pression. Alcohol may mask the symptoms temporarily, but it cannot solve the problems, and this kind of use is more likely to lead to dependence.
8. Adolescence, with its confusions, peer pressures, and tendencies to rebel, is a time when unhealthy patterns of drug use can develop that may persist into later life and be very hard to break. Young people may think they aren't as susceptible to dependence on alcohol as adults, but the evidence contradicts this view. Alcohol is a difficult drug to control at any age, and alcoholism doesn't appear overnight. It is the result of unwise drinking over time, beginning with the earliest experience of the drug.
9. Alcohol contains calories. If you are trying to lose weight, watch your intake.
10. The best way to protect yourself from the harmful effects of alcohol is not to drink it every day.
11. If you drink regularly make sure you maintain good habits of rest, exercise, and nutrition. In particular, take supplemental vitamin B-l |thiamine), 100 milligrams a day on days that you drink. Alcohol selectively destroys this vitamin.
12. If you begin to suspect you have problems with drinking, or if people who know you think you do, seek help from professionals. It is difficult or impossible to deal with problem drinking without outside help.
The manufacturer of this strong liqueur seems to be recommending solitary drinking, a practice that favors abuse and can be a sign of alcoholism.
Barbiturates and Other Sleeping Pills ("Downers")
This class of sedative-hypnotic drugs — loosely known as sleeping pills, or downers — has been around for some time. They are manufactured both legally and illegally, and are widely used. Medical doctors prescribe these substances in low doses to calm people during the day and in higher doses to help them sleep at night. There are millions of people who take sleeping pills every night and can't fall asleep without them. Millions of others take downers for nonmedical reasons: to get high, to feel good, or to party.
Barbituric acid was discovered in 1864. Since then a number of derivatives of it have been introduced. They are all known as barbiturates and arc the most important drugs in this class. The first barbiturate sleeping drug, called barbital, appeared in 1903. The second, called phenobarbital, appeared in 1912. Hundreds of barbiturates are now known, and many arc currently in use.
Some of the barbiturates are slowly metabolized and eliminated by the kidneys. Barbital and phenobarbital are in this group, and are known as long-acting barbiturates because their effects last twelve to twenty-four hours. They are used as daytime sedatives more than as nighttime hypnotics, and since they don't produce much euphoria or stimulation, few people take them to get high.
Another group of barbiturates is more rapidly metabolized by the liver. Their effects last six or seven hours, and they are called short-acting. They include amobarbital (Amytal), pentobarbital (Nembutal), hexobarbital (Sombulex), and secobarbital (Seconal). These drugs behave very much like alcohol, giving pleasant feelings in low doses, especially as they begin to take effect. Therefore, some people seek them out to change the way they feel, and there is no shortage of them on the black market.
Finally, there are very short-acting barbiturates that produce almost immediate unconsciousness when injected intravenously. Thiopental (Pentothal) is the main example; dentists and doctors use it as an anesthetic for surgical operations. Since it wipes out awareness so fast and leaves no memory of the experience, no one takes it for fun.
When people talk about taking downers they usually mean the short-acting barbiturates or a few similar drugs that will be mentioned later. All of these substances are like alcohol, and most of the statements in the alcohol section apply to downers as well.* Sleeping pills can make people feel and look drunk, can leave
*See pages 60-68.
From Chocolate, to Morphine 70
The barbiturate addict presents a shocking spectacle. He cannot coordinate, he staggers, falls off bar stools, goes to sleep in the middle of a sentence, drops food out of his mouth. He is confused, quarrelsome, and stupid. And he almost always uses other drugs, anything he can lay his hands on: alcohol, benzedrine, opiates, marijuana. Barbiturate users are looked down on in addict society: "Goof-ball bums. They got no class to them."... It seems to me that barbiturates cause the worst possible form of addiction, unsightly, deteriorating, difficult to treat.
— William S. Burroughs, from his novel Naked Lunch (1959)
users with hangovers, can kill when taken in overdose by knocking out the respiratory center of the brain, and can produce stubborn addiction with dangerous withdrawal syndromes, marked, in some cases, by convulsions and death.
Since the similarities between downers and alcohol are so numerous, it might be easier to talk about how they differ.
Unlike alcohol, sleeping pills are noncaloric; the body cannot burn them as fuel but must metabolize them in other ways. They are also not as toxic as alcohol over time and don't cause the kind of liver disease and other medical damage so common in alcoholics. Tolerance to downers occurs, as with alcohol, but there is an important and curious difference. As people use them regularly, tolerance to the effects on mood develops faster than tolerance to the lethal dose. For this reason, people run a greater risk of accidentally killing themselves with these substances. For example, people who get into the habit of taking sleeping pills every night to fall asleep might start out with one a night, progress to two, then graduate to four to get the same effect. One night the dose they need to fall asleep might also be the dose that stops their breathing.
It is especially dangerous to combine alcohol and downers because their depressant effects are additive. A dose of alcohol a person is used to plus a dose of a downer that would be all right by itself may add up to coma and death. Many people have died because they were ignorant of this fact.
As with alcohol, the effects of downers 011 mood are extremely variable, depending on individual personality, expectation, and setting. Some people who take sleeping pills feel nothing but sleepiness. Others fight off the sleepiness and say they feel high. A dose of Seconal taken at a wild party might inspire violent excitement, whereas a person taking the same dose in a quiet room might be overcome with lethargy. Some medical patients have strange reactions to prescribed downers, becoming anxious and agitated instead of calmed down. Old people are likely to become intoxicated on ordinary doses, as are people with liver or kidney disease.
Most people take these drugs by mouth, but injectable forms are available. In hospitals, hypnotic doses of Nembutal are often given by intramuscular injection, especially to patients who cannot take medicine by mouth. On the street, some users inject barbiturates intravenously (sometimes crushing and dissolving oral preparations), a practice that greatly increases their toxicity.
Other users like to combine downers and stimulants, claiming that the combined effect is more pleasant. A few such combina-
That "good morning"
The morning feeling after tions are even legally made for medical use. One example, Dexa- taking a sedative is more myl, is a mixture of amobarbital and dextroamphetamine (Dex- likely to be a hangover than edrine). Supposedly, the barbiturate counteracts any tendency of what is pictured here.
the amphetamine to cause anxiety or jitteriness, while the amphetamine reinforces the potential of the barbiturate to produce euphoria. Similarly, people who use a lot of cocaine say that drinking alcohol at the same time reduces the unpleasant side effects of that drug, while the cocaine keeps them from getting drunk and minimizes hangovers. Although these combinations probably do no harm when used occasionally, they may have a higher potential for abuse in the long run because they make it easier to take larger quantities of drugs.
Dependence on barbiturates can occur in both medical patients and street users. Doctors write vast numbers of prescriptions for sleeping pills, and many people fall into the habit of taking them every night. Certainly, it is appropriate to take these drugs when insomnia is temporary and due to a specific, identifiable cause. For instance, the death of a close friend or relative, the breakup of a family, the loss of a job, even moving, may produce serious disturbances of sleep, and sleeping pills may help during the crisis. Some people take these drugs to help them sleep on long plane flights, during other kinds of travel, after periods of
There is no question that Quaa-lude can be dangerous when used irresponsibly, or that it can be addicting. As a recreational drug, taken on occasion in a responsible manner, it seems to me safe and interesting and gives me an experience different from anything else.
— thirty-six-year-old man, drug counselor intense work or stress, and when working shifts. There is no harm in taking sleeping pills a few nights in a row in such situations.
Problems arise when people take them every night over a long time. Persistent insomnia is always a symptom of other trouble, either physical or emotional. Sleeping pills treat the symptom only. Moreover, the sleep induced by downers is not the same as natural sleep. It doesn't provide as much dreaming time, for one thing, and is likely to be followed by a hangover. Because drug-induced sleep may not supply all the needs of body and mind, it may, over time, aggravate an underlying problem. Although many people take sleeping pills regularly for years without having to increase the dose or suffering any obvious difficulties, this kind of usage is a form of drug dependence.
Taking downers as a means of dealing with feelings of depression or low self-esteem is probably the riskiest way of using them. Like alcohol, these drugs may mask the symptoms temporarily, but over time they often increase anxiety and depression, encouraging further drug-taking in a downward spiral that can end in suicide.
As noted earlier, there are a number of nonbarbiturate downers, the most popular of which in the past was methaqualone, marketed under such brand names as Quaalude, Sopor, and Man-drax. Its effects are equivalent to those of the barbiturates, although on its own it is less likely to depress the respiratory center in overdose. Still, deaths have occurred as a result of combinations of alcohol and methaqualone. Street users talk about "hiding out" — that is, taking Quaaludes and wine to produce a numb, euphoric state. Quaalude has gained a street reputation as a sex enhancer and party drug. Like all downers, it can lower inhibitions and reduce anxiety in the same way as alcohol. But also like alcohol, it will interfere with sexual performance in males and may make it more difficult for women to experience orgasm. Real Quaalude is seldom available today, but look-alike tablets containing no methaqualone are commonly sold to gullible buyers on the black market.
Another downer, chloral hydrate, is the oldest sleeping drug still in medical use. Although rare today, abuse of it was not uncommon in the last century. Slipped into alcoholic drinks, it was the notorious "Mickey Finn" or "knockout drops" used to drug unsuspecting people into unconsciousness in order to rob or shanghai them.
Still other nonbarbiturate downers include glutethimide (Dor-iden), mcthyprylon (Noludar), ethchlorvynol (Placidyl), and paraldehyde. All of these drugs are used in medicine as hypnotics.
They sometimes find their way to the black market, where users of illegal downers buy them. Their benefits and dangers are the same as those of the barbiturates.
Suggestions for Using Downers Safely
1. Take sleeping pills by mouth in doses no higher than those recommended by doctors, pharmacists, or manufacturers. (Often lower doses will do.)
2. Don't drive or operate machinery while under the influence of these drugs. Like alcohol, they impair judgment, coordination, and reflexes.
3. Exercise extreme caution about using downers in combination with alcohol or other depressant drugs.
4. Don't fall into the habit of relying on downers for sleep. Insomnia can usually be overcome by improving health; getting more exercise; cutting down on intake of stimulants, including caffeine and tobacco; taking warm baths before bed; and by many other means not involving drugs.
5. Be wary of relying on these drugs to get you out of bad moods.
6. Don't take downers regularly in combination with stimulants just because you like the feeling.
7. Don't take downers if you are ill, especially not if you have any liver or kidney problems, unless a doctor prescribes them for you.
8. If you find yourself becoming dependent on downers, with developing tolerance or any unusual physical or mental symptoms, seek professional help.
The third and last class of sedative-hypnotics consists of relatively new drugs, products of the modern pharmaceutical industry. Dating back only to the mid-1950s, these drugs are called minor tranquilizers, a misleading name. The word minor is supposed to distinguish them from the "major" tranquilizers — compounds such as chlorpromazine (Thorazine), which are used to manage psychotic patients.* Actually, these two kinds of tranquilizers are chemically and pharmacologically unrelated. Minor tranquilizers are not, as their name implies, mild drugs. There is nothing minor about their effects, the problems they can cause, or their potential for abuse.
*Scc pages 142-44.
From Chocolate to Morphine 74
Since their invention, the minor tranquilizers have achieved enormous popularity in medicine. Doctors have written millions upon millions of prescriptions for them, and pharmaceutical companies have made billions of dollars by promoting and selling them as antianxiety agents. In fact, these drugs have been among the most widely prescribed drugs in the world.
The first minor tranquilizer to be released to the world was meprobamate; it appeared in 1954 under the brand name Mil-town,* and within a short time after its appearance, people were holding Miltown parties — taking the drug socially and recrea-tionally, just to get high.
The most popular minor tranquilizers appeared in the 1960s — a family of drugs called benzodiazepines. Some of the most famous are chlordiazepoxide (Librium), diazepam (Valium), flu-razepam (Dalmane), triazolam (Halcion), alprazolam (Xanax), and lorazepam (Ativan). The manufacturer of Librium and Valium, once a small company selling vitamins and antacids, is now one of the most powerful pharmaceutical corporations in the world.
The pharmaceutical industry has tried hard to convince doctors and patients that these chemicals are revolutionary drugs that specifically reduce anxiety, making people calm and relaxed. In fact, the minor tranquilizers are just another variation on the theme of alcohol and other sedative-hypnotics, with the same tendency to produce adverse effects and dependence.
Compared to barbiturates, the minor tranquilizers are safer in overdose and somewhat less dangerous in combination with alcohol. Also, the minor tranquilizers are useful in relaxing tense muscles. As daytime sedatives, they produce less drowsiness than barbiturates, but they can still make driving dangerous and interfere with other motor skills, as well as with memory and clear thinking. As nighttime hypnotics, they induce sleep and may be preferable to barbiturates if anxiety or muscle tension is present or if patients need a sleeping pill for more than a few nights in a row.
Street users of the minor tranquilizers take them for the same reasons they take illegal downers: to improve mood, reduce anxiety and inhibitions, and promote social interaction.
In most cases, abuse of the minor tranquilizers, particularly of Valium, Librium, and Miltown, has resulted from irresponsible practices of marketing and prescribing. In promoting these drugs, the manufacturers portrayed stresses of everyday life as disease
* It was also marketed later as Equanil.
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