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Second in a series: stimulants and malnutrition; Counselors must understand symptoms, results of discontinued use.

Stimulants are probably the favorite drug of choice among Americans. The work ethic requires more work in less time, and done more efficiently. Sleep becomes the "necessary evil" because while we have to sleep to survive, it is viewed as a waste of time due to lack of documented productivity during sleeping hours. In general, Americans are working more hours than they were 40 years ago, taking fewer vacations, experiencing more stress and having more stress-related medical problems.

[ILLUSTRATION OMITTED]

Into this mix, let's add the recovering person who becomes a "workaholic" to try to make up for all the time lost while strung out on drugs. These individuals learn to use their own body chemistry (adrenaline) and caffeine to support their lifestyle patterns of multiple 12-Step meetings, working two or more jobs, and making amends for the damage done while they were under the influence.

The impact of the lifestyle we are living was really brought home when some counselors working in a psychiatric unit reported an influx of computer programmers as their most recent admissions. These individuals had been sent to live in hotels for three-month periods while designing new programs before the competition did. To accomplish this, they had no contact with family or friends, worked 24/7, slept as little as possible, used whatever stimulants (hopefully legal) to keep themselves going, and wrote programs.

The end result was admission to the psychiatric ward due to lack of sleep, stress and stimulant abuse. For those of us working in the addictions field, the question becomes, "Is the end result justified?" Is reliance on stimulants so much a part of our culture that we cannot break the cycle?

At the same time, the media are reporting that two-thirds of Americans are overweight, a fact related to more use of fast foods because of the time pressure to do more with less. Stimulants suppress appetite and promote weight loss.

Caffeine and nicotine

Caffeine and nicotine are the most widely used stimulants. Both substances are self-administered by animals and possess the possibility of dependence. Use of these substances enhances alertness, decreases the desire to sleep, enhances ability to concentrate, suppresses appetite, constricts blood vessels, and alters heart rate and blood pressure.

Caffeine is found most commonly in beverages including coffee, black and some herbal teas, and many soft drinks. In recent years, it has been added to fruit-like beverages that are consumed by individuals in an attempt to increase their fruit consumption. On a number of occasions, recovering persons have reported feeling "really good" as a result of drinking products that they do not think have ingredients such as caffeine, as well as herbal products containing caffeine. In addition, caffeine may be found in bottled water, chewing gum, candy, various dessert confections, and in purified form in tablets.

The overdose symptoms of caffeine are documented under "caffeine psychosis" in the DSM. For many persons, the aversive effects are enough to decrease the amount used. However, tolerance allows some individuals to consume large amounts without being aware of the consequences.

Nicotine use through smoking also decreases the ability of the blood to carry oxygen. The long-term and more severe effects of nicotine that usually appear after many years of use are well-documented. Discontinuing use is extremely difficult for most persons once dependency has developed.

Cocaine

Cocaine use produces reactions similar to those of other psychostimulants. The effects are relatively short in duration, so continued use is required to maintain the enhanced sense of well-being that is the reward for use.

A number of years back, a pharmacologist remarked that amphetamines would replace cocaine as the stimulant of choice because they are "American-made," less expensive and provide a longer effect. This prediction has come true, as indicated by the proliferation of methamphetamine "cook houses" and increased numbers of law enforcement actions taken to stop methamphetamine use.

Amphetamine

Amphetamine has been used for many years and has been readily available to individuals and groups. Adolf Hitler and other persons holding prisoners employed amphetamines so that they could feed the prisoners less and get more work done by them. Amphetamine was used with troops during World War II to overcome fatigue. And Hitler himself was dependent on it.

Benzedrine inhalers were sold over the counter to combat nasal congestion. After the war, truck drivers used it so they could drive for longer periods. GIs who attended college used them as study aids, to enhance concentration. It was no time until their wives and girlfriends found the wonder drug to help them lose weight. "Weight loss doctors" prescribed amphetamine freely to help patients lose weight. When tolerance developed after about three months, the user had to discontinue use so it would work again in a month. Approved medical use for weight loss was discontinued in the 1970s.

Identified effects

The substances of greatest concern in this article are cocaine, amphetamine and MDMA (Ecstasy) because nutritional problems are most likely to be observed and documented in users of these drugs.

To assist the addictions counselor, symptoms are documented from an addictions/nutritional point of view. The medically identified effects of these commonly abused stimulants are as follows.

Amphetamine

* Suppresses appetite (Radcliffe, et al., 1985; Gray and Gray, 1989).

* Causes weight loss.

* Might result in hemolytic anemia, blood clots in the blood vessels of the brain and eyes.

* Might cause allergic reactions and constipation (Stimmel, 1993).

Cocaine

* Suppression of appetite and weight loss (Gray and Gray, 1989; Mondanaro, 1989).

* Nausea and vomiting, malnutrition (Stimmel, 1993).

* Depletion of B complex and vitamin C (Vereby and Gold, 1984).

MDMA

* Appetite suppression (Hanson and Venturelli, 1995).

The assessment of a stimulant addict entering treatment needs to include documentation of malnutrition indicators. The one most commonly observed is poor dentition. Loss of teeth, decaying teeth and mouth odor are indicative of more than poor hygiene. Nutritional deficiencies also occur because of lack of eating plus poor food choices.

The symptoms that can be identified through observation and questioning including those found in the table on page 34.

Persons addicted to stimulants have an increased appetite once the drug use is discontinued. Eating regular meals provides much-needed calories and protein. As a result, most clients report an improved sense of well-being. The addition of a multivitamin and mineral supplement will support nutritional recovery.

Discontinuation of the drug plus the nutritional supplement will stimulate appetite. If the client is concerned about body weight and used the stimulants to suppress appetite, weight gain is viewed as a problem. The client might return to use of the drugs to maintain a low body weight. In such situations, counseling related to body image is an essential aspect of treatment (Hatcher, 1999).

On the basis of what is known about nutritional deficiencies among stimulant-abusing clients, addiction counselors are well-advised to develop skills in identifying physical indicators of nutritional problems and to involve a physician and a dietitian as consultants to the treating agency.
Symptoms Identified Through Observation

Physical Symptom Deficient Nutrients

Sore and bleeding gums Vitamin C and zinc
Missing and decayed teeth Vitamins C and D, zinc,
 calcium, phosphorus, magnesium
Dry mouth and dry eyes Vitamin C
Night blindness (poor adjustment Vitamin A and zinc
between light and darkened areas)
Poor wound healing or old wounds opening Vitamins A and C, and zinc
Offensive body odor Zinc
Lack of sense of taste and smell Zinc
Sensitivity to light (needing to Vitamins A and [B.sub.2], and
wear a cap or dark glasses) zinc
Cracks at the corners of the mouth Vitamin [B.sub.2]
Burning of palms and soles of feet Vitamin [B.sub.1]
Dry or cracking skin Vitamins A, E and [B.sub.1],
 and zinc
Joint pain Vitamin D
Poor coordination, possible changes Vitamin [B.sub.1]
in ability to stand and walk
Muscle tenderness Vitamin [B.sub.1]
Muscle weakness Potassium
Cold extremities Vitamin [B.sub.1]
Muscle twitching, spasms Vitamin [B.sub.6], calcium,
 magnesium
Anemia Iron, Vitamins [B.sub.6] and
 [B.sub.12], folic acid


References

Carvey, P.M. Drugs of abuse and addiction. Drug Action in the Central Nervous System. Oxford Press, N.Y. 1998.

Gray, G.E. and Gray, L.K. Nutritional aspects of psychiatric disorders. JADA. Oct. 1989, p. 1492-1498.

Hanson, G. and Venturelli, P.J. Drugs and Society. Jones and Bartlett Pub., Boston. 1995.

Hatcher, A.S. Links between substance abuse disorders and nutrition. Unpublished manuscript, 1999.

Mondanaro, J. Chemically Dependent Women. D.C. Heath and Co., Lexington, Mass. 1989.

Radcliffe, A.; Rush, P.; Sites, C.F. and Cruse, J. The Pharmer's Almanac. MAC Publications, Denver. 1985.

Stimmel, B. The Facts About Drug Use. Haworth Medical Press. 1993.

Vereby, K. and Gold, M.S. The psychopharmacology of cocaine. Psychiatric Annals. Oct. 1984, p. 714-723.

By Anne S. Hatcher, Ed.D., R.D., CACIII, NCACII

Anne Hatcher is director of the Center for Addiction Studies at Metropolitan State College of Denver, and is a member of the Addiction Professional editorial advisory board. Her work in addictions began as an instructor of a nutrition course for students planning to become addiction counselors. Over 30 years of utilizing her dietetics skills in addiction treatment and then teaching Pharmacology of Drugs and Alcohol, she has studied the role of nutrients in treatment and recovery.

The first article in this series appeared in the January 2004 issue.
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Author:Hatcher, Anne S.
Publication:Addiction Professional
Geographic Code:1USA
Date:May 1, 2004
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