Unit 9: Health

Chapter 39: Substance Abuse

Lumen Learning and Norma Cárdenas

“An overindulgence of anything, even something as pure as water, can intoxicate.”

– Criss Jami


The college environment produces anxiety for students. Stress, courseload, peer pressure, and curiosity are factors that contribute to using or abusing substances (drugs and alcohol). Then there is the drinking culture, where alcohol is available at sporting events, parties, and student get-togethers. There may also be a family history of substance abuse. Excessive drinking can lead to poor academic performance, assault, injury, arrest, or death. If students do not ask for help and support around drug use, there may be serious negative consequences. Enjoying campus events and setting realistic expectations can reduce the risk of substance and alcohol abuse.

A drug is a chemical substance that can change how your body and mind work. Drugs of abuse are substances that people use to get high and change how they feel. They may be illegal drugs like marijuana, cocaine, or heroin. Or they may be legal for adults only like alcohol and tobacco. Assigning “good” and “bad” categories to criminalize drugs because of their association with racist attitudes like Chinese opium or Black crack cocaine and opioids and stimulants with white people hurts everyone.

Medicines that treat illness such as stimulants or painkillers can also become drugs of abuse when people take them to get high. People can even abuse cough or cold medicines from the store if they ignore the directions and take too much at one time.

The stigma around drug use can cause students to feel shame and avoid discussing the problem. Thinking that addiction is a “disease” make it an individual problem and is reduced to biology and ignores social determinants such as meaningful work and stable housing. Most people do think it is a problem that with treatment and an action plan with coping skills can help. During the opioid overdose crisis, some people with addiction struggle with access and treatment more than privileged people who receive compassionate treatment.

People abuse drugs for many reasons:

  • They want to feel good. Taking a drug can feel good for a short time. That’s why people keep taking them—to have those good feelings again and again. Even though someone may take more and more of a drug, the good feelings don’t last. Soon the person is taking the drug just to keep from feeling bad.
  • They want to stop feeling bad. Some people who feel worried, afraid, or sad abuse drugs to try to stop feeling so awful. This doesn’t really help their problems and can lead to addiction, which can make them feel much worse.
  • They want to do well in school or at work. Some people who want to get good grades, get a better job, or earn more money might think drugs will give them more energy, keep them awake, or make them think faster. It doesn’t usually work, may put their health at risk, and may lead to addiction.

Cigarettes and Tobacco

It might surprise you to learn that cigarettes and other forms of tobacco are drugs. It is legal to use tobacco once you are 21 years old in all states. It is not healthy for you at any age.

Tobacco contains nicotine, a substance that excites the parts of the brain that make you feel good. You can get addicted to nicotine just like other drugs.

When you use tobacco, the nicotine quickly gives you a mild rush of pleasure and energy. It soon wears off, which makes you want to use it some more. Sometimes, the rush of energy that comes with nicotine can make you nervous and edgy.

Electronic cigarettes: E-cigarettes deliver nicotine to the lungs in vapor form. Originally marketing to quit smoking, JUULS typically have higher amounts of nicotine and may be more addictive. With flavorings such as fruit and candy, they appeal to young people. Read NIDA’s DrugFacts: Electronic Cigarettes (e-Cigarettes) for information about electronic cigarettes (sometimes called “vaping”), including how safe they are compared to tobacco cigarettes.

Effects of Cigarettes and Tobacco on the Body and Brain

These are just some of the problems cigarettes and tobacco can cause:

Lung diseases: Cigarette smoke causes lung cancer and painful breathing diseases like emphysema. These diseases can happen to people who smoke or to others around them who breathe in their smoke.

Bad breath, stained teeth (nails and skin), loose skin, uneven tone, and deeper wrinkles (around the mouth), mouth cancer: Cigarettes and other kinds of tobacco stain teeth and cause bad breath. Chewing tobacco can make teeth fall out and lead to cancer of the mouth.

Heart and blood problems: If you smoke, you are more likely to have a heart attack or stroke (sometimes called a “brain attack”).

Hurts babies: If a pregnant person uses tobacco, there is a chance of miscarriage, premature birth, or low-weight birth. This can cause health problems for the baby. Early menopause is another problem.

More diseases: Using cigarettes or other kinds of tobacco can lead to heart disease and many kinds of cancer.

Addiction: The nicotine in tobacco is what makes you addicted. The younger you were when you started to smoke, the more likely you are to become addicted. When you smoke, the effects wear off quickly. This makes you want to keep using tobacco again and again throughout the day. The more you do this, the more your body and brain get addicted to nicotine. Fortunately, there are medicines, other treatments, and hotlines that can help people quit tobacco.


Drinks like beer, malt liquor, wine, and hard liquor contain alcohol. Alcohol is the ingredient that gets you drunk.

Hard liquor—such as whiskey, rum, or gin—has more alcohol in it than beer, malt liquor, or wine.

The following drink sizes contain about the same amount of alcohol:

  • 1 ½ ounces of hard liquor (35 to 45 % alcohol content)
  • 5 ounces of wine (12 % alcohol content)
  • 8 ounces of malt liquor (6 to 9 % alcohol content)
  • 12 ounces of beer (5 % alcohol content)

Being drunk can make a person feel silly, angry, or sad for no reason. It can make it hard to walk in a straight line, talk clearly, or drive.

Effects of Alcohol on the Body and Brain

Drinking too much–on a single occasion or over time—can take a serious toll on your health (alcohol overdose or poisoning). The effects of alcohol are not limited to the day of consumption, but the morning after with hangover symptoms like headache, dizziness, and nausea. To avoid Driving Under the Influence (DUI) conviction and/or arrest, use a designated driver (DD) or use the campus shuttle system or “safe ride” program. Here is how alcohol can affect your body and brain:

  • Brain: Alcohol interferes with the brain’s communication pathways and can affect learning and memory. These disruptions can change mood and behavior and make it harder to think clearly and move with coordination. Binge drinking can result in a blackout and can impair memory while intoxicated. Passing out is a temporary loss of consciousness, which affects breathing, heart rate, and temperature control. If someone who has been drinking excessively is not responding, you need to call 911 right away.
  • Stomach: Drinking too much can irritate the stomach and cause vomiting. One-off and regular drinking can cause gastritis (the inflammation of the stomach lining). This triggers stomach pain, vomiting, diarrhea and, in heavy drinkers, even bleeding.
  • Heart: Drinking a lot over a long time or too much on a single occasion can damage the heart, causing problems such as stroke, high blood pressure, and arrhythmia.
  • Liver: Heavy drinking takes a toll on the liver and can lead to a variety of problems such as alcoholic hepatitis, fibrosis, and cirrhosis
  • Pancreas: Alcohol causes the pancreas to produce toxic substances that can eventually lead to pancreatitis, a dangerous inflammation and swelling of the blood vessels in the pancreas that prevents proper digestion.
  • Cancer: Drinking too much alcohol can increase your risk of developing certain cancers including cancers of the mouth, esophagus, throat, liver, and breast.
  • Immune system: Drinking too much can weaken your immune system, making your body a much easier target for disease. Chronic drinkers are more liable to contract diseases like pneumonia and tuberculosis than people who do not drink too much. Drinking a lot on a single occasion slows your body’s ability to ward off infections—even up to twenty-hour hours after getting drunk. Drinking alcohol while taking antibiotics can increase side effects or result in severe reactions or delay your recovery. It is best to avoid alcohol until you finish the antibiotics.

How much is “drinking too much?” The following guidelines are from the National Institute on Alcohol Abuse and Alcoholism (NIAAA):

Drinking Levels Defined

  • Moderate alcohol consumption: According to the Dietary Guidelines for Americans, moderate drinking is up to 1 drink per day for women and up to 2 drinks per day for men.
  • Binge drinking: Binge drinking is a pattern of drinking that brings blood alcohol concentration (BAC) levels to 0.08 g/dL. This typically occurs after 4 drinks for women and 5 drinks for men—in about 2 hours. Binge drinking has become a major health and safety issue on college campuses.
  • Heavy drinking: Heavy drinking is defined as drinking 5 or more drinks on the same occasion on each of 5 or more days in the past 30 days.
  • Low risk for developing an alcohol use disorder: For women, low-risk drinking is no more than 3 drinks on any single day and no more than 7 drinks per week. For men, it’s defined as no more than 4 drinks on any single day and no more than 14 drinks per week. NIAAA research shows that only about 2 in 100 people who drink within these limits have an alcohol use disorder.  Even within these limits, you can have problems if you drink too quickly or have other health issues.

Certain people should avoid alcohol completely, including those who

  • Plan to drive a vehicle or operate machinery
  • Take medications that interact with alcohol
  • Have a medical condition that alcohol can aggravate
  • Are pregnant or trying to become pregnant

Underage drinking

Underage college students drink less often, but drink more when they drink. Drinking can be harmful as the brain is still undergoing development. Brain changes due to underage drinking include information processing and learning, lower attention span, poor memory and worse short-term verbal memory, and lower performance on executive functioning tasks. It can also increase the risk of alcohol use disorders (AUD) later in life.

In most states, the Medical Amnesty Policy protects underage drinkers from being charged with a “Minor in Possession” (MIP) violation when they seek medical attention for themselves or others who might be suffering from alcohol poisoning.


Marijuana is a green, brown, or gray mix of dried, crumbled leaves from the marijuana plant. It can be rolled up and smoked like a cigarette (called a joint) or a cigar (called a blunt). Marijuana can also be smoked in a pipe, soda can, tin foil, etc. Sometimes people mix it in food and eat it or drink it. The risk perception of marijuana has decreased while the potency has increased. Co-using marijuana and alcohol has increased among college students.

Marijuana can make you feel silly, relaxed, sleepy, and happy—or nervous and scared. It may change your senses of sight, hearing, and touch. It can also make it hard to think clearly.

Effects of Marijuana on the Body and Brain

These are just some of the problems marijuana can cause:

  • Memory problems: Marijuana makes it hard to remember things that just happened a few minutes ago. That makes it hard to learn in school or to pay attention to your job. A recent study showed that if you begin regular marijuana use as a teen, you can lose an average of 8 IQ points, and do not get them back, even if you stop using the drug.
  • Heart problems: Using marijuana makes the heart beat fast and raises your risk of having a heart attack.
  • Coughing and breathing problems: Marijuana smokers can get some of the same coughing and breathing problems as cigarette smokers. Marijuana smoke can hurt your lungs.
  • Drugged driving: Driving when you’re high on marijuana is dangerous, just like driving drunk. Your reactions to traffic signs and sounds are slow. It’s hard to pay attention to the road. It’s even worse when you’re high on marijuana and alcohol at the same time.
  • You stop caring: Over time, marijuana users can get “burnt out.” They don’t think about much or do much. They can’t concentrate. They don’t seem to care about anything.
  • Addiction: Although some people don’t know it, you can get addicted to marijuana after using it for a while. This is more likely to happen to people who use marijuana every day, or who started using it when they were teenagers.

Regardless of state law, students are barred from using marijuana in college or university because it receives federal funding.

Cocaine (Coke, Crack)

Cocaine is a white powder. It can be snorted up the nose or mixed with water and injected with a needle. Cocaine can also be made into small white rocks, called crack. It’s called crack because when the rocks are heated, they make a cracking sound. Crack is smoked in a small glass pipe.

Cocaine can make a person feel full of energy, but also restless, scared, or angry.

Effects of Cocaine on the Body and Brain

These are just some of the problems cocaine can cause:

  • You feel sick: Cocaine can cause stomach pain and headaches. It can make you shake, throw up, or pass out.
  • No appetite: Cocaine can make you not want to eat. Over time, you might lose a lot of weight and get sick.
  • Heart attack and stroke: Cocaine raises your blood pressure and makes your heart beat faster. This can hurt your heart. It can give you a heart attack or stroke (brain injury from a blood clot). Some people die because of it.
  • HIV/AIDS, hepatitis: People who inject (shoot up) cocaine can get HIV/AIDS and hepatitis (a liver disease) if they share used needles and syringes. People also get these diseases by having unsafe sex. They may forget to use condoms because they’re high on the drug.
  • Addiction: It is easy to lose control over cocaine use and become addicted. Then, even if you get treatment, it can be hard to stay off the drug. People who stopped using cocaine can still feel strong cravings for the drug, sometimes even years later.


Heroin is a white or brown powder or a black, sticky goo. It can be mixed with water and injected with a needle. Heroin can also be smoked or snorted up the nose.

Heroin causes a rush of good feelings just after it’s taken. But some people throw up or itch after taking it. For the next several hours you want to sleep, and your heart rate and breathing slow down. Then the drug wears off and you may feel a strong urge to take more.

Effects of Heroin on the Body and Brain

These are just some of the problems heroin can cause:

  • Sick and itchy: Heroin can make you throw up and feel very itchy.
  • You stop breathing: Heroin can slow or stop your breathing. It can kill you.
  • HIV/AIDS, Hepatitis: Sharing used needles to inject (shoot up) heroin can give you HIV/AIDS and hepatitis (a liver disease).
  • Overdose: People overdose on heroin because they can’t tell how strong it is until they take it. Signs of a heroin overdose are slow breathing, blue lips and fingernails, cold clammy skin, and shaking. You can die from a heroin overdose. People who might be overdosing should be taken to the emergency room immediately. Naloxone, a drug that prevents opioid overdoses, is available on campus and can be administered by trained Campus Public Safety Officers.
  • Coma: Heroin can put you in a coma. That’s when nothing can wake you up, and you may die.
  • Addiction: It is very easy to become addicted to heroin. Then, even if you get treatment, it’s hard to stay away from the drug. People who stopped using heroin can still feel strong cravings for the drug, sometimes years later. Fortunately, there are medicines that can help someone recover from heroin addiction.

Meth (Crank, Ice)

Methamphetamine—meth for short—is a white, bitter powder. Sometimes it’s made into a white pill or a clear or white shiny rock (called a crystal).

Meth powder can be eaten or snorted up the nose. It can also be mixed with liquid and injected into your body with a needle. Crystal meth is smoked in a small glass pipe.

Meth at first causes a rush of good feelings, but then users feel edgy, overly excited, angry, or afraid. Their thoughts and actions go really fast. They might feel too hot.

Effects of Meth on the Body and Brain

These are just some of the problems meth can cause:

  • You overheat: Meth can make your body temperature so hot that you pass out. Sometimes this can kill you.
  • Crank bugs: Meth can make you feel like bugs are crawling on or under your skin. It makes you scratch a lot. Scratching causes sores on your face and arms.
  • Meth mouth: Meth users’ teeth become broken, stained, and rotten. Meth users often drink lots of sweet things, grind their teeth, and have dry mouth. This is called “meth mouth.”
  • You look old: People who use meth start looking old. Meth users burn a lot of energy and don’t eat well. This can make them lose weight and look sick. Their hands or body might shake. Their skin looks dull and has sores and pimples that don’t heal. Their mouth looks sunken as the teeth go bad.
  • HIV/AIDS, Hepatitis: People who inject (shoot up) meth can get HIV/AIDS or hepatitis (a liver disease) if they share used needles. People also get these diseases by having unsafe sex. They often forget to use condoms because they’re high on the drug.
  • Addiction: Meth use can quickly lead to addiction and hurt different parts of your brain. It can cause thinking and emotional problems that don’t go away or that come back again even after you quit using the drug. For instance, you might feel, hear, or see things that aren’t there. You might think that people are out to get you, or start believing strange ideas that can’t really be true.

Prescription Pain Medicine (OxyContin, Vicodin, Fentanyl)

Pain medicines relieve pain from surgery or injuries. You need a prescription from a doctor to buy some strong kinds of these medicines. Prescription pain medicines are legal and helpful to use when a doctor orders them to treat your medical problem.

Sometimes people take these without a doctor’s prescription to get high or to try to treat themselves or their friends. Drug dealers sell these pills just like they sell heroin or cocaine. Some people borrow or steal these pills from other people.

Some people think that prescription pain medicines are safer to abuse than “street” drugs because they are medicines. Prescription pain medicine abuse can be as dangerous as heroin or cocaine abuse.

Oxycodone is one pain medicine that people often abuse. Sometimes it goes by the brand names OxyContin® or Percocet®. Another one that is often abused is hydrocodone. One of its brand names is Vicodin®.

Pain medicines are usually white, round, or oval pills. They can be taken whole, smoked, or crushed into a powder that is snorted or injected.

Like heroin, pain pills can cause a rush of good feeling when they’re first taken, but they can also make you want to throw up. They can make you very sleepy, and you can get addicted to them.

Effects of Pain Medicine Abuse on the Body and Brain

These are just some of the problems pain medicine abuse can cause:

  • You stop breathing: Pain medicine abuse can slow down or even stop your breathing.
  • Coma: Pain medicine abuse can put you in a coma. That’s when nothing can wake you up.
  • Addiction: Prescription pain medicines can be as addictive as heroin—especially if they are smoked or injected. Then, even if you get treatment, it’s hard to stay away from the drug. Fortunately, there are medicines that can help someone recover from prescription pain medicine addiction.
  • Overdose: Signs of a pain medicine overdose are cold and sweaty skin, confusion, shaking, extreme sleepiness, trouble breathing, and coma.
  • Death: Many people die from pain medicine overdoses. In fact, more people overdose from pain medicines every year than from heroin and cocaine combined.

Other Drugs of Abuse

There are many other drugs of abuse, including:

Adderall (Addys) is a prescription pill that is ingested or crushed up and snorted. It makes people feel confident, euphoric, increases concentration, and suppresses appetite with effects similar to meth. People take it to study, stay awake, lose weight, and athletic performance.

Ecstasy (X, E, XTC, Molly) is a pill that is often taken at parties and clubs. It is sometimes called the “love drug” because it makes people feel very friendly and touchy. It also raises body temperature, heart rate, and blood pressure, and can make you feel sad for days after its effects wear off. Click here for more information about ecstasy.

K2 or Spice (fake weed, Skunk) is a drug made from shredded dried plant materials and chemicals. It is usually smoked. The “high” feels about the same as the “high” from marijuana. Spice users sometimes end up in the emergency room with rapid heart rates, vomiting and other uncomfortable side effects. K2/Spice is illegal. Click here for more information about K2/Spice.

LSD (acid) comes in pills or on small pieces of paper that have been soaked in liquid LSD. It makes you see, hear, and feel things that aren’t there. You might see bright colors, pretty pictures, or things that scare you. Click here for more information about LSD.

PCP (angel dust) is a pill or powder that can be eaten, smoked, or snorted up the nose. It makes people feel far away from the world around them. PCP often makes people feel angry and violent, not happy and dreamy. Click here for more information about PCP.

Inhalants are dangerous chemicals that make you feel high when you breathe them into your lungs (also called huffing or sniffing). These chemicals are found in household cleaners, spray cans, glue, and even permanent markers. Inhalants can make you pass out, stop your heart and your breathing, and kill you. Click here for more information about inhalants.

Club Drugs
Some drugs are called “club drugs” because they are sometimes passed around at nightclubs and parties:

  • Xanax is a pill used to treat anxiety and panic disorder. It has become a popular party drug used to intensify the effects of alcohol. It is a drug commonly slipped into people’s drinks without their knowledge, presumably in an effort to induce sedation and impair decision-making.
  • GHB is a liquid or powder that can make you pass out. It’s called a “date rape” drug because someone can secretly put it in your drink. This means that you can’t fight back or defend yourself. Then they will have sex with you without your permission.
  • Rohypnol (roofies) is a date rape pill and can also be put in a drink.
  • Ketamine (K, Special K) makes you feel far away from what’s going on around you and can feel scary and unpleasant. It is usually taken by mouth, snorted up the nose, or injected with a needle.
  • Click here for more information about these drugs.

Bath salts are drugs made with chemicals like the “upper” found in the Khat plant. They are only sold with the name “bath salts” to make them look harmless. These drugs can make you “high” but they can also make you shaky, afraid, and violent. They look like a white or brown shiny powder and are sold in small packages labeled “not for human consumption.” They can be taken by mouth, by inhaling into the lungs, or with a needle. Some people end up in the emergency room or even die after taking bath salts. Click here for more information about bath salts.

When and Where to Get Help 

Here is a way to think about substance use and abuse: knowing the cause of the condition can enable you to manage it. If your use of drugs or alcohol is interfering with your life—negatively affecting your health, work, school, relationships, or finances—it’s time to quit or seek help. People who are addicted to a substance continue to abuse it even though they know it can harm their physical or mental health, lead to accidents, or put others in danger.

Know that first six weeks of the first semester is an especially critical and vulnerable time for most first-year students. Because lots of students get into the habit of drinking heavily and partying during these early days of college, there’s a risk that excessive alcohol consumption will interfere with successful adaptation to campus life. The transition to college is often difficult, and about one-third of first-year students fail to enroll for their second year.

If you are concerned about your drug or alcohol use, or you need help quitting, visit the Student Health and Counseling or talk with your college counselor. These folks are there to help you—it’s their job to provide information and support.

If you need additional resources or help, the following are good places to check:

Activity 39-1: When and Where to Get Help for Substance Abuse


  • Explain what substance use and abuse is and identify the warning signs that help may be needed
  • Identify resources for further information and guidance about substance abuse


  • Pick a topic: Choose alcohol or one of the drugs discussed in this section on substance abuse.
  • Consider the following scenario: You suspect that one of your college friends may be abusing this drug. Your goal is to educate yourself about the signs of abuse and collect resources that you can share with them.
  • Visit one of the following Web sites to get initial relevant information on your topic. You can research other sites, if you chose a topic that’s not listed here.
  • Research additional sites to identify local resources where someone like your friend might go, or places to call, for help.
  • Creative writing assignment: Write a 2-page letter to the fictional friend in which you share your concerns about his/her behavior and offer to help. Be sure to touch on the following:
    • The type of substance
    • The behavior(s) you’ve noticed your friend engaging in that worry you and cause you to suspect a substance abuse problem
    • The source of your information, which you’re sharing with your friend. For example: “I learned about the signs of heroin abuse from this Web site: . . .”
    • Why you think your friend should quit using or cut down
    • Your suggestions for what your friend should do and where to seek help. Give the names and contact information for at least 3 resources/organizations you found.
  • Follow your instructor’s guidelines for submitting assignments.

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Adaptions: Removed images, relocated learning objectives.


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Blueprint for Success in College and Career Copyright © 2019 by Lumen Learning and Norma Cárdenas is licensed under a Creative Commons Attribution 4.0 International License, except where otherwise noted.

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