Drugs of Misuse and Their Effects: Depressants vs. Stimulants

Depressant medications and illicit drugs work by slowing down the brain and body.  Stimulant medications and illicit drugs work by speeding up the brain and the body.  Depressants and stimulants affect similar parts of the brain, but they work in direct opposition to one another.  If you think of classes of drugs as a driver behind the wheel of car, and your brain as the engine of the car, stimulants press the gas pedal to the floor, while depressants ride the brakes.

Both depressants and stimulants affect the brain and body in predictable ways.  These predictable changes to the brain and body of the user produce predictable physical and behavioral changes.  For example, alcohol and benzodiazepines are both depressant drugs.  Although both affect similar neurotransmitters in the brain, they are different drugs.  Alcohol is a legal recreational drug, while benzodiazepines are legal prescription drugs (e.g. Xanax, Valium, Ativan, Ambien, etc.).  Because both are depressant drugs, the user of either drug can expect a similar physiological, psychological, and behavioral response. 

If the user takes too much of either drug, SIGNS of intoxication will develop.

Common and predictable SIGNS of depressant intoxication include but are not limited to the following:

  • Sleeping
  • Fatigue, sluggishness
  • Frequent yawning
  • Lethargy
  • Laziness
  • Weakness
  • Slurred and/or slowed speech
  • Difficulty walking straight
  • Difficulty balancing
  • Slumped when sitting
  • Droopy eyelids
  • Constricted (small) pupils (especially with opioids and PCP)
  • Memory problems and/or confusion
  • Difficulty problem-solving
  • Change in vocal tone, louder or softer

Common and predictable SIGNS of stimulant intoxication include but are not limited to the following:

  • Restlessness, fidgeting
  • Unable to sit or stand still
  • Highly energetic
  • Excessive sweating
  • Dilated (large) pupils
  • Rapid and/or pressured speech
  • Walking briskly
  • Change in vocal tone, usually louder
  • Paranoia
  • Working quickly
  • Heightened awareness of surroundings
  • Anxiety, nervousness
  • Flight of ideas, rambling speech

Common depressant medications, recreational, and illegal drugs include the following (an * indicates a federally illegal drug):

  • Alcohol
  • Barbiturates
  • Benzodiazepines
  • * Heroin
  • * Inhalants
  • * Marijuana
  • Muscle relaxers
  • Opioid pain relievers
  • PCP

Common stimulant medications, recreational, and illegal drugs include the following (an * indicates a federally illegal drug):

  • Amphetamines
  • * Cathinones
  • Caffeine
  • Cocaine
  • * Crack Cocaine
  • Methamphetamines (*Speed and Ecstasy)
  • Nicotine

There are drugs that cannot be classified entirely as stimulants or depressants (eg. hallucinogens such as LSD or “magic mushrooms”), however all drugs can behave as stimulants or depressants depending on the user.  For example, it is not uncommon for some individuals who misuse opioid medications to be energized by the drug’s effects, while others can become extremely drowsy and hard to awaken.  Alcohol commonly acts like a stimulant for many users for the first one or two drinks; it is only after the first couple of drinks that the depressant effects kick in.  For the heavy drinker, or “alcoholic”, the commonly seen depressant effects of alcohol such as drowsiness or stumbling may not be seen, despite the consumption of numerous alcoholic beverages.

Depressant drugs and their SIGNS…

Alcohol: Also referred to as ethyl alcohol, ETOH, or simply drinking alcohol.  Alcohol is a naturally-occurring and man-made psychodepressant and legal recreational drug.  A user is considered illegally intoxicated if operating a motor vehicle with a blood alcohol concentration (BAC) at and above 0.08% (eight one hundredths of 1%).  Employees covered under Federal Motor Carrier Safety Administration (FMCSA) law, or DOT, are considered illegally intoxicated if operating a motor vehicle with a BAC at and above of 0.04%.

SIGNS of alcohol impairment may be similar to other depressant drugs and can include: an odor of alcohol, loss of balance and coordination, slurred speech, drowsiness, shallow breathing and lowered inhibitions.  Long-term use can result in depression and anxiety, nutrient deficiencies, memory problems, hair loss, irritability and extreme mood swings.  

Barbiturates: Man-made psychodepressants commonly prescribed to those with sleep disorders such as insomnia; also for seizure disorders, anxiety, and other mental illnesses.  Migraine relief is a common off-label use of barbiturates.

Commonly prescribed barbiturates include: Amytal, Butisol, Luminal, Mebaral, Nembutal, Seconal.  

SIGNS of barbiturate impairment may be similar to alcohol and benzodiazepine intoxication, which includes: loss of balance and coordination, lethargy, slurred speech, and lowered inhibitions.  Long-term use can result in excessive weakness and fatigue, depression, and extreme mood swings.

Benzodiazepines (ben-zoe-dye-AZ-e-peens): Man-made psychodepressants commonly prescribed to those with sleep disorders such as insomnia; also for anxiety disorders, panic disorders, and seizure disorders.  They are also commonly prescribed as a detoxification medication to those who are physically dependent on alcohol and benzodiazepines.

Commonly prescribed benzodiazepines include: Ambien, Ativan, Halcion, Klonopin, Librium, Restoril, Xanax, Valium.

SIGNS of benzodiazepine impairment may be similar to alcohol and barbiturate intoxication, and include: loss of balance and coordination, slurred speech, inability to concentrate, drowsiness, and shallow breathing.  Long-term effects can include anxiety and depression, memory problems, and difficulty experiencing and expressing emotions.

Buprenorphine (bew-prih-NOR-pheen): Man-made opioid medication commonly prescribed to help individuals reduce their use of heroin and other opioid drugs.  This is known as medication-assisted treatment, or MAT.  Buprenorphine may be used as part of the detoxification process from opioids.  It is also less frequently prescribed to individuals suffering from chronic pain.  

Well-known prescriptions include: Bunavail, Buprenex, Butrans, Cizdol, Norspan, Suboxone, Subutex, Temgesic, Zubsolv.

SIGNS of buprenorphine impairment or overuse may include: pinpoint pupils, irritability, inability to concentrate, restlessness or drowsiness, shallow breathing, and nausea.  Long-term effects can include anxiety and depression, disorientation and confusion, decreased pain tolerance, and gastrointestinal issues.

Inhalants: Primarily man-made, Schedule I psychodepressants.  Inhalants are typically volatile hydrocarbons and can be extremely dangerous to one’s health, causing immediate death in some cases. 

Commonly used inhalants include: gasoline, glues, keyboard cleaners, nail polishes and removers, spray paints.

SIGNS of inhalant impairment or abuse may include: dizziness, drowsiness, slurred speech, slowed reflexes, general muscle weakness, stupor, euphoria, inability to concentrate, shallow breathing, and flushing.  A hallmark SIGN of abuse includes a colored ring on the face that extends below the mouth and about the mouth or nose.  This occurs when users huff the fumes from a bag or sock.  Long-term abuse often causes severe brain and other organ damage, extreme mood and personality changes, weight changes, seizures, and death.

Methadone: Man-made opioid medication commonly prescribed to help individuals reduce their use of heroin and other opioid drugs.  This use is known as medication-assisted treatment, or MAT.  Methadone may be prescribed as part of a comprehensive treatment program, coordinated between a primary care physician and a behavioral health treatment provider.  It is also less frequently prescribed to individuals suffering from chronic pain.  

Well-known prescriptions include: Diskets, Dolophine, Methadose.

SIGNS of methadone impairment or overuse may include: pinpoint pupils, irritability, inability to concentrate, restlessness or drowsiness, shallow breathing, and nausea.  Long-term effects can include anxiety and depression, disorientation and confusion, decreased pain tolerance, and gastrointestinal issues.

Marijuana: Naturally-occurring plant that contains psychodepressant chemicals known as cannabinoids (cah-NAH-bih-noids); also man-made chemicals that mimic the effects of cannabinoids.  More than half of the states in the U.S.A. have legalized marijuana for medicinal use, though marijuana is still classified by the FDA and DEA as a Schedule I drug.  The fully synthetic versions are approved to treat chronic pain, wasting, and patients undergoing chemotherapy. 

FDA-approved prescriptions include: Epidiolex (cannabidiol), Syndrox (dronabinol), Marinol (dronabinol), and Cesamet (nabilone).

SIGNS of marijuana impairment or overuse may include: Visual distortion and depth perception issues, delayed reaction times, difficulty balancing, mood changes (including extreme anxiety, panic, and paranoia), nausea and vomiting, and an increase in appetite.  Long-term effects may include severe short-term and long-term memory problems, difficulty problem-solving, and adult-onset mood disorders.  Early frequent and/or heavy use of marijuana may also be linked to adult-onset schizophrenia.

Muscle Relaxers: Man-made psychodepressant medications commonly prescribed to relax an individual’s muscles.  They help relieve muscle spasms and musculoskeletal pain.

Well-known prescriptions include: Baclofen, Flexeril, Skelaxin, Soma, Zanaflex.

SIGNS of muscle relaxer impairment or overuse may include: nausea, vomiting, dry mouth, drowsiness, dizziness, difficulty balancing, muscle weakness, delayed reaction times, inability to concentrate.  

Opiates: Naturally-occurring psychodepressant chemicals found in the poppy plant.  The most common include morphine, codeine, and thebaine.  Man-made “opiates” that mimic the effects of natural opiates are referred to as “opioids”, which is the appropriate term when referencing both opiates and opioids.  Opioids are best known for their pain relieving effects.

Well-known opioids include: Dilaudid, Fentanyl, Heroin (illegal), Opana, OxyContin, Percocet, and Vicodin.

SIGNS of opioid impairment or overuse may include: pinpoint pupils, irritability, inability to concentrate, restlessness or drowsiness, “nodding off”, shallow breathing, and nausea.  Long-term effects can include anxiety and depression, disorientation and confusion, decreased pain tolerance, and gastrointestinal issues.

PCP: Man-made psychodepressant and dissociative anesthetic, also referred to as phencyclidine.  PCP was once used as a pharmaceutical drug for human use.  While it is a Schedule II drug, it is no longer used as a pharmaceutical and has a high potential for abuse.

SIGNS of PCP impairment or overuse may include: hallucinations, delirium, mania, extreme fatigue, sleepiness, aggressive behaviors, agitation, sensitivity to bright light and loud sounds, and a very high tolerance to physical pain. 

Stimulant drugs and their SIGNS…

Amphetamines: Man-made psychostimulants commonly prescribed to those with attention-deficit hyperactivity disorders or narcolepsy.  They can also be used to treat medication-resistant depression and eating disorders leading to obesity. 

Commonly prescribed amphetamines include: Adderall, Benzedrine, Concerta, Dexedrine, Ritalin, Vyvance.

SIGNS of amphetamine abuse are similar to cocaine and methamphetamines, and may include: restlessness, inability to sit still, euphoria, anxiety, paranoia, and tremors (shaking hands, legs, face, etc.).  Over long periods of abuse, weight loss and aggressive or violent behavior may be seen.

Cocaine: Naturally-occurring psychostimulant endogenous to the coca plant.  Cocaine is a Schedule II substance and is still used medicinally, mostly in hospitals for its numbing effects and ability to constrict blood vessels.  Crack cocaine is a man-made form of naturally-occurring cocaine and is classified as a Schedule I substance by the DEA.

Cocaine is not provided to patients as a take-home prescription medication.

SIGNS of cocaine impairment and abuse are similar to amphetamines and methamphetamines, and may include: runny nose, white powder at the base of the nose, restlessness, inability to sit still, euphoria, anxiety, paranoia, and tremors (shaking hands, legs, face, etc.).  Over long periods of abuse, weight loss and aggressive or violent behavior may be seen.

Cathinones: Naturally-occurring psychostimulant chemicals endogenous to the khat plant; also man-made chemicals that mimic the effects of the naturally occurring chemicals.  Cathinones are commonly referred to as “Bath Salts” for their crystalline appearance, or “Flakka”.  Cathinones are classified as a Schedule I substance by the DEA.

SIGNS of cathinone impairment or overuse may be similar to amphetamines, methamphetamines, and cocaine, and may include: restlessness, inability to sit still, euphoria, anxiety, paranoia, and tremors (shaking hands, legs, face, etc.).  Mania, psychosis, and aggressive behaviors may also be seen.

Methamphetamines: Man-made psychostimulants commonly prescribed to those with attention-deficit disorders or narcolepsy; may also be prescribed as an appetite suppressant and weight loss aid.  Some methamphetamines are classified as Schedule I substances by the DEA, such as crystal meth (aka “speed”) and Ecstasy (aka “MDMA”). 

Commonly prescribed methamphetamines include: Desoxyn.

SIGNS of methamphetamine impairment and abuse are similar to amphetamines and cocaine and may include: runny nose, white powder at the base of the nose, restlessness, inability to sit still, euphoria, anxiety, paranoia, and tremors (shaking hands, legs, face, etc.).  Over long periods of abuse, weight loss and aggressive or violent behavior may be seen.