Drugs That Affect The:

Nervous System
By Dr. Aftab Hussain
Introducing the Human Brain
• The human brain is the most complex organ in the body.
• This three-pound mass of gray and white matter sits at the center of
all human activity—you need it to drive a car, to enjoy a meal, to
breathe, to create an artistic masterpiece, and to enjoy everyday
activities.
• The brain regulates your body's basic functions, enables you to
interpret and respond to everything you experience, and shapes your
behavior.
• In short, your brain is you—everything you think and feel, and who
you are.
How does the brain work?

• The brain is often likened to an incredibly complex and intricate

computer.
• Instead of electrical circuits on the silicon chips that control our
electronic devices, the brain consists of billions of cells,
called neurons, which are organized into circuits and networks.
• Each neuron acts as a switch controlling the flow of information.
• If a neuron receives enough signals from other neurons that it is
connected to, it fires, sending its own signal on to other neurons
in the circuit.
Cont…..
• The brain is made up of many parts with interconnected
circuits that all work together as a team.

• Different brain circuits are responsible for coordinating and

performing specific functions.

• Networks of neurons send signals back and forth to each other

and among different parts of the brain, the spinal cord, and
nerves in the rest of the body (the peripheral nervous system).
How do drugs work in the brain?
• Drugs interfere with the way neurons send, receive, and process
signals via neurotransmitters.
• Some drugs, such as marijuana and heroin, can activate neurons
because their chemical structure mimics that of a natural
neurotransmitter in the body.
• This allows the drugs to attach onto and activate the neurons.
• Although these drugs mimic the brain’s own chemicals, they don’t
activate neurons in the same way as a natural neurotransmitter, and
they lead to abnormal messages being sent through the network.
Cont…
• Other drugs, such as amphetamine or cocaine, can cause the neurons
to release abnormally large amounts of natural neurotransmitters or
prevent the normal recycling of these brain chemicals by interfering
with transporters.

• This too amplifies or disrupts the normal communication between

neurons.
Cont…
• To send a message, a neuron releases a neurotransmitter into the gap
(or synapse) between it and the next cell.

• The neurotransmitter crosses the synapse and attaches to receptors

on the receiving neuron, like a key into a lock.
• This causes changes in the receiving cell. Other molecules
called transporters recycle neurotransmitters (that is, bring them back
into the neuron that released them), thereby limiting or shutting off
the signal between neurons.
What parts of the brain are affected by
drug use?
• Drugs can alter important brain areas that are necessary for life-sustaining
functions and can drive the compulsive drug use that marks addiction. Brain areas
affected by drug use include:
• The basal ganglia, which play an important role in positive forms of motivation,
including the pleasurable effects of healthy activities like eating, socializing, and
sex, and are also involved in the formation of habits and routines.
• These areas form a key node of what is sometimes called the brain’s “reward
circuit.”
• Drugs over-activate this circuit, producing the euphoria of the drug high. But with
repeated exposure, the circuit adapts to the presence of the drug, diminishing its
sensitivity and making it hard to feel pleasure from anything besides the drug.
Cont…
• The extended amygdala plays a role in stressful feelings like anxiety,
irritability, and unease, which characterize withdrawal after the drug
high fades and thus motivates the person to seek the drug again.

• This circuit becomes increasingly sensitive with increased drug use.

Over time, a person with substance use disorder uses drugs to get
temporary relief from this discomfort rather than to get high.
Cont….
• Some drugs like opioids also disrupt other parts of the brain, such as
the brain stem, which controls basic functions critical to life, including
heart rate, breathing, and sleeping. This interference explains why
overdoses can cause depressed breathing and death.
How do drugs produce pleasure?

• Pleasure or euphoria—the high

from drugs—is still poorly
understood, but probably
involves surges of chemical
signaling compounds including
the body’s natural opioids
(endorphins) and other
neurotransmitters in parts of the
basal ganglia (the reward
circuit).
Cont…

• When some drugs are taken, they can cause surges of these
neurotransmitters much greater than the smaller bursts naturally produced
in association with healthy rewards like eating, hearing or playing music,
creative pursuits, or social interaction.

• It was once thought that surges of the

neurotransmitter dopamine produced by drugs directly caused the euphoria,
but scientists now think dopamine has more to do with getting us to repeat
pleasurable activities (reinforcement) than with producing pleasure directly.
How does dopamine reinforce drug use?
• The feeling of pleasure is how a healthy brain identifies and reinforces
beneficial behaviors, such as eating, socializing, and sex.
• Our brains are wired to increase the odds that we will repeat pleasurable
activities.
• The neurotransmitter dopamine is central to this. Whenever the reward
circuit is activated by a healthy,
• pleasurable experience, a burst of dopamine signals that something
important is happening that needs to be remembered.
• This dopamine signal causes changes in neural connectivity that make it
easier to repeat the activity again and again without thinking about it, leading
to the formation of habits.
Cont….
• Just as drugs produce intense euphoria, they also produce much
larger surges of dopamine, powerfully reinforcing the connection
between consumption of the drug, the resulting pleasure, and all the
external cues linked to the experience. Large surges of dopamine
“teach” the brain to seek drugs at the expense of other, healthier
goals and activities.
Cont…
• Cues in a person’s daily routine or environment that have become
linked with drug use because of changes to the reward circuit can
trigger uncontrollable cravings whenever the person is exposed to
these cues, even if the drug itself is not available.
• This learned “reflex” can last a long time, even in people who haven’t
used drugs in many years. For example, people who have been drug
free for a decade can experience cravings when returning to an old
neighborhood or house where they used drugs. Like riding a bike, the
brain remembers.
Why are drugs more addictive than
natural rewards?
• For the brain, the difference between normal rewards and drug
rewards can be likened to the difference between someone
whispering into your ear and someone shouting into a microphone.
• Just as we turn down the volume on a radio that is too loud, the brain
of someone who misuses drugs adjusts by producing fewer
neurotransmitters in the reward circuit, or by reducing the number of
receptors that can receive signals.
• As a result, the person's ability to experience pleasure from naturally
rewarding (i.e., reinforcing) activities is also reduced.
Cont…
• This is why a person who misuses drugs eventually feels flat, without
motivation, lifeless, and/or depressed, and is unable to enjoy things
that were previously pleasurable.
• Now, the person needs to keep taking drugs to experience even a
normal level of reward—which only makes the problem worse, like a
vicious cycle.
• Also, the person will often need to take larger amounts of the drug to
produce the familiar high—an effect known as tolerance.
Effects of Drugs on The Brain &
Neurotransmitters
• Mind-altering drugs may slow down or speed up the central nervous system and autonomic functions
necessary for living, such as blood pressure, respiration, heart rate, and body temperature. Levels of some
of the brain’s chemical messengers, or neurotransmitters, are also impacted by drug abuse, including:
• Dopamine: This neurotransmitter regulates moods, enhances pleasure, and is involved with movement,
reward and reinforcing behaviors, motivation, and attention.
• Drugs that can impact dopamine levels: Marijuana, heroin & other opioids, stimulants, ecstasy, PCP
• Serotonin: This neurotransmitter is responsible for stabilizing moods and regulating emotions.
• Drugs that can impact serotonin levels: ecstasy and hallucinogens
• Gamma-aminobutyric acid (GABA): GABA acts as a natural tranquilizer, mitigating the stress response and
lowering anxiety levels as well as slowing down functions of the central nervous system.
• Drugs that can impact GABA levels: benzodiazepines
• Norepinephrine: Similar to adrenaline, norepinephrine is often called the “stress hormone,” as it speeds
up the central nervous system in response to the “fight-or-flight” response. It also homes focus and
attention while increasing energy levels.
• Drugs that can impact norepinephrine levels: opioids and ecstasy
Cont…
• Regions of the brain are disrupted by drug abuse, as the National Institute on Drug
Abuse (NIDA) reports that the brain stem, limbic system, and cerebral cortex are all
affected.
• The brain stem controls life-sustaining functions, including sleeping, breathing, and
heart rate, while the limbic system holds the brain’s reward circuitry and helps to control
emotions and the ability to feel happiness.
• The cerebral cortex is considered the “thinking center” of the brain, managing problem-
solving, planning, and decision-making abilities as well as helping people to process
information provided by their senses.
• The more often drugs are used, the more they will impact brain chemicals and circuitry,
which can lead to drug dependence and withdrawal symptoms when the drugs process
out of the body. Drug cravings, dependence, and withdrawal symptoms, coupled with a
loss of control over use, are signs of addiction.
Marijuana
• Marijuana is the most regularly used illicit drug in the United States, and its use is especially
common among adolescents and young adults, NIDA reports. 
• The psychoactive chemical in marijuana, delta-9-tetrahydrocannabinol (TCH), interacts and
binds with cannabinoid receptors in the brain, producing a mellowing and relaxing effect. 
• Regions of the brain with high concentrations of cannabinoid receptors are heavily impacted.
• One such part of the brain, the hippocampus, manages short-term memory, meaning that
marijuana use can impede recollection of recent events.
• Additional regions of the brain that are impacted include the cerebellum and basal ganglia,
which help to control coordination and involuntary muscle movements respectively. 
• When someone abuses marijuana, impaired motor skills, mood alterations, distorted time
and sensory perception, decreased memory, and trouble thinking clearly and solving
problems are all common short-term side effects.
Cont…
• Marijuana also interferes with levels of dopamine in the brain, causing the
euphoric “high” that users document.
• Marijuana also has several long-term side effects on the brain, which are
especially prevalent in individuals who use the drug before the brain is fully
developed. 

• NIDA warns that marijuana use in adolescence, and continued on into

adulthood, may result in a loss of IQ points that are not recoverable even with
abstinence.
• Also, initiating marijuana use before turning age 18 raises the risk for
addiction as an adult.
• As many as 30 percent of those who use marijuana will suffer from addiction to
the drug, and the risk is increased 4-7 times when use begins before the age of 18.
• As a person ages, neurons in the hippocampus are naturally lost, and marijuana
use may speed up this process, leading to memory problems. Impaired
coordination, learning issues, and sleep problems can result from long-term
marijuana use and its impact on the brain.
• NIDA also reports on the possible link between marijuana use and the onset of
psychosis and psychiatric disorders like schizophrenia in those who are genetically
vulnerable. Breathing and respiration problems, chronic cough, and bronchitis are
additional possible consequences of chronic marijuana smoking. Marijuana use
can also disrupt heart rhythm and normal cardiac functions.
Heroin and Prescription Opioids
• Heroin and prescription opioid drugs like OxyContin (oxycodone),
Vicodin (acetaminophen/hydrocodone), fentanyl, methadone, and
Dilaudid (hydromorphone) bind to opioid receptors in the brain and
trigger the release of dopamine.
• In a sense, these drugs hijack the limbic system in the brain, inducing
a powerful high that individuals are often keen to recreate, leading to
reinforcing behaviors. Opioid drugs are considered highly addictive,
as ASAM publishes that almost a quarter of heroin users will suffer
from addiction to opioids.
• Heroin is considered the fastest-acting opioid, taking effect nearly
immediately and making it extremely addictive
• When someone takes an opioid drug repeatedly, they can develop a
tolerance to it as the body gets used to its interaction in the brain.
Individuals may then take more of the drug to feel the desired effects.
The brain will then stop functioning as it did before introduction of the
opioid, causing levels of dopamine to drop when the drug wears off.
• Dependence on opioids can form rather quickly. Physical withdrawal
symptoms may resemble the flu, and emotional withdrawal symptoms
include depression, anxiety, and insomnia.
• Opioid drugs also disrupt the natural production of norepinephrine and
act as central nervous system depressants. Opioids block pain
sensations, induce drowsiness, reduce body temperature, and slow
heart rate, blood pressure, and respiration functions. Opioid overdose is
an all too common consequence of opioid abuse, which can often result
in severe respiratory depression that can be fatal.

• Long-term, chronic heroin use may also result in the deterioration of

some of the brain’s white matter, which can negatively impact the way a
person responds to stress, regulates emotions, and makes
decisions, NIDA publishes. 
Cocaine, Methamphetamine, and Other Stimulants

• Cocaine, methamphetamine (meth), and prescription amphetamines, such as

those used to treat attention deficit hyperactivity disorder (ADHD) like
Adderall (amphetamine/dextroamphetamine) and Ritalin (methylphenidate) are
classified as stimulant drugs. This means that they speed up the central nervous
system, increasing heart rate, body temperature, and blood pressure while
increasing energy levels, focus, attention, alertness, and wakefulness.
•  Cocaine and meth, especially, produce an intense high as they rapidly
flood the brain with dopamine. The high is generally fairly short-lived,
however, and cocaine is often abused in a binge pattern to try and extend the
euphoria. The “crash” that comes after a stimulant high can be significant,
leaving a person feeling extremely fatigued, hungry, irritable, mentally
confused, and depressed, which is followed by intense cravings.
Cont..
• Stimulant drugs are extremely addictive due to the way they impact
dopamine levels and affect the limbic reward system. 
• Meth has similar effects on the brain and central nervous system, and
individuals who abuse it regularly may suffer from hallucinations, anxiety,
and confusion as well.
• Meth also significantly damages the dopamine system in the brain, which
can cause problems with memory and learning, movement, and emotional
regulation issues.
• NIDA warns that even long-term abstinence may not reverse all of the negative
brain changes incurred by meth abuse. Such abuse may also increase the risk for
the onset of Parkinson’s disease, a nerve disorder impacting movement.
Ecstasy
• Ecstasy, also known as Molly or by its chemical name, MDMA, is a popular
club and psychoactive drug. It binds to serotonin transporters in the brain
and has both stimulant and hallucinogenic properties. Within about an
hour after ecstasy enters the bloodstream, it stimulates the activity of
serotonin, norepinephrine, and dopamine, NIDA explains. 
• Hyperthermia, high blood pressure, panic attacks, faintness, involuntary
teeth clenching, blurred vision, nausea, sweating, chills, arrhythmia, heart
failure, kidney failure, dehydration, loss of consciousness, and seizures are
possible side effects of ecstasy abuse and/or overdose.
• Ecstasy is also commonly combined with alcohol or other drugs, or “cut”
with toxic substances, which can have potentially hazardous consequences.
• If a person takes additional doses of MDMA while the drug is still in the system,
it can interfere with the metabolism, which can make the cardiovascular and
toxic side effects worse, NIDA warns.
• While the majority of the side effects of MDMA wear off in a few hours,
confusion and anxiety can last up to a week after taking ecstasy. MDMA
interferes with the way the brain processes information and stores memories,
and with long-term use, these cognitive issues can become more pronounced.
•  Anxiety, irritability, sleep difficulties, depression, aggression, impulsivity, loss of
appetite, and decreased interest in sex may be side effects of regular ecstasy
use. Ecstasy may also be psychologically addictive, leading to withdrawal
symptoms when the drug isn’t taken.
LSD, PCP, Ketamine, and Hallucinogens

• A class of drugs that leads to distortions of reality and perceptions, hallucinogens are
typically broken down into two main categories: classic hallucinogens (LSD, peyote,
psilocybin, DMT,Ayahuasca ai·uh·wa·skuh) and dissociative drugs (PCP, salvia, DXM,
ketamine), per NIDA.
• It is not certain exactly how these drugs work in the brain; however, it is largely
understood that they interrupt normal communication between neurotransmitters.
• Dissociative drugs are believed to disrupt the action of glutamate, a brain chemical that is
involved with memories, cognition, emotions, and how people perceive pain. PCP
interacts with dopamine as well, while salvia activates the kappa opioid receptor present
on nerve cells, per NIDA.
• Dissociative drugs can make people feel separate from themselves, their environment,
and reality. This can result in impaired motor functions, auditory and visual distortions,
memory loss, anxiety, numbness, and body tremors.
Benzodiazepines
• Benzodiazepine drugs are prescription sedatives and tranquilizers,
such as Valium (diazepam), Ativan (lorazepam), Xanax (alprazolam),
and Klonopin (clonazepam). These drugs are prescribed to treat
anxiety, to relieve muscle tension, and as sleep aids. 

• They serve to increase levels of GABA in the brain and slow

functions of the central nervous system. They are commonly
misused, however, and can have a euphoric effect when taken in
large doses.
• After a dependence on a benzodiazepine has formed, the brain can experience a
rebound effect when the drug leaves the bloodstream.
• The central nervous system that was dampened by the benzo can go into
overdrive, and the brain may be slow to produce GABA on its own, which can
result in elevated anxiety, depression, trouble sleeping, tremors, suicidal
tendencies, sweating, hypertension, irregular heart rate, muscle tension and
aches, nausea and vomiting, and even potentially life-threatening seizures.
• These drugs have such an impact on the central nervous system and brain
function that they should not be discontinued suddenly once a dependence has
formed. Instead, they are generally tapered off gradually, with the dosage being
slowly lowered over a safe period of time. Medical supervision is required for
safe withdrawal.