💊Drugs, Brain, and Mind Unit 5 – Depressants: Alcohol & Sedative Drugs

What Are Depressants?

• Depressants are a class of drugs that slow down the central nervous system (CNS) and brain activity
• Reduce arousal, alertness, and energy levels leading to feelings of relaxation and drowsiness
• Common examples include alcohol, benzodiazepines (Xanax, Valium), barbiturates, and opioids (heroin, morphine)
• Act on neurotransmitter systems in the brain, particularly GABA and glutamate
  • Enhance the effects of inhibitory neurotransmitter GABA
  • Suppress the effects of excitatory neurotransmitter glutamate
• Medically used to treat anxiety, insomnia, seizures, and as anesthetics
• Carry risks of overdose, especially when combined with other depressants or opioids
• Have high potential for abuse, tolerance, and addiction due to their reinforcing effects on the brain's reward system

Types of Depressants: Alcohol and Sedatives

• Alcohol is the most commonly used depressant drug
  • Ethanol is the active ingredient in alcoholic beverages (beer, wine, spirits)
  • Absorbed through the stomach and small intestine into the bloodstream
• Sedatives are a broad category that includes prescription medications and illicit drugs
• Benzodiazepines are the most widely prescribed sedatives for treating anxiety and sleep disorders
  • Examples include alprazolam (Xanax), diazepam (Valium), and lorazepam (Ativan)
  • Act on GABA receptors to enhance inhibitory signaling in the brain
• Barbiturates are an older class of sedatives that have largely been replaced by benzodiazepines
  • Examples include phenobarbital and secobarbital
  • Carry higher risks of overdose and respiratory depression compared to benzodiazepines
• Z-drugs are a newer class of sedatives used primarily for treating insomnia
  • Examples include zolpidem (Ambien), zaleplon (Sonata), and eszopiclone (Lunesta)
  • Similar mechanism of action to benzodiazepines but more selective for certain GABA receptor subtypes
• GHB (gamma-hydroxybutyrate) is a CNS depressant used illicitly for its euphoric and sedative effects
  • Also known as a "date rape drug" due to its ability to incapacitate victims

How Depressants Work in the Brain

• Depressants act on neurotransmitter systems in the brain to slow down neural activity
• Primary mechanism is enhancing the effects of GABA, the main inhibitory neurotransmitter in the CNS
  • Bind to GABA receptors and increase the influx of negatively charged chloride ions into neurons
  • This hyperpolarizes the neuron, making it less likely to fire an action potential
• Also suppress the effects of glutamate, the main excitatory neurotransmitter
  • Reduce glutamate release and block glutamate receptors (NMDA, AMPA)
• Net effect is a decrease in overall brain activity, leading to sedation, relaxation, and impaired cognitive function
• Alcohol specifically affects multiple neurotransmitter systems in a dose-dependent manner
  • At low doses, increases dopamine release in the reward pathway leading to euphoria and stimulation
  • At higher doses, enhances GABA and suppresses glutamate leading to sedation and motor impairment
• Chronic use of depressants can lead to adaptations in the brain, such as GABA receptor downregulation and glutamate receptor upregulation
  • These changes underlie tolerance, dependence, and withdrawal effects

Short-Term Effects on Body and Mind

• Depressants have acute effects on various body systems and mental functions
• CNS depression leads to sedation, drowsiness, and impaired coordination
  • Slurred speech, dizziness, and difficulty walking or balancing
  • Increased risk of falls, accidents, and injuries
• Cognitive impairments include reduced attention, concentration, and memory
  • Slowed reaction time and decision-making abilities
  • Blackouts and memory loss, especially with high doses of alcohol
• Emotional effects can include relaxation, anxiety relief, and disinhibition
  • Can also cause mood swings, irritability, and aggression (particularly with alcohol)
• Physiological effects include slowed heart rate, reduced blood pressure, and slowed breathing
  • Respiratory depression is a major risk with high doses of depressants
  • Can lead to hypoxia (lack of oxygen), brain damage, and death in severe cases
• Impaired judgment and decision-making can lead to risky behaviors
  • Unprotected sex, driving under the influence, and engaging in violence
• Combining depressants (e.g., alcohol and benzodiazepines) can have synergistic effects and greatly increase the risk of overdose and death

Long-Term Health Risks

• Chronic use of depressants can lead to a range of long-term health consequences
• Liver damage is a major risk with chronic alcohol use
  • Alcoholic fatty liver disease, alcoholic hepatitis, and cirrhosis
  • Caused by the toxic effects of alcohol metabolism on liver cells
• Increased risk of various cancers, including liver, breast, colon, and esophageal cancer
  • Alcohol is a known carcinogen and can damage DNA and impair immune function
• Cardiovascular problems such as high blood pressure, heart disease, and stroke
  • Alcohol can damage the heart muscle (cardiomyopathy) and increase atherosclerosis risk
• Neurological damage and cognitive impairments
  • Chronic alcohol use can cause brain atrophy, dementia, and Wernicke-Korsakoff syndrome
  • Long-term benzodiazepine use is associated with cognitive decline and dementia risk
• Mental health problems such as depression, anxiety, and suicidal ideation
  • Depressants can worsen pre-existing mental health conditions and cause new ones
• Gastrointestinal issues like gastritis, ulcers, and pancreatitis
  • Alcohol irritates the lining of the stomach and intestines and can inflame the pancreas
• Respiratory problems and increased risk of pneumonia
  • Depressants can impair the gag reflex and increase the risk of aspirating stomach contents
• Sexual dysfunction and reproductive issues
  • Alcohol can cause erectile dysfunction, reduced fertility, and fetal alcohol spectrum disorders

Addiction and Tolerance

• Depressants have a high potential for abuse and addiction due to their reinforcing effects on the brain's reward system
• Tolerance develops with regular use, requiring higher doses to achieve the desired effects
  • Can lead to escalating use and increased risk of overdose
• Physical dependence can occur with chronic use, leading to withdrawal symptoms when use is stopped
  • Alcohol withdrawal can be severe and potentially life-threatening (delirium tremens)
  • Benzodiazepine withdrawal can cause seizures, agitation, and insomnia
• Psychological dependence can develop, characterized by strong cravings and compulsive use despite negative consequences
  • Often driven by the desire to avoid withdrawal symptoms and negative emotional states
• Genetic and environmental factors can influence an individual's vulnerability to addiction
  • Family history of substance abuse, mental health problems, and early life stress
• Addiction is a chronic, relapsing disorder that often requires long-term treatment and support
  • Involves changes in brain circuits involved in reward, stress, and self-control
  • Can cause significant impairments in personal, social, and occupational functioning

Social and Legal Aspects

• Depressant use, particularly alcohol, is deeply ingrained in many social and cultural contexts
  • Often associated with celebrations, socializing, and stress relief
  • Can lead to normalization and peer pressure to use
• Alcohol is legal for adults in most countries, but other depressants are controlled substances
  • Possession, distribution, and use of illicit depressants are criminal offenses
  • Prescription depressants are legal only when prescribed by a licensed healthcare provider
• Depressant use can have significant social and economic costs
  • Increased healthcare expenses, lost productivity, and criminal justice costs
  • Alcohol-related accidents, violence, and domestic abuse
• Stigma and discrimination can be barriers to seeking help for depressant addiction
  • Substance use disorders are often viewed as moral failings rather than medical conditions
• Public health policies aim to reduce the harms associated with depressant use
  • Minimum legal drinking age, taxes on alcohol, and restrictions on advertising
  • Prescription drug monitoring programs and safe prescribing guidelines for sedatives
• Harm reduction approaches focus on minimizing the negative consequences of use
  • Naloxone distribution to reverse opioid overdoses
  • Safe injection sites and needle exchange programs to reduce the spread of infectious diseases

Treatment and Recovery Options

• Treatment for depressant addiction typically involves a combination of behavioral therapies and medication-assisted treatment (MAT)
• Detoxification is often the first step, allowing the body to clear the drug and manage withdrawal symptoms
  • Medical supervision is important, particularly for alcohol and benzodiazepine withdrawal
  • May involve tapering doses of long-acting benzodiazepines to prevent seizures
• Cognitive-behavioral therapy (CBT) helps individuals identify and change maladaptive thoughts and behaviors related to substance use
  • Teaches coping skills, relapse prevention strategies, and stress management techniques
• Motivational interviewing (MI) is a client-centered approach that helps resolve ambivalence about change and enhances intrinsic motivation
  • Explores the individual's goals, values, and reasons for change
• Contingency management (CM) uses positive reinforcement to promote abstinence and treatment adherence
  • Provides rewards (e.g., vouchers, prizes) for meeting specific behavioral goals
• 12-step programs like Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) provide peer support and a structured framework for recovery
  • Emphasize acceptance, surrender, and reliance on a higher power
  • Have been shown to improve outcomes when combined with professional treatment
• MAT involves the use of medications to reduce cravings, prevent relapse, and treat co-occurring mental health conditions
  • Naltrexone and acamprosate are FDA-approved medications for alcohol use disorder
  • Benzodiazepines may be used for alcohol or sedative withdrawal management
• Long-term recovery often involves ongoing support and lifestyle changes
  • Engaging in sober activities, building a support network, and addressing underlying mental health issues
  • Addressing social determinants of health (e.g., housing, employment, education) can improve recovery outcomes