA)


Methamphetamine, also known as crystal meth, is a substance that causes rapid and severe dependence, as well as increased tolerance. It is more popular in the US, Mexico, and South America. Methamphetamine is highly toxic, damaging brain and cardiovascular systems. Its use is commonly associated with psychosis induction, mood disorders, aggressive behaviour, and homicidal tendencies. The behaviour of users is highly unstable, with compromised perception, thoughts, memory, and emotional states. Due to the high physiological and psychiatric impairment, as well as its highly addictive nature, users often turn to criminal behaviours such as theft to continue their consumption and face difficulties reintegrating into society.


Ecstasy’s effects can last up to 8 hours and are characterised by euphoria, social disinhibition, heightened sensitivity to touch and other senses, enhanced colour perception, possible hallucinations, reduced appetite, increased thirst, impulsivity, heightened sexual desire, emotional instability, and other effects common to amphetamines. Prolonged use may lead to irreversible brain degeneration, resulting in behavioural, physiological, and psychiatric complications marked by memory problems, attention deficits, learning impairments, decision-making difficulties, loss of self-control, depression, panic attacks, and psychotic episodes, including paranoia, depersonalisation, derealisation, and delusions.


The most common symptoms of MDMA withdrawal include depression, muscle weakness, fatigue, insomnia, and paranoia.


LSD (Lysergic Acid Diethylamide)


In Portugal, the prevalence of LSD use is 0.4% of the population.


Effects


Its effects can last from 5 to 12 hours and include hallucinogenic effects and alterations in mood (radical mood changes), thinking, and attention, memory, and problem-solving abilities. This includes experiences of dissociation (feeling separated from reality or one's own body), spatial disorientation, and altered perception of time, synesthesia (mixing and overlapping of senses, e.g., smelling colors), increased sensitivity of the senses, heightened perception of colors, visualization of fractals, experiences of unreality, as well as paranoia, panic, delusions, worsened concentration, and accelerated thinking. Users report the experience as either a “good trip” or a “bad trip,” with the former recognized as a pleasurable experience, an expansion of consciousness, creativity, and insights, and the latter marked by panic and fear of annihilation, as well as guilt that can culminate in suicidal acts. Physical effects can include dilated pupils, chills, increased heart rate, decreased appetite, insomnia, tremors, dry mouth, and hyperglycemia.


Consequences


Tolerance develops quickly at physical and psychological levels, and there are no signs of withdrawal. Long-term use can lead to sleep disorders, mood disorders (depression, anxiety, and bipolarity), and more commonly, acute or chronic psychotic episodes, leading to the development of schizophrenia. It is also common to re-experience effects of the substance long after its use (flashbacks), since the substance is not metabolized and remains in the body. There are also phenomena known as delayed psychosis, where there is a kind of flashback of greater severity occurring months after the last use of the substance.



Psilocybin (Magic Mushrooms)


In Portugal, the prevalence of magic mushroom consumption is 0.2% of the population.


Effects


Their effects are similar to those reported with LSD, although they are more mild and shorter-lasting, and the substance is metabolized by the body. Feelings of joy and happiness, distortions of thought and perception of space and time, increased sensitivity to stimuli, and heightened senses are reported. Dissociative experiences, dizziness, drowsiness, difficulty concentrating, muscle weakness, nausea, and lack of coordination are also common. Many users report experiences of communion with nature, with their own life history, and resolution of internal conflicts. Users report the experience can be better controled depending on the dosage.


Consequences


There are no reports of dependence or increased tolerance to the substance; however, its use can lead to psychoses similar to schizophrenia. In the Netherlands, where the consumption of "magic mushrooms" is legalized, studies indicate the relative safety of the product; however, the issues arise in inducing panic attacks and flashbacks that can last for varying lengths of time. Users have reported their experiences with mushrooms as among the most challenging, often lacking the necessary social support (one of the negative factors with legalization without criteria for professional monitoring) and putting themselves (including suicide attempts) and others at risk. If the use were accompanied and integrated into therapeutic processes, it could be a great tool for certain patients. Microdosing on mushrooms, on the other hand, an administration that doesnt produce psychotropic effects, is associated to the cure of depression and hightened neuroplasticity and brain conectivity.



DMT (Dimethyltryptamine)


In Portugal, the prevalence of new substances, with particular attention to DMT, is 0.3% of the population and 0.5% of the young population (15-34 years). DMT has become popular with the expansion of shamanic medicine, the consumption of entheogens (substances of natural origin traditionally used in indigenous rituals), and the use of ayahuasca or Santo Daime tea internationally. These substances are commonly used in indigenous tribes for spiritual and ritual purposes in South America, such as in Brazil, Colombia, Bolivia, and Peru.


Effects


Users report the experience as the strongest in terms of psychedelic and hallucinatory effects, using expressions like “unification with the cosmos,” “the death of the ego,” “rebirth,” “access to the transcendent,” and self-knowledge. Unlike the recreational use of LSD and mushrooms, ayahuasca is usually consumed in a structured context guided by occupational therapists and shamans, or others knowledgeable about the effects of the substance from different areas. In addition to the mentioned psychedelic effects, the most commonly reported effects are nausea and vomiting. Users also report panic attacks during the experience.


Consequences


The substance has been studied, and in many cases, it shows contributions to the treatment of substance dependence and depression. Its use is often reported as a turning point for individuals, making them more aware and fulfilled after using it. However, there are also reports of psychosis induced by its use, and further studies are required to understand the nature of its effects and consequences, particularly outside of structured ritual contexts, which themselves modify the nature of the experience.



Mescaline


Mescaline is another substance found in entheogens, such as the Peyote cactus in the Americas. The substance, like DMT, was also initially used by indigenous tribes for spiritual and ritual purposes.


Effects


The effects of mescaline are also of a psychedelic nature, associated with acute and transient episodes of dissociation, delusions, and hallucinations. They also include increased fluidity of ideas and thoughts, as well as exacerbation of the pre-existing personality traits of an individual.


Consequences


Its use is associated with the development of schizophrenia and other psychoses.



Ketamine


Ketamine (originally an anesthetic for horses) has been used in party environments such as clubs and raves, often alongside other well-known substances in nightlife such as MDMA, cocaine, and LSD.


Effects


The effects last on average two hours and are characterized by alterations in sensations and perception, including a near-death sensation, mystical delusions, hallucinations, amnesia, and increased strength and physical endurance.


Consequences


Ketamine is highly toxic, and in humans, there is evidence of irreversible structural damage to the brain of users, with degeneration of white brain matter. Its use also causes problems at the circulatory level, and prolonged use is associated with psychotic psychopathologies, such as dissociation, hallucinations, continuous flashbacks, development of schizophrenic disorders, catatonia, depression, among others.


Finally, it is important to reiterate that although serious psychological consequences predominantly occur after prolonged use, it is also possible, particularly with psychotropic and psychedelic substances (cannabis, amphetamines, LSD, etc.), to induce psychological disturbances after the first use. The issue at hand is not the drug itself but the complex specific interaction between it and the consumer, and if the consumer has any latent psychological and/or psychiatric vulnerabilities, often just one use is enough to awaken what might have remained dormant.




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PSYCHOLOGIST AND PSYCHOANALITIC PSYCHOTHERAPIST Ana Lúcia Senise

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