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MODULE 4: CONSCIOUSNESS

Nature of Consciousness
Consciousness is the awareness of internal and external stimuli. It includes:
●​ Your awareness of external events (“The professor just asked me a hard question about
medieval history”),
●​ Your awareness of your internal sensations (“My heart is racing and I’m starting to
sweat”),
●​ Your awareness of yourself as the unique being having these experiences (“Why me?”),
and
●​ Your awareness of your thoughts about these experiences (“I’m going to make a fool of
myself!”).
The contents of the consciousness are continually changing. It moves, it flows, it fluctuates, it
wanders. Recognizing that consciousness fluctuates continuously, William James long ago
named this flow the stream of consciousness. Constant shifting and changing is a part of the
essential nature of consciousness.

Variations in Levels of Awareness

Freud argued that people’s feelings and behavior are influenced by unconscious needs, wishes,
and conflicts that lie below the surface of conscious awareness. According to Freud, the stream
of consciousness has depth. Conscious and unconscious processes are different levels of
awareness. Thus, Freud was one of the first theorists to recognize that consciousness is not an
all-or-none phenomenon. Research has shown that people continue to maintain some awareness
during sleep and even when they are put under anesthesia for surgery.

Consciousness and Brain Activity

Variations in consciousness are associated with variations in brain activity. Consciousness does
not arise from any distinct structure in the brain. It is the result of activity in distributed networks
of neural pathways. Scientists are increasingly using brain-imaging methods to explore the link
between brain activity and consciousness. The electroencephalograph (EEG) is a device that
monitors the electrical activity of the brain over time by means of recording electrodes attached
to the surface of the scalp. It summarizes the rhythm of cortical activity in the brain in terms of
line tracings called brain waves. These tracings vary in amplitude (height) and frequency (cycles
per second).

Human brain-wave activity is usually divided into four principal bands, based on the frequency
of the brain waves:
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Biological Rhythms
Rhythms, or repeating cycles, pervade the world around us. Humans and many other animals
display biological rhythms that are tied to these rhythms. A biological rhythm is any repeating
cycle of biological activity, such as sleep and waking cycles or changes in body temperature.
They are periodic fluctuations in physiological functioning. Variations in consciousness are
shaped in part by biological rhythms. The existence of these rhythms means that organisms have
internal “biological clocks” that somehow monitor the passage of time.

Circadian Rhythms
Circadian rhythms are the 24-hour biological cycles found in humans and many other species. In
humans, circadian rhythms are particularly influential in the regulation of sleep. Daily cycles
also produce rhythmic variations in blood pressure, urine production, hormonal secretions, and
other physical functions. These cycles affect alertness, short-term memory, and other aspects of
cognitive performance.

Circadian rhythms can leave individuals physiologically primed to fall asleep most easily at a
particular time of day. This optimal time varies from person to person and retiring at this ideal
bedtime may promote better-quality sleep during the night. Preferences such as being a “night
person” or a “morning person” also reflect individual variations in circadian rhythms.
When exposed to light, some receptors in the retina send direct inputs to a small structure in the
hypothalamus called the suprachiasmatic nucleus (SCN). The SCN sends signals to the nearby
pineal gland, whose secretion of the hormone melatonin plays a key role in adjusting biological
clocks.

Ignoring Circadian Rhythms

If one ignores the circadian rhythms and goes to sleep at unusual times, the quality of sleep
decreases.
●​ Getting out of sync with the circadian rhythms also causes jet lag. The resulting
low-quality sleep can make individuals feel fatigued, sluggish, and irritable during the
daytime.
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●​ The rotating and late-night work shifts can harm employees’ productivity at work, social
relations, and mental health. Studies have also linked rotating shifts to a higher incidence
of many physical diseases, including cancer, diabetes, ulcers, high blood pressure, and
heart disease.

Sleep and Waking Cycle

According to the American Psychological Association, sleep is defined as a circadian state

characterized by partial or total suspension of consciousness, voluntary muscle inhibition, and
relative insensitivity to stimulation.
Although people once believed sleep was a uniform state of inactivity during which the brain is
“shut down”, it is now known that the brain and body remain active throughout the night.
Sleep research is conducted in sleep laboratories, where volunteers spend the night in controlled
“bedroom” settings, typically after being connected to various physiological recording devices.
Some of them are:
●​ Electromyograph (EMG): Records muscular activity and tension
●​ Electrooculograph (EOG): Records eye movements
●​ Electrocardiograph (EKG): Records the contractions of the heart

Stages of Sleep
Sleep stages are levels of sleep identified by brain-wave patterns and behavioral changes. During
sleep, people cycle through a series of four distinct stages. There are two most basic states of
sleep: (i) non-REM (NREM) sleep, which occurs during Stages 1, 2, and 3 (ii) REM sleep.

NREM Sleep
Non-REM sleep consists of sleep stages 1 through 3, which are marked by an absence of rapid
eye movements, relatively little dreaming, and varied EEG activity. The three non-REM stages
are often referred to as N1, N2, and N3.

Stage 1 (N1)
The onset of sleep is gradual, with no obvious transition point between wakefulness and sleep.
Stage 1 is a brief transitional stage of light sleep that usually lasts only 10–12 minutes. In
laboratory studies, subjects are considered to have fallen asleep when their predominant EEG
activity shifts from alpha waves to theta waves. It is marked by small, irregular brainwaves and
some alpha waves. During this stage, the heart rate slows, breathing becomes irregular and body
muscles relax. This may trigger a reflex muscle twitch called a hypnic jerk. Persons awakened at
this time may or may not say they were asleep.
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On average, the length of time it takes people to fall asleep is 10-20 minutes. This time period
depends on quite an array of factors, including how long it has been since you have slept, where
you are in your circadian cycle, the amount of noise or light in the sleep environment, and your
age, desire to fall asleep, boredom level, recent caffeine or drug intake, and stress level.

Stage 2 (N2)
Stage 2 consists of light sleep and typically lasts about 10–25 minutes. The body temperature
drops further, and the EEG begins to include sleep spindles. Sleep spindles are short bursts of
distinctive brainwave activity generated by the thalamus that indicate a person is asleep. They
may help prevent the sleeping brain from being aroused by external stimuli, thus marking the
true boundary of sleep.

Stage 3 (N3)
As one descends through stages 2 and 3 of the sleep cycle, the respiration rate, heart rate, muscle
tension, and body temperature continue to decline. In stage 3, a new brainwave called delta
begins to appear. Delta waves are very large and slow. They signal a move to deeper slow-wave
sleep and a further loss of consciousness. Typically, one reaches slow-wave sleep in less than an
hour and stays there for roughly 20–40 minutes.

REM Sleep
REM sleep is a deep stage of sleep marked by rapid eye movements, high-frequency brain
waves, and dreaming. REM sleep is marked by a return of fast, irregular beta waves similar to
Stage 1, and the brain is so active that it looks as if the person is awake. The REM stage tends to
be a “deep” stage of sleep in the conventional sense that it is relatively hard to awaken a person
from it. It is also marked by irregular breathing and pulse rate. Muscle tone is extremely
relaxed—so much so that bodily movements are minimal, and the sleeper is virtually paralyzed.

REMs are associated with dreaming. Although decades of research have revealed that some
dreaming occurs in the non-REM stages, dreaming is more frequent, vivid, memorable,
emotional, dramatic, and rich in characters during REM sleep. Dreams during REM sleep tend to
be longer, clearer, detailed, bizarre, and more “dream-like”. The brain areas associated with
imagery and emotion become more active during REM sleep. This may explain why REM
dreams tend to be more vivid than NREM dreams. The REM-sleep paralysis prevents people
from acting out their dreams.

Repeating the Cycle

A typical night's sleep consists of 4 to 5 sleep cycles, with the progression of sleep stages in the
following order: N1, N2, N3, N2, REM. The first REM period is relatively short, lasting only a
few minutes. Subsequent REM periods get progressively longer, peaking at around 40–60
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minutes. Additionally, non-REM intervals tend to get shorter. Most slow-wave sleep (N3) occurs
early in the sleep cycle, and REM sleep tends to pile up in the second half of the sleep cycle.

Functions of Sleep
Sleep is an innate biological rhythm that can never be entirely ignored. According to the dual
process hypothesis of sleep, NREM sleep reduces the overall level of brain activation, allowing
unimportant memories to be forgotten, while REM sleep sharpens memory for important events
from the previous day.
Sleep helps keep the body, including the brain, healthy by regulating its temperature and immune
system, conserving energy, and aiding development and repair. According to repair/restorative
theories of sleep, lowering body and brain activity and metabolism during sleep may help
conserve energy and lengthen life.

Dreamless, slow-wave NREM sleep increases after physical exertion and may help us recover
from bodily fatigue. It also appears to “calm” the brain during the earlier part of a night’s sleep.
Slow-wave sleep early in the night brings overall brain activation levels back down, allowing a
“fresh” approach to the next day. Sleep may also contribute to assimilating new memories into
existing networks of knowledge. As slow-wave sleep reduces overall activation in the brain, less
important experiences may fade away and be forgotten. Sleep also improves learning and
problem-solving.

Functions of REM sleep

REM sleep “sharpens” our memories of the previous day’s more important experiences, and
firms up learning. This process is called memory consolidation. REM may also promote creative
insights related to previous learning and improve performance on complicated decision-making
tasks. Daytime stress tends to increase REM sleep, which may rise dramatically when there are
emotionally charged events. This helps us sort and retain memories about strategies for solving
problems. In infants, REM sleep may stimulate the developing brain.

Effects of Sleep Deprivation

Losing sleep can impair individuals’ attention, reaction time, motor coordination, and
decision-making. This can result in transportation accidents and mishaps in the workplace. Sleep
deprivation can affect physiological processes in ways that may undermine physical health. It
can have negative effects on endocrine and immune system functioning, leading to increased
inflammatory responses. Sleep loss appears to trigger hormonal changes that increase hunger,
which increases obesity, which is, in turn, a risk factor for a variety of health problems. Studies
have uncovered links between short sleep duration and an increased risk of diabetes,
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hypertension, and coronary disease. People who consistently sleep less than 7 hours also exhibit
an elevated mortality risk.

Age, Culture, and Sleep

Age and culture are factors that contribute to variations in sleep cycles.

Age Trends
Age alters the sleep cycle. Newborns will sleep six to eight times in a 24-hour period, often
exceeding a total of 16 hours of sleep. Infants also spend much more of their sleep time than
adults do in the REM stage. In the first few months, REM accounts for about 50% of babies’
sleep, as compared with 20% of adults’ sleep. The REM portion of sleep continues to decrease
gradually until it levels off at about 20% during adolescence. In males, the percentage of
slow-wave sleep declines, and the time spent in stages N1 and N2 increases slightly. These shifts
toward lighter sleep are not seen in women, but elderly women do report more insomnia than
elderly men do. The average amount of total sleep time also declines with advancing age.

Cultural Variations
The psychological and physiological experience of sleep does not appear to vary much across
cultures. Studies have found relatively modest differences in the average amount of time that
people sleep, and in the time that it takes for them to fall asleep. However, napping practices
vary along cultural lines. In many societies in the tropical regions of the world, shops close and
activities are curtailed in the afternoon to permit people to enjoy a 1- to 2-hour midday nap. This
practice is adaptive in that it allows people to avoid working during the hottest part of the day.
But this is not found in cultures where it conflicts with the emphasis on productivity and the
philosophy that “time is money”.

Dreams

A dream is defined as a physiologically and psychologically conscious state that occurs during
sleep and is often characterized by a rich array of endogenous sensory, motor, emotional, and
other experiences (APA). Dreams are mental imagery during sleep, often in REM sleep. A
nightmare is a bad dream that occurs during REM sleep. Daydreaming is mind wandering,
spontaneous thoughts during wakefulness. It reduces stress, helps solve problems, uses diverse
brain areas, aids in reaching goals, and expands creativity.
Most dreams are relatively mundane and self-centered. The contents of waking life and events
that have emotional significance are likely to be incorporated into one’s dreams. The contents of
dreams can also be affected by external stimuli experienced while one is dreaming.
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Theories of Dreaming
1.​ Psychodynamic Dream Theory
Psychodynamic theories of dreaming emphasize internal conflicts and unconscious forces.
Sigmund Freud’s landmark book, The Interpretation of Dreams (1900), first advanced the idea
that many dreams are based on wish fulfillment—an expression of unconscious desires. One of
Freud’s key proposals was that dreams express unconscious desires and conflicts as disguised
dream symbols (images that have deeper symbolic meaning). Understanding a dream, then,
requires analyzing the dream’s manifest content (obvious, visible meaning) to uncover its latent
content (hidden, symbolic meaning). For example, if you were feeling unconscious guilt about
being rude to a friend, you might dream about the incident in a way that renders you blameless.

Freud’s influential theory sounded plausible when it was proposed more than 100 years ago, but
research has not provided much support for Freud’s conception of dreaming. However, dreams
do tend to reflect a person’s current concerns, so Freud wasn’t entirely wrong. He also
acknowledged that some dreams are trivial “day residues” or carryovers from ordinary waking
events.

2.​ The Activation-Synthesis Hypothesis

Proposed by psychiatrists Allan Hobson and Robert McCarley, the activation-synthesis
hypothesis is an attempt to explain how dream content is affected by motor commands in the
brain that occur during sleep but are not carried out. They believe that during REM sleep, several
lower brain centers are “turned on” (activated) in a more or less random fashion. However,
messages from the cells are blocked from reaching the body, so no movement occurs.
Nevertheless, the cells continue to tell higher brain areas of their activities. Struggling to
interpret this random information, the brain searches through stored memories and manufactures
(synthesizes) a dream. However, frontal areas of the cortex, which control higher mental
abilities, are mostly shut down during REM sleep. This explains why dreams are more primitive
or more bizarre than daytime thoughts.

Thus, the activation-synthesis model holds that dreams are side effects of the neural activation
that produces the beta brain waves during REM sleep that are associated with wakefulness. It
rejects the idea that dreams are deliberate, meaningful messages from our unconscious.
However, the theory downplays the role of emotional factors as determinants of dreams. Critics
point out that the model has a hard time explaining the fact that dreaming occurs outside REM
sleep, that damage to the lower brain areas does not eliminate dreaming, and that the contents of
dreams are considerably more meaningful than the model would predict.
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3.​ Neurocognitive Dream Theory

According to the neurocognitive dream theory by William Domhoff, dreams actually have much
in common with waking thoughts and emotions. Most dreams do reflect ordinary waking
concerns, because many brain areas that are active when we are awake remain active during
dreaming. From this perspective, our dreams are a conscious expression of REM sleep processes
that are sorting and storing daily experiences. Thus, a student who is angry at a teacher might
dream of embarrassing the teacher in class, a lonely person dreams of romance, or a hungry child
dreams of food. It is not necessary to seek deep symbolic meanings to understand these dreams.
Studies of dream content tend to support the neurocognitive theory’s focus on the continuity
between dreams and waking thought.

4.​ Information-Processing Theory

According to the information-processing theory, sleep allows us to consolidate and process all of
the information and memories that we have collected during the previous day. Dreaming is a side
effect of brain neural activity as memories are consolidated during sleep. The theory suggests
dreams may be important in helping the brain sort, process, and store information gathered
throughout the day. The brain can continue to work on unresolved issues from waking life,
sometimes leading to insights and solutions in dreams. Thus, dreams may help transfer
information from short-term to long-term memory and help weave new information and
experiences into existing knowledge structures.

5.​ Threat Simulation Theory

Proposed by cognitive neuroscientist Antti Revonsuo, the threat simulation theory posits that the
function of dreams is to rehearse threatening situations, which served an evolutionary advantage
for our ancestors. Dreams are an evolutionary defense mechanism that allows individuals to
prepare for real-life dangers. Dreaming allows the brain to safely practice threat perception and
avoidance, which enhances survival skills. By rehearsing responses to dangers in dreams,
individuals can better deal with potential threats and challenges encountered in the waking
world, improving their chances of survival and reproductive success.

Altered States of Consciousness

We spend most of our lives in waking consciousness, a state of clear, organized alertness. In
waking consciousness, we perceive times, places, and events as real, meaningful, and familiar.
But states of consciousness related to fatigue, delirium, hypnosis, drugs, and euphoria may differ
markedly from “normal” awareness. An altered state of consciousness (ASC) is a condition of
awareness distinctly different in quality or pattern from waking consciousness. There are distinct
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shifts in our perceptions, emotions, memories, time sense, thoughts, feelings of self-control, and
suggestibility.

Hypnosis
Hypnosis is often defined as an altered state of consciousness, characterized by narrowed
attention and an increased openness to suggestion. It is a systematic procedure that typically
produces a heightened state of suggestibility. It may also lead to passive relaxation, narrowed
attention, and enhanced fantasy.

The term hypnosis was coined by English surgeon James Braid. The Greek word hypnos means
“sleep,” and Braid used it to describe the hypnotic state. Today, we know that hypnosis is not
sleep. Brain activity recorded during hypnosis is different from that observed when a person is
asleep or pretending to be hypnotized.

The techniques used in hypnosis encourage a person (1) to focus attention on what is being said;
(2) to relax and feel tired; (3) to “let go” and accept suggestions easily; and (4) to use vivid
imagination. A key element in hypnosis is the basic suggestion effect—a tendency of hypnotized
persons to carry out suggested actions as if they were involuntary. That is, one must cooperate to
become hypnotized.

Hypnotic susceptibility refers to how easily a person can become hypnotized. People who are
imaginative and prone to fantasy are often highly responsive to hypnosis. But people who lack
these traits may also be hypnotized. If you are willing to be hypnotized, chances are good that
you could be. Hypnosis depends more on the efforts and abilities of the hypnotized person than
on the skills of the hypnotist.

Theories of Hypnosis
1.​ Neo-dissociation Theory
Ernest Hilgard proposed the theory. It is a state theory, which argues that hypnosis is an altered
state of consciousness, distinct from wakefulness. Hilgard argued that hypnosis causes a
dissociative state, or “split” in awareness. Dissociation is a splitting off of mental processes into
two separate, simultaneous streams of awareness: one stream is in communication with the
hypnotist and the external world, while the other is a difficult-to-detect “hidden observer.” The
hidden observer is a detached part of the hypnotized person’s awareness that silently observes
events.

Hilgard believes that many hypnotic effects are a product of this divided consciousness. For
instance, he suggests that a hypnotized subject might appear unresponsive to pain because the
pain isn’t registered in the portion of consciousness that communicates with other people. One
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appealing aspect of Hilgard’s theory is that divided consciousness is a common, normal

experience. For example, people will often drive a car a great distance, responding to traffic
signals and other cars, with no recollection of having consciously done those specific actions. In
such cases, consciousness is clearly divided between driving and the person’s thoughts about
other [Link], Hilgard presents hypnosis as a plausible variation in consciousness that has
continuity with everyday experience.

2.​ Non-state Theories

Nonstate theorists argue that hypnosis is not a distinct state at all. Instead, it is merely a blend of
conformity, relaxation, imagination, obedience, and role-playing. The role-playing view asserts
that hypnosis produces a normal mental state in which suggestible people act out the role of a
hypnotic subject and behave as they think hypnotized people are supposed to. Many theorists
believe that all hypnosis is really self-hypnosis (autosuggestion). From this perspective, a
hypnotist merely helps another person to follow a series of suggestions. These suggestions, in
turn, alter sensations, perceptions, thoughts, feelings, and behaviors.

Meditation
Meditation refers to a family of practices that train attention to heighten awareness and bring
mental processes under greater voluntary control. It involves a deliberate effort to alter
consciousness. The core of meditation is the relaxation response—an innate physiological pattern
that opposes your body’s fight-or-flight mechanisms.

Approaches to meditation can be classified into two main styles that reflect how attention is
directed: focused attention and open monitoring. In focused attention, attention is concentrated
on a specific object, image, sound, or bodily sensation (such as breathing). The intent in
narrowing attention is to clear the mind of its clutter. This is also known as concentrative
meditation. In open monitoring approaches, attention is directed to the contents of one’s
moment-to-moment experience in a non-judgmental and non-reactive manner. The intent in
expanding attention is to become a detached observer of the flow of one’s own sensations,
thoughts, and feelings. This involves mindfulness meditation. Both approaches seek to achieve a
“higher” form of consciousness than what people normally experience.

Long-Term Benefits of Meditation

Studies have found that meditation is associated with long-term changes in brain structure.
Regular meditation is associated with lower levels of some “stress hormones”, enhanced immune
response and reduced inflammation. Alpha waves become more prominent in EEG recordings,
indicating that meditation is associated with relaxation. Studies also suggest that meditation can
lead to decreases in anxiety and other negative emotions, and to increases in empathy for others
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and in general well-being. Meditation has shown some value as an adjunct in the treatment of
depression, anxiety disorders, and chronic pain. In the physiological domain, meditation may
promote improved cardiovascular health, increase the tolerance of pain, and enhance patterns of
sleep. Meditation may also enhance human potential by improving concentration, heightening
awareness, and building emotional resilience.

Altering Consciousness with Drugs

Drugs are commonly used in deliberate efforts to alter consciousness. The use of drugs for
nonmedical purposes is referred to as “recreational drug use.” Such drug use involves personal,
moral, political, and legal issues.
The drugs that people use recreationally are termed psychoactive. Psychoactive drugs are
chemical substances that modify mental, emotional, or behavioral functioning. It is a substance
capable of altering attention, memory, judgment, time sense, self-control, mood, or perception.
Psychoactive drugs alter consciousness by directly influencing brain activity.

Major Drugs and their Effects

Not all psychoactive drugs produce effects that lead to recreational use. Generally, users prefer
drugs that elevate their mood or produce other pleasurable alterations in consciousness.

1.​ Stimulants
A stimulant is a substance that increases activity in the body and nervous system. Stimulants
range from caffeine and nicotine to cocaine and amphetamines. Amphetamines are synthetic
stimulants. Caffeine stimulates the brain by blocking chemicals that normally inhibit or slow
nerve activity. Cocaine and amphetamines have fairly similar effects, except that cocaine
produces a briefer high. Stimulants produce a buoyant, elated, energetic, “I can conquer the
world!” feeling, accompanied by increased alertness. They speed up the use of the body’s
resources; they do not magically supply energy. After a binge, people suffer from crippling
fatigue, depression, confusion, uncontrolled irritability, and aggression. Repeated use damages
the brain. Amphetamines can also cause amphetamine psychosis, a loss of contact with reality.

2.​ Depressants
A depressant is a substance that decreases activity in the body and nervous system. It includes
alcohol and barbiturates. Barbiturates are sedative drugs that are medically used to calm patients
or to induce sleep. Common barbiturates include amobarbital, pentobarbital, secobarbital, and
tuinal. Alcohol is the most widely used recreational drug in our society. Because alcohol is legal,
many people use it casually without even thinking of it as a drug. Alcohol encompasses a variety
of beverages containing ethyl alcohol, such as beers, wines, and distilled spirits. When people
drink heavily, the central effect is a relaxed euphoria that temporarily boosts self-esteem, as
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problems seem to melt away and inhibitions diminish. Common side effects include impairments
in mental and motor functioning, mood swings, and quarrelsomeness. Getting drunk is a slow but
sure way to get stupid.

3.​ Hallucinogens
Hallucinogens are a diverse group of drugs that have powerful effects on mental and emotional
functioning, marked most notably by distortions in sensory and perceptual experience. The
principal hallucinogens are LSD, mescaline, and cannabis. Cannabis is the hemp plant from
which marijuana, hashish, and THC are derived. It acts as a hallucinogen, stimulant and
depressant. These drugs have similar effects, although they vary in potency. Hallucinogens
produce euphoria, increased sensory awareness, and a distorted sense of time. In some users,
they lead to profound, dreamlike, “mystical” feelings that are difficult to describe. The latter
effect is why they have been used in religious ceremonies for centuries in some cultures. At the
other end, hallucinogens can also produce nightmarish feelings of anxiety and paranoia,
commonly called a “bad trip.” They also result in impaired judgment, emotional swings,
dissociation and temporary psychosis.

4.​ Narcotics or Opiates

Narcotics, or opiates, are drugs derived from opium that are capable of relieving pain. The main
drugs in this category are heroin and morphine. In sufficient dosages, the drugs in this category
can produce an overwhelming sense of euphoria or well-being. On the other side, it can result in
lethargy, compromised immune system, impaired mental functioning and even death.

Tolerance
Tolerance refers to a progressive decrease in a person’s responsiveness to a drug as a result of
continued use. Tolerance usually leads people to consume larger and larger doses of a drug to
attain the effects they desire. Most drugs produce tolerance, but some do so more rapidly than
others. For example, tolerance to alcohol usually builds slowly, while tolerance to heroin
increases much more quickly.

Drug Dependence
People can become either physically or psychologically dependent on a drug. Dependence is
established gradually with repeated use of a drug.
When a person compulsively uses a drug to maintain bodily comfort, a physical dependence
(addiction) exists. Not taking the drug causes withdrawal, which is a physical illness that follows
the removal of a drug. The symptoms of withdrawal illness depend on the specific drug.
Withdrawal from heroin, barbiturates, and alcohol can produce fever, chills, tremors,
convulsions, vomiting, cramps, diarrhea, and severe aches and pains. Withdrawal from
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stimulants leads to a more subtle syndrome, marked by fatigue, apathy, irritability, depression,
and disorientation.

Psychological dependence exists when a person must continue to take a drug to satisfy intense
mental and emotional craving. Psychological dependence is more subtle than physical
dependence, but the need it creates can be powerful. Psychological dependence on drugs leads to
intense cravings, mood swings, depression, and anxiety, as well as a compulsive need to use the
substance to feel normal or avoid negative feelings. Psychological dependence is possible with
all recreational drugs.

Direct Effects of Drugs

If a person overdoses on drugs, the respiratory system usually grinds to a halt, producing coma,
brain damage, and death within a brief period. Fatal overdoses with CNS stimulants usually
involve a heart attack, stroke, or cortical seizure.
In some cases, drugs cause tissue damage directly. For example, chronic snorting of cocaine can
damage nasal membranes. Cocaine use can also foster cardiovascular diseases and respiratory
problems. Long-term, excessive alcohol consumption is associated with an elevated risk for a
wide range of serious health problems, including liver damage, ulcers, hypertension, stroke, heart
disease, neurological disorders, and some types of cancer. Chronic marijuana use increases the
risk of respiratory and pulmonary disease, lung cancer, and severe, psychotic disorders, including
schizophrenia.

Indirect Effects of Drugs

People using stimulants often do not eat or sleep properly. Sedatives increase the risk of
accidental injuries because they severely impair motor coordination. They may trip down stairs,
fall off stools, and suffer other mishaps. Many drugs impair driving ability, increasing the risk of
automobile accidents. Intravenous drug users risk contracting infectious diseases such as
acquired immune deficiency syndrome (AIDS), which can be spread by unsterilized needles.