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Drug Dependency: Investigations of Stimulants and Depressants

ANTHONY KALES, M.D.; GUNNAR HEUSER, M.D., PH.D.; JOYCE D. KALES, M.D.; WILLIAM H. RICKLES JR., M.D.; ROBERT T. RUBIN, M.D.; MARTIN B. SCHARF, B.A.; J. THOMAS UNGERLEIDER, M.D.; and WALLACE D. WINTERS, M.D., PH.D.
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Los Angeles, California


Ann Intern Med. 1969;70(3):591-614. doi:10.7326/0003-4819-70-3-591
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SUMMARY:

The legal and illegal use of psychoactive drugs, including stimulants, hypnotics, tranquilizers, and hallucinogens, is markedly increasing.

Lysergic acid diethylamide (LSD) may cause severe acute or chronic symptoms; one cannot predict adverse reactions or relate them to frequency and length of LSD use. Among its effects are acute psychologic changes, including psychosis; and chronic alterations, such as apathy, psychosis, and "flashback." Chlorpromazine is recommended for treatment of symptoms; psychotherapy and education help prevent further LSD use.

Chronic amphetamine use may lead to toxic psychosis, confusion, or brain damage; acute withdrawal may lead to depression, with suicidal ideation, and increases in rapid eye movement (REM) sleep with nightmares and insomnia. Chronic use of barbiturates and nonbarbiturate hypnotics may lead to mental impairment, motor incoordination, and depression. Withdrawal produces weakness, irritability, and occasionally convulsions or psychosis.

Amphetamines and hypnotics should be withdrawn gradually and patients educated as to possible physiologic alterations, both those patients dependent on large doses and those who have taken therapeutic doses for some months. Withdrawal of these drugs leads to marked increases in REM sleep, nightmares, and insomnia, which may lead to drug dependency.

Marijuana may change time sense and visual and auditory perceptions. Chronic use frequently indicates underlying psychologic disturbances needing psychotherapy.

Psychoactive drugs differentially affect responses of various autonomic systems. Central nervous system (CNS)-active drugs do not induce only one condition and cannot be simply classified as excitants or depressants. The physiologic alterations produced by psychoactive drugs are basic to drug dependency as are personality factors.

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