Recreational Drugs. The military is not immune to the problems of drug addiction.

A survey
conducted by the Substance Abuse and Mental Health Services Administration indicated that from 2004-
2006, 7.1% of veterans (approximately 1.8 million people) met criteria for a recent substance use
disorder. Many illicit drug users inject their substance of choice because of the heightened effect (the
drug bypasses first-pass metabolism, increasing bioavailability, and requires less of the drug to achieve
same effect barring tolerance) and rapid onset (a strong, near immediate response is generated because
the drug reaches the brain faster than many other methods). There are many drugs that can be injected,
including but not limited to heroin, cocaine, morphine, and amphetamines. There are even case studies
of a very rare minority of drug users (typically polydrug abusers) who inject alcohol because of the rapid
onset of effects and reduced likelihood of being discovered as having consumed alcohol recently (e.g.,
no tell-tale “alcohol breath”).
Most drugs of abuse affect the part of the central
nervous system relating to reinforcement of behaviors (the
“reward pathway”). Specifically, many stimulate activity of
dopamine neurons located in the reward pathway: the
ventral tegmental area (VTA), nucleus accumbens (NA),
amygdale, and prefrontal cortex (PFC; see figure at right,
www.learner.org). Using heroin as an example, prior to
injection of heroin, inhibitory neurotransmitters are active
in the synaptic cleft and inhibit the release of dopamine.
Dopamine is naturally released in the body when the body’s
natural opiates activate opiate receptors, thus shutting
down the release of inhibitory neurotransmitters; this VGA & NA in purple, amygdala in green, and PFC
allows for the dopamine to be released from the in grey
presynapse. Heroin mimics the body’s natural opiates,
causing the same effect of releasing dopamine, flooding the synaptic cleft. The fundamental mechanism
of action for other drugs is quite similar in so far as they act as agonists or antagonists at specific
neurotransmitter receptors. Opiates like heroin act on endogenous opioid receptors, nicotine acts on
nicotinic receptors, cocaine acts on cannabanoid receptors, and caffeine acts on adenosine receptors.
Additionally, drugs may act on other neurotransmitter systems. Cocaine, while having a primary affect
on cannabanoid receptors will also block reuptake of dopamine, norepinephrine, and serotonin due to
its additional action on monoamine transporters. Similarly, alcohol influences a variety of other
neurotransmitters because of its influence on GABA and glycine receptors (Wise, 1998). The table below
provides a brief summary of common drugs of abuse and their respective mechanism of action and
treatment.
 DRUG MECHANISM OF ACTION TREATMENT
Opiates (e.g. heroin)
Stimulants (e.g., cocaine)
Amphetamines (e.g., meth)
Marijuana
Hallucinogens (e.g., PCP)
Caffeine
Nicotine

As one would expect based on the type of neurotransmitters affected, different drugs produce
different effects that are sustained via the reward pathway. Heroin users experience a nearly immediate
(as soon as 8 seconds) significant “rush” or high; along with this euphoria comes a dry mouth, warm
flushing on the skin, and a sense of heaviness in one’s extremities. Following the rush, the individual will
vary between alertness and drowsiness, and judgment is clouded. Individuals using cocaine will similarly
experience a rapid high via smoking or injecting the substance because both methods bypass first pass
metabolism, allowing the drug to quickly enter the bloodstream and rapidly reach the brain. In blocking
neurotransmitters like norepinephrine, dopamine, and serotonin, cocaine users will typically feel a
significant increase of energy, euphoria, and a feeling of supremacy; less desirable effects may include
irritability, paranoia, and restlessness.

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