Prolonged use of barbiturates can lead to a state of physical and psychological dependence. Upon discontinued use, the dependant person may go into withdrawal. Unlike narcotic (opiate) withdrawal, barbiturate withdrawal is LIFE THREATENING! Depending on type of barbiturate, signs and symptoms start within 24 hours. The withdrawal syndrome includes nausea, vomiting, sweating, tremors (trembling or shaking), weakness, insomnia, and restlessness. These clinical findings progress to apprehension, acute anxiety, fever, increased blood pressure, and increased heart rate. If untreated, severe and life-threatening effects include delirium, hallucinations, and seizures. The signs and symptoms will stop upon re-administration of the barbiturate and by tapering the dose slowly over several days.

NONBARBITURATE SEDATIVE- HYPNOTIC INTOXICATION

Nonbarbiturate sedative-hypnotics (a "hypnotic" is a sleeping pill) have actions very similar to the barbiturates. However, they have a higher margin of safety; overdose and addiction require larger doses and addiction requires a longer time period to occur. Like the barbiturates, when combined with ethanol or other depressants, there are addictive CNS-and respiratory-depression effects. Most of the traditional, nonbarbiturate sedative-hypnotics are either no longer available (Methaquaalone, Ethchlorovynol, Glutethimide) or rarely used today (chloral hydrate) because of their profound "hangover effect." Newer sedative-hypnotics are emerging for the temporary treatment of insomnia. Benzodiazepines are widely used to treat seizure disorders, anxiety, muscle spasms, and insomnia.

STIMULANT INTOXICATION
The stimulants ("uppers") directly affect the central nervous system by increasing mental alertness and combating drowsiness and fatigue. One group of stimulants, called amphetamines, is legitimately used in the treatment of conditions such as mild depression, obesity, and narcolepsy (sleeping sickness).

Amphetamines are also commonly abused. Usually referred to as stimulants, speed, or uppers, amphetamines can be taken orally, intravenously, or smoked as "ice." Amphetamines directly affect the central nervous system by increasing mental alertness and combating drowsiness and fatigue. They are abused for their stimulant effect, which lasts longer than cocaine.

Amphetamines cause central nervous system stimulation with euphoria, increased alertness, intensified emotions, aggressiveness, altered self-esteem, and increased sexuality. In higher doses, unpleasant CNS effects of agitation, anxiety, hallucinations, delirium, psychosis, and seizures can occur. When stimulants are combined with alcohol ingestion, patients have increased psychological and cardiac effects.

Signs and symptoms associated with amphetamine use include mydriasis (dilated pupils), sweating, increased temperature, tachycardia (rapid pulse), and hypertension. Patients seeking medical attention usually complain of chest pain, palpitations, and shortness of breath.

"Heavy use" (involving large quantities) of amphetamines is physically addicting, and even "light use" (involving small amounts) can cause psychological dependence. Tolerance to increasingly higher doses develops and withdrawal can occur from these levels. Abruptly stopping chronic amphetamine use does not cause seizures or present a life-threatening situation. The withdrawal is typically characterized by apathy, lethargy, muscle aches, stomachaches, increased appetite, anxiety, sleep disturbances, and depression with suicidal tendencies.

Cocaine, although classified as a narcotic, acts as a stimulant and is commonly abused. It is relatively ineffective when taken orally; therefore, the abuser either injects it into the vein or "snorts" it through the nose. Its effect is much shorter than that of amphetamines, and occasionally the abuser may inject or snort cocaine every few minutes in an attempt to maintain a constant stimulation and prevent depression experienced during withdrawal (come- down). Overdose is very possible, often resulting in convulsion and death.

The physical symptoms observed in the cocaine abuser will be the same as those observed in the amphetamine abuser.