False: Amphetamines, especially dexamphetamine and methamphetamine, predominantly release dopamine. The clinical effects of agitation, restlessness and paranoid psychosis can be treated with antipsychotics. Blockade of the postsynaptic D₂ receptors in the mesolimbic pathway is hypothesized to mediate the action of antipsychotic drugs. Blockade of the D₂ receptors in the nigrostriatal pathway causes movement disorders including akathisia (Stahl 2000, pp. 509, 404).

False: Amphetamine is a stimulant. Acute intoxication may cause seizures, but not withdrawal (Lishman 1997, p. 245).

False: Chronic use of cannabis can cause poor social judgement, poor attention span, poor concentration, confusion, anxiety, depression, apathy, passivity, indifference and often slowed and slurred speech. In addition, the patients can be incapable of completing thoughts during verbal communication (Solowij 1998, p. 30).

True: Cocaine was an ingredient of Coca-Cola® until 1902 (Sadock & Sadock 2005, p. 1221).

True: Cocaine is a powerful positive reinforcer in animals. It causes strong dependence in humans. This results from cocaine’s ability to block the reuptake of dopamine into presynaptic terminals, leading to high extracellular dopamine levels in the nucleus accumbens and consequent activation of the ‘reward system’. Even though MDMA acts as a reinforcer in animals, this effect is weaker than that of cocaine (Gelder et al 2006, p. 464).

False: Phencyclidine, ketamine and other NMDA antagonists can cause neuronal vacuolization and necrosis at doses significantly greater than those required for their behavioural effects. Direct evidence for neurotoxicity in humans is lacking, despite the widespread use of ketamine as an anaesthetic. Neurotoxicity may explain the cognitive deficits seen in heavy or repeated intoxication (Sadock & Sadock 2005, p. 1293).

True: Khat is used as a recreational drug. Its mild stimulant effects appear to promote social interaction. Users report loquacity, disinhibition and improved concentration. It reduces appetite and the need for sleep. It can cause a toxic psychosis or a schizophreniform psychosis (Gelder et al 2000, p. 545; Ghodse 2002, p. 122).

False: Psilocybin and related homologues are found in up to a hundred species of mushrooms, mainly the Psilocybe genus. These mushrooms are used for religious activities, e.g. in Mexico, and by Westerners who prefer ‘naturally occurring’ drugs. LSD is a synthetic ergot alkaloid derivative (Sadock & Sadock 2005, p. 1242).

True: The hallucinogen persisting perception disorder may be caused by toxic stimulation and destruction of 5-HT_2A receptor bearing inhibitory neurons, resulting in chronic disinhibition of visual information processing. Post-LSD psychosis resembles schizoaffective disorder with chronic visual disturbances, mystic preoccupations, delusions and auditory hallucinations. However, whether LSD can cause longstanding psychosis is still controversial (Gelder et al 2000, p. 537).

False: Tolerance to the psychological effects of LSD occurs. It is controversial if psychological or physical dependence occurs. Withdrawal symptoms are not observed in humans (Gelder et al 2006, p. 467; Ghodse 2002, p. 125; www.drugabuse.gov).

True: Bupropion is a dopamine and noradrenaline reuptake inhibitor. It may have similar antidepressant effects to tricyclics and may produce improvement in 70% of patients with depression. It is marketed with the trade name Zyban as an aid to smoking cessation and with the trade name Wellbutrin as an antidepressant (Sadock & Sadock 2005, p. 2791).

False: Approximately one-third of those who ever use heroin become dependent. Approximately 7.5% of those who use opioid analgesics (other than heroin) outside of a medical context develop dependence (Sadock & Sadock 2005, p. 1267).

True: Heroin is 3–6 times as potent as morphine, although the pharmacology of the drugs is identical. Opium is the air-dried latex from the unripe capsules of Papaver somniferum. It contains 10–17% morphine, 2–4% codeine and a variable mixture of other alkaloids including noscapine and papaverine (King 2004, p. 498).

False: Like dependence on most other drugs, opiate dependence is characterized by tolerance, withdrawal symptoms and escalating doses (DSM-IV 1994, p. 181).

False: Heroin withdrawal does not cause psychotic symptoms in otherwise healthy individuals. There have been unconfirmed reports of psychosis in patients with pre-existing CNS disorders including HIV and with ultra-rapid detoxification (Gelder et al 2000, p. 524; Sadock & Sadock 2005, p. 1272).

True: Methadone is a synthetic opioid analgesic. The duration of action is approximately 24 hours. Therefore, once-daily administration is sufficient to prevent withdrawal symptoms in opiate dependence (Ghodse 2002, p. 102).

False: Clinicians should always seek the patients’ consent. They should arrange appropriate pre- and post-test counselling. Do not coerce patients but advise them, especially those who are intravenous drug users and those at risk from other sources (Ghodse 2002, p. 182).

True: Clonidine is an α₂ adrenergic agonist which reduces the release of noradrenaline. Opiate withdrawal symptoms are caused partly by noradrenergic overactivity. Clonidine, by blocking noradrenaline release, attenuates the autonomic symptoms of opiate withdrawal. The side-effects of sedation and hypotension limit its use to inpatient treatment settings (Ghodse 2002, p. 247).

False: Naloxone is an opiate antagonist. It displaces opiates by competitive antagonism. Naloxone is used in the treatment of opiate intoxication, e.g. overdose. Due to the relatively short half-life, repeated administration is necessary. Naloxone is also used in accelerated detoxification to precipitate opiate withdrawal that can be treated with neuroleptics, propranolol and atropine. These are inpatient procedures and are done very infrequently (Ghodse 2002, p. 248; Sadock & Sadock 2005, p. 1278).

True: The PCP receptor is located in the ion channel of the NMDA-glutamate receptor. Phencyclidine binds to the PCP receptors and, by allosteric modulation, blocks the NMDA receptor complex (Gelder et al 2000, p. 535; Sadock & Sadock 2005, p. 1292; Stahl 2000, p. 387).

True: Prisoners in the UK have the highest rates of illicit drug use. The majority have a history of drug abuse. In one study, dependence on drugs has been reported by 51% of male and 54% of female remand prisoners and 43% and 41% respectively of convicted prisoners (Gelder et al 2006, p. 451).

True: Most solvents are central nervous depressants but the apparent initial effect can be stimulation and disinhibition (similar to alcohol). They cause giddiness, ataxia, slurred speech, impaired judgement, dullness, apathy and confusion. Approximately 40% experience hallucinations which are usually visual or tactile. One quarter may develop potentially dangerous delusions, e.g. omnipotence or being able to swim or fly (Ghodse 2002, p. 134; Sadock & Sadock 2005, p. 1252).

True: Chronic solvent abuse can cause a variety of neurological problems including headache, hearing loss, paraesthesia with peripheral neuropathy, cerebellar degeneration or reversible cerebellar signs, motor impairment, gait disorders, spasticity, Parkinsonism and memory impairment. MRI and CT scans show diffuse cerebral, cerebellar and brainstem atrophy. Whether these changes may be reversible on abstinence is not yet clear (http://www.drugabuse.gov; Lishman 1997, p. 630; Sadock & Sadock 2005, p. 1251).

True: Irritability, aggressiveness, hypomania and mania are associated with anabolic steroid use. The psychiatric effects are dose-related. Mood syndromes are more frequent and more severe with doses above 1000 mg a week (Sadock & Sadock 2005, p. 1325).

False: Motivational interviewing is the preferred approach for patients who are in the pre-contemplation phase of the cycle of change. Motivational interviewing is a client-centred, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence. In the spirit of this approach, motivation to change is elicited from the client, and not imposed from without. Coercion, persuasion and constructive confrontation are not in the spirit of motivational interviewing (Chick & Cantwell 1994, p. 132; Johnstone et al 2004, p. 371).