Ask the Doctor FAQs: Drugs and Alcohol

FAQs: Drugs and Alcohol

Can you PLEASE help? I am looking for a way to ease the withdrawal symptoms of heroin. I was told to look into Red Clover and St. John's Wort, but I do not know how to use these -- should I buy pills, etc? I am getting desperate.
Hang in there. As you must know, heroin withdrawal can be intensely unpleasant. Cravings for the drug are very strong. Nausea, goosebumps on the skin, diarrhea, tearing of the eyes, a runny nose, fast heart rate, and high blood pressure are all common symptoms. These feelings usually begin within hours of taking the last dose. It's not a life-threatening withdrawal (as with other drugs such as alcohol), but it's certainly nasty enough to keep the addiction going.
What's the best way to get off of heroin? I am not aware of any natural or herbal way of easing withdrawal. In fact, the only withdrawal technique that has been proven to work involves the use of methadone. Methadone, like heroin, is an opiate drug, but its dissimilarities from heroin make it useful in treating heroin addiction. Methadone is well absorbed after taking it by mouth; it is very long acting; and it doesn't produce the same intense euphoria. The idea is to take enough of the drug to eliminate the craving, while not so much that it causes euphoria. The long duration of methadone activity in the body means that there are no sudden peaks of drug activity to produce a high. Because methadone occupies the same opiate receptors in the brain, if heroin is also taken it will no longer have the same intense effects.
Ideally, the substitution is made and the addicted person is no longer obsessessed with the next fix, and can concentrate instead on taking care of life's essentials. It is an imperfect substitute of one drug for another; however, methadone can be maintained for decades without physical adverse effects, and without interference in the ability to work or concentrate. An extensive body of research documents the effectiveness of methadone treatment. Interestingly, heroin does not cause any toxicity to the physical body either, with short- or long-term use. But most heroin is cut (diluted) with other substances that do cause problems such as lung damage or abscesses.
The person on methadone maintenance continues in a state of addiction. This has spawned many ambivalent feelings within society, with the result that inadequate resources have been provided to treat heroin addicts. Many are turned away for lack of funding. To further complicate things, methadone maintenance does not work for everybody. Some heroin addicts participate just to take a vacation from the street scene. Others just don't have the motivation to follow through. Still others seem to like the thrill of injecting, and will continue to shoot other drugs. But there seems to be no question that a life on methadone is better than a life addicted to heroin.
If you live in the US, try to find a methadone maintenance program nearby. You might check with your state's department of public health, or contact a substance abuse treatment center. US doctors are prevented by law from prescribing methadone. But your personal doctor, if you feel comfortable asking him or her, may know where to refer you. In England and Europe, methadone is more readily available. You should look for a doctor or clinic that is convenient, where they have plenty of experience in treating heroin addiction.
Don't give up. You're not only battling a difficult addiction, but also potential problems in accessing help. Let your determination to get off heroin carry you through.
Resources on the Web:
Focus on Methadone Maintenance: Information on methadone side effects, research and how to take it.
State by State Methadone Contacts: Find your nearest methadone provider in the United States.
-- R. Jandl,10/20/96, Category: drugs and alchohol

I have just had a blood test after applying for life insurance and received a very high quote because of my gamma globulin levels. I understand that this can be affected by the amount of alcohol that I drink. There's no doubt about it -- I do drink too much. Can you tell me what this result actually measures and how it might affect my health?
JH
I suspect you are referring to a blood test called "gamma GT," or GGT, which is a sensitive measure of liver inflammation. (Gamma globulins are something else altogether.) It is a type of protein called an enzyme. This means that it is a normal constituent of liver cells, and is used as a part of everyday metabolic processes. A little bit of this enzyme leaks into the blood stream so that it is normally found in everyone's blood.
What does a high GGT level mean? Anything that causes damage or inflammation of the liver will cause a rise in blood levels of GGT. Alcohol, as you probably know, is a toxin to the liver. In small amounts, alcohol is broken down (i.e. metabolized) by the liver without doing any harm. In larger amounts, alcohol is actually toxic to the liver cells. The amount it takes to cause toxicity will vary from one person to the next but may be seen in someone drinking several drinks per day.
What will happen in the future will depend to a large extent on how much alcohol the liver gets exposed to. With elevations of the GGT up to twice normal, and without any physical symptoms, the amount of damage that would be found on a liver biopsy might only be mild to moderate. But if you were to go out on a binge, you might experience a more acute toxicity to the liver, causing nausea, vomiting, jaundice, and other symptoms. This is called "alcoholic hepatitis." Continued drinking over many years, whether as a daily habit or in binges, can result in cirrhosis. Cirrhosis is a scarring of the liver that results from any type of chronic inflammation. It is a cause of liver failure and is a major complication of alcoholism. Remember Mickey Mantle.
Insurance companies and blood banks like to screen for GGT because it can provide an indicator of alcohol abuse or infectious hepatitis (and other types of liver diseases). If it's elevated, they won't want your blood; and they certainly won't want to insure you. Or not at least without covering themselves by charging you a high premium.
Maybe this is a good time to reassess your drinking. People who have trouble with alcohol often have trouble seeing the myriad ways in which it has affected their lives, or the lives of people around them. Although in the short run it is easy to say that a little inflammation of the liver won't cause any harm (which is probably true), the big question is: can you stop drinking now? And if stopping drinking now is not something you decide to do, how much risk or actual damage to your body are you willing to tolerate before doing something? What does that risk tolerance say about your habit? Every doctor, and many a family member, has seen an alcoholic drink himself or herself to death even in the most gross and obvious evidence of physical deterioration, loss of livelihood, or the destruction and loss of families and loved ones. It's worth some serious thought.
-- R. Jandl, 10/2/96, Category: drug & alcohol-related

Why do people like to smoke, and what is the effect?
-- WR
A simple question. Health education literature is replete with warnings of the hazards of cigarette smoking. Tobacco use is said to be the most important single cause of death in the U.S. And Healthy People 2000 has set a goal for reducing the prevalence of cigarette smoking to no more than 15% of all adults by the year 2000 -- a goal that is unlikely to be met.
So why do people smoke? What do they get from cigarettes that is desirable enough to overcome any concerns of health complications? Is it all because of an addiction to nicotine? It seems not. As powerful as nicotine addiction is, common knowledge and experience suggests many other explanations.
Consider the woman who wants to control her weight. Cigarettes help to keep her from eating, and the metabolic effects of smoking serve to keep her weight less than it otherwise would be. To this woman, keeping her weight down by smoking improves her day-to-day self-esteem and is well worth the risk of emphysema when she is older.
How about the man whose stress unnerves him? His life is filled with worries and uncertainties. His thoughts are a continuous whirl of frantic activity that impairs his ability to cope, to relax, to think clearly. Cigarettes help this man to unwind. It takes the edge off his anxiety and helps him to settle down. For him, smoking gets him through his day. The possibility of lung cancer sometime down the road is a worry more remote than any of the others.
Then there is the couple who enjoys smoking together, or when socializing with others. They relax over a meal, and perhaps some wine. They actually enjoy smoking as part of their social life. They are used to this lifestyle -- it makes them feel good. They do not imagine that smoking an occasional cigarette poses any long-term risks.
And what about the glamour and allure of advertising? Smoking will make you sexy, slim, or cool. It means you are hip. And as recent ad campaign targets reveal, smoking helps one to look the part of someone who is independent-minded, capable and assertive. In our minds, each inhalation suggests that we can, for a moment, achieve a status or image that is larger than our day-to-day lives. And it works.
For these, and other reasons, people smoke. They are reasons we understand, that make sense as part of everyday life. They are not the cravings of a lunatic. But for many, it may be a deal with the devil, that devil being the addiction to nicotine. Long after all reason tells us that smoking is no longer worth it, the years of habit and the restless cravings of withdrawal conspire to create a battle that becomes, quite literally, life and death. We're hooked. There is no easy way out. Quitting or not quitting -- both are painful.
-- R. Jandl, 9/22/96, Category: drug & alcohol-related

What are some of the short and long-term side-effects of amphetamine use?
-- WG
Amphetamines are a group of stimulant drugs first synthesized in the 1930s. They are chemically related to adrenaline, a stimulant normally made by the human body. Also known as "speed" the drugs produce a state of high energy. People such as truck drivers or college students who are looking for a quick burst of energy are aware of amphetamines' capacity to keep them awake and to produce periods of high energy and productivity, as well as a feeling of euphoria. The effects overall are similar to cocaine, but last longer.
The most serious side-effects are seen in people who shoot amphetamines or smoke it in the form of "ice" or "glass" in which case paranoia and hallucinations may be seen. Irritability, aggressive behaviors, and anorexia (sometimes with dramatic weight loss) are also relatively common side-effects of regular use. But sporadic use of amphetamines, taken as a pill, is not generally accompanied by serious side-effects. Palpitations, tremors, restlessness, talkativeness and insomnia are common. With certain underlying medical conditions (such as hypertension, heart arrhythmias, or seizures) amphetamines could cause serious complications.
Dexedrine, Benzedrine, Ritalin, and Methedrine are names of different amphetamines. Their effects are similar. At one time they were pushed by pharmaceutical companies as a way of relieving chronic fatigue and depression, and for weight loss. For years they were prescribed inappropriately by doctors in hopes of treating these disorders. Later it became clear that dependence develops to amphetamines, and that the side-effects and long-term consequences for the body and personality are very troublesome. Prescribing is now tightly controlled, and most access to amphetamines is through the black market.
-- R. Jandl,9/11/96, Category: drug & alcohol-related

Does cocaine affect the liver?
In reviewing the literature, it is well documented that cocaine may have significant effects on the liver in laboratory experiments involving rats and mice. There are a number of studies which indicate that even a single dose of cocaine can induce dramatic and severe liver damage in these animals. It is also apparent, especially in babies born of cocaine-addicted mothers, that abnormalities of liver function may occur. Better studies are needed to answer your question in more detail. However, for now it appears as though significant liver toxicity is a relatively rare problem in cocaine users.
-- C Ebelke, 11/13/95; Category: Drugs & Alcohol

I've read that women are more affected by alcohol than men, but I don't really see a difference. Is this really true?
There are a couple of significant differences between men and women when it comes to drinking. First consider typical differences in weight. A person with a large body will tend to handle a larger amount of alcohol before getting drunk or toxic, and, of course, men tend to be larger than women. For example, a 120 lb. person drinking about four drinks in two hours will have an alcohol level of about 0.12, whereas a 200 lb. person drinking the same amount will have a level one-third less, 0.08.
There is also evidence that even after correcting for women's body weight, women have a greater tendency to develop liver complications at a lower level of alcohol intake and after a shorter period of time. Finally, there is the problem of fetal-alcohol syndrome which causes mental retardation and birth defects in the babies of women who drink.
-- R. Jandl

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